I am still confused about the difference between HFA and AS

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I am living in the UK and when I was diagnosed the doctor said that I have Aspergers. However, she said that my diagnosis was down as HFA. Is this just because of formalities and changes in the diagnosis system? I get the feeling that things have changed recently, is tis true? What is the difference? I didn't have late language development, I think, and I have an above average intelligence apparently so I am a bit confused.

Is this to do with Aspergers no longer being an official diagnosis(?)?

Thanks, Sam.

Probably, but your residence in the United Kingdom makes that conclusion a little strange. It is only the Diagnostic and Statistical Manual of Mental Disorders DSM-5 diagnostic criteria that has combined Asperger's Syndrome with Autism Spectrum Disorders including high-functioning autism. The DSM is published by the American Psychiatric Association which is based in the United States. If one or more of the various U.K. psychiatric or psychological groups has mimicked the APA adoption of new diagnostic criteria, I am unaware of it. The World Health Organization International Classification of Diseases (ICD) still shows AS as different than ASD, and its leaders are arguing against the APA criteria.

In the end, AS and HFA seem pretty much interchangeable to me. But, billing codes in the United Kingdom might require one over the other. It might be something as simple as that.

this is a far older topic than DSM-5 and the mysterious disappearance of the aspie

PDD-NOS, Asperger's Syndrome, Kanner Autism, and whatever variant there may or may not be, all are now classified as "a disorder in the autism-spectrum".
In practice, I bet most diagnostics will be performed in the old DSM-4 terminology.

The difference between Asperger's and HFA... well, there is so much near-miss-diagnosis that most have given up distinguishing between the two. There is many a post at this site about the subject, and somehow... well... I always was happy to finally know why and what, and I felt it politically correct to identify with the more severely affected, so in that sense I have never really felt a difference between the types... but many postings here still do present some difference...

Clinicians have given up, as also at a certain time in life many skills are acquired, including the ones that would make HFAs more aspielike.

Technically. by the way, there is no difference, even if some clinicians would possibly search for slightly different clues... but,
IF one has over say 75 IQ (and there always will be doubt as to whether Kim Peek (the real life savant who modeled for the film Rainman) was truly an aspie) - so if your IQ is over that, which it is on the basis of your writing, and if you have autism - you have asperger's.

Below that, you would presumably automatically be considered for Kanner-autism, but that is difficult, as it is very hard to measure IQ for those not verbally inclined... and it would not necessarily be the autism that is the real problem in practical terms, but mental retardation.

One apparent exception is no exception, especially in terms of DSM-5. All these disorders that are autism, are also called "developmental disorder"but that is just another word for the same thing - largely a matter of culture. So, they are all PDDs, one called Asperger's (or HFA), the other called Kanner's Autism, and indeed the third... PDD-NOS (not otherwise specified, so thats an umbrella term for anything else). Diagnostically, it is (or was) much harder to reach an asperger diagnosis, as it requires more "symptoms" in the three areas concerned. My second opinion decided on PDD only because I do not seem to have sufficient ritualistic behaviour. I still beg to differ, but granted, you need to be a pretty keen observer to even consider autism at all. See some of the things I see and listen to my reinterpretations of so many preconceptions in autism... And does anyone ever really wonder why we have rituals and so-called obsessions, and what stimming is??? Autism is full of so many misconceptions and misunderstandings - I really wish the professionals actually started reading their own material... I did.

O, I forgot, you mention in your post "no late language development" - therein I think lies the difference - that would make you more aspie than HFA...

Good luck to you, and enjoy WrongPlanet - it's how I found out... i know the very instant after I clicked that interesting link - aspies are generally deemed to have a poor sense of humour, especially of the ironic variety? Well, it was the very special and yes implied tragical sense of humour you see in the avatars, the names, and the signatures...
O yes, that was it, no doubt...

high functioning autism was never a diagnosis in the UK or US, it means someone with autism who has an IQ over 70,they only use the term as a informal label and will have meant aspergers not classic autism [AKA autistic disorder] otherwise they woud have said it.
those of us who have an IQ under 70 and have also had a functioning assessment on top of an IQ test [eg,WAIS] shows we are intelectualy disabled and we are classed as low functioning autistics,a lot of WPers are confused as to the correct meaning of LFA and HFA when it is just intelectual disability [or not] that sets them apart because ID [or lack of it] gives a very different presentation of autism.

just because someone can post well on a forum doesnt mean theyre over a specific IQ,am diagnosed with mild intelectual disability and can post quite well,its a widely used myth of ID that we cannot put messages together.

also,testing whether those of us with classic autism have intelectual disability or not isnt as difficult as it sounds, it isnt simply a test of IQ we also have to have what is called a functional assessment as well.

No one could agree on the difference, and DSM-IV Asperger Syndrome did not actually exist (anyone who met criteria for it also met criteria for autism, and autism was supposed to take precedence as a diagnosis). So in DSM-V they scrapped Asperger Syndrome and had it just be considered high functioning autism.

Some of the definitions I've heard:
* HFA has language delay but catches up by 6-7 years old, AS no language delay (if they didn't catch up, they'd be LFA)
* HFA are aloof and withdrawn, AS actively seek interaction but are socially awkward
* HFA are well-coordinated, AS are clumsy
* HFA are visual learners, AS have NVLD (verbal better than visual)
* probably others I'm forgetting

The problem is that many people are classified differently by different definitions, so depending on which definition the person they were talking to happened to be using, they'd get classified differently by different people. Which led to a lot of confusion.

