DSM: difference between HFA and Asperger's

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People are always asking the difference between Autism and Asperger's. This defines the difference, per the DSM-IV. In bold/underlined are the differing criteria.

Asperger's

Diagnostic criteria for 299.80 Asperger's Disorder
(cautionary statement)
A. Qualitative impairment in social interaction, as manifested by at least two of the following:
(1) marked impairment in the use of multiple nonverbal behaviors such as eye-to-eye gaze, facial expression, body postures, and gestures to regulate social interaction
(2) failure to develop peer relationships appropriate to developmental level
(3) a lack of spontaneous seeking to share enjoyment, interests, or achievements with other people (e.g., by a lack of showing, bringing, or pointing out objects of interest to other people)
(4) lack of social or emotional reciprocity

B. Restricted repetitive and stereotyped patterns of behavior, interests, and activities, as manifested by at least one of the following:
(1) encompassing preoccupation with one or more stereotyped and restricted patterns of interest that is abnormal either in intensity or focus
(2) apparently inflexible adherence to specific, nonfunctional routines or rituals
(3) stereotyped and repetitive motor mannerisms (e.g., hand or finger flapping or twisting, or complex whole-body movements)
(4) persistent preoccupation with parts of objects

C. The disturbance causes clinically significant impairment in social, occupational, or other important areas of functioning.

D. There is no clinically significant general delay in language (e.g., single words used by age 2 years, communicative phrases used by age 3 years).

E. There is no clinically significant delay in cognitive development or in the development of age-appropriate self-help skills, adaptive behavior (other than in social interaction), and curiosity about the environment in childhood.

F. Criteria are not met for another specific Pervasive Developmental Disorder or Schizophrenia.

Autism

A. A total of six (or more) items from (1), (2), and (3), with at least two from (1), and one each from (2) and (3):

(1) qualitative impairment in social interaction, as manifested by at least two of the following:
(a) marked impairment in the use of multiple nonverbal behaviors such as eye-to-eye gaze, facial expression, body postures, and gestures to regulate social interaction
(b) failure to develop peer relationships appropriate to developmental level
(c) a lack of spontaneous seeking to share enjoyment, interests, or achievements with other people (e.g., by a lack of showing, bringing, or pointing out objects of interest)
(d) lack of social or emotional reciprocity

(2) qualitative impairments in communication as manifested by at least one of the following:
(a) delay in, or total lack of, the development of spoken language (not accompanied by an attempt to compensate through alternative modes of communication such as gesture or mime)
(b) in individuals with adequate speech, marked impairment in the ability to initiate or sustain a conversation with others
(c) stereotyped and repetitive use of language or idiosyncratic language
(d) lack of varied, spontaneous make-believe play or social imitative play appropriate to developmental level

(3) restricted repetitive and stereotyped patterns of behavior, interests, and activities, as manifested by at least one of the following:
(a) encompassing preoccupation with one or more stereotyped and restricted patterns of interest that is abnormal either in intensity or focus
(b) apparently inflexible adherence to specific, nonfunctional routines or rituals
(c) stereotyped and repetitive motor mannerisms (e.g., hand or finger flapping or twisting, or complex whole-body movements)
(d) persistent preoccupation with parts of objects

B. Delays or abnormal functioning in at least one of the following areas, with onset prior to age 3 years: (1) social interaction, (2) language as used in social communication, or (3) symbolic or imaginative play.

C. The disturbance is not better accounted for by Rett's Disorder or Childhood Disintegrative Disorder.

Source: online at http://behavenet.com/capsules/disorders/autistic.htm (Autism) and http://behavenet.com/capsules/disorders/asperger.htm (Asperger's).

Last edited by siuan on 01 Dec 2007, 7:51 pm, edited 1 time in total.

I think it would be more correct to say, in the subject heading, that those are the differences, according to the DSM-IV (and the DSM-IV-TR), between AS and (Kanner's) autism. Technically, there is no DSM category called "high-functioning autism."

Right, but my post addresses those who are confused as to what separates the higher-functioning end of the autism diagnosis from Asperger's.

Right, but that description refers to Kanner's autism, not to high-functioning (Kanner's) autism.

