AS vs HFA

Post Reply New Topic

I'm posty tonight, just full of questions.

My daughter got a diagnosis of autism instead of Asperger's. In fact, AS was not mentioned. We know we saw a good doctor, the center we chose is ranked 19th in the entire nation for psychiatry. I was wondering what factors would have excluded the AS diagnosis. Language delay was not a factor, in fact, she was abnormally fast at it.

A delay in verbal development is what separates classic autism from Asperger's "officially"; many with classic autism also have a delay in cognitive development. The verbal impairment doesn't need to be a delay in speaking per se; rather, an impaired use of language, grammatically incorrect sentences, poor sentence structure and difficulty in rectifying this delay. Conversely, those with AS have no problem with speaking, reading and writing, in fact, they may appear quite advanced in their use of language.

People with classic autism usually appear more aloof and distant to social contact, whereas those with AS seek it out but they have immense difficulty with it, constant failure in such can lead to aloofness for someone with AS due to obvious reasons. People with classic autism have a greater need for order, and they experience more "meltdowns" due to the overwhelming environment.

This is from my observations out there and by reading.

The other language anomaly in the autism DSM is impairment in initiating or sustaining a conversation, despite adequate language ability. I have that one.

I read an article once, it was actually a study, where they were asking "does Asperger's really exist?" - according to the AS criteria, autism has to be ruled out first. In the study almost every person (already diagnosed with AS) fulfilled at least one of the autism language criteria (and you only need one), so they actually qualified for an autism dx.

If AS really does exist though... I agree with Daniel about aspies seeking more social interaction and talking more, and auties being more quiet and aloof - not part of the diagnostic criteria but I've found it to be pretty consistent in my observations.

I am always confused by this topic -- the difference between HFA and Asperger's.

Our son was diagnosed with PDD-NOS, and I think that they would have said that he was more HFA than Asperger's back when he was five (when he was diagnosed).

Back then, and he even tells me this now, he didn't like people or crowds or talking with others.

Now, he is very social, almost too social. He's quiet for the most part, but when he's comfortable, he can be quite talkative. He has friends, a few, but enough to feel good about himself. His obsessive interests are miminal (computer games, DDR, SpongeBob) but he also has kind of figured out who is interested in this stuff as well, and he knows what to talk about with his peers.

He had no real language delay, but he did slow down considerably when acquiring language at three years. It fits pretty much what Danielismyname was describing -- impaired use of language. That is not a problem NOW, or at least it happens very rarely. Our problem now is in too formal language -- we are currently just trying to remind him to use slang instead of more formal words.

Kris

Our constant confusion as well...our doctor stated that the difference between AS and HFA was that in HFA kids regressed and lost speech and that in AS they could either speak or not speak, but they did not regress...hmmm...She didn't mention anything about social interaction though...
Our kiddo is the most social person one can imagine...we always say he'll be running for some political office because he will say hi to just about anyone and attempt to "converse" or at least dance, sing, whatever it takes to keep that person's attention and interaction...hmmm...

My son who is 11 was dx-d thru the Regional Center this last summer. He got a dx of Autistic Disorder and I was kinda shocked as I thought it would be more like AS.

As for Speech when he was little, he was a late talker. I remember on his first birthday he said doggie and we would play a game and he would do animal sound effects, but otherwise he was really quiet. He did say momma, da da, and B for his favorite blanket, but that was really it. I remember thinking wow he's so quiet (because it was the opposite of my dd who was like a tornado at the same age lol). He did learn to eventually talk on his own between 2 1/2 and 3, and then he caught up quickly.

He also had regression with potty training on 3 separete occasions but was finally potty trained at 4 1/2.

And altho he does have friends, he is more aloof than other peers his age, will tend to separate himself from large crowds and do something by himself. He prefers to be alone, but has good times to where he does like to be around kids his age. But then he can't take the atmospher of riding the bus, because of the crowd of kids.

He is in 6th grade and has not connected to the one best friend that you usually see an NT child have by the time he hits 2nd and 3rd grade.

I think those things are what weighed in on the difference between AS and Autistic Disorder dx for him.

Lainie

Usually the hard dividing line is speech development, but that is artificial and arbitrary, and may soon be history.

Asperger's original studies included kids who had delayed speech, as well as those who didn't. Lorna Wing, who was the first English language writer to discuss "Asperger's syndrome," also made no such distinction. Then various parties started writing diagnostic criteria.

The World Health Organization came up with criteria (ICD) which are very widely used. The American Psychiatric Association came out with its new edition of their diagnostic manual (DSM) at about the same time, and it did not include AS, they had decided to merge AS into autism. The WHO and others didn't like this, it made it impossible to work towards common research goals when aspies were being defined as aspies by most of the world, but as autistics by the APA. So the APA relented, and defined AS in the next edition of DSM, closely following the ICD criteria. In order to distinguish it from autism (in persons with IQs of 70+), they defined autism as having greater problems with verbal communication. They also said that if both diagnoses fit, you should diagnose the patient with autism, rather than AS.

Meanwhile, researchers started looking at the differences between AS and "high functioning" autism, and most concluded that the differences were not meaningful. Kids who have a year or two of speech delay usually catch up within a few years, and both groups seem to respond similarly to various attempts at treatment. It is often impossible to distinguish an adolescent diagnosed with AS from one diagnosed with HFA without asking a lot of questions about early childhood. Unless researchers come up with some surprises in the next year or so, it seems likely that the two categories will be merged in future diagnostic manuals, and AS will disappear as a diagnosis.

