What Is High-Functioning Autism?
High-functioning autism (HFA) is a term often used to describe individuals on the autism spectrum who require minimal support. Individuals with HFA typically possess the ability to communicate verbally, read, write, and complete essential tasks independently. Their behaviours usually do not impact their relationships, education, or occupation. However, it’s important to note that ‘high-functioning autism’ is not an official medical diagnosis but rather an informal term to indicate a milder presentation of autism spectrum disorder (ASD). This term, along with Asperger’s syndrome (AS), was previously used to describe individuals with less severe challenges before the introduction of the Diagnostic and Statistical Manual of Mental Disorders Fifth Edition (DSM-5) in 2013.
Although the term high-functioning autism is still occasionally employed in everyday conversation, it is considered inaccurate in professional and research contexts. One of the key issues with this label is that it may create unrealistic expectations about the abilities of autistic individuals, as it doesn’t account for the wide range of challenges they may face. While some individuals may excel in certain areas like language and academics, they may have challenges with other aspects of functioning, such as social interactions or sensory processing. Today, experts advocate for a more person-centred approach that recognises the individual strengths, abilities, and support needs of each autistic person, avoiding labels that perpetuate stereotypes and misunderstandings about this neurodiverse difference.
Signs and Symptoms of High-Functioning Autism
As awareness and diagnosis rates for autism spectrum disorder continue to rise, people are becoming more familiar with the associated symptoms. This increased awareness has improved access to essential support and resources, enabling autistic individuals to lead fulfilling and productive lives. However, high-functioning autism still presents its own unique set of challenges.
One common symptom of high-functioning autism is emotional sensitivity. While individuals may navigate their daily routines without support, they often have challenges regulating their emotions. Simple situations like spilling coffee on their shirt or taking a wrong turn while driving can cause intense emotional reactions, leading to difficulty concentrating for an extended period.
Another distinctive symptom is a fixation on specific ideas or subjects. People with high-functioning autism may obsessively discuss the same topics, play the same song on repeat, or read extensively about a particular subject. While these intense interests can lead to remarkable achievements, they can also interfere with relationships and daily life.
Additionally, social difficulties are also prevalent, particularly in children and teenagers, where limited social circles, challenges in group work, and problems sharing can be observed. However, it’s essential to recognise that these difficulties result from a lack of understanding of appropriate social behaviour, and early intervention from proactive professionals can help individuals with high-functioning autism learn effective social interaction strategies.
Furthermore, sensory processing challenges can be a significant aspect of high-functioning autism. Individuals may have heightened sensitivities to specific tastes, noises, smells, or textures, leading to anxiety and emotional distress in specific situations. However, with the help of professionals and occupational therapy, many individuals with high-functioning autism can develop strategies to manage sensory challenges and improve their overall well-being.
Devotion to routines is another symptom of high-functioning autism. Individuals often hold to rigid routines and may become anxious or frustrated when faced with changes or disruptions. Repetitive habits are also common, manifesting as repetitive movements or restrictive habits, potentially affecting an individual’s daily life.
Challenges with movements are another sign of high-functioning autism and can sometimes manifest as movement patterns such as toe walking. Over time, these movements can result in foot pain and bunions.
It’s important to note that not all individuals with these symptoms have high-functioning autism. Still, when several signs are present together, it is advisable to consult a healthcare professional or autism specialist for a comprehensive evaluation and guidance on appropriate support and interventions.
Why Is High-Functioning Autism Often Diagnosed Later in Life?
High-functioning autism is frequently diagnosed later in life due to various factors that can mask its identification during childhood. Many individuals with high-functioning autism develop coping mechanisms that enable them to mimic neurotypical behaviours in social situations. This can be highly effective, particularly during childhood when social demands are less complex. Another contributing factor is the array of symptoms within the autism spectrum. ASD presents uniquely in each individual, and the symptoms of high-functioning autism can be overlooked or overlap with other differences.
The evolving diagnostic criteria for autism also play a role. Changes in the Diagnostic and Statistical Manual of Mental Disorders criteria over the years have made the definition of autism more inclusive. As a result, differences like high-functioning autism and Asperger’s syndrome have been placed under the broader category of autism spectrum disorder. While this may lead to earlier recognition in some cases, it can also contribute to diagnostic delays if healthcare professionals are not updated on the latest criteria. Furthermore, research has shown that autism is often underdiagnosed in females compared to males, as females with high-functioning autism may exhibit different social and behavioural patterns.
Late-onset challenges, such as increased social and academic demands in adolescence and adulthood, can also bring the symptoms of high-functioning autism to the forefront. Difficulties in navigating complex social relationships, maintaining employment, or managing higher education may become more pronounced, pushing individuals or their families to seek a diagnosis. A lack of awareness and recognition of high-functioning autism in many communities and healthcare systems also contributes to diagnostic delays.
Overlooking Symptoms Due to Other Diagnoses
High-functioning autism is often overlooked or misdiagnosed due to its co-occurrence with other diagnoses and the overlap of symptoms. These diagnoses often include attention-deficit hyperactivity disorder (ADHD), obsessive-compulsive disorder (OCD), social anxiety disorder, and separation anxiety disorder.
For example, difficulties with social interactions, a symptom of ASD, may be attributed to shyness or social anxiety disorder. Challenges in self-expression or language processing may be misdiagnosed as language-based learning disabilities. Autistic individuals may also exhibit repetitive behaviours, which can be seen as symptoms of obsessive-compulsive disorder (OCD). Furthermore, a preference for solitude, hypersensitivity to sensory stimuli, or resistance to change can also lead to misdiagnoses, such as mood disorders, sensory processing disorders, and generalised anxiety disorders.
