Low-functioning autism

Low-functioning autism (LFA) is autism with an intellectual disability (an IQ of 69 or below). Symptoms may include impaired social communications or interactions, bizarre behavior, and lack of social or emotional reciprocity. Sleep problems, aggressiveness, and self-injurious behavior are also possible frequent occurrences.[10] LFA is not a recognized diagnosis in the DSM-5 or ICD-10.

Low-functioning autism
SpecialtyPsychiatry
ComplicationsSocial isolation, employment problems, family stress, bullying, self-harm[1]
Usual onsetBy age two or three[2][3]
DurationLong-term
CausesGenetic and environmental factors
Diagnostic methodBased on behavior and developmental history
Differential diagnosisIntellectual disability, Fragile X, anxiety
ManagementBehavioral therapy, speech therapy, psychotropic medication[4][5][6]
MedicationAntipsychotics, antidepressants, stimulants (associated symptoms)[7][8][9]

Synonyms include Kanner's syndrome, Kannerian autism and classic autism.[11] The terms overlap with severe autism and profound autism (as opposed to "mild" or "moderate"), which may be vaguely defined and not necessarily correlate with severe and profound levels of intellectual disability (where profound is the most severe level).[12][13]

Characterization

People who display symptoms for LFA usually have "impairments in all the three areas of psychopathology: reciprocal social interaction, communication, and restricted, stereotyped, repetitive behaviour".[14]

Severe impairment of social skills can be seen in people with LFA. This could include a lack of eye contact, inadequate body language and a lack of emotional or physical response to others' behaviors and emotions. Due to the lack of these social skills, it may be hard for these patients to form or maintain relationships with others.[15]

Communication impairments shown in people with LFA include lack of communication (both oral communication – i.e. nonverbal autism – and body language), repetitive use of words or phrases, and lack of imaginative play skills.[16] They also may respond only to very direct external social interaction from others. Specific behavioral impairments that may be exhibited by a person with LFA include adherence to nonfunctional rituals or routines, repetitive motor functions such as hand flapping or complex whole body movements, and restrictive or obsessive patterns of interest that are abnormal. Other symptoms may include preoccupation with non-functional elements of play materials such as their odor, feel, or noise they generate.[3]

Causes

The exact causes of autism are unknown, but it is believed that both genetic and environmental factors play a role in its development.[17] Multiple studies have shown different types of structural abnormalities in the brains of people with autism.[18] Experiments have been conducted to determine if the degree of brain abnormality yields any correlation to the severity of autism. One study done by Elia et al. (2000) used magnetic resonance imaging (MRI) on the midsagittal area of the cerebrum, midbrain, cerebellar vermis, corpus callosum, and vermal lobules VI and VII to measure brain abnormalities in children with low-functioning autism. The results suggested that the midbrain structures correlate with certain developmental behavioral aspects such as motivation, mnemonic, and learning processes, but further studies would need to be conducted to confirm this.[19] Furthermore, research has shown that many developmental processes may contribute to several types of brain abnormalities in autism; therefore, determining the link between such abnormalities and severity of autism proves difficult.[20]

Diagnosis

While low-functioning autism has never been an official diagnosis in the Diagnostic and Statistical Manual of Mental Disorders published by the American Psychiatric Association, it was a classification in the DSM-4 to refer to someone with autism who has an intellectual disability (an IQ of 69 or below). But in the present diagnostic standards in the DSM-5, the classification of LFA has been removed.[21]

The criteria for autism spectrum disorders in the DSM-5 is broken down into three levels of support required, the criteria for level 3 (requiring very substantial support) includes severe deficits in communication skills (verbal and nonverbal), inflexibility of behavior, extreme difficulty coping with change, and extreme difficulty with shifting focus and attention. Individuals with level 3 autism would initiate very limited amounts of social interactions and would respond only to direct social approaches from others.[3]

