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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:

Interests in activities, objects, or specialized information (e.g., playing with only a part of a toy or being obsessed with a particular topic)
Social interactions (e.g., lack of eye contact or an inability to understand another person's feelings)
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

Antisocial Behavior in Aspergers Teens

Antisocial behavior is characterized by diagnostic features such as superficial charm, high intelligence, poor judgment and failure to learn from experience, pathological egocentricity and incapacity for love, lack of remorse or shame, impulsivity, grandiose sense of self-worth, pathological lying, manipulative behavior, poor self-control, promiscuous sexual behavior, juvenile delinquency, and criminal versatility among others. As a consequence of these criteria the antisocial individual has the image of a cold, heartless, inhuman being. But do all antisocial individuals show a complete lack of normal emotional capacities and empathy? Like healthy people, many antisocial individuals love their parents and pets in their own way, but have difficulty loving and trusting the rest of the world. Furthermore, antisocial individuals do suffer emotionally as a consequence of separation, divorce, death of a beloved person or dissatisfaction with their own deviant behavior.

Antisocial individuals can suffer emotional pain for a variety of reasons. Like anyone else, antisocial individuals have a deep wish to be loved and cared for. This desire remains frequently unfulfilled, however, as it is obviously not easy for another person to get close to someone with such repellent personality characteristics. Antisocial individuals are at least periodically aware of the effects of their behavior on others and can be genuinely saddened by their inability to control it. The lives of most antisocial individuals are devoid of a stable social network or warm, close bonds.

The life histories of antisocial individuals are often characterized by a chaotic family life, lack of parental attention and guidance, parental substance abuse and antisocial behavior, poor relationships, divorce, and adverse neighborhoods. They may feel that they are prisoners of their own etiological determination and believe that they had, in comparison with normal people, fewer opportunities or advantages in life.

Despite their outward arrogance, inside antisocial individuals feel inferior to others and know they are stigmatized by their own behavior. Although some antisocial individuals are superficially adapted to their environment and are even popular, they feel they must carefully hide their true nature because it will not be accepted by others. This leaves antisocial individuals with a difficult choice: adapt and participate in an empty, unreal life, or do not adapt and live a lonely life isolated from the social community. They see the love and friendship others share and feel dejected knowing they will never take part in it.

Antisocial individuals are known for needing excessive stimulation, but most foolhardy adventures only end in disillusionment due to conflicts with others and unrealistic expectations. Furthermore, many antisocial individuals are disheartened by their inability to control their sensation-seeking and are repeatedly confronted with their weaknesses. Although they may attempt to change, low fear response and associated inability to learn from experiences lead to repeated negative, frustrating and depressing confrontations, including trouble with the justice system.

As antisocial individuals age they are not able to continue their energy-consuming lifestyle and become burned-out and depressed, while they look back on their restless life full of interpersonal discontentment. Their health deteriorates as the effects of their recklessness accumulate.

Social isolation, loneliness and associated emotional pain in antisocial individuals may precede violent criminal acts. They believe that the whole world is against them, eventually becoming convinced that they deserve special privileges or rights to satisfy their desires. As antisocial serial killers Jeffrey Dahmer and Dennis Nilson expressed, violent psychopaths ultimately reach a point of no return, where they feel they have cut through the last thin connection with the normal world. Subsequently their sadness and suffering increase, and their crimes become more and more bizarre.

Dahmer and Nilsen have stated that they killed simply for company. Both men had no friends and their only social contacts were occasional encounters in homosexual bars. Nilsen watched television and talked for hours with the dead bodies of his victims; Dahmer consumed parts of his victims' bodies in order to become one with them: he believed that in this way his victims lived further in his body.

For the rest of us it is unimaginable that these men were so lonely -- yet they describe their loneliness and social failures as unbearably painful. They each created their own sadistic universe to avenge their experiences of rejection, abuse, humiliation, neglect and emotional suffering.

