High-Functioning vs. Low-Functioning Autism: Some Common Assumptions

This post was adapted from a post I originally wrote in 2007 and which I’ve since crossposted to various old blogs of mine. I still like it though.

Autism is a spectrum disorder. There are many differences between individual autistics. Where it gets tricky, however, is when we categorize autistics into specific boxes that are mutually exclusive. This is what happens when we speak of “high-functioning” and “low-functioning” autism. Below, I’m going to write up a list of assumptions about the LFA/HFA divide, and share my comments.

  1. Low-functioning means having an IQ below 70. Well, this is one of several pretty official distinctions being made. The problem is that it’s often hard to determine IQ in people with autism: some people may seem high-functioning at first, but their IQ drops as they age cause of increased developmental demands – something that is extremely common in preemies (autistic or not). Others’ IQ jumps by sometimes as many as 50 points as they learn to use a communication modality that others understand. Here in the Netherlands, autistics whose IQ can be assessed as being in the intellectually disabled range, are considered autistic as well as intellectually disabled, so they essentially have two disabilities that may influence each other and each influence the person’s functioning.
  2. Low-functioning means non-verbal. This is the other kind of official definition. The only thing it omits to say, is that non-verbal does not necessarily mean unable to communicate. Speech, after all, may not be communication (I sometimes hate it when people assume that everything that comes out of my mouth is intended as it comes out), and communication does not need to mean speech.
  3. Autistics will always function at the same level regardless of circumstances. I hate this assumption, and have always hated it, whether you relate it to autism or not – I hated it years before I was labeled autistic or even suspected I was on the spectrum. In my own experience, this prejudice comes in the form of “You’re so intelligent, so …” statements. Some people who make these assumptions, can simply be directed to Stephanie Tolan’s article on asynchronous development, but even those who know about this, tend to have difficulty grasping the concept that I do not always function at the same level. I still have a lot of difficulty grasping this concept myself: that, when I’m overwhelmed, I don’t have skills that I have when I’m in a quiet state, most prominently communication abilities. So, when someone sees me here on the computer typing out a review on the HFA/LFA distinction, they may assume I’m very high-functioning, but you wouldn’t guess so when you’d see me when I’m overwhelmed.
  4. Low-functioning means severely autistic. Well, number of symptoms and functioning level in either of the two relatively official respects, are quite different. In fact, some people with a severe intellectual disability lack the cognitive ability to exhibit some autistic symptoms, such as routines. So are they “low-functioning” because of their IQ, or are they “high-functioning” because they are not severely autistic?
  5. High-functioning individuals do not exhibit certain behaviors, such as self-injury or aggression. So, when someone does exhibit these behaviors, they must be low-functioning? I’m not proud of this, but this belief makes me pretty low-functioning. Often, however, it’s used the other way around, in that people who meet someone’s stereotype of “high-functioning” (eg. the ability to disagree with Autism Speaks in a way that they can read/listen to), is discredited for certainly not having serious problems. This assumption is not only wrong, it is dangerous to autistic people’s wellbeing and health.
  6. High-functioning autistics live independently, while low-functioning autistics don’t. Many factors contribute to an autistic’s ability to live independently. Of course, an intellectual or communicative disability may make it harder, but so does severe executive dysfunction or the risk of certain behavior problems or mental health issues. The concept of independent living is also oftentimes wrongly perceived as black-or-white: some people live independently, but do get home support, or they live in settings with 24-hour assistance but still have their own apartment, or they live with their parents till age 30.
Please note that, again, I am not saying that autistic individuals do not differ from person to person. I am not even saying that there are not various cotinuums of funcitoning. There are, however, so many that it is entirely arbitrary to draw a line between the HFA category and the LFA category. I hope I’ve made this clear in this post.

2 thoughts on “High-Functioning vs. Low-Functioning Autism: Some Common Assumptions

  1. Very well put!(I didn't know that in the Netherlands, people can get diagnosed with both autism and intellectual disability. In fact, one of my diagnostic therapists made an offhand remark about low-functioning autistic people always having a low IQ. I was really proud of myself for immediately saying that I didn't agree with that).

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