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We should stop using functioning labels do describe autistic people

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Voting Style: Open Point System: 7 Point
Started: 12/12/2015 Category: Miscellaneous
Updated: 10 months ago Status: Post Voting Period
Viewed: 464 times Debate No: 83851
Debate Rounds (3)
Comments (2)
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It is common for autistic people to be labeled as either "high functioning" or "low functioning". I think we should stop using these labels.

1. Many autistic people criticize functioning labels
The old adage goes "experience is the best teacher". So why not listen to the people who experience the effects of those labels. Many autistic people feel functioning labels dismiss their struggles, make families, teachers, etc. underestimate autistic children, or are just inaccurate descriptors of many presentations of autism.

2. Functioning labels are misleading
Her name is Carly Fleischmann. She cannot speak orally and had behaviors like hitting herself, fecal smearing, stripping off her clothes, tantrums etc. People assumed she was mentally retarded. One day when she was 11, she went to her therapist's laptop and typed "help" and "hurt" and then vomited. Then they pushed her to type, and now she has a blog called "Carly's voice".

When asked why she does these "behaviors", she replied "Because if I don't it feels like my body is going to explode. It's just like when you shake a can of coke. If I could stop it I would but it is not like turning a switch off"

Clinically, "low functioning" is supposed to mean intellectual disability. But many children are labeled "low functioning" based on inability to speak/communicate, "severe" behaviors like aggression, fecal smearing, stripping off clothes, etc. and little self-care skills. These have nothing to do with intellectual disability (as evidenced by Carly Fleischmann and other autistics). Many of these children learn to communicate by typing, a communication device, writing or using a letter board, as used in the Rapid Prompting Method (RPM) developed by Soma Mukhopadhyay.

Carly Fleischmann, Amy Sequenzia, Larry Bissonnette, Amanda Baggs, Tracy Thresher, Hope Block Sue Rubin and Tito Mukhopadhyay all learned alternative ways to communicate. But people assumed they were retarded. This of course can cause teachers, families, etc to underestimate autistic children, thus put low expectations on them. (Note: RPM is not the same as facilitated communication (FC). In RPM, the instructor prompts you to type. In FC, the instructor physically holds your hands down and types for you).

3. Functioning labels are highly subjective
Take for example a 13 year old kid who is still not potty trained, sometimes self-injures, cannot speak orally or follow 1 step directions (i.e. "turn off the lights"). At age 10 a therapist taught him to type, so he doesn't have intellectual disability, and he can write above grade level. Is he high functioning or low functioning? Depends on who you ask.
People were asked "What is "low functioning" autism?" One answer said the general consensus is minimal communication, intellectual disability and severely delayed adaptive skill. Another person disagreed with needing to be minimally communicating. A child can be so aggressive that their amount of communication doesn't matter, they cannot function within society at all. They cannot be maintained anywhere, except maybe a hospital. Those kids exist and are low functioning. They may speak well and some may even have IQ 70 or higher.

Many people require intellectual disability to be considered "low functioning" (thus, many people say if you can write a blog post, than you're high functioning"). But this person said you don't need to have intellectual disability to be considered "low functioning". In other medical labels, there is a clear set of criteria. We don't have that level of disagreement.

4. Functioning labels don't describe how well someone can function in society
I'll tell you the story of an autistic man who was self-injurious as a child, is unable to speak orally and very stimmy, and can't recognize when he's hungry. But he has his own business, is married and raising a family, vs. a 30 year old Aspie who can't maintain a job, still lives with their parents and still needs help knowing what's appropriate. Who is struggling more?

5. Functioning labels are used to silence autistic people
The original poster said it bothers her when children are described as autistic instead of "has autism". (See people first language)
After finding out most autistic people reject people first language, she said

"I also reject the idea that adults living with autism (mostly highfunctioning or Asperger's) should be able to speak for the autism community as a whole. Being an adult with HFA is quite different from being a young child with moderate autism. I think the families of those kids are justified in seeing autism as a neurological disorder that affects their child negatively and not just as a personality type."

One day her toddler will be told the same thing. Most autistic people don't want to be cured. Her son will likely feel the same way. But she is using functioning labels to dismiss autistic people.

The are "low functioning" people (i.e. those who are unable to speak and have minimal self-care skills) who have stated they don't want to be cured. Amy Sequenzia (who is "low functioning" by that definition, also has epilepsy, cerebral palsy, dyspraxia, and insomnia) is against curing autism, but supports curing epilepsy.


