High-functioning autism

Autism spectrum disorder is a neurological condition that affects a child’s ability to communicate and interact with others. High-functioning autism (HFA) is part of the autism spectrum disorder (ASD), children with HFA often struggle with reading body language and other non-verbal forms of communication such as facial expressions but have fully developed verbal language and no learning or other disability. Children with HFA have a more literal understanding of language and lack imagination and therefore struggle with understanding jokes or idioms. Children with high-functioning autism usually have average or above average levels of intelligence.

Our speech and language therapists can help provide therapy to maximise the potential of children with high-functioning autism and provide them with social skills that can help enhance their communication skills.

HFA is a form of autism spectrum disorder (ASD). Children who have HFA are on the spectrum but have no learning or physical disability that affect their functioning. Children also struggle with the following areas:

Social communication and social interaction

Social communication refers to the social use of language, this requires a child to use and understand language and behaviour with others in communicative context. Social interaction refers to the behaviour of individuals who are sharing an activity.

Children who have high-functioning autism will have some difficulties with their social communication and interaction and may not be able to use the appropriate language and behaviour in particular situations, particularly when interacting with others. Speech and language therapists are able to provide children with techniques and strategies to manage their social communication or interaction difficulties.

Restricted, repetitive patterns of behaviour, interests or activities

Children may have behaviours or habits that are repetitive e.g. self-stimulatory behaviour, playing with toys in a non-functional manner e.g. lining them up rather than using them for their actual function. Children may have a routine that they abide by, changes to the routine may cause the child to become upset and distressed. Children may appear to lack imagination in their thoughts and paly.

Children who have HFA tend to have fewer difficulties than children who function lower on the spectrum (may be non-verbal or have severe learning difficulties) with speech and are less likely to have coexisting learning disabilities. However children may still have learning difficulties such as dyslexia or attention deficit hyperactivity disorder (ADHD).

It is still unknown to what causes of ASD. Research suggests there are genetic and environmental factors that may have an impact on brain development, although research into the area of HFA is still ongoing.

The United Kingdom government have estimated that 1% of the population have autism spectrum disorder that is an estimated half a million people in the UK living with autism spectrum disorder. It is predicted that within this statistic the ratio of autism:high-functioning autism is 16:1. HFA is also found to be more common in boys then in girls, the reason for this is still unknown but it is predicted that girls are better at masking the characteristics of autism at a younger age by imitating others.

Similar to ASD the characteristics of HFA and severity of symptoms vary between children. Some characteristics children with HFA may demonstrate are:

Difficulty with social communication including:

• Expressing their emotions and feelings.
• Understanding body language.
• Understanding facial expressions and tone of voice.
• Understanding jokes, idioms, metaphors, sarcasm.
• Understanding everyday sayings such as “pull your socks up”.
• Literal understanding of language.
• Difficulty with conversational skills such as knowing when to start/end a conversation.
• Unawareness of conversational breakdown, repairing or maintaining a conversation.
• Difficulty choosing appropriate topics to discuss.
• Monotone in speech and lacking emotion.
• May have extensive vocabulary for their age and speak in complex sentences.
• May demonstrate difficulty in understanding other points of view in a discussion.
• May struggle to see multiple possibilities.

Children with high-functioning autism may find it difficult to deal with certain situations that may arise at school or in the home as they find it difficult to read the other people's body language and respond appropriately. For example, they may be unaware they have made a teacher angry as they have failed to pick up the teachers change in tone or frowning upon their face. Due to the lack of awareness the child may give an inappropriate response leading them to get into more trouble.

Similar to ASD the characteristics of HFA and severity of symptoms vary between children. Some characteristics children with HFA may demonstrate are:

Difficulty with social communication including:

• Expressing their emotions and feelings.
• Understanding body language.
• Understanding facial expressions and tone of voice.
• Understanding jokes, idioms, metaphors, sarcasm.
• Understanding everyday sayings such as “pull your socks up”.
• Literal understanding of language.
• Difficulty with conversational skills such as knowing when to start/end a conversation.
• Unawareness of conversational breakdown, repairing or maintaining a conversation.
• Difficulty choosing appropriate topics to discuss.
• Monotone in speech and lacking emotion.
• May have extensive vocabulary for their age and speak in complex sentences.
• May demonstrate difficulty in understanding other points of view in a discussion.
• May struggle to see multiple possibilities.

Children with high-functioning autism may find it difficult to deal with certain situations that may arise at school or in the home as they find it difficult to read the other people's body language and respond appropriately. For example, they may be unaware they have made a teacher angry as they have failed to pick up the teachers change in tone or frowning upon their face. Due to the lack of awareness the child may give an inappropriate response leading them to get into more trouble.

