The Truth About "Acts of Violence" in People with Asperger's

Reports that some of the recent school shootings may have been committed by young people with Asperger's (high functioning autism) have led many to wonder whether the disorder plays a role in such acts of violence (e.g., the Adam Lanza case in which 20 children and six adults lost their lives at a Connecticut elementary school). 

Q & A on High-Functioning Autism: What Parents and Teachers Should Know

Why is this disorder referred to as “high functioning”?

High Functioning Autism (HFA), previously referred to as Asperger’s, is a term applied to children on the autism spectrum who are deemed to be functioning at a higher cognitive level (IQ>70) than other children on the spectrum.

Is there a difference between High Functioning Autism and Asperger’s?

The amount of overlap between HFA and Asperger’s is disputed. While some researchers agree that the two are distinct diagnoses, others argue that they are identical. On the other hand, the term HFA may be used by some researchers to refer to all autism spectrum disorders deemed to be cognitively higher functioning, including Asperger’s, especially in light of the removal of Asperger’s as a separate diagnostic from the DSM-5.

HFA is characterized by traits very similar to those of Asperger’s. The defining characteristic most widely recognized by professionals is a significant delay in the development of early speech and language skills before the age of 3. The diagnostic criteria of Asperger’s exclude a general language delay. Additional differences in traits between children with HFA and those with Asperger’s may include the following…

In contrast to those with Asperger’s, HFA children:

• are less empathic
• have a lower verbal intelligence quotient
• have better visual/spatial skills (higher Performance IQ) 
• have less deviating locomotion (i.e., clumsiness)
• have more curiosity and interest for many different things
• have more problems functioning independently

Also, the male to female ratio of 4:1 for HFA is much smaller than that of Asperger’s.

What are some of the other conditions that may coexist with HFA?

There are several comorbidities (i.e., the presence of one or more disorders in addition to the primary disorder) associated with HFA. Several of these comorbid symptoms are internalized within the child affected by HFA. Some of these include anxiety, depression, bipolar disorder, and obsessive compulsive disorder (OCD). In particular, the link between HFA and OCD has been studied. When observing the connection between HFA and OCD, both have abnormalities associated with serotonin.

Several other comorbidities associated with HFA are external. These external symptoms include ADHD, Tourette Syndrome, and criminal behavior. While the association between HFA and criminal behavior is not completely discerned, several studies have shown that the traits associated with HFA may increase the possibility of engaging in criminal behavior. While more research is needed, recent studies on the correlation between HFA and criminal actions suggest that there is a need to understand the attributes of HFA that may lead to violent behavior. There have been several case studies that link the lack of empathy and social naïveté associated with HFA to criminal actions.

Do we know what causes High Functioning Autism?

Although little is known concerning the biological basis of HFA, there have been many studies revealing structural abnormalities in specific brain regions of children with HFA when compared to typically developing children. Regions identified in the social brain include the amygdala, superior temporal sulcus, fusiform gyrus area, and orbitofrontal cortex. Additional abnormalities have been observed in the caudate nucleus, believed to be involved in restrictive behaviors, as well as in a significant increase in amount of cortical grey matter and atypical connectivity between brain regions.

What are some of the telltale signs that a child has HFA?

The main signs of HFA include the following:

• Insistence on routine: HFA children have an attachment to certain routines or rituals and demonstrate frustration when these can’t be accomplished.
• Language problems: HFA kids have difficulty understanding how others use language. For example, they have trouble comprehending metaphors, figures of speech, irony, humor and sarcasm. Also, the language spoken by others is taken in its literal form.
• Mind-blindness: HFA children have a lack of awareness of the emotions of others.
• Social awkwardness: Unlike other forms of autism, most children with HFA have the desire to interact with others, but do not have the ability to do so appropriately. A significant sign of the presence of HFA is the attempt to interact with peers, but in offensive or abnormal ways. These young people lack the ability to learn from the interactions of others or change their behaviors based on social cues given by others.
• In addition, HFA children have difficulty reading body language and other non-verbal information given off by others, and they may have inappropriate displays of emotion.

Why is HFA hard to diagnose in some children?

HFA is much harder to spot than regular forms of autism because the child can pass with limited problems due to his or her normal - or higher than normal - intelligence levels. However, there are certain things that can be looked for if the presence of this high functioning form of autism is suspected: Look for the child to have an intense passion about a couple specific topics, determine if he or she has the ability to engage in small talk, and watch for how he or she handles conflict – because if autism is present, the child will not handle conflict well.

