low functioning vs. high functioning... difference?

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en_una_isla
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01 Feb 2007, 11:01 am

Where exactly is the line drawn between low functioning ("classic") and high functioning (AS/ HFA) autism?

If a person is non-verbal but can type understandably on a keyboard, what are they?

If a person doesn't talk at all but is not violent (head banging, aggression, etc), what are they?

If a person can talk but has meltdowns upon leaving the house, and stims violently, what are they?

If a person can talk, write, doesn't stim violently, is skilled, but can't hold down a job to support himself, what are they?

Or is the line drawn at being able to use the bathroom, get oneself dressed, feed oneself, and not stim violently?



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01 Feb 2007, 11:10 am

That is interesting to think about because you bring up a lot of good points. I have read that high-functioning auties can generally talk and usually do not stim violently. However, since autism is based on a spectrum (as are most disorders), it would then be difficult for even the experts to know where to draw the line in such cases.


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01 Feb 2007, 12:01 pm

I agree. I think that the distinction is constantly being attempted to determine who qualifies for services and assistance. It is an interesting problem that I am sure would be solved if we let more private companies, charities, whatever, etc. help rather than having some goverment official sit there and dictate who gets what and how much. Because "functioning" is not something neatly describe with check boxes, is it? I mean, the economic aspect is something I am interested in because a lot of people argue that more money and more government programs will lead to better service, but there isn't the demand for efficiency and quality across the board (which is why some schools/states are better than others.) I don't want to turn it into an economic discussion, but I think the biggest problem with "functioning" labels is that they vary from individual to individual and no check box is going to be able to cover that.


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en_una_isla
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01 Feb 2007, 12:29 pm

Is a person who can write, but not speak, really non-verbal?



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01 Feb 2007, 12:36 pm

Technically, "classic," Kanner's autism isn't really defined as "low-functioning." It's just set labeled that to set it apart from HFA and Asperger's. But there are many different classifications for Kanner's autism. They range from mild to severe, so there are higher-functioning individuals within the "low-functioning" category, if that makes any sense. Somebody with Kanner's autism won't be diagnosed with "low-functioning autism." They may get a diagnosis, such as "moderate autism." I believe IQ is factored into the equation, as well as severity of symptoms.
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01 Feb 2007, 12:45 pm

dexkaden wrote:
I think the biggest problem with "functioning" labels is that they vary from individual to individual and no check box is going to be able to cover that.


Exactly and quite often people completely fail to make the distinction between what are considered low functioning autistic people and those with severe challenging behaviour(they merely take the view that it is a case of high vs low). Of the latter group some may be low functioning and some may be high functioning. There was a young woman with an IQ of 150 and a 13 year old boy with an IQ of 130 - they were both clearly high functioning in terms of intellignece, but their social behaviour in the world of people is unacceptable and neither is what you'd term 'well behaved', though, from their own narrow perspectives they function well.

Briefly the percentages in terms of IQ ranges are approximately as follows(You can find articles on normal distribution on the internet):

IQ 100 down to 86 - 34.1% of population(normal range)
IQ 85 down to 71 - 13.6% of population(low normal)
IQ 70 down to 56 - 2.1% of population - mild intellectual impairment.
IQ 55 down to 40 - 0.1% of population - moderate intellectual impairment.
Under 40 severe intellectual impairment - Percentage? Very small.
Under 25 - profoundly intellectually impaired. Percentage? Even smaller.

Strictly speaking low functioning autistics comprise all those who have intellectual impairments. - about 2.3%+/- of the total population and about 80% of all autistics. However, as has been suggested, some "low" functioning autistics(in terms of their IQs) actually function very well, yet some very intelligent autistics do not succeed.

An autistic woman(considered LFA) once wrote:
"For reference, my objection to the subsets that most people believe exist, isn't that they promote intolerance(although the way they're used often do), but that most of them seem to have been wrongly divided. If I believed for instance that a line could be drawn from low to high functioning for *autism* as a whole - I would have no objection to it, but I haven't seen any evidence that it's true and I've seen much evidence that it isn't."

Further views on HFA/LFA:
http://www.autismvox.com/lfa-and-hfa/



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01 Feb 2007, 1:24 pm

en_una_isla wrote:
Is a person who can write, but not speak, really non-verbal?


