What is the difference between Asperger’s and high-functioning autism?

[Mark Smith]

Even though they are supposedly different, I often hear people on this forum use them interchangeably. So it would be helpful to know if they are differences as well as any similarities.

 

[kay]

Some of us were diagnosed before the DSM-5 with Asperger's basically because we had no speech delays and were considered "high functioning". Of course now Aspergers has been removed as a diagnosis and it is simply Autistic Spectrum Disorder with some numbers to indicate how much support you need. A few places still have a diagnosis category of Aspergers but it looks like most everywhere will eventually just go with Autism which is good though today I am looking for a word with more zip. Of course I doubt my word will catch on but that doesn't stop me from wasting hours looking at Latin and Greek trying to make up a new word.

 

[tlc]

The only reason I left my profile as "not sure" is because you have to choose AS or HFA. If the above is true, then I think the forum should at least include another option in the profiles.

So I wondered what the difference was, and the speech thing seemed to be the defining part.

So what do they mean no speech issues or delays? Do they mean that you had problems just trying to speak to start with? Or people like me who didn't have a delay speaking in general, but spent the first 2 years of grade school going to the speech therapist to learn to speak correctly?

 

[kay]

The only reason I left my profile as "not sure" is because you have to choose AS or HFA. If the above is true, then I think the forum should at least include another option in the profiles.

So I wondered what the difference was, and the speech thing seemed to be the defining part.

So what do they mean no speech issues or delays? Do they mean that you had problems just trying to speak to start with? Or people like me who didn't have a delay speaking in general, but spent the first 2 years of grade school going to the speech therapist to learn to speak correctly?

Who knows for sure what they mean but I think it just meant that you were verbal. My mom got a letter recommending speech therapy for me when I was in the second grade but that didn't change that I had started talking earlier than average. Of course my second grade teacher and the the school's speech therapist didn't like the way I talked. My mom chose to ignore them and that time she was right, my brain got the hang of proper pronunciation all by itself, just late.

 

[SplendidSnail]

The only reason I left my profile as "not sure" is because you have to choose AS or HFA.

I'd say choose whichever your official diagnosis is for. It's true that Asperger's is a DSM-4 / ICD-10 term, and ASD is a DSM-5 term, but in the end, depending on which manual was used for your diagnosis, you will have a diagnosis for one or the other.

My diagnosis actually is for ASD, but it actually states in it that Asperger's is a designation that is often more meaningful to people.

Of course, there may be some people who have actually been diagnoses with both, if they actually were diagnosed under more than one manual.

In the end, I guess I agree with you, it's kind of silly to force people to choose.

 

[Mary Anne]

It’s late here. I will try and find my copy of the current DSM 5 tomorrow.

 

[SusanLR]

The time of diagnosis seems to be the only difference between HFA and Aspergers.
I think it was a confusing mistake to take the term Aspergers away. With autism being a spectrum,
the Aspergers diagnosis gave an identifiable place on that spectrum. HFA is too vague IMO.
Tell someone you are HFA and most would say "Huh?"

I asked my psychologist about the change and how do they define HFA?
The reply was no delays in learning to speak, an
average or above IQ and the ability to take care of yourself. (Not sure how that is defined.)

I had no delay in speaking. I spoke earlier than most children my Mom always told me, yet I had no desires to associate with other kids and had selective mutism as a child. Meaning,for me, I wouldn't speak to anyone that came to the house or to visit mainly, because I didn't want to. So it was by selection.
I remained socially isolated, again by my choice, through grade school and totally during my teen years when I was home schooled grades 9 -12.
I never became independent nor did I want to.
Started dating age 24.
Never seriously. Never married or lived with anyone.
Had no desire for children or a life away from home.
Now that my parents are deceased, I am totally lost in
the forest of people because I never knew independence.
So really High functioning is that?

The term Aspergers is a recognisable word for most people without going into every aspect of how autism
has effected you. But, we have no say in such matters
when the regulating board decides to change something.

 

[Tom]

In the USA Aspergers was once thought to be a specific type of HFA. They no longer think that and people diagnosed with that are now just said to be HFA. The distinction is still retained in other countries. I don't know if that will change in time, but suspect it will because of a lack of medical evidence to support a distinct classification.

 

[WereBear]

If you look at my signature, I have it set for officially ASD Level 1 (Asperger's Syndrome).

Because clarity is how I roll.

 

[SplendidSnail]

In the USA Aspergers was once thought to be a specific type of HFA. They no longer think that and people diagnosed with that are now just said to be HFA. The distinction is still retained in other countries. I don't know if that will change in time, but suspect it will because of a lack of medical evidence to support a distinct classification.

The ICD-10 (the manual used in most countries that don't use DSM) currently retains the distinction between Autism and Aspergers, but current draft of the ICD-11 folds Aspergers and PDD-NOS into the single ASD diagnosis.

