Problems wrapping my head around this

[Noctivagus]

Noc, I ask you because you have been diagnosed with HFA, would I be Asperger's or HFA. I feel anxious and a bit stupid now because I feel that no one would agree with my diagnosis (here or rl) and it may be invalid anyway. I am like you, I like definites and for everything to be neatly categorised.

Please do not be anxious - and you are certainly NOT stupid. Benji and I have become involved in our debate and forgotten to think of others who might be more directly affected by this than we ourselves.

I cannot say whether you should have been DXed Aspie or HFA. It would be improper of me to say one way or another... I am not a clinician and even if I was... I am half a world away from you.

My position is that if a developmental spoken language delay is clinically significant, then I believe a DX of HFA should strictly be given... because in the DSM Aspergers specifies that there should be no clinically significant spoken language delay in the subject (I realise that the DSM is not perfect, but I agree with it here). It is the main thing that makes Aspergers peculiar to other forms of Autism at the High Functioning end.

I would say that your DX is NOT invalid in the least if it didn't take into account one detail between two very close positions on the same spectrum - it remains generally accurate and valid (not specifically, but generally... and on such a small point). We are talking about the finese of minutae here. In my position it is simply a matter of detail... and one minute detail does NOT invalidate a diagnosis that places you within the correct Spectrum.

For a minutist, Even I have to support the oft generality of diagnosis in every field.

For instance... for general purposes, I have Rheumatoid Arthritis. However RA requires a symetrical balance of affect between the two sides of the body. My Arthritis does not have that one thing. Strictly speaking, I should be said to have Rheumatoid TYPE Arthritis. One doctor says one and another says the other... almost on whim. In the end it matters not a single whit when it comes down to the correct treatment I am receiving.

If you think the specific DX of Aspergers is incorrect in detail as applied to you... the DX still entitles you to say you have an Autistic Spectrum Disorder... its what we all have, HFA, Aspie, LFA, PDD-NOS... ALL of us

[Noctivagus]

I haven't received answers, I've received opinions. It's kind of different.

And that attitude just goes to show how daft it would be to continue.

Of course opinions can be answers How good an answer an opinion is depends on how informed it is. This whole discussion and many other discussions between clinicians, scientists, politicians and artists, are all about opinions. Some well informed and some less well informed... some logical and some illogical... some objective and some subjective

ALL debate is between opinions, Benji. Otherwise there is NO debate.

I have sought to answer what you have asked. Now you claim they are not answers using a totally irrational and semantically twisted statement, based upon a misunderstanding of plain simple English. Little wonder we have failed to reach an understanding! I've been writing into the wind. Pointless.

What, dear Benji, do you think you have been spouting if not opinions?

[Noctivagus]

But I do hope it didn't distress anyone. I'd wager no one more than myself, anyway.

Good grief!

[SomethingElse]

What is your problem?

If you bothered to quote me properly you'd notice the emoticons. I was making a bit of a joke, in an attempt to make anyone who did feel distressed at all a bit better.

I get the point that you've taken a huge disliking to me, but I'd appreciate not being treated like an idiot for almost everything I say. I'm no more an idiot than you are. Turning nasty and making digs all the time just serves to make you look petty, rather than intelligent, I'm sorry to say.

I haven't received answers, I've received opinions. It's kind of different.

And that attitude just goes to show how daft it would be to continue.

Of course opinions can be answers How good an answer an opinion is depends on how informed it is. This whole discussion and many other discussions between clinicians, scientists, politicians and artists, are all about opinions. Some well informed and some less well informed... some logical and some illogical... some objective and some subjective

ALL debate is between opinions, Benji. Otherwise there is NO debate.

I have sought to answer what you have asked. Now you claim they are not answers using a totally irrational and semantically twisted statement, based upon a misunderstanding of plain simple English. Little wonder we have failed to reach an understanding! I've been writing into the wind. Pointless.

What, dear Benji, do you think you have been spouting if not opinions?

[/quote]

I haven't received answers, I've received opinions. It's kind of different. Unless you're interpreting my questions a different way, or I'm interpreting your answers a different way, because I have been looking out for them! But some of my questions (or at least one that I can think of right now) was genuinely looking for a definite answer). But not to worry, hopefully they will crop up at some point, or I could attempt to find the answers myself (google's not always very helpful but it's worth a try).

The two main questions:

1) Excluding language delay, what are the differences between HFA and Asperger's? This wasn't actually answered. Not with examples of behaviours or traits, which is what I was hoping for. This is actually asking for opinion, true, but...

2) If fitting the criteria for both HFA and AS, which takes precedence? Because you can fit the criteria for AS without fitting the criteria for Autistic Disorder (so you may still be autistic but...). This was the main one, which Renaeden also enquired about. I was hoping that someone might have a more solid idea.

