The difference between Asperger's and HFA: what is it?

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I read that the main difference between HFA and AS is that there is no speech delay associated with Asperger's (although I have Asperger's and I had delayed speech development so I'm a bit confused there), but is there anything else?

From what I can gather, the differences are only tiny and apparently one of the diagnostic things is thinking of merging HFA and AS anyway, is that true?

IQ. They won't chuck you into the Asperger's box if you test at 70-80 or lower. Also delay in self-help skills.

Problem with the lot of that is that after the speech delay's resolved and self-help skills have been learned, your average HFA looks a lot like a case of Asperger's. They're just about identical. And the IQ criterion can very nearly be ignored anyway; IQ in autistics doesn't say very much about their actual abilities just because those abilities are so varied.

I don't think there is really much difference. It could easily be merged into one diagnostic category. There is so much overlap that half the spectrum, somewhere in the middle, could be diagnosed as one or the other depending on who was doing the diagnosis.

There's one difference that I'm seeing that might or might not be significant; asperger's tends to come with poor visual/spatial skills, and HFA with poor verbal skills. But there are people with verbal>visual, self-help delay, and low IQ, as well as people with visual>verbal, high IQ, and completely independent.

Aspies aren't supposed to have a speech delay or developmental delay except in social skills. They are supposed to have developed normally except in social skills. But doctors don't follow that. When an autie is finally not delayed anymore in development and speech, they are considered aspies.


But there are aspies who don't take care of themselves or are unable to do things because of other conditions such as executive dysfunction (sp) and they need help in life.
I'd say I'm high functioning compare to lot of aspies because I can hold down a job and I live in a regular apartment, it isn't an apartment ran for people with disabilties and they have staff there that helps out, and only help I get is free healthcare and I don't get money from SSI anymore. I have a bf so I don't need much help. Splitting the bills gives me more money so I don't need a honorary citizen bus pass and I'm able to drive and take care of myself and my apartment.

But there are NTs out there who need help in life too because of their low income, and some of them even get help from their parents when things go on in their life. Even NTs need help from their parents to move forward in life. They can't do it all on their own. My first ex was in that position (not an NT) because his parents wouldn't help him but it could be because he was lazy and didn't want to do anything to help himself so helping him would have been useless so they didn't bother.

I've heard it said that the only difference between HFA and AS is the spelling. I think they're getting merged in the DSM-V.

My therapist gave me the impression that he considers AS and HFA to be so similar as to possibly be the same thing. I know that Attwood believes the same way. But still, like has already been posted, the speech delay seems to be an indicator of HFA. So what exactly is the speech delay? Not beginning to speak until later than the one is supposed to? Or, not speaking properly until later? I was listening to some tapes of me when I was around 6 to 9 years old---and I had some issues. In one of the tapes I could barely understand myself. And on another tape when I was a teenager, I was doing my impersonations of famous people---many with foreign accents. The more I research my childhood, the more amazed I am at seeing the Aspie traits I had.

This question do pop up from time to time. I think AS is a subset of HFA...but I don't have a Venn diagram to prove it.

HFA is usually a little more severe than Asperger's, but this isn't always the case (some studies say yes, others say no; as always, it depends on the variables they're testing).

Generally speaking, and when they're both diagnosed "properly" and correctly, there's usually a greater propensity for solitude and aloof behaviour in those with HFA, compared to the typical desire for human interaction that's seen in Asperger's. Also, the repetitive behaviours are more "abnormal" in HFA compared to the cerebral interest of AS. They're not always diagnosed properly, and some people don't fit either of the two (this is where PDD-NOS comes in), so there's a whole heap of muddling of the stereotypical symptoms of each across the two populations.

To use a fictional depiction, Rain Man would have HFA, whereas Mr Bean would have AS. Whilst Mr Bean is quite odd in appearance, he is able to drive, form relations in person (his girlfriend), and live by himself; this is something that most with HFA can't do, whereas many with AS can (a little under half or so).

It may be more "severe" than HFA simply because doctors are more likely to say HFA in a case that they consider more severe. That's totally spurious.

I still think the visual/verbal gap is the best indicator, if any; but if you use it then you also have to throw out the idea that Aspies are any higher functioning than HFA. Probably better just to merge the categories. It's not like you can design a standardized plan for all AS or all HFA, anyway.

I had a verbal delay (didn't speak until two years); my visual-spatial is more than a standard deviation above my verbal IQ; I also self-isolate and have a diagnosis of social anxiety. So for a while I've thought of myself as being closer to HFA than Asperger's. But I don't have a diagnosis for either because as an adult my communication and understanding is pretty fluid - theory of mind and all that stuff.

Like you, Callista, I've come to think of the spectrum as separated by more right-brain (visual/spatial) HFA, and left-brain (verbal) Asperger's, with "low" to "high" abilities along a continuum and combinations of the two. Because there are so many permutations of possible weaknesses in areas of the brain, it seems to be next to impossible to separate diagnoses with tidy behavioral check lists. If, in the next revision of the DSM, they are going to discard the term Asperger's, it might be a good thing. They could say "Autism Spectrum with verbal strengths" or "Autism Spectrum with visual/spatial strengths", which would be more positive (and accurate) than low-functioning or high-functioning, or the dreaded Ass-burger's.