I should state before hand that I myself have a very mild form of High Functioning ASD, previously diagnosed as mild aspergers.

First Argument: Functioning Labels are the Basis for the DSM-V definition
Autism is not a single disorder. It is a spectrum disorder (ie Autism Spectrum Disorder). Other disorders previously considered separate from Autism (including aspergers, PDD-NOS and Childhood disintegrative disorder), were recategorized in the DSM-V, published in 2013, as subsets of Autism. While the terms of "High functioning autism" and "low functioning autism" had previously existed, this change cemented them being actual psychiatric diagnoses.
All forms have two basic criteria, social communication and restricted interests & repetitive behaviors (RBR's). Those with high functioning ASD, will, without supports in place, show deficits in social communication, which often causes noticeable impairments difficulty, and have difficulty initiating social interactions and will often respond with atypical and unsuccessful responses. This often leads to those with High Functioning ASD to become more introverted, which often looks like social withdrawal. In the second criteria (RRB’s) will often cause significant interference with functioning in multiple contexts and they often resists attempts by others to interrupt them. These are both the case for me, and I will elaborate further on this in later rounds.
Those with low functioning type often have severe deficits in verbal, and nonverbal, social communication skills, which can cause severe impairments in functioning, and often show very limited initiation in social interactions and minimal responses to social queues from others. RBRs in these cases create preoccupations, fixated rituals and/or repetitive behaviors which severely interfere with functioning in almost all spheres, and they find it very difficult to redirect from fixated interest, and will show distress when interrupted.
There is a moderate functioning form as well.
This provides a better definition of Autism which is supported by the Psyciartric community and experts in the field

Second Argument: Functioning Labels are important for Proper Diagnosis and Management.
The adoption of the new definition has allowed for a better diagnosis and provided more treatment for many with ASD
I can say from personal experience that after the definition was changed, my counseling was modified to be more in line with the new definition. This was found to be much more successful than previous methods of counseling. Now, I am no longer in need of counseling for this.
While this is just one example, the story is the same for many people dealing with ASD.
This new definition also allows for a more accurate diagnoses of Autism. Many who were not diagnosed pre DSM-V because they did not fit the rigid definition for Autism that previously existed. Many were also turned away because previously the diagnosis would have had to have been made for Autism around age 3. The new definition allowed for Diagnosis for anytime in someone's life.

Third Argument: What is Education about ASD, not a name change
What is really required in regards to solve many of the issues that people simply do not understand ASD. By better educating people about ASD, these problems mentioned would mostly be alleviated.

Fourth Argument: Experts Support the Labels
The Changes to the definition are heavily supported by experts in the field. The Change was endorsed by and passed by an overwhelming majority of the DSM board and is supported by the World Health Organization, the National Association of Social Workers, the American Psychological Association and other organizations.
Additionally the Change was endorsed by Temple Granden, who herself suffers from ASD.
This overwhelming support would indicate the that these labels should remain in place.

I will respond to the Pro's Arguments in the next round
Debate Round No. 1


1. The DSM V does not use the terms "high functioning" and "low functioning". They use level 1, 2 and 3
These terms are not the same. They have different connotations. I will point out problems with previous DSM diagnosis.

CDD is a disorder of its own and not a part of the autism spectrum. In autism, abilities are uneven. A child may be good in one area and bad in another. In CDD, children lose all their skills in every area evenly and some have hallucinations and severe fear/anxiety.

PDD-NOS meant means someone who has a developmental disorder but does not meet the full criteria for autism. So we never had a term that means "none of the above".

Asperger's was removed because (as I already pointed out) being able to speak has nothing to do with intelligence.

2. The new level labels have specific diagnostic criteria
As I pointed out in a previous argument that functioning labels are highly subjective. What is high functioning to one person can be low functioning to another. The new labels base on the level of support required, leaving no room for interpretation.

3. What about education instead of changing the terminology?
I agree that education is important and that what I pointed out in my arguments are largely due to ignorance. But terminology can perpetuate ignorance (and cam be a result of ignorance). We changed the term mental retardation to intellectual disability. Should we have educated people on mental retardation instead? Both education/awareness and terminology are important. Terminology can effect how people think about disabilities.

