HFA autism?

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I'm 67, and long finished with High School, and with some college under my belt, including college Psychology, and a whole lot of Life Experience behind me, and _I_ still don't always know how to socialize properly. I'm learning, though, even though slow or "delayed". When I was in school it was not realized that some people need "Social Skills Training", and I've had to figure it out for myself, with a lot of Blind Spots. I never knew until I was diagnosed a couple of years ago, from one of the tests, just how _much_ I was missing in facial expressions, forget Body Language, which I have studied in "book l'arnin'" a little bit. Being on the internet helps, since there are no facial expressions to interpret/misinterpret here, and emoticons are very simplified and easy to interpret.

Go easy, I think the kid actually has trouble spelling. In his/her previous posts they do sound like they are classically autistic.

I think I may give a shot at answering the question.

Asperger's is seen as the most highest functioning type of autism even if 90% of the forum doesn't agree. They are usually fast to talk, walk and curios at a young age. In autism there is a speech delay from 2-5 years, sometimes more. If you had a speech delay chances are you will get the HFA label, if you didn't chances are you will get AS. In the end it's up to the doctor diagnosing you.

From what I've seen people with HFA have more physical rigidity. By that I mean they don't look relaxed when they stand. They have more learning problems. They may have no interest in socialising at first or have very narrow interests and not be curious about anything outside of them. They really have difficulty even knowing when someone is happy or sad. They usually have less awareness about themselves so have less anxiety.

Right, now people can commence the flaming while I go eat a sandwich because I care so much about what they think.

Asperger's: http://www.dsm5.org/ProposedRevisions/P ... px?rid=97# (click DSM-IV)
Autism: http://www.dsm5.org/ProposedRevisions/P ... px?rid=94# (click DSM-IV)

I'm not sure how good this article is: http://apt.rcpsych.org/content/7/4/310.full

In making the recommendation to delete Asperger’s disorder, the following questions were considered:

Q.1. Have the DSM-IV diagnostic criteria for Asperger Disorder worked?

The ‘Asperger’ label has proved popular, ‘acceptable’, and has widened recognition of autism spectrum disorder (ASD) in combination with good language and intelligence. In addition, the introduction of this diagnostic entity has achieved the intended aim of prompting research into possible differences between this and other subgroups of PDD, with more than 500 published articles on Asperger syndrome.

1.1. Do the DSM-IV criteria work in clinical practice?

A number of published papers have argued that the DSM-IV Asperger disorder criteria do not work in the clinic (e.g., Mayes et al., 2001; Miller & Ozonoff, 2000; Leekam, Libby, Wing, Gould & Gillberg, 2000). Specifically, key problems exist in applying the current criteria:

· Early language details are hard to establish in retrospect, especially for older children and adults; average age of first diagnosis is late (7 years according to Mandell et al. 2005; 11yrs, Howlin & Asgharian, 1999).

· The trumping rule means most/all Asperger cases should strictly be diagnosed as having ‘Autistic disorder’ (Miller & Ozonoff, 2000; Bennett et al, 2008; Williams et al, 2008), although clinicians prefer to give the more specific term (Mahoney, et al.,1998)

o Specifically, since language delay is not a necessary criterion for Autistic disorder, to meet criteria for Asperger disorder (without being trumped by Autistic disorder), a person would need to fail to meet Communication criteria for Autistic disorder. In practice, the Communication criterion (B.2.) of “marked impairment in the ability to initiate or sustain a conversation with others” is typically met by even very able individuals fitting the Asperger picture.

As a result, ‘Asperger syndrome’ is used loosely with little agreement: e.g. Williams et al (2008) survey of 466 professionals reporting on 348 relevant cases, showed 44% of children given Asperger, PDD-NOS, atypical autism, or ‘other ASD’ label actually fulfilled criteria for Autistic Disorder (overall agreement between clinician’s label and DSM-IV criteria; Kappa 0.31).



