What Is High-Functioning Autism Spectrum Disorder?

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High-functioning autism (HFA) is a term often used to classify autistic spectrum disorder (ASD) characterized largely by difficulty interpreting and responding to social cues and emotions appropriately. People with high-function autism also may resist changes in routine and be hypersensitive to noise, smell, touch, and other types of sensory input. Treatment for HFA is individualized based on personal symptoms and may include sensory modifications in and outside the home, counseling, and sometimes medication.

Prior to 2013, when the Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-5), was published, people on the high-functioning end of the autism spectrum were often diagnosed with Asperger's syndrome. Now, those formerly thought to have Asperger's are given a diagnosis of autism spectrum disorder, or "level 1 autism."

Children with HFA typically do best when their days are structured and predictable. Sensory modifications in and outside the home, along with counseling, family support (and sometimes medication)

signs of high-functioning autism

Verywell / JR Bee

High-Functioning Autism Spectrum Disorder Symptoms

While people with HFA are likely to have normal cognitive abilities and language development, they typically struggle with social communication and interaction in characteristic ways:

  • Inability to accurately read (or exhibit) gestures or body language and vocal tone, infer what another person is thinking, or show appropriate emotional responses
  • Lack of empathy for what other people are thinking or feeling
  • Difficulty interpreting complex social cues such as humor, irony, romantic interest, and anger
  • Standing too close to someone while talking to them
  • Talking non-stop about a particular topic without noticing the listener's lack of interest
  • Unable to understand when to speak and when to listen
  • Dressing inappropriately
  • Trouble making eye contact
  • Speaking in a flat, high-pitched tone or talking too loudly
  • Inflexibility—a need to know exactly what's going to happen next and to do the same things in the same order each day, eat the same foods, and take the same routes
  • Extreme focus on a particular topic of interest
  • Self-stimulating ("stimming") behaviors, such as hand flapping, pacing, rocking, or humming
  • Hypersensitivity to noise, light, smells, flavors, or physical contact 

Causes

The cause of autism spectrum disorder is not fully understood, although experts suspect ASD likely results from a combination of genes and exposure to one or more environmental factors, such as:

  • Advanced maternal and paternal age
  • Fetal environment (for example, the presence of maternal infection or health issues like obesity, diabetes, or high blood pressure)
  • Perinatal and obstetric events
  • Medications that were taken during pregnancy
  • Smoking and alcohol use
  • Nutritional deficiencies
  • Toxic exposures, like air pollution or pesticides

Diagnosis

Unlike more severe levels of ASD, high-functioning autism typically is diagnosed in older children and teenagers. These kids tend to achieve early developmental milestones, with symptoms emerging when they're expected to be able to manage complex social relationships, conversations, or sensory challenges but show signs of being unable to do so.

If this seems to be the case with your child (or you're aware of these symptoms in yourself), your doctor can recommends a therapist, neurologist, or autism center for testing. To diagnose autism, a clinician typically will take a medical history and ask for details regarding symptoms. They likely will observe your child's behavior and perform a series of tests and assessments that focus on intelligence, behavior patterns, social and communication skills, and personal developmental history, including:

The results of these tests not only can confirm autism but also rule out other disorders that have some of the same or similar symptoms (such as social anxiety disorder, obsessive-compulsive disorder, or social communication disorder).

Plenty of people are socially awkward without being diagnosable on the autism spectrum. The difference between "awkward" and "autistic" lies in the degree to which those delays, disorders, and difficulties impede one's ability to live a normal life.

Treatment

How a person with high-functioning autism is treated will depend largely on their age—as children and teens will require different types of support than adults will—and individual needs. Working out a treatment plan also may involve input from a team of professionals, including a psychologist, occupational therapist, and social worker.

Children and Teens

Interventions that address behavior and education are at the crux of treatment for kids with high-functioning autism. A highly structured home environment, featuring posted calendars and schedules, task lists, and clearly defined rules and expectations, is key.

Similar structure is important in the classroom, along with other accomodations such as:

  • Carpeted floors to reduce noise for children sensitive to loud sounds
  • Classrooms broken into small learning groups
  • Motor-based activities (yoga, hula-hooping) spaced throughout the day to meet sensory needs and promote calm

Children with high-functioning autism also benefit greatly from social-skills training, mental health counseling, family support, and healthy lifestyle habits—a healthy diet and adequate high-quality sleep, and an education plan tailored to their needs and abilities.

Adults

Structure and predictability also are important for high-functioning autistic adults, who also will benefit from interventions such as:

  • Accommodations at work, such as scheduled breaks, written (rather than verbal) instructions, and earplugs or headphones to reduce sensory overload and make it easier to concentrate and think.
  • Cognitive-behavioral therapy (CBT) to develop coping skills for peer and romantic relationships and provide support for frustrations at work and life.
  • Occupational therapy that focuses on optimizing problem-solving skills, building self-esteem and confidence, and managing home and money tasks can improve overall daily functioning and quality of life.

State-based vocational rehabilitation agencies can help individuals with disabilities, including autism, prepare for and find employment.

Medication

There are no medications to directly treat high-functioning autism, but a developmental pediatrician or psychiatrist may prescribe one to manage certain symptoms the often co-exist with ASD.Medications that sometimes play a part in treating autism include:

  • A selective-serotonin reuptake-inhibitor (SSRI) like Prozac (fluoxetine) or Zoloft (sertraline) for anxiety, obsessive-compulsive behaviors, fear of certain situations, or angry outbursts
  • Strattera (atomoxetine) or a stimulant medication such as Ritalin (methylphenidate) to manage inattention or distractibility stemming from sensory over-arousal
  • An antipsychotic such as Risperdal (risperidone) to quell disruptive behaviors like tantrums, aggression, or self-harm

A Word From Verywell

"High functioning autism" is more a descriptive word than a concrete diagnosis, but it does align fairly neatly with level 1 autism spectrum disorder as identified in the DSM-5. Both describe a tier of autism that typically allows for living a full and productive life with the support of family, teachers and support professionals in schools, and accommodations in the workplace. It's important to seek a definitive diagnosis for ASD at any level as soon as it's suspected: Early intervention is key to assembling a treatment plan and taking advantage of services and opportunities for autistic people.

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