High Functioning Autism (A complete guide)

In this blog, we will discuss what high functioning autism is, 

High Functioning Autism: What is it?

Someone with High Functioning Autism (HFA) can be recognized because of their preserved intellectual abilities.

This means, preserved cognitive functioning. 

This isn’t an official diagnosis included in the Diagnostic and Statistical Manual of Mental Disorders (the bible for Mental Health professionals) but it is used to talk about people with Autism that can speak, read, write and have some level of independence in activities such as eating or getting dressed. 

 Is High Functioning Autism considered the Same as Asperger’s Syndrome?

Due to previous versions of the DSM, it was believed that Asperger’s Syndrome (no longer considered a category in the new DSM-5) was the same as high functioning autism since their symptoms were milder and less likely to affect daily functioning, compared to others under the spectrum. 

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Subsequently, high functioning autism is referred to describe those on the milder side of the Autism Spectrum Disorder. 

Additionally, Autism Spectrum Disorder can be divided into three levels to reflect severity, they are:

• Level 1: is the mildest and people at this level won’t have a significant impact or interference with daily life activities such as relationships, work or school. This is what most people understand by “high functioning autism”.

• Level 2: People at this level need assistance and support such as social skills training and speech therapy, and more help with daily living activities.

• Level 3: This is the most severe. People within this level need support most of their lives (full time) and require more intense therapy. 

Autism Spectrum Disorder

You may be familiar with the term Autism Spectrum Disorder, maybe because you know someone diagnosed with this condition, a friend, relative or a neighbor.

However, you may be asking yourself what it means really.

Probably you have seen or noticed how they seem to behave differently, maybe you or someone else have even labeled their behavior as  “odd” or “weird”.

This is due to the fact that they have a hard time interacting with other people and communication can be very restricted or limited.

They can’t seem to read social cues and making friends can be very challenging. 

Autism is considered a neurodevelopmental disorder, which means the condition develops at the same time the brain does, while you are growing up. 

Are there any symptoms?

Physically, they just look like you and me but they display certain behaviors that are characteristic of the disorder. 

Autism is not just one disorder, but a spectrum of disorders that share the same core symptoms.

Every individual with this condition has problems with social interaction, empathy, communication and being flexible.

Their behaviors and abilities can vary from one person to the other but they are still under the “umbrella” of the spectrum. 

Social Behavior 

Symptoms related to difficulties in social interactions include:

• Inappropriate body language, gestures and facial expressions such as avoiding to make eye contact or their facial expressions may not match what they are saying or how they are feeling.
• Avoid or not being interested in starting a social interaction, which can make them come across as aloof or detached. They prefer or tend to be alone. 
• Tend to have difficulties reading social non-verbal cues and understanding people’s feelings (empathy).
• Avoiding or resisting contact or being touched. 
• Difficulty making friends with other children. 

Communication skills: Speech and language

Symptoms related to communication skills include:

• Delays when learning how to speak after the age of 2, or doesn’t talk at all.
• Speaking with an odd rhythm or pitch.
• Perseverating in the use of certain phrases or words without a communicative intent.
• Difficulties starting conversations or keep them going.
• Difficulties communicating their needs or what they want.
• Difficulties understanding simple questions or statements. 
• Difficulties understanding irony or sarcasm, they tend to take it too literally.

Restricted behavior

People with autism tend to have restricted, rigid and obsessive patterns of behavior.  Symptoms include:

• Repetitive body movements such as spinning, hand flapping or rocking. 
• Obsessive attachment to objects such as keys, toys, light switches, etc. 
• Strong need to keep things in order or the same routines (sameness). Making changes to their routine or established order will make them angry and irritable.
• Abnormal posture or odd ways of moving.
• Restricted interests sometimes involving numbers or symbols.
• Obsessed or fascinated with spinning objects, moving pieces or parts of toys.
• Hyper or hypo reactive sensory input. Certain sounds or lights can make them angry or irritable due to sensory overload.

Autism Spectrum Disorder: Is there a treatment?

There are several Autism Spectrum therapies but the most common therapeutic approaches include the Picture Exchange Communication System (PECS), Treatment of Autistic and Communication Handicapped Children (TEACCH), Applied Behavioural Analysis (ABA), sensory integration and speech and language therapy. 

However, there are many others that have proven to be effective, they are based on the principles of Applied Behavior Analysis and they are the Discrete Trial Training (DTT), Early Intensive Behavioral Intervention (EIBI), Pivotal Response Treatment (PRT) and Verbal Behavior Intervention  (VBI). 

Many treatments have been proposed for treating Autism Spectrum Disorders (ASD) were specialized and supportive educational programming, communication and social skills training, and behavioral therapy are contemplated to be the most effective.

Interdisciplinary approaches include occupational and physical therapy to address comorbid difficulties such as coordination and sensory deficits.

In regards to behavioral therapy as is the case of ABA (most empirically supported by far), the main goal is the improvement of severe behavioral problems in several areas such as language, social or academic skills.

If we talk about Autism Spectrum Therapies, we necessarily need to understand what Autism Spectrum Disorder is. 

