Low Functioning Autism: Challenges, and Treatment Options

Low functioning autism, also known as classic autism or severe autism, refers to autism spectrum disorder (ASD) accompanied by significant intellectual disability and impairment in daily living skills.

Individuals with low functioning autism have more severe symptoms and greater support needs compared to those with high functioning autism or Asperger’s syndrome. While there are no standard criteria, low functioning autism is sometimes defined by an IQ below 70 along with limited communication and self-care abilities.

Some key features of low functioning autism include:

• Minimal or absent spoken language abilities. Many are nonverbal or have very limited speech.

• Cognitive and learning disabilities. Most have an intellectual disability with an IQ below 70. Academic skills are significantly delayed.

• Poor adaptive behaviors and self-care skills. Daily living skills like dressing, hygiene, and feeding are severely impacted.

• Repetitive behaviors and restricted interests. Rigid routines, repetitive motions, and intense preoccupations are common.

• Sensory issues. Unusual sensory responses like hypersensitivity to sound or lack of pain awareness.

• Behavioral challenges. Difficulty regulating emotions may lead to tantrums, aggression, or self-injury.

Compared to high functioning autism, where language and cognitive abilities are within the average range, low functioning autism involves more profound disabilities and difficulties functioning independently. However, there is a wide spectrum of severity within low functioning autism. Support needs depend on the individual’s abilities

Common Characteristics

Individuals with low functioning autism have significant impairments in several areas:

• Delayed speech and language skills: Most children with low functioning autism have very limited verbal skills. Many remain nonverbal throughout their lives or have a vocabulary of only a few words. Their receptive language skills (ability to understand speech) are often better than their expressive language skills.

• Significant cognitive impairment: In addition to communication deficits, low functioning autism involves intellectual disability or an IQ below 70. Individuals have trouble with conceptual thinking, problem solving, judgment, and other higher-level cognitive functions.

• Poor social and communication skills: Due to their language delays and cognitive deficits, social interactions are very challenging. Individuals have difficulty relating to others, picking up on social cues, communicating wants and needs, and expressing emotions. Many avoid eye contact and prefer to be alone.

• Repetitive behaviors: Restricted interests, repetitive motions, and rigid adherence to routines are common. These behaviors may include hand flapping, rocking, spinning, lining up toys, obsessive interests, and extreme distress at small changes. Repetitive behaviors are thought to provide comfort amid social difficulties.

Causes and Risk Factors

Low functioning autism appears to arise from a complex combination of genetic and environmental factors that affect early brain development. Research has uncovered some of the key factors that may contribute to autism spectrum disorder, though more study is needed to fully understand the causes.

Genetic Mutations

Certain genetic mutations and variations seem to increase the risk of autism. Studies of identical twins show that if one twin has autism, the other twin is very likely to also have it. Additionally, siblings of people with autism have a higher risk of developing it compared to the general population. Researchers have identified mutations in over 100 genes that may play a role. Many of these genes are involved in brain development and function. However, each mutation only accounts for a small fraction of cases.

Environmental Factors

Environmental influences may interact with genetic factors to affect brain development in ways that lead to autism. Potential environmental risk factors under investigation include viral infections or metabolic imbalances during pregnancy, complications at birth, air pollution, pesticides, and medications taken during pregnancy. More research is needed to confirm environmental risks.

Brain Structure and Function

Autism spectrum disorder appears to arise from differences in brain development and structure that affect behavior, social skills, speech, and learning. Neuroimaging studies show differences in the shape and structure of the brain in children with autism compared to typical development. Regions associated with social skills, empathy, and processing of information tend to be affected. There also appear to be differences in neural connectivity and information processing. However, there is no single “autism brain.” Each person has a distinct set of differences.

Diagnosis

Diagnosing low functioning autism involves a comprehensive evaluation by a team of specialists. There is no single medical test that can diagnose autism spectrum disorder (ASD).

Diagnostic Criteria

To receive a diagnosis of low functioning autism, the diagnostic criteria in the DSM-5 (Diagnostic and Statistical Manual of Mental Disorders) must be met. These criteria involve persistent deficits in social communication and social interaction, restricted and repetitive behaviors, symptoms that are present in early childhood, and symptoms that cause significant impairment in functioning.

Assessment Tools and Evaluations

The diagnostic process involves:

• Developmental screening
• In-depth clinical interview with parents
• Medical exam to rule out underlying medical causes
• Hearing test
• Observation of the child
• Autism-specific behavioral evaluations, such as:
  • Autism Diagnostic Observation Schedule (ADOS-2)
  • Autism Diagnostic Interview-Revised (ADI-R)

These standardized tools assess communication, social interactions, play skills, repetitive behaviors, and restricted interests.

Average Age of Diagnosis

The average age of diagnosis for low functioning autism is 3-4 years old. Early screening and detection can facilitate earlier diagnosis and access to treatment services. However, milder cases may go undetected until social demands exceed capacities.

Treatment and Intervention

Treatment and intervention for low functioning autism focus on managing symptoms and improving quality of life. The main approaches include:

Behavioral Therapy

Behavioral therapy uses positive reinforcement and other techniques to improve communication, social skills, learning, and behaviors. Examples include applied behavior analysis (ABA), which breaks down skills into small teachable steps. Intensive ABA can be over 20 hours per week.

Speech and Language Therapy

Speech therapists work on communication skills like making eye contact, using gestures, improving verbal skills, and learning to interpret body language. Social skills training teaches appropriate interactions.

Medications

While no medication treats the core symptoms of autism, some medications can help manage related conditions like depression, anxiety, obsessive-compulsive disorder (OCD), and attention deficit hyperactivity disorder (ADHD).

