The use of the word spectrum in the condition Autism Spectrum Disorder (ASD) implies a wide range of severity levels. The most functional end of that range belongs to high-functioning autistics (HFA). Although diagnosed formally with ASD, people with HFA often lead remarkably normal lives and have less difficulty assimilating into society than other ASD patients.
There is no technical medical definition for high-functioning autism, so the term is sometimes—maybe even usually—applied unevenly. Many people believe that Albert Einstein was a high-functioning autistic; others apply the term to anyone with ASD who has an IQ over 70… a long way from Einstein’s caliber!
Nonetheless, most people consider HFA less an indicator of relative intelligence than one of social skill. HFA patients may present as neurotypical or nearly neurotypical people with some slight behavioral tics. Their social skills may be underdeveloped but not markedly so. Before autism became widely recognized as a distinct diagnosis apart from other mental disorders, many high functioning autistics simply would never have been diagnosed with any affliction, but rather regarded as simply odd or eccentric.
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HFA is Recognized as Unique, but Classified the Same
Today, they are not categorized differently in psychological terms from any other person on the autism spectrum. But because ABAs work primarily in functional terms, HFA can be a very useful label. ABAs design their treatment programs around observed behaviors, and use different techniques based on the severity of those behaviors and the nature of the antecedents.
Both antecedents and behaviors for high-functioning autistics are likely to trend much closer to non-ASD behavioral norms. An ABA treating a case of HFA might not treat it much different from how they would handle a person exhibiting inappropriate behaviors stemming from issues like excessive anger or depression.
A high-functioning autistic is more likely to understand, at least conceptually, social norms and the importance of complying with them; they can be more a partner to their own therapy than a passive participant. In many cases, they are eager to adapt themselves to fitting into social circumstances. This can allow ABAs to use the rule-based and obsessive tendencies of the HFA patient as part of their treatment!
Is the Approach to Treatment Different with High Functioning Autistics?
There is little clinical research on the efficacy of different ABA treatments between high and low-functioning autism patients, but many individual ABAs have found that HFA patients respond well to incidental teaching, video modeling, and natural environment generalization.
Because ABAs will make a Functional Behavior Assessment (FBA) of each individual patient before building a Behavior Intervention Plan (BIP), they can evaluate for themselves whether or not the patient trends toward the high-functioning end of the spectrum and devise treatments accordingly.
At the furthest reaches of HFA, there remains considerable debate over whether or not Asperger’s Syndrome patients should be considered as high-functioning autistics or vice versa. The original diagnostic guidelines for Asperger’s were essentially the same as for autism, but without the characteristic language and cognitive developmental delays. However, with the re-characterization of Asperger’s and autism into the universal diagnosis of the autism spectrum in 2013, it has become a meaningless distinction.
Instead, there are now severity levels assigned to ASD diagnoses, but even these have not settled the question of what exactly HFA should be defined as. Level 1, the least severe level, simply states that the patient requires support. But many high-functioning autistics do not.
What they do have is a lower than average verbal reasoning ability, empathy and social learning problems, and issues with obsessiveness. Although these issues, individually, may not rise to a level associated with traditional autism, collectively they still indicate an ASD diagnosis.