There are three dominant misconceptions about autism that feed the concept of high functioning. For starters, contrary to popular belief, there is no linear autism spectrum; it’s more of a three-dimensional pyramid with multiple intersecting points.

The psychiatrist and autism researcher Lorna Wing, who coined the term and added it to the DSM, never meant for it to be seen as a linear progression from low to high function, but rather a “triad” of three different “spectra” including social interaction, communication, and imagination.

Another common misconception is that autism is obvious. Only about thirty percent of autistic people are autistic in a way that is noticeable to others. Think about that: the majority of people with autism don’t have the hallmarks associated with the condition to the extent that you’d even notice they have it.

Finally, the biggest and most widely held set of misconceptions is that autism is very rare, very severe, and only affects the very young. At this point, only a small fraction of the autistic population can be described this way.

According to the CDC, 1 in 59 people in the United States is on the autism spectrum, and the majority of them are already integrated into and contributing to their communities, in school and at work, and always have been. In the past, the lack of autism awareness coupled with an overly narrow diagnostic criteria and misinformation gave a skewed impression.

What “The Spectrum” Gets Wrong

Now, one of the biggest information hurdles is around the concept of the spectrum. One of the main reasons that the term “high-functioning autism” is not used by health practitioners, therapists, researchers, or autistics themselves is because most people on the autism spectrum are often “high-functioning” in one area of the triad (and their lives) but need more support in another, as opposed to being “high-functioning” or in need of more support across all three areas of the spectrum. In addition, functionality often changes over the course of the lifespan of an autistic person.

Temple Grandin, who is widely considered one of the most accomplished and successful autistic people in recent history and is known for her powerful public speeches and innovative contributions in her field of animal science, was considered very “low-functioning” as a child. She was nonverbal and could only scream. Once her autism was better understood, she was taught to speak with the proper supports and accommodations.

Many other successful adults on the spectrum, such as John Elder Robison, who designed the rock band KISS’s special effects guitars to do spectacular things such as shoot fire and rockets, were also extremely underestimated as children, but it was because they did not have the right supports or adults around them who understood the way their brains worked, which, they emphasize, is why these labels are so offensive and meaningless.

On the other hand, even autistic people who have truly extraordinary abilities that exceed those of peers in their fields can struggle in other areas of their lives and require support and services.

Parents sometimes seek a diagnosis of “high-functioning” for their autistic children as a reassurance to distinguish their child from other children on the spectrum who may need far more support in the same age range. This is a false reassurance. Just as autistic children like Grandin who were wrongly considered very “low functioning” are often able to gain function and excel as adults with the right support, there are many children on the spectrum who are verbal and can do well in school when they are young with little or no support, but who may need more services later in life as they transition to adulthood and require help in securing employment, living independently, or socializing and dating.

Symptoms Or Traits?

For an autistic person who has a low need for services and support (as opposed to a high need, and this can and often does change throughout the life of an autistic person) all of the symptoms in the DSM 5 listed under Autism Spectrum Disorder can also be experienced as strengths or simply preferences and personality traits as opposed to disabilities.

While autism can be and certainly is debilitating for a fraction of people, many autistics who do not need a high level of support see themselves as a minority group with a shared set of traits and characteristics, as opposed to sufferers of a mental disorder, and more and more of the 5 million autistics in the United States are challenging and questioning that DSM characterization.

Autistic traits such as narrow interests, repetitive actions, heightened reactions to sensory stimuli, vivid imagination, and enjoyment of spending time alone can be beneficial in professional environments that require a high level of focus and specialization or thinking outside of the box, such as coding and engineering, both professions that have high numbers of members on the spectrum.

Similarly, many “symptoms” of autism, such as difficulty socializing or making eye contact, stop being symptoms of a disorder and just become personality traits when autistic people are not trying to interact with unaccommodating neurotypical people and are permitted to engage with their interests alone or with one another. This often happens at conferences and meet-ups within the autistic community, or with friends and family who have learned how to interact with an autistic person without demanding that they behave exactly as neurotypical people do in social settings.