I would say no. Any means of communication would be verbal whether it's sign language, pecs what have you. To me verbal means able to communicate. I dunno?



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01 Feb 2007, 1:52 pm

Verbal means being able to speak. Perhaps a better term would be communicative or non-communicative because then that opens up a whole world of possible mediums of communications. Sign language is a form a non-verbal communication, and so is typing or writing. Pictograms can also be a form of non-verbal communication, but the problem there is that there can be so many different meanings of a picture to individuals that exact translation is kind of difficult. Pictograms always remind me of The Golden Compass (Alethiometer) and the layers of meaning it takes to figure out what it is showing.

But yes, in answer to your question, not being able to speak is being non-verbal.


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01 Feb 2007, 2:00 pm

Erm, low functioning is curled in the fetal position and screams incoherently whenever another person comes near.

High functioning is curled in the fetal position and screaming profanity whenever another person comes near.

(Hope this helps clear things up.)


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01 Feb 2007, 2:04 pm

en_una_isla wrote:
Is a person who can write, but not speak, really non-verbal?


I would say that anybody who does not have speech would technically be considered "nonverbal," whether or not they are able to type, sign, use P.E.C.S., or
manage to get others to understand them via body language or even the few who can follow the pattern of one of their "walking tantrums" (actually I hate that term)...but if NO SPEECH, NON-VERBAL...by definition.



en_una_isla
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01 Feb 2007, 2:21 pm

Prof_Pretorius wrote:
Erm, low functioning is curled in the fetal position and screams incoherently whenever another person comes near.

High functioning is curled in the fetal position and screaming profanity whenever another person comes near.

(Hope this helps clear things up.)


That's the best distinction I've heard to date! Thanks.



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01 Feb 2007, 2:23 pm

en_una_isla wrote:

That's the best distinction I've heard to date! Thanks.


Yer quite welcome, glad to be of service ! !!


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01 Feb 2007, 3:17 pm

Just posted this recently about the (mis)definitions of "Kanner" a lot of people use:

I was watching the recent autism episode of The View, and noticed that early on an “expert” repeated the current common usage of the word “Kanner” in relation to autism.

Quote:
Within this umbrella, you have different severities of autism. You have the more severe strict autism that Dr. Leo Kanner described in 1943, where you have the very non-verbal non-functional individual sitting in the corner banging their head, and then you’ve got milder forms. You’ve got the atypical autism, or the PDD-NOS like you have in your child, they have milder symptoms, they may have a little language, but they may not be as age-appropriate. They have some social interaction issues, but it may not be, again, socially and developmentally appropriate. And then they have some odd behaviors, some repetitive or stereotypic behaviors.


I’m coming to the conclusion that most “experts” on autism have not actually read Leo Kanner’s 1943 paper very thoroughly, and do not know the history that goes along with it. Here are some quotes that show that absolutely none of Kanner’s original patients fit the stereotype she describes on that show:

About Donald T:

Quote:
At the age of 1 year “he could hum and sing many tunes accurately”. Before he was 2 years old, he had “an unusual memory for faces and names, knew the names of a great number of houses” in his home town. “He was encouraged by the family in learning and reciting short poems, and even learned the Twenty-Third Psalm and twenty-five questions and answers of the Presbyterian Catechism.” The parents observed that “he was not learning to ask questions or to answer questions unless they pertained to rhymes or things of this nature, and often then he would ask no question except in single words.” His enunciation was clear. He became interested in pictures and very soon knew an inordinate number of the pictures in a set of Compton’s Encyclopedia.” He knew the pictures of the presidents “and knew most of the pictures of his ancestors and kinfolks on both sides of the house.” He quickly learned the whole alphabet “backward as well as forward” and to count to 100. [Describing a few years later:] He quickly began to read fluently and to play simple tunes on the piano. […] He expressed puzzlement about the inconsistencies of spelling: “bite” should be spelled “bight” to correspond to the spelling of “light”. He could spend hours writing on the blackboard. […] He got hold of an encyclopedia and learned about fifteen words in the index and kept repeating them over and over again. […] Another of his recent hobbies is with old issues of Time Magazine. He found a copy of the first issue of March 3, 1923, and has attempted to make a list of the dates of publication of each issue since that time. So far he has gotten to April, 1934. He has figured out the number of issues in a volume and similar nonsense.


