Autism Spectrum Disorder is characterized by different behaviors and severity, which makes autism a spectrum disorder associated with different levels of independence and assistance. Within the spectrum, there are two often discussed categories: High Functioning Autism and Low Functioning Autism. While these terms are not present in the DSM-5, they are often used to refer distinctions in the degree of assistance and difficulty experienced by an individual with Autism. In this article we will discuss about the What are High Functioning Autism and Low Functioning Autism? How are they different from each other and what are their features that set them apart from each other?
What is High Functioning Autism?
High Functioning Autism (HFA) means Autism at a stage where the symptoms are less severe and the individuals struggling with the condition can handle some activities on their own. These persons may have normal or above-average intelligence but they have certain problems in interpersonal relationships, in the use of words and nonverbal signs, and they may show some kind of dysfunctioning in their behavior like being too rigid or too stereotyped.
Common Characteristics and Behaviors
- Deficits in Social-Emotional Reciprocity: Normal social activity impairment which includes being able to start a conversation, being able to communicate, having something in common with other people or feeling connected with other people.
- Nonverbal Communication Challenges: They are challenged in the social use of other forms of communication, including eye contact, gestures, body language, and facial expressions.
- Difficulty Maintaining Relationships: This make it difficult for them to develop and maintain friendships because they may not know how to go about it or fail to understand social etiquette.
- Restrictive and Repetitive Behaviors: Performing the same motor movements and verbal imitations, having rigid timetables, and showing concern with particular subjects.
- Sensory Sensitivities: Hyper- or hypo-sensitization to sound, light, touch, or smell: and this causes discomfort or distress.
- Strong Attention to Detail: An emphasis on narrowly defined tasks more than the overall set of activities which may be useful at times and disadvantageous at other times.
What is Low Functioning Autism?
The term Low Functioning Autism (LFA) is used to clearly label those on the autism spectrum who need a lot of help with daily activities. They may also have language and learning disability affecting their communication and ability to interact with individuals in the society. The term is not a specific diagnosis but is commonly used to differentiate between diverse types of support requirements of the patient belonging to ASD.
Common Characteristics and Behaviors
- Severe Deficits in Social-Emotional Reciprocity: Limited or absent social interactions – lack of eye contact, no smiling, or social conversations in a back-and-forth manner.
- Pronounced Nonverbal Communication Difficulties: Minimal pointing, waving, and other actions that do not involve vocalization and reduced ability to comprehend such actions in the environment.
- Extensive Support Needs: Being unable to perform most of the daily tasks for a variety of reasons which include but not limited to poor functional skills, thereby being fully dependent on caregivers.
- Restricted and Repetitive Behaviors: Performing activities that involve body or object manipulation with excessive force or frequently reacting with rigid insistence on routines.
- Sensory Sensitivities: A person’s heightened or diminished ability to respond to certain stimuli in his or her environment like sound, light touch, taste, and smell, which causes distress or disruptive behaviors.
- Limited Communication Skills: Often says very little or nothing at all and may communicate in other ways, by pointing or through object manipulation, gesture or picture exchange communication system.
Diagnosis of High-Functioning Autism
vs. Low-Functioning Autism
High-Functioning Autism (HFA) and Low-Functioning Autism (LFA) are now collectively grouped under a single category of ASD in the DSM-5 (Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition). Diagnostic criteria for both HFA and LFA are exactly the same, with the differentiation based on the degree of severity and presentations of symptoms.
Key Diagnostic Criteria include:
1️⃣ Persistent Deficits in Social Communication and Social Interaction:
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- Social-Emotional Reciprocity: Problems with social interaction and impaired ability to approach and communicate with other people and understand social signals.
- Nonverbal Communication Behaviors: Difficulties in making eye contact, maintaining appropriate facial expressions, using gestures, and general movements, and other parts of nonverbal communication.
- Developing and Maintaining Relationships: Difficulties in forming peer relationships, ability to change the mode of their behavior depending on the context, and playing make-believe.
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2️⃣ Restricted, Repetitive Patterns of Behavior, Interests, or Activities:
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- Repetitive Movements or Speech: Restricted and repetitive behaviors including hand flapping, arranging toys in a line, language synthesizing, or use of specific words or phrases.
