Trying to understand here: Asperger's or HFA?

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MCalavera
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04 Apr 2011, 5:46 am

I've been trying to figure out whether there is an actual difference between Asperger's and HFA. What is the distinction exactly if there is?

Monotone and slow speech, must this never be a trait of Asperger's but only of HFA?

When I went to the psychologist/psychiatrist that one time, he confirmed to me that I did have autism and that my self-diagnosis was correct (at that time, I had no idea about Asperger's) but he stressed on the idea that I had it only a little bit and that it's quite mild compared to some other people with autism.

When I first read about Asperger's (which was two years ago), and read that it's a mild form of autism, I thought that this could be a more accurate label for my condition. I can function quite well on my own in the social world given a bit of initial help and support to get me going. So it must've been the correct label for me.

But now that I've researched further (for the last year or so) and noticed that some make a distinction between Asperger's and HFA (with slow speech often considered exclusive to HFA), I've been a bit confused by which label suits me more.

A lot of Aspies here speak quite well in their videos ... at least good enough not to be considered as awkward or ret*d when other people hear them talk.

But if I can only speak properly when I'm mentally prepared to do a good speech, but, naturally, my speech is awkward and slow and indicative of a socially tired person (most of the time), what does that make me? AS or HFA?



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04 Apr 2011, 6:16 am

Labels, labels...

The problem with the various labels given to different syndromes in the Autism Spectrum is that we don't understand enough about autism itself to confidently say what are separate syndromes and what are only facets of the same thing. For instance, there are enough doctors in the US that believe Asperger's isn't a separate syndrome that it will be removed from the list of recognised diseases next year. From them on people with Asperger's syndrome will be diagnosed as having HFA. I personally disagree that those two are the same, but you have to admit that they are similar and maybe even overlapping.

In my understanding, the different between Asperger's and HFA isn't just the level of speech skill at any given moment, but the time it took for a person as a child to learn to talk. People with HFA typically learned to speak at a relatively late age, and often (but not always) never make up for the delay. Aspies, on the other hand, typically don't have a delay in acquiring speech compared to NTs, and usually reach a level of speaking ability that is on par with NTs' (not always, but then even among NT's there are enough people whose speech sounds ret*d).

So it's not how you speak now that determines whether you are Aspie or HFA. It's when you learned to speak as a child. Also, HFA people often suffer from more than just monotone and slow speech. Mixed or repeated syllables, unability to control one's volume and very restricted vocabulary are often (but, once again, not always) indicative of HFA, while those are mostly absent with AS (but, once again, not always).

In my case, for instance, in social events I often sound monotone, as if I was tired. I also tend to not being able to find my words when trying to speak spontaneously. On the other hand, I speak three languages fluently, and at least three more conversationally. What does that make me, Aspie or HFA? I'd say Aspie, but what do I know? :wink:


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04 Apr 2011, 6:36 am

You have this symtpoms?

Quote:
A. A total of six (or more) items from (1), (2), and (3), with at least two from (1), and one each from (2) and (3):

(1) qualitative impairment in social interaction, as manifested by at least two of the following:

(a) marked impairment in the use of multiple nonverbal behaviors such as eye-to-eye gaze, facial expression, body postures, and gestures to regulate social interaction

(b) failure to develop peer relationships appropriate to developmental level

(c) a lack of spontaneous seeking to share enjoyment, interests, or achievements with other people (e.g., by a lack of showing, bringing, or pointing out objects of interest)

(d) lack of social or emotional reciprocity

(2) qualitative impairments in communication as manifested by at least one of the following:

(a) delay in, or total lack of, the development of spoken language (not accompanied by an attempt to compensate through alternative modes of communication such as gesture or mime)

(b) in individuals with adequate speech, marked impairment in the ability to initiate or sustain a conversation with others

(c) stereotyped and repetitive use of language or idiosyncratic language

(d) lack of varied, spontaneous make-believe play or social imitative play appropriate to developmental level

(3) restricted repetitive and stereotyped patterns of behavior, interests, and activities, as manifested by at least one of the following:

(a) encompassing preoccupation with one or more stereotyped and restricted patterns of interest that is abnormal either in intensity or focus

(b) apparently inflexible adherence to specific, nonfunctional routines or rituals

(c) stereotyped and repetitive motor mannerisms (e.g., hand or finger flapping or twisting, or complex whole body movements)

(d) persistent preoccupation with parts of objects

B. Delays or abnormal functioning in at least one of the following areas, with onset prior to age 3 years: (1) social interaction, (2) language as used in social communication, or (3) symbolic or imaginative play.

