High functioning versus low functioning autism - it's more complex than you think
Donna Williams
November 23, 2007
High versus Low Functioning depends on the nature of the ‘autism fruit salad‘ underpinning the diagnosis with autism.
These ‘autism fruit salads’ can be standard or exotic, simple or complex, small or large quantities or pieces, separated contents or very mixed up.
High Functioning Autism
Asperger’s is usually when someone has Emotional-Social Agnosia and so cannot process facial expression, body language or intonation.
This restricts their involvement in the social-emotional realms of life so they compensate via intellectual interests, pursuits and abilities.
If they also have Simultagnosia they will struggle to hold a simultaneous sense of self and other and be rather mono-track, struggling to multi-task. If they also have some auditory agnosia, they’ll find that fans and external noises interfere with their ability to understand verbal information. If they have Dyspraxia or Dysgraphia, they’ll be clumsy, have motor planning problems and poor handwriting. Some will have face blindness, making it difficult to make or keep friendships. Being more stressed than those without information processing challenges, they will be more prone to sensory hypersensitivities than other people.
If they ALSO had oral dyspraxia, Selective Mutism or learned dependancy leading to late speech (ie not speaking by age 4) then they would speak later than those diagnosed with Asperger’s and some may be diagnosed as HFA even if a percentage of non-autistic children also won’t speak until age 3-4. Although if verbal language is clearly normal at the time of diagnosis and shows no signs of significant ongoing language processing disorder at the time of diagnosis, early history of late speech by age 3-4 would likely not change the diagnosis from Asperger’s to HFA. The more present signs of significant ongoing language processing disorder at time of diagnosis, the more likely the diagnosis will be Autism rather than Asperger’s Syndrome. Whether this is High Functioning Autism (HFA), Low Functioning Autism (LFA) or in the Moderate range midway between the two, will depend on the range and degree of functioning challenges at the time of diagnosis. Some people in the LFA group move into the moderate range and may have some skills in the HFA range. there have been reported cases of some in the HFA and even Asperger’s range who have later ended up functioning in the moderate or LFA range due to breakdown, substance abuse, acquired brain injury, neuroleptic abuse, brain infection, or severe CFS.
So what is so called Low Functioning Autism?
The levels of motor planning problems with Dyspraxia could be so disabling as to be on a par with mild-moderate Cerebral Palsy.
They may have all the same agnosias but additional Semantic Agnosia, Form Agnosia, Associative Agnosia, Face Blindness, all of which may make them significantly meaning blind and struggle to learn visually as well as alienated from faces and finding people interchangeable if not for smell, tone and movement and this will make these people LOOK more autistic, be more likely to remain uneducated because pictorial learning won’t be accessible for them and without the capacity to externalise thought through the use of gesture, typing, or representational objects, they may not even know of their own intelligence, let alone others knowing of it. If they have Apperceptive Agnosia, they will also struggle to draw which may lead others to imagine them as retarded even if they can produce beautiful abstract works.
If they also have not only auditory agnosia effecting the perceiving of non-word from word sounds, but also Auditory Verbal Agnosia and Visual Verbal Agnosia, they will also be meaning deaf to what they hear as well as meaning deaf to what they read - yet often still able to ’scan read’. This will commonly lead to either no speech or ‘dysfunctional speech’ (ie Semantic Pragmatic Disorder) and avoidance of reading, or fluent reading without comprehension. Both of which can lead others to presume mental retardation, emotional disturbance etc. It may also lead them to be presumed incapable of typing, even though expressive channels may actually still be relatively intact. If the person also has Alexia, they may be unable to perceive the written word as made up of letters and if this is combined with other significant visual and verbal agnosias they may struggle to demonstrate their intelligence through typing.
If the same person also had significant gut, immune, metabolic disorders which lead to ongoing brain toxicity, fatigue or being brain starved, this would reduce that person’s functioning level until these are addressed. The style with which meaning deaf-meaning blind people with autism learn will be more likely to be kinesthetic, musical or logical rather than visual-verbal, meaning they are less likely to be accomodated in mainstream educational settings. If they are also solitary and not social learners, the degree of their challenges will increase this and solitary learners are already poorly accomodated in most educational programs.
