High-functioning autism

High-functioning autism is a non-medical term for people with mild autism spectrum disorder (ASD) or ASD Level 1.^[1] People with this form of ASD can live independently and generally handle daily activities of daily living. However, they still require some support and show some common symptoms of ASD, such as poor social and communication skills and sticking to highly specific routines.^[2]

What is high-functioning autism?

High-functioning autism refers to individuals whose symptoms fall on the mild end of autism spectrum. As noted above, high-functioning correlates with individuals given an ASD Level 1 diagnosis. ASD Level 1, according to the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), requires “support” (whereas ASD Level 2 requires “substantial support” and ASD Level 3 requires “very substantial support”).^[1]

Before the DSM-5 was released in 2013, people with high-functioning autism were likely to be diagnosed with Asperger’s syndrome. However, the DSM removed this diagnosis and incorporated it into the autism spectrum disorder category. Nevertheless, someone with this form of autism has classic symptoms of ASD, but unlike people with ASD Level 2 or ASD Level 3, there is an absence of intellectual disability.^[3]

High-functioning autism symptoms

People with high-functioning autism exhibit classic symptoms of ASD. These symptoms fall into two categories: deficits of social communication and interaction and restricted or repetitive behavior patterns.^[1] 

For example, one of the most common signs of high-functioning autism is social awkwardness. This can manifest in many ways, including an inability to read body language, not understanding when to let someone else speak, and a failure to manage the volume and tone of one’s voice.^[4]

In addition, it’s common for people with high-functioning autism to have difficulty adjusting to different social situations. Making friends can be anxiety-provoking and difficult. This may be due to a lack of emotional expression, a lack of eye contact when speaking with someone, and an incongruence in conversations with their facial expression or body movements.^[3]

Additional symptoms of high-functioning autism in adults include restrictive or repetitive behavioral patterns. For example, many people with ASD Level 1 are intensely interested in specific, complex topics (e.g., being fixated on learning about a certain topic).

It’s common for people with high-functioning autism to be highly sensitive to sensory information. For example, one might find certain lighting, sounds, temperatures, or textures of clothing to be highly uncomfortable to the point of agitation. On the flipside, some people with ASD may display have a less-than-normal level of sensory sensitivity, known as hyposensitivity).^[4]

High-functioning autism symptoms also include highly structured routines. People with ASD often have difficulty transitioning from one activity to the next, and they can become upset by even the slightest changes in their typical routine.

It is important to note, these are just examples of some symptoms seen in ASD. The list is not exhaustive. Additionally, not all people with ASD experience the same symptoms – one person with high-functioning autism might display a completely different set of symptoms than the next.

How does high-functioning autism differ from other autism spectrum disorders?

The difference between high-functioning autism and other levels of ASD is the severity of the symptoms. In other words, the same diagnostic criteria apply to all three levels of ASD, but ASD Level 1 includes less severe symptoms than Level 2 or Level 3.^[5]

ASD Level 1

The DSM-5 notes that people with ASD Level 1 display difficulties with social communication. These difficulties cause “noticeable impairments” without support.^[1] For example, someone with ASD Level 1 might have a decreased interest in interaction with others, or when attempts are made to make friends, their friendly overtures are awkward and might not be successful.

Moreover, people with ASD Level 1 exhibit inflexible behaviors that impair daily functioning in at least one context.^[1] Children with ASD, for example, might be unable to transition from one school activity to the next without their teacher’s guidance.

ASD Level 2

ASD Level 2 is characterized by “marked deficits in verbal and nonverbal social communication skills.” ^[1] These deficits are noticeable even when supportive interventions are in place. As a result, people with ASD Level 2 seldom initiate social interactions. For example, when engaging in a social situation, the responses to social cues from others are usually minimal or abnormal.

This level of autism is also marked by a rigidity of behaviors that causes difficulty functioning in multiple contexts. These rigid behaviors are severe and frequent enough that even a casual observer can notice them.^[1] For example, some people with ASD have echolalia or repeatedly say the same thing over and over again. This behavior appears to others to have no apparent meaning, and may make social interactions difficult.

ASD Level 3

ASD Level 3 is the most severe type of autism characterized by a near lack or complete lack of verbal communication. ^[1] In some cases, people with this level of autism might not react to their surrounding environment, or if they do, it is minimal. As a result, there are minimal social interactions with others.

The inflexibility of behavior for people with ASD Level 3 is extreme.^[1] The ability to cope with change is nearly nonexistent, while other restrictive or repetitive behaviors are so severe that functioning in any context might be challenging. For example, even the slightest change to typical routines might trigger an angry outburst.

High-functioning autism vs Asperger’s syndrome: What’s the difference?

