The answer is not clear to most people, including professionals.
According to the DSM-5 (Diagnostic and Statistical Manual of Mental Disorders, 5th Edition), Asperger’s was considered related to, but distinct from Autism, and therefore not HFA specifically, but considered different parts of the same diagnosis.
Well, that’s part of the problem.
Even more confusing…
Now the DSM-5 contains a new disorder that replaces both Autistic Disorder and Asperger’s: Autism Spectrum Disorder.
Yet, “Asperger’s Syndrome” is still a part of World Health Organization’s (WHO) ICD-10, which does not contain diagnostic criteria, except for the “Diagnostic Criteria for Research”
There is a lot of debate as to whether or not Asperger’s should even fall under Autism Spectrum Disorder (ASD) at all. So, using the terms HFA or Asperger’s are acceptable, but not differentiated or coded by the DSM-5.
What does that mean? Well, it basically means that both HFA and Asperger’s are considered the same variations on Autism.
This adds to the complexity because all degrees of Autism, including Asperger’s/HFA can have different variations of typical traits.
For instance, some people with Asperger’s/HFA, especially girls, make significantly more eye contact (especially with close relations) than boys, who make little to no eye contact. Thus they are often underdiagnosed by those with a limited knowledge of what constitutes the diagnosis, which is unfortunately very common even among specialist who often treat everything under the umbrella (and most Neurodiverse diagnosis) as a behavioral problem.
Read more about understanding Neurodiverse behavior struggles here.
This, in a nutshell is why it is so difficult to have a solid grasp on what Autism is (or isn’t) and what therapies are needed and helpful to the individual. The spectrum is very broad and varied, and still many don’t treat the individual as such, they treat them as the general definition.
That is a problem.
AND… it’s detrimental to the individual!
It’s important to keep in mind that these diagnoses, just like everything else in humans, are extremely individual. Which can lead us to an interesting debate on the use of labels.
You can read more about that in my blog on Using Labels here.
However, there are some common yet significant differences between the higher functioning and lower functioning within the ‘umbrella’.
Here’s my attempt to get better understanding of how they look:
Asperger’s/HFA – There is usually no language delay. This can be confusing because it means that there is no delay in the development of language once a child begins to speak. However, that can mean that the child may be late to start speaking, but once they do speak, their language quickly gets up to speed (language bloom) and often develops beyond peers in articulation and vocabulary. It’s important to note that language ability and expressive language (the ability to communicate inner experiences) are very different. Expressive language delay is one of the main criteria for this diagnosis and is often at the root of why ABA (Applied Behavioral Analysis), talk therapy, and other therapies often become detrimental to people with Asperger’s.
Autism (moderate to low functioning) – There is often a language delay and sometimes no language at all. They show little to no early verbal communication skills and have difficulty talking and developing vocabulary when their peers are already speaking in complete sentences. Verbal children who are on the moderate to low functioning spectrum may speak with an abnormal tone or rhythm such as singsong or monotone.
Asperger’s/HFA – There is no delay in cognitive ability. Intelligence is average to above average. While more recent research shows Asperger’s/HFA is directly correlated to above average IQ and/or Giftedness, this has not yet been added to the DSM-5. In people with Asperger’s/HFA, the Giftedness or high intelligence can be hidden by severe and chronic anxiety, delays in pragmatic language and undiagnosed learning disorders (also common in the higher IQ/Gifted demographic), which gets in the way of accessing the skills required for demonstrating higher intelligence.
As in a diagnosis of true Giftedness, intelligence in this demographic is asynchronistic, meaning different areas of intelligence develop at different rates. Typically, people with Asperger’s tend to be gifted in math, science, and music, but they can also be gifted in history, art, and writing. It will depend on the individual wiring, nature, and experience as to what area they are gifted in. It is usually easy to tell, because they may have a preoccupation with a specific topic and will talk about it often and at length with a lack of awareness of the interest level of their audience, although this skill can be learned to some degree with time.
Autism (moderate to low functioning) – Cognitive delays are usually the first sign and are associated with low to average IQ. They will remain noticeably behind their peers in all areas of cognitive development and will need assistance throughout their lives.
Asperger’s/HFA – Life skills, such as getting up and ready for school/work, hygiene, feeding, and driving are not intuitive or comfortable. Because these skills require Executive Function (EF), which is lagging in all people on the spectrum and even more so in the Gifted population, life skills can be very challenging, especially during the pubescent years (9 to 23). These skills can be learned over time, but usually require a great deal of effort, because they will need to overcome not only their EF struggles but also Sensory Processing difficulties that trigger the very high anxiety common among this group, all of which are often struggle more during puberty.
