BY: Rachael Sullivan, PsyD
Neurodiversity: High-Functioning Autism (AKA Asperger’s Syndrome)
Thanks to the ever-evolving science of understanding how our brains work, you may have recently encountered the term “neurodiverse.” While this may sound complicated, the term simply refers to recognizing and respecting brain differences, the same way we would with any other individual difference. Neurodiversity is a way to describe individuals whose brain has certain variations that result in these individuals learning in a different way than individuals who are “neurotypical” do. Neurodiversity often refers to those individuals who have received certain diagnoses, such as Attention-Deficit/Hyperactivity Disorder (ADHD), Specific Learning Disorder, and Autism Spectrum Disorder.
It is most important to recognize that we strive to use the term neurodiversity to describe individuals with these diagnoses in order to reinforce that these are brain differences, not deficits. In fact, individuals who are neurodiverse frequently have specific strengths and cognitive abilities that individuals who are neurotypical do not.
Autism Spectrum Disorder, or ASD, is a diagnosis that describes one type of neurodiversity. The word “spectrum” in ASD is a key component of beginning to understand autism – it refers to the vast variations of how ASD presents in any given individual. There is an accurate and important saying about ASD: “If you’ve met one person with autism, you’ve met one person with autism.”
One phrase that is often associated with ASD is “high-functioning,” which refers to an individual who experiences the social and emotional difficulties and stereotyped behaviors or interests that are associated with autism, but does not have any significant delay in intellectual or verbal development. Prior to 2013, an individual with “high-functioning autism” was typically diagnosed with Asperger’s disorder, also known as Asperger’s Syndrome. While the term Asperger’s Syndrome no longer formally exists in the diagnosis and insurance world, it is still a common term used to refer to an individual with high-functioning autism. Individuals who would have been diagnosed with Asperger’s Syndrome prior to 2013, now receive a diagnosis of “Autism Spectrum Disorder, Level 1, Without Accompanying Intellectual or Language Impairment.”
What are some signs and traits of high-functioning ASD?
While many people have an idea of what “stereotypical” signs of ASD are (e.g., delayed speech development, hand-flapping, lining up toys), there are many individuals with ASD who do not ever demonstrate those behaviors. Please note that the following are some of the lesser-known traits of individuals of ASD, many of which are present by early to middle childhood and may not be lifelong. This is by no means an exhaustive list, nor does the presence or absence of any one or combination of these confirm or disconfirm a diagnosis of ASD.
- “Reading” social situations (e.g., appears socially naïve or immature)
- Reciprocal conversation (e.g., understanding the “to-and-fro” elements)
- Answering open-ended questions (e.g., “How was your day?”)
- Engaging in “small talk” (e.g., conversations without an explicit “point”)
- Initiating social conversations or interactions (e.g., asking questions of others)
- Using non-verbal language (e.g., pointing, head nodding)
- Recognizing, understanding, verbalizing and expressing emotions (e.g., difficulties with empathy or expressing comfort)
- Facial expressions (e.g., expressions may be exaggerated or only for extreme emotions, often appears “flat”)
- Transitions/shifting (e.g., takes longer than peers to change between class subjects, pattern of experiencing difficulties at start of new school year)
- Changes in routine (e.g., having a substitute teacher, taking a different route)
- Sharing or being flexible with play with peers (e.g., wanting to “control” play)
- Recognizing bullying or when peers may be unwelcoming
- Sleep (e.g., persistent difficulties falling asleep, seemingly reduced need for sleep)
- Sensory sensitivities (e.g., becomes upset at certain loud noises or bright lights, dislikes tags or seams in clothes)
- Food sensitivities to certain tastes or textures (e.g., highly “picky” eater)
- Integrated motor skills/sensory awareness (e.g., clumsy, seems unaware of their body in space, seems unaware of having food on face/clothing, poor handwriting)
- Maintaining friendships or recognizing elements of friendship (e.g., refers to someone they barely know as their “best friend,” rarely requests play dates)
- Sitting still (e.g., frequently fidgets and/or moves body)
- Flexible thinking (e.g., is a “black and white” thinker, takes things literally, difficulties understanding sarcasm, becomes upset at those who do not follow the rules, difficulties taking advice or receiving constructive criticism)
- Understanding age-appropriate personal space or “stranger danger”
- Personal adaptive functioning (e.g., hygiene, selecting appropriate clothing for weather, cleaning up spills)
- Coping with intense emotions (e.g., age-inappropriate temper tantrums, becoming physically aggressive, biting or hitting oneself, remaining upset for 30 minutes to an hour over a “small” incident)
- Modulating behavior to fit context of situation (e.g., difficulty modulating volume of voice when visiting a library)
- Understanding severity of using threatening language
- Anxiety (e.g., “odd” phobias, difficulties controlling worries, paranoid thinking, dislikes large crowds or gatherings, perfectionistic, “shy”)
- Written expression (e.g., expresses dislike of language arts and essay writing)
- Attention and distractibility (e.g., frequently “zones out”)
- Gravitate towards the same few type/s of activities for play or leisure (e.g., plays in a similar or repetitive manner, re-reads the same books or re-watches the same movies)
- “Hyperfocus” when engaging in preferred activities (e.g., require several attempts of calling their name before responding)
- Limited interest in creative or imaginative play, especially with peers (e.g., does not have action figures “talk” to each other, does not have tea parties for stuffed animals)
- Be verbose, especially when discussing a preferred topic (e.g., difficulty knowing when to stop talking, interrupts others, provides a “running commentary” while playing)
- Act like a “little adult” or “little professor” as a child (e.g., uses more formal language than peers, does not appear as interested in same activities as peers, liked by adults, prefers to sit with adults at a peer’s birthday party)
- Becomes frustrated by having to explain themselves (e.g., acts as if others should automatically know what the individual knows without explaining)
- Act “silly” or “out of control” in an age-inappropriate manner
- Appear indifferent to pain or extreme temperatures
- Have ability to remember specific details even if forgetful in day-to-day life (e.g., dates, movie quotes, notices details others do not)
- Have an atypical learning profile (e.g., may excel in math but struggle significantly with language arts or foreign language)
- Be remarkably honest (e.g., may comment on another’s appearance in an inappropriate way)
What do I do if I believe myself, my child, or a loved one might have ASD?
First of all, know that a diagnosis of ASD can be made at any point in an individual’s life. While many children are diagnosed with ASD in early childhood, it is common for individuals with high-functioning ASD to be “overlooked” in early childhood and not receive a diagnosis until middle school or even middle to late adulthood.
A diagnosis of ASD should only be made by a psychologist or psychiatrist after a formal assessment (aka “testing”) has been completed. Note that psychologists most often complete these assessments. During this evaluation process, the psychologist provides individuals suspected of having ASD with assessments to obtain detailed information about their social and emotional understanding, as well as to evaluate the possible presence of repetitive or stereotypical behaviors or interests. Additionally, a psychologist typically gathers background and developmental information from individuals and their families as another form of data. An IQ assessment may also be included. After the testing process is complete, the psychologist compiles all of the data in a written report and determines whether or not an individual meets DSM criteria for a diagnosis of ASD. This report is reviewed in detail with the individual and/or caregivers during a “feedback” session, where recommendations for next steps are provided. It is important to note that many of the most-effective treatment options for children with ASD (e.g., Applied Behavior Analysis therapy) require a formal diagnosis of ASD in order for treatment to be covered by health insurance.
If you would believe yourself, your child, or a loved one may benefit from an ASD assessment, please contact us the Metis Center and we’d be happy to assist you and answer any questions you may have!