About Frederick W:

Quote:
He has said at least two words [”Daddy” and “Dora,” the mother’s first name] before he was 2 years old. From then on between 2 and 3 years, he would say words that seemed to come as a surprise to himself. He’d say them once and never repeat them. One of first words he said was “overalls,” [The parents never expected him to answer any of their questions, were once surprised when he did give an answer-”Yes”.] At About 21/2 years, he began to sing. He sang about twenty or thirty songs, including a little French lullaby. In his fourth year, I tried to make him ask for things before he’d get them. He was stronger-willed than I was and held out longer, and he would not get it but he never in about it. Now he can count up to into the hundreds and can read numbers, but he is not interested in numbers as they apply to objects. He has great difficulty in learning the proper use of personal pronouns. When receiving a gift, he would say of himself: “You say ‘Thank you.’”

He bowls, and when he sees the pins go down, he’ll jump up and down in great glee.


About Paul G.:

Quote:
At 3 years, he knew the words of not less than thirty-seven songs and various and sundry nursery rhymes. […] Upon entering the room, he instantly went after the objects and used them correctly. He was not destructive and treated the objects with care and even affection. He picked up a pencil and scribbled on paper that he found on the table. He opened a box, took out a toy telephone, singing again and again “He wants the telephone,” and went around the room with the mouthpiece and receiver in the proper position. He got hold of a pair of scissors and patiently and skillfully cut a sheet of paper into small bits, singing the phrase, “Cutting paper,” many times. He helped himself to a toy engine, ran around the room holding it up high and singing, “The engine is flying.” […] His enunciation was clear, and he had a good vocabulary. His sentence construction was satisfactory, with one significant exception. He never used the pronoun of the first person, nor did he refer to himself as Paul. […] Formal testing could not be carried out, but he certainly could not be regarded as feebleminded in the ordinary sense. After hearing his boarding mother say grace three times, he retained it without a flaw and has retained it since then. He could count and name colors. He learned quickly how to identify his favorite Victrola records from a large stack and knew how to mount and play them.


About Barbara K:

Quote:
Ordinary vocabulary at 2 years, but always slow at putting words into sentences. Phenomenal ability to spell, read, and a good writer, but still has difficulty with verbal expression. Written language has helped the verbal. […] In camp last summer she was well liked, learned to swim, is graceful in water (had always appeared awkward in her motility before), overcame fear of ponies, played best with children 5 years of age. […] Attracted by a pen on the desk stand, she said “Pen like yours at home.” Then, seeing a pencil, she inquired: “May I take this home?” […] She read excellently, finishing the 10-year Binet fire story in thirty-three seconds and with no errors, but was unable to reproduce from memory anything she had read. In the Binet pictures, she saw (or at least reported) no action or relatedness between the single items, which she had no difficulty enumerating. Her handwriting was legible. […] She knew the days of the week.


Of Virginia S:

Quote:
She is neat and tidy, and does not play with other children, and does not seem to be deaf from the gross tests, but does not talk. The child will amuse herself by the hour putting picture puzzles together, sticking to them until they are done. I have seen her with a box filled with the parts of two puzzles gradually work out the pieces for each. […] She pays no attention to what is said to her but quickly comprehends what is expected. Her performance reflects discrimination, care, and precision. With the nonlanguage items of the Binet and Merrill-Palmer tests, she achieved an IQ of 94. “Without a doubt,” commented the psychologist, “Her intelligence is superior to this. […] she finds pleasure in dealing with things, about which she shows imagination and initiative. […] She remembered (after more than a year) where the toys were kept and helped herself. […] Quick, skilled moves. Trial and error plus insight. Very few futile moves. Immediate retesting reduced the time and error by more than half. […] In December I heard her hum the perfect tune of a Christmas hymn while she was pasting paper chains.


