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High-functioning autism

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

High-functioning autism (HFA) is a term applied to people with autism who are deemed to be cognitively "higher functioning" (with an IQ of 70 or greater) than other people with autism.[9][10] Individuals with HFA or Asperger syndrome 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 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 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, Tourette syndrome, and possibly criminal behavior. While the 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.[18]

HFA does not cause nor include intellectual disabilities. This characteristic distinguishes HFA from the rest of the autism spectrum; between 40 and 55% of individuals with autism also have an intellectual disability.[19]


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 through multiple large-scale studies conducted in Japan, the United States, and other countries.[21]


Cases are typically diagnosed by 35 months of age, much earlier than those of Asperger syndrome. This phenomenon is most likely due to the early delay in speech and language. While there is no single accepted standard diagnostic measure for HFA, one of the most commonly used tools for early detection is the Social Communication Questionnaire. If the results of the test indicate an autism spectrum disorder, a comprehensive evaluation may lead to the diagnosis of HFA. Some characteristics used to diagnose an individual with autism include a lack of eye contact, pointing, and deficits in social interactions.[21] The Autism Diagnostic Interview-Revised and Autism Diagnostic Observation Schedule are two evaluations utilized in the standard diagnosis process.[10]

There are two classifications of different social interaction styles associated with HFA. The first is an active-but-odd social interaction style classified by ADHD symptoms, poor executive functioning, and psychosocial problems. The difficulty controlling impulses could cause the active-but-odd social behaviors present in some children with HFA. The second social interaction type is a passive style. This aloof style is characterized by a lack of social initiations and could possibly be caused by social anxiety.[11]


Treatments for HFA address individual symptoms, rather than the condition as a whole. For instance, to treat anxiety, which is often associated with HFA, the main treatment is cognitive behavior therapy. While this is the tested and approved treatment for anxiety, it does not quite meet the needs associated with the symptoms of HFA. There is very little discussion[citation needed] of the parent's role in anxiety intervention for children and teenagers. A revised version of cognitive behavior therapy has parents and teachers acting in a role as social coaches to help the children or young adults cope with the issues they are facing. There have been several trials proving that the involvement of parents in the lives of the children affected with anxiety associated with HFA is important.[16]

No single intervention exists to aid individuals with high-functioning autism. However, there are proactive strategies, such as self care and self-management, designed to maintain or change behavior to make living with high functioning autism easier. Self-management strategies aim to provide skills necessary to self-regulate behavior, leading to greater levels of independence. Improving self-management skills allows the individual to be more self-reliant rather than having to rely on an external source for supervision or control. Self-monitoring is a framework, not a rigid structure, designed to encourage independence and self-control. Self-monitoring is not for everyone. It requires the attention and dedication of the individual with high-functioning autism as well as the individual overseeing the progress.

A framework for self-monitoring is provided below

  • Identify positive target behaviors
    • Establish an alternative behavior that is positive/constructive
  • Establish a self-recording sheet
    • Individuals can make sure to stay on track with intended goals
  • Set goals and keep them

The goal of self-monitoring is to enforce self-monitoring independently without prompting.[22]

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.[23] 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.[24][25]

See also

Further reading

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


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