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Todd Drezner

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Nickels, Dimes and 'High-Functioning' Autism

Posted: 01/11/2012 4:46 pm

At my son Sam's school, the math curriculum has recently been focused on coins. By the time Sam is an adult, all financial transactions will probably take place via the microchips implanted in our heads, but nevertheless, we've been dutifully working to help him understand pennies, nickels, dimes and quarters.

It's been a challenge. Unlike reading, which came easily to him and which he's very interested in, Sam doesn't really care about money (lucky kid). So one night, when we were going over the value of coins for what seemed like the hundredth time, I said to Sam, "Repeat after me. One dime is the same number of cents as two nickels."

Sam tried to repeat what I'd said, but what came out was a string of gibberish, along with the words "dime" and "nickels." Only after I simplified the sentence to "One dime is the same as two nickels" was Sam able to repeat it accurately.

Never has ten cents been so valuable. It's not often that you get a snapshot of how another person perceives the world, but my little "repeat after me" gambit provided exactly that.

Of course, it's no surprise to me and my wife that Sam has problems with receptive language. He's on the autism spectrum, after all, and autistic people often have challenges with receptive language. But it's one thing to know that intellectually; it's another to sample what it feels like from the autistic person's perspective. How much of what he hears every day sounds like gibberish to Sam? And how much effort does it take to compensate for this disability?

These questions touch on larger issues in the autism community -- because the world perceives Sam as a "high-functioning" autistic. And why not? Here we were doing math homework appropriate for Sam's age and having a conversation about it. There are parents of other autistic kids who might tell me that they would love to be in my situation.

But as the definition of autism has expanded and more and more people have been diagnosed, "high-functioning" autism is too often thought of as mere "quirkiness." For example, one blogger dismissed Amy Harmon's remarkable New York Times story about two young people with Asperger's navigating a romantic relationship by writing that the story was about "difficulties with personal intimacy, difficulties faced by most adolescents, whether they are autistic, or whether they are neurotypical."

An earlier New York Times piece, also by Harmon, was similarly attacked by Anne Dachel, a blogger at Age of Autism, who wrote about Justin Canha, the subject of the Times piece, "Justin struggles, as all ASD people do, but he's light years ahead of so many kids I know with autism. Giving us a talented, verbal, intelligent young man like Justin Harmon [sic] neatly pushed aside the severely autistic people of the same age."

Oddly, a mere two paragraphs before dismissing Justin Canha as having nothing to do with other autistic people, Dachel cites two important facts from the Times article: Justin barely spoke before he was 10 and hadn't made a true friend by age 20. Wow, I wonder if you could find any other autistic children who have to deal with issues like that. It's too bad that according to Dachel, Justin is too "talented, verbal, [and] intelligent" to teach those children or their parents anything.

Let's be serious. As Sam's story demonstrates, it's extremely difficult to understand how another person experiences the world, even if you know that person very well. Trying to do it for a person you don't know based on a newspaper article is next to impossible. Someone whom we dismiss as "high-functioning" may in fact have to work very hard to "pass" in the neurotypical world.

Why does the autism community continue to obsess over categorizing people as high or low-functioning? It's true that the needs of one autistic person may be very different from the needs of another, but that doesn't mean that they have nothing in common.

As Justin Canha's story shows, the autistic person who needs a lot of support in one area may become a person who needs much less support in that same area. Justin barely spoke before age 10. Now he's verbal.

He didn't suddenly change from "low-functioning" to "high-functioning." Rather, he received the support he needed and developed his skills. It's nothing more than common sense to say that the story of how Justin did it is relevant to many other autistic people, even if they are currently at a much lower skill level.

Autistic people can't be categorized like so many dimes and nickels. Autistic adults, no matter how much or how little support they need, can be our best resource on what it's like to navigate the world with autism. All we have to do is stop dropping them into ill-defined categories and try to learn more about the world from their perspectives.

For more by Todd Drezner, click here.

For more on the mind, click here.

For more on autism, click here.

