Lisa has 27 years of experience treating speech, language, memory and swallowing disorders in a variety of settings. She has a master's degree in speech pathology from Vanderbilt University.
Positions on the Spectrum
The autism spectrum by definition covers a wide range of performance. At one end are persons with normal intelligence who exhibit some of the typical characteristics of autism, such as poor social skills and difficulty with theory of mind, or understanding other people's points of view. At the other end of the spectrum, we find people who often need the help of others to do even the most basic of daily tasks, and whose communication and social skills may seem nearly nonexistent.
Defining Low Functioning Autism
Typically, children and adults with low functioning autism are not verbal. If they do speak, their speech often consists largely of echolalia, or repetition of what they hear. As a result, they have a hard time expressing themselves and may act out when they are upset, in pain or frustrated. Self -injury (hitting or biting themselves) and self-stimulation (flapping hands, walking in circles or spinning around) are common forms of this behavior.
Their memory for events is generally below average, though they may have pockets of exceptional talent, often called savant skills. They may have other physical challenges like seizures, migraines, or digestive disorders. In addition, people with autism often have sensory disturbances, such as discomfort with being touched, or inability to tolerate loud noise or bright light. The medical definition of low functioning autism is an IQ below 80.
Debate Over Terms
There is considerable disagreement within the autism community about the very use of the term 'low functioning' and how it is determined. A score on one test, measured at an arbitrary cutoff point, doesn't take into account much of what makes a person who they are. In fact, these tests may not accurately measure the cognitive ability of an individual, but rather focus on identifying the spectrum level. If a person with autism has a low IQ, but is interested in the world around him, wants to learn new things, and tries hard, is that really low function?
Consider Dennis. He's thirty years old and lives in a group home with two other men with autism. He only says a couple of words, and he needs a caregiver's help to bathe and dress. However, he loves to spend time in the garden out back, and has learned over time, with patient repetition, the names of many plants and tools. If Nita, his primary caregiver, says, ''Dennis, can you hand me the shovel?'' he does it with a big smile on his face.
Making a Connection
When a new caregiver, Byron, started working at Dennis' group home, he assumed at first that Dennis couldn't understand or express himself at all. Nita showed him how Dennis communicates using picture cards laminated and velcroed to a board. Byron was quietly amazed when Dennis pulled a photo of a bottle of juice off the board and brought it to Nita to ask for a drink.
Over time, Byron learned Dennis' language. One day, Dennis made some unhappy noises, and then began to slap himself on the forehead. Byron panicked, tried to block Dennis' hand, and called for Nita. Nita explained that Dennis hadn't yet mastered a better way to tell them when he has a sinus headache. She reassured Dennis and got the nurse to bring him his medicine, and he calmed down.
Byron tried to hug Dennis one day, and Dennis became upset. That upset Byron too, but after some thought, he had an idea. He began teaching Dennis to give him a fist bump as a greeting. When Dennis' sister and her family came to visit, they were amused to see Byron arrive for work and Dennis immediately trot across the room with his fist held out!
Byron has learned a vital lesson about people with low functioning autism: Never underestimate their potential, and always give them a chance to learn and try new things at their own pace. Dennis learns in baby steps, so to speak. His rate of improvement is slow, but he is capable of learning.
In the winter, Dennis spent more time pacing in circles and sitting rocking. Nita wondered if he was bored because they couldn't garden outside, and she and the other caregivers brainstormed some ideas. Byron took Dennis to the local garden store and helped him pick out some pots and supplies, including his own pair of gardening gloves.
The whole house got involved and enjoyed planting and growing fragrant herbs indoors. The next time Dennis' sister visited, he took her hand and led her to see 'his garden'. As she and Byron watched Dennis carefully and thoroughly water each plant, she admitted with a smile, ''I never imagined Dennis could ever learn to do anything so--well, normal!''
Low functioning autism is a term used for people at one extreme of the autism spectrum. The clinical definition is persons with an IQ lower than 80 who also demonstrate a number of behaviors that limit their ability to perform daily tasks, including echolalia, self-injury, self-stimulation, lack of theory of mind, and sometimes savant skills. However, a good argument can be made that the term 'low functioning' is misleading, since all people with autism can learn new skills, if the teaching is geared toward their particular set of strengths and challenges.
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