Dahmer and Nilsen claimed that they did not enjoy the killing act itself. Dahmer tried to make zombies of his victims by injecting acid into their brains after he had numbed them with sleeping pills. He wanted complete control over his victims, but when that failed, he killed them. Nilsen felt much more comfortable with dead bodies than with living people -- the dead ones could not leave him. He wrote poems and spoke tender words to the dead bodies, using them as long as possible for company. In other violent antisocial individuals, a relationship has been found between the intensity of sadness and loneliness and the degree of violence, recklessness and impulsivity.

Violent antisocial individuals are at high risk for targeting their aggression toward themselves as much as toward others. A considerable number of antisocial individuals die a violent death a relatively short time after discharge from forensic psychiatric treatment due to their own behavior (for instance as a consequence of risky driving or involvement in dangerous situations). Antisocial individuals may feel that all life is worthless, including their own.

Treatment Developments—

In the last decade, neurobiological explanations have become available for many of the traits of antisocial behavior. For example, impulsivity, recklessness/irresponsibility, hostility and aggressiveness may be determined by abnormal levels of neurochemicals including monoamine oxidase (MAO), serotonin (5-HT) and 5-hydroxyindoleacetic acid (5-HIAA), triiodothyronine (T3), free-thyroxine (T4), testosterone, cortisol, adrenocorticotropic hormone (ACTH), and hormones of the hypothalamic-pituitary-adrenal and hypothalamic-pituitary-gonadal axes. Other features like sensation-seeking and an incapacity to learn from experiences might be linked to cortical underarousal. Sensation-seeking could also be related to low levels of MAO and cortisol and high concentrations of gonadal hormones, as well as reduced prefrontal grey matter volume. Many antisocial individuals can thus be considered, at least to some degree, victims of neurobiologically determined behavioral abnormalities that, in turn, create a fixed gulf between them and the rest of the world.

It may be possible to diminish traits like sensation-seeking, impulsivity, aggression and related emotional pain with the help of psychotherapeutic, psychopharmacological and/or neurofeedback treatment.

Long-term psychotherapeutic treatment (at least five years) seems effective in some categories of antisocial individuals, in so far as antisocial personality traits may diminish.

Psychotherapeutic treatment alone may be insufficient to improve symptoms. Psycho-pharmacological treatment methods may help normalize neurobiological functions and related behavior/personality traits. Lithium is impressive in treating antisocial, aggressive and assaultive behavior. Hollander (1999) found that mood stabilizers such as divalproex (Depakote), selective serotonin reuptake inhibitors, monoamine oxidase inhibitors (MAOIs) and neuroleptics have documented efficacy in treating aggression and affective instability in impulsive patients. To date there have been no controlled studies of the psychopharmacological treatment of other core features of antisocial behavior.

Cortical underarousal and low autonomic activity-reactivity can be substantially reduced with the help of adaptive neurofeedback techniques.

Conclusions--

It is extremely important to recognize hidden suffering, loneliness and lack of self-esteem as risk factors for violent, criminal behavior in antisocial individuals. Studying the statements of violent criminal antisocial individuals sheds light on their striking and specific vulnerability and emotional pain. More experimental psychopharmacological, neurofeedback and combined psychotherapeutic research is needed to prevent and treat antisocial behavior.

My Aspergers Child: Help for Parents with Antisocial Children/Teens

Traits of ASD that May Influence Criminal Behavior

“I'm currently studying law and was wanting to know what some of the characteristic features are that predispose to criminal offending for teens with [high-functioning] autism?”

First of all, let me be clear that there is little to no evidence that teens on the autism spectrum engage in criminal behavior any more than the general population of similar age. Second, the following characteristics may apply to some “typical” teenagers, not just those with ASD:

1.   Social naivety and the misinterpretation of relationships can leave the autistic teen open to exploitation as a stooge. His or her limited emotional knowledge can lead to a childish approach to adult situations and relationships, resulting in social blunders (e.g., in the mistaking of social attraction or friendship for love).

2.   Overriding obsessions can lead to offenses (e.g., stalking, compulsive theft). Harshly reprimanding the teen can increase anxiety - and consequently a reflective thinking of the unthinkable that increases the likelihood of repeating the offense.

