How "high functioning*" is too high?

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If I'm honest with myself, I think I'm perhaps a bit too worried about confirmation bias. My wife keeps telling me that I'm over thinking it and to trust my instincts. As I mentioned, I had already received a positive diagnosis for an ASD evaluation I took prior to visiting this therapist, so it's not like I'm desperately searching for the one therapist that will agree with how I view myself. More like I've already had my suspicions officially confirmed by an ASD specialist and this guy still refuses to treat me as on the spectrum.

Also, the therapist in question isn't so much telling me that my symptoms aren't interfering with my functioning in society as he seems to be telling me that they're not interfering enough. In the cases where they are interfering significantly he wants to attribute and treat them as primarily anxiety related, which I don't always agree with.

For example, in this last session I told him that I have difficulties processing spoken language over background noise and gave an example of a recent interaction with an executive at my company where it was a problem. His solutions all focused on dealing with my anxiety that I experienced in that situation, such as simply saying that I couldn't hear in the room and excusing myself, or not attending the event at all. Saying that's an anxiety problem seems wrong to me. Addressing the anxiety doesn't solve the problem. In both of his solutions, I still miss the opportunity of accomplishing what I wanted to in that interaction. The problem is still there, even if I'm not feeling the anxiety about it.

Last edited by gamerdad on 19 Sep 2014, 8:15 am, edited 1 time in total.

As a NT parent who spends much of their free time learning about ASD and freely admits to barely scratching the surface I agree with pretty much all these comments. The therapist is an idiot. Any medical person that pretend they more than they do on a subject is never any more than that in my mind. My own medical condition is rare and I get it all the time so it's not unique to this field either.

I would look for a different therapist. If mine said that I would question her qualifications. People with Asperger's do feel and care about others. For me its more a problem of recognizing what I'm feeling and how to express it. I may laugh instead of cry. Or get mad instead scared.

"High functioning" refers to an IQ above 70, low functioning to an IQ below 70. Someone with low functioning autism may have few sensory problems for example,whereas someone with high functioning autism may have severe sensory issues, the term high/low functioning is a misnomer as it refers to IQ (a fallible idea anyway...) and not to their ablity to function in life. As such, HFA and LFA are unofficial labels, with "high functioning" autists offically being often diagnosed with ASD or Aspergers and LFA being diagnosed with classical (kanners) autism.

The crux of the problem here is that the process of diagnosis is partly a judgement call on the part of the person assessing you. I saw a documentary about Asperger's where Simon Baron Cohen, an expert on it, said it is not just about strict criteria being met; the assessor has to make an intelligent judgement. I seem to remember he said something along the lines that some people would get a diagnosis with one assessor but perhaps not with another assessor, because each is using their judgement slightly differently. Kind of similar to if you go for a driving test, whether you pass or fail may partly depend on the particular driving examiner you have that day. After all, they are only human.

So I'm inclined to say that your diagnosis is neither right or wrong, and that your current therapist's rejection of the diagnosis is also neither right or wrong. But rather, they are different interpretations of the guidelines. It could be argued that all people are somewhere on the spectrum, and it's just a matter of where you draw the line as to whether a diagnosis is made. Opinions change all the time, and different experts can interpret the guidelines slightly differently.

I realise this doesn't sit well with the aspie brain, because we like things to be black and white, either yes or no. But I'm not sure the reality is that simple.

I'm just wondering whether it's possible for you to see your therapist's opinion as just that - merely an opinion. Maybe you could become interested more in why he thinks that, and see it as a positive thing. Because, if you put the whole diagnosis issue to one side for a moment, what he's basically saying is: "you're not as bad as some people I see". And that's a good thing, isn't it? You can see it as a positive and move forwards from that, don't you think?

I just think that if you get too stuck on this one issue, it's like you've fallen at the first hurdle (if you get my metaphor?). You already have you diagnosis. He can't take that away from you. And your diagnosis got you to this point. Ironic really. Without your diagnosis, you might not even be seeing the therapist. I wonder if he gets that irony too.

I've often wondered whether I would get a diagnosis if I was assessed again by somebody different. But what matters is that my life has moved forwards in a positive direction since the diagnosis. If somebody was to question it now, I would say, "Well, my diagnosis enabled me to get treated differently and get help to get the best job I've ever had, and get support and understanding in that job. So it makes perfect sense to me and has served it's purpose very well."

Laughingatthesky, I think you are right in saying that the OP should try to see the therapists point of view and see why he thinks what he thinks. But on the other hand, I think it is also important to for him to be able explain to the therapists if his daily life is really impaired. If it were me, a therapist could very easily assess me sitting in his office, looking, speaking and acting like a normal well balanced NT and think that I am not impaired at all if the therapist is not as skilled and does not know how to look deeply. But in reality, if he were to spend every day looking at my life for a week, he would have a very different opinion of me. It would be very clear how my symptoms disable and impair my ability to function on a daily basis. So in this case, I think that a real open and honest dialogue from both sides is very important so that each can understand the perspective of the other. If the therapist is just going by what he sees on the surface, he might miss the whole boat and it's a big boat to miss.