Z

I too had a verbal delay, I didn't speak until I was about 4. I was tested to have a 60 IQ when I was 6 years old, and I had the poor social skills and obsessions. But since I am able to interact to a degree with other people, (though not perfectly, mind you ) and I can speak quite well now and have a much better IQ, I am diagnosed with Asperger's.

It scares me sometimes to hear stories like that, when people say "I was tested as a kid and my IQ was 60", or 44 or 70 or whatever... and then as an adult it's up to average or maybe even higher... the scary part is not the IQ increase, obviously; but how important people seem to think IQ is, how much they think it foretells what you can do.

How many kids are being written off because their IQs tested out low when they were young, before they had a chance to grow into their autistic brains? How many parents are convinced that their kids "can't do" a huge long list of things, and aren't giving their kids the kind of chances that'll let them learn?

I wonder how many kids with autism and "mental retardation" are being put in ABA for hours and hours because that's "the only way they can learn", and being forced to pass up the chance to learn to communicate and the time to play and the means to develop their talents...

One the the best descriptions I have seen, but views seem to change like the weather in regards to the diagnostic criteria!

High functioning versus low functioning autism
- it's more complex than you think - Donna Williams
High versus Low Functioning depends on the nature of the ‘autism fruit salad‘ underpinning the diagnosis with autism.

These ‘autism fruit salads’ can be standard or exotic, simple or complex, small or large quantities or pieces, separated contents or very mixed up.

High Functioning Autism

Asperger’s is usually when someone has Emotional-Social Agnosia and so cannot process facial expression, body language or intonation.

This restricts their involvement in the social-emotional realms of life so they compensate via intellectual interests, pursuits and abilities.

If they also have Simultagnosia they will struggle to hold a simultaneous sense of self and other and be rather mono-track, struggling to multi-task. If they also have some auditory agnosia, they’ll find that fans and external noises interfere with their ability to understand verbal information. If they have Dyspraxia or Dysgraphia, they’ll be clumsy, have motor planning problems and poor handwriting. Some will have face blindness, making it difficult to make or keep friendships. Being more stressed than those without information processing challenges, they will be more prone to sensory hypersensitivities than other people.

If they ALSO had oral dyspraxia, Selective Mutism or learned dependancy leading to late speech (ie not speaking by age 4) then they would speak later than those diagnosed with Asperger’s and some may be diagnosed as HFA even if a percentage of non-autistic children also won’t speak until age 3-4. Although if verbal language is clearly normal at the time of diagnosis and shows no signs of significant ongoing language processing disorder at the time of diagnosis, early history of late speech by age 3-4 would likely not change the diagnosis from Asperger’s to HFA. The more present signs of significant ongoing language processing disorder at time of diagnosis, the more likely the diagnosis will be Autism rather than Asperger’s Syndrome. Whether this is High Functioning Autism (HFA), Low Functioning Autism (LFA) or in the Moderate range midway between the two, will depend on the range and degree of functioning challenges at the time of diagnosis. Some people in the LFA group move into the moderate range and may have some skills in the HFA range. there have been reported cases of some in the HFA and even Asperger’s range who have later ended up functioning in the moderate or LFA range due to breakdown, substance abuse, acquired brain injury, neuroleptic abuse, brain infection, or severe CFS.

So what is so called Low Functioning Autism?

The levels of motor planning problems with Dyspraxia could be so disabling as to be on a par with mild-moderate Cerebral Palsy.

They may have all the same agnosias but additional Semantic Agnosia, Form Agnosia, Associative Agnosia, Face Blindness, all of which may make them significantly meaning blind and struggle to learn visually as well as alienated from faces and finding people interchangeable if not for smell, tone and movement and this will make these people LOOK more autistic, be more likely to remain uneducated because pictorial learning won’t be accessible for them and without the capacity to externalise thought through the use of gesture, typing, or representational objects, they may not even know of their own intelligence, let alone others knowing of it. If they have Apperceptive Agnosia, they will also struggle to draw which may lead others to imagine them as ret*d even if they can produce beautiful abstract works.

If they also have not only auditory agnosia effecting the perceiving of non-word from word sounds, but also Auditory Verbal Agnosia and Visual Verbal Agnosia, they will also be meaning deaf to what they hear as well as meaning deaf to what they read - yet often still able to ’scan read’. This will commonly lead to either no speech or ‘dysfunctional speech’ (ie Semantic Pragmatic Disorder) and avoidance of reading, or fluent reading without comprehension. Both of which can lead others to presume mental retardation, emotional disturbance etc. It may also lead them to be presumed incapable of typing, even though expressive channels may actually still be relatively intact. If the person also has Alexia, they may be unable to perceive the written word as made up of letters and if this is combined with other significant visual and verbal agnosias they may struggle to demonstrate their intelligence through typing.