About Dorothy, the sister of Herbert B (not diagnosed as autistic but described as in early life ignoring most people, dancing in circles, making queer noises with her mouth, and reversing pronouns):

Quote:
She was first declared to be feebleminded, then schizophrenic, but after the parents separated (the children remaining with their mother) she “blossomed out”. She now attends school, where she makes good progress; she talks well, has an IQ of 108, and — though sensitive and moderately apprehensive — is interested in people and gets along reasonably well with them.


About Herbert B himself:

Quote:
Within certain limits, he displayed astounding purposefulness in the pursuit of self-selected goals. Among a group of blocks, he instantly recognized those that were glued to a board and those that were detachable. He could build a tower of blocks as skillfully and as high as any child his age or even older. […] He went after the Seguin form board and instantly busied himself putting the figures into their proper spaces and taking them out again adroitly and quickly. […] When one figure was stealthily removed, he immediately noticed its absence, became disturbed, but promptly forgot all about it when it was put back.


About Alfred L.:

Quote:
He has gradually shown a marked tendency toward developing one special interest which will completely dominate his day’s activities. He talks of little else while the interest exists, he frets when he is not able to indulge in it (by seeing it, coming in contact with it, drawing pictures of it), and it is difficult to get his attention because of his preoccupation…. there has also been the problem of an overattachment to the world of objects and failure to develop the usual amount of social awareness. […] Since he talked, there has been a tendency to repeat over and over word or statement. He almost never says a sentence without repeating it. Yesterday, when looking at a picture, he said many times, “Some cows standing in the water.” We counted fifty repetitions, then he stopped after several more and then began over and over. […] Alfred, upon entering the office, paid no attention to the examiner. He immediately spotted a train in the toy cabinet, took it out, and connected and disconnected the cars in a slow, monotonous manner. He kept saying many times, “More train- more train- more train.” He repeatedly “counted” the car windows: “One, two windows-one, two windows-one, two windows-four window, eight window, eight windows.” He could not in any way be distracted from the trains. A Binet test was attempted in a room in which there were no trains. It was possible with much difficulty to pierce form time to time through his preoccupations. He finally complied in most instances in a manner that clearly indicated that he wanted to get through with the particular intrusion; this was repeated with each individual item of the task. In the end he achieved an IQ of 140. […] Alfred was extremely tense during the entire interview, and very serious-minded, to such an extent that had it not been for his juvenile voice, he might have given the impression of a worried and preoccupied little old man. At the same time, he was very restless and showed considerable pressure of talk, which had nothing personal in it but consisted of obsessive questions about windows, shades, dark rooms, especially the X-ray room. He never smiled. No change of topic could get him away from the topic of light and darkness. But in between he answered the examiner’s questions, which often had to be repeated several times, and to which he sometimes responded as the result of a bargain -”You answer my question, and I’ll answer yours.” He was painstakingly specific in his definitions. A balloon “is made out of lined rubber and has air in it and some have gas and sometimes they go up in the air and sometimes they can hold up and when they got a hole in it they’ll bust up; if people squeeze they’ll bust. Isn’t right?” A tiger “is a thing, animal, striped, like a cat, can scratch, eats people up, wild, lives in the jungle sometimes and in the forests, mostly in the jungle. Isn’t right?” […] He once stopped and asked, very much perplexed, why there was “The Johns Hopkins Hospital” printed on the history sheets: “Why do they have to say it?” This, to him, was a real problem of major importance, calling for a great deal of thought and discussion. Since the histories were taken at the hospital, why should it be necessary to have the name on every sheet, though the person writing on it knew where was writing? The examiner, whom he remembered very well from his visit six years previously, was to him nothing more nor less than a person who expected to answer his obsessive questions about darkness and light.


Charles N:

Quote:
He will break a purple crayon into two parts and say, “You had a beautiful purple crayon and now it’s two pieces. Look what you did.” … He is proud of wetting, jumps up and down with ecstasy, says, “Look at the big puddle he made” […] Without looking at anyone, he said, “Give me a pencil!” and took a piece of paper from the desk and wrote something resembling a figure 2 ( a large desk calendar prominently displayed a figure 2; the day was February 2). He had brought with him a copy o Readers Digest and was fascinated by a picture of a baby. He said, “Look at the funny baby,” innumerable times, occasionally adding, “Is he not funny? Is he not sweet?” When the book was taken away from him, he struggled with the hand that held it, without looking at the person who had taken the book. When he was with a pin, he said, “What’s this?” and answered his own question: “It is a needle.” […] When confronted with the Seguin form board, he was mainly interested in the names of the forms, before putting them into their appropriate holes. He often spun the forms around, jumping up and down excitedly while they were in motion. the whole performance was very repetitious. He never used language as a means of communicating with people. He remembered names, such as “octagon,” “diamond,” “oblong block,” but nevertheless kept asking, “What is this?”


