High-Functioning Autism and Asperger’s: The Importance of Early Identification and Intervention

Early identification and intervention are considered key to positive outcomes for kids with High Functioning Autism (HFA) and Asperger’s (AS). In order to reach all children on the autism spectrum, moms and dads, teachers, school psychologists, mental health professionals, and doctors need to work together to become better informed regarding the best proactive interventions to increase social skills, personal communication, behavior, and peer interaction. They also should be knowledgeable about assessment tools, diagnostic criteria, and current research.

The 3 major benefits of early identification and intervention:

1. The lifetime societal cost of autism spectrum disorders, including care and lost productivity, has been estimated at $3.2 million per youngster, with health care expenditures increasing sharply (142%) over the last five years. Thus, it is crucial to the child, the parents, and even to society that we improve our efforts at early detection and access to early intervention in order to attempt to lessen the impact of the challenges associated with HFA.

2. Diagnosing HFA as soon as possible gives parents some answers they are seeking to their questions about their youngster’s “abnormal” development. This allows them to begin the process of learning about HFA, understanding its effects on their youngster, and beginning the process of perceiving the future differently.  It allows parents to replace worry and fantasy with solid information about the nature of their youngster’s strengths and weaknesses.  For many moms and dads, receiving a diagnosis allows them to move from unfocused worry to mobilized efforts to learn about the disorder, to find help for their youngster, and to move into some action plan. This mobilization is often a source of relief from some of the anxiety they experience as they move through the screening process.

3. HFA kids have a different learning profile pattern of relative strengths and weaknesses than do “typical” kids.  Thus, it is not surprising that young people with HFA learn most rapidly when they receive unique teaching and curriculum approaches built for their distinctive learning profile. The methods for teaching these students contain elements that are not seen in early intervention approaches for students with other kinds of disabilities.  Specifically, there is more focus on direct instruction, higher levels of structure, higher numbers of intervention hours per week, and lower student-to-educator ratios than are typically seen in early intervention services in most communities for kids with other developmental issues.  A number of studies have documented better outcomes for young kids with HFA who receive intensive and specialized treatment as early as possible.  Some of these studies have demonstrated considerable IQ and speech gains and much better functioning in elementary school for those receiving intensive and specialized intervention by age 3. Thus, earlier diagnosis allows the most appropriate treatment to be selected and delivered.

HFA impacts normal development of the brain in the areas of social interaction and communication skills. The disorder makes it hard for the affected child to communicate with others and relate to the social world. In some cases, aggressive and/or self-injurious behavior may be present; however, internal behaviors (e.g., withdrawal, depression, anxiety, eating disorders, and social isolation) may be just as prevalent. Thus, a team of professionals should be making an informed diagnosis to ensure that appropriate supports, accommodations, medications, and systems are in place to provide an appropriate public education in the least restrictive environment.

HFA is not a disease, rather it is a neuro-biological difference in brain functions. Symptoms of HFA are usually recognized during the first three years of childhood; however, it is often not diagnosed until the preschool or elementary school years. Moms and dads frequently begin to suspect that there is something wrong before the age of two. Many kids who are diagnosed at a very young age with Attention Deficit Disorder may, in fact, have HFA.