If the same person also had significant gut, immune, metabolic disorders which lead to ongoing brain toxicity, fatigue or being brain starved, this would reduce that person’s functioning level until these are addressed. The style with which meaning deaf-meaning blind people with autism learn will be more likely to be kinesthetic, musical or logical rather than visual-verbal, meaning they are less likely to be accomodated in mainstream educational settings. If they are also solitary and not social learners, the degree of their challenges will increase this and solitary learners are already poorly accomodated in most educational programs.

Similarly if the same person had significant untreated co-morbid mood, anxiety and compulsive disorders dramatically channeling their resources into exhausting self management at best, chaos at worst, this would greatly reduce functioning until treated.

If the same person also had severe Dystonia they would be very floppy in their body, easily fatigued and if combined with Tactile Agnosia, Finger Agnosia or Pain Agnosia, they may appear to have little sense of their body, little identification with it and a poor relationship between volition and action through the body. Combined with severe Dyspraxia and Simultagnosia, they may also be unable to experience body messages relating to toileting or switch perceptual channels when involved in another task in order to attend to toiletting. Where this is taken as reflection on their intellect this will usually lead people to presumption one is low functioning if not mentally ret*d.

Chronic stress, emotional dysregulation and burden on information processing will put up the tempo of not just sensory hypersensitivities but also any natural personality trait. Those with extremely large, complex ‘autism fruit salads’ will be more likely to display a range of personality disorders as their natural personality traits display in the disorder proportions for each trait. As these then become labeled ‘the autism’ it can escalate the same issues if the person feels their personhood is being devalued.

Because those with more severe challenges struggle to manage on many more simpler levels, opportunities for the environment to take over, outshine, pursue relentlessly, fixate on the person as a case or pathology or build pathological levels of co-dependency, this can dramatically increase learned dependency in those with some personality traits, withdrawal in others. Self injury can escalate where this contributes to Dependant Personality Disorder where it is used to force the environment to take over, self injury due to extreme sense of helplessness where the environment constantly outshines the individual by taking over, or self injury where a solitary personality feels constantly pursued and finds self injury causes the environment to back off. All of these responses can be considered part of being ‘low functioning’.

Essentially, those in the low functioning group may be as intelligent as those in the high functioning group but are more likely to perform badly on the same IQ tests and may have great potential in fields far different to those people in the high functioning group may excel in but be socially more unlikely to get those opportunities or make the social contacts which would lead to those.

For more information please see The Jumbled Jigsaw by Donna Williams.
Donna Williams - utistic author and autism consultant:http://www.donnawilliams.net

Funnily enough, the two separate cognitive patterns of Autism and Asperger's are actually in the DSM. Under Autistic Disorder, it says that those with such usually have a higher performance IQ than their verbal one, no matter what their overall IQ is (from profound mental retardation to above-average), and that those with Asperger's tend to have higher verbal scores than their performance ones.

If one wishes to separate it by cognitive patterns, you'd have:

NLD and AS on one side of the brain, and
SPD and HFA/LFA on the other side of the brain

Some clinicians do do this above.

A problem arrises when PDD-NOS is included, which is the most fragmented group of individuals in regards to symptoms and severity, and since it makes up the other half of the spectrum.... The distinction between AS and HFA kinda seems trivial compared to PDD-NOS and its place compared to AS and HFA [and LFA].

The way I see it is that all neurological conditions should be under one big autism umbrella, we are all just differently able and does it matter if we have a higher IQ or not and if so why don't they have categories for NTs like low and high functioning

Well, labelling someone with LFA does help them in receiving aid in relation to education. Of course, it's best to assess each individual's strengths and weaknesses, and work from there, but a simple catch all phrase can cut down on a lot of the work after these assessments are done.

Most likely, people with LFA will need more special education than those with HFA/AS when the populations are looked at as separate groups.

(I'm not a fan of any form of social education for asocial people, but that's beside the point.)

I think every child should have an overall assessment for neurological differences and as has been said up to 40% of all children have to some degree, and then work with there strengths and weaknesses, the word low functioning sounds sub human to me and do not know anyone who likes to use the word, I also feel the word special education has out lived its day, the stigma with being within the special needs system is huge. I feel everyone with neurological differences should just be classed as differently able and get support where needed. Even HF children need support, but bstill not recognized enough... as for calling children gifted please, its like saying your child is better than the next, to me all children are a gift and all have a place, but many especially from poorer family just get lost in the system, its like throwing the injured to the wolf pack at times, why it continues in this day and age amazes me, is about time everyone got behind the next generation of children, communities as every child has a right to an education, does not happen and some barely survive school. It amazes me that many of the so do good groups often only support nice family too many rules, and those in real need so often no one seems to have the time for. Of course there are some great programs and inspirational people who really do help, but not enough. Still I guess the existing school system does not suit many children and for real change the whole system needs to be looked at!