Who knows What Is High-Functioning Autism?

High-Functioning Autism (HFA) has been a controversial term which occasionally refers to and sometimes is used interchangeably with Asperger’s Syndrome and Pervasive Developmental Disorder, not otherwise specified (PDD, NOS). Great confusion and controversy about the definition of High-Functioning Autism (HFA) continue, with the main issue being whether or not Asperser’s Syndrome is truly distinct from autistic disorder (Asperger, 1944; Wing, 1981; Baron-Cohen, 2002; Freeman, et. al. 2002; Klin, et. al. 2000; Volkmar & Klin, 2001; Young & Brewer, 2002). Goldstein, et. al. (2002) stated that the diagnostic criteria between Asperger’s Syndrome and High-Functioning Autism (HFA) overlap and are unclear according to the DSM-IV (1994). Blacher et. al. (2003) stated that “definitional and boundary issues are major research concerns in the area of Asperser’s Syndrome and High-Functioning Autism (HFA). The term Asperger’s Syndrome was first described by Dr. Hans Asperger in 1944, but was not widely used in the United States until after 1981, when his work was translated into English. In addition, when classification of Asperger’s Syndrome is compared in the DSM-IV and ICD-10 with PDD, NOS, Dr. Szatmari (2000) considers that the conceptualization is deeply unsatisfying to many parents, front-line clinicians and academic researchers. Given that HFA is not classified in the DSM-IV or ICD-10, some would say that it isn’t a diagnosis.

In 1991, Dr. Frith in her book “Autism and Asperger’s Syndrome” mentions that many professionals felt Asperger’s Disorder was simply a milder form of autism and they used the term “High-Functioning Autism” to describe these individuals. Dr. Szatmari stated that by not specifying symptom differences, the differentiation of Asperger's Syndrome from High-Functioning Autism becomes confused. Eric Schopler et. al. (1992) in his book, High-Functioning Individuals with Autism, proposed that Asperger’s Syndrome and High-Functioning Autism did not have any difference and he recommended that the term Asperger’s Syndrome be discarded. Wing (1998) concluded that Asperger's syndrome and High-Functioning Autism were synonymous and stated that Asperger's Syndrome and High-Functioning Autism are not distinct conditions. She recommended that Asperger's Syndrome be used for "children and adults who have autistic features, but who talk grammatically and who are not socially aloof".

Moreover, Ozonoff, et. al. (2000), suggested that Asperger's Syndrome and High-Functioning Autism involve the same fundamental symptomatology, but differing only in the severity. According to Gilbert (1998), there are no widely accepted diagnostic guidelines specifically for High Functioning Autism (Gillberg, 1998). When individuals diagnosed with Asperger’s Syndrome are compared with those with HFA, they generally have lower Full Scale IQs, with less apparent Verbal/Performance IQ discrepancies.

Due to the confusion in the diagnostic criteria and definitions between Asperger’s Syndrome, PDD, NOS and High-Functioning Autism, Dr. Pomeroy (1992) presents a model for subtyping the Pervasive Developmental Disorder (PDD). He suggested that it is justifiable to define three subtypes of PDD without mental retardation (a) a group with higher verbal skills than performance skills, b) a group with language impairment, and c) a group with non-language impairment.).

There is no consensus within the scientific community that Asperger's syndrome is indeed separate and distinct from High-Functioning Autism. Also it remains unclear whether Asperger’s Syndrome is different from the autistic spectrum disorders. The Autism Society of America states that “more advanced”, "high-functioning", or "mild" autism are subjective terms and that there are no clear clinical definitions for them. Researchers and clinicians are working to determine if Asperger’s Syndrome is a form of High-Functioning Autism or if it is a different entity with different etiology and treatment. The problem arises in individuals within the spectrum with borderline cognitive ability (IQ>70 or above) who sometimes are described as High-Functioning Autism. Some researchers report differences in verbal skills, for example, between Asperger’s Syndrome and High-Functioning Autism (Fitzgerald & Corvin, 2001). Some researchers are still using Asperger’s Syndrome interchangeably with High-Functioning Autism, while others use only High-Functioning Autism/PPD (HFPDD) (Kamio, 2007). However, making the diagnosis based on verbal skills or IQ differences are not supported by the research data (Fitzgerald & Corvin, 2001).

So, then, to return to the question: Who knows what is High-Functioning Autism? Based on the current status of the scientific knowledge and diagnostic classifications (DSM-IV & ICD-10), a lot of clinicians and researchers would say that they know the “right answer”- that is, they are the ones who know what is High-Functioning Autism (HFA) -, but without a much needed consensus of a differential diagnosis and treatment, the scientific community is unable to have a clear dialogue to better understand the phenomenon of High-Functioning Autism (HFA), Asperger’s Syndrome (AS) and Pervasive Developmental Disorder, not otherwise specified (PDD, NOS).