AS vs. HFA?

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It shouldn't, really. But in some cases, it seems to.

The phrase "autism and Asperger's" suggests that they are two different things. They are not. The phrase is close in usage to "cats and Siamese".

However you categorize yourself, whatever you're doing... just stop. Forget HFA/LFA/Aspie/whatever. We're all autistic. We're wildly different and if we're ever going to get anything done we have to understand, accept, and even take advantage of those differences.

People who have just established to themselves that Asperger's isn't a disability for them, often don't want it connected to "LFA"; they don't want to go back to the stereotype of being defective. But they're being too specific. Being "LFA", you'd have the same problem, only expressed in a different way. Whether you're disabled or not, autistic never means "defective". Accepting association with disability when you're not very impaired yourself can be difficult. And it's all too easy to swing to the opposite extreme--all your life, having been told you're stupid, shy, nerdy, lazy, etc., now you want to say, "Hey, I have all these talents, I'm actually more important than the people who've been calling me stupid/nerdy/bratty/lazy"... swinging right past equality, which is the actual truth.

Of course, then there's the people who are disabled, and need help... so you're getting along fine, but suddenly there are people who want to say, "Oh, autism's not a disability!" and you think, "uh-oh, no way, it definitely is," and you have a hard time getting across the idea that acknowledging disability and self-pity aren't synonymous... all the people with milder social impairments are celebrating their talents and their superiority, and nobody seems to take seriously that you're dealing with some problems that you'd like help with, and you can't help wondering how many of those people are even "really autistic" at all... and suddenly you're rejecting the milder end of the spectrum because they "can't possibly understand"... even though they've probably had abuse and miscommunications and maybe even been drugged half to zombiehood, even though both sides of the spectrum suffer from prejudice and involuntary exclusion.

You see the downward spiral? The more exclusive and insistent on their own point of view either side gets, the harder it is for the other side to understand. The urge to categorize things in order to understand them seems to be irresistible, but we've got to try to get rid of it, because when it comes to autistic people, categories just don't work. The more we try to assert that "my way to be autistic is the only possible experience any autistic person could ever have", or, "this is what makes me valuable, so I'm going to categorize all the people with that trait as my favorite kind of autistic person and reject the rest," the more we push each other away, the more we fight, the more energy we expend on each other instead of getting what everybody needs--that is, basic human rights; respect; education; meaningful occupation; and acceptance.

I think that in some ways Callista is right, but we should still try to consider how we classify minds to help our understanding of who and what we are.

Strictly speaking AS is a form of autism, one term for it is "Asperger's autism". I would say that both Kanner's autism and Asperger's autism are forms of autism, in modern times other flavours of autism have been discovered which do not fall simply into Kanner's or Asperger's.

I would say that if one categorizes one's self into LFA, HFA AS, ADHD, XYZ or alphabet soup and then uses your bit of "alphabet soup" to try to make yourself feel better than some other person who has what you view as a worse form then you need to rethink many things. Firstly you might be in the wrong place here, at WP you will need to learn to tolerate people with different minds to your own. WP is a very pro neurodiversity place, so for a person with HFA, ADHD, AS or something else (take your pick) to view some other group with a different clinical group as lesser beings than yourself then you are a neurobigot. You might be a different class of neurobigot than some of the high profile "cure autism now" brigade but you will still be a neurobigot, as this is a family show I will not tell you and the good folk at home what I think of the neurobigots (it is close to unprintable and might make some people choke on their cornflakes).

On the other hand, we have a duty to ourselves to make the best of who and what we are. Those of us who can get off their butts and do something constructive in our lives should go and do something constructive. If we look at Liane Holliday Willey Self-affirmation Pledge which was written for those with AS then the duty and joy of making the best of what we are meets term 8 and may well go a long way to meeting the standards in some of the other points.

One of the things which may well help us make the best of what we are and what we have is a better understanding of who and what we are. Temple Grandin for instance has done some good work on autism as part of her academic work, while several of the wrong planet citizens are active researchers in the area of neuroscience. Like it or not, a part of good science requires good classification of things into different groups to allow progress to be made. I am in favour of making improvements to the classification of non-NT minds as long as it is not used to oppress people. By understanding ourselves better, I think we will understand our needs and abilities better.