Healthcare professionals often focus on treating these diagnoses without recognising the undiagnosed autism. It is usually only when treatments do not result in positive outcomes or additional characteristics are brought to light that healthcare professionals may begin to recognise autism. The complexity of coexisting challenges can complicate diagnosis, highlighting the need for comprehensive assessments that consider the possibility of autism alongside other challenges.
Is Asperger’s Syndrome High-Functioning Autism?
Asperger’s syndrome was previously considered a form of high-functioning autism. Before the publication of the DSM-5 in 2013, psychologists distinguished autism and Asperger’s syndrome. This differentiation was based on language development, cognitive abilities, and the level of daily life impact. Individuals with Asperger’s syndrome typically exhibited average or above-average language and intelligence skills and milder symptoms than individuals with autism.
Although the term high-functioning autism has been informally used to describe individuals with characteristics similar to AS, it is not an official medical diagnosis. Today, individuals who might have previously received an Asperger’s syndrome diagnosis are usually diagnosed with ASD, regardless of their required level of support. While some people may continue to identify themselves as having Asperger’s syndrome, it is essential to recognise that this term is no longer used in practice, and the focus has shifted to understanding and supporting individuals across the autism spectrum.
Emotional and Psychological Impact of a Late Diagnosis
A late diagnosis of high-functioning autism can profoundly impact individuals emotionally and psychologically. However, not everyone responds to a late diagnosis in the same way. Some individuals may feel a sense of relief upon receiving a diagnosis, as it explains the challenges they have faced throughout their lives. This newfound understanding can empower them to navigate their difficulties and seek appropriate support. Some individuals may be challenged with the diagnosis, experiencing different emotions, including fear, confusion, and grief. Children and adolescents who receive a late diagnosis may question their identity and self-confidence. This adjustment period can be challenging, and some individuals may need time to process their diagnosis and its implications.
Since approximately 70% of autistic people have at least one co-occurring diagnosis, such as ADHD, anxiety or depression, a late diagnosis may also cause them to seek further psychological evaluations to better understand their overall mental health profile. This information can guide the development of a tailored treatment plan that addresses their specific needs. Individual therapy can be particularly beneficial for high-functioning autistic individuals to help them manage their unique challenges.
Late Diagnosis of High-Functioning Autism and Anxiety
For many individuals, the late diagnosis of high-functioning autism can disrupt their existing sense of identity and self-concept, leading to confusion and uncertainty. They may have difficulty reconciling their new understanding of themselves with their previous perceptions, which can cause anxiety.
Anxiety is a common co-occurring diagnosis in adults with high-functioning autism, with generalised anxiety disorder being the most prevalent. Anxiety can manifest in many ways, including physical symptoms like restlessness and sleep disturbances and psychosocial symptoms like obsessive thinking and difficulty concentrating. For individuals with autism, anxiety can significantly impact repetitive behaviours and social withdrawal. It may also interfere with their ability to find employment and live independently. Untreated co-occurring anxiety in individuals with autism has been linked to the development of depression, aggression, and self-injury, highlighting the importance of recognising and addressing anxiety.
Managing anxiety in individuals with high-functioning autism often requires a multidisciplinary approach. Cognitive-behavioural therapy (CBT) is an effective way of treating anxiety disorders and obsessive-compulsive disorder (OCD) in individuals with autism. CBT helps individuals differentiate between helpful and unhelpful anxiety, identify anxious thoughts, and develop strategies to reduce negative feelings and unhealthy responses. Daily interventions, such as keeping a diary or using applications, can help individuals with autism manage and understand their anxiety.
Impact on Family and Friends
High-functioning autism can profoundly impact family and friends, often requiring them to navigate unique challenges. A common symptom of high-functioning autism is difficulty interacting with peers and forming friendships. For families and friends, witnessing their loved ones’ social challenges can be both concerning and frustrating. They may experience feelings of helplessness in trying to support their family member or friend in developing social skills and building meaningful relationships.
The difficulties of developing and sustaining friendships for individuals with high-functioning autism are influenced by several factors, such as challenges with starting conversations, interpreting nonverbal cues, social anxiety, and inflexible thought patterns. Understanding these challenges can be vital for families and friends in providing appropriate support. Encouraging individuals with autism to seek therapy and participate in social skills groups can be beneficial. Additionally, promoting open communication and patience within family and friendship circles can help foster understanding and empathy, allowing them to better support their loved one in their journey to establishing and maintaining friendships.
Find Support With Unique Community Services
At Unique Community Services, we provide compassionate and tailored person-centred care to individuals on the autism spectrum. We create personalised care plans that transform lives, helping people feel encouraged to be more independent.
Our heartfelt approach involves clinicians engaging in thoughtful conversations with individuals to gain a profound understanding of their unique needs and diagnoses. We prioritise open communication and collaboration with family members, caregivers, and educators to create a comprehensive understanding of the person’s specific needs, preferences, potential triggers, and personal boundaries. This approach allows us to honour each individual’s dignity and worth.
If you or a loved one with high-functioning autism require tailored care services, Unique Community Services is available to provide person-centred care. Our clinicians are always available to provide support, with offices located in Manchester and Bristol.
Contact us today to learn about our transformative approach.
