What is high functioning autism?

According to the Diagnostic and Statistical Manual of Mental Disorders v.5 (DSM V), autism is defined as a condition where an individual has; 

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1. Persistent deficits in social communication and social interaction across multiple contexts, as manifested by the following, currently or by history.
2. Restricted, repetitive patterns of behaviour, interests, or activities, as manifested by at least two of the following, currently or by history. 
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The symptoms of autism need to have been present in a child's early developmental period in order to receive a diagnosis of autism, however the symptoms may not become fully apparent or manifest until social demands exceed a child's capacities. Additionally, a child may learn to 'mask', a coping mechanism that allows them to fit in, which can keep certain behaviours or traits of their autism hidden. 

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In order to be diagnosed with autism, the symptoms listed above need to cause significant impairment in a child's day-to-day life. This may be social, educational, or occupational impairment, but it also needs to be a form of impairment that is not better explained by an intellectual disability, e.g. global developmental delay. 

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Autism is a spectrum condition and affects each individual differently. Our understanding of autism is constantly evolving, and where we once thought autism was a linear spectrum where one is simply either more or less autistic, we now understand that it is far more complex. 

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What are the causes of autism spectrum disorder?

The exact cause of autism is still unknown, but it is widely thought that autism is thought to have a combination of genetic and environmental factors. There are a few genetic conditions where autism appears to be frequently co-morbid, including Fragile X Syndrome and Prader-Willi Syndrome, but most of the time, there is no known cause. It also appears that there is a genetic link as families with one autistic child are more likely to have another autistic child - though this does not mean that autism is hereditary. 

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In 1998, Andrew Wakefield and some of his colleagues published a study in the medical journal, The Lancet, where they suggested that the Measles, Mumps and Rubella (MMR) vaccine was linked to autism. Despite a small sample size (n=12), unstructured design and speculative conclusions, the study received a lot of publicity and led to a large number of parents not vaccinating their children. Shortly after the publication, The Lancet published various other studies that refuted the link between the vaccine and autism. Eventually, 10 out of the original 12 co-authors admitted that, “no causal link was established between MMR vaccine and autism as the data were insufficient”. 

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The Lancet completely retracted the Wakefield et al. paper in February 2010, admitting that several elements in the paper were incorrect, contrary to the findings of the earlier investigation. Wakefield et al. were held guilty of ethical violations and scientific misrepresentation and also found guilty of deliberate fraud as they picked and chose the data that supported their case and falsified facts.

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It was also once thought that autism was caused by a poor home environment or cold, stand-offish parenting styles. Kanner (1943) proposed the "refrigerator mother" theory which stated that, although Kanner believed that autism was probably innate in the child, he also noted an apparent coldness on the part of his patients' mothers and assumed that this added to the problem. Again, this theory has also been debunked and it is widely accepted that parenting style is not related to autism. 

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What does it mean to be 'high-functioning' autistic?

In earlier literature, you may have come across the term 'high-functioning autistic'. This is an out-dated term and realistically should no longer be used as people from the autistic community feel that this language diminishes the daily struggles they have to navigate.

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It is the same for using terms like 'higher ability' and 'lower ability'; it is inflammatory language and can lead to assumptions being made about a child's current and future ability level. It is important to understand how people who are autistic want to be addressed or spoken about, but for the purposes of this article, we will discuss in depth what it means to be 'high-functioning' and how their support needs may differ. 

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High-functioning autism isn't a clinical diagnosis but it is often referred to individuals who have lower support needs. The characteristics of a person who is high-functioning autistic are very similar to those who have Asperger Syndrome.

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What are the symptoms of Asperger Syndrome?

The term 'Asperger Syndrome' derives from a 1944 study by Austrian paediatrician Hans Asperger. Those who fit the profile for Asperger's are now being diagnosed as having autism spectrum disorder, though it is up to the individual to choose how they identify; some may want to keep the label as having Asperger's, others may want to say that they are autistic or on the autism spectrum. Often people feel that Asperger syndrome is a fundamental aspect of their identity. 

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People with Asperger syndrome see, hear and feel the world differently to other people. Some have described the world as being an overwhelming and confusing environment, often feeling like they don't quite fit it or understand how things work. Again, we all experience the world differently but for people who have Asperger's, their perception and experience of the world around them significantly impacts their daily life. 

