Understanding High-Functioning Autism

As an autism expert, I was recently asked to define high-functioning autism. However, that term is more nuanced than you may expect. So today, I will offer some insight into neurodiversity and the terms associated with autism. 

High-functioning Autism vs. Low-functioning Autism

Society and the medical community’s understanding of autism have evolved over the last 50 years. So have the terms related to autism. The term high-functioning autism is commonly used to describe individuals with autism who do not have an intellectual disability (meaning their IQ is in the average or higher range). Whereas low-functioning autism refers to individuals who have both autism and an intellectual disability. 

The Challenges with this Terminology

The terms high functioning autism and low functioning autism are misleading. You would think they refer to functional daily living skills. But that’s not true. They refer to intellectual ability.

What is confusing is that individuals with “high functioning autism”, who have an average IQ or are even gifted, can still have significant challenges when it comes to daily living skills and social skills. For example, they may struggle with things like caring for their hygiene, cleaning, planning, organizing, driving, starting conversations, making friends etc. This is where the term high vs. low functioning breaks down. Just because an individual is high-functioning, it does not mean there are not skills they struggle with.

Due to the misleading nature of these terms, some may expect individuals with “high functioning autism” to be successful on certain tasks where they actually need support. This is why so many people with autism get called “lazy”. Others just did not understand their needs and did not provide them with the support they needed to be successful. 

As an autism expert, I am aware of and sensitive to the intense emotions and controversy these terms carry. These terms can bring up feelings of shame and have negative connotations. As our understanding of autism is evolving so are our terms for describing autism.

Defining Neurodiversity:

Neurodiversity is a biological term that is frequently used to describe individuals with autism. Neurodiversity refers to the neurological differences that are a natural part of human variation. It does not solely describe autism. Actually, neurodiversity can be broadly applied to those whose brains are wired to function in ways that may differ from the majority of people. For example, it can also describe those with ADHD, dyslexia, and autism.

What does neurotypical mean?

Another term that is important to understand is neurotypical because it is often used in contrast to neurodiversity. Neurotypical refers to a person whose brain functioning falls within the average range of functioning. 

Why the use of the word neurodiversity is important. 

Neurodiversity is an empowering term used to describe individuals with autism and other neurological differences. It’s empowering because it acknowledges that differences in brain functioning are normal. And, it removes the stigma that these differences are deficits. 

At a socio-cultural and political level, the term neurodiversity honors and embraces neurological differences. It is used as a social identifier category to be respected and protected, such as gender, race, and age. 

Judy Singer and the Neurodiversity Movement:

Judy Singer is an autistic woman and advocate. She coined the term neurodiversity and was a pioneer in the neurodiversity movement. In her honors thesis presented in 1998, Judy identified that people with brain differences are oppressed like other minority populations including underrepresented ethnic groups, women, and LGBTQ+ individuals. 

Singer promoted the idea that autism spectrum and other neurological differences were not deficits. They are actually aspects of diversity. These differences are actually the backbone of human strength and survival. Furthermore, it encourages society to embrace neurological differences and not look to cure or fix them. After being introduced to the term neurodiversity, autism advocates have used it to combat stigma and promote inclusion and support.  

The Positive Impact of the Neurodiversity Movement:

Most of the neurodiverse clients I have worked with have felt shame about being “different”. You can feel both the shame and blame Judy Singer must have encountered as a child just by reading the title of her chapter, “Why Can’t You Be Normal for Once in Your Life?” published in the book Disability Discourse in 1999. 

Shame usually stems from others not understanding an autistic person’s neurological differences. Unfortunately, it’s all too common for a young autistic person to be criticized, dismissed, or invalidated by family, teachers, and others. They are often told that they shouldn’t feel that way. Or they are told that they are weird or abnormal. Often, they experience gaslighting and are shamed for feeling certain emotions or thoughts that are very real to them.

But, the neurodiversity movement is an important step in embracing differences. It reduces the stigma that someone with autism has “something wrong with them.” Feeling supported helps reduce autistic individuals’ feelings of depression and anxiety and promotes resiliency. 

