AS/HFA Confusion

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Okay. I'm sure this has been covered a million times, but i never seem to be able to find a clear answer. Are AS and HFA actually distinct things, or is AS a kind of HFA? AS gets referred to as a type of Autism everywhere, and a hear many people refer to it as a type of High-Functioning Autism... So, my first impression was that AS was sort of sub-type of HFA.. but then i also see people listing distinctions between between AS and HFA. So, ummm... CONFUSION.

One thing i notice that people use to distinguish between Asperger's and (other kinds of?) Autism is speech development. Reading what the DSM says about a diagnosis of Autism, though, it's pretty clear that late language development is NOT a requirement for Autism, but, rather, one of a few possible manifestations of it(along with delays in social interaction or imaginative play.. only one being needed for diagnosis) The Autism diagnosis described in the DSM seems to clearly include AS. So... That seems to line up with AS being a TYPE of HFA, as opposed to a separate thing.. Or... am i just over-analyzing this, and when people contrast AS and HFA do they really just mean AS vs. *other* HFA?

So, yeah. This is just confusing me, and i want to get this stuff straight in my head.

There is no actual diagnosis of "Higher Functioning Autism". There is only Autism and Aspergers.

This part of the diagnostic criteria is not found in aspergers, but is found in autism.

The term "Higher Functioning Autism" can mean one of two things.

Sometimes it is used to describe anyone on the autism spectrum who has high functionality in life.

Sometimes it is used to describe someone with a diagnosis of autism who is high-functioning. I'd suggest you use this meaning when using the term on this website.

Many psychiatrists will give people an aspergers diagnosis instead of an autism diagnosis, even if they meet the criteria for autism. This is because aspergers is seen to have less stigma about it, and will make the parents feel better. (Talk about a lack of objectivity.)

I believe the new DSM guidelines will define exactly what all the different terms mean, we'll just have to wait until it's out.

It seems like it would be really easy to fit the criteria for both at the same time, though.. Especially if the only difference in diagnosis is that bit.

Someone with autism will meet the criteria for both autism and aspergers. Someone with aspergers will only meet the diagnosis for aspergers (not for autism). If you meet the diagnosis for autism, you technically shouldn't be diagnosed with aspergers, since that's how the DSM regarding ASD's is meant to work.

Autism > Aspergers > PDD-NOS

I'm not surprised you are confused. Professionals have not been able to reach a concensus on this.

Hans Asperger thought it different to Kanner's autism. Lorna Wing, however, believed AS to be high-functioning autism. She based this on her clinical experience and research. There was great overlap between them; some subjects had a mixture of both, and many previously diagnosed Kanner's were indistinguishable from Asperger's later in development.

Evidence was sought for many years to see whether AS and HFA differed on more than just severity. Most studies were inconclusive or showed more similarities than not, while a few showed their differences. Some studies show they differ on severity alone, existing on a continuum; however, this is likely to be too simplistic. Genetic and neuropsychological studies also support their relationship.

Lorna Wing did not intend AS to be distinguished from high-functioning autism, and in some ways regretted having coined the term Asperger's syndrome. However, she acknowledged that it allowed many who otherwise would have had no diagnosis to be recognised and that it spread awareness of autism associated with average or above cognitive ability.




Some neurobiological differences have been found between possible subgroups; for example those with signficant language delay and those without. This might form part of the basis for valid autism subgroups, although more research would have to be conducted. They'd also have base any division on other aspects of neuropsych profile (such as a type of motor skill deficit within each subgroup), because basing subgroups on language onset alone might mean they could significantly overlap on other dimensions. Even if scientifically valid subgroups are found, the diagnostic criteria may not be altered to reflect this unless it has some clinical use. If there is too much overlap in treatment response and outcome, it would not be clinically useful.

Lorna Wing and others believe a multidimensional approach should be taken rather than dividing the spectrum into diagnostic subgroups; in clinical practice it's often better to focus on individual profiles of strengths and weaknesses rather than diagnostic subgroup.




Ah yes, the DSM-IV criteria and precedence rule.

AS was included in the ICD-10 and DSM-IV to encourage investigations into its validity as a separate entity from HFA. In order to do this, AS had to be categorically separated from autism, so the diagnoses had to be defined to mutually exclude each other. This was in spite of there being evidence they existed on the same continuum, not as distinct categories. People have been receiving the AS diagnosis even though there's no consensus as to whether it is essentially HFA. The strong overlaps with other conditions (e.g., NLD and SPD) have also yet to be fully investigated.

