RE: "What's the difference between level 1 autism and high-functioning autism?"
The DSM 5 (Diagnostic and Statistical Manual of Mental Disorders, 5th Edition) specifies the severity levels of Autism as follows:
Level 1: Requiring Support—
•Social Communication: With supports in place, deficits in social communication cause noticeable impairments. Has difficulties initiating social interactions, and demonstrates clear examples of atypical or unsuccessful responses to social overtures of others. May appear to have decreased interest in social interactions. [Note: Level 1 autism is most commonly referred to as high-functioning autism.]
•Restricted Interests and Repetitive Behaviors: Rituals and repetitive behaviors (RRB’s) cause significant interference with functioning in one or more contexts. Resists attempts by others to interrupt RRB’s or to be redirected from fixated interest.
Level 2: Requiring Substantial Support—
•Social Communication: Marked deficits in verbal and nonverbal social communication skills; social impairments apparent even with social supports in place; limited initiation of social interactions and reduced or abnormal response to social overtures from others.
•Restricted Interests and Repetitive Behaviors: RRB’s and/or preoccupations or fixated interests appear frequently enough to be obvious to the casual observer and interfere with functioning in a variety of contexts. Distress or frustration is apparent when RRB’s are interrupted; difficult to redirect from fixated interest.
Level 3: Requiring Very Substantial Support—
•Social Communication: Severe deficits in verbal and nonverbal social communication skills cause severe impairments in functioning; very limited initiation of social interactions and minimal response to social overtures from others.
•Restricted Interests and Repetitive Behaviors: Preoccupations, fixated rituals and/or repetitive behaviors markedly interfere with functioning in all spheres. Marked distress when rituals or routines are interrupted; very difficult to redirect from fixated interest or returns to it quickly.
So as you can see, Level 1 would be considered high-functioning Autism. Disability will be common among children with Level 3 Autism and non-existent in Level 1 (where children currently diagnosed with Aspergers will be reclassified).
The new method for diagnosing Autism replaces the five prior diagnoses: Asperger Syndrome, Pervasive Developmental Disorder Not Otherwise Specified (PDD-NOS), Childhood Disintegrative Disorder, and Autistic Disorder. If a child has a pre-existing diagnosis of any of these disorders, he or she is automatically considered to have an Autism diagnosis.
Children who are being newly diagnosed (or re-evaluated) and do not fit into the new criteria for Autism may receive a new diagnosis called Social Communication Disorder. This appears to be an extremely mild version of Autism (the child does not have sensory issues or repetitive behaviors) and is similar in many ways to the old PDD-NOS.
The DSM-5 defines Autism as a single “spectrum disorder,” with a set of criteria describing symptoms in the areas of social communication, behavior, flexibility, and sensory sensitivity. If a child has symptoms in these areas, he or she will probably be diagnosed as “on the spectrum.” When a physician diagnoses a youngster with Autism, it's important to know the severity of the disorder. If the physician does give his/her opinion on the severity, it’s with the disclaimer that it’s only an opinion, not a medical diagnosis. Whether the opinion is that it's severe, or that it's mild, it has no bearing on the actual diagnosis. A youngster with Autism deemed as mild is just as autistic as one believed to be severe. The medical diagnosis for both is exactly the same.
Autistic kids have issues with social interactions, behavioral issues, restricted interests, self-stimulatory activities and sensory issues. So severity in each of these categories needs to be determined to assess severity as a whole. While the severity of Autism is not a diagnosis, physicians who specialize in Autism can tell where a youngster is in relation to the other kids they have treated. The same youngster will get different opinions of severity from different people. Since determining a “Level” is subjective and not a technical diagnosis, there is no right or wrong answer.
The severity of Autism changes not only day to day, but also situation to situation. For example, autistic kids may exhibit significant social deficits when trying to play with their peers on the playground -- but in the classroom, they may blend in perfectly with their peers. Autism severity is simply a place to start. It’s something to use to help the youngster make progress by getting more services and to help describe the youngster to therapists, teachers, etc. It’s just a snapshot, not something that reflects the future or the youngster in all situations.