Autism therapy: What is it supposed to do?

There are many approaches to the topic of Autism Therapy, however, we mention some of the most used and known therapies. 

Picture Exchange Communication System (PECS)

This type of therapy teaches children to trade pictures for items or activities.

This is specially designed for those who don’t speak, are difficult to understand or can’t understand.

Some studies have shown it can improve communication but there could be little o no gains in speech. 

TEACCH

As mentioned by the National Autistic Society, some of the TEACCH Autism Program priorities are:

• Personal focus approach, their skills, interests, and particular needs.
• Active participation in the “culture of autism” identifying differences based on individualized assessments
• Usage of visual aids to organize the environment and tasks when teaching new or underdeveloped skills. 
• Supportive approach in various contexts, not only when teaching new skills.
• Being flexible and teaching flexibility.

Applied Behavior Analysis (ABA)

This approach is based on behaviorist theories (learning principles) that systematically target desired and disruptive behaviors through a system of rewards and consequences.

It has been proven through research that this type of therapy uses reinforcement as the main way of improving social, communication and the process of learning new skills.

There are different types of interventions based on Applied Behavior Analysis principles, here we mention a few that have proven to be highly effective when treating people with ASD:

• Discrete Trial Training (DTT): this is a teaching method characterized by breaking down the skill meant to be taught by using discrete trials. 
• Early Intensive Behavioral Intervention (EIBI): this type of intervention uses the principles of Applied Behavior Analysis to teach adaptive behaviors to young children with Autism Spectrum Disorder. 
• Pivotal Response Treatment (PRT): this type of intervention consists of Applied Behavior Analysis (ABA) principles, to teach (within a naturalistic teaching format) people with Autism Spectrum Disorder (ASD), functional social/communicative and adaptive behaviors.
• Verbal Behavior Intervention (VBI): this type of intervention encourages people with Autism Spectrum Disorder (ASD) to learn language by associating to its purpose. Meaning, children or young adults can learn that “using language” can help in getting desired results or objects.

Limitations to the Applied Behavior Analysis Interventions 

 the required amount of time invested to see results, also, there could be questionable generalizability of the skills being taught and can also derive in lack of motivation.

Additional limitations of these types of interventions are the cost of these intensive therapies, which can be substantial, given the intensive nature of treatment (usually 20+ hours a week).

Occupational Therapy

Occupational therapy teaches daily life skills (to achieve a certain level of independence) such as dressing, bathing, eating and how to interact with other people. 

Sensory Integration Therapy

Since one of the main characteristics of people with autism is heightened sensory overload.

Within Sensory integration, therapy, the main idea is to help the person to deal with sensory information (sight, touch, sounds, and smells). 

Speech Therapy

Speech therapy helps to improve communication skills, where some might be able to learn verbal communication skills and others, can start learning and using gestures or picture boards as a way of communication.

Therapeutic Horseback Riding

This is also referred to as “hippotherapy.” The idea is for the therapist to guide the child while it rides a horse.

Riding is considered a form of physical therapy because the rider needs to react and adjust to the movements of the horse.

Research shows it helps children from ages 5 to 16 improve their social and speaking skills and in addition, it can also help with symptoms such as irritability and hyperactivity.

Where can I find professionals specialized in autism therapy?

There are many organizations and research-based centers that can provide specialized in a range of options on autism therapy for children and adults, but here we just mention two of them:

• National Autistic Society
• GEMIINI

The main idea is to ask as many questions as you can to make sure they are the right fit and for you have the certainty that they can actually help you either because you have a child with autism or you have been diagnosed with an autism spectrum disorder.

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Autism and medication: another option related to autism therapy?

The most commonly prescribed autism medications to treat autistic symptoms are selective serotonin reuptake inhibitors (SSRIs), such as sertraline (Zoloft) or fluoxetine (Prozac).

Even when there is clinical evidence on the currently used medication, approving their usage and considered safe for use with children, they are not specifically developed for autism.

Risperidone and Aripiprazole are currently the only medications approved to treat the symptoms associated with ASD.

It seems that Children and adolescents with ASD are more susceptible to side effects, therefore it is recommended to start with low doses. 

When dealing with a difficult child or adolescent with autism, medication seems to be the solution to all the problems.

However, this is not a cure for a lifelong condition such as anxiety and must be handled carefully because not everyone responds to medicine the same way and it actually comes with the possibility of developing some side effects.

Frequently asked questions (FAQ’s) about High functioning autism. 

Please feel free to comment in the comments section below!

Recommended reading

1. Autism and Asperger Syndrome in Adults
2. The Parent’s Guide to Occupational Therapy for Autism and Special Needs: Practical Strategies for Motor Skills, Sensory Integration, Toilet Training, and More
3. Autism: A New Introduction to Psychological Theory and Current Debate
4. Autism: How to raise a happy autistic child
5. Understanding and Working with the Spectrum of Autism: An Insider’s View

References

Help Guide

Health Line

Child Autism UK: Applied Behavior Analysis (ABA) and Autism.

Autism Spectrum Therapies

Hindawi: Autism Research and Treatment

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