I have not seen any evidence the confusion is any less with the DSM 5. In the DSM IV era Aspergers was always considered part of the Autism Spectrum with the exception of a few shiny aspies who were ashamed to be associated with autism. The actual diagnosis goes on the diagnostic report but nobody describes themselves or others as Autism Spectrum Disorder Level 1. The clinicians and us still use the colloquial terms. What I have seen happen since the DSM 5 was proposed and implemented is the whole idea of overdiagnises (be it wannabees, fakers, or excuse maker) has gotten a lot more support with the validation from the American Psychiatric Association and the term aspie itself has a much more negative connotation.

As for the autistic people who don't want to be associated with autistics they still call themselves aspies or emphasize they are on "the spectrum"

The OP should ask for, if they haven't already received, a written copy of their assessment and diagnosis. That should clearly state which diagnostic criteria were used, and indicate how they were deemed to have met those criteria.

Or, make an appointment with the doctor to discuss the diagnosis and find out what she meant when she mentioned HFA, which as KOR has pointed out, isn't a formal diagnosis anyway.

HFA is not a diagnosis as such. It is used to describe people who had classic autism, but have grown up to have more AS type traits. They did have significant language delays, but now do not. But since it is not a diagnosis, then one cannot come up with real differences.

Tony Attwood has found that those with HFA, ie those diagnosed as children who were classically autistic but no longer are, are significantly more likely to be completely asexual, than those with Asperger's who do seek intimate relationships, even if they do not do well at them.

Autism is a spectrum and people vary in where they fall on the spectrum. While it is true that generally intelligence is connected to Autism, it is not always the case. There are people with quite severe Autism who have really high IQ's. There are also people with quite significant intellectual disabilties with very mild Asperger's type symtpoms. One cannot link Autism to IQ, directly, while there are generalisations one can make, they are not guaranteed.

Those with classic Autism are very aloof and choose to be totally alone. Those with Aspergers want to be with people and often have some friends. Those that fall in between sort of want company from people, but do not care for relationships as such. They are like toddlers playing next to each other, but not together. Those inbetween also have more deficits in communication, more imagination problems, etc.

This is a stereotype and not true. People all over the spectrum vary in how social they are -- it's not dependent on diagnosis.

I haven't read forward into the thread so I apologise if this has been answered for you. In regards to myself I had a similar scenario during my own diagnosis (I am in the UK BTW). I was diagnosed under ICD-10 F84.5 as having Aspergers Syndrome - HFA isn't recognised under ICD-10. However I am very high functioning and I had a very stark language delay when I was young, I have a very high performance IQ, I learn better visually and I have multiple specialised interests. My psychiatrist said I fit HFA more than AS, but I had enough traits for AS to justify that diagnosis regardless of the restrictions within ICD-10.

Only the USA uses DSM-V and it seems to be a vehicle for selling drugs more than anything else (IMHO). Regardless, I am on the fence in regards to the Aspergers/ASD thing. Still not convinced either way.

Hope this helps.

Last edited by Moridin8 on 26 Jun 2014, 11:49 am, edited 1 time in total.

The HFA vs Aspie is/was used in public schools for obtaining services. I live in the States.

HFA kids could receive OT/PT/Speech and life skills classes. Plus an aide if needed.

Aspies weren't entitled to s**t, and parents had to fight tooth and nail to get anything.

The ONLY difference is speech delay. My husband would qualify as HFA but his mother said he had no speech delay (though this is debatable in the family). His testing scores were rubbish.

That is how it worked here.

My own experience in Canada is that HFA = Aspie.

I think this thread confirms my belief that ASD can mean anything you want it to mean.

If you believe that you are ASD, then you need go no further - nobody can prove you wrong, and nobody can prove you right.

A professional diagnosis is no more than a matter of opinion, and there are many professional opinions to choose from.

In research, AS is included within HFA.
HFA is the category that includes people with autism who have IQ > 70 or 80.
AS is an afterthought that does not need to be distinguished within the HFA category.

KOR is absolutely right, as per usual. Very good reply.

I am in New Zealand where both the DSM-5 and the ICD-10 are in use, complimenting each other. My diagnosis states both ASD and Asperger's to cover both bases.



Yes, for example I have an IQ in the profoundly gifted range and had no language delay (I spoke early but rather strangely which was made all the more unusual because I am profoundly Deaf and ought not to have picked up spoken language without intense intervention at all!) - The IQ combined with no speech delay gives me an Asperger's diagnosis, qualified with a comment that I have a more pronounced autistic presentation than would normally be expected in someone with my intellect and linguistic ability. I have much more noticeable and disabling symptoms than most of the others with an Asperger's diagnosis who describe themselves here and in face to face situations people know I am Autistic without asking. There have also been several more informal references to my likely having savant syndrome (It's not a genuine diagnosis which can be given but is an observable trait which is being studied in others). I am better served under the ASD umbrella, in my experience, simply because I don't fit easily into one 'pigeon hole' as interpreted by laypeople who over-generalise about the typical presentation of one diagnosis or another where I do not fit easily.

Wings triad: Difficulties with:

Social interaction
Social communication
Social imagination

People with HFA has difficulties in all three on a significant level, whereas Aspergians only have to meet two of them.
Aspergers is now part of the spectrum along with tourettes and other, and is now called a "spectrum disorder".
Perhaps it makes reseach easier somehow, but ......