"My child (high functioning autistic) is currently struggling to have good relationships with his peers? He is mostly disliked because he is frequently aggressive and disruptive."
One of the traits of young people on the autism spectrum is social unresponsiveness (social avoidance behavior). Social unresponsiveness is fear of, or withdrawal from, people or social situations. This becomes a problem when it interferes with relationships with peers, in social situations, or other aspects of a youngster’s life.
Symptoms of social unresponsiveness may appear as part of the child’s overall personality or as a situation-specific response to a particular stressor. Many kids with Asperger’s (AS) and High-Functioning Autism (HFA) are especially susceptible to self-consciousness in social situations that make them feel exposed or psychologically unprotected.
Social unresponsiveness can also develop as an ongoing reaction to repeated failure, mistreatment, or rejection by peers. Some AS and HFA children may show good peer-group adjustment and ability to interact socially, but they may display communication apprehension when asked to perform in public, answer academic questions, or engage in an activity that they know will be evaluated. Other types of social unresponsiveness may result from specific experiences or environmental factors.
In a manner of speaking, the opposite of social unresponsiveness is social competence. Social competence refers to a child’s ability to get along with others. A youngster’s social competence is affected by how well he communicates with peers, teachers and other adults. A youngster’s view of himself in relation to his family, friends and the wider world also affects his social competence.
How well a youngster gets along with others may be the single best childhood predictor of how well she will function later in life. Kids who are unable to sustain close relationships with peers, who are generally disliked, who are aggressive and disruptive, who can’t establish a place for themselves in the peer-culture, and who do not have a basic level of social competence by the age of 6 usually have trouble with relationships when they become adults. The long-range risks for a youngster who can’t interact well with peers may also include poor mental health, low academic achievement and other school difficulties, and poor employment history.
Conversely, a youngster is more likely to have stronger relationships, better mental health, and more success in school if she has many chances to strengthen her social competence by playing, talking, collaborating with others, and working out disagreements. The youngster doesn’t necessarily have to be a "social butterfly." Quality matters more than quantity when it comes to friendships. Kids who have at least one close friend tend to increase their positive feelings about themselves.
The checklist below was created to help parents and teachers check to see whether a youngster’s social competence is developing satisfactorily. Many of the traits included in the checklist indicate adequate social growth if they are “usually” true of the youngster. If a youngster seems to have most of the traits in the checklist, then he is not likely to need special help to outgrow occasional difficulties. Conversely, a youngster who shows few of the traits on the list will benefit from strategies to help build social competence.
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The youngster:
Asserts own rights and needs appropriately
Displays the capacity for humor
Does not draw inappropriate attention to self
Does not seem to be acutely lonely
Enters ongoing discussion on a topic
Expects a positive response when approaching others
Expresses frustrations and anger effectively, without escalating disagreements or harming others
Expresses wishes and preferences clearly
Gains access to ongoing groups at play
Gives reasons for actions and positions
Has “give-and-take” exchanges of information or feedback with others
Has positive relationships with one or two friends
Interacts nonverbally with other kids (e.g., smiles, waves, nods, etc.)
Is able to maintain friendships even after disagreements
Is accepted versus rejected by other kids
Is invited by other kids to join them in play
Is named by other kids as someone they are friends with or like to play with
Is not easily intimidated by bullies
Is not excessively dependent on parents or teachers
Is usually in a positive mood
Is usually respected rather than feared by other kids
Makes relevant contributions to ongoing activities
Negotiates and compromises with others
Shows appropriate response to new people (as opposed to extreme fearfulness or indiscriminate approach)
Shows interest in others
Shows the capacity to empathize
Shows an interest in keeping friends and misses them if they are absent
Takes turns fairly easily
Usually copes with rebuffs or other disappointments adequately
Though each component contributes to the other, there is a necessary initial sequence to the elements of learning social competence for children: (1) the ability to enter play successfully, which (2) creates feelings of being accepted by others, which (3) leads to friendships and to caring about others, which (4) makes the youngster more willing to consider the perspective of others instead of just his own. When these components are in place, the youngster is usually open to assistance with social skills and behaves in a fairly socially acceptable manner.
