2 interesting articles about functioning

I think it's mainly the difference in terminology between science and everyday usage? 
In psychology "functioning" mainly just refers to "cognitive functioning", which is largely IQ and executive function.
But people more familiar with the layman's term might misinterpret the term?

Which suggests a certain degree of myopia on the part of psychologists .

I think it's just different meaning of the word, and misunderstanding between the scientific community and laypeople community. I personally often find it quite frustrating when laypeople misunderstand the psychology word referring to "cognitive functioning" and then criticise the term functioning... 

For example, when scientists are specifically exploring question "cognitive functioning" alone as a specific research question, laypeople criticise them for not thinking about other types of functioning.... a similar scenario would be as asking a physicist studying "electric cells" why aren't they thinking about other cells, like "animal cells". You can't say the physicist studying electric cells has myopia when it is their research interest to focus on that.

Another example I've heard is that people think of "functioning" as describing machines, and feel it's inhumane to study autistic people like that. But this is wrong too, as "functioning" (i.e., "cognitive functioning") is a very common psychology word and is used when studying neurotypicals too.

I think there will be less confusion if the general community understands the psychology term. I mean DSM-5 changed it's classification of ASD, and requires the assessor to specific the diagnosis "with or without accompanying intellectual impairment" and "with or without accompanying language impairment", etc. I suppose that kind of better clarifies what "functioning" means, but still focuses on IQ.
https://www.autismspeaks.org/dsm-5-criteria 

I agree that there are other "types" of functioning, that are not captured by IQ. For example, social functioning and emotional functioning, etc. And it's possible a high-cognitive-functioning person to have lower (in layman's terms) "functioning" in real life than a low-cognitive-functioning person. For example, a a high-cognitive-functioning person might have come from a abusive family with no support and experience depression and anxiety, while a low-cognitive-functioning person might have a supportive family and have lots of access to government support and do not have to worry about daily living. 

And it's not that psychologist are blind to social and emotional functioning, it's just different areas of research - a cognitive psychologist would use functioning to refer to "cognitive functioning", and a social psychologist might use "functioning" to refer to "social functioning". 

I don't think there's anything wrong when one want to focus on talking about IQ, and I don't think there's anything wrong when one wants to focus talking about emotional and social support either. But I don't see the point in arguing about the term when people are just focused on talking about different things. Neither of them is wrong. They are just using the word to mean IQ or social support. 

Here are some examples of different scientific and layman words. Some words are used very differently in different fields of science too, for example "model" requires mathematical formulas in some fields, but only a general outline in other fields. 
https://www.scientificamerican.com/article/just-a-theory-7-misused-science-words/

I am understanding perfectly well. How psychologists categorise people is one thing.

I'm not sure you understand. You keep going back thinking that psychologists use IQ to categorise people according to "adaptive functioning", but they are NOT. They are only using IQ to categorise people according to "cognitive functioning".

Diagnosing someone with intellectual disability (https://www.mentalhelp.net/intellectual-disabilities/dsm-5-criteria/), is the same as diagnosing someone with ASD, ADHD, dyslexia, etc. It's an additional diagnostic description of the person, and has NOTHING to do with categorising people according to "general adaptive functioning" or "whether you need support". 

I agree - just because a high IQ means you're quick enough to be a fake NT for a little while, doesn't mean you can keep it up or experience the same world as NTs.   High IQ means you don't appear to need any support during the 10 minutes they assess you..

I am understanding perfectly well. How psychologists categorise people is one thing. Whether that  is the best method to ensure people get the help and support they need is quite another. 

onlinelibrary.wiley.com/.../aur.2081

I think you are still not understanding that the scientific jargon "functioning" is a synonym of IQ. Only the layperson's word "functioning" means adaptive functioning. I've already explained this from the very beginning. When psychologists and scientist say "high/low functioning" it is NOT categorising people by adaptive functioning, but it's a specification of their IQ.

People's functioning should not be  categorised solely by IQ re ASD as there can be a gap between adaptive functioning and IQ.   It's not a case of dismissing IQ , but saying there should be more to the process of saying how well a person on the spectrum functions than just basing it on IQ.

