Autism Spectrum: mild, moderate or severe AS?

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There was a thread a while back trying to discern the differences between mild, moderate and severe Asperger's by Another_Alien. Here was his definition on mild Asperger's:

His definitions did not bode well with all of the users, particularly when he said anybody with severe Asperger's will probably not be on this site and his definitions of success were based around material wealth. Whilst his categories may have been problematic for some of the reasons other users pointed out, I think they do have more than a grain of truth in them.

When we talk about the severity of an aspie's condition, what we mean is how impaired they are by their autism when in comes to fitting into, adapting to and participating in the neurotypical world. The neurotypical world is based around non-verbal communication. Things that seem entirely superficial, particularly to us, such as popularity, social and romantic lives, material wealth and a successful career requires at least some limited understanding of non-verbal communication and the ability to emulate them successfully. Whether we like it or not, the neurotypical world is mostly superficial. For example, if you don't have a car or don't drive by my age, you are seen as having something wrong with you by many NT's. Moreover, you haven't gotten laid or had a relationship by my age, your sexuality will come into question. If you're not working or you're still living at home with your parents, you are seen as a bit of a loser. If you don't have friends or a social life you will be called a hermit. The sad truth is, and many of you may not like it, NT's judge you heavily by these superficial things. They view not having these things by a certain age as a sign of a lack of independence or maturity. A person with mild Asperger's or autism probably has the capacity to be accepted by NT peers and become unwittingly an honoury neurotypical. Now, not having those things does not necessarily you have moderate or severe Asperger's or autism. Off the top of my head, I can think of four reasons why a person with mild Asperger's will not have the things Another_Alien listed:

*They're too young to have all these things yet
*They have other issues besides Asperger's or autism preventing them from getting those things
*Their Asperger's or autism are more significant than they or other people think
*They have general apathy or disinterest in having any of those things, but could probably obtain those things if they really wanted them

I'm not implying though having material wealth and being accepted by NT's will necessarily lead to happinness. Now I know not everyone will agree with me on this, and some will dispute this vehemently, but if you want to have the things that Another_Alien listed but are unable to and you do not fall into into the exceptions that I listed, then I'm sorry but you do not have mild Asperger's. In fact, it is probably a problematic statement to some to suggest that mild Asperger's even exists, rather simply put it is just a measure of one's ability to adapt to the NT world.

So please post what you think makes one's Asperger's mild, moderate or severe and the differences between them and how to identify which category an aspie belongs to. And if you want to dispute that these categories are problematic or don't exist, please explain why and how you think we should place an aspie or autie on the spectrum.

Determining mild, moderate and severe is entirely too subjective to me.

In the context of jobs, I have almost always had a job. But is it a good thing that a person with a 99th percentile IQ is working a grill at McDonald's as his primary income?

In the context of relationships - I never had a date until I met the person I married. I was 20. And REALLY lucky that she took a liking to me. Her parents hated me.

Impairment must be measured against some baseline. What is that baseline? Some statistical measure based on sampling populations? All this does is tell us that a person is or is not at variance to the general population.

Is a person that can run faster than me impaired if they have a clubbed foot (I'm not slow for a guy my age)? Are they impaired because they would be able to run even faster with a normal foot?

Determining mild, moderate and severe is incredibly subjective, but I think it needs to both take into account more than just functioning level. High functioning does not mean mild.

I don't think anyone can determine severity on the basis of success or lack thereof. Even if someone made a list of traits that are expected in mild, moderate, or severe cases that made sense when applied to autistic people, I suspect that most people would basically draw from two or three lists for different traits.

Another_Alien's thread seems to me to be one of many statements that most everyone here is mild, which I find factually incorrect based on what people post here.

mild - the type that could skate by without support, who don't believe it impairs them.
moderate - typical Asperger's
severe - needs a lot of support, very noticeable, etc.

too vague too vague too vague

I agree that there is no objective way to determine severity, and success would probably be a better way of determining functionality rather than severity, which are not necessarily the same thing. I've heard aspies say there are auties who are higher functioning than they are. As somebody pointed out in Another_Alien's thread, the difference between AS and autism is not severity, but the number of symptoms. However, I do get annoyed when people say my condition is mild. Whether my lack of success in life can be attributed towards functionality rather than severity, I do not know. But what I do know is my condition does affect my day-to-day life and I could do without the "mild" label.

