View source for High-functioning autism

{{Short description|Historical autism classification}}
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{{Infobox medical condition (new)
| name = High-functioning autism
| image = 
| caption = 
| synonyms = [[Grunya Sukhareva|Sukhareva]] syndrome<ref>{{cite journal | vauthors = Manouilenko I, Bejerot S | title = Sukhareva – Prior to Asperger and Kanner | journal = Nordic Journal of Psychiatry | volume = 69 | issue = 6 | pages = 479–82 | date = August 2015 | pmid = 25826582 | doi = 10.3109/08039488.2015.1005022 | s2cid = 207473133 | publication-date = 31 March 2015 | type = Report | url = http://urn.kb.se/resolve?urn=urn:nbn:se:oru:diva-47358}}</ref>
| field = [[Psychiatry]]
| symptoms = Trouble with [[Interpersonal relationship|social interaction]], impaired [[communication]], restricted interests, repetitive behavior
| complications = Social isolation, employment problems, family stress, [[bullying]], [[self-harm]]<ref>{{cite web |title=Autism spectrum disorder - Symptoms and causes |url=https://www.mayoclinic.org/diseases-conditions/autism-spectrum-disorder/symptoms-causes/syc-20352928 |website=Mayo Clinic |access-date=13 July 2019 |language=en |archive-url=https://web.archive.org/web/20190714024941/https://www.mayoclinic.org/diseases-conditions/autism-spectrum-disorder/symptoms-causes/syc-20352928 |archive-date=14 July 2019 |url-status=live}}</ref>
| onset = By age two or three<ref>{{cite web |title= NIMH " Autism Spectrum Disorder |url= https://www.nimh.nih.gov/health/topics/autism-spectrum-disorders-asd/index.shtml |website= nimh.nih.gov |access-date= 20 April 2017 |date= October 2016 |archive-url= https://web.archive.org/web/20170421093226/https://www.nimh.nih.gov/health/topics/autism-spectrum-disorders-asd/index.shtml |archive-date= 21 April 2017 |url-status= live}}</ref><ref>{{cite book |author=American Psychiatric Association |title=Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) |chapter=Autism Spectrum Disorder. 299.00 (F84.0) |year=2013 |pages=50–59 |location=Arlington, VA |publisher=American Psychiatric Publishing |isbn=978-0-89042-559-6 |doi=10.1176/appi.books.9780890425596 |hdl=2027.42/138395}}</ref>
| duration = Lifelong
| causes = [[Heritability of autism|Genetic]] and environmental factors
| risks = 
| diagnosis = Based on behavior and developmental history
| differential = [[Asperger syndrome]], [[attention deficit hyperactivity disorder]], [[Tourette syndrome]], [[anxiety]], [[bipolar disorder]], [[obsessive–compulsive disorder]]
| prevention = 
| treatment = [[Behavioral therapy]], [[speech therapy]], [[psychotropic medication]]<ref>{{cite journal | vauthors = Myers SM, Johnson CP | title = Management of children with autism spectrum disorders | journal = Pediatrics | volume = 120 | issue = 5 | pages = 1162–82 | date = November 2007 | pmid = 17967921 | doi = 10.1542/peds.2007-2362 | doi-access = free }}</ref><ref>{{cite journal |last1=Sanchack |first1=KE |last2=Thomas |first2=CA |title=Autism Spectrum Disorder: Primary Care Principles. |journal=American Family Physician |date=15 December 2016 |volume=94 |issue=12 |pages=972–79 |pmid=28075089}}</ref><ref>{{cite journal |last1=Sukhodolsky |first1=DG |last2=Bloch |first2=MH |last3=Panza |first3=KE |last4=Reichow |first4=B |title=Cognitive-behavioral therapy for anxiety in children with high-functioning autism: a meta-analysis. |journal=Pediatrics |date=November 2013 |volume=132 |issue=5 |pages=e1341–50 |doi=10.1542/peds.2013-1193 |pmid=24167175|pmc=3813396}}</ref>