Parents and teachers should think about a youngster’s motivation for prosocial behaviors (e.g., sharing, compromising, taking turns, etc.). Some young people simply don’t care if they hurt others or make them upset. These are usually the kids who feel rejected by peers – and who reject peers in return. If a youngster has little empathy, then parents and teachers are going to have little luck with lessons about “getting along.”
A basic component for learning social competence is having friends, which for most kids, means having playmates. In order to have playmates, young people must be able to successfully enter into play with their peers, which may be the most basic part of developing social competence. The process of playing with others not only provides motivation for learning social skills, it also provides superb practice. Play provides many opportunities for conflict resolution and negotiation, which help kids to be empathic (i.e., to consider the needs and feelings of others). Considering the needs and feelings of others is called “perspective-taking,” which is also “basic” to developing social competence. ==> Parenting System that Significantly Reduces Defiant Behavior in Teens with Aspergers and High-Functioning Autism Why Asperger's/HFA is Largely a Disorder of Social Skills
Below are suggestions for AS and HFA kids who are socially unresponsive, and how parents and teachers can promote the development of social competence:
1. Any time your AS or HFA youngster exhibits socially appropriate behavior, praise her and let her know you are proud of her. Also, be sure to state exactly why you are proud (e.g., “Julie, you did a great job saying ‘hello’ to Mrs. Johnson. That’s you being friendly.”).
2. Don’t speak FOR your youngster. When someone approaches her (e.g., asks her name or comments on her pretty dress), it may be tempting to speak for her. By speaking for your youngster, it lets her off the hook because she doesn’t have to respond. Also, it sends the message that her voice isn’t necessary, which can reinforce social unresponsiveness. So, let you child speak for herself as often as possible.
3. Find information on the internet, in books and magazines, etc. on ways to be prosocial and make friends. Share this information with your child. In addition, social stories about “making and keeping friends” are especially helpful when attempting to promote prosocial behavior in AS and HFA children (click here for an example).
4. For the AS or HFA youngster who is socially unresponsive, it may take her a while just to muster up the courage to attempt to join a play group. Let her go at her own pace with your support and encouragement. Pushing a youngster to join in play may lead to humiliation and resentment towards you.
5. Help the youngster develop confidence that she will be accepted by her peer-group. A youngster who approaches playmates with confidence is more likely to gain entry to play. On the other hand, the hesitant child is more likely to experience peer-rejection. Peer-rejection starts a cycle of ineffective behaviors that lead to even more rejection. Parents and teachers can make a difference with careful confidence-building strategies. ==> Parenting System that Significantly Reduces Defiant Behavior in Teens with Aspergers and High-Functioning Autism
6. Parents and teachers can help kids on the autism spectrum become socially competent by encouraging friendships. Friendships are crucial for a variety of reasons: (a) friendships offer the best opportunities for developing the interpersonal understandings needed for socialized behavior; (b) kids are more likely to be successful when initiating contact with friends, thus increasing their confidence; (c) kids care more about the feelings of friends than about those of others, thus encouraging them to practice perspective-taking; and (d) kids’ play is more sophisticated and mature when they are playing with friends, which improves their competence.
7. Teach your youngster positive self-talk. Have her list the things she can do, what she is good at, and friends and family that care about her. Have her practice saying all of this to herself. Keep the list posted in a prominent place. In this way, she is reminded of all her good qualities.
8. The AS or HFA youngster will have a much easier time being outgoing in social situations if his parents model good social behavior. For instance, when you are out with your youngster, make an effort to be especially friendly and outgoing to people. This will let your youngster see that it is safe to relate to others (i.e., family members, friends, acquaintances, and even strangers).
