Low Functioning Autism and High Functioning Autism

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Isa and I are talking about the DSM-5 which is THE current definition, at least in the USA. Isa’s table is from the DSM-5 and my link and post are also about the DSM-5. Maybe in jolly old England there was a different definition in the past when Joe90 was diagnosed. ICD and DSM tend to follow each other mostly but they sometimes diverge a bit. England has state run socialized medicine so they might have their own rules. Even the DSM has changed over time. High-functioning means better able to function in the world low-functioning means less able to function in the world. A kid who is completely non-verbal and seems to be in his own little world is not high functioning. It is easy to see the difference between very high functioning and very low functioning. Shades of meaning might be different from doc to doc and from Autistic person to Autistic person. What Joe90 means when she says high functioning is what she means. What her experience is is her experience.
Others may mean something else.
My understanding is that the DSM is based observable behavior only.
It also tends to follow current research mostly and political lobbying some.

I have province-run socialised medicine but we still use DSM5. Our rule is that the diagnosis needs to be made by a Clinical Psychologist or a Neuropsychologist, and psychometric testing needs to be conducted. Those tests go beyond observable behaviour by quantifying various "invisible" measures, including mindblindness, our ability to draw inferences, pattern recognition, short term memory, etc.

I'm curious if anyone has the current ICD criteria for levels, or how levels are determined there? It seems they must be defined because people would need all that data for PIP, and because ICD is usually similar to DSM.

I agree that in general it's easy to differentiate high vs low functioning by observation. It's the middleground which is often overlooked, even in terms of social services. HFA is generally taught how to compensate socially. LFA is usually given caseworkers or a support team. In the middle there are many of us with significant deficits who can't function normally, but don't qualify for enough care or subsidy to cope.

The chart doesn't even mention sensory and executive functioning issues, despite the fact that they're routinely associated with autism and are considered in assessment.

Joe, we completed my son's evaluation last week. He was not diagnosed with ASD (I concur). He has sensory issues and was diagnosed with moderate anxiety and ADHD ---even though he currently doesn't have close friends (he's had BFFs in the past and we hope he does in the near future). So in my area, anxiety and sensory are not Autism. The evaluators said it was difficult b/c he has moderate rigid and repetitive behavior and he body rocks and stims and flaps (a lot), but these overlap with anxiety and ADHD also. So even near constant stimming and some echolalia isn't ASD aside an otherwise charming personality with a good sense of humor . I half wonder if he's just sooooooo smart he can compensate that much socially despite ASD, but he's probably on the GAD/ADHD/ASD cusp, close to ASD but leaning away. He gets explosive when the milk shows up in a different carton, but after the initial response he can be talked into trying it. So... GAD and ADHD it is.

Meanwhile, our 2nd attempt to have my daughter diagnosed with ASD is next month. So happy she has two friend groups now!! ! My NT husband drove her to a competition recently and observed her with her friends. He said she is just like me: She giggles to cover her cautiousness or confusion, but she's managing. ---Today she was under stress during a sports game --- she scored a goal and wasn't sure how to react, so had two meltdowns (uncontrollable crying) and then an anxiety attack from her embarrassment. Sarcasm: "high functioning" is fun!

I think it's unfortunate that anybody still uses function labels at all as even under ideal circumstances, they're still incredibly misleading. By all definitions, I'd be high functioning, but it takes a massive toll trying to remain so. And, ultimately, anytime I hit burnout, I fall pretty far and pretty hard. The day before yesterday, it took like 40 words to tell somebody that I'd set aside a loaf of bread, which is pretty pathetic by my usual ability level.

Support level is a lot better, but still isn't super easy for the public to really understand as you might be in need of a lot of help in one area, or a little bit in many areas and have roughly the same amount of functioning overall.

I agree with you, but I didn't make the chart and sensory isn't required for a diagnosis.



In the DSM diagnostic criteria Part A is Social & Communication, Part B is RRB.
That's why those titles are on the severity chart.

Sensory is only one descriptor in Part B, and people don't need to meet all the descriptors.
I wish it was worded a little differently though, too.

As for EF I don't think those words are in DSM but I could be wrong, even though they allude to it.

Those words were used more in my ADHD assessment.

I'm the textbook example of anxiety disorder. That's all I've been all my life, a bag of nerves. But despite that, I've never rocked or flapped when anxious.
My ears are sensitive to certain noises but I do have a perforated eardrum and I read somewhere that can cause sound sensitivity to extreme high or low sounds. I am also very easily startled, which is why I don't like sudden loud noises even if they're expected. I don't like the feeling of being startled, it's like having an electric shock. I also have misophonia.
I've always had a bit of a phobia of clothing tags. Just looking at them makes me feel physically sick, the same reaction you'd get when looking at puke. I heard there's a similar phobia about buttons that some people have, although I don't have that, but this phobia with tags is equivalent to the phobia of buttons). So if I can feel a clothing tag in my clothes then I know I will be distracted and disturbed by it, which is why I remove most clothing tags.

My two prominent disorders are anxiety and ADHD. Take them both away and I probably wouldn't exhibit any autism traits at all. Even my social awkwardness isn't caused by social cluelessness, it's caused by lack of confidence, like I may be afraid to assert myself which can lead to embarrassing situations and make me look weak or timid. But it's not that I don't understand the cues or anything, because all that seems natural to me, it's just I suddenly back away timidly rather than be confident. If I work on this I believe my social performance will be of the same level as NT.

So my personal theory: DSM talks about observable behavior but as a computer scientist I think about mechanism too. My model for ASD is a collection of hyper- and hypo-sensitivities. Brain scans show some parts of the brain have extra volume and activity and other parts less (compared to neuro-typical control s). This would account for both the sensory hyper-sensitivity and hypo-sensitivity and for emotional hyper-sensitivity and hypo-sensitivity. Each individual can have a different collection of hyper- and hypo-sensitivities.

This model covers adhd too. YMMV

Joe, your experience sounds a lot like my son. He still is in soft clothing and just beginning to wear shorts.

Fenn, I am totally on board with that theory!! !! I'm reading about cranial nerves right now...

I wonder if that new way of dividing us into 4 Types of Autism they've discovered will affect these criteria in the next few years.

e.g. I fit right into level 1 ASD in the social communication aspect but have hardly any repetitive behaviours.

Have you tried any meds for anxiety? Beta blockers or benzos, for example?
Sertraline is a great med but it's often paired with something else for anxiety.
I think Wellbutrin is the one I hear most.
I'm probably going to try Buspar again for my anxiety.
I see my doctor on Friday.

Lower functioning autism has intellectual disability. Lower functioning is more likely severely disabled and it is easier to diagnose.

Higher functioning autism is of average or high intelligence. Higher functioning is more likely able to mask symptoms of Autism. It is harder to diagnose high functioning autism.