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Typically, one of the defining characteristics of Asperger's is significant language delay and the  development of early speech. Often, children do not learn to speak until above the age of 4. This isn't an inability to speak, many children just choose not to speak for one reason or another. Many parents or carers do seek the support of a language therapist to aid speech production. Other defining characteristics for Asperger's include; 

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• Difficulty with social interaction 
• Restricted or highly specific interests 
• Strong desire for sameness or routine
• Distinctive strengths

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Strengths of high-functioning autism can include

1. Often above average intellectual ability

2. High integrity and moral compass

3. Aptitude for recognising patterns

4. Having values that aren't shaped by finance, politics or society

5. Extreme attention to detail

6. Being happy spending time alone

7. Great work ethic

8. Not going along with the crowd if they see a future problem

9. Persistent and can usually be trusted to follow through on tasks that are started

10. Not being inclined to lie or harm others intentionally

11. Bringing a different perspective when problem solving

12. Being more likely to pursue higher or further education

13. Have a lot of passion when engaging in activities that interest them

14. Tendency to adhere to routines

Challenges of high-functioning autism can include

As a pervasive developmental disorder, Asperger syndrome is distinguished by a pattern of symptoms rather than a single symptom. It is characterised by qualitative impairment in social interaction, by stereotyped and restricted patterns of behaviour, activities, and interests, and by no clinically significant delay in cognitive development or general delay in language skills. Having Asperger syndrome can impact one's quality of life, as the areas of life that Asperger's affects are ones that we have to engage in nearly all day every day. 

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Social Interaction

Individuals with Asperger syndrome can experience difficulties in 'reading' other people. Whereas neurotypical people can find it somewhat effortless to recognise and understand other's emotions based on their communication, body language and expressions, people who have Asperger's struggle with this even when they are consciously paying attention to it. Therefore, they can sometimes appear insensitive in situations, and can appear to behave in ways thought to be socially inappropriate or not seek comfort from other people. 

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These difficulties with social interaction can mean that it is challenging for some students with high functioning autism to make friends. It is not that they don't want to make friends or form relationships, but they just don't know how to go about it. Many people who are high functioning autistic may appear to be more socially functional than they actually are and this is due to them mimicking or mirroring others around them, preparing conversations ahead of time or masking their autistic behaviours. This can be effective, but exhausting.

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Communication

All people who are autistic, whether they are high-functioning or not, can have difficulties with communication skills. They may have difficulty in understanding verbal and nonverbal communication (facial expressions, tone of voice, body language) and often have a very literal way of interpreting language. This means that 'reading between the lines' can also pose a challenge as high functioning autistic people will often believe that people mean exactly what they say. Additionally, this can mean that idioms such as 'pull your socks up' or 'let's get the ball rolling' can be problematic.

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High-functioning autistic children often have very good verbal skills are eloquent but they may still find it difficult to initiate conversations, understand social procedures within social conversations or they may talk at length about their special interests. Maintaining eye contact is also challenging, but this does not mean that the child is not paying attention or listening to the person talking.

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Highly Focused Interests

A core trait of autism is that individuals will often have very particular and highly focused interests. These interests are usually formed in early childhood and they could be on literally anything from the arts to mathematics, from trains to flags of the world. Researching and spending time indulging in this special interest is often extremely enjoyable for autistic children and many choose careers or work where they can engage in their interest daily, e.g., someone with a high interest in computing could become a software engineer. 

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Routine and Structure

The world can be a very unpredictable place and whereas the majority of us have the ability to navigate unexpected changes and surprises with ease, autistic children find this to be very anxiety-inducing. Many autistic children will develop a series of restrictive habits that they form into a structured routine that, once they feel is satisfactory, very rarely changes or deviates. 

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Some autistic people have expressed that their minds are sometimes going at what feels like a million miles an hour and are taking in so much information, and having a routine that rarely changes allows them to go through their day without having to think about it in too much detail. Others from the autism community have expressed that structure and routine calms their anxieties and brings them a sense of peace when they know what to expect in certain places or at certain times of the day.

How can teachers support high-functioning autistic children?

Teaching children who are high functioning autistic will require some adaptations, but the impact those adaptations will have are far-reaching. Here are some changes you can make to your classroom and teaching methodologies that will make it more inclusive; 

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• Introduce a visual timetable. A visual timetable shows what is happening over a certain period of time in a visual way. It might use real photographs, cartoon pictures or symbols. This will help children with autism feel relaxed in the classroom environment as they can check what is coming up on the schedule at any time. 

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• Be mindful of sensory distractions in your classroom. Processing sensory information can be a challenge and overwhelming which can sometimes cause disruption to learning. For example, the hum of fluorescent lighting is extremely distracting for some people on the autism spectrum. Consider classroom changes such as removing some of the “visual clutter” from the room if the student seems distracted or upset by the classroom environment. The overload and under-stimulation problems may occur in other senses, including tactile and olfactory stimuli. Avoid wearing strong perfumes and the touching of hands, etc. unless you know the student is not challenged by this.