 
 
 

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08:30 PM on 01/21/2012
I am hurt by the people who use the "high functioning" label when speaking of my son, as if it negates all of the pain and suffering we went through when he was a young child just to get someone, anyone to pay attention to us, and agree that there was something wrong with him, and his problems were not caused by the old "bad parenting" crap.
The days I spent crying on the floor because he was in the psych hospital AGAIN at the age of 8, 9 and then, finally at 11 a med student said, "Hey, I think he might be autistic."
High functioning? Low functioning? He and the rest of the family went through hell until we found out what was wrong, and then for years afterward undoing the harm that was done when he was treated as just a bad kid with a bad mom. He was a good kid with a good mom, but no one gave us any credit. He is now a great adult with a proud mom.
12:47 PM on 01/14/2012
Rather than these labels above, I'm excited for the time, just around the corner, where we have some biological subtypes available based on research. Where you are lucky, Todd, is that your son has no related biological issues intertwined with his DX. My son's GI and immune issues are tied directly into his atypical autism and all are a result of complications from a fragile x premutation, mitochondria dysfunction and MTHFR genes. In our case, this highly verbal, highly "functioning" child is also sick and his atypical autism is just one symptom of the RNA-1 toxicity and FRMP levels. Peer-reviewed research is beginning to flush this out (look at UC Mind's work) but until we get specific biological categories and treatments, we just have ASD. At that ti e you might want to consider remaking Loving Lamposts... Some of this kids are sick and for them, their regressive autism is a symptom, not a difference.
09:40 PM on 01/13/2012
Superb article, it raises very important, meaningful ideas. My son has been referred to as "moderate". I have hated this designation because I see it used by professionals to limit his potential, with the inference that he could not possibly understand/utilize certain certain therapies and thereby they can limit access to services. When he was a toddler and first heard it said I knew it was garbage, because I knew and could see he was/is capable of more than they were acknowledging. I can see how that may work for quote-unquote "high" functioning, that they aren't really in need of whatever services they may need, so they deny access. Professionals and nonprofessionals seem to confuse the "spectrum" as a sort of even grade from high to low, so I really think that we should do away with the terms, as it does not at all consider the uneven nature of autism's effects on the complex human brain and behavior.
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Xenia Grant
denver, co
10:53 AM on 01/14/2012
Love your comment. It is so accurate!
02:51 PM on 01/13/2012
For us, HF vs LF serves a purpose. It is the quickest answer to the painful/uncomfortable questions like "Can she talk? Is she potty trained?" from people who know nothing about ASD outside of Rain Man and what they see on Dateline. And selfishly, it also is a reminder in our particular situation that things could be worse for her.

Love the paragraph about Justin that said "He didn't suddenly change from "low-functioning" to "high-functioning. Rather, he received the support he needed and developed his skills."

Fantastic and pointed statement. Support and services are what kids on the Spectrum need regardless of their level of function.

Thank you Todd for the work on an issue that is still the elephant in our country's room.
11:22 AM on 01/13/2012
As long as we define people with disabilities by what they cannot do, these meaningless labels will persist. I'm glad to see the field of special education (very) gradually moving towards defining individual by strengths -- a movement that will particularly benefit the Autism community as so many Autistic people have remarkable strengths!
10:00 AM on 01/13/2012
both of my boys have been diagnosed with autism & people often ask me low or high functioning,well i dont know,they both can speak,read & write & very often my younger sons school have said well hes just a little bit autistic,or well all kids do what he does,they are good at some things & not so good at others,so i couldnt answer that question
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Xenia Grant
denver, co
09:22 PM on 01/12/2012
Great article! It shows that 'high functioning', 'low functioning' are subjective terms. Not only that, but each of us who live with autism experience it differently. The best way to get information on what it is like to have autism is to speak to someone who experiences it. And each of us on the spectrum are different. For example, when I was your son's age, I was good at math and had a calendar memory. But now, over 40 years later, I am good at other things. I hope you continue writing more good articles! Keep up the good work!

