Severity? Help!

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I don't like the idea of placing a severity level on AS, using the labels "mild", "moderate", "severe", or "very severe" but that is precisely what my student loans office is forcing me to do. How do I tell which one I am? What are your opinions:

I am almost 27, still live at home with my parents. I have had many jobs, but I haven't been able to keep one for very long. Right now I work casually, and that I can handle with a few minor upsets there. I have never had a relationship. I would like to have one someday, but I highly doubt it will ever happen because I simply don't know how to interact with someone long enough to create a relationship. I also have no friends, and likely never will because I don't know how to interact with other people. A couple people talk to me in one of my classes, but we never see eachother outside of class. I do go to school; however, it can be very distressing sometimes due to the sensory issues I have as well as my lack of social interactions and my inability to interpret the thousands of people around me. I spend hours every night wide awake until 3, 4, 5 in the morning rejuvinating from the day before. And while I do go to school, I am a mature student. I just went back to study my obsession. I dropped out of high school because of AS related symptoms, and basically hibernated for several years. I went back for my high school diploma, and got it four years later. Then I hibernated in my house for another few years before finally returning to college. I've also been diagnosed with comorbid anxiety due to living so long as an undiagnosed autistic person. I have to rate that as well, but I am more concerned with where they will rate the AS since that is the permanent disability.

Any thoughts as to where I might fall within those four labels as I really do have to pick one (I do not have the report back yet).

Average it out and pick "moderate". You neither need full time care, nor are you fully independent, so pick something in the middle. It doesn't bode well that they're making you pick a severity level though. You may have to stress exactly what your problems are and what you need help with, otherwise they may stereotype you at whatever level you pick, and that's never good.

By report, do you mean psychiatric report?

I think only a psychiatrist could make a proper call on that, the student loans office may think that a psychiatrist has given you information specific to this.

In my personal opinion if you are able to work and go to school, I wouldn't put it at a severe, or very severe level;

From what you have said here I think it would be considered moderate, but really only a psychiatrist could make a proper call, because there are many other factors they might consider, other than what you have presented here.

Most important, they have to be able to observe your physical behavior (verbal interaction, social interaction, eye contact, psychomotor agitation, gesturing, etc.) to be able to determine severity, along with what you report to them about your personal life.

Except that there are people (many of them, actually) considered among the most severe range of autism who have gotten degrees, and people considered mild who can't come even close. Autism doesn't rank like that.

Agreed. That is part of the reason why I think only a psychiatrist could make a proper call.

However, if she is able to go to school independently and work independently with no support aids, that is taken into consideration in global ability to function. She didn't mention any; so I could only assess a personal opinion on her words as presented.

GAF, is likely the measurement the psychiatrist will use in coming to a decision on her level of impairment. If the new DSMV as proposed goes into effect, severity levels should be much clearer, when a diagnosis is made.

Thanks for the replies everyone. No, I am not going to school without support. I go to school...I also have meltdowns frequently, and I go to a therapist regularly to help me manage it all. Yes, I work...less than 10 hours a week most weeks. I could not handle much more than that. I am applying to the student loans as a student with a disability because I need the support. I have literally no money (I would be homeless if it weren't for my parents).

Also, I haven't been to a psychiatrist, and I don't intend to go unless necessary. I don't even know if there are any around here who can diagnose Aspergers---or can all of them diagnose it? Anyway, the psychologist I went to is qualified to diagnose it, and my regular psychologist is the one who told me I should have received a report (she knows it wasn't a psychiatrist I went to see).

Good to know, I had never heard of psychologists diagnosing it until you brought it up. I would think that would be a cheaper route than someone like a neuropsychiatrist. This kind of information might be good to help someone get a diagnosis that can't afford the other options that might be more expensive.

My general practioner didn't know a psychologist could diagnose it, but not everyone can be aware of all options. In my case I saw a psychiatrist and psychologist. The psychiatrist was much more expensive. Probably because they are Medical Doctors.

By support aid, I meant devices needed in the school environment to help you function, like a communication device if you needed one or if you participated only online because you could not tolerate the school environment. The support you are talking about, though, is also very relevant in determining your level of impairment.

When I was diagnosed the only information I had on impairment level was GAF. I had to ask for a report to get this information. Otherwise, I was just told I had Aspergers and then PDD NOS when I told them I had a significant speech delay in childhood.

Again, the DSMV may provide a clearer understanding of severity levels for people that need this information, as you do.

Last edited by aghogday on 04 Apr 2011, 7:33 pm, edited 1 time in total.

Thanks for the response! Actually here in Canada psychiatrists are free (even private ones) BECAUSE they are medical doctors. All MDs are free for us. Unfortunately, not all PhDs are though, only those employed in public places. My diagnostician was in the private arena so I had to pay quite a sum for that. I was not able to find anyone else around here, even a psychiatrist, who was able to do diagnose. There must be at least one psychiatrist in the city, but I looked for YEARS and couldn't find anyone.

I think this is awful that there is a severity index there for AS, but maybe it is something I should just discuss with whoever I am getting to fill out the form. Thanks again!

That is very interesting. Makes since that psychologists would have to diagnose it in Canada given what sounds like a shortage of psychiatrists that are capable of doing it.

The severity index is part of a new Autism Spectrum disorder covering four of the spectrum disorders currently diagnosed, separately; it is only a proposed revision at this time to replace the existing DSMIV used as a guide for diagnosis. The GAF is not specific to Autism, it considers all co-morbid conditions, as well. Just the closest thing I know of here as an objective measurement of overall impairment in the ability to function.

I don't know if they use any of these standards in Canada, but regardless the professional that helps you fill out the form should be able to provide an objective determination on the severity of your condition.

