It May Take Years to Learn You Have High Functioning Autism

Frustrated Teen
Frustrated Teen. SW Productions

High functioning autism (HFA) can be hard to spot; few people with HFA exhibit obvious autism-like symptoms such as rocking, flapping, or really unusual use of voice or language. This is one of many reasons why people with HFA (sometimes called mild autism or — until 2013 — Asperger syndrome) may be diagnosed as teens or adults rather than as young children. 

The symptoms that lead to a late diagnosis, however, would have to be present from early childhood to qualify for an autism diagnosis. Which begs the question, if symptoms have been around since a person was, say, two years old — why wouldn't he or she have received an autism diagnosis as a toddler? 

Why Autism Can Be Hard to Diagnose

There are a number of answers to that question.  For example:

  1. Higher intelligence and language skills may have masked certain symptoms.  The ability to do well in school, communicate effectively, and pass an IQ test with flying colors are all impressive — and may set parents and teachers down the wrong path when looking for reasons for a child's unusual issues or behavior.  Even general practice pediatricians can miss signs of autism when a child is able to communicate intelligently using spoken language. In some cases, kids' strengths carry them through early elementary school with only minor issues, but become serious concerns when schoolwork becomes more abstract, demanding, and verbal — and when social interactions become more complex. 
  2. The individual may have been born before the diagnosis of Asperger syndrome or high functioning autism was included in the diagnostic literature. There were plenty of kids with symptoms consistent with HFA before 1988 when Asperger syndrome was added to the diagnostic manual along with other "milder" forms of autism.  These folks may or may not have received a diagnosis of something other than autism (autism would have been far too extreme a diagnosis for a high functioning individual) — and they may never have thought of seeking a new diagnosis as an adult.
  1. The individual may have developed means to hide, manage, or overcome his or her symptoms.  People with high functioning autism are, by definition, of average or above average intelligence.  If they are told often enough to make eye contact, stop rocking, flapping, or talking about the same things over and over again — they are often able to either hide, control, or actually overcome the need to present overt symptoms.  When that happens, the obvious external signs of autism are not present, making a diagnosis very tricky indeed.
  2. Some research suggests that women and girls are under-diagnosed with autism.  While 4 times as many boys and men are diagnosed with autism than women and girls, the reasons are not clear.  Are girls really less likely to be autistic?  Or are their behaviors (apparent shyness, discomfort with public speaking, difficulties with motor coordination, confusion over social communication in situations such as team sports) considered "feminine" rather than problematic?  Or do girls with high-functioning autism actually behave differently from boys with autism, tending to be less aggressive, more imitative, and more likely to work hard to "fit in?"  While the reasons are not well understood, it seems clear that being a female on the spectrum may make you less likely to receive a diagnosis.
  1. Individuals from poorer and/or minority backgrounds are under-diagnosed with autism.  There seem to be two major reasons for this disparity.  The first and most obvious is that people with less money have less access to behavioral healthcare — and so are less likely to be able to access services, particularly for a child who is not obviously autistic.  The second reason seems to relate to cultural differences: in some communities, the "oddnesses" associated with high functioning autism are not considered to be particularly problematic. And, of course, for recent immigrants, it's not surprising to hear that their child is not fitting in perfectly with American or "First World" cultural norms!
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