Difficulty with social interaction:

• Difficulty understanding social norms and social rules.
• Inappropriate behaviour in social settings and situations.
• Difficulty predicting others reactions, thoughts and behaviours.
• Lack empathy towards others.
• Difficulty making and maintaining friendships.

Children with high-functioning autism may struggle with making friendships as they could find it difficult to understand and join in with conversations and jokes made by their peers.

Unusual behaviours:

• Self-stimulatory behaviours (shaking, rocking, flapping).
• Experience hypersensitivity or hyposensitivity to any of their senses (touch, sight, smell, noise, taste).
• Children with HFA may have a limited range of interests which may develop to an intense and obsessive level.
• Difficulty in playing games where ‘pretending ‘is needed, may prefer games with rules, consistency and an end result.
• Difficulty in predicting what may happen next in a situation or envisioning an alternative situation or outcome.

Children may carry out repetitive self-stimulatory behaviours such as rocking back and forth, playing with their fingers, flapping their hands up and down. These behaviours may be used by the child as a way of calming down, dealing with stressful situations or stimulate their senses. These behaviours can also be sensory pleasing therefore they are occasionally carried out by the child for the pleasure they receive.

Children with high-functioning autism can experience hypersensitivity or hyposensitivity to their five senses, and therefore may have a strong like or dislike to particular foods, smells, textures, lights and sounds.

HFA can affect a child’s functioning on a day to day basis. As a result many aspects of a child’s home and school life can become challenging. Some difficulties shared by children with HFA are:

• Difficulty having conversations with others.

• Difficulty understanding concepts that don’t have logic such as love, time and religion.

• Difficulty making and maintaining friendships.
• Difficulty joining in with games.
• Difficulty with accessing the curriculum.
• Difficulty understanding non-verbal language on TV or in real life.

Speech, language and communication difficulties can make a child with HFA everyday functioning extremely problematic. A detailed assessment carried out by our speech and language therapist can outline these difficulties, to reduce the impact of these difficulties our speech and language therapist can create an individualised therapy programme.

Our speech and language therapist can provide detailed assessments on your child’s language and communication skills. Formal and informal assessments can be offered by our speech and language therapist for these difficulties:

• Attention and listening difficulties.

• Receptive language difficulties.
• Expressive language difficulties.
• Social communication difficulties.

Our speech and language therapist will provide you with a tailor made programme that caters to the needs and abilities of your child. As each child’s ability varies the assessments chose by therapists and the assessment procedure used (formal/informal) would vary according to each child’s skills.

To book an assessment with our speech and language therapist call 0330 088 2298.

Speech and language therapy can be beneficial for a child who has HFA. Our speech and language therapists can help develop social communication by developing conversation skills or by learning to read non-verbal language in others.

Our speech and language therapists main aim would be to improve your child’s language and communication skills and maximise their potential.

A child with high-functioning autism may have difficulties with reading the body language of others this can influence their behaviour within school as they may react inappropriately to staff and peers. A social skills intervention programme can help children to learn to look for cues in others that demonstrate how the other person is feeling.

Our speech and language therapist will collaborate with you and your child’s school to produce an individualised programme that works on your child’s needs and priorities. The programme will be developed using your child’s learning style and will include their interests and motivators.

Therapy options we offer are:

• Language development programmes.
• Social skills intervention.
• Advising training and supporting parents, carers and other professionals.
• Adapting the environment for the child.
• Individual therapy.
• Group therapy.
• Communication groups.

Speech and language therapy can help increase the ability of a child who has high-functioning autism to develop a better understanding of those around them and to create, maintain and develop new relationships with peers, friends and family. Our speech and language therapist can assess your child’s abilities at school and home to create a holistic individualised therapy programme that aims to work on their potential goals and concerns.

Some of those with high-functioning autism may identify as having Asperger syndrome. Asperger syndrome is similar to high-functioning autism, there is a lot of overlap between the two diagnoses as they will have difficulties with their social communication and interaction as well a restricted or repetitive behaviours or interests. Some of those that were diagnosed with Asperger syndrome may have had a co-existing learning disability or had an IQ lower than some of those with high-functioning autism.

Asperger syndrome has been removed from the DSM 5 (the criteria for diagnosis), meaning that the term is now classed as autism spectrum disorder. Many of those with Asperger syndrome now identify as high-functioning autism or continue to use the term Asperger syndrome.