What Is High-Functioning Autism Spectrum Disorder?

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High-functioning autism spectrum disorder is a type of autism characterized by challenges with social functioning. A person with high-functioning autism (HFA) may have difficulty interpreting and responding to social cues and emotions appropriately. In addition, they may resist changes in routine and be hypersensitive to sensory input.

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) are also important components of a treatment plan.

Signs of Asperger Syndrome
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. They may have difficulties including:

  • An inability to accurately read body language and vocal tone, infer what another person is thinking, or show appropriate emotional responses at the right time
  • Difficulty interpreting more complex social cues like humor, irony, romantic interest, and anger. When conversing or interacting with others, a person with HFA may stand too close to someone or talk non-stop about a topic, failing to notice the listener's lack of interest. Additionally, they may not understand when to speak, when to listen, or how to dress appropriately for a specific situation. 
  • Trouble making eye contact and acting appropriately when relating to others. Someone with HFA may appear awkward, maintain the same facial expression (e.g., not smiling in response to someone sharing good news), not use gestures or posture changes throughout the conversation, and/or exhibit an unusual speech pattern (e.g., a flat, high-pitched, or inappropriately loud voice).

Other symptoms include:

  • Difficulty with change: Most people with high-functioning autism prefer to know exactly what's going to happen next. Many prefer to do the same things in the same order each day, eat the same foods, and take the same routes.
  • Extreme focus on a topic of interest: Some people with HFA are so fascinated by a particular interest that they find it hard to change the subject.
  • Challenges with empathy: This means that a person has trouble imagining what other people are thinking or feeling.
  • Engaging in stereotyped, repetitive behaviors: Some people with HFA engage in self-stimulating ("stimming") behaviors, such as hand flapping, pacing, rocking, or humming.
  • Hypersensitivity to sensory input: It may be tough for a person with ASD to be in a loud, bright space or function well in an open classroom or large restaurant. They may also react strongly to smells or tastes, or have a hard time with physical contact.

Causes

The cause of autism spectrum disorder is not fully known. Experts suspect that a combination of genes and exposure to one or more environmental factors may trigger its development.

Environmental factors that have been investigated as potentially contributing to the development of ASD include:

  • 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

High-functioning autism is different from other disorders on the autism spectrum, in part because it is often diagnosed in older children and teenagers. (More severe forms of autism tend to be diagnosed in toddlerhood.) Those with HFA tend to achieve early developmental milestones; the disorder doesn't become evident until they reach an age (around preschool, but sometimes later) when they are expected to manage complex social relationships, conversations, or sensory challenges that they need to be evaluated.

If you decide to seek a diagnosis for your child (or yourself), ask your doctor for recommendations of individual therapists, neurologists, and autism centers that are familiar with tests for high-functioning autism.

Your pediatrician will want to take a medical history, ask questions about your child's behavior, and observe them. They will likely perform a series of tests and assessments that focus on intelligence, behavior patterns, "adaptive" social and communication skills, and personal developmental history. These include:

Based on the results, an experienced clinician will be able to tell you whether or not autism can be diagnosed or whether the symptoms are more in line with other disorders that have some of the same or similar characteristics (such as social anxiety disorder, obsessive-compulsive disorder, or social communication disorder).

Sorting out various diagnoses can be a very tricky process and sometimes no disorder is present—a person may simply have a shy temperament, for example.

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

Treatment

The treatment of HFA/ASD requires a multifaceted approach and must be tailored to each individual's age and needs. Several types of professionals, including a psychologist, occupational therapist, and social worker are usually involved.

Children and Teens

Interventions that address behavior and education are at the crux of treatment.

For instance, creating a home and school environment that is structured and organized—one where there are visual schedules, task lists, and clearly defined rules and expectations—can help children and adolescents stay focused.

In addition, classroom settings may be adjusted in order to minimize over-arousal, such as placing carpet to reduce noise or breaking up the class into smaller learning groups where there are fewer students. Motor-based activities done intermittently throughout the school day, such as yoga, hula-hooping, or jumping on a mini-trampoline, can also help provide calmness and fulfill a child's sensory need.

Social-skills training, mental health counseling, family support, engaging in healthy lifestyle habits (for example, eating healthfully and obtaining adequate sleep), and formulating an education plan that is tailored to an individual child or adolescent's needs are also essential components of the treatment plan.

Adults

Adults with HFA may need accommodations at work, such as implementing scheduled breaks, requesting written instead of verbal instruction for a task, or using earplugs or headphones throughout the day to reduce sensory overload and improve executive functioning.

Cognitive-behavioral therapy has emerged as a therapy for those with HFA, especially adults. This type of therapy can help adults develop concrete coping skills for navigating peer and romantic relationships, and help them address frustrations related to achieving goals in 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.

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

Medication

Medication, prescribed by a developmental pediatrician, or a child or adult psychiatrist, is sometimes used to complement the care of someone with HFA/ASD who has other behavioral or mental health issues.

Depending on what symptom is being targeted, various types of medications may be prescribed.

For example, a doctor may prescribe a selective-serotonin reuptake-inhibitor (SSRI) like Prozac (fluoxetine) or Zoloft (sertraline) to manage anxiety, obsessive-compulsive behaviors, fear of certain situations, or angry outbursts.

For inattention or distractibility, often stemming from sensory over-arousal, Strattera (atomoxetine) or a stimulant medication like Ritalin (methylphenidate) may be recommended.

For disruptive behaviors like tantrums, aggression, or self-injurious behaviors, an antipsychotic, such as Risperdal (risperidone), may be prescribed.

A Word From Verywell

Living with high-functioning autism can be challenging on a daily basis, but numerous treatment options have emerged over the years, as diagnoses and awareness have increased.

It's key to be proactive in helping your child or teen navigate this disorder and to avail yourself of the services and opportunities out there that exist to help people with HFA live a productive and happy life.

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