The therapist's remark, that 'people on the spectrum don't care about others', shows only that
he knows less about autism spectrum disorder than his client does.
So how could he possibly be of any help with this specific condition?
The OP is more likely to find practical advice and workable solutions on this forum,
than from such an uninformed 'expert'. Why waste any more money on that?
Better to find someone who really understands the condition properly and who preferably
has lot's of practical experience with helping people on the spectrum.
What's the use if he is specialized on totally different conditions like social anxiety disorder,
that have nothing to do with autism?
You wouldn't go to a plumber when you need an electrical problem fixed.

If that therapist is really so ignorant that they think people on the Autism Spectrum can't care about what their spouse is thinking or feeling or care about what anyone but themselves - they are way too low functioning as a therapist and you should consider finding someone else.

Following this line of thinking that some strict criteria has to be met - would that mean that a person with autism who improved their social skills, became more interactive and learned to make good eye contact and could hold down a job and be a valued employee was then no longer autistic?

And if you don't mind some thoughts on your problem with tuning out while your wife is talking to you.:

I think, if she is talking a lot with changing subjects, maybe you don't need to focus on the verbal
communication so much. She is probably just trying to connect with you by telling you about her day. It's called sharing.
If you only pick up on a couple of details and confirm with her that you care about her well-being, that would be sufficient for her to feel emotionally connected with you.
If you only manage to appear to be listening, but she get's the impression that you try to stay focused on her,
that may be good enough. You need not worry about all the details of the conversation.
If a particular subjects appears to be important, you could ask her to slow down.
It shows even more that you care.
Fast talking female NT's (if she is NT) don't usually want advice or fixing problems,
all they need in that case is the impression of getting that loving attention, to feel that someone cares.
I don't think you need to feel bad, you are probably doing it right.
I would say, if she doesn't complain, it doesn't need fixing.

skibum and laughingatsky, I think you both make good points. I think I'd be happy to talk with a therapist that considered my issues not clinically significant enough to be diagnosable as ASD, so long as they were willing to still address my issues as interrelated from a spectrum perspective. He wants to address everything from the perspective that it's all based in anxiety though (see my example about how he addressed my auditory processing issues above). The more I think about this, the more I think I'm done with this therapist.

He doesn't have a clue what he's talking about. This isn't what "high functioning" means. It's a matter of IQ. An autistic person with an IQ below 70 is considered to be low functioning. Above that is high functioning.

I know I'm a bit "late in the game" to be responding to the original question, but when I read the OP's post, my concern was this:

For the longest time, it was thought that those on the spectrum completely lacked empathy. I didn't ever really understand this. I know that there is a difference between understanding a situation [as when they do certain theory of mind tests], and feeling as though you are feeling the same emotions, though.

When I see the typical situation [which used to be constantly overplayed in media- movies. television, etc- of a child dropping their ice cream, I SERIOUSLY used to get upset. Because I could imagine the huge feeling of disappointment and I don't want people to feel disappointed like that. I've felt that- it's awful.

Anway- my point? The therapist seems locked in backward, dated thinking: supposedly those on the spectrum lack empathy, compassion, care for others, etc etc etc...

This has potential to really be a huge obstacle in a therapeutic relationship. In that situation I would really just "cut and run", because it seems a no-win.

But, ya know, I'm a random person on the internet.

I hope whatever you choose to do, you do end up with someone who works out well.

Thanks everyone for the feedback. I canceled my remaining appointments with this therapist.

I've had a lot of experience with child psychologists and my initial frustration with them never addressing my daughters issues overlap with some of the points you are making.

Many of these experienced therapists (who are so hard to get an appointment with) were trained back in the 1970s and 1980s. The reason they are locked into a backward style of thinking with autism is because back then parents were less suspicious of the stuff they claimed was evidence based.

For instance the only therapy for children with autism which a modern child psychologist can draw upon is Ivar Lovaas's 1970 study on ABA which he eventually published in 1987. While many of you will have heard of Lovaas and ABA you may not realise he was using BF Skinner's Theory of behavior (operant conditioning) to young autistic children. This is was originally used to train animals using simple reinforcement to obtain the desired response. Based on reinforcement training with animals it was assumed by Lovaas in 1970 it would work for training non-verbal autistic kids.

So what did Lovaas prove? According to resident developmental child pediatrician Dr James Coplan in US Psychology Today
**Lovaas' claim of 47% normal outcome following intensive ABA (Lovaas, O.I., Behavioral treatment and normal educational and intellectual functioning in young autistic children. Journal of Consulting Clinical Psychology, 1987. 55(1): p. 3-9) has never been replicated; the paper in which he made the claim suffers from severe methodological flaws. And Behaviorism has no way of dealing with concepts such as "empathy," "understanding," or "Theory of Mind" (one of the key deficits in ASD).**

To be fair ABA can eliminate unwanted behaviors (self-injury, or harming others for example), and to promote desired behaviors in their place, to at least give the child outward display of "normalised" social behavior. **

The problem I have is with vast majority of psychologists who think you can apply repetitious and cruel reinforcement tested on lab rats for 40 hours a week to a child barely out of nappies to replace harmless repetitious behavior or echolalia type communication skills. The jury is out what the long term trauma is for children who are put through this regime and whether the positives really outweigh the negatives?

Attwood and Baron-Cohen have published that IQ for instance is a much better predictor of outcomes of autistic children into adulthood than ABA. regardless the child will learn in the own time and without trauma. Imagine if NT children were forced to do 40 hours of ABA per week to minimise bad behaviors. There would surely be an outcry about ethical breach of human rights.