3.   Misinterpreting rules, particularly social ones, teens on the spectrum may find themselves unwittingly embroiled in offenses (e.g., date rape).

4.   Lacking motivation to change, these young people may remain stuck in a risky pattern of behavior.

5.   For those teens who have been traumatized by teasing, rejection, and bullying from their peer group, “revenge-seeking behavior” may become their method of establishing equality (i.e., to even the score).

6.   The teen’s tendency to misjudge relationships and consequences can result in a risky openness (i.e., dangerous self-disclosure) and the revealing of private fantasies which, although no more shocking than any teen’s, are best not revealed.

7.   Impulsivity, sometimes violent, can be a component of comorbid ADHD or of anxiety turning into panic.

8.   Difficulty in judging the age of others can lead the teenager into illegal relationships and acts (e.g., sexual advances to somebody under age).

9.   An innate lack of concern for the outcome can be problematic (e.g., an assault that is disproportionately intense and damaging). Young people on the spectrum often lack insight and deny responsibility, blaming someone else, which may be part of an inability to see their inappropriate behavior as others see it.

10.   An innate lack of awareness of the outcome can lead the teen to embark on actions with unforeseen consequences (e.g., fire-setting may result in a building’s destruction).

Many of the traits listed above affect the teen’s ability to make logical decisions, thus limiting his or her level of responsibility. Whether the teen is identified as an “offender” (as distinct from someone who has committed an offense) depends on chance factors in his or her environment (e.g., effectiveness of his/her supervision, the recognition of ASD and the understanding of those around.

Resources for parents of children and teens on the autism spectrum:

==> How to Prevent Meltdowns and Tantrums in Children with Autism Spectrum Disorder

==> Parenting System that Reduces Defiant Behavior in Teens with Autism Spectrum Disorder

==> Launching Adult Children with Autism Spectrum Disorder: Guide for Parents Who Want to Promote Self-Reliance

==> Teaching Social-Skills and Emotion-Management to Children with Autism Spectrum Disorder

==> Parenting Children and Teens with High-Functioning Autism: Parents' Comprehensive Handbook

==> Unraveling the Mystery Behind High-Functioning Autism: Audio Book

==> Crucial Research-Based Parenting Strategies for Children and Teens with High-Functioning Autism

==> Videos for Parents of Children and Teens with ASD

More articles for parents of children and teens on the autism spectrum:

Social rejection has devastating effects in many areas of functioning. Because the ASD child tends to internalize how others treat him, rejection damages self-esteem and often causes anxiety and depression. As the child feels worse about himself and becomes more anxious and depressed – he performs worse, socially and intellectually.

Click here to read the full article…

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Meltdowns are not a pretty sight. They are somewhat like overblown temper tantrums, but unlike tantrums, meltdowns can last anywhere from ten minutes to over an hour. When it starts, the Asperger's or HFA child is totally out-of-control. When it ends, both you and your child are totally exhausted. But... don’t breathe a sigh of relief yet. At the least provocation, for the remainder of that day -- and sometimes into the next - the meltdown can return in full force.

Click here for the full article...

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Although Aspergers [high-functioning autism] is at the milder end of the autism spectrum, the challenges parents face when disciplining a teenager on the spectrum are more difficult than they would be with an average teen. Complicated by defiant behavior, the teen is at risk for even greater difficulties on multiple levels – unless the parents’ disciplinary techniques are tailored to their child's special needs.

Click here to read the full article…

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Your older teenager or young “adult child” isn’t sure what to do, and he is asking you for money every few days. How do you cut the purse strings and teach him to be independent? Parents of teens with ASD face many problems that other parents do not. Time is running out for teaching their adolescent how to become an independent adult. As one mother put it, "There's so little time, yet so much left to do."