- Insistence on Sameness: For example, it may mean sticking to the schedules, rituals, and other patterns, and experiencing significant anxiety even at minor alterations of a routine.
- Highly Restricted Interests: Preoccupation with one or more aspects of life to an excessive degree.
- Sensory Sensitivities: A possibility to be oversensitive or undersensitive to sounds, touches, lights, or other types of stimuli.
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3️⃣ Early Developmental Period:
Symptoms must be present in the first stage of development although they may not be apparent when the child is young or may be masked by coping strategies in later years when the demands of social life increase.
4️⃣ Significant Impairment:
Symptoms have to interfere with important areas of functioning in social, occupational, or other important spheres.
5️⃣ Exclusion of Other Conditions:
The symptoms should not be better accounted for by another primary diagnosis of intellectual disability or global developmental delay. Although both conditions commonly occur in combination, they point out that social communication impairment must be significantly more impaired than in cases of isolated developmental delays.
Differences in Diagnosis Process: High-Functioning Autism vs.
Low-Functioning Autism
To compare High Functioning Autism and Low Functioning Autism, the following outline has been created:
High-Functioning Autism (HFA)
Patients with HFA are usually characterized by less severe forms of the above mentioned symptoms and have average or even above average intelligence. The diagnostic process often includes:
- Behavioral Assessments: Assessments of social communication skills forward, range of behaviors, and adaptive skills.
- Standardized Tests: For autism-specific behaviors, there are assessment tools being used such as the Autism Diagnostic Observation Schedule (ADOS) and Autism Diagnostic Interview-Revised (ADI-R).
- Parent and Teacher Reports: Obtaining information on specific behaviors of a child as reported by peers, teachers, and parents in varying situations.
- Cognitive Testing: Diagnosing cognitive functioning to differentiate Autism from other disorders that might be affecting a patient.
Low-Functioning Autism (LFA)
In LFA cases, individuals are usually more affected and often present serious learning difficulties. The diagnostic process for LFA may involve:
- Comprehensive Developmental History: A detailed examination of a person’s past developmental patterns and traits.
- Behavioral Observations: Official evaluation of social responsiveness, communication and play or stereotyped behaviors, formal, and play-based activities.
- Speech and Language Evaluations: Comprehensive evaluation to determine the degree and possible nonverbal communication strategies.
- Adaptive Behavior Assessments: The assessment of the degree to which the subject is capable of carrying out specific activities of daily living safely and spontaneously.
- Multidisciplinary Team Approach: Information given by psychologists, speech-language pathologists, occupational therapists, and neurologists to ensure the child undergoes a complete assessment.
The essential criteria for both high-functioning and low-functioning autism are contained in the criteria for Autism Spectrum Disorder in DSM-5. The distinction is based on the severity of the side effects or the effect they have on daily life thus the intensity of care needed. Such an approach guarantees comprehensive assessment and enables the development of relevant and adequate treatment methods for each patient.
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Signs of High-Functioning Autism
vs. Low-Functioning Autism
Signs of High-Functioning Autism (HFA)
✅ Social Interaction
Difficulty with Social Cues: Problems in understanding basic and complex signals including gestures, skip, intonation and coming up with an adequate response.
Limited Eye Contact: Some may, but they find it hard to maintain eye contact or gazing directly at the eyes of the person they are conversing with.
Challenges in Developing Friendships: Difficulties in forming and maintaining the relationships with peers because the child fails to grasp nonverbal cues which are important in social interactions and academic knowledge about friendship.
✅ Communication Skills
Advanced Vocabulary: May have rather a large vocabulary but the communications might be rather cautious and tending to the pompous.
Literal Interpretation: Would not be able to understand puns, jokes or sayings so easily since they are more of the direct kind when it comes to issues to do with words.
Monologues: May have the habit of continued talk while the other speaker is speaking, normal conversation may not occur, or be interrupted.
✅ Behavioral Traits
Repetitive Behaviors: Concerned with a strict format of procedures, such as the arrangement or ordering of some things in a certain way, doing activities in a certain order, preference for some words over others.
