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MrXxx
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25 Jun 2010, 12:09 pm

Don't worry, I don't think this is exactly the same question that's been posted here a gazillion times already.

I'm NOT actually asking what the differences are. There are already enough of those threads, so please, if you could, stick to the specific question I'm asking here.

I was browsing Tony Atwood's book, The Complete Guide...

and came across his opinion on AS vs. HFA, which, in a nutshell, is that they are essentially the same thing. He said the descriptions are similar enough, and treatments for both are nearly identical, so discussing them as if they were different is, in terms of dealing describing or therapy, is pointless.

He did say though, that in many specific circumstances, the very real difference between the two is in whether or not funding is available. According to him, in many places Asperger's gets no funding, but HFA does, so a lot of clinicians opt to DX HFA instead of Asperger's. As far as he is concerned, the two are interchangeable, so he has no problem with that.

Here's the question I have:

Is anyone here aware of any authors, who are DOCTORS, who disagree with his opinion? Are there any doctor authors who feel that Aspgerger's and HFA are distinctly different?

(I'm not asking for YOUR opinion here. I've already seen there are plenty of those here already. I can search those up easily. I respect everyone's opinions, but that isn't what I'm looking for this time. Thanks! :wink: )


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hutchscott
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25 Jun 2010, 1:19 pm

This is what I did...and what you can do.

Go to the Google home page. In the top left hand corner there is a menu. Click "more". Scroll down and click "Scholar". This is a search engine of dissertations and clinical studies. I entered "as and hfa difference". There were several hits, the first one being a paper written by Simon Baron-Cohen, who is well respected in the autism community.

Hope this helps.



anbuend
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25 Jun 2010, 1:35 pm

I am fairly sure but not certain (because I heard this viewpoint from a colleague of his) that Dr. Laurent Mottron believes the following:

There is no distinction between HFA and LFA. These are just "autism" (characterized by delays in speech, "regression" in speech, and/or certain unusual patterns of speech development.

So the concept of "HFA" is nonsensical since functioning levels are not real. (Although because of research protocol terms like that are sometimes used).

So the concept of "HFA vs AS" is nonsensical also, and the only question is whether autism and AS are different.

And, yes, autism and AS are different. Because of the patterns of strengths on standardized testing (the same reason that HFA and LFA are not different from each other because there is no difference between them in their strengths on standardized testing).

These patterns of strength are not something as simplistic as a verbal/performance split (and in fact in both autism and AS people can have such a split either direction or not at all). It has to do with a complex pattern of subtest scores. The problem with conflating autism and AS is that if you count the two together and analyze scores statistically, the different strengths cancel each other out, and you are left with only the weaknesses. So autism and AS are separate because to call them the same thing makes it impossible to study the separate cognitive strengths of each.

That is my best paraphrase of what I have seen one of his colleagues write. It is not my opinion.


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25 Jun 2010, 2:33 pm

It's all evaluated symptomatically, and completely subjective to the clinician, at best it's Dr A's considered professional opinion vs. Dr B's. Personally I have good days, symptoms barely noticeable and bad days when they are obvious; does that change whether I'm a Aspie or an Autie? Even at that Asperger's is getting folded into the Autism Dx in the next DSM and all that means is the name is being changed.


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25 Jun 2010, 2:39 pm

I think that there are two minor differences. HFA comes with a speech delay, and people with HFA are more likely to have stronger obsessions, that they're not shy about talking about.


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25 Jun 2010, 3:04 pm

My unschooled opinion is that it seems that people with Kanner's Autism have less of a need for social interaction than people with Asperger's.



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25 Jun 2010, 3:45 pm

budgenator wrote:
Even at that Asperger's is getting folded into the Autism Dx in the next DSM and all that means is the name is being changed.



So many refer to that as if it were a done deal and the new DSM was already on its way to the printer's - the DSM-V is already more than five years overdue, because the experts can't agree on whether or what to change about a great many things, not just AS. I'm not holding my breath personally, because those changes may never be made. The opinion anbuend quotes from Dr. Mottron would be a vote decidedly against merging AS and HFA into a 'spectrum', as he doesn't recognize either as Autism to begin with. I would have to assume, from that opinion, that he would recommend coming up with one completely new name for the two, as a single condition separate from Classic Autism.

We'll just have to wait and see. I have a feeling they aren't going to reach a consensus anytime soon. :shrug:



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25 Jun 2010, 5:38 pm

I don't think she's written anything, but I mentioned it to my psychiatrist and she agrees they're pretty much identical, and the important thing is whether your diagnosis gets you the accommodations you need. I've kept the official Asperger's diagnosis despite technically being PDD-NOS (and regular autism in childhood) mostly because it gets the government to let me go to school rather than into training for a menial job. People hold lots of stereotypes about autism; so they say "Asperger's" on my record so people won't assume I'm stupid. I, on the other hand, tend to say "autism" more often than not; that's what it is, Asperger's type or not, and if I can inform a few people that "autism" can mean the eccentric science-obsessed engineering student who can talk the hind leg off a mule, then maybe it'll move them away from the "hopeless, soulless child" stereotype a little.


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26 Jun 2010, 1:41 am

I read somewhere that Simon Baron-Cohen is skeptical to fusing AS and HFA into the same diagnosis, but I can't recall what his POV was, just that he wasn't convinced it's the same thing.