In general, people with Asperger’s/HFA will develop life skills, but they will develop much later than their peers. A high degree of success in this area comes from those who have patient and persistent care givers that continue to work with them at their current skill level, and understand that fear and anxiety which is often caused by an inability to express their inner experience (Pragmatic Language Delay) during intense feelings (Intense World Theory). As a result of these delays real independence is often reached 5 to 10 years later than their peers. Many people with Asperger’s can live on their own or with a partner, with little to no support.
Autism (moderate to low functioning) – There is cognitive struggle to grasp basic life skills and many cannot preform simple tasks like brushing their teeth or hair without assistance all the way into adulthood. These people will need daily support for life.
Social and Emotional:
Asperger’s/HFA – You will find a great variety of social and emotional skills in people with Asperger’s/HFA. Most will learn at a young age how to greet and say ‘good bye’, say ‘thank you’ and ‘please’. By the teen years they usually learn polite conversation like “how are you?” However, these skills are learned not intuitive, thus socializing can be very stressful and often leads to social anxiety. Because they are intelligent, they can learn a range of social skills, but they are learned in an analytical and pragmatic way. If someone unexpectedly uses sarcasm or has an unpredictable emotional response, it can throw them off and even cause panic to set in. These situations can result in coming across as rude, insensitive, or lacking in empathy, when in fact they are anxious and dealing with some inner turmoil. It is a great misunderstanding that people with Asperger’s/HFA are lacking in empathy. The real problem is that they experience a very high level of anxiety when dealing with social and emotional situations, which gets in the way of their ability to sympathize in the moment.
Research shows that people with Asperger’s/HFA not only empathize with others, but in many cases, they are MORE sensitive to others pain and suffering (Intense World Theory), when they understand it. People with Asperger’s/HFA often struggle with social interaction and relationships because they are not aware that they are not aware.
It is not uncommon for them to misread facial expressions, like mistaking frustration or concentration for anger, or excitement for worry or anxiety. Because they misinterpret people’s reactions they may deny or completely miss that they are misreading people or situations. Many times, they lose friends because they don’t notice that the friend didn’t want to play a certain way, or felt uncomfortable talking only about what the Aspie (person with Asperger’s/HFA) was interested in. After a while the one-sided conversation, play, or interest degrades the relationship, if it developed at all in the first place. Many Aspies, in social or emotional situations, believe they are behaving or reacting in the correct way because they see their behavior as logical or right. This can make if very difficult for them to learn what to watch for in their social interactions. This particular skill has been shown to be key in Aspies developing relationships.
Autism (moderate to low functioning) – The person will remain unaware of social problems and struggles. They do not have the ability to take the perspective of others. Where Aspies can learn these skills intellectually, generally neither Autistics or Aspies learn these things intuitively. Low to moderate functioning Autistic’s do feel for others, although it can be limited by their understanding of others ‘feelings’.
Anxiety and Depression:
It is common for both Autistics and Aspies to struggle with chronic anxiety and depression because there is a constant pervasive struggle to incorporate information that Neurotypical people intuitively and easily assimilate.
The biggest difference is that Aspies can learn skills to manage anxiety and depression, practice focused self awareness and go on to live fulfilling lives. Most moderate to lower functioning autistics are usually not capable of the understanding necessary to manage their thinking and habits in a way that would allow them to manage difficult emotions, and thus they may need significant support throughout their lives.
It’s important to note that no matter which diagnosis a person has, they are a person; varied, individual, and unique. There are no simple clear cut lines for any diagnosis and often there are multiple elements from all over the spectrum. Those with Asperger’s/HFA can have traits of classic autism and the other way around. It’s also possible to have many but not all of the traits and again, there will be significant differences in the way boys and girls present.
The saying is “if you have met one person with Autism, you have met one person with Autism”, and I think we can safely say that is true of everyone, whether you are talking about the Autism Spectrum, a Nationality, a religion, or a health condition. We are all different, and yet… we are all the same
*It is interesting to note that there is a significant move by professionals (and many Aspies) to change the terms ‘disorder’ and ‘syndrome’ to ‘condition’. (Click here to learn more http://aspergers.com/aspcrit.html )
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Hi! I’m Yvette Marie a Thought Wrangler (an intellectual nomad looking for understanding and hope in all things). I created this blog space because I believe Flexibility and Flow in Neurodiversity is not only possible, but necessary for living a full life of health and wellness.