high-functioning autism

{{Infobox medical condition (new)

| name = High-functioning autism

| image =

| caption =

| synonyms = Sukhareva syndrome{{cite journal | vauthors = Manouilenko I, Bejerot S | title = Sukhareva – Prior to Asperger and Kanner | journal = Nordic Journal of Psychiatry | volume = 69 | issue = 6 | pages = 479–82 | date = August 2015 | pmid = 25826582 | doi = 10.3109/08039488.2015.1005022 | s2cid = 207473133 | publication-date = 31 March 2015 | type = Report | url = http://urn.kb.se/resolve?urn=urn:nbn:se:oru:diva-47358}}

| field = Psychiatry

| symptoms = Trouble with social interaction, impaired communication, restricted interests, repetitive behavior

| complications = Social isolation, employment problems, family stress, bullying, self-harm{{cite web |title=Autism spectrum disorder - Symptoms and causes |url=https://www.mayoclinic.org/diseases-conditions/autism-spectrum-disorder/symptoms-causes/syc-20352928 |website=Mayo Clinic |access-date=13 July 2019 |language=en |archive-url=https://web.archive.org/web/20190714024941/https://www.mayoclinic.org/diseases-conditions/autism-spectrum-disorder/symptoms-causes/syc-20352928 |archive-date=14 July 2019 |url-status=live}}

| onset = By age two or three{{cite web |title= NIMH " Autism Spectrum Disorder |url= https://www.nimh.nih.gov/health/topics/autism-spectrum-disorders-asd/index.shtml |website= nimh.nih.gov |access-date= 20 April 2017 |date= October 2016 |archive-url= https://web.archive.org/web/20170421093226/https://www.nimh.nih.gov/health/topics/autism-spectrum-disorders-asd/index.shtml |archive-date= 21 April 2017 |url-status= live}}{{cite book |author=American Psychiatric Association |title=Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) |chapter=Autism Spectrum Disorder. 299.00 (F84.0) |year=2013 |pages=50–59 |location=Arlington, VA |publisher=American Psychiatric Publishing |isbn=978-0-89042-559-6 |doi=10.1176/appi.books.9780890425596 |hdl=2027.42/138395}}

| duration = Lifelong

| causes = Genetic and environmental factors

| risks =

| diagnosis = Based on behavior and developmental history

| differential = Asperger syndrome, attention deficit hyperactivity disorder, Tourette syndrome, anxiety, bipolar disorder, obsessive–compulsive disorder

| prevention =

| treatment = Behavioral therapy, speech therapy, psychotropic medication{{cite journal | url = https://pediatrics.aappublications.org/content/120/5/1162 | vauthors = Myers SM, Johnson CP | title = Management of children with autism spectrum disorders | journal = Pediatrics | volume = 120 | issue = 5 | pages = 1162–82 | date = November 2007 | pmid = 17967921 | doi = 10.1542/peds.2007-2362 | doi-access = free | access-date = 2019-05-24 | archive-url = https://web.archive.org/web/20190323092305/https://pediatrics.aappublications.org/content/120/5/1162 | archive-date = 2019-03-23 | url-status = live| url-access = subscription }}{{cite journal |last1=Sanchack |first1=KE |last2=Thomas |first2=CA |title=Autism Spectrum Disorder: Primary Care Principles. |journal=American Family Physician |date=15 December 2016 |volume=94 |issue=12 |pages=972–79 |pmid=28075089}}{{cite journal |last1=Sukhodolsky |first1=DG |last2=Bloch |first2=MH |last3=Panza |first3=KE |last4=Reichow |first4=B |title=Cognitive-behavioral therapy for anxiety in children with high-functioning autism: a meta-analysis. |journal=Pediatrics |date=November 2013 |volume=132 |issue=5 |pages=e1341–50 |doi=10.1542/peds.2013-1193 |pmid=24167175|pmc=3813396}}

| medication = Antipsychotics, antidepressants, stimulants (associated symptoms){{cite journal | vauthors = Ji N, Findling RL | title = An update on pharmacotherapy for autism spectrum disorder in children and adolescents | journal = Current Opinion in Psychiatry | volume = 28 | issue = 2 | pages = 91–101 | date = March 2015 | pmid = 25602248 | doi = 10.1097/YCO.0000000000000132 | s2cid = 206141453}}{{cite journal | vauthors = Oswald DP, Sonenklar NA | title = Medication use among children with autism spectrum disorders | journal = Journal of Child and Adolescent Psychopharmacology | volume = 17 | issue = 3 | pages = 348–55 | date = June 2007 | pmid = 17630868 | doi = 10.1089/cap.2006.17303}}{{cite journal |last1=Jaeggi |first1=S. M. |last2=Buschkuehl |first2=M. |last3=Jonides |first3=J. |last4=Perrig |first4=W. J. |title=From the Cover: Improving fluid intelligence with training on working memory |journal=Proceedings of the National Academy of Sciences |volume=105 |issue=19 |pages=6829–33 |year=2008 |doi=10.1073/pnas.0801268105 |pmc=2383929 |pmid=18443283|bibcode=2008PNAS..105.6829J |doi-access=free}}

