High-Functioning Autism: Symptoms, Diagnosis And Support
Autism is a common neurodevelopmental disorder, and as it’s considered a spectrum disorder, each autistic person has their own unique characteristics, experiencing a wide variety of symptoms and severity levels. In some cases, someone may be referred to as having high-functioning autism.
High-functioning autism is not an official medical term, but some people may find it helpful when determining how much support someone on the autism spectrum may require. There are ways that high-functioning autism is both different and similar to autism. Understanding these nuances may help provide someone with high-functioning autism get the support they need to thrive.
What Is High-Functioning Autism?
Autism spectrum disorders—often just referred to as autism—are a group of neurodevelopmental disorders that can be characterized by repetitive patterns of behavior, restricted interests or activities and challenges and differences in communication and interactions with other people.
High-functioning autism is not a formal medical diagnosis, but has historically referred to people on the autism spectrum who do not have intellectual or language disabilities, according to Geraldine Dawson, Ph.D., a psychiatry and behavioral sciences professor at Duke University School of Medicine and the director of the Duke Center for Autism and Brain Development.
Instead, Dr. Dawson says that high-functioning autism may present itself as having challenges navigating social interactions (such as having trouble understanding social cues and forming social relationships) and having restrictive and repetitive behaviors. Dr. Dawson specifies that everyone on the autism spectrum presents with these symptoms; what sets people with high-functioning autism apart is that they are able to speak using verbal language and are largely independent, whereas others on the spectrum may not be.
Autism is a spectrum, Dr. Dawson emphasizes, and people who are diagnosed with it vary greatly in terms of their interests, strengths and challenges. For instance, some autistic people need full-time care and are not able to communicate verbally, she notes.
“On the other end of the continuum, many people on the spectrum live independently, marry and are highly intelligent,” she says. These individuals have what is informally referred to as high-functioning autism, although it bears repeating that high-functioning autism is not an actual diagnosis.
When it comes to an autism diagnosis, there are three levels of autism severity based on how much support an individual needs, explains Peter Jinwu Chung, M.D., an associate professor of pediatrics at the University of California, Irvine and the medical director of The Center for Autism and Neurodevelopmental Disorders.
The first level is what is referred to as high-functioning autism, which typically means a person’s symptoms are the least severe. For example, someone with high-functioning autism may struggle with maintaining eye contact during conversations and be obsessed about a specific interest. This is in contrast to someone with level 3 autism spectrum disorder, who may not be able to communicate verbally and has severe sensory sensitivities that interfere with daily life.
The second level falls in the middle; an individual has more challenges with social interactions that go beyond trouble maintaining eye contact, but can hold a conversation more than someone with level 3 autism who has deficits in verbal and nonverbal communication (they may only want to talk about their specific interests, for example). Someone with level 2 autism may also engage in more repetitive behaviors than someone with level 1 autism. In all three levels, symptoms must be present since childhood, however they may not be recognized as signs of autism until adulthood.
Even with autism spectrum disorder broken up into three levels, Dr. Chung and Dr. Dawson say that every individual is different. For this reason, Dr. Dawson says that the term high-functional autism has fallen out of favor. “Now we recognize that people on the autism spectrum have a variety of support needs and each person is unique,” she says.
High-Functioning Autism vs. Autism
Both autism and high-functioning autism are linked to challenges navigating the social world, notes Dr. Dawson. This is something that autistic people live with no matter where they fall on the spectrum—although how severe the struggle is varies.
“Also, all individuals on the autism spectrum have what has been called ‘restrictive and repetitive behaviors,’” Dr. Dawson says. “The person might be strongly focused on a single interest, enjoy engaging in repetitive behaviors and be upset by unexpected changes in routine.”
Individuals with high-functioning autism can experience sensory differences (such as being over- or under-sensitive to light, sound or touch), but are typically less troublesome than they are for people with more severe forms of autism.
High-Functioning Autism Symptoms
Since high-functioning autism is not a diagnosable medical condition, there is no set of symptoms listed to identify it in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), which is used to classify mental health disorders, explains Dr. Chung. Instead, it makes more sense to consider the severity of the symptoms that are expressed.
“Everyone [on the autism spectrum] has the same kinds of symptoms that fall within the three diagnostic categories [for autism spectrum disorder],” Dr. Chung says. The three diagnostic categories are outlined below, and people with high-functioning autism experience these symptoms to a lesser effect than other autistic individuals:
- Difficulty with social interactions. Autistic people struggle interpreting and expressing social cues. For example, someone with high-functioning autism may struggle with maintaining eye contact or adjusting behavior for different social settings.
- Repetitive patterns of behavior or obsessive interests. Someone with high-functioning autism may be highly educated about a certain subject or have a very fixed routine.
- Symptoms must be present during childhood. Despite this diagnostic criteria, Dr. Chung says that many people with high-functioning autism may not be diagnosed with autism spectrum disorder until they’re adults (if at all) because their symptoms are not as pronounced as what many associate with autism.
How Is High-Functioning Autism Diagnosed?
There is no biomedical test for autism, says Dr. Chung, explaining that trained clinicians diagnose someone with autism by looking at their developmental history and behavior.
According to the Centers for Disease Control and Prevention (CDC), children as young as 2 can be diagnosed, although often a diagnosis does not come until later in childhood, or even adulthood. Often, pediatricians are the first to notice if a child may have autism through well-child visits. They may notice, for example, if a child is not hitting certain milestones or exhibit repetitive behaviors or sensory sensitivities. If a pediatrician believes a child may have autism, they will likely refer them to an autism specialist who can administer a formal evaluation.
When it comes to diagnosing children, Dr. Chung says that a trained clinician considers the child’s symptoms (often explained by the child’s caregivers or teachers) to determine if they are typical of autism spectrum disorder. They should also give the child a comprehensive assessment, which includes testing and behavioral observations. Using the DSM-5 as a guide, a clinician determines if someone matches the criteria for autism spectrum disorder, says Dr. Chung; if they don’t meet the criteria, an official diagnosis cannot be given.
For adults who think they have high-functioning autism, Dr. Chung recommends meeting with an autism specialist for an assessment instead of attempting to self-diagnose. During the assessment, the specialist may observe how the adult is interacting with them, ask about any repetitive behavior patterns or highly-focused interests, any sensory sensitivities and how long any of these symptoms have been occuring.
Support for High-Functioning Autism
Regardless of where an autistic person falls on the spectrum, they can benefit from support and services. For people with high-functioning autism, Dr. Dawson says that this can include going to therapy to learn how to understand and interact with other people, help with sensory sensitivities and address mental health conditions, such as anxiety and depression.
“Accommodations at school and work can help an autistic person succeed and apply their interests and talents to the benefit of society,” Dr. Dawson says. To this point, schools are legally required to provide special services to autistic people to help meet their needs at school.
Adults with high-functioning autism should know that workplaces must make reasonable accommodations for employees with a disability (including autism) as long as it doesn’t create an “undue hardship” to the business (such as interfering with the type of work that is required).
When it comes to high-functioning autism, both experts reiterate that autism is a spectrum and that each person’s experience is unique.
“There’s a benefit to being diagnosed with autism if you are an adult who hasn’t been officially diagnosed,” Dr. Chung says. “It can be helpful for self-identity and being able to understand why some things may be harder for you than they are for other people; for example why you may not feel emotions the same way other people do.” For this reason, he advocates that anyone who thinks they may have autism be screened. As with other mental health conditions, being properly diagnosed is the first step to getting the support that can help you thrive.