High Functioning Autism and Other Types of Autism
What is autism?
Autism spectrum disorder (ASD) is a broad term used to describe a grouping of neurodevelopmental disorders. It can often affect a person’s way of interacting with others. People with autism often experience the world differently than their neurotypical peers. While the term autism covers a broad spectrum of symptoms, it is typically characterized by a delay in speech, social, and motor skills as well as repetitive behaviors. According to the Centers for Disease Control and Prevention (CDC) Autism and Developmental Disabilities Monitoring (ADDM) Network, an estimated one in 59 children has been diagnosed with ASD and it is reported to occur in all racial, ethnic, and socioeconomic groups.
While there is no cure for autism, there is a multitude of therapies and medications available to help with some of the related symptoms such as sleeplessness, seizures, trouble focusing, and depression. Studies have shown that medication is most effective when it’s combined with behavioral therapies. While scientists have not determined an exact cause of autism at this time, significant evidence has suggested that the cause is likely to be genetic. According to the CDC (ADDM) Network, parents with a child diagnosed with ASD have a 2-18 percent chance of having a second child with autism. It’s important to recognize multiple risk factors can also contribute including biological and environmental causes. Let’s define some of the common terminology used when talking about autism.
The autism spectrum
The autism spectrum refers to the set of developmental delays that involve social, motor, and language skills. The spectrum is broad, covering different faces of autism. Because of this spectrum, people with autism can have differing personalities. Some can be talkative, while others are aloof. Some are affectionate while others are not. There are so many differences to be considered.
Different types of autism
No two people with autism have the same symptoms and behavior. And because there are so many variables involved in autism diagnosis, the way each person experiences and exhibits autism can be very different. There are varying diagnoses within the category of autism in addition to high functioning autism to include classic autism, Asperger’s syndrome, pathological demand avoidance, Pervasive Developmental Disorder – Not Otherwise Specified (PDD-NOS), also known as atypical autism. Sometimes doctors will indicate a child has mild or severe autism or even mention Broad Autism Phenotype. Let’s take a look at what these terms mean.
What are the most common characteristics of autism? The core symptoms are:
- Difficulty in social and communication skills
- Restricted or repetitive behaviors
People with autism can also have sensory and eating issues. They can be highly sensitive to loud noises, bright lights, and certain textures in clothing. Some cases of autism may manifest other physical symptoms such as seizures, chronic constipation, and diarrhea.
Some people with autism can communicate verbally while others cannot. However, both verbal and non-verbal people with autism can have a hard time:
- Recognizing other people’s emotions
- Recognizing own emotions
- Saying what they feel
- Asking for help
- Processing sensory overload
- Taking turns when talking to people
- Maintaining personal space
Repetitive behaviors, also called stimming, are done in different ways with varying degrees of severity. While stimming is something that neurotypical people engage in, it is most prevalent in people with autism.
Repetitive or stimming behaviors include:
- Rocking back and forth (or side to side)
- Jumping or spinning
- Repeating or echoing words or phrases (echolalia)
- Scratching or rubbing the skin
- Blinking repetitively
- Staring at lights or rotating objects
- Licking unusual objects
- Sniffing at people or objects
- Rearranging objects
While most repetitive behaviors are not a cause for concern, in some instances the behavior can become harmful. Head-banging, biting body parts, punching, and swallowing non-food items can all lead to serious physical injury and require medical care. In these rare cases, it is best to find ways to lessen stimming behavior for the sake of the person’s safety. Keep in mind a safer stimming behavior may be needed to replace a more dangerous one.
Does my child have autism?
Autism can be diagnosed in as early as 24 months, and early detection is ideal because of the malleability of the child’s brain and the opportunities for intervention. Babies with autism are often mistaken for simply quiet and conforming babies because they seldom fuss and cry. While this is true, the key to detecting autism is noticing the absence of normal behaviors rather than the presence of abnormal ones.
An early autism diagnosis for children is highly beneficial to ensure timely and effective treatment. Parents play an important role in recognizing the signs of autism. Studies have shown that intervention in children ages three and younger are more likely to improve their condition as compared to those who were treated after five years old.
Babies and toddlers with autism might:
- Avoid eye contact
- Not respond when his/her name is called (by 12 months)
- Resist physical contact
- Not point to objects (by 14 months)
- Not play pretend games (by 18 months)
- Not follow objects with their eyes
- Not mimic facial expressions
- Not smile
- Not speaking at all (by 16 months)
- Have no two-word phrases that are not an “echo” from others (by 24 months)
These behaviors can change as babies grow into school age. Children with autism might:
- Prefer to play alone
- Line up toys and other objects
- Give inappropriate answers to questions
- Not understand other people’s emotions or facial expressions
- Have unusual reactions to certain sights, sounds, smells, and textures
- Stick to a routine and not like change
- Talk in a monotone or sing-song voice
- Say “you” when he/she means “I”
- Repeat words and phrases
- Stand too close to someone
Children with autism acquire skills at varied speeds and in different areas. They might have normal skills in some aspects (physical, motor), but are delayed in others (verbal, social). For example, a child with autism might be able to recite a long poem, but can’t say the ABCs in the correct order.