| medication = [[Atypical antipsychotics|Antipsychotics]], [[antidepressants]], [[stimulants]] (associated symptoms)<ref>{{cite journal | vauthors = Ji N, Findling RL | title = An update on pharmacotherapy for autism spectrum disorder in children and adolescents | journal = Current Opinion in Psychiatry | volume = 28 | issue = 2 | pages = 91–101 | date = March 2015 | pmid = 25602248 | doi = 10.1097/YCO.0000000000000132 | s2cid = 206141453}}</ref><ref>{{cite journal | vauthors = Oswald DP, Sonenklar NA | title = Medication use among children with autism spectrum disorders | journal = Journal of Child and Adolescent Psychopharmacology | volume = 17 | issue = 3 | pages = 348–55 | date = June 2007 | pmid = 17630868 | doi = 10.1089/cap.2006.17303}}</ref><ref>{{cite journal |last1=Jaeggi |first1=S. M. |last2=Buschkuehl |first2=M. |last3=Jonides |first3=J. |last4=Perrig |first4=W. J. |title=From the Cover: Improving fluid intelligence with training on working memory |journal=Proceedings of the National Academy of Sciences |volume=105 |issue=19 |pages=6829–33 |year=2008 |doi=10.1073/pnas.0801268105 |pmc=2383929 |pmid=18443283|bibcode=2008PNAS..105.6829J |doi-access=free}}</ref>
| prognosis = 
| frequency = 
| deaths = 
}}
'''High-functioning autism''' ('''HFA''') was historically an [[Autism spectrum|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.<ref>{{cite journal|last1=Sanders|first1=James Ladell|title=Qualitative or Quantitative Differences Between Asperger's Disorder and Autism? Historical Considerations|journal=Journal of Autism and Developmental Disorders|volume=39|issue=11|year=2009|pages=1560–1567|issn=0162-3257|doi=10.1007/s10803-009-0798-0|pmid=19548078|s2cid=26351778}}</ref><ref name="arn">{{cite journal |last1=Carpenter |first1=Laura Arnstein |last2=Soorya |first2=Latha |last3=Halpern |first3=Danielle |title=Asperger's Syndrome and High-Functioning Autism |journal=Pediatric Annals |year=2009 |volume=38 |issue=1 |pages=30–5 |doi=10.3928/00904481-20090101-01|pmid=19213291}}</ref><ref>{{Cite journal|last1=Andari|first1=Elissar|last2=Duhamel|first2=Jean-René|last3=Zalla|first3=Tiziana|last4=Herbrecht|first4=Evelyn|last5=Leboyer|first5=Marion|last6=Sirigu|first6=Angela|date=2 March 2019|title=Promoting social behavior with oxytocin in highfunctioning autism spectrum disorders|url=https://www.pnas.org/content/pnas/107/9/4389.full.pdf|journal=[[PNAS]]|volume=107|issue=9|pages=4389–4394|doi=10.1073/pnas.0910249107|pmid=20160081|pmc=2840168|doi-access=free}}</ref> 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.<ref>{{Cite web |date=August 25, 2024 |title=Making information and the words we use accessible |url=https://www.england.nhs.uk/learning-disabilities/about/get-involved/involving-people/making-information-and-the-words-we-use-accessible/#:~:text=Many%20autistic%20people%20see%20autism,from%20autism%2C%20symptoms%20and%20treat. |access-date=August 25, 2024 |website=NHS England}}</ref><ref>{{Cite book |last=Price |first=Devon |title=Unmasking Autism: Discovering the New Faces of Neurodiversity |date=April 5, 2002 |isbn=9780593235232 |pages=47 |publisher=National Geographic Books |language=English}}</ref><ref>{{Cite journal |last=Alvares |first=Gail A. |date=June 19, 2019 |title=The misnomer of 'high functioning autism': Intelligence is an imprecise predictor of functional abilities at diagnosis |url=https://pubmed.ncbi.nlm.nih.gov/31215791/ |journal=Autism |volume=24 |issue=1 |pages=221–232 |doi=10.1177/1362361319852831 |pmid=31215791 |via=NIH: National Library of Medicine}}</ref><ref>{{Cite web |last=Coffey |first=Laura T. |date=August 13, 2021 |title=Autism glossary: What to say, and what not to say, when talking about autism |url=https://www.today.com/parents/autism-terms-words-can-be-considered-insensitive-why-t227779 |access-date=August 25, 2024 |website=Today (TV show)}}</ref>

