LFA and HFA
LFA—”low-functioning autism”—and HFA—”high-functioning autism”—are two phrases that I prefer not to use in writing about autism and, more specifically, about my son Charlie. Generally, “LFA” is associated with being at the “severe” end of the autism spectrum (Ballastexistenz writes about LFA stereotypes) and “HFA” is associated with being at the “mild” or “Asperger’s” end of the spectrum. LFA has been defined as having an IQ lower than 70, and HFA as having one higher than 70 (see Investigation of neuroanatomical differences between autism and Asperger syndrome).
I prefer to talk about the “level” that Charlie “functions” at, and even of just where he is at, by talking about he struggles to do and what he needs yet to learn, and about what he can do.
How do you feel about using the phrases LFA and HFA?
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POSTED IN: Asperger's Syndrome, Language, Psychology, Stereotypes
20 opinions for LFA and HFA
Jannalou
Jul 20, 2006 at 6:38 am
Honestly, I think they’re over-used and far too generalized to be of any practical use. The kids I’ve worked with can’t be classified easily as one or the other; sure, one of the kids I hang out with on Saturdays is really social and able to carry on conversations, but he’s not working at grade level in his school stuff. So is he “HFA” or “LFA”? Probably “HFA” to most people. But what about the girl I worked with in Vancouver, who has tons of friends and is really outgoing and social, but is working far below grade level academically and doesn’t have a lot of functional language?
And leave us not forget the variability of “functioning level”. Someone can be quite capable of looking after themselves one day and be incapacitated the next. Are they “high” or “low”?
Kristina Chew, PhD
Jul 20, 2006 at 6:39 am
I agree—-and yet, despite a sense of frustration with these terms among the parents I know, they are STILL used so much.
Rose
Jul 20, 2006 at 8:33 am
I don[’t see anything about Ballestexistenz’s mind that is low functioning, let alone of low IQ.
Maybe, in many ways, a “LFA” kid could be one who hasn’t found an outlet, yet…
Ballastexistenz
Jul 20, 2006 at 9:05 am
I don’t believe in LFA and HFA. Period. They’re a one-dimensional measure of a many-dimensional thing, and they’re not backed up as meaningful by science either.
I don’t want to give any credit to IQ tests by claiming IQ to be an actual thing instead of an imaginary cooked-up number, so I don’t consider it a compliment to be told what my IQ must “really” be. There is no such thing as a “real” IQ versus a “fake” IQ, they’re all false as far as I’m concerned, and doubly false when applied to autistic people.
To say that I obviously don’t have a low IQ is to say that people who do score low on IQ tests (for reference I don’t know my own score, I’ve only had one fairly-conducted-by-IQ-test-standards IQ test and nobody ever told me the results except that they seemed to be all over the place) aren’t smart. I know many people far smarter and more educated than me (and who I’ve seen routinely accomplish mental feats I may never accomplish) who score low on IQ tests. It seems like one more form of stereotyping to think that you’d know someone’s “IQ” from their writing, and it’s landed people with low IQs in the self-advocacy movement in trouble. They get told “You don’t really have an intellectual disability, you’re too smart, too articulate, etc.” So… no. I’m not going into that territory.
I would not mind the ideas of high and low functioning in various areas quite so much, if they corresponded to a measure of where specific narrow skills were at a particular point in time, rather than a designator that encompasses all of a person’s abilities.
If you looked at that, you would actually find that, as one autie I know put it, “My islands of ability have steep cliffs.” I have incredible levels of skill in some areas (that pretty much tie back to one or two cognitive abilities I’m really good at), and then in most other areas of thinking I’m not exactly great at them.
If you want to see “low functioning” areas of my cognition, you don’t actually have to go very far. Tell me to brush my teeth. Tell me to take papers that are coming out of the printer and collate them in piles on my desk. Tell me to fix my own food and eat it. Tell me to figure out how to wash myself. Tell me to walk upright in unfamiliar surroundings without walking into walls and people. Tell me… oh lots of things, it’s very easy to find the areas in which my thinking doesn’t work too well.
Anything, on the other hand, that can be got at by a certain method of pattern-matching, I can be extremely skilled at.
I think, by the way, that all people have “low functioning” cognitive areas. Most just don’t have them thrown in their face every day like I do.
Kassiane
Jul 20, 2006 at 11:45 am
I HATE the dichotomy. Utterly and totally.
I’m very verbally adept. I know this, I have known this, and it only changes under extreme stress. I can rely on words. So people automatically assume I am Aspie or “high functioning”. Neither of these is strictly true. High functioning in language, yes. In gross motor skills, yes. In cooking/cleaning/paying bills on time? HA! In their dreams! Then I know people who can maintain a household who verbalize much more poorly than I do if at all. So which of us is high functioning? Both and neither.
Kristina Chew, PhD
Jul 20, 2006 at 1:25 pm
One of my “low functioning” cognitive areas is in visualizing physical space—–I have a great deal of trouble parking the car……. and I need to see a map to figure out directions.
alexander's daddy
Jul 20, 2006 at 2:14 pm
I’m extremely “high functioning” at finding patterns like Amanda. When I was into video games as a teen, I was able to find the pattern in the games with relative ease and when at the arcade, I could play for hours off of one quarter and I would always draw a crowd of people (however, I never felt comfortable with that aspect although I did like the attention, as long as no one talked to me). However, I’m very low functioning when it comes to empathizing with someone else’s interests, although I really try hard to put on a “face” that I’m interested, but really, I’m just dying to leave.
Alexander has been described by a UNC Pscyhiatrist and NIH researcher as very “high functioning” and at the same time “robustly” autistic. I’ve written this before but for some reason, I just love the label “robustly autistic”. It’s almost as if they mean that Alexander’s autism is sort of “out of this world autistic”, “world champion autistic” or something and I guess it just brings out my natural competitiveness. He is extremely talented with letters, words, and visual pattern recognition.