Impossible to catagorise yet easy to apply to an individual case these levels are.

If you'll pardon me talking like Yoda for a sec.

Despite the difference in number of symptoms required for a diagnosis, most people who are diagnosed with AS apparently can meet at least six of the required criteria required for an autism diagnosis.

I agree completely with you on the "mild" label.

Sometimes it's the professionals who apply the "mild" label, but other times, it's the people who apply it to themselves.

I know plenty of people who don't have any of those four things and do not have AS...and they are socially successful. These things can help with gaining additionial social contacts, but these are not really the foundations for social success.

Although I'm not a fan of functioning labels, mild AS to me presents as someone having reasonably good social and life skills.

If I had Asperger's it would be severe but being 25 I have learnt a lot of skills, and then lost some.

I probably know a lot more social skills than a gifted 12 year old AS boy with a promising future in particle physics, even if I remain unemployed for life. I still can't always execute these social skills and ADHD certainly gets in the way.
I have some really classic symptoms like routines, sensory issues, isolation from others (being my own choice). And they're all quite extreme.
I rely on medication a lot these days.

People actually do call me mild because they're idiots and don't realise it's the medication and the fact that I'm taking control over my environment so I'm able to cope.
People need to realise that you can be intelligent, not physically disabled but still be struggling with autistic symptoms. And then there's the co-morbids. I hate the co-morbids.

http://www.wrongplanet.net/postt138223.html

Read the whole thread.

I think that broadly assigned severity labels tend to focus on one or two features, and don't really deal with the remainder. The number of shutdowns I experience, the severity and nature of my sensory issues, and my inability to intuitively grasp what other people are thinking (or sometimes even remember that other people think) are not part of that equation. Nor is the fact that I spend a non-trivial amount of time being rather less functional because of these issues. I am verbal, but there are times I find it incredibly difficult to be coherently verbal. I also can end up spending 2-3 hours a day unable to function at all depending on how much sensory overload is going on.

And then there's executive function. Left to my own devices with no interruptions or reminders, I'd just spend all day on my computer and once I realize I'm hungry, it may take me an hour, two hours, three hours, more to even get up to eat. Being organized enough to prepare anything more complex than scrambled eggs without assistance? Not usually likely. Earlier this year, it was pushing my organizational abilities to the limit to keep track of my SSI application and ensure I had appropriate appointments. It took me two months longer than it should have just to get a PCP, which ultimately delayed my diagnosis as well. It took me over two months from the time I filed my request for a hearing to get an attorney to assist me with paperwork. When I met the attorney I was barely able to string a sentence together, and I kept taking him too literally (since i couldn't think of any questions to ask, he said he'd answer common questions. Then he recited the first question, and I tried to answer him).

When I was dating I can say there were actually times I was on a date and did not know I was on a date. When I had relationships I didn't know how to maintain them. My one long-term ex once tried to provoke me and provoke me and provoke me until I finally yelled back at her, at which point she said "So you are human" and while I consider it a part of her abusive behavior it is somewhat indicative to me how I come across (that is, barely emotional at all).

I can't drive. I mean I can learn to operate a car, although I remember someone teaching me to drive manual after I had already learned manual on a tractor and I could not even remember learning that, let alone how to adapt what I knew to from the tractor to the car. Further, when I did get to the point of operating a car, I could not pay attention to both the road and objects in the road.

And then on here, people say things like "high functioning means you can drive, have a relationship, hold down a job" and I can't do any of these things, but I am still told I am "high functioning." And the label is not even derived from these things, but from the fact that I have a high IQ and am verbal. Does this term have any meaning?