Xenia Grant
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Christschool
Proud to be on the Left
01:12 PM on 01/13/2012
In some cases, high vs. low is subjective. In other cases it isn't at all.
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Xenia Grant
denver, co
07:49 PM on 01/12/2012
Love your essay! I wish more people would listen to us who live on the spectrum day in and day out. Whether it is a kid who is in first grade or someone like me who'll be 47 in a couple of months. We all are unique and deal with different things. And to box us as 'high functioning' or 'low functioning' does a great disservice. We need to be looked on as individuals and as people who will and can and have contribute to this country and to our culture. I learned when I studied political science over 25 years ago that the best views I get from what ever it is that I am reading is from the source itself. And then I go on do a multitude of viewpoints. The same goes for autism. You want to know what it is like to have autism, talk to someone who experiences it. And then go on from there. Keep on writing the good stuff!
12:01 PM on 01/12/2012
Why not try finding adults who get the old High function means BS trope. "Wow you don't seem autistic" was recently used by a caregiver agency, as was my lack of parents in my life (because I should keep violent people who want to KILL ME around so I can get services), in order to try to deny my care. They lost out to my self advocacy skills which often get people dismissing the autism factor. Autism is also only a disability when you cannot either get help adapting or run into people who presume autism vanishes the moment you hit puberty. High and low functioning labels are mostly pap anyway. I am glad you figured out how to teach your son math and that you stumbled on this issue. I just suggest reaching for adult autists in order to assist his further adaptation to society. As far as microchips in brains go? That is not feasible with the limited knowledge of the diversity of human brains. IE we do not know enough about the brain to successfully utilize such a protocol so the coins are important.
10:08 AM on 01/12/2012
I hate the "functioning" labels. They downplay and sometimes over-state the needs of the individual. Putting it quite bluntly, the labels only delineate between verbal vs. non-verbal Autistics (especially when they are young). If they are not given other ways to communicate, "behavior" becomes language as the child gets ages.

Often, we see modern "intervention" focus too strongly on "verbal" communication for those with speech delays. Perhaps if we focused on early-intervention for communication rather than verbal speech, these so-called parents of "low functioning" children might actually see that their child is indeed just as functional as the next kid. Humans are all functional along a spectrum, regardless of a diagnosis or not.
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misspoptart
The suspense is terrible. I hope it will last
01:30 AM on 01/12/2012
I have twin sons on the spectrum who are now 17 so I can complete relate to this dimes and nickels experience! Oh the fun! Eventually the intense repetition paid off and the boys learned to identify the value of coins, however they quickly figured out they prefer dollars to coins - because they are easier to count and they buy a lot more stuff, of course!
12:43 AM on 01/12/2012
"Nobody realizes that some people expend tremendous energy merely to be normal." - Albert Camus
12:40 AM on 01/12/2012
My daughter is PDD-NOS, and I "likely" have Asperger's (will get this made official soon, hopefully). There's no question that I could be considered high-functioning, but that wouldn't have made me feel better when I was eight and going to a counselor because I didn't fit in and had no friends. (No, not even one. And for the record, *never* promise a child like the one I was that they'll have friends on their ninth birthday. Crushing disappointment ensued.)

My daughter is labeled high-functioning. Compared to the severely disabled,she is, but she may never be independent. She barely takes care of her basic physical needs. She is nine and barely at kindergarten or first grade level in her academics, she has fits at school in which she gets "stubborn" and crawls beneath furniture and/or screeches, has thrown her recorder in the music room in front of all other fourth graders, etc. Then she'll turn around and say or do something profound.

As far as seeing things from a different perspective, that's part of what I do on my own blog: http://www.happilyeccentric.com

A good post is: http://happilyeccentric.com/2010/06/12/im-not-broken-im-just-different-or-tap-shoes-and-phones/

My point is that even though there are labels such as "high-functioning," that doesn't equate normal. Trust me. I know.

~Christy Fix
11:09 PM on 01/11/2012
I could really relate to this statement, "Someone whom we dismiss as "high-functioning" may in fact have to work very hard to "pass" in the neurotypical world."...as it is a challenge for my son to "pass" even though he does quite often.

But being that my son did start off on the severe side...practically nonverbal with lots of behaviors, I can also understand the temptation to compare low and high functioning kids. It was incredibly difficult when my son was younger with all the behavior...being called up to school all the time, etc. But things sort of turned around by 4th grade, and he is now considered Aspergers.

However, he still has a lot of needs and challenges...they are just different. And for us, the uncertainty of the future remains no matter how well he does academically.

When it comes to making connections with other parents, I am in touch with parents whose kids are literally all over the spectrum. And even though my son knows kids who are on different levels so to speak, he has close circle of friends are like him...other Aspies. And even within his friends and as much they are alike in some ways, they are all very different and have different needs/strengths/weakness/likes/dislikes from each other as well.
07:59 PM on 01/11/2012
Great article Todd. High or Low functioning, Asperger's, Autism or PDD-NOS. All of these are general labels applied to a hugely diverse population of people (and frequently applied inconsistently from one specialist to the next). On MyAutismTeam we've found that most parents connect & form real friendships with other parents based on something more than just the labels. They form the friendship with other parents whose children have similar developmental needs, face the same challenges, are in the same city & school districts, or have similar experiences. Not as tidy as a label, but more relevant.