Click here to read the full article…

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Two traits often found in kids with High-Functioning Autism are “mind-blindness” (i.e., the inability to predict the beliefs and intentions of others) and “alexithymia” (i.e., the inability to identify and interpret emotional signals in others). These two traits reduce the youngster’s ability to empathize with peers. As a result, he or she may be perceived by adults and other children as selfish, insensitive and uncaring.

Click here to read the full article...

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Become an expert in helping your child cope with his or her “out-of-control” emotions, inability to make and keep friends, stress, anger, thinking errors, and resistance to change.

Click here for the full article...

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A child with High-Functioning Autism (HFA) can have difficulty in school because, since he fits in so well, many adults may miss the fact that he has a diagnosis. When these children display symptoms of their disorder, they may be seen as defiant or disruptive.

Click here for the full article...

Asperger’s and High-Functioning Autism: Do Symptoms Improve with Age?

Asperger’s (high functioning autism) is a lifelong developmental disorder, but ironically, most research studies on the disorder have been cross-sectional (i.e., they only provide a snapshot of what it looks like at a single point in time). Why?

Because following people with Asperger’s and HFA over long periods of time is expensive and requires a lot effort on the part of families and researchers, which is unfortunate since long-term studies are the only way to understand what early-life factors help some kids with the disorder do better than others over the long haul (something that can’t be assessed in cross-sectional studies).

Thanks to new statistical techniques, researchers can now group their study participants based on shared characteristics that unfold over time. A handful of long-term studies, each including up to several hundred participants, have now followed individuals on the autism spectrum for nearly 20 years. As the young people in these studies come of age, researchers are piecing together how the disorder progresses through the life span. Let’s look at a few of these studies (in no particular order):

Study #1: The researcher assessed cognitive skills in 37 kids on the autism spectrum and average IQ. She found that kids between 4 and 7 years of age who have the strongest “executive function skills” (i.e., skills required for planning and carrying out complex tasks) also have the strongest “theory of mind” (i.e., the ability to understand others’ thoughts and beliefs) 3 years later. The study suggests that improving executive function skills in kids with Asperger’s (HFA) may also yield benefits for “theory of mind.”
Study #2 showed that kids whose moms and dads are more engaged in their treatment early on have better verbal and daily living skills as teenagers. Unpublished data showed that the kids with the best outcomes (e.g., able to attend college with no extra support) all had moms and dads who had been involved in their treatment beginning at age 2 (this should not be interpreted as assigning blame to parents if their kids do poorly though).
Study #3 revealed that adolescence is a time of behavioral and symptomatic improvement for some Asperger’s and HFA teens; however, this improvement slows down around the time the teens leave high school. This may be in part because (a) the structure and routine of school is beneficial for these teenagers, and (b) these young people frequently lose access to services around the time they finish school.
Study #4 followed about 300 participants from age 2 to 21, and found that about 10% improved dramatically by their mid-teens. It should be noted that these young people tended to (a) start out with a high verbal intelligence quotient and (b) improve their verbal skills early on. This is supportive of other studies suggesting that language skills and IQ are the strongest predictors of a youngster’s outcome.
Study #5 was a longitudinal study that tracked 39 kids on the spectrum from about age 4 to age 19. Analysis of the data suggests that building “theory of mind” skills may help kids who start out with poor language skills overcome their deficits. These findings are typical of the way researchers are using longitudinal studies to analyze how changes in one area of development influence another.
Study #6: According to yet another study, most teenagers and grown-ups with Asperger’s have less severe symptoms and behaviors as they get older.

It has long been the hope of moms and dads with Asperger’s and HFA kids that the right care and support can reduce - or even reverse - some of the developmental problems associated with the disorder. But, while studies find that behavioral intervention programs are linked with improved social skills, the question of whether kids can technically “outgrow” the disorder remains difficult to answer. Studies to date that have hinted at this possibility are fraught with questions about whether the kids who apparently shed their autistic traits were properly diagnosed in the first place.

