People with autism are often described as being ‘high-functioning’ or ‘low-functioning’ but is there really such a thing?
Yes, the society differentiates high-functioning or low-functioning but recently, such diagnoses have been removed from the DSM (diagnostic manual) and were replaced with different levels of autism (1,2,3). The issue arises when most high-functioning and low-functioning autism are mostly based on a personal perspective of the individual. Regardless of the levels, I believe that it should not matter.
Ways high-functioning and low-functioning autism differs
Though not an official medical diagnosis, the term ‘high-functioning’ typically refers to individuals who are able to speak, write, read and manage life skills without much assistance. In contrast, ‘low-functioning’ individuals require most support including intensive therapy in some cases.
Communication difficulties
One of the first few indicators that a child has autism would be the limited communication skills they possess, sometimes not being able to point or speak short phrases. Children who are considered ‘high-functioning’ have relatively high cognitive and language abilities, are able to use spoken language to communicate and are often integrated into the regular school system. In contrast, those labelled as ‘low-functioning’ typically remain non-verbal, may appear to take no notice of people and may mimic actions or tone of others without comprehension. Additionally, poor non-verbal communication skills are more evident in ‘low-functioning’ children. This includes having a blank face even when experiencing pain.
Impaired social interaction
Children with autism generally have a difficult time comprehending facial expressions. They also display a lack of social responsiveness such as possessing limited eye contact or no acknowledgement of others.
One of the hallmark signs of ‘low-functioning’ would be responding inappropriately. For example, the child might laugh when a peer is in pain or display a lack of engagement. Additionally, socialising with others can be particularly difficult for children who are ‘low-functioning’.
Sensory Processing difficulties
Many individuals with autism have sensory dysfunction which could be extreme. In some cases, they are either too sensitive or not sensitive enough to various stimuli such as light, sound, touch, taste or smell. Individuals who are ‘low-functioning’ seemed to possess a lower threshold and are extremely sensitive as compared to their ‘high-functioning’ peers.
Are those labels fair?
In view of this, Dr Mary Barbera, a Board-Certified Behavioural Analyst (BCBA) shared that each child possesses different strengths and needs.
In her video, she recalled an experience whereby her son ‘Lucas’ was trying out in an ABA school and she took notice of one of his peers named ‘Nathan’ during circle time because he flopped to the ground and threw a temper tantrum. Immediately, she thought that he was ‘low-functioning’ and felt that the group was not a good fit for her son whom she labelled as ‘high-functioning’. However, upon clarification with the teacher, it was brought to her attention that Nathan has good reading comprehension and possess as much language skills that Lucas had.
This was the defining moment for her as she realised how skewed her thinking was. Therefore, such labels such as ‘low-functioning’ and ‘high-functioning’ are not only artificial but also misleading. This is because ‘low-functioning’ individuals may be successful in situations where ‘high-functioning’ people are not, and vice versa.
For example, a ‘high-functioning’ person may appear ‘normal’ in a classroom but struggle to function at a party. Meanwhile, the ‘low-functioning’ individual who is non-verbal may be more than capable of leading a conversation online. Nothing is absolute
Despite the said differences above, I believe that all these distinctions are not absolute. It is important to note that over time these levels could change. An individual may start off as level 3 (requiring substantial support) but with the right therapy, he/she can move to level 1.
Ultimately, the label of ‘high’ or ‘low’ functioning should not matter but instead, we should work towards helping each child with autism to reach their full potential and celebrate their strengths. More importantly, we should help create an environment where the child can feel safe, independent and happy.
Written by: Jermaine Tan
References:
Barbera, M. (28 November, 2018). High functioning autism vs. low functioning autism: Is there a difference? Retrieved from A Dr. Mary Barbera Website :
Hobbs, K. G. (n.d.). Low functioning autism - What sets it apart . Retrieved from A Autism Parenting Magazine Website:
Holland, K. (18 July, 2018). High-functioning autism. Retrieved from A Healthline Website: https://www.healthline.com/health/high-functioning-autism#diagnosis
Ricon, T., & Sorek, R. (10 January, 2017). Association between sensory processing by children with high functioning autism spectrum disorder and their daily routines. The Open Journal of Occupational Therapy, 5(4).
Rudy, L. J. (20 May, 2019). Severe autism: The symptoms and challenges. Retrieved from A Verywell Health Website: