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High-functioning autism

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High-functioning autism
Other namesSukhareva syndrome[1]
SpecialtyPsychiatry
SymptomsTrouble with social interaction, impaired communication, restricted interests, repetitive behavior
ComplicationsSocial isolation, employment problems, family stress, bullying, self-harm[2]
Usual onsetBy age two or three[3][4]
DurationLifelong
CausesGenetic and environmental factors
Diagnostic methodBased on behavior and developmental history
Differential diagnosisAsperger syndrome, ADHD, Tourette syndrome, anxiety, bipolar disorder, obsessive–compulsive disorder
TreatmentBehavioral therapy, speech therapy, psychotropic medication[5][6][7]
MedicationAntipsychotics, antidepressants, stimulants (associated symptoms)[8][9][10]

High-functioning autism (HFA) was historically an autism classification to describe a person who exhibited no intellectual disability but otherwise showed autistic traits, such as difficulty in social interaction and communication, as well as repetitive, restricted patterns of behavior. The term is often applied to autistic people who are fluently verbal and of at least average intelligence.[11][12][13] However, many in medical and autistic communities have called to stop using the term, finding it simplistic and unindicative of the difficulties some autistic people face. [14][15][16][17]

HFA has never been included in either the American Psychiatric Association's Diagnostic and Statistical Manual (DSM) or the World Health Organization's International Classification of Diseases (ICD), the two major classification and diagnostic guidelines for psychiatric conditions.

The DSM-5-TR subtypes autism into three levels based on support needs. Autism Level 1 has the least support needs and corresponds most closely with the "high-functioning" identifier.[18]

Characterization

The term high-functioning autism was used in a manner similar to Asperger syndrome, another outdated classification. The defining characteristic recognized by psychologists was a significant delay in the development of early speech and language skills, before the age of three years.[12] The term Asperger syndrome typically excluded a general language delay.[19]

Other differences noted in features of high-functioning autism and Asperger syndrome included the following:[12][20][21][22]

  • Lower verbal reasoning ability
  • Better visual/spatial skills (Being uniquely artistically talented)
  • Less deviating locomotion (e.g. clumsiness)
  • Problems functioning independently
  • Curiosity and interest for many different things
  • Not as good at empathizing with other people
  • Male to female ratio (4:1) much smaller

HFA is not a recognised diagnosis by the American Psychiatric Association or the World Health Organization. HFA was, however, previously used in clinical settings to describe cases of autism spectrum disorder where indicators suggested an intelligence quotient (IQ) of 70 or greater.[23]

Comorbidities

See main article: Conditions comorbid to autism

There are several comorbidities, the presence of one or more disorders in addition to the primary disorder, associated with high-functioning autism. Individuals with autism spectrum disorders risk developing symptoms of anxiety. While anxiety is one of the most commonly occurring mental health symptoms, children and adolescents with high functioning autism are at an even greater risk of developing symptoms.[24] Other associated conditions of include bipolar disorder and obsessive–compulsive disorder (OCD). In particular the link between HFA and OCD, has been studied; both have abnormalities associated with serotonin.[25] Observable comorbidities associated with HFA include ADHD and Tourette syndrome. HFA does not cause, nor include, intellectual disabilities. This characteristic distinguishes HFA from low-functioning autism; between 40 and 55% of individuals with autism also have an intellectual disability.[26]

In addition to mental health disorders, several medical conditions are comorbid to autism. These medical conditions include, but are not limited to: seizure disorders, sleep disorders, gastrointestinal disorders, and hormonal dysfunction. [27]`

Behavior

Several studies have shown that the features associated with HFA may increase the probability of engaging in criminal behavior, though more research needs to be done in this area.[25] Recent studies on the correlation between HFA and criminal actions suggest that there is a need to understand the attributes of HFA that may lead to violent behavior. There have been several case studies that link the lack of empathy and social naïveté associated with HFA to criminal actions.[28]

