How "high functioning*" is too high?

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Ok, I already kinda know how I feel about this, but I wanted to get the community's feedback just to be sure I'm thinking clearly.

I've been seeing therapist to sort out some issues of mine recently. Several times now he's mentioned that I'm too "high functioning*" to be on the spectrum (I have a diagnosis, but he doesn't seem satisfied with the report). Specifically he mentioned it when we were talking about my job, education, and moves I've made between states. He also mentioned it during our last session when I was talking about how I felt bad about this thing I do with my wife when she's telling me about her day and I just kinda tune her out and pretend that I'm listening because it's difficult for me to stay focused on her, especially if she's changing subjects a lot. He said, "someone who's really on the spectrum wouldn't even worry about how she felt about it".

At the extreme I can kind of see where his reasoning makes sense. If ASD doesn't cause any problems for you, then it's not really much of a disorder and you don't really need any help for it. But it just seems like a really simplistic and stereotyped way of looking at autism to me. Not to mention that I don't really see myself as anywhere near that extreme either.

What do people here think? Do you ever encounter people that you think are too "high functioning*" to really be on the spectrum? How would you respond/react to a therapist like this?


*I know, functioning labels and all that. His words, not mine.

There are people who go to college and learn how to classify things and give them labels. This then they assume is the same as understanding something.

It sounds like your therapist has a mental checklist on which "AS people do not care about anyone", you failed to make the list.

I would say the problem is not that you are "too high functioning", but that your therapist is too "low" functioning.

A more adequate therapist would have offered some suggestions about how you might solve the problem with your wife such as suggesting that since you can get overloaded with information that when she tells you about her day that she tells you only two things at a time.

LOL!! ! Good one!! I very much care about how what I do affects my husband. I care about it to the point of anxiety sometimes and I always have. And I know that lots of people on this forum care very much about how their actions affect their spouses, partners and other loved ones. So I think your therapist is uneducated in that regard.

Sounds like a very narrow minded and uninformed therapist!

People on the spectrum actually hold their loved ones very dear, we just have our difficulties expressing how much we love people close to us. This assumption is solely based on a very negative, demonizing and completely untrue stereotype about people with autism.

Exactly. Very well put, qFox.

For me, I care about my family and others. My challenge is in expressing it. But I do care.

It sounds like the therapist's take on this is more defining of a sociopathic personality, not autistic.

I concur with everyone here so far

Pfft. I am pretty social lately with other people. I rarely have meltdowns, have no sensory overloads and stim very little. I also don't get all that upset about broken routines. I do get upset, but I am able to control it. I have more control over my actions unless something really triggers me. Just because of that doesn't make me any less on the spectrum than I should be. I have a lot of other problems that get into my way as well. I do know I'm autistic because I see it in myself everyday and so do my parents too.

I'd consider getting another therapist.

personally, i think people who claim to just have trouble getting some jokes and just generally dont like people is WAY too high functioning, to the point where its not even ASD. my guidelines are:

-Sensory Issues,

-Communication and Social Issues ( and i mean real issues, not able to read body language, facial expressions, no eye contact, the whole shebang! of course this is just the most mild symptoms)

-obsessive and/or repetitive tendancys.

of course ASD affects the entire brain but the list i made is just for the most basic symptoms and in my opinion must be consistant

It's not being high-functioning that precludes autism, but being NT that does.
I can't think of some upper limit for functioning of an autistic person in life, like which job position is too HF, or what kind of marriage is too HF, or how many friends is too HF.

Thanks everyone. You all pretty much echoed more or less how I felt about it. It's good to have a little validation.

I'm trying to avoid too much confirmation bias in this process. I don't want to just jump from therapist to therapist until I find one that tells me what I want to hear. But this guy seemed to just be applying standard stereotypes and deciding that I don't fit them. He pretty clearly wants to treat all of my issues as related to social anxiety, but that seems really inadequate to me. I have lots of issues that don't have anything to do with anxiety, like executive functioning, auditory processing, and rigid thinking. Most of the time I cope well enough and they aren't major obstacles, but they can be.

I have a follow up meeting with the other psych that did my diagnosis next week. Depending on how that goes, I get the feeling I won't be going back to see this guy.

He seems like he is suffering from a touch of Idiot Syndrome to me. I would find someone else.

Here's how I look at it:

I am a shadow. I have a number of aspie-like traits, and I do struggle considerably more than NT's do with a number of things. I am 100% certain that my brain is not wired like most people's. But I am also 100% sure that I am not diagnosable, and this is after serious consideration.

My daughter is definitely autistic, and probably as high functioning as you can be without simply being a shadow.

Here's the difference:

When things do not go as planned, when sensory input exceeds what can be comfortably tolerated, when social situations get ambiguous and confusing, etc....I can hold my "stuff" together and keep on functioning. I might have a bear of a time doing it and it will be unpleasant and I might even be exhausted by it, but I do not meltdown and I do not shutdown. I think or will my way through it.

My daughter, on the other hand, in those same situations, will most likely shut down. She cannot will her way through it. And she cannot think her way through it because although she is very bright, when she gets past capacity, she loses her ability to process effectively. My processing might be diminished and it becomes extremely taxing, but I can still do it. She can't.

As to how to respond to your therapist: Simply tell him you are not coming to see him to discuss the merits of your already existing diagnosis. You do not wish to discuss it any further, but rather to focus on the issues that are driving you to see him in the first place.

Although, if I am to be completely honest, I suspect his ability to help you with anything at all is going to be compromised as he clearly fails to see that, whether you are a high functioning autie/aspie or a shadow, you do not process things the same way as other's do, so his "out-of-the-box" kind of interventions will not likely work for you. You may want to consider either finding a therapist who is more accustomed to working with someone on the spectrum or someone who couldn't care less about your diagnosis and is more able to focus on the problem at hand and helping you find workable solutions.

It's got nothing to do with intelligence or "tier of functioning"; it's a matter of if it interferes with your life or not.

If it does, then there you go. If you feel as though this therapist is not helping you, that's fine- your money's just as good somewhere else.

Have you considered telling him/her this? I mean, maybe they think you waltzed on in there and got this diagnosis, which they feel doesn't explain your issues. If the other professional tells you what's up, then drop the therapist like a bag of dirt.

The therapist is an idiot, at least about autism....I mean yeah if someone is diagnosed with autism but have no impaired functioning of any kind the diagnoses would not make sense since you're supposed to have clinically significant impairment...if it causes troubles in your life then you're on the spectrum. But the comment about if you where autistic you wouldn't care how she felt...is very idiotic people with autism are capable of caring about other people and how they effect them. I excessively worry about how people feel and thought it was kinda common with people on the spectrum since we can have misunderstandings with people due to problems with social interaction so seems like a valid concern a lot of autistic people would have.

I don't think the difference between autistic and non-autistic is in how people cope with problems like sensory overload.
I think it is the potentially measurable differences in sensory processing or social cognition caused by different activity patterns and connectivities in the brain.
The coping part is different from individual to individual.
Some autistic people can cope with a lot, some NTs with little, and the other way around.

On the surface this sounds subjective and perhaps illustrates your therapist is not addressing your concerns. So logically find another one.

On the other hand there is a risk you are you seeking an "expert" to support your confirmation bias?? If the latter then perhaps the therapist is saying "you don't have any symptoms that are interfering with your functioning in society"

If the latter is more likely the case (and you will know) then re-assess why you are seeing the therapist in the first place.