I have classic autism, and whatever it is, it's generally not mild. Still, people say (these are clinicians), "You are sooo high functioning!" Let's see... I'm unable to speak about half the time. I have extreme sensory issues. I rarely know what's going on around me, and I have little to no memory of my experiences day to day. I have trouble understanding speech. I experience physical symptoms (vertigo, migraines, etc) due to sensory issues. I don't work (except for my writing), I can't go into a store or even cross the street without help. I consider myself to be, more or less, moderately affected, though I have more mild traits (socially, I do quite well, although I'm rather withdrawn) and severe (sensory) issues.

It's all about stereotypes, really, rather than being about usefulness.

If I were to go down the DSM list and rate myself mild/moderate/severe for each one: -

(I) Qualitative impairment in social interaction, as manifested by at least two of the following:

(A) marked impairments in the use of multiple nonverbal behaviors such as eye-to-eye gaze, facial expression, body posture, and gestures to regulate social interaction MILD
(B) failure to develop peer relationships appropriate to developmental level MILD
(C) a lack of spontaneous seeking to share enjoyment, interest or achievements with other people, (e.g.. by a lack of showing, bringing, or pointing out objects of interest to other people) MILD
(D) lack of social or emotional reciprocity MILD

(II) Restricted repetitive & stereotyped patterns of behavior, interests and activities, as manifested by at least one of the following:

(A) encompassing preoccupation with one or more stereotyped and restricted patterns of interest that is abnormal either in intensity or focus SEVERE
(B) apparently inflexible adherence to specific, nonfunctional routines or rituals MODERATE
(C) stereotyped and repetitive motor mannerisms (e.g. hand or finger flapping or twisting, or complex whole-body movements) MILD (sometimes MODERATE when overstimulated)
(D) persistent preoccupation with parts of objects MODERATEto SEVERE

I can easily imagine being more severe in the first category if my childhood had been different (I was fortunate enough to live on a street with 4 NT guys in my age range who would chide me for any out of line behavior -- it hurt but it ultimately taught me a lot and helped me fall in line/conform).

^I like what you did, I think I'll do the same for myself. Im comparing childhood(17 and younger) vs. now(22)

I) Qualitative impairment in social interaction, as manifested by at least two of the following:

(A) marked impairments in the use of multiple nonverbal behaviors such as eye-to-eye gaze, facial expression, body posture, and gestures to regulate social interaction Before(moderate), Now(mild)
(B) failure to develop peer relationships appropriate to developmental level: Before(Severe), Now(mild)
(C) a lack of spontaneous seeking to share enjoyment, interest or achievements with other people, (e.g.. by a lack of showing, bringing, or pointing out objects of interest to other people) Before(moderate/severe), Now(mild/moderate)
(D) lack of social or emotional reciprocity: Before(moderate/severe), Now(mild)

(II) Restricted repetitive & stereotyped patterns of behavior, interests and activities, as manifested by at least one of the following:

(A) encompassing preoccupation with one or more stereotyped and restricted patterns of interest that is abnormal either in intensity or focus Before(mild/moderate), Now(mild, only strong intensity, not restrictive at all)
(B) apparently inflexible adherence to specific, nonfunctional routines or rituals Before(mild/moderate), Now(dont have it anymore)
(C) stereotyped and repetitive motor mannerisms (e.g. hand or finger flapping or twisting, or complex whole-body movements) Before/Now(very seldom, only when excited)
(D) persistent preoccupation with parts of objects Before/Now(never had it)

So in catagory I, every symptom is mild, the only symptom might be somewhat noticeable is C. Catagory II, only 1 symptom half way. Yep I'm probably borderline now, when I was a child, I was mild/moderate when everything is taken into consideration.

I think, like 3/4 of the people on here claim to be mild. Which really range from awkward NTs to aspies who really arent mild. But the definitions are in for misintepretation. Aspergers is mild autism, but mild aspergers is a mild form of aspergers(already mild autism). So probably 80-90% of aspies are mild when taking the entire spectrum into account and would fall on the broad catagory of HFA.