The misnomer of ‘high functioning autism’: Intelligence is an imprecise predictor of functional abilities at diagnosis

Author:

Alvares Gail A1ORCID,Bebbington Keely1,Cleary Dominique1,Evans Kiah1,Glasson Emma J1,Maybery Murray T1,Pillar Sarah1,Uljarević Mirko2ORCID,Varcin Kandice1,Wray John3,Whitehouse Andrew JO1

Affiliation:

1. Telethon Kids Institute, The University of Western Australia, Australia

2. Stanford University, USA

3. WA Department of Health, Australia

Abstract

‘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. This study investigated the relationship between adaptive behaviour, cognitive estimates (intelligence quotient) and age at diagnosis in autism spectrum disorder. Participants ( n = 2225, 1–18 years of age) were notified at diagnosis to a prospective register and grouped by presence ( n = 1041) or absence ( n = 1184) of intellectual disability. Functional abilities were reported using the Vineland Adaptive Behaviour Scales. Regression models suggested that intelligence quotient was a weak predictor of Vineland Adaptive Behaviour Scales after controlling for sex. Whereas the intellectual disability group’s adaptive behaviour estimates were close to reported intelligence quotients, Vineland Adaptive Behaviour Scales scores fell significantly below intelligence quotients for children without intellectual disability. The gap between intelligence quotient and Vineland Adaptive Behaviour Scales scores remained large with increasing age at diagnosis for all children. 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.

Funder

Raine Medical Research Foundation

National Health and Medical Research Council

Publisher

SAGE Publications

Subject

Developmental and Educational Psychology

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