Looking into the future…

Over two decades after the term neurodiversity was introduced into our world, the neurodiversity movement is still at an early stage. But, I am excited to see that the neurodiversity movement has gained traction in educational settings and in the workplace. The neurodiversity movement is about raising awareness and embracing and supporting neurodiversity. It is time for neurological differences to be respected and for the shame and stigma around them to end. In a time when the Me Too movement spread like wildfire, and support of the black lives matter movement surged with the force of a tsunami, the nation and world are ready for the neurodiversity movement as well. 

Signs and Symptoms of Autism:

As autism is becoming better understood by society, it is important to discuss why the symptoms are so misunderstood and why many individuals spend a large portion of their life going undiagnosed. 

We’ve discussed in previous blogs how common it is for adults with high-functioning autism to be misdiagnosed and misunderstood. This happens because sometimes the symptoms of autism can be so subtle that it’s missed by physicians and education professionals. Especially, if an individual has an average or high IQ. Also, they may wind up being, misdiagnosed. Their outbursts could be attributed to a variety of concerns and their social challenges could be attributed to a variety of causes. Unfortunately, neurotypical individuals often write off these behaviors as being eccentric, weird, or intentionally rude. 

Part of autism advocacy and acceptance is understanding and recognizing the signs of the autism spectrum. Some of these signs and symptoms are subtle and take advanced training to pick up on. If you or your loved one exhibit these traits, talk to your physician and ask for diagnostic testing. 

Autism Spectrum Disorder Diagnostic Criteria (based on DSM-V)

To meet the diagnostic criteria for autism a person must have persistent deficits (they must lack skills) in two areas: 

1. Persistent deficits in social communication and social interaction

• Deficits in social-emotional reciprocity. This includes things like having back and forth conversations, challenges initiating or maintaining conversation, lack of interest in what others are saying, lack of empathy, etc. 
• Poor non-verbal communication skills. This includes challenges establishing eye-contact, inability to understand facial expressions, and body language, little to no facial expressions, or inappropriate facial expression usage.
• Challenges surrounding creating and maintaining relationships which include challenges adapting to changes, poor social or imaginative play, lack of interest in peers. 

2. Restricted, repetitive patterns of behavior, interests, or activities (including hyper or hyposensitivity)

• Repetitive motor movements, use of objects, or speech. This includes things like lining up toys in specific orders, hand flapping, or other stemming behaviors, repeating the same word or phrase multiple times. 
• Extreme instance on sameness. This includes becoming upset when routines are not followed, when things are different, rigid thinking, and repetitive behaviors. 
• Intense fixation on an interest. We often call these “special interests.” This is an extreme fixation on objects, topics, or activities. 
• Hyper- or hyporeactivity to sensory input. This includes things like extreme like or dislike of certain textures, temperatures, sounds, smells, colors, lighting, etc. 

Real-World Examples of The Symptoms of Autism 

I wanted to share with you some common examples of the way individuals with autism describe these symptoms so you can better understand, in a less clinical way, how they impact a neurodiverse person’s life. 

Social deficits

• Difficulty with small talk
• Feeling like you’re missing social cues that others easily pick up on
• Finding it difficult/unnatural to predict human behavior
• Difficulty making friends
• Feeling like you fake it to fit in (what we call camouflaging or masking), which can lead you to feel like an imposter
• Social interactions deplete you of energy or drain your social battery
• You feel like an alien. Like you are intrinsically different from others.
• While growing up, you were not interested in pop culture or things peers cared about
• Inappropriate use of slang or popular verbiage
• Speech sounds unnatural (monotone, robotic, use of grammar or words that are not commonly used by others)
• Smiling or nodding, even though you don’t understand what others said, just to fit in
• Being overly trusting or easily taken advantage of
• Taking people’s words literally
• Not noticing sarcasm, backhanded compliments, or slights
• Not understanding why you’re being teased.
• Others say it’s hard to read your facial expressions or you often misread their expressions
• You find it difficult when people are not direct or concrete
• Eye contact can feel painful or uncomfortable
• You are uncertain about what is socially expected, especially in newer situations