9. Well-meaning parents and teachers often insist that “no child be left out,” but this eliminates a teachable moment that may actually make things worse for the AS or HFA youngster in the long-term. There is usually a reason for a youngster being rejected by the play group, and it is the adult’s job to assess the situation and figure out why. Usually there is a missing skill that the child needs to develop. So, parents and teachers should try to identify what needs to be learned – and then teach it. Insisting that a particular youngster be allowed to play just covers up the problem, teaches no social skills or understanding, and makes the other kids more resentful of the “special needs” youngster forced upon them. Consider how you would feel if you were in a meaningful conversation with your best friend, and an uninvited acquaintance jumps in and disrupts the conversation. It’s reasonable at times for kids to ask not to be disrupted by others.
10. Young people on the autism spectrum must be helped to avoid advances that disrupt the ongoing play among his peers. Too often, the AS or HFA youngster will barge into a play situation like an Army tank and be totally surprised and disappointed when the other kids get angry. In these cases, it would be helpful to teach the child a “beginning strategy” that does not interrupt. For example: (a) doing a similar activity near the play group; (b) observing what the desired playmates are doing, which provides information that the youngster can use by offering a way to contribute or fit into the existing play (the youngster who joins a group with a contribution to ongoing play is most likely to be accepted); or (c) simply playing alongside potential playmates.
Play is a common form of interaction between - and among - all kids. Young boys and girls do not construct their own understanding of a concept in isolation – but in the course of interaction with peers. Some of the social skills developed through play are (a) the ability to work towards a common goal, (b) cooperating with peers, and (c) initiating a conversation. By using the strategies listed above, parents and teachers can help the AS or HFA child to move past social unresponsiveness – and on to social competency.
More resources for parents of children and teens with High-Functioning Autism and Asperger's:
"What are some ideas that teachers can use to help an autistic child with meltdowns?!"
Meltdowns can be difficult and frightening to children with Asperger’s (AS) and High Functioning Autism (HFA), as well as to their parents and siblings. However, the good news is that with just a few critical changes, the household can move past such episodes fairly easily. The affected child will feel more in control of his or her feelings/reactions and will, hopefully, come to trust that help will always be there.
Here are a few simple strategies that parents and teachers can use to lessen the intensity and frequency of autism-related meltdowns:
1. Initiate some dietary changes: There is no specific diet for AS or HFA children, but removing certain proteins may relieve symptoms. The gluten-free, casein-free diet has the most research and is one of the most common dietary interventions. About 25% of young people on the autism spectrum find relief and improvement with this diet. It excludes gluten, casein, the protein in wheat, and the protein in milk. In theory, these kids improve on the diet because incomplete breakdown of these proteins creates a substance that inflames the gut. Research has shown improvement, and parents anecdotally report success when these two proteins are removed from their child’s diet.
2. Provide a safe zone: A large closet or a pop-up tent can be effective in calming your youngster by providing her with some “alone-time.” Place soothing objects inside (e.g., bean bag, soft blanket, favorite book, iPod, etc.).
3. Teach “cause and effect” early in your child’s life: “Experiential learning” can be difficult for kids with AS and HFA, and it will become increasingly challenging as the youngster matures and grows. If the results of behavior are felt early in life, it will create resiliency for these children. Thus, make a connection between your youngster's misdeed and the discipline that results (i.e., cause and effect). Let him experience the negative consequences of his poor choices whenever possible.
4. Employ diversionary tactics: Creating a diversion will take your youngster’s attention elsewhere, thus possibly avoiding a meltdown (e.g., taking a walk, singing a song, making silly faces – anything that makes her laugh).
5. Identify “meltdown triggers”: Do some research on your child’s triggers (especially if they aren’t obvious) to determine what factors were in place that resulted in a meltdown. Create a list of things going on before behavior took a turn for the worse, and see if you can find some patterns.