1.2. Do the DSM-IV criteria delineate a meaningful subgroup for research or practice?

In part because of the difficulty in applying the criteria (as outlined in section 1.1.), different research groups often uses different criteria, and quality of early language milestone information is variable (Eisenmajer et al., 1996; Klin et al., 2005; Woodbury-Smith, Klin, & Volkmar, 2005). Different criteria lead to different samples being identified (see Klin et al, 2005 comparison of 3 diagnostic approaches; also Kopra et al., 2008; Woodbury-Smith et al., 2005).



* Research suggests early language criteria do not demarcate a distinct subgroup with different:
o Course/outcome: Children with autism who develop fluent language have very similar trajectories and later outcomes to children with Asperger disorder (Bennett et al., 2008; Howlin, 2003; Szatmari et al., 2000) and the two conditions are indistinguishable by school-age (Macintosh & Dissanayake, 2004), adolescence (Eisenmajer, Prior, Leekam, Wing, Ong, Gould & Welham 1998; Ozonoff, South and Miller 2000) and adulthood (Howlin, 2003).
o Cause/aetiology: Autism and Asperger syndrome co-occur in the same families (Bolton et al., 1994; Chakrabarti & Fombonne, 2001; Lauritsen et al., 2005; Ghaziuddin, 2005; Volkmar et al., 1998). No clear evidence to date of distinct aetiology.
o Neuro-Cognitive profile: mixed evidence, for example some authors have reported worse motor functioning in Asperger than HFA (Klin et al., 1995; Rinehart et al, 2006), while others have not found significant group differences (Jansiewicz et al., 2006; Manjiviona & Prior, 1995; Miller & Ozonoff, 2000; Thede & Coolidge, 2007). Evidence is similarly mixed for differentiation of Asperger group by lower performance than verbal IQ profile (for, Klin et al, 1995; against, Barnhill et al., 2000; Gilchrist et al., 2001; Ozonoff, South & Miller, 2000; Spek et al., 2008), better theory of mind (for, Ozonoff et al, 2000 ; against, Dahlgren & Trillingsgaard, 1996; Spek et al, in press JADD; Barbaro & Dissanayake 2007) or executive function (for, Rinehart et al, 2006; reviewed by Klin, McPartland & Volkmar, 2005 ; against, Miller & Ozonoff, 2000; Thede & Coolidge, 2007; Verte et al., 2006) . Note the risk of circularity for group differences relating to verbal ability, since early language development (grouping criterion) is generally predictive of later language abilities (Paul & Cohen, 1984; Rutter, Greenfield & Lockyer, 1967; Rutter, Mawhood & Howlin, 1992).
o Treatment needs/response: no empirical studies demonstrating the need for different treatments or different responses to the same treatment, and in clinical practice the same interventions are typically offered.

Q.2. Does the existing research literature allow us to suggest new criteria to diagnose Asperger Disorder, in contrast to Autistic Disorder/ASD?

The current clinical and research consensus appears to be that Asperger disorder is part of the autism spectrum, although with possible over-use of the term it is quite likely that other (non-ASD) types of individuals have received this label.

Research field currently reflects two views:

o That Asperger disorder is not substantially different from other forms of ‘high functioning’ autism (HFA); i.e. Asperger’s is the part of the autism spectrum with good formal language skills and good (at least Verbal) IQ. Note that ‘HFA’ is itself a vague term, with underspecification of the area of ‘high functioning’ (performance IQ, verbal IQ, adaptation, or symptom severity).
o That Asperger disorder is distinct from other subgroups within the autism spectrum (see Matson & Wilkins, 2008, review): e.g. Klin, et al. (2005) suggest the lack of differentiating findings reflects the need for a more stringent approach, with a more nuanced view of onset patterns and early language (e.g. one-sided verbosity, unusual circumscribed interests).

