A review of:Kuusikko, S., Pollock-Wurman, R., Jussila, K., Carter, A.S., Mattila, M., Ebeling, H., Pauls, D.L., Moilanen, I. (2008). Social Anxiety in High-functioning Children and Adolescents with Autism and Asperger Syndrome. Journal of Autism and Developmental Disorders DOI: 10.1007/s10803-008-0555-9

When I first picked up this article I was excited because it seemed to directly address a clinical feature that some researchers and many clinicians have used to differentiate children with High Functioning Autism vs. Children with Asperger’s. We know that technically, based on DSM-IV diagnosis, the main difference between HFA and AS is the presence or absence of language delays. Kids with HFA, by definition, experience language delays, while kids with Asperger’s have typical language development. But in all clinical settings I have practiced, we have discussed other possible differences between these kids, specifically in regards to their neuropsychological profile and the nature of their limited social interaction with other peers. As for neuropsychological profile, HFA tend to have even verbal vs. non-verbal skills, while children with AS tend to have much higher verbal than non-verbal skills, consistent with the profile of children with “non-verbal learning disabilities”. In regards to their social interactions, in my clinical experience and interaction with colleagues, we see a difference in their ‘relative’ need for social companionship. In general children with HFA seem to just want to be by themselves without an explicit desire to interact with peers. They interact when necessary and when such interaction is functional, but not for the “intrinsic joy” of having social interactions. On the other hand, children with AS tend to desire close relationships with peers and explicitly talk about wanting more friends, but their social uniqueness make the establishing of such relation more difficult. Based on this last apparent clinical difference, you would expect that children with AS would experience more social anxiety due to a relative high need for social acceptance as compared to children with HFA. To test these hypotheses, a group in Finland compared 35 kids with AS, 21 kids with HFA (diagnosed via ADI and ADOS), and a large group of 353 typically developing kids of the same age (8-16 years old). The results were surprising: There was NO difference between the AS and the HFA in anxiety, social anxiety, social phobia, etc. As a group, the children with HFA/AS experienced higher level of anxiety and social phobia than the typically developing children. Furthermore, a developmental trajectory was observed. The anxiety problems tended to decrease with age in typically developing kids, but these problems increased with age in the children with HFA/AS. In summary, the data suggest that children with AS and HFA experience the same levels of social anxiety and phobias, which does not support the clinical view that these children may differ in regards to relative levels of social desirability.
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6 Responses to High Functioning Autism vs. Asperger’s: You say tomato I say tomahto

  1. “We know that technically, based on DSM-IV diagnosis, the main difference between HFA and AS is the presence or absence of language delays. Kids with HFA, by definition, experience language delays, while kids with Asperger’s have typical language development.”

    Interesting commentary.

    I have always been puzzled by some persons, purportedly with Autism Disorder, who can speak and express themselves orally without difficulty who are diagnosed, once they are adults, as autistic. Would the absence of language delays mean they are actually likely, by DSM criteria, to have AS? Or is that line also blurred between HFA and AS categories?

  2. Hello H. If we go by DSM-IV alone, language functioning as an adult would not help differentiate between HFA and AS. It is “a history of typical vs. delayed language development” that makes the difference. Thus, an adult with very well developed language functioning would be diagnosed with HFA if there was clear evidence of language delay during early childhood. This can be something as simple as a parent reporting that the adult offspring did not start talking until he/she was 4 years old. Now, if there is evidence of typical language development (talking before 24-30 months), then a AS diagnosis is more appropriate. Nestor.

  3. Thanks for that clarification Nestor.

  4. Jen P says:

    “while children with AS tend to have much higher verbal than non-verbal skills”

    Our child who is 4yo has Aspergers, yet his nonverbal IQ is 146 (99th percentile) while his verbal IQ was closer to the 50th percentile. How can that be explained based on your knowledge of AS?

  5. Dear Jen, thank you for your comment. As I mentioned, children with Asperger’s ‘tend’ to have higher verbal than non-verbal skills. This is not a profile that is consistent with 100% of children diagnosed with Asperger’s. Such variability is common, and that’s why cognitive profile is not used in the diagnostic criteria. Thank you again for your comment, and congrats, you certainly have a very smart kid! Nestor.

  6. BCC says:

    I’m really confused. My 4y 9m old daughter was just diagnosed with Asperger’s by her pediatric neurologist. I personally thought she’d get an HFA or PDD-NOS label because she initially did have a language delay. She tests in normal range, but her pragmatic speech/conversational skills aren’t good. I don’t know if this makes enough of a difference in terms of services that I should press the point, but it just doesn’t seem correct.

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