4. Functioning labels are used to silence and underestimate autistic people
I pointed out in my previous argument. Some people say "you don't speak for low functioning autistics".
This blogger says she is "low functioning". She doesn't speak, needs help using the bathroom (her body doesn't tell her brain when she needs to pee), cannot make reasonable decisions about finances and requires round the clock care so she won't hurt herself. Someone said she is not "low functioning" because she can write a blog post.

This implies people who are level 3 cannot write a blog post, and that level 3 children will not be able to write a blog post one day. Carly Fleischmann, Amy Sequenzia, Larry Bissonnette, Amanda Baggs, Tracy Thresher, Hope Block, Sue Rubin, Tito Mukhopadhyay and Rhema Russell have proven this wrong.

This causes families, teachers, etc. to underestimate autistic children. Carly Fleischmann said "people think I'm dumb because I can't talk".


Responses to Round 2
First Argument
According to Mayo Clinic "Childhood disintegrative disorder is part of a larger category called autism spectrum disorder."
And aspergers is a part of the autism spectrum. Refer to my source from the Autism Society, which states, "In 2013, the DSM-5 replaced Autistic Disorder, Aspergers Disorder and other pervasive developmental disorders with the umbrella diagnosis of autism spectrum disorder."

The inability to communicate is considered a part of level 3, or low functioning, autism spectrum disorder.

Second Argument
These new levels are based upon the previous concepts of "high functioning" and "low functioning", refer to my University of Washington Source and the Autism source in my previous arguments. These levels were created to incorporate other disorders which could not be determined to be separate from Autism.

Third Argument
I would simply like to ask what the Pro would suggest changing the terminology too? If the Pro suggests the Terminology that should be changed, so this begs the question "what should it be changed to?"

Fourth Argument
I do not claim to speak for anyone with low functioning autism, however I am simply stating my concurrence with the experts on this subject.
Being able to write a blog post does not determine whether one is high functioning (level 1), moderate functioning (level 2) or low functioning (level 3). Additionally an anonymous internet comment is not a reliable source in determining whether someone is high or low functioning.
If a person falls into the criterion laid out in the University of Washington (which I will repost the link for), then they would be considered level 3 or low functioning. The ability to perform one task, or not perform one specific task, does not determine this.

Responses to Round 1
First Argument
While many people with ASD may oppose the labels, the concept is supported by the scientific community and many others with ASD, as I referenced in my fourth contention in the previous round.

Second Argument
They are not as misleading as the Pro would have you think, as they contain specific criteria for diagnosis in each and refer to the ability to perform certain tasks and the severity of symptoms.
Again, please reference the link to the University of Washington.

Third Argument
Please refer to my response to the Pro's second argument in this round.

Fourth Argument
This is blatantly ridiculous, as this is two anecdotal stories, both are unsourced. This also lacks any context to the story as how the two cases are related, or any background of the lives of the people in question. This argument should be disregarded.

Fifth Argument
This argument lacks any coherence and does not say anything about people with autism being "silenced" in anyway. This argument should be disregarded.

Lastly, I would like to point out that the sources cited by the Pro have thus far been from blogs, Youtube videos (mostly vlogs), and online forum comments. This is with the exclusion of one source, which I have also posted, and therefore should be disregarded. I have cited academics, the Autism society, the Autism Research Institute and Mayo Clinic. As in all debates, the burden of proof is on the Pro side, and thus far this burden has not been fulfilled.

Debate Round No. 2


1. Preponderance of evidence indicates that CDD is distinct from ASD.
In approximately 1/3 of ASD patients, the regression of language is observed between 18-24 months of age with the appearance of autistic behavior. In childhood disintegrative disorder (CDD), autistic regression occurs after 3 years of age, and mainly includes motor regression and a loss of bowel and bladder use.

According to Kurita et al.4), EEG abnormalities are significantly more common in CDD patients than infantile autism patients.
According to this website "Since CDD is so rare and resembles autism, correct diagnosis is sometimes difficult. Some children later diagnosed with CDD were first misdiagnosed with autism. Both CDD and autism share a similar set of language, communication, social and behavioral impairments. According to the National Institute of Mental Health, there have been studies suggesting that CDD may be a rare form of autism, which further complicated diagnosis. However, CDD has the following unique symptoms not shared by autism and other PDDs:

• Normal development for two or more years
• Sudden loss of previously acquired language, communications and social skills
• Previous potty training lost and child is no longer able to control his bladder and bowel
• Child begins to suffer seizures periodically

2. The new levels are not the same as "high functioning" or "low functioning" labels.
The DSM 5 labels contain specific criteria related to communication and repetitive behaviors–and not related to the more common global interpretation of high or low function as related to intellectual disability and activities of daily living, which is highly subjective and misleading, as I pointed out in my previous arguments.