Ashley Morgan
Jul 20, 2006 at 3:56 pm
I think LF and HF are so broadly used that they really don’t have a definition that most people accept. I was reading everyone’s take, and boy are they different! I always thought LF and HF was more of a quantitative reference to deficits/challenges/differences, what have you. Who knows!
I use the word HF in my site (not much, but it’s there) to demonstrate there is a spectrum in this spectrum, so that I may reach out to support mainstreamed elementary school age children and their parents. Maybe I need a better adjective….
I thought the aspie ref was legit too, but what about those aspies that cannot speak? I wonder what their test scores were like.
Just like being on the spectrum really doesn’t tell you a whole heck of a lot either, other than a person or child may or may not have X,Y, and Z.
And IQ? I didn’t think anyone paid attention to IQs anymore, since they really don’t indicate much. When my child didn’t understand how to use language, his IQ was low. Later he used language, and was tested to be very intelligent.
Those comments about IQ are indeed hurtful in my opinion. I am also of the belief that most people with ASD don’t have cognitive deficits, that it’s other deficits that cause them to test poorly.
Ignorance still dominates when it comes to ASD. I think this attributes to the numerous definitions of the spectrum, as well as what ABA is, anything on this topic.
Kristina Chew, PhD
Jul 20, 2006 at 8:59 pm
IQ scores mean little to me, as regards Charlie. Just another test he has to struggle through, indeed.
“Robustly autistic”?!!!?? That is a new phrase for me—-I will venture that it indeed applies to Charlie (who, AD, you may note has always been macrocephalic).
Ballastexistenz
Jul 21, 2006 at 4:43 am
By using “HF” to refer to “mainstreamed” children, you’re implying that only certain kinds of children can be mainstreamed. Which isn’t true either.
Ashley Morgan
Jul 21, 2006 at 4:57 am
I’m not implying anything.
Shawn
Jul 22, 2006 at 10:10 am
My thinking on this topic is very much along the lines of Ballastexistenz. When HFA and LFA are used the turn autism into a one dimensional spectrum. The terms are useless in this context. HF and LF can be very useful to communicate about particular skills (and as Ballastexistenz said, at particular points in time).
The other issues is that the terms define autism in only two shades: HF, and LF. Even when we talk about particular skills, the terms are not specific or descriptive. Maybe they are useful as a start, but only as a start.
Kristina Chew, PhD
Jul 22, 2006 at 6:10 pm
Thanks Shawn for your insights—they are a start to move on from, indeed!
Autism Vox
Jul 27, 2006 at 8:29 am
[…] Nazeer does not use terms like “high-functioning” or “low-functioning” in writing about his former classmates, though not all have been able to “achieve” the “success” of Craig and André, and of Nazeer himself. What Send In the Idiots: Stories from the other side of autism shows is how, however many academic skills one has acquired, however many social skills one has been trained in, the difference of autism remains. Randall is a bike messenger in Chicago and the only one of the former classmates to be involved in a romantic relationship (which ends when Randall discovers that his partner, Mike, has been cheating on him—and that Mike thought that Randall would be unaware of this). Elizabeth struggled to learn to take the bus to the library by herself, lived with her parents, and gave piano lessons. She committed suicide at the age of 26 in 2002 by swallowing “the contents of most of her bottles and jars, even the nutritional supplements” (p. 173) and climbing into the swimming pool. […]
Autism Vox » Dangerous and Misleading: Alison Singer on cure, lfa, hfa, and autism
Oct 6, 2006 at 1:47 pm
[…] Singer makes a distinction between those who are “lower-functioning” and “higher-functioning”—-terms that I think (see this earlier post) are not only inaccurate, but highly, and dangerously, misleading (see what Mom-NOS writes about this subject and also Ballastexistenz). […]
Autism Vox » The ‘head-spinning heterogeneity’ of the autism spectrum
Nov 24, 2006 at 6:48 pm
[…] You can follow any responses to this entry through the RSS 2.0 feed. You can leave a response, or trackback from your own site. Related Posts: A Really Big Windmill…Dangerous and Misleading: On cure,lfa, hfa, and autism…Unathletic…….not!…No Single Explanation for Autism?…6 Facts You Need to Know About Autism?…Why I Worry About Charlie on the Bus…Welcome to Teenage and Adult Autism… […]
MFA
Nov 16, 2007 at 3:38 am
[…] am not comfortable with, not think it accurate, to describe Charlie as “LFA” or “HFA,” most of all because what I gather to be the commonly used meanings of these terms does not truly […]
High and Low
Feb 13, 2008 at 3:05 am
[…] was some discussion yesterday about bring “high” or “low” or “middle” “functioning.” Charlie’s experience learning to play […]
ATM
Jun 19, 2008 at 11:14 pm
B”H
I would be classified as HFA. However, there are times when I doubt that classification. I agree with the lady who stated that she was verbal,yet that in “cooking/cleaning/paying bills on time? HA! In their dreams!” This describes my situation perfectly. Is it against the definition of “LFA” to have existential angst?
ATM
Melody
Jun 19, 2008 at 11:45 pm
Hmm, yeah. I’m quite high-functioning in math, chemistry, and physics, whereas I’m high to middle to low functioning (depending on what time you see me) in auditory processing, laundry, food preparation, speech, dealing with change, navigating bureaucracy (aren’t we all!), etc.
However, in areas of physics, calculus, and chemistry, the special services staff were mostly quite low-functioning. Those poor, poor soles ;-)
However, when it comes to auditory processing and movement initiation, they are astonishingly high-functioning. Splinter skills, anyone?
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