Years ago, professionals used different terms to discuss autism spectrum disorder (ASD). Rather than thinking of a spectrum that could encompass a wide range of manifestations of the disorder, they used disparate boxes for each type of diagnosis.
In those days, high-functioning autism was called Asperger's syndrome. Some people still use that term.
People with high-functioning autism still have autism. But they have abilities and needs that set them apart from people on the other end of the spectrum. Their employment opportunities are different too.
What Is High-Functioning Autism?
As an umbrella term, autism refers to people who struggle with traditional social interactions and relationships. That symptom reverberates across the spectrum. But those with high-functioning autism have a few characteristics that others may not share.
Autism Speaks explains that people with high-functioning autism are often highly intelligent, and their verbal skills are usually exceptional. At the opposite end of the spectrum, people may be nonverbal, and it's difficult to assess their intelligence or learning aptitude. But someone with high-functioning autism may be able to define autism clearly and explain how the diagnosis affects their life.
People with high-functioning autism usually have:
- Strained social interactions. Nonverbal communication is tough to understand, and they may not understand puns or other subtle forms of humor.
- Restricted interests. A topic such as car engines or astronomy takes over the person's thoughts almost all the time, and it's often a favorite topic of conversation.
- Clear strengths. Attention to detail, persistence, pattern recognition, and intense focus are a few common strengths.
- Interest in routine. A desire for consistency and sameness is prominent.
Films and television shows often portray people with high-functioning autism as "numbers people" with few social skills and an unwillingness to make or keep friends. First-person accounts of life with autism show how limiting that label can be.
Plenty of people with high-functioning autism have close friends, understanding bosses, and adoring romantic partners. Clear conversations about preferences and accommodations are often required, so the parties function well together. When that work is done, many people with high-functioning autism find their way in the world quite happily.
But many people with high-functioning autism have other mental health conditions. These comorbid problems require treatment, so people can learn to manage them and live more balanced lives. Common issues include:
- Attention deficit hyperactivity disorder (ADHD). Researchers say this is the most common comorbid condition among people with high-functioning autism. People with ADHD may struggle to calm their minds, so they can focus and learn. This could put a damper on their ability to participate fully in therapy.
- Social phobia. Relentless teasing, communication struggles, and a feeling of loneliness can lead people with high-functioning autism to avoid social situations altogether. Researchers say about 30% of people with high-functioning autism struggle with some degree of social phobia.
- Generalized anxiety disorder. Some people always feel nervous and stressed, even when they don't know why. This is generalized anxiety disorder, and about 16% of people with high-functioning autism have this issue too, researchers say.
Symptoms of these comorbid disorders can abate with therapy. But many people with high-functioning autism don't get the proper diagnosis, so they don't get the help they need.
How Is High-Functioning Autism Diagnosed?
No blood test or brain scan can pinpoint autism or find a person's place on the spectrum. Instead, professionals use tests and observations to both identify autism and determine the proper type of help.
The National Autism Society in the United Kingdom explains a diagnosis of high-functioning autism is appropriate when people have:
- Persistent difficulties with both social communication and interaction. Body language, tone of voice, and innuendo are confusing to someone with high-functioning autism. They may seem insensitive, as they may not know how to navigate delicate conversations. Or they may behave in ways that others don't find appropriate.
- Restricted and repetitive behavior patterns or interests. They may find comfort in routine, and they may attempt to reduce their exposure to bright lights, smells, colors, or temperatures. They may fixate on one activity and feel best when engaging in that endeavor.
- Symptoms that limit and impair everyday activity. Everyone has an eccentricity or two. But people with high-functioning autism have issues that are severe enough that they can't do everything they'd like to with ease.
Mental health experts conduct interviews with the person, and if it's appropriate, others can chime in on the conversation too. Parents, teachers, and close family members may have insights to share about children. Romantic partners, employers, and friends may be able to speak to the habits of adults.
The Autism Society explains that the number of people who have a high-functioning autism diagnosis is rising. But it's unclear if this is due to increased awareness and better screening or if more people are developing the disorder.
With all of this information, doctors can determine the appropriate diagnosis. And when they do, therapy can begin.
Is Therapy Important?
Autism spectrum disorder can't be cured. It's a set of symptoms that persist throughout life.
Many people with high-functioning autism believe that the way they think, communicate, and act is a key part of who they are as individuals. They question whether they need therapy at all or whether the world should be more accepting of their needs.
It's important to understand, researchers say, that the term high-functioning doesn't refer to how much help people need. Some people with very high IQ levels get the high-functioning label, but they still struggle with everyday activities, and they need help with them.
For example, experts explain that people with high-functioning autism often miss social cues, and they feel terrible when they do so. They want to connect with others, but they don't know how to form those authentic, organic relationships.
Applied behavior analysis (ABA) can be useful for those with high-functioning autism, says Autism Speaks. Therapists and technicians can help clients build skills relating to:
- Social interactions. How do these people start conversations? How do others respond? With coaching, a child might learn how to enter and exit a conversation gracefully.
- Obsessions. For someone with high-functioning autism, a favorite topic may dominate every conversation. An ABA professional could coach the client on other topics to discuss. A therapist could also help the person to identify and respond to nonverbal cues of boredom or worry.
- Body language. A behavior technician could coach the client on how to make direct eye contact or shake hands, or they can explain why these steps aren't ideal in certain situations.
Therapy sessions like these can take place in the home, in the classroom, or out in public spaces. The lessons last long after a session ends, as clients can practice what they have learned between sessions.
The goal isn't to change personality. Instead, therapists and technicians aim to give their clients the tools they need to succeed in the world around them.
Unfortunately, many people with high-functioning autism just don't get this type of help. Researchers say it's much more common for people like this to get medications rather than therapy.
Can People With High-Functioning Autism Succeed at Work?
Intelligence, focus, pattern recognition, and other common attributes of people with high-functioning autism make them exceptional employees. But they often need a little help from bosses and coworkers to succeed.
Temple Grandin says, for example, that she believes people on the high end of the spectrum often need to be "so good in a specialized field" that their bosses will overlook missing social skills. For example, if someone has extraordinary computer programming skills, a company might be willing to hire them despite their inability to participate in group brainstorming sessions.
This may sound fanciful or inaccurate, but the data bears out Grandin's assumption. Researchers say about half of all people with ASD have no paid job or technical experience two years after college.
The Autism Society explains that three types of employment opportunities exist for people with ASD:
- Competitive: Employers offer no support during the workday. People may succeed here, despite the lack of support, if their jobs are focused and don't rely on extensive human interaction.
- Supported: Employers develop structures to help the person succeed during the workday. Mentors, structured work crews, or individual coaching could be part of the program.
- Sheltered: Employment is guaranteed, and people get work training and skills while they work.
Each person with high-functioning autism is different. Some people might succeed with lower levels of help. Others will not.
In a talk given during the Chicago Humanities Festival, Grandin recommended that people start small and work up. Perhaps they can take on an internship and parlay that into a job. Maybe they can work part-time and then segue into full-time work.
Therapists can also be helpful here. Roleplaying exercises can help the clients to do better in interviews, succeed in social interactions, and more.
A Bright Future
Most people with high-functioning autism are able to live full, independent lives.
Again, a label of high-functioning doesn’t necessarily mean that the person will have few to no issues. But individuals with high-functioning autism are in a good place to do quite well in therapy.
Specialized assistance from ABA therapy, in conjunction with occupational therapy and speech therapy, can focus on areas where the individual may be struggling. Individuals with high-functioning autism are likely to experience substantial long-term gains with these therapies.
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