If people think more "severe"/level 3 autism MUST have intellectual disability, than people are going to underestimate autistic children. Carly Fleischmann, Amy Sequenzia and Rhema Russell were all assumed to have intellectual disability.

3. What should the terminology be?
Anything that isn't "high functioning" or "low functioning", associated with intellectual disability (as people will wrongfully underestimate autistic children), or anything that's unclear, stigmatizing or has negative connotations.

4. People labeled "low functioning" can speak for themselves
Amy Sequenzia, Carly Fleischmann, Ido Kedar, Rhema Russell, Amanda Baggs.

Amy Sequenzia and Amanda Baggs are against being cured.

However many parents have the mentality of "You don't speak for my kid. my kid will never be able to write a blog post."
"What she wrote is our autism. It is the autism for many of the low functioning families that we know of.

I read her post to my wife and then read some of the negative comments and one of them said "what if my autistic son read that?" and wifey's reaction was "I wish we had that problem..."

First Argument
The scientific community may support the concept, but they don't support "high functioning" and "low functioning" labels. We are gaining a better understanding of autism. We learned that people like Carly Fleischmann and Rhema Russell don't have intellectual disability.

Second Argument
Levels 1 2, & 3 contain specific criteria but were not actual diagnoses until recently. "High functioning" and "low functioning" were never actual diagnoses and they do mean different things to different people. Refer to my 3rd argument in round 1.

Third Argument
Please refer to "Second Argument".

Fourth Argument
I was trying to make a point that functioning labels can't tell you how well someone can function in society.

Fifth Argument
Many autistic people are told "you're too high functioning to speak for my child".


The Con should win this debate for several reasons.

1: The Pro has not provided adequate evidence to support her claims, Con evidence outweighs
Throughout the round the Pro has referred to blogs, comment sections, youtube videos and Vlogs. Only in the final round did she provide any credible evidence, however much of this evidence, when examined undermines her argument and infact disagrees with her claim.
And only two of these sources can be considered legitimate (if they are relevant) because the article from was not written by a doctor, but rather "a freelance writer who specializes in jewellery and crafts."

In her first argument in the final round she contended that CDD is a separate disorder from ASD, however the Kurita et al. evidence is from 2011, two years BEFORE the release of the DSM-V, and therefore prior to the revised definition which included CDD as a subtype of ASD.
The other website provided both acknowledged this change by the DSM-V, and while it was written after the DSM-V was proposed, in 2012, it was still written before the DSM-V was adopted in 2013.

The website states
"Under the proposed DSM-5 revisions, all PDDs, including CDD, will be subsumed under the single diagnostic category of autism spectrum disorders. The rationale for this is the similarity between the disorders, as it is now thought that the symptoms of the disorders are on a continuum with autism."

No credible evidence was provided to support the argument by the Pro, while I have provided numerous credible and credentialed sources.
The Pro therefore has not met the burden of Proof and cannot win the debate.

2: The Pro has failed to sufficiently address the challenges against her arguments
In the final round, the Pro did not refute any of my arguments, with the exception of the first argument.
Rather than address the University of Washington evidence I provided, the Pro has simply stated that the criteria is different than what people believe, and what people believe is wrong. The fact is that false misconceptions by the wider population is not a reason to throw out the criteria which is based on concepts of high functionality and low functionality.
The Pro also failed to answer my question as to what terminology should be used instead of high and low functioning, and just stated it should not be the latter or the former. This is simply dodging the question posed by the con, and all challenges by the con must be answered or they are conceded.
And rather than acknowledging that I do not speak for the Autistic community, the Pro has extended this argument.
These are just a few of the examples

3: The Pro conceded that Scientific Community and the Experts agree with Labels
The Pro has stated that the "the scientific community may support the concept". This is a key argument in this debate and by conceding it, the Pro has conceded the debate.

Vote Con
Debate Round No. 3
2 comments have been posted on this debate. Showing 1 through 2 records.
Posted by BrendanD19 10 months ago
As someone with mild ASD (alongside ADHD) I would be very interested in this debate.
Posted by SarcasticMethod 10 months ago
If dumb folk keep sitting around with their thumbs up their asses, whining about which 'politically correct label' to use, they won't get things done in fields like autism research where help's needed.
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