The misnomer of ‘high functioning autism’: Intelligence is an imprecise predictor of functional abilities at diagnosis
Open accessAbstract
‘High functioning autism’ is a term often used for individuals with autism spectrum disorder without an intellectual disability. Over time, this term has become synonymous with expectations of greater functional skills and better long-term outcomes, despite contradictory clinical observations. This study investigated the relationship between adaptive behaviour, cognitive estimates (intelligence quotient) and age at diagnosis in autism spectrum disorder. Participants ( n = 2225, 1–18 years of age) were notified at diagnosis to a prospective register and grouped by presence ( n = 1041) or absence ( n = 1184) of intellectual disability. Functional abilities were reported using the Vineland Adaptive Behaviour Scales. Regression models suggested that intelligence quotient was a weak predictor of Vineland Adaptive Behaviour Scales after controlling for sex. Whereas the intellectual disability group’s adaptive behaviour estimates were close to reported intelligence quotients, Vineland Adaptive Behaviour Scales scores fell significantly below intelligence quotients for children without intellectual disability. The gap between intelligence quotient and Vineland Adaptive Behaviour Scales scores remained large with increasing age at diagnosis for all children. These data indicate that estimates from intelligence quotient alone are an imprecise proxy for functional abilities when diagnosing autism spectrum disorder, particularly for those without intellectual disability. We argue that ‘high functioning autism’ is an inaccurate clinical descriptor when based solely on intelligence quotient demarcations and this term should be abandoned in research and clinical practice.
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Autistic individuals exhibit a 'spiky profile' representing development with great variability between the exhibition of skills across tasks.
“Autistic individuals exhibit a 'spiky profile' representing development with great variability between the exhibition of skills across tasks (Alvares et al., 2019).”
From Neurodivergent (Autism and ADHD) student experiences of access and inclusion in higher education: an ecological systems theory perspective (2025) · cites this paper as Alvares et al., 2019
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- Authors
- Alvares, G. A., Bebbington, K., Cleary, D., Evans, K., Glasson, E. J., Maybery, M. T., Pillar, S., Uljarević, M., Varcin, K., Wray, J., & Whitehouse, A. J.
- Affiliations
- The Kids Research Institute Australia (AU)
- Stanford University (US)
- Government of Western Australia Department of Health (AU)
- Corresponding author
- Alvares, Gail A
- ORCID
- Venue
- Autism
- Publisher
- SAGE Publications
- Published
- 2019-06-19
- Volume
- 24
- Issue
- 1
- Pages
- 221-232
- ISSN
- 1362-3613 (ISSN-L)
- 1461-7005
- OpenAlex
- W2950856395
- Cited by
- 331
- References
- 48
- Citations by year
- 2026: 107 · 2025: 40 · 2024: 32 · 2023: 37 · 2022: 47 · 2021: 44 · 2020: 19 · 2019: 5
- FWCI
- 16.72
- Type
- journal article
- Language
- en
- Open access
- green
- hdl.handle.net
- Locations
- Autism (publishedVersion)
- PubMed (publishedVersion)
- UWA Profiles and Research Repository (UWA) (submittedVersion)
- Griffith Research Online (submittedVersion, other-oa)
- Funders
- Raine Medical Research Foundation (RPG103-18)
- National Health and Medical Research Council (APP1077966)
- Topics
- Life Sciences › Neuroscience › Cognitive Neuroscience › Autism Spectrum Disorder Research
- Health Sciences › Medicine › Psychiatry and Mental health › Child Nutrition and Feeding Issues
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Down syndrome and intellectual disability research
- Keywords
- high-functioning autism, autism spectrum disorder, intellectual disability, intelligence quotient, adaptive behavior, functional capacity, age at diagnosis, Vineland Adaptive Behavior Scales, diagnostic terminology
- MeSH terms
- Autism Spectrum Disorder, Activities of Daily Living, Adaptation, Psychological, Adolescent, Age Factors, Child, Child, Preschool, Cognition Disorders, Female, Humans, Infant, Intelligence, Intelligence Tests, Male, Western Australia
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