Why High Functioning Autism Is Difficult To Define


Highly functional autism (HFA) is not an official diagnosis or an agreed definition of what the term means. In the broadest sense of the word, high-functioning autism can mean any of the following:

  • A person with relatively mild symptoms that, while mild, are significant enough to warrant an autism spectrum diagnosis.
  • A person with autism with an IQ greater than 70
  • A person with autism who successfully navigates through a typical school or work environment.
  • A person who can mask the symptoms of autism and can pass for neurotypical.
  • A person who was once diagnosed with Asperger syndrome , a diagnosis that hasn't been officially used since 2013.

Adding to the confusion is the fact that many people with autism may be smart and educated, but have severe symptoms (such as anxiety and sensory dysfunction ) that significantly affect their daily functioning.

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HFA against Asperger syndrome

Before 2013, many people who could be said to have high-functioning autism were diagnosed with Asperger's syndrome or PDD-NOS (Comprehensive Developmental Disorder Not Otherwise Specified).

But there are differences that differentiate the two diagnoses:

  • Asperger syndrome was a separate diagnosis that described a person with average or above average intelligence and age-appropriate language skills who also had significant social and communication problems.
  • PDD-NOS was a comprehensive diagnosis. Often understood as the same as "high-functioning autism," it included people at all functional levels whose symptoms were not fully correlated with classic autism.

More importantly, people with Asperger's often had different symptoms than people with higher IQs and autism. For example, anxiety has often been an Asperger's symptom, but not all that can be described as affected by HFA.

In 2013, when the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) was published, neither PDD-NOS nor Asperger's syndrome is an official diagnostic category in the United States. Both are now on the list for autism spectrum disorder (ASD) diagnoses. Those at the more functional end of the spectrum are said to have a "Level 1" ASD.

HFA and autism level 1

Autism spectrum disorder is a single diagnosis that encompasses many people who are very different from each other. So to clarify these differences, the DSM-5 also includes functional levels. People who have the ability to communicate are often diagnosed with level 1 ASD.

However, the distinction does not provide a clear indication of what a level 1 ASD is. For example:

  • People with Level 1 ASD can show affection, perform daily tasks, and use age-appropriate language, reading, and math skills. On the other hand, they may not be able to maintain eye contact, carry on a conversation, participate in a game, or pick up on social cues.
  • People with Level 1 ASD may have a significant speech and language delay, but can participate in an inclusive academic program due to their age-appropriate academic skills.
  • People with level 1 ASD may have relatively mild speech and social delay, but may have severe sensory problems that prevent them from participating in an inclusive academic program.
  • People with Level 1 ASD may have severe anxiety, learning disabilities, and sensory issues, but still have age-appropriate speech and exceptional abilities in music, math, and engineering.

With a level 1 ASD diagnosis, the possible combinations of strengths and challenges are virtually limitless. This not only makes it difficult to characterize behavior, but can also leave you at a loss as to the level of qualified support that is required.

Identify support needs

Although few people with high functioning autism need help using the bathroom or basic hygiene, they may need significant support in other settings. For example, a highly intelligent person with severe sensory issues, anxiety, and persistence in the workplace may have a harder time than a less intelligent person with less anxiety and fewer sensory issues.

Additionally, a "malfunctioning" person may spend most of the day in a supportive environment where the likelihood of dangerous interactions is practically nil. Meanwhile, a highly functional person may need to navigate a world full of difficult and dangerous situations.

While it may be reasonable to think that people with high-functioning autism need less support, they often face more serious challenges in the real world compared to less-functional people in care settings.

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Autism is a mystery, not because people with autism are so confused, but because the ever-changing definitions of autism can lead to confusion.

Not only are definitions changing, but so are societal expectations that make high functioning autism challenging. In the past, personal communication was the key to personal success; Today, many people with social problems are more than capable of connecting with other people online, making friends through social media, and even working remotely.

Some companies, like Google, are hiring people with high-functioning autism because of their unique skills. while others cannot imagine hiring someone with impaired social skills.

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