Also the LFA / HFA / AS division may be quite poor or inaccurate.

By the way for those who need to look it up Liane Holliday Willey Self-affirmation Pledge is

1. I am not defective. I am different.

2. I will not sacrifice my self-worth for peer acceptance.

3. I am a good and interesting person.

4. I will take pride in myself.

5. I am capable of getting along with society.

6. I will ask for help when I need it.

7. I am a person who is worthy of others' respect and acceptance.

8. I will find a career interest that is well suited to my abilities and interests.

9. I will be patient with those who need time to understand me.

10. I am never going to give up on myself.

11. I will accept myself for who I am.

Of note, when people say that AS and HFA are the same thing, they aren't speaking of severity. Most outcome studies I've seen state that those with HFA are worst off compared to the group with AS, and those with LFA are worse off than those with HFA and AS. It's just that all three groups tend to have a poor outcome. Whilst some say the severity between AS and HFA are the same, there's more that don't (balance of probabilities is in effect here). I have all of the studies on my computer.

Even Attwood, king of "no difference between AS and HFA" will tell you that AS is a milder version of HFA (I have an "official" quote from him), but they are the same thing in regards to what disorder it is. Just as everyone will tell you that HFA is a milder version of LFA.

There's exceptions to this above, but generally speaking, it holds true insofar as outcome studies go.

I wouldn't call people with mild AS/PDD-NOS as "autistic" for the simple reason that they don't meet the definition of the word. Both Kanner and Asperger coined their terms for individuals who're socially cut-off from others and socially withdrawn (just read the papers), and they both got the term from Eugene and his "Autism" in Schizophrenia.

All forms of autism (including Asperger's) have different severity levels in different people.

It may just be that when a doctor sees somebody with more impairment, he's likely to say "HFA" rather than "AS", the HFA>AS thing isn't established by the criteria or by any objective viewpoint, but simply perpetuated by doctors who think HFA is more autistic than AS.

As in,
AS is considered higher functioning than HFA because people diagnosed with AS tend to be higher functioning.
People with AS are diagnosed that way because they are higher functioning than those with HFA.

See the circular? The cycle feeds back into itself, with no independent basis for anything.

(Incidentally, by the official definition, the only thing required to have HFA rather than AS is to have, five rather than three from the list of AS criteria, idiosyncratic language or difficulty sustaining conversations or a lack of pretend play, and qualitative social, language, or play impairment before age 3. That makes AS technically very rare because most people diagnosed with AS can also be diagnosed with autism, and autism takes precedence.)

So you think most people diagnosed with AS really shouldn't have been?

The difference between HFA and AS is suppose to be two things. Language delay occurs in HFA but doesn't in AS. And secondly HFA are said to have zero interest in social interaction with others whereas AS people want to interact with others even if their social skills are terrible.

But what do you call it when you have someone with no language delay but they hate interaction with others? See the spectrum lines are blurry. That's why the DSM does need to be changed to not have so many differential ASD diagnoses.

I think the difference between the diagnostic criteria between AS and Autism is too small. Either they need to change the criteria or merge it with Autism, because as things stand, so many Asperger's cases that also fit into the Autism category that there's no practical use to dividing them at all--it falls almost completely to the decisions of the individual doctors, and that goes against the DSM's main purpose--that is, providing an objective set of criteria for diagnosis.

The DSM-IV-TR is oftentimes applied incorrectly, however. If people were to utilize the expanded text in addition to the criteria (which is how it should be, as the criteria are explained in-depth in the book itself. Each point manifests differently in AS and AD, even though they say the same thing).

When it's applied correctly, AS and AD fall into two nice little groups of around the same prevalence.

PDD-NOS is the problem child of the bunch, as there's no neat little groups like AS and AD.