As for why the doctor chose the autism diagnosis over AS, I don't know enough to speculate. Sometimes insurance or government benefits will be more abundant, or more readily available, for one than the other, so a doctor may give the diagnosis which offers the most practical help. In other cases, it seems like they flip a coin.

If you want to try to analyze the diagnosis despite that, you could try slogging your way through some of the many papers that have been done on the topic. This one will probably do as well as any. http://apt.rcpsych.org/cgi/content/full/7/4/310

Last edited by geek on 17 Oct 2007, 8:56 pm, edited 1 time in total.

It's odd that you'd get so many varied responses that originate with doctors, psychiatrists, et al. My son is autistic, I don't believe "high functioning" is a diagnostic term. He has significant language delay though is considered at age range (has been since 5). They don't seem to really assess for receptive language which seems to be a common thread for both AS and verbal autistics. I can tell when he doesn't understand what he hears but others are distracted by his script or vernacular. In fact, it wasn't until he was 6 that he started asking, "what did you say?"
He inserts script to express emotion and people find it very sophisticated. Again, sometimes he doesn't even know what it means.
He has always sought social interaction, always. Doesn't always know what to do with it.
He never regressed either. I understood that regression is rare among autistics, though there is a lot of talk about it in the media. He was just very, very delayed with milestones.
I don't know if he'd be "indistinguishable" from his peers or from AS peers by his teens. My guess is that he'll be "quirky-nos" by then. (not my phrase)

No, it isn't. "High functioning," along with "medium" and "low" are used quite commonly, including in many research papers. Many find them offensive, as they tend to overlook nonverbal autistic abilities. But there is no formal definition for any of them. AS and autism, on the other hand, are formally defined in a somewhat subjective and arbitrary way.

Here's what the lastest DSM says (it'll change in several years no doubt):

See, the responses here were what I thought. She had no speech delay. In fact, she was quite advanced. She was speaking small sentences, saying her entire alphabet and counting in three languages shortly after her second birthday. Clearly not a delay. She could also identify letters and numbers visually, so it was not a matter of memorization. Socially, she functions fairly well except for being somewhat poor at the non-verbal things and some of the social niceties like being polite, asking a name, etc. So she seems very AS to me. Perhaps at our next visit I'll bring this up and they can clarify for me. What they said was she has autism, mild to moderate.

"Experts" aren't always right.

I had two say I have AS over autistic disorder due to the very fact I can converse one on one with professionals; I'd like to see where it states that someone with classic autism cannot do such. The guy who diagnosed me as autistic has another adult patient with autism who can talk and is "smart", I was seeing said guy for two years beforehand however, so he had a lot more information, to be fair.

I've been reading over the DSM-IV criteria and she's got Asperger's. I did call and talk to the doctor who diagnosed her and I asked why AS was excluded. Her answer was that, based on the assessment, she felt that she had too many sensory issues for AS. She also felt that her language (difficulty with why and some of the non-verbal things) pushed her into the Autism diagnosis. She also said PDD-NOS was excluded because she exhibited more classic autism. She did say she is open to re-evaluating that diagnosis as we go. She says she isn't ruling out Asperger's. It seems to me that MANY individuals with AS exhibit a great deal of sensory issues. I feel very strongly it's AS.

My son on the other hand, he's exhibiting very classic autism. He lines things up, he flaps and toe walks when exited or agitated, he doesn't speak much except for his favorite catch-all phrase "I DID IT" (has no words for things or people, even his favorite blanket) and is completely indifferent to the presence of other people except me, his sister and daddy. My friend commented the other day after babysitting him that he completely ignored her existence the entire time. He played with toys and occasionally whined at the door. It's as if he really just does not notice other human life for the most part. Occasionally he surprises the heck out of me, picks a random person in a crowd and waves hi and says hi, which sounds more like "EEE!! !"

I think we're going to get a second opinion like it or not. School district does their own assessment. I don't know the scope of their diagnostic abilities though...and I'm not expecting good things from them.

I had a funny conversation on this topic the other day.

My son has never had a diagnosis, the local school had nothing to offer him whether he was diagnosed or not, so there seemed to be no point. But changing circumstances made it seem like we should get one for him soon, so we called the family doctor.

The family doctor happens to be my father-in-law, who is an amazingly astute family practitioner, and is currently working at a psychiatric hospital, so he has diagnosed many a kid on the spectrum, and is now dealing with every sort of psych issue imaginable. He comes from the OCD and ADD side of the family, so he has some subjective reality on the topic as well. When my son was about 3, didn't talk much, and had echolalia, he was the first person to suggest that he might be an aspie. So we call him up and ask about a diagnosis. He's observed him for hundreds of hours, knows his personal history, his family's history, and so on, so why not?

Sure, he tells my wife, I'll send you a letter. I ask to talk to him, to nitpick a little about AS vs HFA, since the speech delay kind of forces a diagnosis of autism. And, to my surprise, he wouldn't go for it! He said that if my son was autistic, he was the highest functioning autistic he'd ever seen, so his diagnosis was going to be AS. (This followed a 10-15 minute discussion of the history of all 4 sets of diagnostic criteria, and I have to say, he had them down cold.) So chalk up another case of a doctor ignoring DSM and ICD in favor of the Asperger/Wing/Gilberg view of AS, which allows for speech delay.

It's a crapshoot, isn't it?

You seem unhappy with the (HF)A diagnosis, as if you'd prefer an AS one. Is there a particular reason for that? IIRC, the treatment options are the same, and the doctor has already said that the dx could change to AS later...

That's really interesting, and yes, it seems to be.