2 interesting articles about functioning

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. 

I think most of us who are very intelligent have a very good idea what cognitive functioning means . For me it's

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 .

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 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 

A. Persistent deficits in social communication and social interaction across multiple contexts, as manifested by the following, currently or by history

B. Restricted, repetitive patterns of behavior, interests, or activities, as manifested by at least two of the following, currently or by history

D. Symptoms cause clinically significant impairment in social, occupational, or other important areas of current functioning.

E. These disturbances are not better explained by intellectual disability (intellectual developmental disorder) or global developmental delay. Intellectual disability and autism spectrum disorder frequently co-occur; to make comorbid diagnoses of autism spectrum disorder and intellectual disability, social communication should be below that expected for general developmental level.

Intellectual disability alone actually rules out ASD if you don't have the core ASD symptoms. 

Also, the DSM criteria D emphasises social, occupational, or other important areas of current functioning.

The extra IQ specification
Specify if:
- With or without accompanying intellectual impairment
- With or without accompanying language impairment

is an attachment to the ASD diagnosis, which emphasises social communication and restricted behaviours, and other social/occupational functioning. 

The high/low-functioning label to me is the same as the extra specifications that just adds something additional to the major ASD traits. It's an additional description, rather than the core symptoms. 

I think people are criticising the usage of cognitive functioning without knowing what scientists mean by cognitive functioning, or what is in the literature. There are psychologists that focus on cognitive stuff, and there are psychologists that focus on social stuff. There are many different areas in psychology and people usually find something to specialise in.

...a similar scenario would be criticising a biologist studying "animal cells" why aren't they thinking about "plant cells", and saying they will be missing out on understanding all the cells of living organisms. 

And yet the narrow emphasis  on IQ  with regards to functioning  is counterproductive re truly helping people and acknowledging their difficulties.

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/

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

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?