Similarly if the same person had significant untreated co-morbid mood, anxiety and compulsive disorders dramatically channeling their resources into exhausting self management at best, chaos at worst, this would greatly reduce functioning until treated.
If the same person also had severe Dystonia they would be very floppy in their body, easily fatigued and if combined with Tactile Agnosia, Finger Agnosia or Pain Agnosia, they may appear to have little sense of their body, little identification with it and a poor relationship between volition and action through the body. Combined with severe Dyspraxia and Simultagnosia, they may also be unable to experience body messages relating to toileting or switch perceptual channels when involved in another task in order to attend to toiletting. Where this is taken as reflection on their intellect this will usually lead people to presumption one is low functioning if not mentally retarded.
Chronic stress, emotional dysregulation and burden on information processing will put up the tempo of not just sensory hypersensitivities but also any natural personality trait. Those with extremely large, complex ‘autism fruit salads’ will be more likely to display a range of personality disorders as their natural personality traits display in the disorder proportions for each trait. As these then become labeled ‘the autism’ it can escalate the same issues if the person feels their personhood is being devalued.
Because those with more severe challenges struggle to manage on many more simpler levels, opportunities for the environment to take over, outshine, pursue relentlessly, fixate on the person as a case or pathology or build pathological levels of co-dependency, this can dramatically increase learned dependency in those with some personality traits, withdrawal in others. Self injury can escalate where this contributes to Dependant Personality Disorder where it is used to force the environment to take over, self injury due to extreme sense of helplessness where the environment constantly outshines the individual by taking over, or self injury where a solitary personality feels constantly pursued and finds self injury causes the environment to back off. All of these responses can be considered part of being ‘low functioning’.
Essentially, those in the low functioning group may be as intelligent as those in the high functioning group but are more likely to perform badly on the same IQ tests and may have great potential in fields far different to those people in the high functioning group may excel in but be socially more unlikely to get those opportunities or make the social contacts which would lead to those.
For more information please see The Jumbled Jigsaw by Donna Williams.
Donna Williams
autistic author and autism consultant
http://www.donnawilliams.net
These ‘autism fruit salads’ can be standard or exotic, simple or complex, small or large quantities or pieces, separated contents or very mixed up.
High Functioning Autism
Asperger’s is usually when someone has Emotional-Social Agnosia and so cannot process facial expression, body language or intonation.
This restricts their involvement in the social-emotional realms of life so they compensate via intellectual interests, pursuits and abilities.
If they also have Simultagnosia they will struggle to hold a simultaneous sense of self and other and be rather mono-track, struggling to multi-task. If they also have some auditory agnosia, they’ll find that fans and external noises interfere with their ability to understand verbal information. If they have Dyspraxia or Dysgraphia, they’ll be clumsy, have motor planning problems and poor handwriting. Some will have face blindness, making it difficult to make or keep friendships. Being more stressed than those without information processing challenges, they will be more prone to sensory hypersensitivities than other people.
If they ALSO had oral dyspraxia, Selective Mutism or learned dependancy leading to late speech (ie not speaking by age 4) then they would speak later than those diagnosed with Asperger’s and some may be diagnosed as HFA even if a percentage of non-autistic children also won’t speak until age 3-4. Although if verbal language is clearly normal at the time of diagnosis and shows no signs of significant ongoing language processing disorder at the time of diagnosis, early history of late speech by age 3-4 would likely not change the diagnosis from Asperger’s to HFA. The more present signs of significant ongoing language processing disorder at time of diagnosis, the more likely the diagnosis will be Autism rather than Asperger’s Syndrome. Whether this is High Functioning Autism (HFA), Low Functioning Autism (LFA) or in the Moderate range midway between the two, will depend on the range and degree of functioning challenges at the time of diagnosis. Some people in the LFA group move into the moderate range and may have some skills in the HFA range. there have been reported cases of some in the HFA and even Asperger’s range who have later ended up functioning in the moderate or LFA range due to breakdown, substance abuse, acquired brain injury, neuroleptic abuse, brain infection, or severe CFS.
