High-functioning autism

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High-functioning autism
Other names Sukhareva syndrome [1]
Specialty Psychiatry
Symptoms Trouble with social interaction, impaired communication, restricted interests, repetitive behavior
Complications Social isolation, employment problems, family stress, bullying, self-harm [2]
Usual onsetBy age two or three [3] [4]
DurationLifelong
Causes Genetic and environmental factors
Diagnostic method Based on behavior and developmental history
Differential diagnosis Asperger syndrome, ADHD, Tourette syndrome, anxiety, bipolar disorder, obsessive–compulsive disorder
Treatment Behavioral therapy, speech therapy, psychotropic medication [5] [6] [7]
Medication Antipsychotics, antidepressants, stimulants (associated symptoms) [8] [9] [10]

High-functioning autism (HFA) was historically an autism classification to describe a person who exhibited no intellectual disability but otherwise showed autistic traits, such as difficulty in social interaction and communication, as well as repetitive, restricted patterns of behavior. The term is often applied to autistic people who are fluently verbal and of at least average intelligence. [11] [12] [13] However, many in medical and autistic communities have called to stop using the term, finding it simplistic and unindicative of the difficulties some autistic people face. [14] [15] [16] [17]

Contents

HFA has never been included in either the American Psychiatric Association's Diagnostic and Statistical Manual (DSM) or the World Health Organization's International Classification of Diseases (ICD), the two major classification and diagnostic guidelines for psychiatric conditions.

The DSM-5-TR subtypes autism into three levels based on support needs. Autism Level 1 has the least support needs and corresponds most closely with the "high-functioning" identifier. [18]

Characterization

The term high-functioning autism was used in a manner similar to Asperger syndrome, another outdated classification. The defining characteristic recognized by psychologists was a significant delay in the development of early speech and language skills, before the age of three years. [12] The term Asperger syndrome typically excluded a general language delay. [19]

Other differences noted in features of high-functioning autism and Asperger syndrome included the following: [12] [20] [21] [22]

HFA is not a recognised diagnosis by the American Psychiatric Association or the World Health Organization. HFA was, however, previously used in clinical settings to describe cases of autism spectrum disorder where indicators suggested an intelligence quotient (IQ) of 70 or greater. [23]

Comorbidities

See main article: Conditions comorbid to autism

With the notable exception of intellectual disabilities, which were not part of HFA, cormobidities found in HFA populations reflected those found in autism. (Between 40 and 55% of individuals with autism also have an intellectual disability. [24] ) Studies that looked specifically at HFA have examined anxiety, [25] bipolar disorder, Tourette syndrom, ADHD, and obsessive–compulsive disorder (OCD). Both HFA and OCD have abnormalities associated with serotonin. [26]

Behavior

A 2012 study noted that HFA "disorders are over-represented in the criminal population as compared to the general population," though more research needs to be done in this area. [26] Some case studies have linked the lack of empathy and social naïveté associated with HFA to criminal actions. [27]

See also

Related Research Articles

<span class="mw-page-title-main">Asperger syndrome</span> Formerly recognized subtype of autism

Asperger syndrome (AS), also known as Asperger's syndrome or Asperger's, was a diagnosis used to describe a neurodevelopmental disorder characterized by significant difficulties in social interaction and nonverbal communication, along with restricted, repetitive patterns of behavior and interests. Asperger syndrome has been merged with other conditions into autism spectrum disorder (ASD) and is no longer a diagnosis in the WHO's ICD-11 or the APA's DSM-5-TR. It was considered milder than other diagnoses which were merged into ASD due to relatively unimpaired spoken language and intelligence.

The diagnostic category pervasive developmental disorders (PDD), as opposed to specific developmental disorders (SDD), was a group of disorders characterized by delays in the development of multiple basic functions including socialization and communication. It was defined by the Diagnostic and Statistical Manual of Mental Disorders (DSM), and the International Classification of Diseases (ICD).

<span class="mw-page-title-main">Lorna Wing</span> British autism researcher (1928–2014)

Lorna Gladys Wing was a British psychiatrist notable for her pioneering research into autism. She coined the term Asperger's syndrome and helped found the National Autistic Society.

Pervasive developmental disorder not otherwise specified (PDD-NOS) is a historic psychiatric diagnosis first defined in 1980 that has since been incorporated into autism spectrum disorder in the DSM-5 (2013).

<span class="mw-page-title-main">Conditions comorbid to autism</span> Medical conditions more common in autistic people

Autism spectrum disorder (ASD) or simply autism is a neurodevelopmental disorder that begins in early childhood, persists throughout adulthood, and is characterized by difficulties in social communication and restricted, repetitive patterns of behavior. There are many conditions comorbid to autism, such as attention deficit hyperactivity disorder, anxiety disorders, and epilepsy.