I honestly don't think the expanded text sheds any more light on the issue, since it's basically a paragraph version of the "outline" we use as diagnostic criteria. There still isn't any real gap, and the diagnostic criteria are still very close together, and while you may draw an arbitrary line, it'll be arbitrary. The problem here is that you can be easily diagnosed with Autistic Disorder even if you have no speech delay or developmental delay, which many people consider to be necessary for a diagnosis of Kanner's. The other problem is, of course, that the criteria were designed for children, not for adults; in adults the presentation is different.

I'm one of those people that can be diagnosed with Autistic Disorder despite the lack of speech delay or cognitive delay, simply because I have numerous strong autistic traits, including some problems with language--idiosyncratic, sometimes repetitive or scripted speech, and difficulty with using speech in a conversation (they tend to turn into lectures). But any professional would say Asperger's, as do I, because I do use language and started doing so on time, and because I'm better at verbal than visual skills. I'm not unusual. The "gap" between Kanner's and Asperger's isn't much of a gap at all, because there are so many people in it--those who used to have speech problems but learned and are now fluent speakers; those who simply have a lot of autistic traits; those who have self-help delays but no cognitive or speech delays; those who are socially aloof but without a language delay...

When you were 3, and if your mother asked how you are, and all you could respond with is good or bad, i.e., single words, and if she asked for you to elucidate, and you couldn't respond as you are unable to, that'd be a failure to sustain a conversation. Most individuals with AS can do this in a normal way at the age of 3, those with Autism can't.

If you couldn't approach someone with a simple mechanical approach, i.e., I'm sick mummy! Then that'd be autism (people with autism will usually scream when they are sick, even if they have some speech). People with AS can do this.

In regards to imaginative play, if all you did at the age of three was line toys up, open and close a car door on a toy car, or only played with an arm of a doll (spinning it around and around without playing with it normally), this is an Autism thing. People with AS don't do this often (but they can).

And of note, most people tend to have nearly all of the symptoms, it's just that they don't show them in a clinical environment, that's why there's a whole heap for the clinician to choose from and one only needs a certain amount to be displayed.

If you're close to the Autism picture above, then that's what you have.

Well, y'see, that's the thing; I'm in the middle. I wouldn't have said "good" or "bad" to my mother, because "how are you feeling" was at that point pretty vague to me; so I would've ignored it altogether. I often ignored things that weren't interesting to me. (My mom wouldn't have been the one asking, though. She's not one for small talk.) I did a lot of repetitive talk, just playing with words, saying them repeatedly. I remember repeating things I'd heard mom say or read from books, because I had the idea that you said certain things in certain situations--more like matching speech to situation than anything else. Eventually it clicked, though, probably around the time I learned to read. See? Speech, appropriate speech, but still highly unusual... where do you put that? (A note: Memories from age three and four are shaky. This is my best guess from fragments of memory and bits of baby book.)

Pretend play? Yes, I was capable of that, and enjoyed it thoroughly. At the time I was three, every single one of my dolls got an appendectomy, repeatedly. However, I also spent hours sorting beans into patterns or drawing "trees" on my chalkboard. ("Tree" for a three year old is a lollipop-like figure... truly representational, no savant realism here.) I also spent time running in circles. Mom says I was trying to burn off energy when I did that.

BTW. You only need one out of those three characteristics to diagnose autism; so if you've got a lack of pretend play, speech can be completely normal. Or you can use grammar perfectly, spend most of your speech lecturing at people, and it'd be correct to say you have no ability to carry on a conversation. Or you could use very unusual language, like functional echolalia, neologisms, or scripted phrases, and even if you communicated just fine still match the speech-delay criterion. I still lecture at people, to this day, and play with words when I'm alone. And scripts get used whenever I'm in a default exchange, such as the "how are you" situation.

Seriously, AS is very close to what Autism is defined as. There's a difference and it might be possible to have AS and not also have autistic disorder, but using the criteria (and their descriptions) strictly, most Aspies fit both lists, at least during childhood, and it isn't very useful to say "Well, AS has to be higher functioning" and tweak the criteria to that end, saying "this needs to be obvious and severe" rather than "this needs to be present and significant". Those lists of traits need to be changed, if you want any sort of distinction between any group of autistics, though you have to be willing to accept that you'll always have some people near the diagnostic borderline.