Perhaps it might be clearer to simply post a link to this page:

http://autism.about.com/od/whatisautism/f/whatishfa.htm

What you're missing is that if HFA doesn't exist then including it in the title is misleading. Putting Asperger's and autism in a hierarchy (in which Asperger's is at the highest end of functioning) leads to the fallacy that Aspies are inherently less affected by their autistic traits.
What really needs to be sorted out is if one can be considered "just as affected" by Asperger's as "Kanner's" autism. It seems to me that there are plenty of Aspies that are not "at the highest end" of any spectrum. At the same time, I know autistic individuals and autistic-like people who had severe developmental delays who are much less affected.

One of the problems with the Asperger's criteria is that it excludes language delay, which would include receptive language development. Well, most if not all parents of Aspies and Aspies themselves recall having problems understanding sarcasm, certain kinds of jokes, parts of speech (metaphor, similie and subtext) to varying degrees. So, this is a massive conflict or contradiction.

Related to that is that many adults have acquired language and when they are assessed, their current language skills are assessed as normal, so they are dx'ed Asperger's. This makes no sense to me at all, especially if their developmental history is known.

Often times people with HFA are dx as PDD-NOS (Pervasive Developmental Disorder - Not Otherwise Specified) if they do not might the diagnostic criteria for AS or (Kanner's) autism.

Another thing is the DSM is confusign and not as emcompassing as it should be, given what we understand about autism and AS now. Many experts, including people like Tony Attwood, have commented on this. One major problem with the DSM criteria is it's oriented toward chidlhood diagnosis, and is often not appropriate for adulthood diagnosis. Hence why it ought not be used as a definitive description of what AS and HFA are. There are much better, more encompassing descriptions around.

The diagnosis of "High Functioning Autism" may not exist, but being a high functioning autistic certainly does, and HFA is a commonly-used term here. As stated previously, a lot of people have difficulty understanding what specifically differentiates people who are high functioning from people with AS. I think a few nit-pickers find the topic misleading, but that's about it.



They are, compared to people who are seriously disabled (non-verbal, cannot function in society without help, etc.) by their autism. It's not a hierarchy, it's a spectrum. This isn't to say life as an aspie isn't difficult, I can tell you AS an aspie that it is. Quite.



Another topic for another thread.



No, it's not. The DSM-IV criteria specifically states words *used* not words understood, referencing apoken language. We went over this in my college psych classes (was my major). Speaking and comprehending are two vastly different things. My son cannot speak anywhere near what is typical for a 2 year old, but he understands more than most 3 year olds. He has a language delay. On the other hand, my daughter had no language delay, but if you tell her it is raining cats and dogs outside - she would expect to see animals falling from the sky. She would have received a diagnosis of Asperger's, but the amount of sensory issues (and the impairment caused by them) and behaviors were more classic of autism.



That's where you have a gray area in diagnosis, yes.

[quote="AspieMartian"]One major problem with the DSM criteria is it's oriented toward chidlhood diagnosis, and is often not appropriate for adulthood diagnosis. quote]

That I will agree with. But for the sake of taking the diagnostic criteria and finding the difference between autism and AS, language development seems to be the difference. There are definitely better descriptions out there.

Here's some more from the DSM-IV-TR:

Doctors also take this into account, well, that's what mine told me.

Also, to those who think autistic disorder without mental retardation is "mild" (the mythical HFA): 4% of HFA/LFA combined go on to work and live independently; 12% of those with HFA do. In contrast, 40% of those with Asperger's do (it's probably far more than that as many people aren't diagnosed and they function in society without too much trouble).

Interesting. I didn't realize that the percentage was that low.

I think the term "Asperger's" could be dropped and replaced either with "high functioning autism with language delay" and "high functioning autism without language delay." Or if people are offended by the "high functioning" part then it could be "PDD with language delay," and "PDD without language delay." Because there definitely are "HFA" people who had or have a significant language delay (i.e. Einstein as a famous example).

The problem with that approach is that many scientists are moving away from distinguishing between AS and HFA based on language delay. The research in the area is very much in flux.

Just FYI and all, people with Asperger's can have a language delay, it's there in Gilberg's criteria for AS, it's also in Wing's work.

The difference in autism is that it's a verbal impairment (cognitive); a delay in verbal ability. For example, I have a below average verbal IQ, that's cognitive impairment; I couldn't speak due to retardation in that specific area, it transposed over my ability to read and write too (boy, did I have trouble learning to read/write).

Since I'm just a "nit picker", I guess it's all good.

I find you annoying. Refrain from further responses to my posts, and I'll extend the same courtesy when I see yours.