How is degree of functioning determined?

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Treysar
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25 Jun 2012, 1:42 pm

My twins have ASD. They aren't even 2.5 yet. I have no idea to what degree they have it.

How did you get a determination on if your child is high or low functioning? What is the criteria for this?

I don't want to know yet, either way. I just want to know who and or how this is determined.

Thanks.



Wreck-Gar
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25 Jun 2012, 1:52 pm

No way to know at that age. They still have a ton of development to go.

When we talk about "high" or "low" functioning it really doesn't mean how they are as toddlers. How many toddlers would be considered "high functioning" anyway, ASD or no?



Treysar
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25 Jun 2012, 2:03 pm

I'm not sure. What is the definition of high functioning?



McAnulty
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25 Jun 2012, 2:37 pm

I think it's very subjective. Form what I understand even doctors don't agree because there is no diagnostic criteria to differentiate high from low functioning. Even classifying Asperger's, classic Autism, and PDD-NOS is being thrown out because no one can completely agree as to who should be diagnosed with what, and none of the categories can predict prognosis. A lot of the people who are diagnosed as adults with Asperger's technically don't fit the diagnosis because they spoke late, but doctors find them high functioning so they change the label. There is no real system for determining functioning level, it depends on what you interpret to be high functioning. Functioning levels can also change through time.



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25 Jun 2012, 2:41 pm

right now, I think it is personal opinion based on the experiences of the "expert."

here is the proposition for mild, moderate, and severe for the new dsm5


Severity Level for ASD

Social Communication

Restricted interests & repetitive behaviors

Level 3

‘Requiring very substantial support’

Severe deficits in verbal and nonverbal social communication skills cause severe impairments in functioning; very limited initiation of social interactions and minimal response to social overtures from others.

Preoccupations, fixated rituals and/or repetitive behaviors markedly interfere with functioning in all spheres. Marked distress when rituals or routines are interrupted; very difficult to redirect from fixated interest or returns to it quickly.

Level 2

‘Requiring substantial support’

Marked deficits in verbal and nonverbal social communication skills; social impairments apparent even with supports in place; limited initiation of social interactions and reduced or abnormal response to social overtures from others.

RRBs and/or preoccupations or fixated interests appear frequently enough to be obvious to the casual observer and interfere with functioning in a variety of contexts. Distress or frustration is apparent when RRB’s are interrupted; difficult to redirect from fixated interest.

Level 1

‘Requiring support’

Without supports in place, deficits in social communication cause noticeable impairments. Has difficulty initiating social interactions and demonstrates clear examples of atypical or unsuccessful responses to social overtures of others. May appear to have decreased interest in social interactions.

Rituals and repetitive behaviors (RRB’s) cause significant interference with functioning in one or more contexts. Resists attempts by others to interrupt RRB’s or to be redirected from fixated interest.


http://www.dsm5.org/ProposedRevision/Pa ... px?rid=94#

Here is a really good post on the legitimacy of the subject by someone here at wrongplanet

http://www.wrongplanet.net/postt138223.html

Here is one explanation based on level of care

http://www.livestrong.com/article/8228- ... ing-scale/

One article makes the following point:


DIAGNOSTIC CRITERIA. The following are the diagnostic criteria for Autistic Disorder, Asperger’s Disorder and Pervasive Developmental Disorder, Not Otherwise Specified (PDD-NOS), as taken from the DSM-IV. Both Rett’s Syndrome and Childhood Disintegrative Disorder are very rare and will not be discussed here. The diagnostic criteria provide a roadmap to understanding the similarities and differences among these three ASDs.

Autistic Disorder. Autistic Disorder has been referred to simply as “autism,” “classical autism,” “infantile autism” and “Kanner’s autism.” All are one in the same. There are no formal diagnostic categories for the popular terms “mild,” “moderate,” and “severe” autism. Rather, these terms probably have their origins in a widely used diagnostic assessment tool called the Childhood Autism Rating Scale (CARS) that does divide children into the two categories “mild-to-moderate” and “severe.” Many children who are initially categorized as being “severely” affected by autism, become only “mildly” so after appropriate treatment.

There is also no diagnostic category, and no commonly accepted definition, for the label “high functioning” autism. It is sometimes associated with those children who rank in the “mild-to-moderate” range on the CARS test, or who have autism unaccompanied by mental retardation. This vague "high functioning" label draws its meaning, presumably, by being contrasted with the label “low functioning." Like "high functioning autism," "low functioning autismi" has no concrete definition. The term is offensive to many parents since it can be very damaging to the children labeled with it. That's because "low functioning" too often connotes “low expectations," which can become a self-fulfilling prophecy when children are denied effective treatment based on “low expectations." Unfortunately, even the Autism Society of America contributes to this confusion regarding “high vs. low functioning" by using these terms in their information materials.

http://www.ctfeat.org/labels.htm

Anyway, this information probably just confused the situation, but its all relative.



Wreck-Gar
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25 Jun 2012, 2:45 pm

Treysar wrote:
I'm not sure. What is the definition of high functioning?


Well high/low functioning are not official diagnoses. High functioning can mean IQ above 70 (meaning not retarded.)

Some people tend to apply the term high-functioning to ASD kids who are verbal.



NigNag
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25 Jun 2012, 7:20 pm

Treysar wrote:
My twins have ASD. They aren't even 2.5 yet. I have no idea to what degree they have it.
How did you get a determination on if your child is high or low functioning? What is the criteria for this?
I don't want to know yet, either way. I just want to know who and or how this is determined.
Thanks.


Usually their functioning level is determined at the time compared to other kids their same age (usually using tests, checklists, standard deviations, etc.)
If you are trying to get services they usually have a list of requirements you have to meet. Our state for example, will give services to those children who are developmentally delayed under the age of 3 if they are two standard deviations below on testing. Once they turn 3, IQ testing has to be under 70. Those are considered "low functioning". If your IQ is over 70, then you are considered high functioning unless you can prove adaptive behavior is equivalent to someone with an IQ of 70 or under. This requirement changes dependent on each state and their requirements.
That being said, their functioning level often changes, especially at that age.

I had the schools professionals all telling me in a meeting that my son would never be able to read past a 3rd grade level, write anything but his first and last name or do math beyond simple adding and subtracting of single digit numbers. This past year he passed his 7th grade math (which is actually 8th grade level math), he was writing essays in his accelerated writing class, was taking 8th grade social studies, played in his middle school band and the last book he read was Catcher in the Rye.

Don't concentrate so much on functioning level. Just get them into therapy, learn all you can, be flexible and of course love them :)

:)



Treysar
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25 Jun 2012, 7:54 pm

Thank you everyone for the great, informative replies.

I guess I suspected that it's a very inexact science. Trying to "score" these kids and their level of functioning is pretty hard when they essentially speak another language. It's like giving a person an exam in chinese when they speak german.



zette
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26 Jun 2012, 9:15 am

There's no official definition of functioning level, but I found a questionnaire online that is an experimental one. See this post: Autism severity level test