Educational Support

Many children with low functioning autism benefit from special education services and individualized education programs (IEPs). This may involve small classroom sizes, one-on-one aides, social skills instruction, and life skills development.

The goal is to provide structure, routine, and support for learning and positive behaviors. A team approach with therapists, teachers, parents, and other professionals benefits the child.

Daily Living and Care

Individuals with low functioning autism require varying levels of support in their daily lives depending on the severity of their symptoms. Their ability to function independently can range from needing full-time care to being able to handle some daily tasks on their own.

Level of independence

• Those with severe low functioning autism often have very limited independence and require around-the-clock care and supervision for basic needs like eating, bathing, and dressing. They may be unable to communicate their wants and needs effectively.

• Higher functioning individuals may be able to handle more self-care tasks independently but still need assistance with managing more complex daily living skills like household chores, transportation, shopping, and finances. They generally require some level of routine support.

Residential options

• 24/7 residential care facilities provide fully supervised care and accommodate medical needs. These can be public, private, or non-profit group homes.

• Some higher functioning adults may live in semi-independent housing with visiting caregivers or aids. Others may be able to manage with outpatient services.

• Living at home with family members who serve as caregivers is also an option based on the individual’s support needs.

Caregiver support needs

• Caring for someone with severe low functioning autism requires physical stamina and emotional resilience. Caregivers need respite care breaks and support services.

• Specialized training in behavioral and communication strategies is essential for both professional and family caregivers.

• Counseling, support groups, and advocacy resources can help prevent caregiver stress and burnout. Securing adequate public services is often a challenge.

• Financial assistance for medical care, therapies, and residences is crucial but not always readily available. Long-term care planning is important.

Transition to Adulthood

The transition to adulthood can be challenging for individuals with low functioning autism. As they near adulthood, it’s important to start planning and preparing them for the future. Some key areas to focus on include:

Academic and Vocational Options

• Consider vocational training programs that provide hands-on experience and teach practical job skills. These programs can help individuals with low functioning autism explore potential careers that match their interests and abilities.

• Look into supported employment programs that provide coaching and support on the job site. A job coach can help with training, managing behaviors, and social interactions.

• For those pursuing higher education, meet with disability services at colleges to discuss accommodations and supports. Things like extended time on exams, note-takers, and assistive technology can help.

Developing Life Skills

• Work on daily living skills like managing money, cooking, cleaning, and using public transportation. Role-playing real-world situations can help reinforce these skills.

• Teach practical skills like time management, organization, hygiene, and appropriate social skills. Use schedules, checklists, and visual aids as needed.

• Explore living options such as living at home, group homes, or supported/independent living. Identify the level of support needed.

Importance of Routines

• Stick to consistent daily routines and schedules to provide structure and stability. Make adjustments gradually and with preparation.

• Create visual schedules and calendars to reinforce routines. Review them regularly.

• Practice flexibility within routines. Unexpected changes can happen, so work on coping skills. Offer rewards for flexibility.

With preparation, adolescents and young adults with low functioning autism can successfully transition to more independent living and working. Focusing on their strengths and providing the right support are key.

Prognosis and Outlook

Individuals with low-functioning autism have a wide range of capabilities and outcomes. While some may require significant lifelong care and support, others can live semi-independently with assistance. With appropriate interventions and accommodations, many can lead productive and fulfilling lives within their communities.

The level of independence possible for each person depends on factors like communication and cognitive abilities. Some are unable to speak and have limited self-care skills, relying on caregivers for basic needs. Others develop speech and self-help skills with therapy. A minority learn to read and write.

Regardless of skill level, most benefit from structure, routine, and support. With help transitioning to adulthood, some hold simple jobs or live in group homes with supervision. More impaired individuals may live in residential care facilities providing medical and living assistance.

While low-functioning autism poses challenges, the right interventions and support system can enable individuals to maximize their potential. The prognosis focuses on adaptive skills and quality of life over typical milestones. With compassion and opportunity, those with low-functioning autism can thrive.

Challenges Faced by Families

Raising a child with Low Functioning Autism can be an overwhelming experience for families. The challenges faced by families of individuals with Low Functioning Autism are numerous and multifaceted. These challenges can have a significant impact on the physical, emotional, and financial well-being of the family members.

1. Emotional and Physical Exhaustion

One of the most significant challenges faced by families of individuals with Low Functioning Autism is emotional and physical exhaustion. Caring for a child with Low Functioning Autism requires round-the-clock attention, which can lead to sleep deprivation, chronic stress, and burnout. Parents may find themselves constantly on edge, anticipating their child’s next meltdown or outburst. This constant state of alertness can take a toll on their mental health, leading to anxiety, depression, and other stress-related disorders.

2. Financial Burden

Another major challenge faced by families of individuals with Low Functioning Autism is the financial burden associated with caring for their child. The cost of therapy sessions, medications, specialized equipment, and other necessary resources can quickly add up. Many families struggle to afford these expenses while also providing for their basic needs such as food, housing, and transportation.

3. Social Isolation

Families of individuals with Low Functioning Autism often face social isolation due to the unique needs of their children. It can be challenging to find appropriate social activities that cater to their child’s specific needs. Additionally, some parents may feel embarrassed or stigmatized by their child’s behavior in public settings such as restaurants or stores.

4. Lack of Support and Resources

Finally, families of individuals with Low Functioning Autism often face a lack of support and resources within their communities. It can be challenging to find qualified therapists or healthcare providers who specialize in working with children with autism. Additionally, many schools do not have adequate resources or training to support students with autism effectively.