High-functioning autism (HFA) is the condition of individuals who display some symptoms of autism but who are able to function close to or above a normal level in society. HFA is sometimes also known as "high functioning Asperger syndrome". In everyday terms, those who are affected by it may be understood as being "eccentric"s, "geek"s, or termed a "little professor" or boffin.

HFA as a developing clinical label

The term Asperger syndrome is sometimes used in the same sense as HFA, but the exact difference between autism, Asperger syndrome, and HFA varies. There are a range of deficiencies and talents in HFA, the precise configuration of which can vary widely from individual to individual, ranged along a continuum.

There is a high correlation between HFA characteristics and those described in the Myers-Briggs INTP profile [http://www.intp.org/intprofile.html description. Another theory states that Asperger's correlates to the INTJ personality type, whereas HFA correlates to the INFJ personality type.

There is some evidence that the label has wrongly become a catch-all diagnosis for badly-behaved children. In 2000 in the UK, the lead clinician and autism specialist at Northgate and Prudhoe NHS Trust in Morpeth, Dr Tom Berney, published a paper commenting on this. He wrote in the prestigious British Journal of Psychiatry:- "There is a risk of the diagnosis of autism being extended to include anyone whose odd and troublesome personality does not readily fit some other category. Such over-inclusion is likely to devalue the diagnosis to a meaningless label."

What are the social aspects of HFA?

In general, people with HFA tend to make fairly frequent social faux pas involving an inability to accurately predict someone else's thoughts, feelings or reactions to something possibly said. They may also forget to display basic social pleasantries (e.g. forgetting to knock before entering a room; or when greeted with "how are you?" they may not reciprocate by following on to ask how the other person is).

Their naive understanding of social interaction may lead them to be overly trusting and thus open to manipulation by others. They may thus be seen as lacking "common sense". For this reason it can be a disaster if youth services departments create large 'treatment' groups that place vulnerable young HFA people alongside amoral manipulative youths with psychopathic disorders.

They may appear somewhat removed or disconnected or 'dreamy' at times, especially in situations of sensory overload, or perceive extreme social pressure such as during a party or in a crowded bar. They may have only limited levels of eye contact during one-to-one encounters, and this can lead to them being labelled as being "shy". Lack of eye contact in job interviews may be seen as "shiftyness" by interviewers, and thus lead to a cumulative difficulty in finding employment. This may contribute to comparative poverty, although intelligent HFA adults can usually find a good job if they can specialise in their area of interest at university level.

Unlike autism, there is no general learning disability. The research community recognises that HFA does not happen in people with an IQ of less than about 75 (i.e.: able to complete elementary school and live independently in modern society). People with HFA are articulate - the DSM IV says that spoken language development must be normal for a diagnosis to be made.

People with HFA generally like routine and order, and this may manifest early as childhood traits (e.g.: as a child, writing out a A-Z library card-index catalog for their comic book collection). They may restrict their daily choice of clothes to only a limited range.

When interested in a task or subject area they will work intently on it. If uninterested they may ignore the task, try to alter it so it reflects one of their personal interests, or only do the 'bare minimum' required to complete the task. Their preferred method of working may be to produce a complete rough structure or draft first, and then focus intently on taking it through many incremental revisions until it is complete.

What difficulties do people with HFA have?

Generally, there are difficulties with social interaction. This does not adversely impact their ability to interact with others on a day-to-day basis at a basic working level, although they may be seen as being overly serious or earnest, and as being without any "small talk" in conversation.

They may have difficulty initiating love and friendship relationships, often being rejected because potential partners perceive them as being either too "nerdy" or too intelligent. This can lead to low self esteem and loneliness, which further impairs their ability to find meaningful companionship.

People with narrow horizons may cruelly label HFA people as "oddballs" or worse, and HFA people may become the target of bullying. This can be especially true of the teenage years. Young intelligent HFA people usually do best by seeking out the company of their intellectual peers or by joining hobby groups, while avoiding their age-group peers.

Some may have minor difficulty with motor skills and co-ordination, especially in free-form social situations or sports (they may have been "the last to be picked for the sports team" as children, and labelled as "clumsy"). This may partly explain their preference for order and neatness, since they use neatness to compensate. Some may also nurture a complex habitual movement (termed 'Stimming') at which they become adept, e.g. pen spinning, while otherwise being prone to clumsiness.

They do not lack empathy (although they may have difficulty expressing it), and can thus enjoy films and stories with emotional content. Some may gain the bulk of their insight into why people behave the way they do through watching movies that provide a forceful and musically-cued "capsule lesson" in human emotions (e.g. melodramas).

Some people with HFA can be extreme procrastinators. A small minority may be unusually sensitive to sudden or annoying noise.

HFA adults are usually at higher risk for becoming poor than the general population.

What benefits can HFA give?

Alongside deficiencies they may simultaneously benefit from some of the more positive aspects of autism. For example, they may have the ability to focus intensely and for long periods on a difficult problem. There is often an enhanced learning ability, although this may not be applied to subjects they are uninterested in. They often present no problems in a supportive, well-resourced educational institution and usually do well academically if they can be stimulated by good teachers.

People with HFA often have intense and deep knowledge of an obscure or difficult subject and a passion for pursuing it in an organised and scholarly manner.

They are usually intelligent, gifted, honest, hard workers when interested in a task and excellent problem solvers. People with HFA tend to become excellent scientists and engineers or enter other professions where painstaking, methodical analysis is required.

Speech and diction can be unusually precise in some individuals with HFA. Some may be unusually adept at wordplay and use language in inventive ways.

Are there gender differences in HFA?

It would seem unlikely that such a major social factor as gender would not affect how HFA manifests itself in an individual. There is a general consensus that HFA seems to affect far more males than females. Some have gone as far as to refer to HFA as a form of "extreme maleness". An alternative hypothesis is that females are more competent at compensatory strategies and are less visible.

What causes HFA?

There seems to be no agreement as to the cause or causes. Accurate medical diagnosis usually cannot happen before a child enters into the more complex and demanding social situation of an advanced school environment, age 7-12. Before about age 7, there is a strong danger that the normal traumas associated with infant development and family life will be confused with symptoms.

How often does HFA occur in the population?

In the 1990s the prevelance was assumed to be about 1 person per 2,000 in England. However, a study published in The Lancet medical journal in July 2006 reported that a team at a hospital in London England had applied autism tests to a large number of children aged 9 to 10. They found 39 of 10,000 children had autism, and 77 of 10,000 had some form of "autism spectrum disorders". The apparent rise may be due to better diagnosis, and to better awareness of HFA in people without learning disabilities.

See also

• Controversies about functioning labels in the autism spectrum
• Autism Spectrum Quotient
• Asperger syndrome

References

• Autism Research Center: The Autism Spectrum Quotient (AQ) — A self-administered test for High-Functioning Autism (HFA): S. Baron-Cohen, S. Wheelwright, R. Skinner, J. Martin and E. Clubley, (2001), The Autism Spectrum Quotient (AQ) : Evidence from Asperger Syndrome/High Functioning Autism, Males and Females, Scientists and Mathematicians. Journal of Autism and Developmental Disorders 31:5-17.

• Wired magazine's Autism-Spectrum Quotient test.

Autism

Autisme de haut niveau | אוטיזם בתפקוד גבוה | hoogfunctionerend autisme | HFA