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• Be specific with your language. When giving instructions, be specific with what you want the students to do. Until you know a student's understanding of language, avoid using things like; 
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- Idioms - 'jump the gun', 'save your breath', 'let's get the ball rolling'

- Sarcasm - saying 'Good job...' after a child spills something. It is important to note that a child may be able to use sarcasm but still have a difficult time detecting it in others.

- Double meanings 

- Nicknames 

- Do not overload with verbal information. Use shorter sentences and convey your point clearly and concisely. 

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• If a student is not looking at you, do not assume they are not listening. Eye contact or even looking at a speaker can be difficult for high functioning autistic people and sometimes they may appear to be in their own world. This does not mean that they are not listening! A majority of the time, they are taking in exactly what you're saying, they just may not be looking directly at you.

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• Use their interests to aid teaching. Whatever special interest a child may have, it will undoubtedly bring them immense joy and this can be a huge motivator as well. Teaching to interests can be used at any age, just adapt the difficulty of the question to be age appropriate. If a student really likes trains, for example, you can use this to teach new concepts. In a maths lesson, you could set a question such as, "If a steam locomotive is leaving Station A for Station B at a rate of 89 mph and the distance is 105km, how long will the journey last?". These interests can be used to teach life skills in addition to academic subjects. 

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• Prepare for changes ahead of time. Prepare the student for schedule changes, such as assemblies, substitute teachers, special events, etc. ahead of time. Sudden changes to a schedule can be quite alarming, so wherever possible, give a warning that there is going to be a change and also explain why it has happened and what the new plan is.

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• Help them recognise their talents. Many, not all, high functioning autistic children will have a particular skill set or talent and it may be linked to their special interest. For example, they may be extremely talented at maths, where they are able to take on work well above their age. To the individual, they may not recognise this as a talent as it comes so naturally to them and some may assume that everyone is able to do what they do, so it is important to praise and highlight that this is a unique skill. This may then inspire them to pursue vocations in this field and they could go on to make major contributions to that field. 

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• Differentiate work where appropriate. People with autism may find some school work, especially in subjects where they excel, quite boring if it is not challenging for them. If, for example, you have a particularly gifted student in the sciences, speak with them individually to assess their level of understanding and if it is higher than the rest of their class, provide them with work of a more challenging level. Similarly, you could link up this student with any other academic staff who may be able to pursue their particular subject of interest at a higher level, e.g. university professors.

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• If working in pairs or groups, use an arbitrary way of picking them. Whilst it is sometimes nice for students to be able to choose the partner they work with, children with autism will often be left out as they have struggled to make friends or close relationships with their peers. Instead, use numbers, pick at random or work in table groups.

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• Do not place too much emphasis on them being gifted. The quote below is from the film X+Y and is a great insight into the mental well-being of children who are autistic. Some children will be gifted in a certain area or subject, but this could evolve into their gift being their only sense of purpose or worth. If this child then gets a 'bad' grade in this subject or no longer has any interest in the subject, this can lead to real mental health difficulties as they may lose part of their identity or feel like they are now 'just weird' rather than 'weird but gifted'. Support them by assuring them of multiple qualities they possess outside of specialist subjects and also support them in understanding their mental well-being, emotions and thoughts and how these can be effectively expressed. 
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It's okay to be weird as long as you're gifted." 

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If you would like to know more about autism, or how to support students with special needs in general, check out this educational blog or get in touch with Liv directly here.

Further reading on High-Functioning Autism

Stevens, S. S.(1946). "On the Theory of Scales of Measurement".Science103(2684): 677–680.Bibcode:1946Sci...103..677S.doi:10.1126/science.103.2684.677.PMID17750512.S2CID4667599.

https://ui.adsabs.harvard.edu/abs/1946Sci...103..677S

J Autism Dev Disord Screening Adults for Asperger Syndrome using the AQ: a Preliminary Study of its Diagnostic Validity in Clinical Practice J Autism Dev Disord Bishop, et al.

https://www.ncbi.nlm.nih.gov/pubmed/16119474

Manouilenko I, Bejerot S (August 2015). "Sukhareva – Prior to Asperger and Kanner". Nordic Journal of Psychiatry(Report) (published 31 March 2015).69(6): 479–82.doi:10.3109/08039488.2015.1005022.PMID25826582.S2CID207473133.

https://api.semanticscholar.org/CorpusID:207473133

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