High Functioning Autism

Autism is a strange disorder, primarily because there is no consensus on what qualifies someone as an "Autistic" person.

To be more specific, Autism is based on something called the Autism Spectrum Conditions, which is a sliding bar of social disorders. If you hit certain points on the spectrum, then you may have one of the following things:


 * 1) Autism (social inability, speech delay, highly unusual speech, or absence of speech; can include cognitive disability)
 * 2) Asperger's Syndrome (social inability, but no speech delay or cognitive disability)
 * 3) Pervasive Developmental Disorder - Not Otherwise Specified (a catch-all category for anything that doesn't fit into the top two; covers about 65% of the autism spectrum because the current diagnostic categories are only marginally useful)
 * 4) Rett Syndrome (an X-linked neurological disorder with autism as a primary symptom. Very rare)
 * 5) Childhood Dis-Integrative Disorder or Heller Syndrome (which involves loss of skills and speech rather than simply not gaining them to begin with; extremely rare)

For a while, this worked out really well and helped determine who was and who wasn't autistic. However, autism is such a broad spectrum that it covers everything from the eccentric engineer who spoke in full sentences by age four, to the fellow who can't use symbolic communication at all and needs an aide 24/7. Awareness campaigns emphasized the small minority of autistics with the most obvious, severe cases, and implied that autistics could not learn or have meaningful lives; often, in an effort to gather more donations, autism "charities" would make autism sound like a fate worse than death (one Autism Speaks spokesperson claimed to have considered killing herself and her child, but to have been prevented by the fact that she had another, normal child).

With autism having such an unrealistically frightening reputation, doctors became afraid that a child's mother would hit them with her purse (or, more realistically, either refuse to believe the diagnosis or else give up on the child) if they were told that the child was "autistic"; so they began using the term "high-functioning" to mean "this person does not fit my stereotype of a low-functioning autistic," i.e., shows ability to learn, has some language or shows signs of using symbolic communication, has a normal or higher IQ, etc.

"High-functioning" is a term that has no official medical definition; it is mostly determined by the perception of the person using the term. If someone says "high-functioning autistic," they may be implying something like, "I know you're autistic, but I don't want to 'lump' you with Those People who can't talk or use the toilet," a statement which of course has serious Unfortunate Implications.

When "high-functioning autistic" is used in a neutral sense, it may be used with the assumption that some criterion that the writer is using is the universal criterion for "high-functioning". For example, a writer may assume that "high-functioning" means being able to speak out loud, or that it means being able to live independently, or that it means not needing help with basic activities of daily living, or that it means someone who has an IQ above some arbitrary level (like mild mental retardation or higher, normal or higher, or bright or higher). There is only one actual assessment of "functioning", the GAF scale (global assessment of functioning), which is a 100-point scale on which most people will score from 70 to 90 and many autistics will score from 20 to 60; but most people who use the term "high-functioning" are not referring to GAF.

"High-functioning" can be used to claim that a person does not deserve assistance or should be capable of doing something which he may not in fact be able to do. It is also used by people trying to discredit autistic self-advocates, to state that "you are high-functioning; therefore you cannot know what it is like to be low-functioning; therefore you are not allowed to demand equal rights for all autistics." This is essentially a way of shutting up autistics: If you can talk, then you're too high-functioning to know what it's "really like"; if you can't, then others must speak for you; therefore, no autistic can ever speak for himself.

For now the term is "High Functioning Autistic", or HFA. When referenced in fiction, it is the justification for the Idiot Savant and the TV Genius as HFA's can be intelligent but also socially bizarre. Can lead to Intelligence Equals Isolation, especially if the HFA develops a preoccupation with science or the arts.

See also The Rainman.