Who better to poll than the people who grew up on the autism spectrum? So, we asked a few young adults with Asperger’s to address the following question: “Was there a reduction in Asperger’s-related symptoms as you got older, or did things tend to get worse?” Here are their responses:

“Although the condition remains a constant certainly, the expression can change over time. At times, I might seem quite neurotypical (albeit shy) and at other times....well, the opposite. From my own personal observation, I have days when I really seem to "read" others better and other days are not. Certainly I've had really rough periods, but inside I am still the same.”

“Asperger's is actually supposed to get easier to manage as the person gets older. This isn't to say, however, that big set-backs can't happen. The truth is that they WILL happen. I have improved overall since my teenage years, but this 'improvement' has brought with it two suicide attempts and many really low moments too.”

“For me, when under stress I'm just not able to put in the effort to initiate my coping mechanisms. Some of them are automatic (e.g., blocking out too much sensory input) and fail when I'm under stress. The net effect is my autistic nature affects me worse - it's not that I'm any more autistic, it's that my coping strategies aren't working.”

“From my experience I have gotten more aspergery every year since 16 years old, however I got less every year from 11-16, which was high school. So the high school environment must have made me much more NT, almost certainly because I was in a group of NT guys the whole time. Now as I get older the differences become increasingly apparent and it's increasingly harder to relate to people and to tolerate society. A lot of things changed around, for example when I was young I used to collect rocks and I was much more verbose for my age, now I find it harder to relate to people though and I have more social anxiety. I'm sure AS traits will continue to switch around as I grow. I think a part of it is the people you have in your life and the way you see yourself.”

==> Launching Adult Children with Asperger's and High-Functioning Autism: Guide for Parents Who Want to Promote Self-Reliance

“I don't necessarily think your Aspergers gets worse as you get older, or better for that matter. The things you're doing and the skills you've learned can either help you manage your condition, or make things go out of control. Stress fluctuates, and stress/anxiety makes our coping mechanisms less effective. So, sometimes, it looks like we're getting worse as we get older because there are life changes that are very stressful... spouse, kids, home, job, etc. The longer you work, the more "upper level" you are generally expected to become, so you get promoted into a job that has more social interaction.”

“I don't think it is a matter of AS getting worse (at least in my case), so much as comorbidities and just plain life making it harder to compensate for. It's tough to do anything when you also have to deal with depression or anxiety. I know that during the very stressful times in my life, it was extremely hard to deal with the negative effects of AS on top of it all. Changing jobs, graduating, recuperating after a bad relationship, etc. I found that my ability to compensate and adapt could at times drastically decrease.”

“I think I have improved some things over the years what are related to my disability, for example I am better at handling my special interests at a ''safer'' level. By that I mean when I was aged 13-15, I got obsessed with some local people who lived next door to my cousin. I started this obsession, and got to a point where I tried getting really involved in their lives (in other words, stalking), and it got too ''freaky'' for them (plus they had a baby), so they went to the police station and reported me. The obsession got so out of hand, and I went on about this couple to people at school - who got so fed up with me that I did lose a lot of friends because of it. Now I am obsessed with some people who I didn't know before (these are bus-drivers), but they don't know it. So I have learnt to keep my obsessions under control more - which is one improvement. I'm proud of myself there.”

“I would have to say it is up to the individual. Though technically Aspie symptoms are supposed to get better with age, your will to constantly struggle with it can weaken. Some Aspies choose to give up and seclude themselves and with no social interaction to keep your symptoms in check. And some Aspies are perfectly content like this… it's all about what makes you happy.”

“In some ways it seems like I’m getting more autistic as I get older, and in other ways less. My autistic traits have mostly just moved around, and in some cases just show up differently. As a kid I didn't stim much, at least not noticeably. Now I stim A LOT. But I’m more tolerant of certain sensory things... My social abilities have improved a little as I’ve gotten older and learned things, and I’ve gotten more outgoing around people. So, I talk more sometimes, but that means that I'm more likely to make mistakes in socializing and that my special interests are more obvious to other people. When you're an adult there's more stuff expected of you than when you're little, so my problems with life skills are more apparent now.”

