Low Functioning, High Functioning

The Black Oil

These terms sometimes seem to be used in a fairly unclear way in relation to Autism/Asperger's/ASD.

Is there any official line how they should be used? On the one hand we have the debate about whether Asperger's and High Functioning Autism are the same. Parents sometimes call their child high functioning in spite of their difficulties or low functioning because of their difficulties or because of the how intelligent their child is. I don't think we need to be too strict about these terms, just clear up some of the confusion.

Kevster

I have always wondered about this too, to be honest; and I have seen conflicting resources saying that HF-Autism is/is not the same as Asperger's Syndrome. The unusual thing is that the Diagnostic & Statistics Manual (DSM) of the US doesn't list HF-Autism as a disorder. Instead, it lists Autism and Asperger's Syndrome (The 'Autism' here referring to the more severe type that we are familiar with).

Kevin

Gibs

The following is largely drawn from what Tony Attwood, renowned clinical psychologist and expert on Asperger's syndrome has written on the subject in his 2007 book "The Complete Guide to Asperger's Syndrome"


The term "High Functioning Autism" was first used in 1981 by DeMeyer and his colleagues - the very same year that Lorna Wing first used the term "Asperger's Syndrome". "High Functioning Autism" (HFA) has been used in the past to describe children who had classic signs of autism in early childhood but who were shown in formal testing of cognitive skills to have a greater degree of intellectual ability and greater social and adaptive behaviour skills and communication skills than is usual with children with Autism, accompanied by a better than expected outcome. Currently there are no explicit diagnostic guidelines for the diagnosis of HFA.

The cognitive abilities of those with HFA have been compared to the cognitive profile of children with Asperger's syndrome, who did not have a history of early cognitive or language delay. The results of the research have not established a consistent profile for each group. A team in Yale back in the 1990's suggested that the two groups of children are neuropsychologically different, but other teams did not find any difference. Howlin (2000) and his team did a summary of research on this issue and found that studies that found a difference betweeen the two groups on measures of cognitive, motor, social or neuropsychological tasks are probably equal in number to those that found no difference.

A more recent study in 2004 (by Dissanayake et al) also found that the two groups were indistinguishable in their current behavioural profiles.

A diagnosis of Asperger's syndrome is usually given if a person has an Intelligence Quotient (IQ score) within the Average range, but this is problematic due to the often uneven cognitive profile that children and adults with the clinical features of ASperger's syndrome often demonstrate, and hence the difficulty in reporting a meaningful overall IQ score.

According to Tony Attwood:
"To date, there is no convincing argument or data that confirm that High Functioning Autism and Asperger's Syndrome are two separate and distinct disorders.......A common dilemma for clinicians is whether a particular diagnosis - autism or Asperger's Syndrome - enables the child to access to the services and benefits that he or she needs.......as a result, some clinicians may write reports with a diagnosis of autism or High Functioning Autism, rather than the more accurate diagnosis of Asperger's Syndrome so that the child has access to resources and the parents don't need to resort to litigation."

cranks

Recently heard nice rule of thumb re Asperger/HFA debate which seems to fit. All things being equal, Asperger's typified by awareness of own social deficits and recognition and reaction to own difficulties in this sphere - wants to be social but invariably fails in trying; HFA may be aware but doesn't desire to be social/is indifferent - bears a more 'autistic' flavour in this regard.

The Black Oil

Thanks for the responses. I'm familiar with some of Tony Attwood's work and have that book you referenced, Gibs, but have yet to read it. Will try to get around to it soon.