About John F:

Quote:
At 5 1/2 years, he had good mastery of the use of pronouns. He had begun to feed himself satisfactorily. He saw a group photograph in the office and asked his father, “When are they coming out of the picture and coming in here:”
He was very serious about this. His father said somethig about the pictures they have at home on the wall. This disturbed John somewhat. he corrected his father: “We have them near the wall” ( “on” apparently meaning to him “above” or “on top”).
When he saw a penny, he said, “Penny. That’s where you play tenpins.”He had been given pennies when he knocked over tenpins while playing with his father at home. He saw a dictionary and said to his father, “That’s where you left the money?”
Once his father had left some money in a dictionary and asked John to tell his mother about it. His father whistled a tune and John and correctly identified it as “Mendelssohn’s violin concerto.”


Elaine C:

Quote:
When she began to speak at about 5 years, she started out with complete though simple sentences that were “mechanical phrases” not related to the situation of the moment or related to it in a peculiar metaphorical way. She had an excellent vocabulary, knew especially the names and “classifications” of animals. She did not use pronouns correctly, but used plurals and tenses well. She “could not use negatives but recognized their meaning when others used them.” […] She speaks well on almost any subject, though with something of an odd intonation. Her conversation is still rambling talk, frequently with an amusing point, and it is only occasional, deliberate, and announced. She reads very well, but she reads fast, jumbling words, not pronouncing clearly, and not making proper emphases. Her range of information is really quite wide, and her memory almost infallible.


As you can see, none of Kanner’s subjects fit the stereotype the “expert” was describing. So why is it that people invoke the name of Leo Kanner to describe people who fit a certain stereotype (an “LFA” stereotype)? It’s interesting. Last fall, I speed-read a number of books on autism, from different time periods, that describe it in different ways. (When I read in that manner, I don’t understand what I read until later.) In one of the books (I wish I could remember which), they are very explicit about their usage of the term Kanner autism. They used it very similarly to the way people today would say “high functioning”. They then described an newer category of “autistic PDD” that was making its way into the concept of diagnosing autism, and that included more “lower functioning” or “severely affected” people than Kanner had talked about.

So invoking the name of Kanner used to mean high-functioning, and now is used to mean low-functioning. (High-functioning and low-functioning by the way are stereotypes, and not things I believe in as realities, because human beings’ abilities are more complex with that.) I wish more people who throw that word around would learn what it means and what it doesn’t mean and who particularly Kanner studied, and who they were and were not. Because all this stuff about “not talking at all, not interacting at all, sitting in a corner rocking and head-banging, unaware of anything, etc” is not what his study of these children actually describes — even with his own biases and such all in there. It’d be nice if people actually read this stuff. By the standards of that particular “expert” on that show, most of Kanner’s patients would probably now be diagnosed with PDD-NOS or possibly even Asperger’s, because none of them fit the stereotype she described.


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01 Feb 2007, 3:20 pm

Anyway, to reply to Oddducknash, that's not always how the term "Kanner" has been used. As you can see, most of his patients would now be considered "HFA" or "AS" or "PDD-NOS", so it doesn't make sense to use his name to differentiate between autism and those things.


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01 Feb 2007, 3:38 pm

Anyone else think some of the old definitions need to be thrown out and everything updated? I think a lot of what was written in past about autism and even some of the stuff about Aspergers is turning out not to hold true.

Sometimes on the board we use low and high functioning in reference to only Aspergers. But does the medical and scientific community have any clear definitions of variations on Aspergers or are we just lumped together as one group? Just curious. When I meet other Aspergers people it seems there is extreme variations in functioning or behavior levels.