In the ASD case, I think the IQ part is an "additional specification", rather than diagnosis category, it's always ASD + extra specification in either DSM or ICD, but anyway

(1) Could you explain the ASD versus NT categorisation? It's also a categorisation flaw where NT people are missed out on need for help and support.

(2) And according to your logic that people should not be categorised by IQ, then the DSM and ICD diagnoses of intellectual disability should be removed. But they are diagnostic categories, https://www.mentalhelp.net/intellectual-disabilities/dsm-5-criteria/
https://apps.who.int/classifications/apps/icd/icd10online2004/fr-icd.htm?gf70.htm+ 

(3) Categorisation helps make support more specific for each group. Most low-functioning ASD will need speech therapy whereas most high-functioning ASD will not. However, all ASD will need extra social communication support where's most NTs will not. 

You're still missing the point  re the flaw as to how people are categorised in terms of functioning, and the need for help and support.

IQ does not equal coping, neither does the term functioning mean coping.

it's just an extra description in addition to the ASD phenotype of communication and repetitive behaviour in both manuals. 

I'm fine with anything as long as it's all logically consistent. If no there is no categorisation of ASD and NT, and no categorisation of cognitive functioning, then that's logically consistent. 

For example, there are many NT people who have minor social difficulties but do not reach diagnosis criteria, and they should be able to get help too. But because of the diagnostic categorisation of ASD vs NT, NTs with social communication difficulties are expected by society to deal with it without any reasonable adjustments, and I think that's quite unfair to those NTs.

All diagnosis labels have this flaw of categorising people. For example, the dyslexia diagnosis is one of the most unfair ones. If a native English speaker at university has a dyslexia diagnosis they can get extra time on exams; however, a foreign student who does not speak English as a first language but does not have dyslexia cannot require extra exam time (yet they are possibly more disadvantaged than the native dyslexic person).

Categorisation is useful to generally describe the phenotype differences between groups of people, but of course, there are differences within each group that are irrelevant to the category. For example, when categorising someone as ASD vs NT, one will immediately know whether that person has social difficulties if they are ASD. Categorising someone as ASD + intellectual impairment vs ASD + without intellectual impairment, you will immediately know whether they might need intervention on IQ or speech therapy. Other factors unrelated to the category can vary, such that low IQ people may have more family support and thus coping better with life, but family support is not the category's dimension. Similarly, someone with ASD may have been fortunate enough to be allowed to pursue their special interest whereas some NT may end up doing a job they dislike, which may lead to the ASD person coping better than NT. 

Yes, think high IQ can be a liability to coping for auties.

So long as functioning = cognitive functioning re ASD  there will always be a problem ,  irrespective of how things are described in the DSM5 and ICD 11.  

It's a big and inaccurate leap  to say an issue with how people on the spectrum are categorised  means one should have issues with people being categorised as autistic vs  neurotypical.

It's not about  whether features are on a continuum , which I would agree with , but whether the method used to categorise people , in terms of functioning, who have a diagnosis , is the best there is to ensure people get the help and support they need.

A fair number of people,including psychologists and scientists, think not. 

It's just when they go on to categorise  people in terms of high or low functioning  IQ is used as a means of separating people. It's that that   some laypeople, and some psychologists too, have an issue with.

Low/high functioning is not an ASD-specific category, but functioning is a term also used to describe neurotypical people too.

If you see it as ASD + normal intelligence and ASD + intellectual impairment, according to either DSM-5 or ICD-11, the IQ part is an extra specification to the ASD. 

It's not necessarily an issue of misinterpreting things. One can know well what 'cognitive functioning' means while still being able to see flaws in the way people are categorised .

So, do you also have an issue with the ICD diagnoses Arran posted? For example "ASD with without disorder of intellectual development and with mild or no impairment of functional language" and "ASD with disorder of intellectual development and with impaired functional language"? It means the same thing as "ASD + high-functioning" and "ASD + low-functioning". No one seems to complain about it when it's "ASD + cognitive specification", but people complain about it when the word "function" is used, even though they mean the same thing. If you have an issue with one, then you'll need to have an issue with the other. 

