Was rainman low or high functioning?

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Ray Babbitt's character (the 'Rainman') was an Autistic Savant.

During the road-trip, the Psychiatrist who examined Ray described him as 'high functioning'

But I think it's probably important to keep this in context.

Rainman was released in 1988 - before Asperger's had been formally recognised, so this would have been a statement in relation Kanner/Classical Autism.

'High Functioning' in 1988 would not have the same meaning as it does today because in 1988 the condition and diagnosis of HFA/Aspergers/PDD-NOS simply did not exist.

In a later scene where Charlie Babbitt (Ray's brother, played by Tom Cruise), meets with one of the Doctor's from the Institution where Ray had been living, the Doctor describes Ray as 'a severely disabled individual'.

Despite being financially independent, through his father's legacy, Ray clearly was incapable of living a remotely independent life.

I would tend to see Ray Babbitt as lower functioning - (who happened to have prodigious Savant skills)

The big problem with this discussion is that "HFA" does not have a defined meaning; I think that the term is invented by researchers with the meaning of "autism without mental retardation"; but, when the expression becomes familiar to the public, its meaning slowly changed to "mild autistic".

correct.

not entirely correct...

i once tried to make a illustration that visualized it a bit better:



let me try to explain what it tried to show...

the be Dx'ed with either autism or asperger, you have to fulfill the 3 criteria from wings triad. if you only fulfill 1 or 2, you will get a PDD-NOS Dx.

so PDD-NOS (the yellow color) stretches along the whole spectrum, but can't ever be as "severe" as either classic autism or asperger, since it "only" needs two out of three disabling criteria...

classic autism spans the whole IQ spectrum with most auties being challenged intellectually (the red color in the illustration), concentrating on <70 IQ area.

the IQ and functionally challenged auties are typically LFA... and the more the are able to do by themselves the more HFA they become.

the HFA label is only applicable to persons with classic autism.

the aspies (green color) also have to conform to the three criteria of wings triad, but cannot have a cognitive delay nor low IQ. the cutoff for this is typically around 70 IQ points.

all three Dx can be from severe to mild in relation to the three criteria of wings triad.

so it is not correct to state that aspergers i a mild form of autism... it is simply false... it is also false to state that classic autism is severe...

the difference between a HFA and a corresponding aspie (where the red and green colors overlap) is only defined by the development of their language at age three or four........ and the aspies being more prone to have rigid special interests.

the PDD-NOS group (yellow) also can vary from mild to severe... but will by definition never be as severe as the other two.

hope this makes a little sense... otherwise... discuss!

If I understand, the vertical axis is supposed to be a measure of "mildness", yes?

I am not much sure if PDD/NOS are supposed to be milder than AS - AS only requires 2 in 3 impairments, much like PDD/NOS.

no the vertical axis is not trying to symbolize that... since all three Dx can vary on that scale...

it is not correct that AS only requires 2 in 3 impairments... that is the whole point.

only PDD-NOS can get away with that...

so...

wings triad consist of:

1. Social impairment
2. Verbal and non-verbal language impairment
3. Repetitive/stereotyped activities

http://www.awares.org/static_docs/about ... cSection=3

meaning that an aspie could "score" something like this on a "severity scale" from 0 -100:

1. 80
2. 30
3. 90

an autie could score:

1. 80
2. 90
3. 30

and a PDD-NOS could score:

1. 80
2. 0
3. 30


if one looks at these examples, one could conclude that the aspie and the autie are equally "severe" or mild overall... although the aspie has a more severe disability at Repetitive/stereotyped activities than the autie... and the autie has a worse Verbal and non-verbal language impairment than the aspie..

the autie and the PDD-NOS are equally impaired on point 2 and 3... but the latter has no Verbal and non-verbal language impairment...
and all three are equally Socially impaired... while the autie has the greatest Verbal and non-verbal language impairment...

so what is the milder Dx???

you simply can't tell!

also read this earlier topic:

http://www.wrongplanet.net/postt159260.html

and these are the asperger criteria acc. to dsm iv:

DSM-IV DIAGNOSTIC CRITERIA FOR ASPERGER'S DISORDER

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

(1) marked impairment in the use of multiple nonverbal behaviors such as eye-to-eye gaze, facial expression, body postures, and gestures to regulate social interaction
(2) failure to develop peer relationships appropriate to developmental level
(3) a lack of spontaneous seeking to share enjoyment, interests, or achievements with other people (e.g., by a lack of showing, bringing, or pointing out objects of interest to other people)
(4) lack of social or emotional reciprocity

B.Restricted repetitive and stereotyped patterns of behavior, interests, and activities, as manifested by at least one of the following:

(1) encompassing preoccupation with one or more stereotyped and restricted patterns of interest that is abnormal either in intensity or focus
(2) apparently inflexible adherence to specific, nonfunctional routines or rituals
(3) stereotyped and repetitive motor mannerisms (e.g., hand or finger flapping or twisting, or complex whole-body movements)
(4) persistent preoccupation with parts of objects

C.The disturbance causes clinically significant impairment in social, occupational, or other important areas of functioning.