The early symptoms of HFA and AS that parents and teachers should be looking for:
  • A general lack of fear may be evident. Kids with HFA may talk openly with strangers, hug strangers, invade people's personal space, bump into peers in lines, touch or climb people inappropriately, or have excessive - or a complete lack of - separation anxiety from the parent.
  • Children on the autism spectrum often struggle to understand why they are not liked and frequently feel rejected.
  • Blurting out, excessively asking the same question over and over, echoing or mimicking, large vocabulary, or difficulty listening to another and understanding another perspective can be apparent.
  • An unusual tone or quality, rote or repetitive speech may present.
  • An extreme perfectionism or "having to finish" what they have started, to the point of tantrums, may be evident especially during unexpected or unwanted transitions.
  • Children with HFA tend to rely heavily on rigid internal rules and struggle with the unwritten social rules of social interaction.
  • Communication may not appear to be delayed, but comprehension and social language requiring give-and-take may be lacking.
  • Establishing friendships, with give-and-take interactions, may be lacking. 
  • Given that characteristics of HFA may include a lack of fear, too little or too much eye contact (which can appear as overly aggressive, threatening, or seductive) combined with a hindrance in the ability to judge another person's feelings or intentions accurately, females with HFA may be at increased risk for assault, abuse and violence. Many of these girls assert that they have been singled-out or picked on mercilessly due to their odd behaviors or not “fitting in.” Many teenage HFA girls are literally “disabled” when it comes to surviving the more sophisticated social complex of adolescent female society.
  • HFA is typically characterized by sensory processing difficulty, rigid need for rules and routine, poor social skills, poor social communication, perseverative thought processes, pedantic speech, lack of eye contact, average to above average intelligence, anxiety, and depression.
  • These kids may interact very well with grown-ups, but struggle with appropriately initiating peer interaction. Sometimes, these kids do not notice if a playmate loses interest, or even wanders away.
  • They may not have an interest in sharing toys and tend to be viewed as "lost in their own little world" at times. 
  • Kids who are overly reactive to crowds may appear uncomfortable or avoidant of cafeterias, malls, gymnasiums, parties, family gatherings, or theaters. In reaction, they may feel hot, get a stomach or headache, or resist going to such places.
  • Kids with HFA are limited in brain areas that enable them to understand subtle, non-verbal cues. 
  • These young people are often highly intelligent and appear capable of communication – they just don't do it well. 
  • They develop a tendency to distrust others due to “social failures” and negative social experiences over time, which can lead to self-isolation and social phobia. This behavioral reaction may be viewed as "rude" by others.
  • HFA kids may appear to play next to – but not with – others.
  • They may become extremely upset if their routine or ritual is changed in any way, and can become very upset if someone touches their things, moves furniture or toys around, or takes a different driving route to or from school.
  • Kids with HFA may display a very narrow or an unusual range of interests, with elaborate or unusual play-based behaviors.
  • They may exhibit and excessive desire or intense aversion to sensory input.
  • Misunderstandings, literal interpretation, and/or sensory over-stimulation can lead to over-reactions, irritability, a low frustration tolerance, tantrums, aggressiveness, an explosive temperament, self-stimulation, anxiety, depression, and self-injury.
  • They may act out elaborate rituals, which appear to be creative play, but are actually scripted activities without the variation or creativity of imaginary play.
  • They may appear hyperactive, and pursue movement to an excessive degree, or they can appear unresponsive or “flat” if overwhelmed by sensory input or movement. 
  • They may appear to never be able to "let it go," and tend towards appearing argumentative or "splitting hairs." A conversation can lead to tantrums, emotional meltdowns, or withdrawal with seemingly little provocation. 
  • They may appear very rigid in their point of view, and unable to accept or understand another's perspective.
  • Most HFA children are affected by smells, tastes, textures and heat.
  • Motor clumsiness or fine motor difficulties may be present, and intuitive physics may be higher than intuitive psycho-social abilities.
  • Non-verbal communication (e.g., posture, gestures, eye contact, facial expression, tone, etc.) are clues in revealing emotions, attitude, personality and relationships. This helps guide the interpretation of how another feels leading to an empathetic awareness or understanding of others. This empathetic understanding can be limited in a child with HFA.
  • The unwritten social rules seem to be confusing, and interpreting social comments, facial expressions, tone of voice, or body language can be similar to trying to interpret a foreign language.
  • The HFA youngster may be able to dismantle and recreate elaborate Lego designs, set a clock, reprogram a VCR, match shapes, or display artistic and musical talents.
  • Stereotypical movements (e.g., spinning, flapping, lining things up, toe walking, body rocking, grimaces, twirling, pacing, racing around, noisemaking, leg bouncing, clearing of the throat, verbal repetitions, and chair rocking) may be more pronounced and frequent during periods of stress or change/transitions.
  • Some may have an unusual or extreme response to sounds and cover their ears in response to vacuum cleaners, hair dryers, crying babies, sirens or other loud or unexpected noise.
  • Some children with HFA demonstrate extreme abilities in remembering facts, numbers, phone numbers, maps, words, birth dates, or other factual information. 
  • Parents may notice a lack of eye contact and social smiles, or they may observe too much eye contact and notice that their HFA youngster views people as interesting to observe, but not necessarily to interact with or seek recognition from.
  • They may be very rigid and insist on doing things the same way every time.
  • They may demonstrate fixations on things (e.g., Pokémon, television shows, computer games, numbers, trains, cars, etc.) and tend toward lining things up, organizing by color, or even repeating lines verbatim.
  • HFA kids may have a greater interest in sensory and physical play with others (e.g., tickling, hugging, piggy back, chasing, video games, fantasy play, repetitive watching of movies, reading books, etc.) to the exclusion of verbal exchanges.
  • Many of these children may have problems falling asleep, or staying asleep.

==> Preventing Meltdowns and Tantrums in Asperger's and HFA Children

HFA is a developmental disorder. The term “developmental delay” is an important one in early intervention. Generally speaking, it means that the youngster is delayed in some area of development. There are five areas in which development may be affected: 
  1. Adaptive development
  2. Cognitive development
  3. Communication development
  4. Physical development, including vision and hearing
  5. Social or emotional development

Kids born with HFA or any other type of developmental delay are at risk for falling behind in their educational potential. The earlier a youngster receives services to address the symptoms of HFA, the more time there is to influence positive learning outcomes. The parent’s full commitment and involvement in an early intervention plan is vital to the success of the youngster.

If your child has a developmental delay, he or she may be eligible for early intervention services. Those services will be tailored to meet your child’s individual needs and may include:
  • Physical therapy
  • Audiology services
  • Psychological services
  • Speech and language services
  • Occupational therapy
  • Nutrition services
  • Counseling and training for a family
  • Medical services
  • Nursing services
  • Assistive technology

HFA is life-long, and there is no quick fix or cure. However, early diagnosis and effective treatments can provide for better outcomes for kids on the autism spectrum. Thus, one of the first things that should happen if you suspect that your child may have HFA is to have him or her evaluated.

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