So yes, in the future, the designation "Aspergers" will go away worldwide.

 

[Aidan49]

I thought it had to do with when the individual started to speak?

 

[the_tortoise]

Read for yourself:

DSM IV Criteria for Diagnosing Autistic Disorder* | Interactive Autism Network

DSM IV Criteria for Asperger's Disorder* | Interactive Autism Network

http://www.who.int/classifications/icd/en/GRNBOOK.pdf (ICD-10 criteria are in here)


In reality, a person could be diagnosed with Autistic Disorder in the DSM-IV or the ICD-10 without any speech/language delay and without any delay in self-help skills or intellectual/cognitive delays, as follows:

In the DSM-IV, one only needed to demonstrated a "lack of varied, spontaneous, make-believe play or social imitative play appropriate to developmental level," as specified in the Communication category, in addition to the required number of symptoms in other categories.

In the ICD-10, the criteria are a bit more complicated to explain but a person could be diagnosed with "Childhood Autism" without any speech or language delay and without any self-help/cognitive delays, if they had "abnormal or impaired [...] functional or symbolic play" prior to age 3 [1], problems with social reciprocity/conversation and modulation/use of things like tone of voice and rhythm of speech, and at least 2/5 symptoms from the rigid/repetitive behavior section (which include obsessive/narrow interests and stimming/"repetitive motor movements", two things loads of aspies have) plus the usual exclusionary/"this must be the best explanation" criteria at the end.

You can go through the criteria for a classic autism diagnosis in either manual and create a symptom profile that meets the requirements for diagnosis of classic autism without the presence of speech/language delay or intellectual/cognitive delay.

On the flip side of things, lot of people who arguably meet criteria for classic autism (at least if you go strictly by the book) have been diagnosed with Asperger's or PDD-NOS instead.

Clinicians are not at all immune to the adoption and use of stereotypes when it comes to the way that they evaluate and diagnose people (they are only human -- fallible and sometimes even incompetent); Nor are they immune from choosing one diagnosis over another for pragmatic rather than scientific reasons, often reasons steeped heavily in social politics (diagnosis of Asperger's = less stigma and less risk of limiting a person's future social/vocational/academic opportunities, for example).....


Partly as a consequence of the aforementioned things; Partly because of how the diagnoses were written up [2]; Partly because of a lack of knowledge about the etiology involved in either diagnosis and the heterogeneity of people with either diagnosis [3]; Partly because of the many people not diagnosed until later childhood, adolescence or adulthood (when it may be difficult to confirm a person's early history) and the fact that people with HFA and Asperger's may have identifcal symptoms and neuropsychological profiles once they reach adulthood; And probably partly for other reasons I'm forgetting or unaware of, there has never been a concensus among clinicians and/or researchers about where the boundaries lie between Asperger's and Autistic Disorder.

If you read in academic journals about the arguments for and against the separation of Asperger's Syndrome from other types of ASD, you will find loads of discussion about how clinicians did not adhere strictly to the criteria (or basically made up their own), about how there was quite a lot of disagreement in how the criteria should be interpreted and used, about whether the diagnostic criteria as written were or were not useful/valid. There is evidence that what diagnosis a person with higher functioning autism received depended more on who diagnosed them than on what symptoms they did or did not display (in early childhood, at the time of diagnosis, or both).

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Footnotes:

1. Basically "make believe" or "social-imaginative" play like copying the social and practical behaviors of others and using toys in whatever way they were intended to be used. (As opposed to lining them up, sorting them by physical characteristics, repeatedly moving arms or spinning wheels, spinning them or throwing them, etc.)

2. In the DSM-IV, if a person met criteria for both classic autism and Asperger's, they were supposed to be diagnosed with classic autism (see criterion F) -- but this rule was often completely ignored in clinical practice.

In the ICD-10, it's entirely down to the clinician's judgement -- the relevent part of criterion E for Childhood Autism and criterion D for Asperger's Syndrome (the text is identical) states "The clinical picture is not attributable to the other varieties of pervasive developmental disorder".

3. Attempts have been made to find distinct neuropsychological profiles or to evalute particular areas of ability for the purpose of validating or invalidating a distinction between Asperger's and classic autism without intellectual disability. The results, across studies, are conflicted.

Even when a particular study does claim to provide support for having two separate conditions, the results are generally (perhaps always -- I can't claim to have read every study) useless because the logic is circular....all that anyone seems to have proven is that people with ASD can be separated into distinct categories based on particular areas of ability, not that there is any valid reason (e.g. etiological or therapeutic) to do so.
..........
Please note that making footnotes is not an attempt to be fancy or give the appearance that I'm some kind of expert (I'm absolutely not an expert, I have read a lot but I'm just an average layperson and I'm sure there are others on here who have read a lot more and have a lot more knowledge and understanding than I do) -- I just wanted to make my post slightly more readable, less tangential.