If it's an issue with categorisation, then to be logically consistent, you will also need to have issues with categorising people as autistic versus neurotypical. Because every feature in the ASD diagnosis criteria is a continuum and not one dimension. ASD largely is made to describe a category of people who have social communication issues and repetitive/restricted behaviour. But neurotypicals can vary on these dimensions too but do not meet all criteria or cutoff in the extent of impairment. But both autistics and neurotypicals are both people with varying degrees of the above features. Then one should not give people these labels, and just refer to everyone as "people".

Arran said:

There is a question whether we should use DSM or whether we should ignore DSM and focus entirely on using ICD.

You said yourself in another post, that

In ICD-11 we have the following categories of ASD:

6A02.0 Autism spectrum disorder without disorder of intellectual development and with mild or no impairment of functional language

6A02.1 Autism spectrum disorder with disorder of intellectual development and with mild or no impairment of functional language

6A02.2 Autism spectrum disorder without disorder of intellectual development and with impaired functional language

6A02.3 Autism spectrum disorder with disorder of intellectual development and with impaired functional language

6A02.4 Autism spectrum disorder without disorder of intellectual development and with absence of functional language

6A02.5 Autism spectrum disorder with disorder of intellectual development and with absence of functional language

6A02.Y Other specified autism spectrum disorder

6A02.Z Autism spectrum disorder, unspecified


So, in both ICD and DSM, it's  ASD + a specification for cognitive function. 

So, I don't see any issue regardless which you use.

It's not so much psychologists miss out on other types. (Or laypeople misinterpret "cognitive functioning") I have no doubt they acknowledge them as part of the diagnostic process.

It's just when they go on to categorise  people in terms of high or low functioning  IQ is used as a means of separating people. It's that that   some laypeople, and some psychologists too, have an issue with.

It's not necessarily an issue of misinterpreting things. One can know well what 'cognitive functioning' means while still being able to see flaws in the way people are categorised .

qwerty said:

I don't think that's true. Look at the diagnosis criteria:

To get diagnosed, you need to have (according to DSM5):
https://www.autismspeaks.org/dsm-5-criteria 

There is a question whether we should use DSM or whether we should ignore DSM and focus entirely on using ICD.

That is my point exactly.... high-functioning only refers to IQ-functioning, it doesn't take away any of the other ASD-related difficulties.

“The term ‘high functioning autism’ is not a diagnostic term and is based on an IQ assessment, rather than a functional assessment,” Dr Alvares said.

"high functioning autism" is not a diagnosis term and is based on an IQ assessment, rather than a functional assessment.--->I've been trying to point this out over and over! Psychologists & scientists already know this, and that is exactly what they mean when they say it. So I don't see why people are complaining about the meaning. 

"functioning" = cognitive functioning
"ASD" = low social, occupational, sensory, emotional, societal, etc. functioning

therefore...

high-functioning + ASD = high-cognitive functioning + low social, occupational, sensory, emotional, societal, etc. functioning
low-functioning + ASD = low-cognitive functioning + low social, occupational, sensory, emotional, societal, etc. functioning

There's nothing wrong with interpretation of the term in psychology/science. It's the extra specification. 

But laypeople either (1) interpret misinterpret "cognitive functioning" to include other functioning, or (2) think that psychologists/scientists miss out on other types of functioning. 

“The term ‘high functioning autism’ is not a diagnostic term and is based on an IQ assessment, rather than a functional assessment,” Dr Alvares said.

https://www.telethonkids.org.au/news--events/news-and-events-nav/2019/june/researchers-call-for-term-high-functioning-autism/?fbclid=IwAR1zPMl_ioZmjhZZ0mkL0XtNfrdbH6-M_RyeVPhCKUrfR_MvmkzhZeYdyms 

So not required for a diagnosis ,  but called into play when deciding if someone is high functioning or not.

I'll write it out logically.

