High-functioning autism (HFA) is a neurodevelopmental disorder characterized by significant limitations in social communication skills and restricted interests/repetitive behaviors. HFA is often accompanied by intellectual disability and other co-occurring conditions. The prevalence rate has been estimated at 1% to 2%.
People with HFA typically show good academic performance, although they struggle with some aspects of social interactions. They might also experience anxiety or depression.
This article outlines the most common symptoms of high-functioning autism that may be overlooked by many people.
High-functioning autism symptoms
The following are the most common symptoms associated with HFA:
Fixation on particular ideas or subjects.
Autistic fixations can be extremely persistent and difficult to change. For example, an autistic child may have one obsession that lasts for years.
Intense interest in objects or topics.
Some people with ASD have intense obsessions about specific topics such as trains, numbers, animals, etc.
High focus on details.
An autistic person might spend hours looking at a single object, or obsessively counting items.
Learning to speak, building vocabulary, or being able to maintain conversations with others are common linguistic issues for children on the high-functioning end of autism.
Dependent on routines.
People with high-functioning ASD tend to follow very strict routines when it comes to daily activities like eating, sleeping, dressing, bathing, brushing their teeth, and going to school. This makes them less flexible than typical individuals. Any deviation from their routine can trigger extreme distress.
Some people with ASD find it hard to make friends or interact with others. Others have no trouble making friends but prefer to stay home alone rather than go out in public. Other symptoms of high-functioning autism in children can include a restricted social circle, unwillingness to share toys, and issues with completing group work.
Strong dislike of change.
Many people with high-functioning ASD have strong negative reactions to changes in their environment. They might become anxious if something new happens, even if it's positive. They might also be unable to cope with sudden changes in plans or schedules. For example, if they are forced to choose a different brand than their usual cereal provider, they might become highly activated and irritated.
Uncommon movement patterns.
One of the most common movement patterns in individuals with autism is toe walking. By walking on their toes and not putting too much weight on the rest of the body, they are likely to experience foot pain, hammertoe, or high tension in their toes.
High focus on self.
High-functioning autistics often don't notice other people's emotions and feelings. Instead, they focus on themselves and what they want to do. They might talk excessively about themselves, not pay attention to other people's emotions or needs, thus having difficulties in building deep relationships.
This goes hand in hand with dependency on routines. High-functioning autism may manifest through repetitive, often restrictive habits that can interfere with a person's daily life. These behaviors include:
- Sticking to one type of food. It's common for people with high-function autism to eat only certain foods. They might refuse to try new foods because they're afraid of getting sick.
- Using the same set of clothes every day. A lot of people with high-function autistic wear the same outfit every single day. They might feel uncomfortable wearing anything else.
- Using the same set of tools every day. People with high-functional autism might use the same tools over and over again. They might get frustrated when they need to use another tool.
Sensory processing issues.
Sensory processing issues are common among people with high-function ASD. They might have difficulty distinguishing between sensory stimuli such as light touch, sound, taste, smell, and sight. They might also have problems with identifying objects and learning how to communicate using sign language.
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Difficulty with social cues.
People with high-functioning autism tend to misinterpret facial expressions and body language. They might react inappropriately to situations and events. They might also have trouble understanding jokes and sarcasm.
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How can high-functioning autism be diagnosed?
The first step toward diagnosing high-functioning autism is to rule out any mental disorders or health conditions that could mimic its symptoms. The following list includes some of the most common disorders that cause similar behavior patterns as those seen in high-functioning autism.
- Depression. Depression affects an estimated 10% of children and adolescents worldwide. Symptoms include sadness, irritability, hopelessness, sleep disturbances, appetite changes, fatigue, and low energy levels. If you suspect your child has depression, speak with his doctor.
- Anxiety. Anxiety affects approximately 20% of children and teens worldwide. Common anxiety disorders include separation anxiety disorder, generalized anxiety disorder, obsessive compulsive disorder (OCD), post-traumatic stress disorder (PTSD), and panic attacks. Speak with your pediatrician if you think your child might be experiencing these types of emotional struggles.