2.1. What are the proposed differences? How strong is the evidence?

Several recent comprehensive reviews of the topic are available (Howlin, 2003; Macintosh & Dissanayake, 2004; Matson & Wilkins, 2008; Witwer & Lecavalier, 2008). Matson & Wilkins (2008) suggest current criteria could work if refined and supplemented. However, the research literature to date is not able to provide strong, replicated support for new or modified criteria likely to distinguish a meaningfully different group with Asperger disorder versus autism with good (current) language and IQ. Witwer and Lecavalier’s (2008) perhaps more comprehensive review concludes there is little evidence that Aspergers is distinct, and that current IQ is the main differentiating factor. Bennett et al’s (2008) follow-up study suggests that language impairment at 6-8years might have greater prognostic value than early language milestones, and Szatmari et al (2009) argue (on the basis of later developmental trajectory) for a distinction between ASD with (autism) versus without (Aspergers) structural language impairment at 6-8 years.

The draft criteria for ASD proposed by the Neurodevelopmental disorders workgroup would include dimensions of severity that include current language functioning and intellectual level/disability.



Q.3. If Asperger disorder does not appear in DSM-V as a separate diagnostic category, how will continuity and clarity be maintained for those with the diagnosis?

The aim of the draft criteria is that every person who has significant impairment in social-communication and RRBI should meet appropriate diagnostic criteria. Language impairment/delay is not a necessary criterion for diagnosis of ASD, and thus anyone who shows the Asperger type pattern of good language and IQ but significantly impaired social-communication and repetitive/restricted behavior and interests, who might previously have been given the Asperger disorder diagnosis, should now meet criteria for ASD, and be described dimensionally. The workgroup aims to provide detailed symptom examples suitable for all ages and language levels, so that ASD will not be missed by clinicians in adults of average or superior IQ who are experiencing clinical levels of difficulty.

There may be some individuals with subclinical features of Asperger/ASD who seek out a diagnosis of ‘Asperger Disorder’ in order to understand themselves better (perhaps following an autism diagnosis in a relative), rather than because of clinical-level impairment in everyday life. While such a use of the term may be close to Hans Asperger’s reference to a personality type, it is outside the scope of DSM, which explicitly concerns clinically-significant and impairing disorders. ‘Asperger-type’, like ‘Kanner-type’, may continue to be a useful shorthand for clinicians describing a constellation of features, or area of the multi-dimensional space defined by social/communication impairments, repetitive/restricted behaviour and interests, and IQ and language abilities.

HFA people have physical rigidity - definitely not. My daughter and at least one other autistic child I know of (a boy) have excellent fine and gross motor skills. I have come across a Harvard funded diagnostic study where they claim HFA children have a gait when they walk and their arms go floppy. My daughter walks perfectly normally and swings her arms naturally.

I'm 67, and long finished with High School, and with some college under my belt, including college Psychology, and a whole lot of Life Experience behind me, and _I_ still don't always know how to socialize properly. I'm learning, though, even though slow or "delayed". When I was in school it was not realized that some people need "Social Skills Training", and I've had to figure it out for myself, with a lot of Blind Spots. I never knew until I was diagnosed a couple of years ago, from one of the tests, just how _much_ I was missing in facial expressions, forget Body Language, which I have studied in "book l'arnin'" a little bit. Being on the internet helps, since there are no facial expressions to interpret/misinterpret here, and emoticons are very simplified and easy to interpret.

Haven't read all but I'm diagnosed with HFA and HFA is autism in a person with at least normal IQ.
The difference between AS and HFA is that a person with HFA need to have either speach delays or cognitive delays in a way a person with AS don't. So you can say that HFA is AS but with speach delay or cognitive delay.

My initial diagnosis is HFA because I had delays in speech, motor development and toileting. That doesn't bother me at all, to be honest. My original IQ was 87 when I was 5 years old. The last time I was tested, I scored 115 on an IQ test. You only live once and I choose to have fun in this life that God gave me. It's only a problem if you make it a problem.