All ASD requires meeting DSM5 criteria 4: social, occupational, sensory, emotional, societal, etc. functioning

IQ is irrelevant whether the individual gets the diagnosis or not 

So how does one call someone with "intellectual impairment + low social, occupational, sensory, emotional, societal, etc. functioning"? and someone "without intellectual impairment + low social, occupational, sensory, emotional, societal, etc. functioning", that's where the low/high cognitive functioning comes in --> "low-cognitive functioning + low social, occupational, sensory, emotional, societal, etc. functioning" and "high-cognitive functioning + low social, occupational, sensory, emotional, societal, etc. functioning". But this is very very long, right? Psychologists are very aware that low/high functioning refers to the extra intellectual disability specification added on to the original DSM diagnosis that needs to meet DSM5 criteria 4. So they are not leaving out any other areas of functioning: when saying one has ASD already means problems with "D. Symptoms cause clinically significant impairment in social, occupational, or other important areas of current functioning." I think the problem is that the general public thinks psychologists are not clear on what functioning means, or that they are leaving things out, but in the psychologist's mind it's meeting everything that's listed in the DSM criteria, plus an additional description of IQ. There's a difference between laypeople's understanding and scientific understanding of it.

The thing is autism is 'spectrum' disorder... so encompasses:

 - cognitive functioning

 - executive functioning

 - social functioning

 - sensory functioning

 - emotional functioning

 - societal functioning

So to label people as high/low 'functioning' without specifying in which areas this refers to is meaningless and ultimately reductive and harmful.

Personally, I think IQ is a pointless oversimplification.

not so much a case of criticising the usage ,  but saying that  level of IQ  doesn't dovetail neatly with how well people on the spectrum  manage in everyday life .

Yes, it's true that IQ doesn't completely dovetail with how well people on the spectrum manage in everyday life. I agree with this, as I've given examples of it being possible that high-cognitive-functioning people can manage more poorly in everyday life than low-cognitive-functioning people. 

There's a difference between criteria D being part of the diagnostic process , and how IQ  is very much  used  to distinguish between people who are deemed low or high functioning .

I think IQ is just mainly used to distinguish between people who are low- or high- cognitive functioning, not whether they are low- or high- socially/occupationally/emotionally functioning. 

not so much a case of criticising the usage ,  but saying that  level of IQ  doesn't dovetail neatly with how well people on the spectrum  manage in everyday life .

Yes, it's true that IQ doesn't completely dovetail with how well people on the spectrum manage in everyday life. I agree with this, as I've given examples of it being possible that high-cognitive-functioning people can manage more poorly in everyday life than low-cognitive-functioning people. 

There's a difference between criteria D being part of the diagnostic process , and how IQ  is very much  used  to distinguish between people who are deemed low or high functioning .

I think IQ is just mainly used to distinguish between people who are low- or high- cognitive functioning, not whether they are low- or high- socially/occupationally/emotionally functioning. 

For me it's that IQ is still used to categorise people in terms of the help and support they need,and that that is counterproductive . I agree that  the  point where we differ  is  on how many psychologists rely on IQ as the primary tool to judge functioning levels.

You have more rose tinted glasses as to the approach of psychologists and I am more cynical  as to their approach.

Anyway, I think from very early on, we already have a consensus that IQ does not equate to better long-term outcomes of the individual. And that's what's important.

The disagreement is mainly whether we think most psychologists think that way. 

Are you happy with this conclusion? 

The bit in bold does not show that IQ is used in clinical circles to judge a person's general functional abilities, it just implies the term can lead to misinterpretation. 

According to your article, "High functioning autism’ is a term often used for individuals with autism spectrum disorder without an intellectual disability. Over time, this term has become synonymous with expectations of greater functional skills and better long-term outcomes, despite contradictory clinical observations."

(1) Clinical psychologists are clear what the term means - ASD without intellectual disability
(2) Clinical psychologists know from clinical observations that high-functioning do not mean greater functional skills and better long-term outcomes

But for some weird reason, "over time" the term has become synonymous with expectations of greater functional skills and better long-term outcomes --> this means that the original definition of functioning does not imply adaptive functioning, but because people misinterpret the term, it has been misunderstood as the layman's definition.