“It doesn't get worse, but it may seem like it does because there is the anxiety and the depression. Depression makes your AS symptoms worse. It's just an illusion.”

“I've found myself becoming more isolated as time goes on. I think in school you have friends (often with similar traits) but once you leave, your true nature slowly takes control. If you are stressed or don't like being around people much, then you will inevitably find solitude. I'm not sure if things have gotten worse regarding my aspie traits or if I'm just more aware of what they are.”

“I've had some 'worsening,' but it's not been like a path back to where I was when I was younger. It's just different. Even though I have cognitive losses, I still have what I learned when pushing myself hard to interact with people. As a teen, I found interacting even with store clerks to be terrifying, but I eventually learned how to deal with it, and it remains not-a-very-big-deal, today. And, I can still even manage short bursts of small talk (though it is still exhausting).”

“Periods of high stress definitely regress my symptoms, my obsessions become more intense and impulsive behaviour harder to control. You lose those management skills developed over many years. I would say yes, your AS can appear to deteriorate (get worst) during periods of high stress throughout life.’

“Stress is my culprit. All of the coping strategies I've learned over the years shut down systematically as stress increases. Verbal communication is the first to go... I do not desire it, I shy away from it to the point I finally don't bother to speak at all. Meltdowns start to increase. Auditory problems seem to get more sensitive. One by one, it seems to be getting worse. But, if I can eliminate the stress, my ability to cope increases. I don't think there is any literal change in my challenges, only my ability to deal with them.”

In working with clients on the autism spectrum over the years, it has been my experience that many of these individuals do not get worse over time. In fact, it often gets somewhat better with time as they learn some coping skills that they lacked earlier in life. Most people with Asperger’s and HFA tend to gain these skills by default as they age (the concept of “the longer you live, the more you learn”).

Having said this, there does seem to be a period of time (lasting about 5 – 10 years) post high school where there is an increase in symptoms (e.g., anxiety, depression, isolation, etc.). As suggested in the information above, this may be due to (a) the loss of structure provided by regularly attending school, and/or (b) the absence of frequent association with “typical” peers. But, by the time these young adults reach their mid-to-late 20s, many find that the accumulation of life experiences has helped lessen some their (unwanted) Asperger’s-related symptoms.

However, the exception to this (again, based on my practice) seems to be those who are unemployed, not attending college or some other form of continuing education, and still living with their parents. This suggests that being insulated from the community (i.e., isolation) exacerbates the symptoms - and possibly stunts emotional growth due to the lack of ongoing, multifaceted life experiences.

More resources for parents of children and teens with High-Functioning Autism and Asperger's:

==> How To Prevent Meltdowns and Tantrums In Children With High-Functioning Autism and Asperger's

==> Parenting System that Significantly Reduces Defiant Behavior in Teens with Aspergers and High-Functioning Autism

==> Launching Adult Children with Asperger's and High-Functioning Autism: Guide for Parents Who Want to Promote Self-Reliance

==> Teaching Social Skills and Emotion Management to Children and Teens with Asperger's and High-Functioning Autism

==> Parenting Children and Teens with High-Functioning Autism: Comprehensive Handbook

==> Unraveling The Mystery Behind Asperger's and High-Functioning Autism: Audio Book

==> Parenting System that Reduces Problematic Behavior in Children with Asperger's and High-Functioning Autism

References:

•    Anderson D.K. et al. Am. J. Intellect. Dev. Disabil. 116, 381-397 (2011)
•    Bennett T.A. et al. J. Can. Acad. Child Adolesc. Psychiatry 22, 13-19 (2013)
•    Georgiades S. et al. J. Child Psychol. Psychiatry 54, 206-215 (2013)
•    Gotham K. et al. Pediatrics 130, e1278-e1284 (2012)
•    Green S.A. et al. J. Autism Dev. Disord. 42, 1112-1119 (2012)
•    Pellicano E. Autism Res. Epub ahead of print (2013)
•    Smith L.E. et al. J. Amer. Acad. Child Adolesc. Psychiatry 51, 622-631 (2012)