Sula Wolff has compared AS with SPD rather than HFA. I don't know why she didn't think to compare AS and HFA.

That's all I know.


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26 Jun 2010, 1:53 am

Sure, there's plenty of medical opinions, and the biggest one in this context is Hans Asperger, who said "his" disorder was different to Leo Kanner's Infantile Autism (HFA being the main portion of Kanner's first paper, so Hans read up on individuals with the so-called "HFA" too).

Wing put his opinion as (I haven't read his opinion):

Quote:
Asperger acknowledged that there were many similarities between his syndrome and Kanner's early infantile autism. Nevertheless, he considered they were different because he regarded autism as a psychotic process, and his own syndrome as a stable personality trait.


I'd like to read Hans' opinion in full, personally.



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26 Jun 2010, 3:45 am

The opinion I described is not based on subjective impressions on seeing patients, but on cognitive research.

Also it's not that he (as assumed by what a colleague of his said) doesn't regard HFA as autism. It's that he doesn't regard it as a legitimate subcategory of autism. Because people arbitrarily (as there are several arbitrary ways of dividing it, for instance by the criteria of some studies I would be HFA and by others LFA because my IQ is within the zone where when they base it on IQ my most recent one is in between the range of the different cutoff points) put people in one category or the other, and yet people in both categories, no matter which way they divide it, have indistinguishable strengths on the cognitive tests in question.

So it's not that HFA isn't autism, it's that it's a bad way of subcategorizing autism. (Although again he uses the term in research papers presumably because it's a standard way of dividing things.)

Again, repeating the opinion of a researcher on his team, not my own, although I do think it's a good piece of legitimate evidence against the use of functioning levels, among others also cited by researchers I know on different teams.


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26 Jun 2010, 6:40 am

My psychologist told me that the main difference between AS and HFA has to do with whether or not you're eventually able to learn social cues.



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26 Jun 2010, 10:29 am

Willard wrote:
So many refer to that as if it were a done deal and the new DSM was already on its way to the printer's - the DSM-V is already more than five years overdue, because the experts can't agree on whether or what to change about a great many things, not just AS.


Guilty as charged, and point taken. :wink:


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26 Jun 2010, 7:19 pm

Skilpadde wrote:
Sula Wolff has compared AS with SPD rather than HFA. I don't know why she didn't think to compare AS and HFA.


Probably because she was an expert in SPD (or in the childhood version of that), not in Autism/HFA.

However, she made a study comparing SPD (or SPD/AS) with HFA:

http://www3.interscience.wiley.com/jour ... 1&SRETRY=0



MrXxx
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26 Jun 2010, 8:24 pm

hutchscott wrote:
This is what I did...and what you can do.

Go to the Google home page. In the top left hand corner there is a menu. Click "more". Scroll down and click "Scholar". This is a search engine of dissertations and clinical studies. I entered "as and hfa difference". There were several hits, the first one being a paper written by Simon Baron-Cohen, who is well respected in the autism community.

Hope this helps.


Thanks. I've done a LOT of searching in Google Scholar (not specifically on this topic, but may others), and have found there is little in the way of detailed information available there unless either a hefty fee is paid for it, or you belong to a particular institution that has access to the actual study materials. Mostly all one can get there without paid or membership access are abstracts, which don't reveal much. There are some rare exceptions of free material, but they are so far and few between, it requires a tremendous amount of time searching to find them.

The Baron-Cohen abstract isn't actually about differences between AS and HFA. In fact, the study the abstract is for indicates they use AS and HFA subjects in the study interchangeably.

Quote:
...we employed the EQ with n = 90 adults (65 males, 25 females) with Asperger Syndrome (AS) or high-functioning autism (HFA), who are reported clinically to have difficulties in empathy. The adults with AS/HFA scored significantly lower...


The indication is that Baron-Cohen apparently doesn't consider the two to be different as they can be used for the same purpose in a study, regardless of which DX they have.

Below that though, is another paper. "Asperger's Syndrome: Evidence of an Empirical Distinction from High-Functioning Autism"

The abstract of which can be read here.

Which indicates there is a difference, however, as with most of the papers on Google Scholar, only the abstract is available for free. Without the study itself to evaluate, I won't agree or disagree with what is said there.

This is the problem with Google Scholar. If you've got the bucks or the memberships it's great. If not, you either have to simply accept what the abstract says, or find the info published where laymen can get their hands on it.

I have some training in reading studies, and have found numerous times that studies are often not constructed properly, but in ways that produce basically bogus results, or that conclusions are often drawn that are not at all supported by the study evidence.

Lacking the funds to purchase the papers themselves, I prefer to look in laymen's land for now.

So far, it looks as thought the entire subject is up for debate, but that the majority of clinicians don't feel the differences are worth consideration.


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MrXxx
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26 Jun 2010, 8:27 pm

Skilpadde wrote:
I read somewhere that Simon Baron-Cohen is skeptical to fusing AS and HFA into the same diagnosis, but I can't recall what his POV was, just that he wasn't convinced it's the same thing


If this is true (and I'm not saying it isn't - people do change their minds), it seems odd when you consider the study by him mentioned above. ^^


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I'm not likely to be around much longer. As before when I first signed up here years ago, I'm finding that after a long hiatus, and after only a few days back on here, I'm spending way too much time here again already. So I'm requesting my account be locked, banned or whatever. It's just time. Until then, well, I dunno...