D.There is no clinically significant general delay in language (e.g., single words used by age 2 years, communicative phrases used by age 3 years).

E.There is no clinically significant delay in cognitive development or in the development of age-appropriate self-help skills, adaptive behavior (other than in social interaction), and curiosity about the environment in childhood.

F.Criteria are not met for another specific Pervasive Developmental Disorder or Schizophrenia.

and acc. to the icd-10

ICD-10 Diagnostic Criteria for Research : F84.5 - Asperger’s Syndrome*

A. A lack of any clinically significant general delay in spoken or receptive language or cognitive development. Diagnosis requires that single words should have developed by two years of age or earlier and that communicative phrases be used by three years of age or earlier. Self-help skills, adaptive behaviour and curiosity about the environment during the first three years should be at a level consistent with intellectual development. However, motor milestones may be somewhat delayed and motor clumsiness is usual (although not a necessary diagnostic feature). Isolated special skills, often related to abnormal preoccupations, are common, but are not required for diagnosis.

B.Qualitative abnormalities in reciprocal social interaction (criteria as for autism).

C.An unusually intense circumscribed interest or restrictive, repetitive, and stereotyped patterns of behaviour, interests and activities (criteria as for autism; however, it would be less usual for these to include either motor mannerisms or preoccupations with part-objects or non-functional elements of play materials).

D.The disorder is not attributable to other varieties of pervasive developmental disorder; schizotypal disorder (F21); simple schizophrenia (F20.6); reactive and disinhibited attachment disorder of childhood (F94.1 and .2); obsessional personality disorder (F60.5); obsessive-compulsive disorder (F42).

ERM

Why does Mid Functioning not exist in you peoples vocab?

Rainman was high-functioning in the sense that he could talk. But in the sense that he could not care for himself on his own (i.e. cannot go anywhere by himself without getting into trouble, relies on strict routines, cannot make a meal for himself), he was pretty low-functioning. But on the whole, I would say that rainman was relatively low-functioning.

True, Rainman could talk, but I'm not sure being non-verbal is a requirement for LFA?

It looks good so far and there's really just one small wrong assumption (at least as according to the DSM) I can think of.

DSM-IV-TR allows AS with a mild cognitive delay.

MR cannot became apparent before school-age/during the first few years of life and is supposedly rare though.

Do you have access to a copy of the DSM-IV-TR? It is explained in the diagnostic guidelines that explain the criteria's intended use and meaning.

If not, I managed to find this and hope the link to google books works: http://books.google.com/books?id=3SQrtpnHb9MC&printsec=frontcover#v=onepage&q&f=false Asperger's starts on page 80. I think the entire paragraph as well as the one about classical are an interesting read, but if you just want to check this quickly for the moment, see under "Associated Features and Disorders".

I think Raymond Babbitt would have been high-functioning and much better off if he hadn't been placed in that institution in the first place. I'd say that he is actually more low-functioning due to being in the institution for so many years.

The effect of the institution sure can't be discounted. People in institutions are easier to "handle" if they learn to do only what they're told, not take the initiative, not do things for themselves. People have become disabled because they were put in institutions where they weren't allowed to make their own decisions.

That said, one can't really put a functioning label on him, because functioning labels are not at all precise enough to apply to people.

If I were to describe the character, I would probably use "autistic prodigious savant". The savant syndrome is the most striking part of his autism.

In real life, of course, Kim Peek was a savant but not autistic in the first place.

I found some research that questioned the assumption that the majority of those with classic autism are intellectually challenged. As it turns out much of the research that claims such was not actually validated, and since IQ tests with autistic people are notoriously inaccurate, it's difficult to make such an assertion.

I also think that PDD-NOS is used for people who fit the criteria for autism but childhood history cannot be established, which means that severity can be anywhere, not just the least severe cases with only one or two areas.

I also think for a lot of people, which diagnosis they get depends a lot more on who diagnoses them than which category they most closely fit.

There's also some research I linked to recently that points out that the majority of people diagnosed with AS or PDD-NOS actually do fit the criteria for autism, which is one of the reasons that they're consolidating diagnoses in the DSM-V.

i have seen that too... very interesting indeed.

i also read that when given a ravens IQ test, instead of WAIS, most auties score some 30 IQ points higher than otherwise... meaning that most labelled with retardation, actually have a normal IQ...

revision on all autism accounts is definitely in order... not sure though if the DSM V solution is going to do any good...

we'll see.