Even autistic behaviors such as “stimming” (self-stimulation from looking at colorful and detailed images; or lightly tapping skin with an object to focus and counteract sensory overstimulation from the outside world), can become social when they are done by groups of autistic people.

This type of social behavior happens more and more with the help of the internet, where groups of autistics might share images that they know their peers will enjoy looking at or discuss narrow topics of interest such as train schedules or anime in detail for hours—without worrying that their shared enjoyment and enthusiasm will be pathologized.

The Implication For A Diagnosis

Diagnosing a child with autism as “high-functioning” is thought of as offensive within the autistic community because of the implication that other people on the spectrum are “low-functioning,” but it has also been proven time and again to not be a useful diagnosis.

There’s no biomarker for different types of autism (in fact, there’s no biomarker for autism at all), so a label of high or low functioning is not based on any test or scientific evidence. This is why doctors and therapists, for the most part, do not use “high-functioning” autism as a diagnosis; it’s simply not accurate.

Asperger’s Syndrome, which used to be considered a type of “high-functioning” autism, is also no longer a medical diagnosis either. Instead, it is now included within the broader autism spectrum. Some “Aspergians” do continue to self-identify that way though since it was their initial diagnosis.

How Interventions Impact Functioning

Once given the correct support and services such as a keyboard or some alternate means of communication, many once so-called “low-functioning” people on the autism spectrum become able to communicate quite effectively—even exceptionally. The abilities of so-called “low-functioning” autistics have been underestimated for decades while the challenges of so-called “high-functioning” autistics have also been underestimated and under supported.

There are as many examples of autistics who have trouble with communication but have adaptive skills and are able to pay their bills and live independently as there are of autistics who can carry a conversation quite well on some topic of interest, but may not be able to live independently without support. And this is exactly why it is as much of a false reassurance to assign “high-functioning” to a child with autism as it is incorrect and offensive to diagnose a child, whose future potential is inherently unknown and limitless once given access to the correct support and services, as “low functioning.”

Treatment

Being autistic and a part of a community or school system with the proper support and services can be similar to being a person in a wheelchair who lives in a town with ramps and proper wheelchair accessibility. This is why a diagnosis and support plan are so important.

When adults, who don’t have a high need for support and were not diagnosed as children, enter treatment, it’s usually not because autism is suspected. Instead, they might come in for anger management or anxiety and depression, or even GI issues or an eating disorder.

There are high co-morbidities within autism in all of these other therapeutic areas. One reason that autism was so under-diagnosed in the past is because the initial diagnostic criteria did not allow for co-existing conditions such as epilepsy, developmental disorders, Down Syndrome, or anxiety disorders and depression, all of which have since been found to have very high co-morbidity with autism. In a recent study, 50 percent of people on the autism spectrum were found to have been diagnosed with depression and 40 percent to have co-occurring anxiety disorders.

In many cases, the treatment for autistics who do not have a high need for support consists of the same kinds of interventions and treatments that therapists would use for neurotypical people who are anxious or depressed, or struggling at work or with dating or food or other issues that bring anyone into therapy.

It might be that the therapy needs to be delivered in a different way to be effective, such as in a way that is more visual, text-based, and systematic, and less based on conversation, and this is why cognitive behavioral therapy is usually preferred over typical talk therapy for people on the spectrum.

Of course, some autistics do have high support needs and need one-on-one support daily. Others may need an intermediate level of support such as headphones or lighting accommodations in school or work, while others might not need any support most of the time but might require counseling support and behavioral therapy occasionally throughout their lives.

Some people with autism take ADHD medication, antidepressants, antianxiety medication, or other psychiatric medications, as well as anti-seizure medication or medications for GI issues when those physical symptoms co-exist with autism, as they often do. So, while autism has no cure, it is not only treatable; but can fluctuate over time and can seem less extreme when it’s not judged against neurotypical behavior.

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Last Updated: Feb 14, 2020