Intense Focus on Interests: Has no other interests but focuses to a large extent on interests or concerns about specific matters or things.
Sensory Sensitivities: Listens to sounds that are unpleasant to most people, has difficulty with light, and is offended by certain kinds of textures.
✅ Cognitive Abilities
Strong Memory: Often performs well in tests of more memorized content such as factual information, histories, details, and crudes or boasts of specialization.
Difficulty with Abstract Concepts: May have relatively lower capacities for abstract and complete information processing and needs.
Executive Function Challenges: Experiences problems in planning the goal, designing the tasks and organizing time.
Signs of Low-Functioning Autism (HFA)
✅ Social Interaction
Minimal or No Social Engagement: The effected individuals do not have or limited experience in performing any of these social related activities such as making eye contact, smiling or even acknowledging the presence of other people.
Severe Difficulty Understanding Social Cues: Neuropsychological disturbances affecting faces and objects processing, including impairments in social interaction.
Preference for Isolation: It is also possible to be lonely, that is, the subject may not always desire or require the presence or the interaction with other people.
✅ Communication Skills
Limited Verbal Communication: Because of some of these conditions, the amount of speech may be minimal or absent and may need to use other forms of communication like picture charts, sign language or any other assistive equipment.
Nonverbal Communication Difficulties: Difficulty in making a number of gestures, facial expressions and other signifying communication.
Echolalia: Frequently rely on words or phrases that in fact are actually repeated and are unaware of the meaning or context of a specific word or a phrase.
✅ Behavioral Traits
Pronounced Repetitive Behaviors: The child exhibits more often self-stimulation which could be in the form of hand flapping, rocking or spinning.
Resistance to Change: They find even the smallest changes to daily arrangements and environment to be very uncomfortable.
Severe Sensory Sensitivities: Very high activity levels that lead to or accompany an autistic meltdown or shutdown in an attempt to escape sensory stimuli.
✅ Cognitive Abilities
Intellectual Disabilities: Possibly can have severe learning disabilities including those who are unmotivated or unable to learn and study information of the particular grade level.
Difficulty with Daily Tasks: Severely handicapped in the ability to carry out daily tasks and instrumental tasks that are required in the course of the day.
Limited Problem-Solving Skills: Loses in problem solving and in terms of applied reasoning particularly when he will be required to reason out cause and effect patterns.
The signs of high-functioning autism vs. low-functioning autism vary significantly in terms of social interaction, communication skills, behavioral traits, and cognitive abilities. While individuals with High Functioning Autism exhibit milder symptoms and can often achieve a higher level of independence, those with LFA face more severe challenges and require extensive support in their daily lives. Understanding these differences is crucial for providing appropriate interventions and support tailored to each individual’s needs.
Causes of High-Functioning Autism
vs. Low-Functioning Autism
High Functioning Autism (HFA) and Low Functioning Autism (LFA) do have certain genetic causes that play a role in the development of these two types of autism.
➡️ Familial Patterns: ASD often co-segregates in families, which points to the fact that it has a genetic basis. People with a family history of autism or other developmental disorders are at a higher risk of developing autism.
➡️ Gene Mutations: Some of the mutations and variations in genes have been attributed to ASD. Some of the genes assumed to be involved in brain development and functioning have been pointed and this explains the variation in the symptoms associated with the spectrum.
➡️ Genetic Syndromes: Some genetic disorders such as Fragile X syndrome and Rett syndrome are strongly linked to increased risks of developing autism, inclusive of HFA and LFA.
Environmental factors also contribute to the development of both, high-functioning as well as low-functioning autism.
➡️ Prenatal Factors: Pregnant women who are exposed to some environmental factors are likely to give birth to autistic children. These include:
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- Maternal infections and illnesses
- Ingestion of toxins or chemicals
- Old age of the parents at the time of conception
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➡️ Perinatal Factors: Low birth weight, premature delivery, or oxygen deprivation during birth are also potential risk factors for autism.
➡️ Postnatal Factors: Features that can contribute to the occurrence of autism include early childhood environmental toxins and the overall environment.