- Obsessive Compulsive Disorder. OCD affects approximately 2% of all children and teens worldwide. Symptoms include obsessions (repeated thoughts or images) and compulsions (repetitive actions performed to reduce distress). Your child might experience obsessions like fears about germs or contamination; or he might obsessively check things like locks or doorways. He might also perform compulsions like counting or repeating words. Talk with your child’s doctor if you notice any signs of OCD.
- Attention Deficit Hyperactivity Disorder (ADHD). ADHD affects approximately 5% of school-aged children worldwide. Symptoms include hyperactive behaviors, impulsivity, and inattention. Children who suffer from ADHD often struggle to focus on tasks and may find it difficult to sit still for long periods of time. Speak with your child’ s doctor if you observe any of these symptoms.
- Tourette's Syndrome. Tourette’s syndrome affects approximately 1% of children worldwide. It causes uncontrollable tics — repetitive movements or sounds — which usually begin during childhood. Tics can range from mild eye twitches to full-blown vocalizations or rapid blinking. Some people with Tourette’s also experience inappropriate laughter or swearing. Talk with your child's doctor if you see any signs of this condition.
After ruling out any of these disorders, a professional will likely diagnose your child with high-functioning ASD. This diagnosis requires meeting two criteria:
- A delay in developing skills related to social communication, such as making friends, using gestures, or sharing interests
- Behaviors that are unusual compared to other kids their age
The severity of ASD symptoms varies widely among individuals. In general, however, there are three categories of ASD:
- Low-Functioning Autism: Individuals with low-functioning ASD have fewer than five core symptoms. They tend to be less verbal and don't talk much. They do not develop language until they're older. They are more likely to engage in repetitive behaviors.
- High-Functioning Autism: People with high-functioning ASD have between five and 15 core symptoms. They have some speech but little understanding of others' feelings. They are able to communicate through gestures and body language. They may use words appropriately, but they lack the ability to understand what is said. They may be socially awkward.
- Asperger Syndrome: People with Asperger Syndrome meet both criteria for low-functioning and high-functioning ASD. They have fewer core symptoms than those with high-functioning autism, but they show similar patterns of behavior. They typically have normal intellectual development. They have trouble communicating verbally and may have difficulty reading facial expressions. However, they do understand basic concepts like numbers and colors.
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There is no cure for ASD. But early intervention helps most young people with ASD learn how to function in society. Treatment options include behavioral therapy, medication, and special education services.
Treatment options for high-functioning autism
Potential ASD support can incorporate:
Applied behavioral analysis (ABA)
Behavioral interventions help teach children with autism spectrum disorders how to behave in ways that make them feel comfortable. This technique usually uses a reward system and encourages positive behavior while reducing self-harming behaviors. According to a study, ABA therapy has been shown to reduce aggressive behaviors in children with autism spectrum disorders. The researchers found that when ABA was combined with intensive one-on-one training, it helped improve the children's abilities to interact with peers and adults.
This type of treatment focuses on helping an individual perform daily activities independently. Occupational therapists work with clients to identify areas where they need extra practice, and then provide strategies to help them succeed at tasks. Research shows that occupational therapies can improve fine motor skills, problem-solving, and attention in children with autism.
Children who struggle with speech often benefit from speech therapy. Speech therapists help children learn new vocabulary and improve their pronunciation. They also teach parents about communication techniques such as nonverbal cues and eye contact. Research suggests that speech therapy can improve social interactions in children with autism by increasing their ability to express themselves and participate in conversations.
High-functioning autism may cause unusual movement patterns and trouble with motor skills. Physical therapists can help these individuals develop muscle strength and coordination. They can also teach caregivers how to safely handle and care for children with ASD.
Studies show that physical therapy intervention for children on the autism spectrum can be beneficial in improving motor skills (balance, coordination, agility, strength) and provide a reduction in repetitive movements.
People with sensory processing disorders experience difficulties interpreting sensations from their environment. For example, symptoms of autism cause hypersensitivity to sounds or touch. Sensory integration therapy teaches children and adults with autism to interpret their senses more accurately.
Sensory training aids in making people on the spectrum feel more comfortable with sensory input.
High-functioning autism can frequently be overlooked, as people with HFA might not seem "autistic". However, it is of paramount importance to pay attention to the symptoms presented in this article and contact a professional if you suspect your child may have HFA.
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