Asperger's syndrome vs. High-functioning autism

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VisInsita
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19 Mar 2012, 2:08 pm

Verdandi wrote:
Also, you can be diagnosed with autism based on the lack of imaginative play criteria, and not even have affected speech at all. People seem to confuse "AS requires that you rule out speech delays" with "Since AS rules out speech delays, then autism must automatically require them." The truth is that the items that are used to rule out an AS diagnosis are not mandatory for an autism diagnosis.


Is it really so (referring to you first sentence)? If the only clear impairment regarding communication would be a lack of imaginative play, would you get a diagnosis of autism? I think it isn’t simple as that. Yes, the diagnostic manual says so, but I think in practice that probably doesn’t happen (at least very often). I think giving an autism diagnosis still would in practice require something else – like a clear impairment in social interaction.



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19 Mar 2012, 2:21 pm

The impairment in HFA is often quite mild, sometimes they are able to cope with life than somebody who has been dx'ed with Asperger's.
As far as I am concerned, they are either the same condition, or maybe autism effecting slightly different areas of the brain. Not all docs agree with the speech impairmen before 3 as the defining factor..
Under that system, I have HFA rather than Asperger's. However, I mainly show Asperger traits now. I had speech, but lost it for awhile at 18 months. I regained it around three (about the time I can remember things for the first time. Nothing before..). I do have one other trait of HFA according to one author, I have always accepted frienships if the other person approached me (or if someone introduced me in the case of all my female friendships..)first. I never set out to make a friend on my own.

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19 Mar 2012, 5:09 pm

It might be possible to have both because I have been diagnosed with both. That is if they are not one and the same thing mind you. Half the time i can get along fine with large crowds and such other times I cannot it is weird. Originally at first the diagnostics were HFA as a child due to not being able to talk until I was 4 years old. I was somewhat able to talk at 3 but only by mimicing what other people said to me. If my mom asked me if I wanted a cookie I would ask her if she wanted a cookie. I was able to sing before I could talk as well very odd indeed.


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chtucker18
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19 Mar 2012, 5:54 pm

I have HFA and i have speaking problems so i think my diagnosis was right.



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19 Mar 2012, 5:55 pm

chtucker18 wrote:
I have HFA and i have speaking problems so i think my diagnosis was right.


Speaking problems/language delay is the only seperation. And a lot of doctors don't even care about that. As in there is no difference.


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19 Mar 2012, 6:48 pm

Verdandi wrote:
Aimless wrote:
They say the difference is whether there is a speech delay or not and once you start talking the differences are negligible. They say the difference between an autistic who craves social interaction but cannot manage it and one who feels no or little need for it are merely personality differences. I disagree but that's just my opinion.


I started speaking early and I feel no or little need for social interaction. It seems to me I have "HFA" and AS traits...


I keep noticing when people list "'HFA' traits" or "AS traits", that I tend to not fall in either category with whatever they've listed.

The aloof/passive/active but odd/formal and rigid split makes more sense than anything else I've seen, but I don't agree with that being a strict ordering of severity. I personally am primarily passive with formal and rigid traits, but not active but odd.



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19 Mar 2012, 8:00 pm

The way that I think of it is that there is a spectrum of development of communication skills, verbal and non-verbal, in early childhood. Some autistic children develop these basic communication skills like responding to your name or being able to tell others of your needs (hungry, thirsty, bathroom, hurt, sick, etc) or being able to talk about your favorite topic earlier than others do, starting within the same age range as NT children, but not developing the typical pattern of communication and socialization. These children would be diagnosed with AS, while children who started developing these skills with a significant delay compared to NT children would be diagnosed with HFA. But I don't think that there is a fundamental difference between AS and HFA.

An HFA child who has low communication skills can appear socially aloof, e.g. not being able to respond to name, while an AS child with more advanced communication skills can appear active but odd, e.g. talking about favorite topic to anyone and on and on and on.

IMO, children who fit the criteria for AD should be diagnosed with AD, not AS.