Shutdowns: The Opposite of Meltdowns
6. Identify some sensory-soothing techniques that work for your child: Find out the colors, textures, sounds and feelings she finds peaceful (e.g., pastel colors, squeeze balls, white noise such as a fan blowing, etc.).
7. Break down large tasks into smaller chunks: By breaking down a particular task into workable steps, you are ensuring your child’s feeling of success, thus raising his self-esteem. The more he has mastery over his environment, the better he will feel about himself.
8. Consistently focus on the positives: Little everyday occurrences that are often ignored need to be noticed and brought to the child’s attention in the form of acknowledgment and praise (e.g., finished eating her vegetables, picked her coat up off the floor, started doing homework without having to be asked, etc.). It's always better for children to feel good about the things they are doing right, rather than to be punished for what they are doing wrong.
9. Be a good role model on how to maintain composure: In the face of adversity, always aim to stay calm – and seek a calm environment to encourage de-escalation.
10. Transfer control: As often as possible, allow your child to be in charge of his responsibilities, rather than stepping in and taking over or over-assisting. In the short term, it may seem easier to simply do things yourself, but that's only if you want to continue doing this for your child for the rest of his life. Balance your decision to give the responsibility back to your child by maintaining a supportive and caring attitude, rather than being the “bad guy.”
11. Work as a team: When creating “house rules” for your AS or HFA child, do so WITH her, not just FOR her. In this way, she will buy into the process and will be more likely to cooperate. Social stories and visual cues about the rules can be quite helpful. You can place pictures or text in a place your child normally sees so she can easily access the rules. It’s good to put words next to pictures so the child can learn to associate the meaning.
12. Think structure, structure, structure: Children with AS and HFA need – and even crave – routine and structure. They handle change best if it is expected and occurs in the context of a familiar routine. A predictable routine allows these kids to feel safe and to develop a sense of mastery in handling their lives. As this sense of mastery is strengthened, they can tackle larger changes (e.g., walking to school by themselves, going to sleepaway camp, paying for a purchase at the store, etc.). Of course, many changes can't be avoided. But that's why you need to offer your child a predictable routine as a foundation in his life – so he can rise to the occasion to handle big changes when he needs to. While helping AS and HFA kids feel safe and ready to take on new challenges and developmental tasks would be reason enough to offer them structure, it has another important developmental role as well: structure and routines teach them how to constructively control themselves and their environments.
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Other benefits to having a significant amount of structure in your youngster’s life include the following:
Structure helps moms and dads maintain consistency in expectations. If everything is an argument, the parent often ends up settling just to keep the peace (e.g., more computer time, more TV, go to bed an hour later, skip brushing teeth for tonight, etc.). With a consistent schedule, the parent is more likely to stick to healthy expectations.
Structure allows children to be in charge of themselves. This feeling increases their sense of competence. Children who feel more independent and in charge of themselves have less need to rebel and be defiant.
Structure allows children to learn the concept of "looking forward" to things they enjoy, which is an important part of making a happy accommodation with the demands of a schedule. For example, your child may want to go to the playground now, but she can learn that the family always goes to the playground in the afternoon, and she can look forward to it then.
Structure eliminates power struggles because you aren't bossing your youngster around. A particular activity (e.g., brushing teeth, napping, turning off the TV to get ready for bed, etc.) is just what family members do at the designated time of day. Mom stops being the bad guy, and nagging is greatly reduced.
Structure helps children cooperate by reducing stress and anxiety for everyone. Everybody knows what comes next, they get fair warning for transitions, and no one feels pushed around.
Structure helps children learn to take charge of their own activities. Over time, they learn to feed the dog, brush their teeth, pack their backpacks, etc., without constant reminders from the parent.
One of the biggest challenges for parents of children with autism spectrum disorders is dealing with negative behaviors. If meltdowns are an issue for your AS or HFA youngster, the techniques listed above should provide a significant amount of relief for all family members.
More resources for parents of children and teens with High-Functioning Autism and Asperger's:
