HIGH-FUNCTIONING AUTISM
High-functioning autism (HFA) is an informal
term applied to individuals with autism,
an IQ of 80 or above, and the ability to speak, read, and write.[1]
High-functioning autism may simply refer to autistic people who have normal overall
intelligence; that is, are not cognitively challenged.[2]
developing clinical label for high-functioning autism
Care should be exercised when attempting to determine
whether a person with autism is "high functioning" or
"low functioning" based on an IQ score since it is sometimes
difficult to measure IQ in autistic persons accurately using standard
measurement instruments. The amount of language processing necessary
on the tests and the large quantity of verbal instructions involved
in the testing process even on the "non-verbal" portion
of standard intelligence measures can produce a misleadingly low
score. There can be a significant difference between an autistic
person's measured IQ scores when comparing standard testing methods
and a truly non-verbal method such as the Leiter-R. [1]
A diagnosis
of high-functioning autism exists in neither the DSM-IV-TR nor the
ICD-10, which have diagnoses of autistic disorder and childhood
autism respectively. Analogous to high-functioning when applied
to schizophrenia and other psychiatric disorders, the term high-functioning
autism started out as a shorthand to describe diagnosed autistic
individuals who could nevertheless speak and carry on with many
day-to-day activities like eating and dressing independently. Low-functioning
autism was the conceptual opposite. Researchers then began using
high-functioning autism as a quasi-diagnostic label itself, along
with low-functioning autism and sometimes also Asperger's
Syndrome, to distinguish relative levels of adaptation and development.
There is some evidence that the label has wrongly
become a catch-all diagnosis for badly-behaved children. In 2000
in the UK, the lead clinician and autism specialist at Northgate
and Prudhoe NHS Trust in Morpeth, Dr Tom Berney, published a paper
commenting on this. He wrote in the prestigious British Journal
of Psychiatry:- "There is a risk of the diagnosis of autism
being extended to include anyone whose odd and troublesome personality
does not readily fit some other category. Such over-inclusion is
likely to devalue the diagnosis to a meaningless label."
Differences between aspergers syndrome & high-functioning
autism
Although individuals with Asperger's tend to perform
better cognitively than those with autism, the extent of the overlap
between Asperger's and high-functioning autism is unclear.
A neuropsychological profile has been proposed
for Aspergers syndrome; if verified, it could differentiate between Aspergers syndrome and high-functioning autism and
aid in differential diagnosis. Relative to high-functioning autism, people with Aspergers syndrome have
deficits in nonverbal skills such as visual-spatial problem solving
and visual-motor coordination, along with stronger verbal abilities.
Several studies have found Aspergers syndrome with a neuropsychologic profile of
assets and deficits consistent with a nonverbal learning disability,
but several other studies have failed to replicate this. The literature
review did not reveal consistent findings of "nonverbal weaknesses
or increased spatial or motor problems relative to individuals with
high-functioning autism", leading some researchers to argue that increased cognitive
ability is evidenced in Aspergers syndrome relative to high-functioning autism regardless of differences
in verbal and nonverbal ability.
Social aspects of high-functioning autism
Autistic people are prone to commit social faux
pas because of an inability to predict others' reactions. They may
also neglect social niceties like knocking or returning a greeting.
Similarly, they may be overly trusting or paranoid of strangers.
It may be best summed up as an inability to understand/perceive
the intent or emotional wants and needs of others around them.
They may appear somewhat removed or dissociated
or dreamy at times, especially when in sensory overload or from
a perception of extreme social pressure. They may make little eye contact, leading others to conclude that they are shy, uninterested
or evasive.
Unlike those with low-functioning autism, people
with high-functioning autism are not mentally retarded; persons
with high-functioning autism have an IQ at the average to above-average
range. Although they may have an adequate vocabulary, they may have
a delay in communicating events and use less emotional content in
their speech. They may also appear not to notice non-verbal cues
from others such as when others have become bored with the topic
of conversation they appear oblivious and continue.
As with people elsewhere on the autism spectrum,
people with high-functioning autism generally prefer routine and
order, and this usually begins in early childhood. They may, for
example, write an alphabetized index of their comic book collection,
or they may stick to a limited wardrobe.
Associated difficulties with high-functioning autism
Generally, there are difficulties with social
interaction. This might not adversely affect their ability to interact
with others on a day-to-day basis at a basic working level, although
they may be seen as being overly serious or earnest, and as being
without any "small talk" in conversation. In many instances
though, these individuals have such severe social delays and difficulties
that interaction within a "normal" social setting can
be severely hampered.
They may have difficulty initiating love and friendship
relationships, often being rejected because potential partners perceive
them as being either too "nerdy" or too intelligent. This
can lead to low self esteem or loneliness, which further impairs
their ability to find meaningful companionship.
People may label high-functioning autism people as "oddballs"
or worse, and high-functioning autism people can easily become the target of bullying.
This can be especially true from primary school through the late
teens. Young, intelligent high-functioning autism people usually do best by seeking
out the company of their intellectual peers or by joining hobby
groups, while avoiding their age-group peers. Exposure to an age
equivalent peer group within the autism spectrum on a regular basis
can be especially beneficial.
Given the proven crucial role of body language
in job interviews, lack of eye contact in such a situation may be
perceived by potential employers as indicating that the candidate
is "not telling the truth" or "uninterested in the
job", and thus lead to a cumulative difficulty in finding employment.
Attending social and business events to network is also proven to
play a crucial role in job hunting, but events such as these are
the type that high-functioning autism people usually avoid due to their unease with
the complex social interactions required. Difficulties with such
pre-employment factors may contribute to comparative poverty, although
intelligent high-functioning autism adults can usually find a good job if they can specialise
in their area of interest. Once in a good job, however, their talents
may lead to promotion and they may find themselves in a new job
description that does not fit their personality.
Some may have minor to moderate difficulty with
motor skills and co-ordination. This may manifest itself as mere
clumsiness or awkwardness but in some instances can be found at
a level where the child is a danger to themselves (this is especially
true when younger), but may manifest itself in adulthood by "bumping
into walls" and doors or other people without intention. "Sensory
motor dysfunction" is a comorbid diagnosis that is increasingly
being associated with individuals with high-functioning autism. Many of these motor
skills and functional issues can be helped through the use of regular
physical therapy.
Some may also nurture a complex habitual movement
(termed "stimming") at which they become adept, for example,
pen spinning, while otherwise being prone to clumsiness.
They do not lack empathy (although they may have
difficulty expressing it), and can thus enjoy films and stories
with emotional content. Some may gain the bulk of their insight
into why people behave the way they do through watching movies that
provide a forceful and musically-cued "capsule lesson"
in human emotions (e.g. melodramas).
positive aspects of high-functioning autism
Alongside deficiencies they may simultaneously
benefit from some of the more positive aspects of autism. For example,
they may have the ability to focus intensely and for long periods
on a difficult problem. There is often an enhanced learning ability,
although this often is not applied to subjects they are uninterested
in. They often present no problems in a supportive, well-resourced
educational institution and often do well academically if they can
be stimulated by good teachers. People with high-functioning autism often have intense
and deep knowledge of an obscure or difficult subject and a passion
for pursuing it in an organized and scholarly manner.
They are usually intelligent, gifted, honest,
hard workers when interested in a task and excellent problem solvers.
People with high-functioning autism are thought to become excellent scientists and engineers
or enter other professions where painstaking, methodical analysis
is required. Some believe this particular assertion is a stereotype,
as some high-functioning autism adults tend to struggle with the traditional work setting
and the surrounding societally accepted ways of behaving.
Speech and diction can be unusually precise in
some individuals with high-functioning autism but this may be delayed or awkward in
many other individuals.
Gender differences with high-functioning autism
High-functioning autism affects far more males than females. The Autism Spectrum Disorder
sex ratio, which averages 4.3:1, is greatly modified by cognitive
impairment: it may be close to 2:1 with intellectual
disability and more
than 5.5:1 for high-functioning autism.[3]
Prevalence of high-functioning autism
In the 1990s the prevalence was assumed to be
about 1 person per 2,000 in England. However, a study published
in The Lancet medical journal in July 2006 reported that a team
at a hospital in London had applied autism tests to a large number
of children aged 9 to 10. They found 39 of 10,000 children had autism,
and 77 of 10,000 had some form of "Autism Spectrum Disorders"
(i.e.: a ratio of about 1 in 130 people). The apparent rise may
be due to better diagnosis, and to better awareness of autism related
disorders in people without learning disabilities.
references
1 Study Provides Evidence That Autism Affects
Functioning of Entire Brain: Previous View Held Autism Limited to
Communication, Social Behavior, and Reasoning National Institute
of Health News, Aug. 16, 2006
2 Validity and Neuropsychological Characterization of Asperger Syndrome:
Convergence with Nonverbal Learning Disabilities Syndrome A. Klin
et al (1995) The Journal of Child Psychology and Psychiatry and
Allied Disciplines, Vol. 36, No. 7, pp. 1127-1140, 1995. Reprinted
with permission from Cambridge University Press. See section titled
"Validity of Asperger syndrome"
3 Newschaffer CJ, Croen LA, Daniels J et al. (2007). "The epidemiology
of Autism Spectrum Disorders". Annu Rev Public Health 28: 235–58.
doi:10.1146/annurev.publhealth.28.021406.144007. PMID 17367287.
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