Autism Spectrum Disorder (ASD) is a developmental condition that affects communication, behavior, and social interaction. It is called a “spectrum” disorder because individuals with autism can experience a wide range of symptoms and varying levels of support needs. Within this spectrum, the term “high functioning autism” is often used to describe individuals who have autism but do not have intellectual disabilities and may have milder symptoms compared to others on the spectrum.
While the term is not a formal diagnosis in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), it is often used informally to describe individuals who are able to handle everyday tasks and communicate verbally but still experience challenges related to social interactions, repetitive behaviors, and sensory sensitivities. In this post, we’ll explore what high functioning autism is, how it is diagnosed, and what the implications are for individuals who receive this label.
Defining High Functioning Autism
High functioning autism is a term that has historically been used to describe individuals on the autism spectrum who exhibit fewer behavioral challenges and have relatively higher cognitive abilities. Often, individuals labeled as high functioning can manage daily living tasks such as attending school, working, and maintaining relationships, though they may still struggle with certain social skills, sensory sensitivities, or communication difficulties. They may also exhibit repetitive behaviors or have intense, focused interests, all of which are hallmarks of autism.
However, the use of the term “high functioning” can be misleading. Just because an individual has stronger verbal or cognitive skills does not necessarily mean they don’t face significant challenges. Many people labeled as high functioning still struggle with anxiety, depression, or difficulties in maintaining friendships and managing sensory overload. The term can also imply that the person doesn’t need support, which is not always the case. For these reasons, some in the autism community prefer to avoid the term “high functioning” and instead refer to individuals simply as being on the autism spectrum.
The Shift Away from Asperger’s Syndrome
Before the DSM-5 was published in 2013, many individuals who would now be considered high functioning were diagnosed with Asperger’s Syndrome. Asperger’s was characterized by difficulties with social interactions and nonverbal communication, as well as restricted interests and repetitive behaviors, but without the language or cognitive delays seen in other forms of autism.
The DSM-5 eliminated the separate diagnosis of Asperger’s Syndrome and instead included it under the broader category of Autism Spectrum Disorder (ASD). This change was made because researchers and clinicians found that there was little scientific evidence to support maintaining Asperger’s as a distinct diagnosis. Individuals who would have previously been diagnosed with Asperger’s are now typically considered to be on the autism spectrum without intellectual impairment, which may overlap with what people commonly refer to as high functioning autism.
Common Characteristics of High Functioning Autism
People with high functioning autism often have strengths and challenges that may be different from those with more severe forms of autism. Here are some common characteristics that individuals with high functioning autism may display:
1. Social Challenges
One of the hallmark traits of high functioning autism is difficulty with social interactions. People may struggle to interpret social cues such as body language, facial expressions, and tone of voice. They may also find it hard to make eye contact or engage in reciprocal conversation. Even though they may want to form relationships, these social challenges can make it difficult to develop and maintain friendships.
2. Repetitive Behaviors and Restricted Interests
Like all individuals on the autism spectrum, those with high functioning autism may engage in repetitive behaviors, such as hand-flapping, rocking, or repeating certain words or phrases. They may also have very focused, intense interests, sometimes referred to as “special interests.” For example, someone might be fascinated by trains, computers, or historical facts and spend hours learning and talking about their passion.
3. Sensory Sensitivities
Sensory processing difficulties are common in individuals with high functioning autism. They may be overly sensitive or under-sensitive to sensory input, such as loud noises, bright lights, strong smells, or certain textures. Sensory sensitivities can lead to discomfort or even anxiety in environments that are too stimulating or overwhelming.
4. Communication Difficulties
While individuals with high functioning autism are typically verbal, they may have difficulty with pragmatic language—meaning they struggle with the social aspects of communication. They may take things literally, have trouble understanding sarcasm or humor, and find it difficult to engage in back-and-forth conversations. Some individuals may also exhibit speech patterns that are overly formal or monotone.
5. Anxiety and Emotional Regulation
Many individuals with high functioning autism also experience anxiety, particularly in social situations or unfamiliar environments. They may have difficulty regulating their emotions, leading to outbursts, meltdowns, or withdrawal when they become overwhelmed. Managing these emotions can be a significant challenge for individuals and may require strategies such as cognitive behavioral therapy (CBT) or mindfulness techniques.