The ICD-10 criteria for childhood autism postulate that abnormal or impaired development is evident before the age of 3 in receptive or expressive language used in social communication, development of selective social attachments or reciprocal social interactions, or functional or symbolic play. The patients would also be required to exhibit six other symptoms from three macro-categories pertaining to qualitative impairment in social interactions, quantitative abnormalities in communication, and restricted/repetitive/stereotyped patterns of behavior, interests, and activities. ICD-10 differentiates patients with high functioning and low-functioning autism by diagnosing the additional code of intellectual disability.[22]

Therapy

Augmentative and alternative communication

Augmentative and alternative communication (AAC) is used for autistic patients who cannot communicate orally. Patients who have problems speaking may be taught to use other forms of communication, such as body language, computers, interactive devices, and pictures.[23] The Picture Exchange Communication System (PECS) is a commonly used form of augmentative and alternative communication with children and adults who cannot communicate well orally. Patients are taught how to link pictures and symbols to their feelings, desires and observation, and may be able to link sentences together with the vocabulary that they form.[24]

Speech-language therapy

Speech-language therapy can help those with autism who need to develop or improve communication skills.[14] According to the organization Autism Speaks, “speech-language therapy is designed to coordinate the mechanics of speech with the meaning and social use of speech”.[25] People with low-functioning autism may not be able to communicate with spoken words. Speech-language Pathologists (SLP) may teach someone how to communicate more effectively with others or work on starting to develop speech patterns.[26] The SLP will create a plan that focuses on what the child needs.

Occupational therapy

Occupational therapy helps autistic children and adults learn everyday skills that help them with daily tasks, such as personal hygiene and movement. These skills are then integrated into their home, school, and work environments. Therapists will oftentimes help patients learn to adapt their environment to their skill level.[27] This type of therapy could help autistic people become more engaged in their environment.[28] An occupational therapist will create a plan based on the patient's’ needs and desires and work with them to achieve their set goals.

Sensory integration therapy

Sensory integration therapy helps people with autism adapt to different kinds of sensory stimuli. Many with autism can be oversensitive to certain stimuli, such as lights or sounds, causing them to overreact. Others may not react to certain stimuli, such as someone speaking to them.[29] Many types of therapy activities involve a form of play, such as using swings, toys and trampolines to help engage the patients with sensory stimuli.[30] Therapists will create a plan that focuses on the type of stimulation the person needs integration with.

Applied behavioral analysis (ABA)

Applied behavioral analysis (ABA) is considered the most effective therapy for Autism spectrum disorders by the American Academy of Pediatrics.[31] ABA focuses on teaching adaptive behaviors like social skills, play skills, or communication skills[32][33] and diminishing problematic behaviors like eloping or self-injury[34] by creating a specialized plan that uses behavioral therapy techniques, such as positive or negative reinforcement, to encourage or discourage certain behaviors over-time.[35]

Medication

There are no medications specifically designed to treat autism. Medication is usually used for symptoms associated with autism, such as depression, anxiety, or behavioral problems.[36] Medicines are usually used after other alternative forms of treatment have failed.[37]

Criticism of functioning labels

Many autistic rights activists disagree with the categorisation of individuals into "high-functioning autism" and "low-functioning autism", stating that the "low-functioning" label causes people to put low expectations on a child and view them as lesser. [38] Furthermore, critics of functioning labels state that an individual's functioning can fluctuate from day to day, and categories do not take this into consideration. [39]

See also

References
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  11. Boucher, Jill (13 November 2008). The Autistic Spectrum: Characteristics, Causes and Practical Issues. SAGE. p. 38. ISBN 978-1-4462-0533-4. [...] what may be a major change in terminology over the next decade. This major change, if it comes about, will involve using the word ‘autism’ to apply only to what has been variously termed Kanner's syndrome, classic autism, autistic disorder, or low-functioning autism, whilst using ‘Asperger syndrome’ synonymously with high-functioning autism. [...] A demotion of the term [...] to refer only to one subtype of ASD is likely to be slow to percolate into popular usage, if it ever does. (The author is a professor of developmental psychology at City University in London.)
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