So what is so called Low Functioning Autism?
The levels of motor planning problems with Dyspraxia could be so disabling as to be on a par with mild-moderate Cerebral Palsy.
They may have all the same agnosias but additional Semantic Agnosia, Form Agnosia, Associative Agnosia, Face Blindness, all of which may make them significantly meaning blind and struggle to learn visually as well as alienated from faces and finding people interchangeable if not for smell, tone and movement and this will make these people LOOK more autistic, be more likely to remain uneducated because pictorial learning won’t be accessible for them and without the capacity to externalise thought through the use of gesture, typing, or representational objects, they may not even know of their own intelligence, let alone others knowing of it. If they have Apperceptive Agnosia, they will also struggle to draw which may lead others to imagine them as retarded even if they can produce beautiful abstract works.
If they also have not only auditory agnosia effecting the perceiving of non-word from word sounds, but also Auditory Verbal Agnosia and Visual Verbal Agnosia, they will also be meaning deaf to what they hear as well as meaning deaf to what they read - yet often still able to ’scan read’. This will commonly lead to either no speech or ‘dysfunctional speech’ (ie Semantic Pragmatic Disorder) and avoidance of reading, or fluent reading without comprehension. Both of which can lead others to presume mental retardation, emotional disturbance etc. It may also lead them to be presumed incapable of typing, even though expressive channels may actually still be relatively intact. If the person also has Alexia, they may be unable to perceive the written word as made up of letters and if this is combined with other significant visual and verbal agnosias they may struggle to demonstrate their intelligence through typing.
If the same person also had significant gut, immune, metabolic disorders which lead to ongoing brain toxicity, fatigue or being brain starved, this would reduce that person’s functioning level until these are addressed. The style with which meaning deaf-meaning blind people with autism learn will be more likely to be kinesthetic, musical or logical rather than visual-verbal, meaning they are less likely to be accomodated in mainstream educational settings. If they are also solitary and not social learners, the degree of their challenges will increase this and solitary learners are already poorly accomodated in most educational programs.
Similarly if the same person had significant untreated co-morbid mood, anxiety and compulsive disorders dramatically channeling their resources into exhausting self management at best, chaos at worst, this would greatly reduce functioning until treated.
If the same person also had severe Dystonia they would be very floppy in their body, easily fatigued and if combined with Tactile Agnosia, Finger Agnosia or Pain Agnosia, they may appear to have little sense of their body, little identification with it and a poor relationship between volition and action through the body. Combined with severe Dyspraxia and Simultagnosia, they may also be unable to experience body messages relating to toileting or switch perceptual channels when involved in another task in order to attend to toiletting. Where this is taken as reflection on their intellect this will usually lead people to presumption one is low functioning if not mentally retarded.
Chronic stress, emotional dysregulation and burden on information processing will put up the tempo of not just sensory hypersensitivities but also any natural personality trait. Those with extremely large, complex ‘autism fruit salads’ will be more likely to display a range of personality disorders as their natural personality traits display in the disorder proportions for each trait. As these then become labeled ‘the autism’ it can escalate the same issues if the person feels their personhood is being devalued.
Because those with more severe challenges struggle to manage on many more simpler levels, opportunities for the environment to take over, outshine, pursue relentlessly, fixate on the person as a case or pathology or build pathological levels of co-dependency, this can dramatically increase learned dependency in those with some personality traits, withdrawal in others. Self injury can escalate where this contributes to Dependant Personality Disorder where it is used to force the environment to take over, self injury due to extreme sense of helplessness where the environment constantly outshines the individual by taking over, or self injury where a solitary personality feels constantly pursued and finds self injury causes the environment to back off. All of these responses can be considered part of being ‘low functioning’.
Essentially, those in the low functioning group may be as intelligent as those in the high functioning group but are more likely to perform badly on the same IQ tests and may have great potential in fields far different to those people in the high functioning group may excel in but be socially more unlikely to get those opportunities or make the social contacts which would lead to those.
For more information please see The Jumbled Jigsaw by Donna Williams.
Donna Williams
autistic author and autism consultant
http://www.donnawilliams.net
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