High functioning Kanner's

Post Reply New Topic

Back before DSM-V we used the classifications LFA, MFA, HFA (all Kanner's), AS and PDD-NOS.
High functioning Kanner's is what I think of still when I hear HFA.

Which version of DSM are you referring to? In DSM 4 there was Autistic Disorder (which is synonymous with Kanners), Retts Disorder, Childhood Disintegrative Disorder (which is synonymous with Heller's), Asperger's Disorder, and PDD-NOS.

Prior to DSM 4, there was no Asperger. Thats why I am confused: the fact that you included Asperger in the list seem to suggest you are talking about DSM 4, yet in DSM 4 I wouldn't find LFA, MFA and HFA.

Or are you saying that Rett's Disorder and Childhood Disintegrative disorder are synonymous to those labels? It doesn't seem like the case because the profiles of those disorders are far more specific than the ones of LFA and MFA. In case of Retts there are some physical features such as deceleration of head growth, plus it affects only girls, and in case of Childhood Disintegrative Disorder there is supposed to be normal development first year of life following by losing previously acquired skills. Neither of those two specific things would apply across either end of the spectrum.

So can you clarify what you meant?

The broadening of the diagnosis from Kanner's original description to a spectrum was a result of parents and other clinicians identifying children he and his team would have rejected (they denied ~90% of the autism diagnoses by other clinicians!). It took him until 1973 to admit that there might be a broader spectrum, when even some of his close colleagues were early on arguing for it (Frankl, for one). At that point, arguably, Kanner's and autism ceased to be synonymous, and Lorna Wing's influence began to take root.

Asperger's was rediscovered (by the aforementioned Lorna Wing) in time to influence the 1994 publication of DSM IV, but was still mired in obscurity during the filming of Rainman, only a few years earlier (1988). Asperger's and Kanners accounts anchored the "ends" of the spectrum that Lorna was observing, essentially equivalent to the low and high functioning labels, with an obvious missing middle that Asperger and most clinicians allowed for.

Kanner himself would not have recognized DSM IV's definition of autism as "his" syndrome, but only the lower end of it. I'm grateful that Lorna Wing, et al, won out and broadened the spectrum (though I disagree with the subsequent loss of distinctions within the spectrum, as the result is a dependence on functional labels, or their inverse - DSM V's support labels).

"High Functioning Autism" is a term that has been used professionally to describe Autism with average to above average intellegence for a long time. Anecdotally it seems to have become a more popular diagnosis since "Aspergers" was dropped in the latest DSM manual. Which is very strange since "High Functioning Autism" and "Low Functioning Autism" diagnoses are not been any DSM or any diagnostic manual that I know of. It seems a near-universal belief even amoung people knowledgable about ASD's that functioning labels are a "official" diagnosis listed in the manuals. Bizzare.

Arguably, the current system of "levels of support" are an inverse analog for functioning labels (the lower the number, the higher the functioning).

Are you sure it would have actually been the "lower end"? I mean, like I pointed out in the other reply, he described them as having "high intellectual potential" (see here: see here https://www.news-medical.net/health/Autism-History.aspx )

Yes. He only saw intellectual potential, not potential for emerging from "acute autistic aloneness" or "elaborate ritualistic behavior" -- a reflection of the fact that "functioning" does not have a simplistic direct correlation to intelligence (anecdotally, I have two brothers also on the spectrum, among the three of us there is a total IQ difference of ~15 points, & the one with the highest IQ is also the most impaired in everyday life).

Kanner only saw the "hardest" of cases (1 in 10 of those who made it to his clinic), and even then claimed to rule out 90% of those diagnosed by other clinicians. He claimed (in his one reference to it) that Asperger's broad, higher-functioning definition was, at best a "42nd degree cousin" of his own syndrome.

It wasn't until the 50's that he did follow-ups with some of his earliest patients and realized that they had reached what would now be considered "moderate" functioning, but still insisted on the narrow definition until '73.

But according to the stats presented in DSM 4, two thirds of people diagnosed with DSM 4 version of Kanners are mentally ret*d, in contrast to his patients that aren't.

As far as acute autistic aloneness, that applies to me too, and I have Asperger's.