C. The disturbance is not better accounted for by Rett’s Disorder or Childhood Disintegrative Disorder.


Yes - You have Autism (if you are verbal and have IQ > 70, you have HFA).

No - Then, you have this symptoms?

Quote:
A. Qualitative impairment in social interaction, as manifested by at least two of the following:

(1) marked impairment in the use of multiple nonverbal behaviors such as eye-to-eye gaze, facial expression, body postures, and gestures to regulate social interaction

(2) failure to develop peer relationships appropriate to developmental level

(3) a lack of spontaneous seeking to share enjoyment, interests, or achievements with other people (e.g., by a lack of showing, bringing, or pointing out objects of interest to other people)

(4) lack of social or emotional reciprocity

B. Restricted repetitive and stereotyped patterns of behavior, interests, and activities, as manifested by at least one of the following:

(1) encompassing preoccupation with one or more stereotyped and restricted patterns of interest that is abnormal either in intensity or focus

(2) apparently inflexible adherence to specific, nonfunctional routines or rituals

(3) stereotyped and repetitive motor mannerisms (e.g., hand or finger flapping or twisting, or complex whole-body movements)

(4) persistent preoccupation with parts of objects

C. The disturbance causes clinically significant impairment in social, occupational, or other important areas of functioning.

D. There is no clinically significant general delay in language (e.g., single words used by age 2 years, communicative phrases used by age 3 years).

E. There is no clinically significant delay in cognitive development or in the development of age-appropriate self-help skills, adaptive behavior (other than in social interaction), and curiosity about the environment in childhood.

F. Criteria are not met for another specific Pervasive Developmental Disorder or Schizophrenia.


Yes - You have AS

No - You have any other thing



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04 Apr 2011, 7:01 am

Only problem is that the majority of people with AS match the autistic disorder criteria. I match it, depending on how abnormal the functioning needs to be in part B. I didn't have normal eye contact or expressiveness before age three, that was apparent... but the rest of it wasn't very obvious at that age because I spoke well and was only expected to interact with family. If I take it exactly as written, then the abnormal eye contact and expressiveness would fall under abnormal social interaction, meaning that I match all the criteria. Yet I'm diagnosed with AS and have very good verbal skills. They don't go by the criteria in the first place.



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04 Apr 2011, 7:41 am

It's my impression that the art of diagnosis in this field depends more on the individual preconceptions of the diagnostician than on absolute determinism.

What's more, since there's little that can be done in therapeutic or remedial senses for adults with high functioning autism / aspergers, it really makes very little difference.



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04 Apr 2011, 10:55 am

basic rule of thumb put foward by Lorna Wing:

speech delay but no learning difficult: HFA
no speech delay or learning difficult: AS
speech delay and learning difficult (low IQ): classic autism.

maybe


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emuman100
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04 Apr 2011, 11:32 am

I read there was a slight speech delay with AS. I know mine was six months or so, and I stutter. I can use great vocabulary and my voice isn't too monotone. Most people don't think there is anything really wrong with me except for being shy and quiet.



tenzinsmom
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04 Apr 2011, 12:15 pm

Wait a minute!

"speech delay and learning difficult (low IQ): classic autism."

Does having learning difficulties necessarily equate a low IQ?

If you take a different path to get to the information/understanding does that mean you don't think well????????

I don't think so.


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04 Apr 2011, 1:28 pm

tenzinsmom wrote:
Wait a minute!

"speech delay and learning difficult (low IQ): classic autism."

Does having learning difficulties necessarily equate a low IQ?

If you take a different path to get to the information/understanding does that mean you don't think well????????

I don't think so.


not necessarily, When I said "learning difficulties (low IQ)" I mean that low IQ was the specific learning difficulty I was talking about, not that learning difficult necessarily means a low IQ, that's just the one I was talking about.


