High-functioning autism

High-functioning autism (HFA) is autism without an intellectual disability (an IQ of 70 or less).[9][10] Individuals with HFA may exhibit deficits in areas of communication, emotion recognition and expression and social interaction.[11] HFA is not a recognized diagnosis in the DSM-5 or the ICD-10.

High-functioning autism
SpecialtyPsychiatry
SymptomsTrouble with social interaction, impaired communication, restricted interests, repetitive behavior
Usual onsetBy age two or three[1][2]
DurationLong-term
CausesGenetic and environmental factors
Diagnostic methodBased on behavior and developmental history
Differential diagnosisAsperger syndrome, ADHD, Tourette syndrome, Anxiety, Bipolar disorder, Obsessive–compulsive disorder
TreatmentBehavioral therapy, speech therapy, psychotropic medication[3][4][5]
MedicationAntipsychotics, antidepressants, stimulants (associated symptoms)[6][7][8]

Characterization

High-functioning autism is characterized by features very similar to those of Asperger syndrome. The defining characteristic most widely recognized by psychologists is a significant delay in the development of early speech and language skills, before the age of three years.[10] The diagnostic criteria of Asperger syndrome exclude a general language delay.[12]

Further differences in features between people with high-functioning autism and those with Asperger syndrome, include the following:[10][13][14][15]

  • People with HFA have a lower verbal reasoning ability
  • Better visual/spatial skills (higher performance IQ) than people with Asperger syndrome
  • Less deviating locomotion (e.g. clumsiness) than people with Asperger syndrome
  • People with HFA more often have problems functioning independently
  • Curiosity and interest for many different things, in contrast to people with Asperger syndrome
  • People with Asperger syndrome are better at empathizing with another
  • The male to female ratio of 4:1 for HFA is much smaller than that of Asperger syndrome

Individuals with autism spectrum disorders, including high-functioning autism, risk developing symptoms of anxiety. While anxiety is one of the most commonly occurring mental health symptoms, children and adolescents with high functioning autism are at an even greater risk of developing symptoms.[16]

There are other comorbidities, the presence of one or more disorders in addition to the primary disorder, associated with high-functioning autism. Some of these include bipolar disorder and obsessive compulsive disorder (OCD). In particular the link between HFA and OCD, has been studied; both have abnormalities associated with serotonin.[17]

Observable comorbidities associated with HFA include ADHD and Tourette syndrome. HFA does not cause nor include intellectual disabilities. This characteristic distinguishes HFA from low-functioning autism; between 40 and 55% of individuals with autism also have an intellectual disability.[18]

An association between HFA and criminal behavior is not completely characterized. Several studies have shown that the features associated with HFA may increase the probability of engaging in criminal behavior.[17] While there is still a great deal of research that needs to be done in this area, recent studies on the correlation between HFA and criminal actions suggest that there is a need to understand the attributes of HFA that may lead to violent behavior. There have been several case studies that link the lack of empathy and social naïveté associated with HFA to criminal actions.[19]

Cause
Main articles: Causes of autism and MMR vaccine controversy

Although little is known about the biological basis of autism, studies have revealed structural abnormalities in specific brain regions. Regions identified in the "social" brain include the amygdala, superior temporal sulcus, fusiform gyrus area and orbitofrontal cortex. Further abnormalities have been observed in the caudate nucleus, believed to be involved in restrictive behaviors, as well as in a significant increase in the amount of cortical grey matter and atypical connectivity between brain regions.[20]

There is a mistaken belief that some vaccinations, such as the MMR (measles, mumps, rubella) vaccine, may cause autism. This was based on a research study published by Andrew Wakefield, which has been determined fraudulent and retracted. The results of this study caused some parents to take their children off vaccines clinically proven to prevent diseases that can cause intellectual disabilities or death. The claim that some vaccinations cause autism has not been proven; multiple large-scale epidemiological studies conducted in Japan, the United States, and other countries do not support this link.[21][22]

