High-functioning autism

High-functioning autism (HFA) was historically an autism classification to describe a person who exhibited no intellectual disability but otherwise showed autistic traits, such as difficulty in social interaction and communication. The term was often applied to verbal autistic people of at least average intelligence.^[11][12][13] However, many in medical and autistic communities have called to stop using the term, finding it simplistic and unindicative of the difficulties some autistic people face.^{[14][15][16][17]}

High-functioning autism
Other names	Sukhareva syndrome[1]
Specialty	Psychiatry
Symptoms	Trouble with social interaction, impaired communication, restricted interests, repetitive behavior
Complications	Social isolation, employment problems, family stress, bullying, self-harm[2]
Usual onset	By age two or three[3][4]
Duration	Lifelong
Causes	Genetic and environmental factors
Diagnostic method	Based on behavior and developmental history
Differential diagnosis	Asperger syndrome, attention deficit hyperactivity disorder, Tourette syndrome, anxiety, bipolar disorder, obsessive–compulsive disorder
Treatment	Behavioral therapy, speech therapy, psychotropic medication[5][6][7]
Medication	Antipsychotics, antidepressants, stimulants (associated symptoms)[8][9][10]

HFA has never been included in either the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders (DSM) or the World Health Organization's International Classification of Diseases (ICD), the two major classification and diagnostic guidelines for psychiatric conditions.

The DSM-5-TR subtypes autism into three levels based on support needs. Autism Level 1 has the least support needs and corresponds most closely with the "high-functioning" identifier.^[18]

Characterization

The term "high-functioning autism" was used in a manner similar to Asperger syndrome, another outdated classification. The defining characteristic recognized by psychologists was a significant delay in the development of early speech and language skills, before the age of three years.^[12] The term Asperger syndrome typically excluded a general language delay.^[19]

Other differences noted in features of high-functioning autism and Asperger syndrome included the following:^{[12][20][21][22]}

• Lower verbal reasoning ability
• Better visual/spatial skills (Being uniquely artistically talented)
• Less deviating locomotion (e.g. clumsiness)
• Problems functioning independently
• Curiosity and interest for many different things
• Not as good at empathizing with other people
• Male to female ratio (4:1) much smaller

HFA is not a recognised diagnosis by the American Psychiatric Association or the World Health Organization. HFA was, however, previously used in clinical settings to describe cases of autism spectrum disorder where indicators suggested an intelligence quotient (IQ) of 70 or greater.^[23]

Comorbidities

Main article: Conditions comorbid to autism

With the notable exception of intellectual disabilities, which were not part of HFA, cormobidities found in HFA populations reflected those found in autism. (Between 40 and 55% of individuals with autism also have an intellectual disability.^[24]) Studies that looked specifically at HFA have examined anxiety,^[25] bipolar disorder, Tourette syndrome, attention deficit hyperactivity disorder (ADHD), and obsessive–compulsive disorder (OCD). Both HFA and OCD have abnormalities associated with serotonin.^[26]

Behavior

A 2012 study noted that HFA "disorders are over-represented in the criminal population as compared to the general population," though more research needs to be done in this area.^[26] Some case studies have linked the lack of empathy and social naïveté associated with HFA to criminal actions.^[27]

See also

• Autism therapies
• Causes of Autism
• Conditions comorbid to autism
• Diagnosis of autism