As detailed earlier, before the revisions made to the DSM-5, Asperger’s syndrome was the diagnosis for high-functioning autism. Now that Asperger’s has been absorbed into autism spectrum disorders, it is no longer used as a clinical term.^[2] Instead, high-functioning autism and Asperger’s syndrome can be considered colloquial terms that describe ASD Level 1.

High-functioning autism diagnosis

The DSM-5 outlines specific criteria to diagnose ASD. These criteria are summarized as follows: ^[5]

• Deficits in social communication and interaction that persist in varying contexts, including:n
  • A lack of social-emotional reciprocity (e.g., failure to initiate social interactions, lack of sharing emotions)
  • A lack of nonverbal communication (e.g., littleor no eye contact, lack of understanding of how to use nonverbal gestures)
  • Inability to develop, maintain, or understand relationships (e.g., little or no interest in befriending peers, inability to adjust behavior to different social contexts)
• Restricted or repetitive behavioral patterns, including two or more of the following:n
  • Repetitive or stereotyped motor movements, speech, or use of objects (e.g., echolalia)
  • Inflexible routines or adherence to ritualized patterns of behavior (e.g., rigid thinking patterns, eating the same food each day)
  • Fixated interests that are abnormal in focus or intensity (e.g., a strong attachment to a specific object)
  • Sensory difficulties that can either be hyperreactive (extreme sensitivity to sensory input) or hyporeactive (extreme insensitivity to sensory input)(e.g., strong reaction to certain sounds or apparent indifference to changes in temperature)

A diagnosis of ASD Type 1 requires the Type 1 specifier to indicate that “support” is needed for normal functioning in the areas discussed above.

The DSM-5 further outlines the following diagnostic criteria for ASD:

• Symptoms must begin in early development, though they might not fully manifest until later.
• Symptoms cause clinically significant impairment in multiple areas of functioning, including social and occupational contexts.
• A developmental delay or intellectual disability does not better explain the behaviors.

How to manage high-functioning autism

Even though people with high-functioning autism can live independently and live relatively normal lives, they might require assistance when managing their symptoms. This assistance can come in various forms, including therapy, medication, and self-help strategies.

Therapy for high-functioning autism

The most commonly known type of therapy for autism is cognitive-behavioral therapy (CBT).^[6] This approach can assist people with ASD Level 1 by exploring how thoughts, behaviors, and feelings are interconnected. CBT can result in an improved ability to cope with ASD symptoms, such as learning to accept changes in one’s routine with fewer feelings of anxiety. Although, it is important to note that CBT also presents with drawbacks for neurodivergent individuals as the therapeutic intervention was originally created with neurotypical individuals in mind.

Applied behavioral analysis (ABA) is another therapeutic option that reinforces positive and adaptive behaviors. ABA takes complex behaviors, like interacting with peers, and breaks them down into small, achievable steps. Each step represents an opportunity to learn a new skill, put that skill into practice, and gain reinforcement for using newly acquired skills. ^[7] It is also important to note that many neurodivergent advocates have been discussing the downsides and harms of ABA therapeutic interventions. Again, ABA is an intervention that promotes a neurotypical way of functioning rather than empowering neurodivergent individuals to find their unique way of interacting with the world.

Various other therapies can also target the development of improved social-relational functioning. For example, social skills groups provide a highly structured environment where children with ASD can practice interacting with others. Another approach, commonly called “floor time,” encourages parents and family members to show interest in and follow their child’s activities to improve communication and interaction.^[6]

Many people with ASD Level 1 can benefit from other types of therapies, as well. For example, sensory integration therapy can help people with ASD cope better with overwhelming sensory inputs. Likewise, physical therapy and speech-language therapy can address the motor and verbal issues common with ASD.^[6]

Medication for high-functioning autism

At present, there are no pharmacologic treatments for ASD.^[4] However, medications for comorbid conditions might be prescribed to help improve day-to-day functioning. For example, someone with ASD Level 1 might take an antidepressant or anxiolytic to help manage associated depression or anxiety symptoms.

Some people with ASD Level 1 might also take medications to address sleep problems, inattentiveness, or seizures. People with more severe types of ASD might take medications  (e.g., antipsychotics like risperidone or aripiprazole ^[7]) to address self-harming behaviors, such as biting or head banging.

Self-help techniques for high-functioning autism

Since people with high-functioning autism need minimal support to manage their symptoms, self-help techniques might be all that’s required to function normally from one day to the next. Common self-help techniques include the following:^[8]

• Break complex tasks into small steps to help avoid frustration and improve the ability to transition from one thing to the next.
• Keep a sensory record to help improve your understanding of what sensations are troublesome so you can make adjustments.
• Use visual cues to help you stay organized (e.g., write tasks on a calendar).
• Don’t be afraid to ask for help when you need it, be that from family, friends, or mental health professionals.
• Be open about your autism and be willing to share your experience with others. With increased understanding, others can provide improved support when you need it.