That sounds like problems with pragmatics, rather than receptive language problems; if you could understand the words individually, but not the sentence and how it applied to you, that's a common AS thing in childhood. Of course, it's best to ask your mother, or someone else, how you were in regards to specific points; as you said, memory for self isn't that good in the childhood years (I can't remember much until I was 5/6, and even then it's only fleeting images of things I liked). Usually, a child with Autism will ignore nearly everything what's said to them (like you said); if you did respond to things at the age of three, that's more AS. Some individuals can start off with Autism, and improve to the level of Asperger's.

Of note, Leo Kanner will tell you that if one thing is there (the autistic aloneness, i.e., the aloof and unresponsive infant), all of the other symptoms are there. And this is accurate. As I said, the diagnostic guidelines are "two of five" because in a clinical setting, one won't display the whole lot. If one lacks speech, they'll also lack imaginative play, for example. If one lacks imaginative play, there's a very good chance that they'll lack speech, or it'll be behind in many ways. He had individuals who owned their own homes, who worked, who drove, but were "autistic" in that they couldn't and didn't want to interact with people in the basic of ways; they had all of the symtptoms, and these people were the highest functioning he had (for good reason).

Also, how you are now is very telling of what disorder you have. So if your parents or guardians can't provide early history, you can look at how you are now and apply yourself to the criteria. If you can't initiate and sustain a conversation as an adult in person, that's pointing towards Autism more than AS. Whilst nearly all individuals with Autism gain adequate speech as an adult, most of them can't apply it to a conversation; which is in stark contrast to the individual with AS who is quite verbose as an adult. If you are socially indifferent to people, i.e., if someone on the street walked up to you and asked for the time, and you ignored them completely, that's autism. If you can speak to someone in person, purely mechanically, and ask for something without too much trouble (i.e., do you happen to have this book in stock?), that's AS.

There's not much difference, no, but severity and manifestation does deviate a little, and it's nice to know which one you have, to be pedantic, that is.

Here's Lorna on such; this is how they're defined as of now:

This one I will catch....about Lorna's writing: Tangential and outdated in that her assessment would never be valid in any science journal. Lorna may have her opinion but, again, that's simply her opinion - that excerpt is not accepted and not peer-reviewed. To clarify: Asperger's Syndrome is a autism. That is, a form of autism. Autism comes in various forms with differing manifestations, yes. But AS is inclusive of Autism - not a separate disorder.

Just exercise caution when reading since science journals need to be accredited, peer-reviewed or it's merely a magazine article of someone's opinon. Whilst Lorna is a good (in her field) and well-respected, her writings don't necessarily reflect what is accepted in the science community. And STOP. I know of Dr. Ritvo (& Ornitz) and his work (I've read his journals) and he's not even remotely considered reputable.

As an example I've read 'science articles' that state that Down's Syndrome is autism - absurd and this isn't even plausible. Junk science.

Hypothetically, we all could read all the articles and online writings but that wouldn't be valid either. In sum, to say AS is NOT autism is at least convoluted. AS can be considered a milder form but it's still autism.

For ex: There are many forms of cancer, all having different manifestations with varying prognoses and treatments. Look at skin melanoma, osteo sarcoma, breast cancer, leukemia, etc. These are all cancer but present quite differently. Still, the common denominator of cancer is proliferating cells gone awry, genetic factors, etc. Disclaimer: This is just an analogy and I'm not implying autism is a disease to be cured - just providing this as a thought model.

That's what I think.

I thought that was a rather autistic trait to have too, to want to know what definition applies exactly.



I agree with that completely.

Though I personally think that many individuals with one label have a problem understanding the finer issues of those with other diagnostic label. Usually for the sole reason that you're in for a lot of confusion if you try to understand what you do not experience yourself.

But there's definitely the group of people who displays traits well into adulthood that are typical for both labels. Guess I'm one of these too.

But nevertheless I'd like to have a neat category to fit into.