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19 Mar 2012, 8:41 pm

VisInsita wrote:
Verdandi wrote:
Also, you can be diagnosed with autism based on the lack of imaginative play criteria, and not even have affected speech at all. People seem to confuse "AS requires that you rule out speech delays" with "Since AS rules out speech delays, then autism must automatically require them." The truth is that the items that are used to rule out an AS diagnosis are not mandatory for an autism diagnosis.


Is it really so (referring to you first sentence)? If the only clear impairment regarding communication would be a lack of imaginative play, would you get a diagnosis of autism? I think it isn’t simple as that. Yes, the diagnostic manual says so, but I think in practice that probably doesn’t happen (at least very often). I think giving an autism diagnosis still would in practice require something else – like a clear impairment in social interaction.


Impairments in social interaction are separate from speech delays, however. I have impairments in social interaction but do not have identified speech delays (I have problems with speech, but because in certain situations I have been able to speak well, the problems were ignored or dismissed).

Moopants described being diagnosed in the way you said doesn't happen in practice:

Moopants wrote:
I have a dx of childhood autism not Aspergers but I had no speech delay. In fact I was very early with language using sentences by 10 months. However I had problems with other early childhood development stages namely relating to imaginative play. I questioned why it wasn't AS and was told some major developments were missed out completely. I always assumed late speech had to be the main difference. I had three professional people involved in the diagnostic process so it's not just one person's idea. They used ICD10


Moopants actually describes a history similar to mine (at least in broad strokes - I spoke in full sentences at 10 months as well, and my "imaginative play" was pretty atypical and I would say delayed).

Tuttle wrote:
I keep noticing when people list "'HFA' traits" or "AS traits", that I tend to not fall in either category with whatever they've listed.

The aloof/passive/active but odd/formal and rigid split makes more sense than anything else I've seen, but I don't agree with that being a strict ordering of severity. I personally am primarily passive with formal and rigid traits, but not active but odd.


It happens to me all the time around here. I never fit neatly into one category or the other - when people offer up lists of traits that are for sure "this is HFA and that is AS" I have traits from both.

I'm mostly passive as well, but I have tendencies toward active but odd and formal and rigid. Most of the time, people don't exist to me unless they approach me. More rarely, sometimes I approach them if I have a reason to do so, but even getting from "maybe I should do that" to doing it takes time.



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19 Mar 2012, 8:48 pm

I have moderate autism. I have high fucntioning autism also becase my IQ is with in noraml leavels. high functiongin autism just means clasic autism with a IQ with in normal leavels. high functiong autism inlcudes peopel with a IQ with in normal ranges all over the difernt types of autism. it means peopel with asperger with a Iq with in normal ranges and also clasic autism people with a IQ with in normal leavels. I have been wondering a lot about hich functionign autism. My mum says its just a way of tellign a person that this person may have autism but they are still smart.



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19 Mar 2012, 8:50 pm

The more people on the spectrum I encounter, the more convinced I am that they're interchangeable. The fact that nobody can seem to agree on a distinction just reinforces that.



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19 Mar 2012, 8:54 pm

Sometimes the difference is just a difference in diagnosis patterns among different areas.


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20 Mar 2012, 4:39 am

btbnnyr wrote:
An HFA child who has low communication skills can appear socially aloof, e.g. not being able to respond to name, while an AS child with more advanced communication skills can appear active but odd, e.g. talking about favorite topic to anyone and on and on and on.

I'm somewhere in between, and it seems most ASD people are.

As usual, your description makes sense to me quite well (the whole post).



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20 Mar 2012, 4:50 am

VisInsita wrote:
In my opinion the main difference between HFA and Asperger’s is the onset of language and your early years. If you got your diagnosis of Asperger’s as a child, it was probably at then already obvious that you have a higher functioning form of autism – that’s why you got the AS diagnosis. It was already certain that you will not end up nonverbal or severely affected by your autism. You were talking and acting somewhat “normal”.