People diagnosed with Asperger’s syndrome will often present as normal in intelligence and language skills but possess significant issues with social interaction and nonverbal communication. Typically, behavior and interests can be very singular.
Asperger’s syndrome was coined after Viennese pediatrician Hans Asperger who observed boys who had “autism-like” behaviors despite their otherwise normal and even high IQs. People with Asperger’s syndrome can struggle with everyday interaction. While a person with classic autism may not want to mingle with others, people with Asperger’s syndrome often have the desire to connect with others but have a hard time doing it the way it is expected.
Some common traits of Asperger’s syndrome include:
- Inability to detect sarcasm
- Limited eye contact and gestures
- May not understand humor
- Obsessive tendencies
- Narrow interests
- Good memory skills
To be diagnosed with Asperger’s syndrome, a person must have normal cognitive and speech development. Despite social challenges, most people with Asperger’s can lead a satisfying life. School-age children can complete their studies, while adults can get mainstream jobs. Some people, however, will need sustained support.
What is high functioning autism?
High functioning autism is used to describe people with autism with standard intelligence who can read, write, and speak. It is not a medical term and is used informally to stress a particular group of people with autism who do not fall under the category of classic autism.
People with high functioning autism may exhibit a delay or lack of social skills. They can have difficulty understanding the feelings and reactions of others which can make them appear to be insensitive at times. Some people may struggle to interact and insist on talking about things they are passionate about instead. Sarcasm and humor are sometimes lost to a person with high functioning autism, and he/she might prefer to rely on movies and books to learn about social customs.
High functioning autism characteristics
You might wonder, “What does high functioning autism look like in adults?,” or “How do we recognize high functioning autism in children?”
Because there are no obvious indicators that a person has high functioning autism, it can be hard to spot and diagnose. Conducting accurate high functioning autism tests is crucial to identify this unique but treatable disorder correctly.
Parents and school personnel are sometimes not able to notice high functioning autism behaviors until a child is older and social interactions become more complex and, at the same time, become a bigger part of his/her life. A person with high functioning autism may thrive academically but struggle socially, which will have an impact on his/her confidence and self-esteem.
High functioning autism symptoms include:
- Little or limited eye contact
- Problems understanding verbal cues
- Challenges relating to humor and/or sarcasm
- Monotonous voice
- Narrow interests and obsessions
- Difficulty maintaining relationships
- Clumsiness and sensitivity to specific stimuli
Applied behavioral analysis (ABA)
ABA, which is known to be the most effective treatment for autism, can benefit a person with high functioning autism as it assists in managing challenging behaviors through positive reinforcement while teaching social and motor skills.
Social skills training
Social Skills Training is now emerging as a way for people on the spectrum to deal with social challenges. Social skill therapists come from different medical backgrounds but are all working toward one goal: to provide people with autism the ability to converse, share, play, and work with typical peers.
The many types of autism
There are several other types and subtypes of autism people should know about. Autism is a disorder that involves motor, sensory, and social skills. However, a person does not have to be delayed in all areas to be considered autistic. It is common to see people with autism that do not have delays in speech and yet are on the spectrum. This is where different types of autism are used to understand better the different ways autism can affect a person.
What is PDD-NOS?
Pervasive Developmental Disorder (Not Otherwise Specified) or PPD-NOS was a subtype of autism spectrum disorder before it was removed from the DSM-5 diagnostic manual in 2013.
PPD-NOS was used to refer to people with autism who do not fully meet the criteria to warrant a classic autism diagnosis. It’s a diagnosis used for someone who has some but not all characteristics of autism. Unlike Asperger’s syndrome, people with pervasive developmental disorders have minor challenges in language and cognitive development.
Pervasive developmental disorders signs and symptoms
- Challenges in socializing and communicating with others
- Unusual play with toys
- Repetitive body movements (stimming)
- Resistance to change in routine
Treatments for PDD-NOS
Treatments for PPD-NOS are mostly similar to those meant for other types of autism. However, children diagnosed with PPD-NOS are advised to pursue an Early Intervention Program (EIP) for a pre-school child or Individual Education Program (IEP) for a school-age child.
What is mild autism?
The term mild autism is not an accepted medical term nor diagnosis for autism spectrum disorder. It is an informal term to mean someone has some but not all symptoms of autism.
The DSM-5 does, however, recognize the term and states that people who are “mildly” autistic are “generally considered to be level 1, meaning they need relatively little support to live a normal life.”