| prognosis =

| frequency =

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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. The term was often applied to verbal autistic people of at least average intelligence.{{cite journal|last1=Sanders|first1=James Ladell|title=Qualitative or Quantitative Differences Between Asperger's Disorder and Autism? Historical Considerations|journal=Journal of Autism and Developmental Disorders|volume=39|issue=11|year=2009|pages=1560–1567|issn=0162-3257|doi=10.1007/s10803-009-0798-0|pmid=19548078|s2cid=26351778}}{{cite journal |last1=Carpenter |first1=Laura Arnstein |last2=Soorya |first2=Latha |last3=Halpern |first3=Danielle |title=Asperger's Syndrome and High-Functioning Autism |journal=Pediatric Annals |year=2009 |volume=38 |issue=1 |pages=30–5 |doi=10.3928/00904481-20090101-01|pmid=19213291}}{{Cite journal|last1=Andari|first1=Elissar|last2=Duhamel|first2=Jean-René|last3=Zalla|first3=Tiziana|last4=Herbrecht|first4=Evelyn|last5=Leboyer|first5=Marion|last6=Sirigu|first6=Angela|date=2 March 2019|title=Promoting social behavior with oxytocin in highfunctioning autism spectrum disorders|url=https://www.pnas.org/content/pnas/107/9/4389.full.pdf|journal=PNAS|volume=107|issue=9|pages=4389–4394|doi=10.1073/pnas.0910249107|pmid=20160081|pmc=2840168|doi-access=free}} 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.{{Cite web |date=August 25, 2024 |title=Making information and the words we use accessible |url=https://www.england.nhs.uk/learning-disabilities/about/get-involved/involving-people/making-information-and-the-words-we-use-accessible/#:~:text=Many%20autistic%20people%20see%20autism,from%20autism%2C%20symptoms%20and%20treat. |access-date=August 25, 2024 |website=NHS England}}{{Cite book |last=Price |first=Devon |title=Unmasking Autism: Discovering the New Faces of Neurodiversity |date=April 5, 2002 |isbn=9780593235232 |pages=47 |publisher=National Geographic Books |language=English}}{{Cite journal |last=Alvares |first=Gail A. |date=June 19, 2019 |title=The misnomer of 'high functioning autism': Intelligence is an imprecise predictor of functional abilities at diagnosis |url=https://pubmed.ncbi.nlm.nih.gov/31215791/ |journal=Autism |volume=24 |issue=1 |pages=221–232 |doi=10.1177/1362361319852831 |pmid=31215791 |via=NIH: National Library of Medicine}}{{Cite web |last=Coffey |first=Laura T. |date=August 13, 2021 |title=Autism glossary: What to say, and what not to say, when talking about autism |url=https://www.today.com/parents/autism-terms-words-can-be-considered-insensitive-why-t227779 |access-date=August 25, 2024 |website=Today (TV show)}}

HFA has never been included in either the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders (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.{{Cite book |title=The Diagnostic and Statistical Manual of Mental Disorders |date=March 18, 2022 |publisher=American Psychiatric Association (APA) |edition=5th edition, text revision (DSM-5-TR)}}

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. The term Asperger syndrome typically excluded a general language delay.[http://behavenet.com/aspergers-disorder Asperger's Disorder] {{webarchive|url=https://archive.today/20130425044118/http://www.behavenet.com/aspergers-disorder |date=2013-04-25}} – Diagnostic and Statistical Manual of Mental Disorders Fourth edition Text Revision (DSM-IV-TR) American Psychiatric Association (2000)

