The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) defines autism as a spectrum disorder with three levels of severity. Level 1 is the least severe, with people requiring the least support, and Level 3 is the most severe, with people requiring the most support.
Table of Contents
- High functioning autism: the history, the controversy and the meaning today
- Signs and symptoms of high-functioning autism in children
- Diagnosis of high-functioning autism
- Treatment for high-functioning autism
High functioning autism: the history, the controversy and the meaning today
In the past, the term “high-functioning autism” was also used interchangeably with Asperger’s syndrome because people with Asperger’s syndrome are less likely to have language issues and fewer noticeable signs of autism. This association became stronger in 2013, when the American Psychiatric Association grouped Asperger’s syndrome into autism spectrum disorder (ASD). Over time, “high functioning” became a term synonymous with expectations of greater functional skills and better long-term outcomes, despite contradictory clinical observations. 
Many children and young people with autism may have an appropriate IQ for their age but still struggle with everyday skills like getting themselves to school, navigating public transport, or communicating at the same level as their peers.
The term “high-functioning autism” first appeared in the 1980s, but its meaning has evolved over time. It was once used interchangeably with Asperger’s syndrome, but is now more commonly used to describe people with autism who have mild to moderate symptoms.
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The controversy surrounding the term high-functioning autism
- Receives their autism diagnosis as an adult, or relatively late in childhood
- Does well in school or at work
- Does not have language differences or clear developmental delays
- Can live independently
- The term presumes functional strengths that an individual may not have; and It may ignore the need of people labeled “high-functioning” to get support.
- Some people use the term to downplay or dismiss the concerns of autistic adults about how society treats autistic children.
- The term focuses on how well a person with autism fits into society, rather than how society can accommodate the needs of people with autism.
The term “high-functioning autism” is controversial, with some arguing that it is inaccurate and harmful, while others maintain that it is useful for describing people with autism who have mild to moderate symptoms. It is important to be aware of the different perspectives on this term and to use it respectfully.
#highfunctioningautism #autism #autismawareness #autismacceptance #autismpride #autismspectrumdisorder #autismadvocacy
The meaning of “high-functioning” today
Signs and symptoms of high-functioning autism in children
- Social challenges
Like all people on the autism spectrum, people who are high functioning also have a hard time with social interaction and communication. Because they may not be able to easily understand social cues, people with high-functioning autism may have difficulty making friends and may be perceived as socially awkward.
People with high-functioning autism may sometimes focus more on themselves than on others. This can be challenging for neurotypical people, who may perceive them as talking about themselves too much, interrupting others, or having difficulty paying attention in conversations
- Emotional sensitivity
People with high-functioning autism are often very sensitive to emotions and even small things, like loud noises, changes in routine, or spilling of juice, can cause intense emotional reactions and upset them for the rest of the day.
The fact that high functioning autism is challenging to detect can make such children frequently suffer extreme emotional sensitivity which can also lead to intense sorrow and isolation.
- Physical sensation sensitivity
Most children with autism spectrum disorder (ASD) have difficulty processing sensory information, but high-functioning autistic people tend to be particularly sensitive to physical sensations such as:
- loud noises
- uncomfortable clothing
- physical touching by another person
- bad smells or tastes
These physical sensation challenges may cause a child to be easily distracted which can be overwhelming. For example, a loud noise or bad smell that does not bother neurotypical children may be very disruptive and upsetting for a high-functioning autistic child, leading to emotional distress and possibly a meltdown.
- Focus on repetitiveness
High-functioning autism is characterized by a strong interest in a specific subject or activity. For example, the child could be interested in dinosaurs, trains, or space. These obsessions cause negative impact when they interfere with social interactions or quality of life. However, it can be also used to improve the child’s understanding of the particular subject. For example, a child who is interested in dinosaurs could be encouraged to visit a museum, read books about dinosaurs, or watch documentaries about dinosaurs.
- Focus on routines and restrictive habits
Children with high-functioning autism often have a strong preference for routine and repetition. This can include things like:
- eating the same meal every day
- wearing the same outfit every day
- brushing the teeth for exactly 2 minutes
- getting exactly 8 hours of sleep each night
- Perceived inattention due to lack of eye contact
Children with high-functioning autism may have difficulty making eye contact with their parents or caregivers and responding in the way that neurotypical children do. For example, when most young children find something funny, they look at their caregivers to see if they are also amused, signaling their social awareness. If a child fails to look to their caregiver for shared interest, it may be a sign that they lack this particular social skill.
- Depression or Anxiety
People with high-functioning autism (HFA) can experience depression and anxiety. In fact, studies have shown that Anxiety disorders are disproportionately prevalent among adolescents with autism spectrum disorder, affecting approximately 42% of this population. This rate is more than double that of adolescents without developmental disorders, where it is only around 20% . The risk factors for anxiety and depression include:
- Difficulties with social interaction and communication: People with HFA may have difficulty forming and maintaining relationships, which can lead to feelings of isolation and loneliness.
- Sensory sensitivities: People with HFA may be more sensitive to sights, sounds, smells, tastes, and textures, which can lead to stress and anxiety.
- Executive functioning challenges: People with HFA may have difficulty with planning, organizing, and problem-solving, which can lead to stress and frustration.
- Genetic factors: There is some evidence that genes play a role in the development of both autism and depression.
Diagnosis of high-functioning autism in children
Treatment for high-functioning autism in children
- Occupational therapy
- Physical therapy
- Speech therapy
- Behavioral treatment:
- Applied Behavior Analysis (ABA)
- Social Skills Therapy
- Ameli R., Courchesne E., Lincoln A., Kaufman A. S., Grillon C. (1988). Visual memory processes in high functioning individuals with autism | Journal of Autism and Developmental Disorders, 18, 601–615
- The misnomer of ‘high functioning autism’: Intelligence is an imprecise predictor of functional abilities at diagnosis
- Impact of anxiety disorders on quality of life of adolescents with autism spectrum disorder without intellectual disability