These data indicate that estimates from intelligence quotient alone are an imprecise proxy for functional abilities when diagnosing autism spectrum disorder, particularly for those without intellectual disability. We argue that ‘high functioning autism’ is an inaccurate clinical descriptor when based solely on intelligence quotient demarcations and this term should be abandoned in research and clinical practice.

https://journals.sagepub.com/doi/abs/10.1177/1362361319852831?journalCode=auta

The bit in bold clearly shows that IQ is still used in clinical circles to judge a person's functional abilities . The problem being that, for high IQ people on the spectrum,adaptive functioning can lag considerably behind what might be expected based on a person's  IQ.

I think you are the one who is not grasping what I am saying and you are not capable of understanding what I'm saying. You keep thinking that psychologists use cognitive functioning to determine someone's adaptive functioning, but psychologists aren't doing that. 

Post-doctoral researcher Dr Gail Alvares said while 'high functioning' is used to describe people diagnosed with autism who have IQs in the normal range, it does not indicate their functional status.

Every psychologist see it the way sees Dr Gail Alvares it, but somehow you agree with her, yet you keep insisting that psychologists are using IQ to indicate someone's functional status. No psychologist is doing that.

You are not grasping what I am saying. I'm going to leave this thread as it's frustrating that you are not capable  of understanding what I'm saying .

You are not understanding the meaning between scientific jargon vs. layman's terms.

This is like explaining what "theory" means in science to a layperson. The scientific jargon "theory" and the layman word "theory" mean contradictory things. But neither is incorrect.

It's like (I'll use simile): I keep telling you that theory in science means a logical, systematic set of principles or explanation that has been verified—has stood up against attempts to prove it false". Yet you keep saying "theory is just a hinch or idea that's not tested. And that scientists are wrong to say a theory is true. Scientists should not be seen as judges to define the word theory". 

You cannot get over the layman's definition of "functioning". Whereas in psychology, that word has nothing to do with the layman's word "functioning". It also has nothing to do with autism either. It's a term used in cognitive studies of all people (neurotypical included).

Psychologists are not ignoring other aspects of support that people need, nor is IQ used in determining whether someones gets the ASD diagnosis. The word has a different meaning in psychology versus in everyday life. But you keep thinking that psychologists use cognitive functioning to determine someone's adaptive functioning, but psychologists aren't doing that.

There are even more definitions of the word functioning than you might know. For example the word "functional" in "functional imaging" has nothing to do with how "functional" a person is in in life. Another example, the word "functional" in "functional connectivity" is yet another meaning, and is calculated as a correlation measure in contrast to "effective connectivity".

Psychologists should not be seen  as the judges of what a word means. .Most people on the spectrum  know that IQ is not used to diagnose a person. However it is used to  say what the level of support needed is when a diagnosis of ASD has been made.

Psychologists may very strongly see functioning as 'cognitive functioning' but that does not mean they are right in doing so, or that that is the best way to ensure people get the help and support they need.

Plastic said:

just because a high IQ means you're quick enough to be a fake NT for a little while, doesn't mean you can keep it up or experience the same world as NTs

Not sure if you have read the thread carefully, but IQ is not what psychologists use to determine whether or not you're ASD or NT, in fact, in both DSM5 and ICD. But intellectual disability in its own is a diagnosis, it's an additional diagnostic label, just like ASD + ADHD, or ASD + dyslexia. "Functioning" does not mean "how well someone functions in society", but it only means "cognitive functioning", so low-cognitive-fucntioning means ASD + intellectual impairment. I feel the main issue is that people get confused with the jargon, and keep thinking that "functioning" means "how well someone functions in society"...

I agree - just because a high IQ means you're quick enough to be a fake NT for a little while, doesn't mean you can keep it up or experience the same world as NTs.   High IQ means you don't appear to need any support during the 10 minutes they assess you..

IQ does not equal coping, neither does the term functioning mean coping.

it's just an extra description in addition to the ASD phenotype of communication and repetitive behaviour in both manuals. 

Yes, think high IQ can be a liability to coping for auties.