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 [[Psychiatry|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.<ref>{{Cite book |title=The Diagnostic and Statistical Manual of Mental Disorders |date=March 18, 2022 |publisher=American Psychiatric Association (APA) |edition=5th edition, text revision (DSM-5-TR)}}</ref>

==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.<ref name="arn" /> The term Asperger syndrome typically excluded a general language delay.<ref>[http://behavenet.com/aspergers-disorder Asperger's Disorder] {{webarchive|url=https://archive.today/20130425044118/http://www.behavenet.com/aspergers-disorder |date=2013-04-25}} – ''[[Diagnostic and Statistical Manual of Mental Disorders]]'' Fourth edition Text Revision (DSM-IV-TR) [[American Psychiatric Association]] (2000)</ref>

Other differences noted in features of high-functioning autism and Asperger syndrome included the following:<ref name="arn" /><ref>{{Cite web|url=https://www.sacramentoasis.com/|archiveurl=https://web.archive.org/web/20070809090928/http://www.sacramentoasis.com/docs/8-22-03/as_%26_hfa.pdf|title=News and general information &#124; Finance, High tech, Health, ...|date=March 14, 2022|archivedate=August 9, 2007}}</ref><ref>{{cite journal |pmid=12199137 |year=2002 |last1=Rinehart |first1=NJ |last2=Bradshaw |first2=JL |last3=Brereton |first3=AV |last4=Tonge |first4=BJ |title=Lateralization in individuals with high-functioning autism and Asperger's disorder: A frontostriatal model |volume=32 |issue=4 |pages=321–331 |journal=Journal of Autism and Developmental Disorders |doi=10.1023/A:1016387020095|s2cid=23067447}}</ref><ref>{{cite journal |doi=10.1007/s10803-006-0251-6 |title=Emotion Perception in Asperger's Syndrome and High-functioning Autism: The Importance of Diagnostic Criteria and Cue Intensity |year=2006 |last1=Mazefsky |first1=Carla A. |last2=Oswald |first2=Donald P. |journal=Journal of Autism and Developmental Disorders |volume=37 |issue=6 |pages=1086–95 |pmid=17180461|s2cid=12094187 |url=https://scholarscompass.vcu.edu/cgi/viewcontent.cgi?article=2448&context=etd|url-access=subscription }}</ref>
* Lower [[verbal reasoning]] ability
* Better [[Visual thinking|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.<ref>{{Cite journal |last=de Giambattista |first=Concetta |date=2019 |title=Subtyping the Autism Spectrum Disorder: Comparison of Children with High Functioning Autism and Asperger Syndrome |journal=[[Journal of Autism and Developmental Disorders]] |volume=49 |issue=1 |pages=138–150 |doi=10.1007/s10803-018-3689-4 |pmc=6331497 |pmid=30043350}}</ref>