Other differences noted in features of high-functioning autism and Asperger syndrome included the following:{{Cite web|url=https://www.sacramentoasis.com/|archiveurl=https://web.archive.org/web/20070809090928/http://www.sacramentoasis.com/docs/8-22-03/as_%26_hfa.pdf|title=News and general information | Finance, High tech, Health, ...|date=March 14, 2022|archivedate=August 9, 2007}}{{cite journal |pmid=12199137 |year=2002 |last1=Rinehart |first1=NJ |last2=Bradshaw |first2=JL |last3=Brereton |first3=AV |last4=Tonge |first4=BJ |title=Lateralization in individuals with high-functioning autism and Asperger's disorder: A frontostriatal model |volume=32 |issue=4 |pages=321–331 |journal=Journal of Autism and Developmental Disorders |doi=10.1023/A:1016387020095|s2cid=23067447}}{{cite journal |doi=10.1007/s10803-006-0251-6 |title=Emotion Perception in Asperger's Syndrome and High-functioning Autism: The Importance of Diagnostic Criteria and Cue Intensity |year=2006 |last1=Mazefsky |first1=Carla A. |last2=Oswald |first2=Donald P. |journal=Journal of Autism and Developmental Disorders |volume=37 |issue=6 |pages=1086–95 |pmid=17180461|s2cid=12094187 |url=https://scholarscompass.vcu.edu/cgi/viewcontent.cgi?article=2448&context=etd|url-access=subscription }}

Lower verbal reasoning ability
Better visual/spatial skills (Being uniquely artistically talented)
Less deviating locomotion (e.g. clumsiness)
Problems functioning independently
Curiosity and interest for many different things
Not as good at empathizing with other people
Male to female ratio (4:1) much smaller

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.{{Cite journal |last=de Giambattista |first=Concetta |date=2019 |title=Subtyping the Autism Spectrum Disorder: Comparison of Children with High Functioning Autism and Asperger Syndrome |journal=Journal of Autism and Developmental Disorders |volume=49 |issue=1 |pages=138–150 |doi=10.1007/s10803-018-3689-4 |pmc=6331497 |pmid=30043350}}

=Comorbidities=

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.{{cite journal |last1=Newschaffer |first1=Craig J. |last2=Croen |first2=Lisa A. |last3=Daniels |first3=Julie |last4=Giarelli |first4=Ellen |last5=Grether |first5=Judith K. |last6=Levy |first6=Susan E. |last7=Mandell |first7=David S. |last8=Miller |first8=Lisa A. |last9=Pinto-Martin |first9=Jennifer |last10=Reaven |first10=Judy |last11=Reynolds |first11=Ann M. |last12=Rice |first12=Catherine E. |last13=Schendel |first13=Diana |last14=Windham |first14=Gayle C. |year=2007 |title=The Epidemiology of Autism Spectrum Disorders* |journal=Annual Review of Public Health |volume=28 |issue=1 |pages=235–258 |doi=10.1146/annurev.publhealth.28.021406.144007 |issn=0163-7525 |pmid=17367287 |doi-access=free}}) Studies that looked specifically at HFA have examined anxiety,{{cite journal |last1=Reaven |first1=Judy |year=2011 |title=The treatment of anxiety symptoms in youth with high-functioning autism spectrum disorders: Developmental considerations for parents |journal=Brain Research |volume=1380 |pages=255–63 |doi=10.1016/j.brainres.2010.09.075 |pmid=20875799 |s2cid=5226904}} bipolar disorder, Tourette syndrome, attention deficit hyperactivity disorder (ADHD), and obsessive–compulsive disorder (OCD). Both HFA and OCD have abnormalities associated with serotonin.{{cite journal |doi=10.1186/1744-859X-11-16 |title=Psychiatric comorbidities in asperger syndrome and high functioning autism: Diagnostic challenges |year=2012 |last1=Mazzone |first1=Luigi |last2=Ruta |first2=Liliana |last3=Reale |first3=Laura |journal=Annals of General Psychiatry |volume=11 |pages=16 |pmid=22731684 |issue=1 |pmc=3416662 |doi-access=free}}

=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. Some case studies have linked the lack of empathy and social naïveté associated with HFA to criminal actions.{{cite journal |first1=Matthew D. |last1=Lerner |first2=Omar Sultan |last2=Haque |first3=Eli C. |last3=Northrup |first4=Lindsay |last4=Lawer |first5=Harold J. |last5=Bursztajn |title=Emerging Perspectives on Adolescents and Young Adults With High-Functioning Autism Spectrum Disorders, Violence, and Criminal Law |journal=Journal of the American Academy of Psychiatry and the Law |pmid=22635288 |url=http://www.jaapl.org/cgi/pmidlookup?view=long&pmid=22635288 |year=2012 |volume=40 |issue=2 |pages=177–90 |access-date=2013-03-24 |archive-date=2019-12-11 |archive-url=https://web.archive.org/web/20191211055002/http://jaapl.org/content/40/2/177.long |url-status=dead}}

high-functioning autism

Characterization

=Comorbidities=

=Behavior=

See also

References

Further reading