Diagnosis

While high-functioning autism was never an official diagnosis in the Diagnostic and Statistical Manual of Mental Disorders published by the American Psychiatric Association, it was a classification in the DSM-4 for individuals with autistic disorder but do not have an intellectual disability (an IQ of 70 or more). In the present diagnostic standards of the DSM-5 the classification of HFA is no longer used and has been replaced by 3 support levels for Autism-spectrum disorders.[2][23][24] Typically cases of high-functioning autism are diagnosed by 35 months of age, much earlier than those of Asperger syndrome; this is possibly due to the delay in speech and language development. Some characteristics used to diagnose an individual with autism include persistent deficits in social communication and social interaction, along with restrictive, and repetitive patterns of behavior.[11][25]

Treatment

While there exists no single treatment or medicine for people with autism, there exists several strategies to help lessen the symptoms and effects of the condition.

Augmentative and alternative communication

Augmentative and alternative communication (AAC) is used for autistic patients who cannot communicate orally. Patients who have problems speaking may be taught to use other forms of communication, such as body language, computers, interactive devices, and pictures.[26] The Picture Exchange Communication System (PECS) is a commonly used form of augmentative and alternative communication with children and adults who cannot communicate well orally. Patients are taught how to link pictures and symbols to their feelings, desires and observation, and may be able to link sentences together with the vocabulary that they form.[27]

Speech-language therapy

Speech-language therapy can help those with autism who need to develop or improve communication skills.[23] According to the organization Autism Speaks, “speech-language therapy is designed to coordinate the mechanics of speech with the meaning and social use of speech”.[27] People with autism may have issues with communication, or speaking spoken words. Speech-language Pathologists (SLP) may teach someone how to communicate more effectively with others or work on starting to develop speech patterns.[28] The SLP will create a plan that focuses on what the child needs.

Occupational therapy

Occupational therapy helps autistic children and adults learn everyday skills that help them with daily tasks, such as personal hygiene and movement. These skills are then integrated into their home, school, and work environments. Therapists will oftentimes help patients learn to adapt their environment to their skill level.[29] This type of therapy could help autistic people become more engaged in their environment.[27] An occupational therapist will create a plan based on the patient's’ needs and desires and work with them to achieve their set goals.

Applied behavioral analysis (ABA)

Applied behavioral analysis (ABA) is considered the most effective therapy for Autism spectrum disorders by the American Academy of Pediatrics.[30] ABA focuses on teaching adaptive behaviors like social skills, play skills, or communication skills[31][32] and diminishing problematic behaviors like eloping or self-injury[33] by creating a specialized plan that uses behavioral therapy techniques, such as positive or negative reinforcement, to encourage or discourage certain behaviors over-time.[34]

Sensory integration therapy

Sensory integration therapy helps people with autism adapt to different kinds of sensory stimuli. Many with autism can be oversensitive to certain stimuli, such as lights or sounds, causing them to overreact. Others may not react to certain stimuli, such as someone speaking to them.[35] Many types of therapy activities involve a form of play, such as using swings, toys and trampolines to help engage the patients with sensory stimuli.[27] Therapists will create a plan that focuses on the type of stimulation the person needs integration with.

Medication

There are no medications specifically designed to treat autism. Medication is usually used for symptoms associated with autism, such as depression, anxiety, or behavioral problems.[36] Medicines are usually used after other alternative forms of treatment have failed.[37]

Criticism of functioning labels

Many autistic rights activists disagree with the categorisation of individuals into "high-functioning autism" and "low-functioning autism", stating that the "low-functioning" label causes people to put low expectations on a child and view them as lesser.[38] Furthermore, critics of functioning labels state that an individual's functioning can fluctuate from day to day, and categories do not take this into consideration.[39]

See also

Further reading
  • Robison, John Elder (2007). Look Me in the Eye: My Life with Asperger's. Three Rivers Press. ISBN 9780307395986.

References
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