On the other hand autism diagnosis was given to you (and you were maybe then later on referred as high functioning) probably because at the point of diagnosing you, they couldn’t predict the outcome. If you were still after three years of age nonverbal and aloof, it could be very well that in your twenties you will still be nonverbal and aloof or it could be very well that you will learn to speak and develop later on more typically. Therefore you have a diagnosis of autism.

I also think this is the reason why some sort of a distinction between these two situations may persist to exist. You can’t predict the outcome. Sometimes a nonverbal person might even in late adulthood reach communication and that again might open up new doors to development. That just shows how no label can ever measure the power and possibilities that a one unique person might hold. And because of the advancement in rehabilitation, support, acceptance and so on, more and more kids from pretty affected grounds grow to become very functioning adults – despite the fact they were righteously given an autism diagnosis in their early childhood.

This is also a good description. It points out that development in early years is crucial, and language delay is only a part of it, and that the predictable outcome (the prognosis), although can be very vague and proved otherwise at times, is the main difference between the two.



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20 Mar 2012, 5:22 am

btbnnyr wrote:
An HFA child who has low communication skills can appear socially aloof, e.g. not being able to respond to name, while an AS child with more advanced communication skills can appear active but odd, e.g. talking about favorite topic to anyone and on and on and on.

IIRC these are actual phrases used by a clinician (well ours) to categorise Autism "sub-types" in children.
"Aloof" is more affected and indicates the child who appears oblivious to the world and people.
"Active but Odd" is essentially used for the child with Aspergers.
"Passive" is in between, our son was categorised this way.



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20 Mar 2012, 4:17 pm

I think that one aspect of the communication abilities spectrum is the instinct for communication, or lack thereof. I am mostly passive now, after being aloof for most of my childhood, and part of my former aloofness was the lack of an instinct for communication, even in response to direct overtures of others. Since I had no natural instinct for communication, the idea of communicating through speech or gesture occurred to me very infrequently, and when someone asked me a direct question like "do you want pancakes", there was no answering through verbal or non-verbal means, because there was no they ask you answer communication instinct in my brain to drive the communication behavior. When someone called my name, and I didn't appear to notice that I had heard anything, it was because I didn't recognize the sound of my name as something that I was supposed to respond to, no they call you respond communication instinct. Same with gestures that people made at me. So what if they point at something for me to look at? I saw the physical movements of their arm, hand, and finger, and I looked at and followed these physical movements to the tip of their finger and not beyond, so I didn't look at the thing that they pointed at. In this context, it is hard for me to figure out whether I had the abilities that were not displayed due to lack of instinct or lack of instinct plus lack of abilities, but I do think that lack of instinct played a huge role in non-communication and aloofness. I started learning communication in the 8-10 year old range, but I am sure that I could have learned it earlier and spoken on my own and used gestures earlier, if I had been eggsplicitly taught what communication was through a combination of pictures and words, and if I had a prompting system, like a sign that someone held up to remind me that this is a time to communicate at the same time that they asked me a question or called me by name. The way that I learned communication was through learning a foreign language from children's books where you read the words out loud, and there is a picture to go along with each sentence, and you do repetitive drills from these books until you can speak the foreign language on your own. Also, it helped that a lot of the subject matter in these books and drills was communication itself, like people asking questions and other people answering questions or people greeting each other in foreign language. For some autistic children, receptive language and reading are less severely affected than eggspressive language, e.g. autistic child being able to read before speak, so teaching a child with low communication skills a first language like you would teach a normal child a foreign language might be effective for earlier development of communication skills. I don't know how my development would have gone if I had not learned a foreign language starting around age eight. I feel like this was eggstremely important in my development.



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20 Mar 2012, 5:21 pm

The guy who diagnosed me said that there has been discussion of merging the diagnosis for High Functioning Autism with Asperger's

He said there wasn't enough differentiation between the two, and then said it usually revolved around language development in early childhood - like others in this thread have mentioned

He said that people who had more difficulty with social functioning often got tossed in the HFA pile quicker than someone who functions reasonably well socially


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