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11th June 2023.
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High Functioning Autism (HFA), defined
Let's start at the beginning. The group of professionals who diagnose Autism Spectrum Disorder (ASD) symptoms prefer distinct diagnostic categories to ensure the most accurate identification.
The term ASD is used to help explain the wide variation between individuals regarding the severity and combination of each impairment. To add to complexities, ASD can coexist with other conditions; intellectual disability, anxiety and depression, speech and language disorders, epilepsy, attention disorders, Tourette syndrome, etc.
ASD is used to group together -
- Autism - impairments in the social and communication areas are severe and constant. They are clearly present before the age of three years
- Asperger syndrome - severe and constant social impairments, but impairments are not as severe in the language and communication area. The impairments tend to be subtle in young children and become more obvious as the child reaches school age. These individuals usually score in the normal intelligence range.
- Pervasive Developmental Disorder - Not Otherwise Specified (PDD-NOS) - children who present with some of the characteristics of Autism or Asperger Syndrome, but not severe enough for a diagnosis of either
There are also 3 more relatively clear-cut disorders under the ASD banner. They are;
- Childhood Disintegrative Disorder - http://www.nlm.nih.gov/medlineplus/ency/article/001535.htm
- Rett syndrome - http://www.ninds.nih.gov/disorders/rett/detail_rett.htm
- Fragile X syndrome - http://www.fragilex.org/html/autism.htm
However, we often hear about High Functioning Autism (HFA). What is it?
It is not an official diagnostic term and is not a recognised in the DSM-IV. It is used to describe an individual who meets the criteria for a diagnosis of Autism, but is not as severely affected as the typical autistic person. HFA is a subjective term because there's no agreed upon definition of what 'high functioning' really means. Nevertheless, it is a helpful diagnosis that guides families towards appropriate treatment and school placement.
Guidelines to support and treat children identified with HFA
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There is no single solution to addressing HFA. The best approach is to seek early identification, and cleverly plan layers of interventions to support the needs of the child. These usually include the development of social, behavioural, communication and motor skills. Here are a few ideas as starters;
- Special Education - this is the concept of tailoring or adapting day to day education to specifically meet a child's unique learning needs. This may include modified curriculum and modified reporting systems. It is obligatory in most developed countries.
- Establish an Individualised Educational Plan (IEP) or a Negotiated Educational Plan (NEP) - this is a plan formulated by school staff, specialists and parent input. This plan lays the groundwork for necessary therapies and academic training. IEP's and NEP's can be developed as funded or unfunded options.
- Behavior Modification - the development of positive strategies to support the behaviour of the child to improve their learning and functioning (Applied Behavior Analysis makes use of reinforcements so that the child learns to respond in a particular manner. It rewards positive behaviours and ignores the undesirable ones. The desired outcomes are broken down into attainable, success-based tasks. This teaches the child how to learn so that they can then move on to academic work)
- Teaching and learning - some say HFA children are unable to learn because of their lowish IQ scores. Quite often, these children simply require more time to learn and respond. Their learning is always buoyed by additional visual input. We tend to accept that people with Autism think in more visual terms than most others.
- Develop visual aids; schedules, planners and timetables - many autistic children resist change to their routines. It is important to provide them with a plan so they know what activities are first, next, and last. If they are unable to read, then use picture cues on the schedule. These kids are reliant on advanced notice of imminent changes.
- Speech Therapy - this specialised additional work is often needed to correct specific letter and word pronunciations. When necessary, language skills are addressed to help the child learn how to respond appropriately to certain phrases and questions. This type of therapy is often administered on an individualised basis, by a speech therapist. It is very appropriate for therapy to occur during the course of the school day.
- Occupational Therapy - offers designs to increase the child's day to day and classroom functional abilities (sensory integration therapy). Sensory problems often cause children to be overly sensitive to textures, noises, smells and sounds. If the child has problems with fine motor skills that hinder writing and other class tasks, therapy can be used to address these problems as well. Again, it is very appropriate for therapy to occur during the course of the school day.
- Medication - considered to treat specific secondary symptoms such as anxiety, depression, hyperactivity and highly aggressive or reactive behaviours
- Social Skills Training - where children are explicitly taught pro-social behaviours; how to interact with their peers in specific situations
- Complementary Therapies - martial arts, gymnastics and music therapy, assist children flex their muscles, literally and figuratively, as they learn how to function in a group setting away from school
Valuable links to websites on High Functioning Autism (HFA)
http://autism.about.com/od/whatisautism/f/whatishfa.htm
http://www.autismvictoria.org.au/diagnosis/#autism
http://www.autism-help.org/autism-high-functioning-hfa.htm
http://www.betterhealth.vic.gov.au/bhcv2/bhcarticles.nsf/pages/Asperger_syndrome_and_adults