This should probably be general knowledge, but what does GAF stand for? I keep seeing it everywhere, and I just don't know. I think I will have to look up the dsm-v again as that will be my "new" diagnosis in two years anyway. Might enlighten me a bit....

From Wikipedia, the free encyclopedia:

The Global Assessment of Functioning (GAF) is a numeric scale (0 through 100) used by mental health clinicians and physicians to subjectively rate the social, occupational, and psychological functioning of adults, e.g., how well or adaptively one is meeting various problems-in-living. The scale is presented and described in the DSM-IV-TR on page 34. The score is often given as a range, as outlined below.


91 - 100 Superior functioning in a wide range of activities, life's problems never seem to get out of hand, is sought out by others because of his or her many positive qualities. No symptoms.

81 - 90 Absent or minimal symptoms (e.g., mild anxiety before an exam), good functioning in all areas, interested and involved in a wide range of activities, socially effective, generally satisfied with life, no more than everyday problems or concerns (e.g., an occasional argument with family members).

71 - 80 If symptoms are present, they are transient and expectable reactions to psychosocial stressors (e.g., difficulty concentrating after family argument); no more than slight impairment in social, occupational, or school functioning (e.g., temporarily falling behind in schoolwork).

61 - 70 Some mild symptoms (e.g., depressed mood and mild insomnia) OR some difficulty in social, occupational, or school functioning (e.g., occasional truancy, or theft within the household), but generally functioning pretty well, has some meaningful interpersonal relationships.

51 - 60 Moderate symptoms (e.g., flat affect and circumstantial speech, occasional panic attacks) OR moderate difficulty in social, occupational, or school functioning (e.g., few friends, conflicts with peers or co-workers).

41 - 50 Serious symptoms (e.g., suicidal ideation, severe obsessional rituals, frequent shoplifting) OR any serious impairment in social, occupational, or school functioning (e.g., no friends, unable to keep a job).

31 - 40 Some impairment in reality testing or communication (e.g., speech is at times illogical, obscure, or irrelevant) OR major impairment in several areas, such as work or school, family relations, judgment, thinking, or mood (e.g., depressed man avoids friends, neglects family, and is unable to work; child frequently beats up younger children, is defiant at home, and is failing at school).

21 - 30 Behavior is considerably influenced by delusions or hallucinations OR serious impairment, in communication or judgment (e.g., sometimes incoherent, acts grossly inappropriately, suicidal preoccupation) OR inability to function in almost all areas (e.g., stays in bed all day, no job, home, or friends)

11 -20 Some danger of hurting self or others (e.g., suicide attempts without clear expectation of death; frequently violent; manic excitement) OR occasionally fails to maintain minimal personal hygiene (e.g., smears feces) OR gross impairment in communication (e.g., largely incoherent or mute).

1 - 10 Persistent danger of severely hurting self or others (e.g., recurrent violence) OR persistent inability to maintain minimal personal hygiene OR serious suicidal act with clear expectation of death.

I put in bold what is considered moderate problems. This is the only objective criteria I know of that specifically describes what is considered moderate function. Not a specific measure for Autism, but these are the guidelines my psychiatrist used in determining functionality. After this point, from there down problems are serious to severe.

You can see how something you might not have listed like suicidal ideation put a person in a more serious category. And many other items, that you may have shared with your psychologist, in confidence, might put you even further down on the scale.

I was close to the top in the prime of my life thanks to being able to find coping mechanisms that worked well for me. For the last few years, around 50. Health issues played a large part, and I think they were strongly influenced by the energy required to cope at a high level of functioning, in the mainstream world, with Autism.

Wow! Thanks for posting that!

91-100= No symptoms?? Isn't that code for neurotypical?

My guess is that I fall around.....41-50 most of the time.....sometimes I might even be the next category down.

Actually, anything above 80 - maybe even 70 - would not qualify for a diagnosis of anything. Remember, this isn't just for ASDs. This is a scale used to rate ANYONE who is being evaluated for ANYTHING. They have to have categories for people who really don't need an evaluation but ended up getting one for some reason (involuntary commitment, perhaps).

few friends and conflict with peers and occasional panic attacks counts as moderate severity!...........awwwwwwww and here I thought I was mild

Ages 19 to 21 in the 30's to 40's. Ages 22 to 45 in the 90's. At age 48 in the 20's

I had no idea I had autism until age 47. I had a speech delay until age four and problems with speaking most of my life, but I adjusted by being a good listener; my comments were few and short lived, but mostly positive ones.

Somehow, I managed to get three college degrees in some of the hardest years between 18 and 24, but I credit that ability to laser focus and exceptional long term memory, a part of Autism that was good to me; input still worked, when social output was almost zero during some of those years.

I don't think I would have had the positive attitude that others thought was unusually positive, during the best years, unless I had to work so hard to overcome the adversity in social interaction, I had earlier in life. I learned to mimick people during social interaction and the smiles I copied, from the many happy faces I encountered made me into the person I became.

So I think the ability to mimick, another quality of Autism, helped me in gaining a positive attitude. Things would likely have been different in a negative environment.

The biggest factors though were, I was fortunate to have the same wonderful job for 18 years, surrounded by hundreds of generally positive people, and a wonderful wife, mother, and sister, that accommodated all my eccentricties.

Others let me know of my eccentricities, but the excitement of being part of the game, was more powerful than any comment that I was rather odd.

For me the '91 to 100' years, were due mostly to fortune, that made adaptation possible.

I was in the 20s a couple years ago. I think I kind of moved into the 30s when I went back to school and work approximately 10 hours a week at a casual job. Other than that though, my mindset is quite the same as it has always been.