Cause

Main article: Causes of autism

Although little is known about the biological basis of autism, studies have revealed structural abnormalities in specific brain regions. Regions identified in the "social" brain include the amygdala, superior temporal sulcus, fusiform gyrus area and orbitofrontal cortex. Further abnormalities have been observed in the caudate nucleus, believed to be involved in restrictive behaviors, as well as in a significant increase in the amount of cortical grey matter and atypical connectivity between brain regions.[29]

Diagnosis and IQ

Main article: Diagnosis of autism

Treatment

Main article: Autism therapies

While there are no one-size-fits-all treatments for people with autism, there are several strategies to help lessen the symptoms and effects of the condition. The best treatment course is different for each individual.[30]

See also

References

  1. ^ Manouilenko I, Bejerot S (August 2015). "Sukhareva – Prior to Asperger and Kanner". Nordic Journal of Psychiatry (Report). 69 (6) (published 31 March 2015): 479–82. doi:10.3109/08039488.2015.1005022. PMID 25826582. S2CID 207473133.
  2. ^ "Autism spectrum disorder - Symptoms and causes". Mayo Clinic. Archived from the original on 14 July 2019. Retrieved 13 July 2019.
  3. ^ "NIMH " Autism Spectrum Disorder". nimh.nih.gov. October 2016. Archived from the original on 21 April 2017. Retrieved 20 April 2017.
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  10. ^ Jaeggi SM, Buschkuehl M, Jonides J, Perrig WJ (2008). "From the Cover: Improving fluid intelligence with training on working memory". Proceedings of the National Academy of Sciences. 105 (19): 6829–33. Bibcode:2008PNAS..105.6829J. doi:10.1073/pnas.0801268105. PMC 2383929. PMID 18443283.
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  14. ^ "Making information and the words we use accessible". NHS England. August 25, 2024. Retrieved August 25, 2024.
  15. ^ Price D (April 5, 2002). Unmasking Autism: Discovering the New Faces of Neurodiversity. National Geographic Books. p. 47. ISBN 9780593235232.{{cite book}}: CS1 maint: date and year (link)
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  17. ^ Coffey LT (August 13, 2021). "Autism glossary: What to say, and what not to say, when talking about autism". Today (TV show). Retrieved August 25, 2024.
  18. ^ The Diagnostic and Statistical Manual of Mental Disorders (5th edition, text revision (DSM-5-TR) ed.). American Psychiatric Association (APA). March 18, 2022.{{cite book}}: CS1 maint: date and year (link)
  19. ^ Asperger's Disorder Archived 2013-04-25 at archive.today – Diagnostic and Statistical Manual of Mental Disorders Fourth edition Text Revision (DSM-IV-TR) American Psychiatric Association (2000)
  20. ^ "News and general information | Finance, High tech, Health, ..." (PDF). March 14, 2022. Archived from the original on August 9, 2007.
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  25. ^ a b Mazzone L, Ruta L, Reale L (2012). "Psychiatric comorbidities in asperger syndrome and high functioning autism: Diagnostic challenges". Annals of General Psychiatry. 11 (1): 16. doi:10.1186/1744-859X-11-16. PMC 3416662. PMID 22731684.
  26. ^ Newschaffer CJ, Croen LA, Daniels J, Giarelli E, Grether JK, Levy SE, Mandell DS, Miller LA, Pinto-Martin J, Reaven J, Reynolds AM, Rice CE, Schendel D, Windham GC (2007). "The Epidemiology of Autism Spectrum Disorders*". Annual Review of Public Health. 28 (1): 235–258. doi:10.1146/annurev.publhealth.28.021406.144007. ISSN 0163-7525. PMID 17367287.
  27. ^ Margaret L. Bauman ,Medical Comorbidities in Autism: Challenges to Diagnosis and Treatment , Neurotherapeutics: The Journal of the American Society for Experimental NeuroTherapeutics , 2010, https://www.neurotherapeuticsjournal.org/action/showPdf?pii=S1878-7479%2823%2900229-5
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  30. ^ "What are the treatments for autism? | NICHD - Eunice Kennedy Shriver National Institute of Child Health and Human Development". www.nichd.nih.gov. 2021-04-19. Retrieved 2023-06-10.

Further reading

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