The DSM precedence rule is as follows: Those who meet the criteria for autism are not to be given an AS diagnosis. To have met the autism criteria, they must have had the early developmental delay (such as in language onset), plus meet criteria in the communication domain. However, this has caused the definition of AS to be overly narrow; those who otherwise appear to fit AS get excluded because they might have had some language delay, for example. Many criticize how the DSM AS criteria do not include features such as motor clumsiness or pragmatic language difficulties, and social deficit manifestations that might be AS-specific. Some of these are covered only in the expanded text.

In practice, clinicians do not follow diagnostic criteria strictly, for many reasons, such as which diagnosis would provide more access to services or less stigma. The criteria are also a work in progress, so some flexibility is required. Many prefer to divide AS and HFA based mainly on early language onset. The varied diagnostic approaches complicate research into AS and HFA differences.

I tend to make distinction.

People who are idiots and have asperger's diagnosis have really more borderline HFA. I am talking about category who is playing with rubber dolls and pretending to be dragons. I find them disgusting and want to lobotomise them.

I won't be as blunt as some here. But AS is SUPPOSED to be a TYPE of HFA, in a way. Frankly, AS is supposed to be more restrictive and most people that are high functioning that have Autism that don't fit are supposed to fall into HFA. Those that don't fit THERE may have PDD-NOS. PDD-NOS REALLY only requires that they appear autistic. It is supposed to be a sort of catchall, AS and HFA are more resttrictive, but in different ways.

Some "professionals" simply broaden the restrictions, or ignore them, and THAT is where AS and HFA start appearing SO similar. HEY, if you forget about the social aspect, sex organs, and cultural convention, the line between male and female blurs ALSO!

I find this confusing as well, but I have another dimension to add:

I though a person was diagnosed AS if they are diagnosed late (after toddler yrs./school age or later) & had no apparent speech delays (at least that were detected). I believe(d) HFA is given to people who function well, (can learn to control habits, "improve"/depending on what you call that relatively quickly compared to those with lower-functioning autism (gain speech, coping strategies etc.)

Plus PDD-NOS, given to those who do not entirely fit into either one of the HFA or AS categories (missing some DMS criteria in (a) certain area(s). Do they ever give the diagnosis of just PDD anymore (its what I have & a kid who is around 10 (as of now) I used to know a few years ago has. What is the difference anyway? How about the differentiation between diagnoses get more specific & clearer please ( for those who they cannot place in 1 category, just give them "an ASD" unspecified/so much simpler for me to keep track of ). Also, at one point I heard they moved all diagnoses out of umbrella of autism to umbrella of PDD (why stopped using diagnosis). They confuse me & possibly rest of planet's inhabitants (who care anyway) !

p.s. Zyborg, would you put me in the category w/ the rubber doll people (I was diagnosed with Autism, than PDD at 18 mos., have average to above average intelligence/memory, but my interests include slinkies, a japanese toy that is basically an infinite supply of bubble wrap, religious stuff (the heretical/ non orthodox stuff & non Christian stuff), fantasy stuff (I like dragons, have had dreams about them but do not believe I am one/find fact almost all cultures have dragon lure of some kind fascinating) , writing & WP? I can preoccupy myself with a slinky or something for hours at a time (easily)!

I think you have that backwards! They aren't diagnosed with AS because they are diagnosed late, but are diagnosed late because they seem so normal because they have AS.

To be realistic,

There's just as much variety amongst the population with AS, compared to its similarities with HFA, and the same with HFA too and its similarities to AS, that's it's effectively moot.

Verbal autism is as verbal autism does.

You only run into problems on the extreme end, where "disorder" and "normality" are brought into question (Schizoid PD or very mild AS that's effectively introversion taken to abnormal limits, are the perfect examples).

Where are you meeting all these people who are pretending to be dragons? One does not have the opportunity to be disgusted by things, in which one is not immersed. What sort of rubber dolls are we talking about here?

I think people with AS are just born milder on the spectrum while people with HFA either grew out of LFA or got misdiagnosed. Another theory could be that AS is HFA or that AS could indeed include a speech delay in some cases. In my opinion, HFA is just a synonym for AS or autism without mental retardation, which are almost the same thing. Again, I'm not a doctor so I don't even know myself if AS and HFA are distinct conditions or if HFA people just outgrow LFA.

I imagine he's just trying provoke a response by telling people like me that we should be labotamised. If you are seeking intelluctual conversation i suggest you ignore his posts.

To avoid being blunt and possibly insulting, I should say that you may be VERY wrong! He SAID "I find them disgusting and want to lobotomise them.", NOT that they SHOULD be lobotomized. GRANTED, it seems a subtle difference, but it really isn't so subtle.

I can assure you that within the context of the post, that there is no functional difference between what i said and what he said. The literal nature of aspies never seizes to make me laugh.

When I first joined WP, my wife asked how it was. One of my first comments was, "It's crazy! Imagine a whole bunch of people that focus on too many details and take each other literally. It's amazing they can communicate at all!"