High-functioning autism
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High-functioning autism (HFA) is the condition of individuals who display some symptoms of autism but who are able to function close to or above a normal level in society. HFA is sometimes also known as Asperger syndrome, however this is a misnomer. The difference is that in Asperger syndrome there is no linguistic delay however there is in HFA. In everyday terms, those who are affected by it may be understood as being "eccentrics", "nerds", "geeks", or termed a "little professor" or boffin.
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[edit] HFA as a developing clinical label
Experts disagree on whether or not high-functioning autism and Asperger's syndrome are synonymous, but both, by definition, require a relatively high level of adaptive functioning in comparison to low-functioning autism. It should be noted that 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 described diagnosed autistic individuals who could nevertheless speak and carry on with many day-to-day activities like eating and dressing independently. Low-functioning 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.
Many people on the autistic spectrum contest that a simple categorical division into low- and high-functioning creates an illusive division. They prefer to see the spectrum as multidimensional, with several autistic traits varying in intensity and sometimes varying day by day. For instance, the definition of Asperger's syndrome as essentially autism without speech or other cognitive delays creates an arbitrary barrier in a common condition, they believe.
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."
Some intellectually gifted students are also being diagnosed with an autistic spectrum disorder.
[edit] Social aspects
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 of strangers. It may be best summed up as a lack of common sense with respect to social matters.
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, leadings others to conclude that they are shy.
Unlike with low-functioning autism, people with high-functioning autism are not mentally retarded. The research community recognizes that high-functioning autism does not happen in people with an IQ of below roughly 70. They also have adequate speech.
As with people elsewhere on the autistic 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.
[edit] Difficulties for people with HFA
Generally, there are difficulties with social interaction. This does not adversely impact 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.
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 and loneliness, which further impairs their ability to find meaningful companionship.
People with narrow horizons may cruelly label HFA people as "oddballs" or worse, and HFA people may become the target of bullying. This can be especially true of the teenage years. Young intelligent HFA people usually do best by seeking out the company of their intellectual peers or by joining hobby groups, while avoiding their age-group peers.
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 HFA 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 HFA adults can usually find a good job if they can specialise in their area of interest at university level. 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 difficulty with motor skills and co-ordination, especially in free-form social situations or sports (they may have been "the last to be picked for the sports team" as children, and labelled as "clumsy"). This may partly explain their preference for order and neatness, since they use neatness to compensate. Some may also nurture a complex habitual movement (termed "Stimming") at which they become adept, e.g. 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).
Some people with HFA can be extreme procrastinators. A small minority may be unusually sensitive to sudden or annoying noise.
HFA adults are usually at higher risk for becoming poor or homeless than the general population.
[edit] Benefits of HFA
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 may not be applied to subjects they are uninterested in. They often present no problems in a supportive, well-resourced educational institution and usually do well academically if they can be stimulated by good teachers.
People with HFA often have intense and deep knowledge of an obscure or difficult subject and a passion for pursuing it in an organised and scholarly manner.
They are usually intelligent, gifted, honest, hard workers when interested in a task and excellent problem solvers. People with HFA tend to become excellent scientists and engineers or enter other professions where painstaking, methodical analysis is required.
Speech and diction can be unusually precise in some individuals with HFA. Some may be unusually adept at wordplay and use language in inventive ways.
[edit] Gender differences
It would seem unlikely that such a major social factor as gender would not affect how HFA manifests itself in an individual. There is a general consensus that HFA seems to affect far more males than females. Some have gone as far as to refer to HFA as a form of "extreme maleness"[citation needed]. An alternative hypothesis is that females are more competent at compensatory strategies and thus are less visible.
[edit] Causes
There seems to be no agreement as to the cause or causes. Accurate medical diagnosis usually cannot happen before a child enters into the more complex and demanding social situation of an advanced school environment, age 7-12. Before about age 7, there is a strong danger that the normal traumas associated with infant development and family life will be confused with symptoms.
[edit] Frequency in the population
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 England 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.
An article by Dr. Arthur Caplan of the Center for Bioethics at the University of Pennsylvania, stated that... "autism appears in certain ethnic groups more than others."1
[edit] See also
- Controversies about functioning labels in the autism spectrum
- Autism Spectrum Quotient
- Asperger syndrome
[edit] References
- Autism Research Center: The Autism Spectrum Quotient (AQ) — A self-administered test for High-Functioning Autism (HFA): S. Baron-Cohen, S. Wheelwright, R. Skinner, J. Martin and E. Clubley, (2001), The Autism Spectrum Quotient (AQ) : Evidence from Asperger Syndrome/High Functioning Autism, Males and Females, Scientists and Mathematicians. Journal of Autism and Developmental Disorders 31:5-17.
- Wired magazine's Autism-Spectrum Quotient test.