===Comorbidities===
{{Main|Conditions comorbid to autism}}
With the notable exception of [[Intellectual disability|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.<ref>{{cite journal |last1=Newschaffer |first1=Craig J. |last2=Croen |first2=Lisa A. |last3=Daniels |first3=Julie |last4=Giarelli |first4=Ellen |last5=Grether |first5=Judith K. |last6=Levy |first6=Susan E. |last7=Mandell |first7=David S. |last8=Miller |first8=Lisa A. |last9=Pinto-Martin |first9=Jennifer |last10=Reaven |first10=Judy |last11=Reynolds |first11=Ann M. |last12=Rice |first12=Catherine E. |last13=Schendel |first13=Diana |last14=Windham |first14=Gayle C. |year=2007 |title=The Epidemiology of Autism Spectrum Disorders* |journal=Annual Review of Public Health |volume=28 |issue=1 |pages=235–258 |doi=10.1146/annurev.publhealth.28.021406.144007 |issn=0163-7525 |pmid=17367287 |doi-access=free}}</ref>) Studies that looked specifically at HFA have examined [[anxiety]],<ref>{{cite journal |last1=Reaven |first1=Judy |year=2011 |title=The treatment of anxiety symptoms in youth with high-functioning autism spectrum disorders: Developmental considerations for parents |journal=Brain Research |volume=1380 |pages=255–63 |doi=10.1016/j.brainres.2010.09.075 |pmid=20875799 |s2cid=5226904}}</ref> [[bipolar disorder]], [[Tourette syndrome]], [[attention deficit hyperactivity disorder]] (ADHD), and [[obsessive–compulsive disorder]] (OCD). Both HFA and OCD have abnormalities associated with [[serotonin]].<ref name="Mazzone">{{cite journal |doi=10.1186/1744-859X-11-16 |title=Psychiatric comorbidities in asperger syndrome and high functioning autism: Diagnostic challenges |year=2012 |last1=Mazzone |first1=Luigi |last2=Ruta |first2=Liliana |last3=Reale |first3=Laura |journal=Annals of General Psychiatry |volume=11 |pages=16 |pmid=22731684 |issue=1 |pmc=3416662 |doi-access=free}}</ref>

===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.<ref name="Mazzone" />  Some case studies have linked the lack of empathy and social naïveté associated with HFA to criminal actions.<ref>{{cite journal |first1=Matthew D. |last1=Lerner |first2=Omar Sultan |last2=Haque |first3=Eli C. |last3=Northrup |first4=Lindsay |last4=Lawer |first5=Harold J. |last5=Bursztajn |title=Emerging Perspectives on Adolescents and Young Adults With High-Functioning Autism Spectrum Disorders, Violence, and Criminal Law |journal=Journal of the American Academy of Psychiatry and the Law |pmid=22635288 |url=http://www.jaapl.org/cgi/pmidlookup?view=long&pmid=22635288 |year=2012 |volume=40 |issue=2 |pages=177–90 |access-date=2013-03-24 |archive-date=2019-12-11 |archive-url=https://web.archive.org/web/20191211055002/http://jaapl.org/content/40/2/177.long |url-status=dead}}</ref>
==See also==
* [[Autism therapies]]
* [[Causes of Autism]]
* [[Conditions comorbid to autism]]
* [[Diagnosis of autism]]

== References ==
{{reflist}}

== Further reading ==
* {{cite book
|title=Look Me in the Eye: My Life with Asperger's
|first=John Elder
|last=Robison
|publisher=[[Three Rivers Press]]
|year=2007
|isbn=978-0-307-39598-6
|url-access=registration
|url=https://archive.org/details/lookmeineyemyl00robi
}}
* {{cite book
|last1                   = McCreary
|first1                  = Michael
|year                    = 2019
|editor-last             = Ayer
|editor-first            = Paula
|title                   = Funny, You Don't Look Autistic: A Comedian's Guide to Life on the Spectrum
|language                = en
|publication-place       = Toronto
|publisher               = Annick Press Ltd.
|publication-date        = 2019
|pages                   = 169
|isbn                    = 978-1-77321-257-9
|lccn                    = 2018303582
}}
{{Pervasive developmental disorders}}
{{Autism resources}}

[[Category:Autism spectrum disorders]]
[[Category:Learning disabilities]]