Saturday, April 20, 2013

What Is High Functioning About Autism?


What is High Functioning about Autism?  
(above see Temple Grandin and Steven Wiltshire--Each with autism and great giftings)

You may hear the description "high functioning" connected to the word autism.  What does that mean? Does it mean the person is high functioning with relationships, work, play, mood?  Does it mean there are no struggles or challenges?  Are these individual higher functioning than others outside the spectrum?  Great questions!

High functioning only refers to an individual's cognitive function.  There is a misperception that most individuals in the autistic spectrum are low functioning cognitively.  In fact, when I was in graduate school, we learned that 2/3 of individuals in the spectrum are intellectually handicapped and measure in what we call the Mentally Retarded range.  Turns out, that was a huge error! While it is difficult to measure exactly  how many people are in the autistic spectrum from different ranges of "intellect"--it is clear that autism does not discriminate on the basis of intellect. In fact,it is becoming clear that many people who are in the gifted range of intellect are within the spectrum.  They may be described as having high functioning autism or Asperger's Disorder.  Some argue there is a difference between the two and others argue they are the same.  For the sake of this discussion, we don't need to solve that question! 

But let's get back to the original question.  Does that mean the individual is "high functioning" in life?  No.  These individuals may be high functioning and accomplished in life, but many have significant struggles in certain areas, or at least need some accommodations or help to maintain their really functional life.  Why?  Consider this--
     1. Although I said high functioning refers to cognition, I should say it refers to intellect.  There is a cognitive domain called executive function that is very problematic in the autistic spectrum.  It involves things like multi-tasking, initiating a task, time management, flexible thinking, quick attention, thinking outside the box, sequencing through a task with multiple steps, etc.  (See my other posts on executive function by clicking on the tags/labels on the right hand column). 
     2. In addition to significant problems with executive function, individuals in the spectrum also tend to have difficulty with social communication, facial recognition, and imaginative play with others.  Therefore, relationships can be problematic and difficult to maintain well. 
     3. Individuals in the spectrum often have significant sensory symptoms (see sensory tag). This can mean that they feel drained in their environment, well before others would.  They may need things "just so" to get through the day well (e.g., wearing a certain type of clothes, eating certain foods, dimmer lights etc). 
     4. Anxiety is very prevalent in the spectrum.  Anxiety and executive function problems may cause rigidity in day to day functioning.  Also, anxiety is more difficult to treat with medications in the spectrum than outside (although can certainly be helped with medication).  Counseling may be difficult because it can rely on thinking abstractly in an interpersonal setting.  E.g. "What are you feeling?"  Counselors who specialize in treating individuals in the spectrum may use an approach based on problem solving, teaching self-monitoring, and learning social skills. 
      5. Sleep disturbance is often present.  This can be very disruptive if the individual is unable to initiate sleep, maintain sleep, and have good functioning during the day when they need to be at work, engaging with family, etc.  
      6. Individuals in the spectrum may have special interests that consume all their time. They may have collections that turn into hoarding.  They may spend so much time playing video games, organizing baseball cards, and building lego sets, that they don't maintain other aspects of their life well.

So beware--- If you see a child or adult struggling, consider whether they may have spectrum symptoms.  Being "high functioning" with intellect does not rule out a neurologic problem causing pain and impairment. I once heard a preschool teacher refer to a young boy in her class by saying "I don't know what's wrong with him! He's not stupid!"  As a culture, we are not good at recognizing high functioning autism, as this boy clearly had.  She was right--he wasn't stupid.  He was a gifted artist and a bright boy.  But, he was struggling, as were his parents, and they were unable to get help and assistance because autism was the furthest from their mind.  Why?--because he wasn't stupid.  

Let's increase our understanding of autism, both "high functioning" and for individuals with less language and problem solving.  Let's focus on recognizing the symptoms in the young and old.  We will improve our schools, homes, and communities.