How is a child diagnosed with this disorder?

A diagnosis is based on the physician's assessment of the youngster's symptoms in three areas:

1. Interests in activities, objects, or specialized information (e.g., playing with only a part of a toy or being obsessed with a particular topic)
2. Social interactions (e.g., lack of eye contact or an inability to understand another person's feelings)
3. Verbal and non-verbal communication (e.g., not speaking or repeating a phrase over and over again)

The physician may gather information about these areas by:

• Seeking a speech and language assessment
• Requesting physical, neurological, developmental, or genetic testing
• Observing the youngster's behavior
• Interviewing moms and dads and others who have frequent contact with the youngster
• Establishing the history of the youngster's development
• Conducting psychological testing

In addition, the physician may request tests to rule out other causes of the behavior (e.g., hearing problems).

Cases of HFA are typically diagnosed by 35 months of age (much earlier than those of Asperger’s). This may be due to the early delay in speech and language. While there is no standard diagnostic measure for HFA, one of the most commonly used tools for early detection is the Social Communication Questionnaire. If the results of the test indicate an autism spectrum disorder, a comprehensive evaluation follows and leads to the diagnosis of HFA. Some traits used to diagnose a child on the autism spectrum include a lack of eye contact, pointing, and severe deficits in social interactions. The Autism Diagnostic Interview-Revised and Autism Diagnostic Observation Schedule are two evaluations utilized in the standard diagnosis process.

Do all children with HFA have similar social-interaction styles?

There are two classifications of different social interaction styles associated with HFA. The first social interaction type is a “passive” style. This aloof style is characterized by the lack of social initiations and could possibly be caused by social anxiety. The second is an “active-but-odd” social interaction style classified by ADHD symptoms, poor executive functioning, and psychosocial problems. The difficulty controlling impulses may cause the active-but-odd social behaviors present in some kids with HFA.

How is High-Functioning Autism Treated?

HFA can be treated with a variety of therapies. Behavioral training is the primary method used to help HFA children overcome problems with social interaction. Here are therapies that are often used:

• Applied Behavior Analysis (ABA): This is a method of rewarding appropriate social behavior and communication skills. This method is based on the theory that rewarding behavior encourages it to continue.
• Cognitive Behavior Therapy (CBT): Treatment for HFA often involves addressing the individual symptoms. For example, to treat anxiety, the main treatment is cognitive behavior therapy. While this is the approved treatment for anxiety in general, it may not meet all the needs specifically associated with the symptoms of HFA, because there is little attention given to the parent's role in anxiety intervention and prevention. A revised version of cognitive behavior therapy has moms and dads and educators acting in a role as social coaches to help HFA kids and teens to cope with the issues they are facing. The involvement of the parent in the life of the youngster affected by anxiety associated with HFA is extremely valuable.
• Treatment and Education of Autistic and Related Communication Handicapped Children (TEACCH): This is a structured way of teaching communication and coping skills. The system uses the youngster's strengths in memorization and visual skills.
• Other treatments may be recommended based on the youngster's needs. These include: (a) speech and language therapy to help with communication and language development; (b) social skills therapy to work on language and social issues in the context of a typical group interaction; (c) physical or occupational therapy for assistance with motor skills; and (d) medications to treat obsessive behaviors, anxiety, inattention, hyperactivity, and depression.

Are there any techniques to help alleviate some of the symptoms associated with HFA?

While no single effective intervention exists for children with HFA, there are some proactive strategies (e.g., self-management) designed to maintain or change the child’s behavior to make living with HFA easier. Self-management techniques provide the child with the skills necessary to self-regulate his or her own behavior, leading to greater levels of independence. Improving self-management skills allows the child to be more self-reliant rather than having to rely on external sources for supervision or control. Self-monitoring is a framework, not a rigid structure, designed to encourage independence and self-control. A framework for self-monitoring may include:

• Setting goals and keeping them
• Identifying positive target behaviors 
• Establishing alternative behaviors that are constructive
• Establishing a self-recording sheet

The goal of self-monitoring is to have the child obtain the self-monitoring skills independently without prompting.

Online Parent Coaching: Help for Parents with Children on the Autism Spectrum