High-functioning autism

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.[1][2] Individuals with HFA or Asperger syndrome may exhibit deficits in areas of communication, emotion recognition and expression, and social interaction.[3] HFA is not a recognized diagnosis in the DSM-5 or the ICD-10.

The amount of overlap between HFA and Asperger syndrome is disputed.[4]


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.[2] The diagnostic criteria of Asperger syndrome exclude a general language delay.[5]

Further differences in features between people with high-functioning autism and those with Asperger syndrome, include the following:[2][6][7][8]

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.[9]

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 depression, bipolar disorder, and obsessive compulsive disorder (OCD). In particular the link between HFA and OCD, has been studied; both have abnormalities associated with serotonin.[10]

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.[10] 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.[11]

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.[12]


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.[13]

There is a mistaken belief that some vaccinations, such as the MMR, the measles/mumps 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 the vaccines; these diseases 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.[14]


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.[14] The Autism Diagnostic Interview-Revised and Autism Diagnostic Observation Schedule are two evaluations utilized in the standard diagnosis process.[2]

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.[3]


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 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.[9]

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

The goal of self-monitoring is to enforce self-monitoring independently without prompting.[15]

See also


  1. Sanders, James Ladell (2009). "Qualitative or Quantitative Differences Between Asperger's Disorder and Autism? Historical Considerations". Journal of Autism and Developmental Disorders. 39 (11): 1560–1567. doi:10.1007/s10803-009-0798-0. ISSN 0162-3257. PMID 19548078.
  2. 1 2 3 4 Carpenter, Laura Arnstein; Soorya, Latha; Halpern, Danielle (2009). "Asperger's Syndrome and High-Functioning Autism". Pediatric Annals. 38 (1): 30–5. doi:10.3928/00904481-20090101-01.
  3. 1 2 Sanders, J (2009). "Qualitative or quantitative differences between Asperger's disorder and autism? Historical considerations". Journal of Autism & Developmental Disorders. 39 (11): 1560–1567. doi:10.1007/s10803-009-0798-0. PMID 19548078.
  4. Tsai, Luke Y. (2013). "Asperger's Disorder will be Back". Journal of Autism and Developmental Disorders. 43 (12): 2914–2942. doi:10.1007/s10803-013-1839-2. ISSN 0162-3257.
  5. Asperger's DisorderDiagnostic and Statistical Manual of Mental Disorders Fourth edition Text Revision (DSM-IV-TR) American Psychiatric Association (2000)
  6. T. Attwood, Is There a Difference Between Asperger's Syndrome and High Functioning Autism?
  7. Rinehart, NJ; Bradshaw, JL; Brereton, AV; Tonge, BJ (2002). "Lateralization in individuals with high-functioning autism and Asperger's disorder: A frontostriatal model". Journal of autism and developmental disorders. 32 (4): 321–331. doi:10.1023/A:1016387020095. PMID 12199137.
  8. Mazefsky, Carla A.; Oswald, Donald P. (2006). "Emotion Perception in Asperger's Syndrome and High-functioning Autism: The Importance of Diagnostic Criteria and Cue Intensity". Journal of Autism and Developmental Disorders. 37 (6): 1086–95. doi:10.1007/s10803-006-0251-6. PMID 17180461.
  9. 1 2 Reaven, Judy (2011). "The treatment of anxiety symptoms in youth with high-functioning autism spectrum disorders: Developmental considerations for parents". Brain Research. 1380: 255–63. doi:10.1016/j.brainres.2010.09.075. PMID 20875799.
  10. 1 2 Mazzone, Luigi; Ruta, Liliana; Reale, Laura (2012). "Psychiatric comorbidities in asperger syndrome and high functioning autism: Diagnostic challenges". Annals of General Psychiatry. 11 (1): 16. doi:10.1186/1744-859X-11-16. PMC 3416662Freely accessible. PMID 22731684.
  11. Lerner, Matthew D.; Haque, Omar Sultan; Northrup, Eli C.; Lawer, Lindsay; Bursztajn, Harold J. (2012). "Emerging Perspectives on Adolescents and Young Adults With High-Functioning Autism Spectrum Disorders, Violence, and Criminal Law". Journal of the American Academy of Psychiatry and the Law. 40 (2): 177–90. PMID 22635288.
  12. Newschaffer, Craig J.; Croen, Lisa A.; Daniels, Julie; Giarelli, Ellen; Grether, Judith K.; Levy, Susan E.; Mandell, David S.; Miller, Lisa A.; Pinto-Martin, Jennifer; Reaven, Judy; Reynolds, Ann M.; Rice, Catherine E.; Schendel, Diana; Windham, Gayle C. (2007). "The Epidemiology of Autism Spectrum Disorders*". Annual Review of Public Health. 28 (1): 235–258. doi:10.1146/annurev.publhealth.28.021406.144007. ISSN 0163-7525. PMID 17367287.
  13. Spencer, Michael; Stanfield, Andrew; Johnstone, Eve (2011). "Brain imaging and the neuroanatomical correlates of autism". In Roth, Ilona; Rezaie, Payam. Researching the Autism Spectrum. pp. 112–55. doi:10.1017/CBO9780511973918.006. ISBN 978-0-511-97391-8.
  14. 1 2 Klin, Ami (2006). "Autismo e síndrome de Asperger: Uma visão geral" [Autism and Asperger syndrome: an overview]. Revista Brasileira de Psiquiatria (in Portuguese). 28: S3–11. doi:10.1590/S1516-44462006000500002. PMID 16791390.
  15. Wilkinson, L. A. (2008). "Self-Management for Children with High-Functioning Autism Spectrum Disorders". Intervention in School and Clinic. 43 (3): 150–7. doi:10.1177/1053451207311613.
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