While it might be true in theory, it does not always translate in real life. For instance, a person with mild autism may excel in school academics but find it difficult to make friends, making him/her lonely and depressed. In this context, mild autism is not necessarily a “better” condition.
What are the signs and symptoms of mild autism?
As someone who falls on the autism spectrum, signs and symptoms of mild autism would be the same as with other types of autism. These include:
- Challenges in holding a conversation
- Difficulty making friends and having relationships
- Doing the same things repeatedly (lining up toys, repeating words and phrases)
- An interest in one specific thing only (dinosaurs, butterflies, etc.)
- Hypersensitivity or hyposensitivity to stimuli (lights, sounds, tastes, etc.)
These characteristics of mild autism may vary from one person to another and may not all be present.
How to diagnose mild autism
Mild autism may not be detected in the early stages of life simply because the signs are not there or are not that noticeable. To warrant a diagnosis, the child must be taken to a developmental pediatrician, child neurologist, or child psychologist/psychiatrist for a developmental screening and comprehensive diagnostic evaluation. Once completed, a diagnosis is given and the doctor will recommend treatment/s if needed.
Treatments for mild autism
Treating mildly autistic people/children is usually the same across for everyone in the spectrum. This includes:
- Behavioral therapy (learning behaviors and getting rewards for it)
- Play or developmental (integrating skills development in play activities)
- Anxiety Medication
- Speech therapy to improve conversation skills and reading body language
- Occupational therapy for dealing with sensory issues
- Physical therapy to improve muscle tone and avoid clumsiness
What is severe autism?
Severe autism refers to the low functioning end of autism spectrum disorder. While it is not an official diagnosis, it is often used to describe people with autism who have the most significant and debilitating traits. People with severe autism are on Level 3 on the autism spectrum disorder.
- Common signs and symptoms of severe autism
- Unable to use spoken language
- Extreme sensitivity to light, sounds, smells, and tastes
- Low intelligence
- Repetitive behaviors (often leading to self-harm)
- Physical symptoms (epilepsy, restlessness, gastrointestinal problems)
Diagnosis of severe autism
The diagnosis for severe autism is the same procedure as for other types of autism but may involve more tests and visits to different specialists depending on the symptoms.
Treatments for severe autism include:
- Identify and treat physical issues like food sensitivities, allergies, migraines, etc.
- Improvise communication skills with sign language, picture cards, and keyboards
- Follow a routine and create a stress-free environment
- Applied behavioral analysis
- Occupational therapy
- Physical therapy
- Play therapy
What is broad autism phenotype?
Broad Autism Phenotype (BAP) is used to refer to people who have significant challenges with language, social skills, and behaviors but not significant enough to be diagnosed with autism. It is not a diagnosis but a “research construct,” which is used by scientists when studying autism.
This condition is said to be prevalent in parents or siblings of people with autism, supporting the theory that autism is caused by genetics.
The definition of CDD states that this condition is related to autism, but it is not a form of autism. Other terms for CDD are Heller’s syndrome, dementia infantilis, and disintegrative psychosis.
Causes and symptoms of CDD
The cause of CDD is not known to this day. A popular theory is that it is caused by the neurological makeup of the brain. Studies showed that almost half of the children with CDD have an abnormal electroencephalogram (EEG), which measures the electrical activity of the brain.
Symptoms of CDD include:
- Normal development up to two years of age
- Behavioral changes
- Unprovoked anger
- Gradual or rapid loss of motor, language, and social skills
- Loss of bowel and bladder control
- Inability for self-care
- Repetitive activities
- Withdrawal from social activities
Diagnosis and treatments of CDD
Diagnosis for CDD is made by a pediatrician. Normal development for up to two years of age is required to be considered a diagnosis of CDD. Other illnesses that need to be ruled out are epilepsy, Rett’s disease, and schizophrenia.
The treatment of CDD is similar to autism. Speech therapy, occupational therapy, and physical therapy are all needed to counter the challenges of a person with CDD. However, only 20 percent of children diagnosed with this disorder can speak again. Children with CDD who grow into adulthood without progressing will require full-time caregivers.
Characteristics of Individuals with an Autism Spectrum Disorder (ASD). Retrieved from https://www.iidc.indiana.edu/pages/characteristics
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Defining Key Features of the Broad Autism Phenotype. (18 September 2008). Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2746421/
Childhood disintegrative disorder. Retrieved from http://www.minddisorders.com/Br-Del/Childhood-disintegrative-disorder.html
Early Intervention for Children With Autism Spectrum Disorder Under 3 Years of Age: Recommendations for Practice and Research. (October 2015). Retrieved from https://pediatrics.aappublications.org/content/136/Supplement_1/S60
Diagnostic Criteria for Autism Spectrum Disorder. (2013). Retrieved from: https://www.iidc.indiana.edu/pages/Diagnostic-Criteria-for-Autism-Spectrum-Disorder
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