2. Restricted, repetitive patterns of behavior, interests, or activities (including hyper or hyposensitivity)

• Special interests (others might describe it as an obsession) you have a passion at a level that seems much greater than most people’s hobbies. It’s what you think about and want to talk about at length. You learn about the topic at an incredibly detailed level and have expert knowledge of the topic. I’ve heard some describe it like you would describe falling in love. It fills you with joy, consumes your mind and heart. You want to talk about it whether or not other people care to hear the details).
• When you feel especially uncomfortable, anxious, or agitated, you stim. This means you make repetitive or unusual movements or sounds that calm your internal system (pacing, rocking your body, jumping up and down, rubbing or tapping your fingers together, flapping your hands, stroking your arms or thighs, pencil tapping/finger tapping). You might use objects, pets, or fidgets to stim. For instance, you might repeatedly rub an object in your hand because the feel of the texture is soothing.
• Finding routine and predictability comforting. Likewise, when things are unpredictable or difficult, you may feel anxious or even have an autistic meltdown (can’t think straight, might yell, kick, fall to the floor and flail, headbang). Even changes that appear small to others could trigger intense distress in you and life can feel chaotic.
• Sensitivity to certain tastes, smells, textures, sounds, light, etc. You can be hypersensitive. This means you find a sensory experience uncomfortable or even intolerable. Hyposensitive means the opposite. You need a large amount of something to even notice it. So, you might like REALLY spicy food, or lots of pressure (like from a heavy weighted blanket, or you like your pet to lie on top of you).
• You like things in a certain order, and notice and get upset when things are out of order
• You like hearing some tune, phrase, movie, etc over and over again 
• Echolalia – you precisely repeat again and again (echo) something you hear

In Conclusion…

The movement to better understand autism spectrum disorders (ASD) and neurodiversity is important because it is changing the way society and the autism community views ASD. It gives society a better understanding that individuals with autism are as different as everyone else. Like the rest of society, they have varying degrees of IQ. And, their ability to function academically and in other areas of their life varies as well. Likewise, it brings awareness that autism is not something that needs to be “cured or fixed.” An individual’s neurodiversity simply indicates a difference in the way their brain works.

Autism understanding provides relief for individuals on the autism spectrum

Furthermore, a better understanding of neurodiversity helps individuals who are on the autism spectrum understand how their brain’s differences do not make them “weird or abnormal.” Therefore, it removes the stigma that there’s something wrong with them. This improves their self-esteem and overall confidence to face their challenges with a sense of resiliency and strength. 

Lastly, understanding the signs and symptoms of autism provides individuals who are struggling to understand their behaviors and challenges. It gives them a light at the end of the tunnel. Many clients who are diagnosed later in life share with me the profound sense of relief they felt when they were finally diagnosed with ASD. These individuals have struggled throughout their life to get answers as to why they are struggling, only to be met with diagnoses and treatment plans that don’t seem to fit.

Now, the medical, psychological, and educational communities are starting to better understand the symptoms of autism. More providers are acknowledging that autism is not always accompanied by intellectual difficulties. Therefore, these professionals are better able to understand why individuals with normal or high IQs are struggling in the two areas we discussed above. 

Autism Therapy and Support in California at Open Doors Therapy

Regardless of where you are on your autism journey, recently diagnosed, or diagnosed long ago, we would be honored to offer you support via autism therapy in California. We are a team of autism experts and we are passionate about helping individuals with high-functioning autism find happiness and success. This means learning coping tools to better handle distress and anxiety, learning to self-advocate, growing in self-confidence, and working on developing effective social skills. Learn more about our wide variety of social skills groups and therapy options here. 

Begin Autism Therapy in California:

If you are ready to begin counseling or group therapy, we would love to hear from you. We are currently offering our autism therapy services online until it is safe to resume in-person counseling. To begin autism therapy services in California, follow these steps:

1. Contact us for a free phone consultation using this link. You will meet with our care coordinator.
2. Like us on Facebook. On our page, we post useful information about our practice
3. Sign up to receive our newsletter.

Autism Therapy Services offered at Open Doors Therapy:

Our autism therapy clinic located in the South Bay Area serves teens and adults on the autism spectrum. We help high functioning individuals who identify as having Aspergers, high functioning autism, undiagnosed autism traits, and their families.

Right now, we are providing all our autism counseling services online. Our autism therapists offer a variety of counseling services including individual counseling for autistic teens and adults, parent counseling, and group therapy.  Also, we run several different social skills groups for neurodiverse working professionals, college students with autistic traits, gifted youth & caregivers, neurodiverse adults, women who identify as neurodiverse, a summer social skills college transition training program for youth transitioning to college, teens & caregivers, and a mothers group. Contact our autism therapy office for more information on our services or to schedule a consultation.

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