Abnormalities in the neural connectivity are noticeable in children with both high- and low- functioning autism.
➡️ Brain Development: Neurodevelopmental atypicalities in areas of the brain that are linked to language, interpersonal relationship abilities, and behavior are apparent in autistic persons.
➡️ Neurotransmitters: Chemical imbalances in the brain especially in neurotransmitters are thought to be a root cause of autism. For instance, variations in serotonin levels have been recorded in some of the people with autism.
➡️ Brain Connectivity: It has been noted that some areas of the brain are wired and connected differently in people with autism. This may impact their ability to perceive and interact with the world around them.
High-Functioning Autism (HFA)
- Milder Genetic Mutations: People with HFA may possess genetic changes that confer less severe neurological effects meaning that the overall cognitive skills and self reliance of such a person may not be as significantly compromised.
- Less Severe Brain Abnormalities: The brain abnormalities may be less severe in HFA than in LFA, and therefore the problematic aspects of life skills and intelligence may be less evident.
- Adaptive Coping Mechanisms: This may explain why individuals with HFA may develop better coping strategies for managing their symptoms, thus achieving a relatively higher level of functioning.
Low-Functioning Autism (HFA)
- More Significant Genetic Mutations: Those with LFA might have larger genetic differences that lead to more extensive cognitive impairments and more difficulties.
- Pronounced Brain Abnormalities: In LFA, the neurological abnormalities in various areas are usually more extensive and lead to significantly greater deficits in language, behavior, and adaptive functioning.
- Limited Coping Mechanisms: As symptoms are severe, people with LFA may be unable to learn coping skills and may need a lot of support.
It is considered that there are several factors related to the emergence of high-functioning autism vs. low-functioning autism: genetic, environmental, and neurological ones. It indicates that although both types have similar etiological factors, the intensity and patterns of these factors define the disparities in the manifestations and the quality of life of affected persons. It is crucial to comprehend these causes so that appropriate approaches and support mechanisms can be designed and delivered to the individual.
┃Suggested – How Can I Find Out What Caused My Child’s Autism?
Treatment of High-Functioning Autism
vs. Low-Functioning Autism
Treatment Approaches for High-Functioning Autism (HFA)
➡️ Behavioral Interventions
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- Applied Behavior Analysis (ABA): ABA is used broadly to enhance social, communication as well as learning behaviors through reinforcement positive. For the case of individuals with HFA, ABA can assist in enhancing social skills and minimizing such behaviors.
- Cognitive Behavioral Therapy (CBT): CBT is useful in the treatment of anxiety, depression and other present comorbidities. It assists a person to know how to deal with his way of thinking as well as his actions.
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➡️ Social Skills Training
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- Group Therapy: The social skills groups are used to help students with those disorders practice social skills and to make friends.
- Individual Therapy: Special attention can be paid to potentially difficult social scenarios during individual training sessions or courses.
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➡️ Educational Support
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- Individualized Education Programs (IEPs): Development of learning programs that are responsive to the learning needs and challenges of the learner.
- Specialized Instruction: Tutoring or extra time in academic or resource rooms to aid with learning difficulties.
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➡️ Communication Therapy
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- Speech-Language Therapy: Involves the improvement of the student’s receiver skills by attending to such factors as idiomatic understanding, jokes and sarcasm.
- Pragmatic Language Therapy: This may help enhance such real-life skills as might be used within interpersonal interactions.
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➡️ Therapeutic Support
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- Psychotherapy: Assists people with dual diagnosis such as anxiety, depression, and ADHD, among others.
- Family Therapy: Helps family members to learn about autism and how they can help the affected person.
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Treatment Approaches for Low-Functioning Autism (HFA)
➡️ Behavioral Interventions
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- Applied Behavior Analysis (ABA): Describes programs that require more frequent and individualized sessions designed to teach basic daily living skills, reduce maladaptive behaviors, and improve communication skills.
- Early Intensive Behavioral Intervention (EIBI): A type of ABA for children below the age of two years, which concentrates on early childhood milestones and actions.