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04 Apr 2011, 1:32 pm

The diagnostic criteria doesn't require a speech delay though.



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04 Apr 2011, 2:16 pm

the difference is that in aspergers speech is precosious but body motor skills are delayed.with kanner syndrome high functioning or not body dexterity is precosious and speech is delayed or non existent.if someone starts with precosious speech and body motor dexterity and starts to lose it over time that is childhood disintagrative disorder.when i was a kid i talked like i was 40 very echolalic albiet and i wore leg braces because my legs were so clunbsy.that classic aspergers



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04 Apr 2011, 2:22 pm

vermontsavant wrote:
the difference is that in aspergers speech is precosious but body motor skills are delayed.with kanner syndrome high functioning or not body dexterity is precosious and speech is delayed or non existent.if someone starts with precosious speech and body motor dexterity and starts to lose it over time that is childhood disintagrative disorder.when i was a kid i talked like i was 40 very echolalic albiet and i wore leg braces because my legs were so clunbsy.that classic aspergers


I had to wear leg braces also as a small child (luckily stopped having to wear them before school started as if I needed something else to be "different" about myself).

I did also have to go to speech therapy because I had trouble enunciating (hate that word because my parents would always tell me to e-nun-see-ate) certain words and had a lisp. But I think I started talking on time. Does that count as "delayed speech"?



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04 Apr 2011, 2:27 pm

What if someone had precocious speech and motor development?



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04 Apr 2011, 2:50 pm

Okay...forgive the ramble but:

I tend to see Autism Spectrum Diagnoses as very similar to the Attention Deficit Hyperactivity Disorder diagnsoses, in that:

1. Both are diagnosed purely based on observable and/or measurable symptomology.

2. The underlying neurobiology that manifests itself as autism/ADHD is extremely complex, and no single cause for the symptoms of either been identified. Also, many of the symptoms are purely behavioral--and behavior is highly individual.

For example: Two people experiencing heightened sensitivity to sound may react in two completely different ways (one person might shut down and become withdrawn, the other person might become agitated and hyperactive. How is an observer, such as a clinician diagnosing a person with something, supposed to figure out whether or not those two people are experiencing the same underlying symptom, or whether or not they are experiencing it to the same degree? I don't think they can--at least not with any degree of clinical reliability.

Because the diagnosis is made based on observed behavior and cognitive symptoms, and neither of those things can be said to be related to only one condition (e.g. the ability to speak with fluency is sometimes a problem for people with ASDs, but it can also be a problem for people with language disorders, neurdegenerative diseases, and brain injury...and behavior is individual) it's hard to clearly separate out the details and specifics of one disorder from another. As a result, disorders that share enough symptomology are just grouped together into a heterogeneous mix of people whose symptoms are more similar than they are different.

You can have ADHD without hyperactivity (ADD--Inattentive Type), you can have ADHD without too much inattention (ADHD hyperactive type)....you can an autism spectrum disorder with or without language delay or sensory sensitivities....but the overall picture of a person with difficulties in specific areas (give or take one or two, or to a greater or lesser degree of severity) is essentially the same.

It can suck to not have precise answers/definitions/labels for things, but in general (for practical purposes) I'm not sure it really matters....I guess that depends on who you are and why precision is important to you.



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04 Apr 2011, 3:18 pm

good questions.i dont think dificulty pronoucing words would be a delay in speech,you would have to ask a expert.but if that qualifies as a speech delay that sounds like a kanner syndrome diagnosis,but im not a doctor.however hfa's and almost all people with classic kanner autism use there body's well and have good fine motor dexterity.your autism your describing sounds out of the box,maybe you have pervasive dvelopmental disorder not specified in a known catagory ppd-nos actualy a common form of autism



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04 Apr 2011, 4:15 pm

If by slow speech you mean speech that is slow to start (or disappears after it started and then is delayed awhile), then yes, that's used to differentiate them. If by slow speech you mean speaking slowly, then no, that has nothing to do with it. Monotone voice can occur (or not) in either, has nothing to do with it either.

Not that I care that much, considering that I don't think the AS/autism separation does anything good for noticing the true distinctions between different autistic people.


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