Low-functioning autism (LFA) refers to autistic people who fall into the severe categories of autism spectrum disorder. 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.
Contents
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".
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.
Communication impairments shown in people with LFA include lack of communication (both oral communication and body language), repetitive use of words or phrases, and lack of imaginative play skills. 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.
Causes
The exact causes of autism are unknown, but it is believed that both genetic and environmental factors play a role in its development. Multiple studies have shown different types of structural abnormalities in the brains of people with autism. 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) imaging 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. 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.
Diagnosis
The most current criteria used for the diagnosis of autism are contained in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) published by the American Psychiatric Association (APA), and the International Classification of Diseases (ICD-10) coding system published by the World Health Organization (WHO).
The criteria defined for categorizing an individual’s autism are broken down by three levels of severity according to DSM-5. “Level 3” would describe a person with low functioning autism. The specific criteria for diagnosis of a person with Level 3 autism include severe deficits in communication skills (verbal and nonverbal), inflexibility of behavior, extreme difficulty coping with change, and extreme difficulty with shifting focus and attention. Patients who exhibit the criteria defined for diagnosis of LFA would require “very substantial support” according to the DSM-5 standards. They would initiate very limited amounts of social interactions, and would respond only to direct social approaches from others.
The ICD-10 criteria for childhood autism postulates 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 mental retardation.
Augmentative and Alternative Communication (AAC)
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. 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.
Speech-Language Therapy
Speech-language therapy can help autistics who need to develop or improve communication skills. 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”. 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. 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. This type of therapy could help autistic people become more engaged in their environment. 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 autistics 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. 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. 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) focuses on changing the behavior of the individual. A therapist will create a specialized plan that uses behavioral training techniques, such as positive or negative reinforcement, to encourage or discourage certain behaviors over time. Some skills that are taught include social skills, play skills and communication skills.
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. Medicines are usually used after other alternative forms of treatment have failed.