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➡️ Communication Therapy
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- Augmentative and Alternative Communication (AAC): Talks to patients with impaired speech and language by employing devices, picture boards, or sign language.
- Speech-Language Therapy: Meets the most essential need for communication, allowing a person to convey some needs and receive basic instructions.
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➡️ Occupational Therapy (OT)
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- Daily Living Skills: Teaches people how to go about their day to day activities like feeding, dressing and even bathing.
- Sensory Integration Therapy: Tackles sensory disorders by aiding people to better manage sensory stimuli.
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➡️ Educational Support
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- Special Education Programs: Offers individualized educational environments that prioritize teaching and learning basic math, reading, writing, and daily living skills.
- One-on-One Instruction: Provides personal approach to learning to account for certain learning requirements and speed.
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➡️ Therapeutic Support
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- Behavioral Therapies: Emphasises on reducing problematic behavior and building healthy behavior.
- Respite Care: Serves to relieve the caregiver of his/her duties for a while while at the same time offering the individual in question the necessary care.
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The intervention strategies for high functioning autism differ vastly from those of low functioning autism and should thus be addressed as such. HFA treatments on the other hand are aimed at improving social skills, communication skills and learning to cope with other disorders, while LFA interventions involve teaching basic life skills, using Augmentative and Alternative Communication, and addressing severe behavioral concerns. It is important to understand these differences so that every person can be provided with the necessary assistance to live a happy and successful live.
Frequently Asked Questions & Answer
Is High-functioning Autism More Common Than Low-functioning Autism?
Yes, high-functioning autism is more commonly diagnosed than low-functioning autism. High-functioning autism refers to individuals on the autism spectrum with intact language and cognitive abilities, albeit with challenges, while low-functioning autism involves more significant intellectual and developmental disabilities.
What is a Low Functioning Autism IQ?
The term “Low Functioning Autism IQ” is not a clinical classification used in formal diagnostic criteria. However, individuals with autism may have a range of intellectual abilities, and IQ scores can vary widely among individuals with autism spectrum disorder.
What is the Mildest Form of Autism?
The mildest form of autism is typically referred to as Level 1 Autism Spectrum Disorder (ASD) in the DSM-5 diagnostic criteria. This level is characterized by mild symptoms that may require some support but generally allow individuals to function independently.
Do High Functioning Autism Have High IQ?
While individuals with high-functioning autism may exhibit strengths in certain cognitive areas, such as attention to detail or memory, it is not accurate to assume that all individuals with high-functioning autism have high IQ scores. IQ levels can vary among individuals with autism, regardless of their functioning level.
Conclusion
Autism is a spectrum disorder and therefore it is essential to comprehend the differences between high-functioning and low-functioning autism. Low functioning autism is characterized by severe difficulties in communication, behaviors, and coping with daily life, whereas high functioning autism is defined by relatively mild symptoms and the ability to be more independent. Interventions for high functioning autism usually target improvement of social skills alongside treatment of other related disorders. For low-functioning autism, behavioral interventions and augmentative and alternative communication systems play a central role. AutismCOE is another organization that can offer useful information and advice to cope with such difficulties. At AutismCOE, the services provided are ABA Therapy, Autism Early Intervention Program, Autism School Readiness Program, Speech Therapy as well as Occupational Therapy to children aged between 2 and 14 years. These comprehensive services mean that each child is offered treatment plans and follow-up care according to the child’s needs. Understanding these differences enables people to get the right help they need to live productive lives. This way, caregivers, educators as well as healthcare professionals can be in a position to address the needs of the various clients or learners in the best ways possible.
Please Note: The content of this blog is for informational purposes only and should not be considered a substitute for professional medical advice, diagnosis, or treatment. Consult a qualified health care professional for personalized guidance tailored to your specific situation.
Bhavika Bhasin (Author)
Bhavika Bhasin is the Research and Marketing officer at AutismCOE. She works with children and adults with ASD. Her clinical research includes evaluating various available autism screening and diagnosis methods and their efficacy. She is currently developing a novel screening exam that is indicated to be more accurate than the existing available exams. She is also writes articles papers for various publications.