Diagnosing High Functioning Autism
The process of diagnosing high functioning autism can be complex, especially since individuals with milder symptoms may go undiagnosed until later in life. The diagnostic criteria for Autism Spectrum Disorder (ASD) in the DSM-5 include difficulties in two main areas:
-
- Social communication and social interaction: This includes challenges with verbal and nonverbal communication, difficulties in developing and maintaining relationships, and struggles with understanding social nuances.
-
- Restricted, repetitive patterns of behavior: This includes repetitive movements or speech, strict routines, intense interests, and sensory sensitivities.
For a diagnosis of ASD, symptoms must be present from early childhood, although they may not fully manifest until social demands increase, such as when a child starts school or begins forming peer relationships. Additionally, the symptoms must cause significant difficulties in daily functioning.
The Diagnostic Process
The diagnostic process for high functioning autism typically involves multiple steps, including:
-
- Developmental Screening: Pediatricians or healthcare providers may perform a developmental screening during early childhood to check for developmental delays. This screening often includes questions about social interaction, communication skills, and behavior.
-
- Comprehensive Diagnostic Evaluation: If concerns arise from the screening, a more comprehensive evaluation is conducted. This evaluation may involve a team of professionals, including psychologists, neurologists, and speech-language pathologists. The evaluation often includes parent interviews, observations of the child’s behavior, and various tests of cognitive, language, and motor skills.
-
- Autism-Specific Tools: Clinicians may use autism-specific diagnostic tools, such as the Autism Diagnostic Observation Schedule (ADOS) or the Autism Diagnostic Interview-Revised (ADI-R), to assess the presence of autism-related behaviors.
-
- Exclusion of Other Conditions: The diagnostic process also involves ruling out other developmental or psychiatric conditions that may present with similar symptoms, such as ADHD, social anxiety disorder, or language disorders.
It is important to note that the diagnosis of ASD is based on behavior and developmental history, and there are no medical tests, such as blood work or brain imaging, that can definitively diagnose autism.
Challenges with Late Diagnosis
Many individuals with high functioning autism are not diagnosed until later in childhood, adolescence, or even adulthood. In some cases, they may have developed coping strategies that mask their difficulties, leading others to overlook or misinterpret their symptoms. Unfortunately, late diagnosis can result in missed opportunities for early intervention, which is known to be particularly beneficial for individuals with autism.
Late diagnosis can also bring its own set of emotional challenges. Many adults who are diagnosed later in life express feelings of frustration or confusion about why they have struggled with social interactions or sensory sensitivities for so long without understanding the underlying cause. However, receiving a diagnosis can also provide clarity and relief, allowing individuals to access support services and accommodations that can improve their quality of life.
Support and Treatment for High Functioning Autism
While there is no cure for autism, individuals with high functioning autism can benefit from a variety of therapies and interventions. Applied Behavior Analysis (ABA) therapy, speech therapy, occupational therapy, and social skills training are all commonly used to help individuals on the spectrum develop essential skills and navigate daily challenges.
Applied Behavior Analysis (ABA)
ABA therapy is a widely used, evidence-based therapy for autism that focuses on improving specific behaviors and skills through positive reinforcement. For individuals with high functioning autism, ABA can target social skills, communication, and coping strategies for managing sensory sensitivities or emotional regulation.
Speech and Social Skills Therapy
Speech therapy can help individuals with high functioning autism improve pragmatic language and conversation skills, while social skills training focuses on teaching individuals how to interact appropriately with peers, recognize social cues, and build relationships.
Cognitive Behavioral Therapy (CBT)
For individuals who struggle with anxiety or emotional regulation, CBT can be highly effective. This therapeutic approach helps individuals identify and change unhelpful thought patterns and behaviors, which can reduce anxiety and improve emotional control.
Ready to Support Your Child’s Journey? Reach Out to Alight Behavioral Today!
If you suspect your child may be on the autism spectrum, or if they have already been diagnosed with high functioning autism, Alight Behavioral is here to help. Our dedicated team of highly trained BCBAs offers personalized ABA therapy plans tailored to meet your child’s specific needs. We work closely with families to create supportive, compassionate environments that promote growth, learning, and self-regulation. Ready to take the next step in your child’s journey? Contact Alight Behavioral today and discover how our services can empower your child to thrive!