Lars Christopher Gillberg is a professor of child and adolescent psychiatry at Gothenburg University in Gothenburg, Sweden. He has also been a visiting professor at the universities of Bergen, New York, Odense, St George's, San Francisco, and Glasgow and Strathclyde. Gillberg is the founding editor of the journal European Child & Adolescent Psychiatry.

The Autism Diagnostic Observation Schedule (ADOS) is a standardized diagnostic test for assessing autism spectrum disorder. The protocol consists of a series of structured and semi-structured tasks that involve social interaction between the examiner and the person under assessment. The examiner observes and identifies aspects of the subject's behavior, assigns these to predetermined categories, and combines these categorized observations to produce quantitative scores for analysis. Research-determined cut-offs identify the potential diagnosis of autism spectrum disorder, allowing a standardized assessment of autistic symptoms.

The epidemiology of autism is the study of the incidence and distribution of autism spectrum disorders (ASD). A 2022 systematic review of global prevalence of autism spectrum disorders found a median prevalence of 1% in children in studies published from 2012 to 2021, with a trend of increasing prevalence over time. However, the study's 1% figure may reflect an underestimate of prevalence in low- and middle-income countries.

The autism-spectrum quotient (AQ) is a questionnaire published in 2001 by Simon Baron-Cohen and his colleagues at the Autism Research Centre in Cambridge, UK. Consisting of fifty questions, it aims to investigate whether adults of average intelligence have symptoms of autism spectrum conditions. More recently, versions of the AQ for children and adolescents have also been published.

Asperger syndrome (AS) was formerly a separate diagnosis under autism spectrum disorder. Under the DSM-5 and ICD-11, patients formerly diagnosable with Asperger syndrome are diagnosable with Autism Spectrum Disorder. The term is considered offensive by some autistic individuals. It was named after Hans Asperger (1906–80), who was an Austrian psychiatrist and pediatrician. An English psychiatrist, Lorna Wing, popularized the term "Asperger's syndrome" in a 1981 publication; the first book in English on Asperger syndrome was written by Uta Frith in 1991 and the condition was subsequently recognized in formal diagnostic manuals later in the 1990s.

<span class="mw-page-title-main">Classic autism</span> Former neurodevelopmental disorder now classified under autism spectrum disorder

Classic autism, also known as childhood autism, autistic disorder, or Kanner's syndrome, is a formerly diagnosed neurodevelopmental disorder first described by Leo Kanner in 1943. It is characterized by atypical and impaired development in social interaction and communication as well as restricted, repetitive behaviors, activities, and interests. These symptoms first appear in early childhood and persist throughout life.

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In psychiatry, stilted speech or pedantic speech is communication characterized by situationally inappropriate formality. This formality can be expressed both through abnormal prosody as well as speech content that is "inappropriately pompous, legalistic, philosophical, or quaint". Often, such speech can act as evidence for autism spectrum disorder (ASD) or a thought disorder, a common symptom in schizophrenia or schizoid personality disorder.

The relationship between autism and memory, specifically memory functions in relation to autism spectrum disorder (ASD), is an ongoing topic of research. ASD is a neurodevelopmental disorder characterised by social communication and interaction impairments, along with restricted and repetitive patterns of behavior. In this article, the word autism is used to refer to the whole range of conditions on the autism spectrum, which are not uncommon.

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<span class="mw-page-title-main">Edward Ross Ritvo</span> American psychiatrist, autism researcher (1930–2020)

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References

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  14. ↑ "Making information and the words we use accessible". NHS England. August 25, 2024. Retrieved August 25, 2024.
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  16. ↑ Alvares GA (June 19, 2019). "The misnomer of 'high functioning autism': Intelligence is an imprecise predictor of functional abilities at diagnosis". Autism. 24 (1): 221–232. doi:10.1177/1362361319852831. PMID   31215791 – via NIH: National Library of Medicine.
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  24. ↑ Newschaffer CJ, Croen LA, Daniels J, Giarelli E, Grether JK, Levy SE, Mandell DS, Miller LA, Pinto-Martin J, Reaven J, Reynolds AM, Rice CE, Schendel D, Windham GC (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.
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  26. 1 2 Mazzone L, Ruta L, Reale L (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   3416662 . PMID   22731684.
  27. ↑ Lerner MD, Haque OS, Northrup EC, Lawer L, Bursztajn HJ (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. Archived from the original on 2019-12-11. Retrieved 2013-03-24.

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