[SomethingElse]

*Sigh* I have PMed Sophist asking for some constructive criticism. I am well aware that the problem may lie primarily with me. I do insist, however, that it honestly isn't intentional.

[Noctivagus]

1) Excluding language delay, what are the differences between HFA and Asperger's? This wasn't actually answered. Not with examples of behaviours or traits, which is what I was hoping for. This is actually asking for opinion, true, but...

Yes it was, as far as I could.

I do not claim to know everything... even within fields I consider myself an expert in... and this is not one of those.

There is a whole section of difference in the DSM diagnostic criteria (A whole section of the Autistic criteria is unnecessary for the Aspie DX)... I've already been through that right at the beginning of this - in great detail. However, as far as actual biological difference is concerned... it is a question I have spent time asking before. Spoken language delay is the big one, but the Doctor who diagnosed me said there were other differences... but did not specify them. I've been wondering about them ever since - as other threads here will testify.

2) If fitting the criteria for both HFA and AS, which takes precedence?

Neither. HFA does not take precedence over AS and neither does AS take precedence over HFA. EDIT: In terms of AS and Autism I guess AS takes precedence in the criteria because it does not permit something that is open in the other DX... dare I mention it again? Nope - lol OK... Developmental Delay in Spoken Language. The AS criteria in the DSM goes out of its way to disallow it. You might say that AS is HFA Minus and HFA is AS Plus. END EDIT.

If you bothered to quote me properly you'd notice the emoticons. I was making a bit of a joke...

Adding emoticons does not make something a joke if it wasn't in the first place... Removing emoticons does not alter what has been actually said - any joke would still have been obvious.

I get the point that you've taken a huge disliking to me, but I'd appreciate not being treated like an idiot for almost everything I say.

If I disliked you and if I thought you an idiot, do you think I would have spent any time discussing with you? It is true that you have descended in my estimation in the past few months (but that is nothing to do with any estimation of your intelligence), but I'm aware that I have done the same in your estimation also. EDIT: I do not permit this to discolour my conversations with you, though I do try and keep more of a distance.

[SomethingElse]

I am not continuing with this... I'm losing the will to live!

But... Comments (which can be jokes) are about context. For me, emoticons can make all the difference. No one else can tell me how I mean something. I do not understand why a joke (of which there are many kinds) has to be obvious without other signs to suggest it's meant in humour.

[Noctivagus]

I am well aware that the problem may lie primarily with me.

Don't hit yourself over the head with it. The problem is probably more mutual than that. We're like two flints sparking against each other - lol

[SomethingElse]

I PMed you an apology anyway, Noc. Possibly a long overdue one.

[Noctivagus]

I read it and replied.

I respect what you PMed and I think it was very big of you to do that. Not something I would have ever asked for or deemed necessary from you

[Noctivagus]

NB: The following is NOT part of the Debate but intended to simply be helpful.

Excluding language delay, what are the differences between HFA and Asperger's?

I just happen to have come across a very interesting article which will probably be of some interest, not only to Benji perhaps, but to me and maybe others here I list what appear to be the points made... however I do not necessarilly agree or disagree with any individual items. I've presumed a lot about HFA because of the context even though a lot of it is not spelled out in the articles - my 'whereas HFA does'-ing.

http://www.autism.org.uk/nas/jsp/polopo ... 049&a=3337

If I might summarise possibilities this article suggests (be aware I skimmed the first part of the article about the history of Autism recognition) - I am a bit shakey in my understanding is some of this and have been liberal in how I have taken what the article says in my attempt to understand it. It doesn't go into great detail, you see.

1) Aspergers Syndrome may possibly include some learning disability, whereas HFA does not. Both are Normal or high IQ.

2) Aspergers Syndrome may have poor fine motor skills and poor co-ordination, whereas HFA generally does not (I was definitely tested for fine motor skills and co-ordination for my DX).

3) Aspergers Syndrome has no significant delay in [spoken] language developement (but exhibits peculiarities), whereas HFA has significant delay in the development of [spoken] language. (They, like I often do, forgot the word 'spoken').

4) HFA can be diagnosed preschool whereas Aspergers Syndrome may only be able to be diagnosed after a child has attended school (up to 11 years according to Attwood) . I guess this means that Aspergers is less apparent before the school age... I guess that is likely if Spoken Language Delay plays a part in HFAs being discovered earlier.

That is my liberal paraphrase - I know it plays a little loose with the article's text.

* Both people with HFA and AS are affected by the triad of impairments common to all people with autism.
* Both groups are likely to be of average or above average intelligence.
* The debate as to whether we need two diagnostic terms is ongoing.
* However, there may be features such as age of onset and motor skill deficits which differentiate the two conditions.

It never ends... I've found another article... http://www.sacramentoasis.com/docs/8-22-03/as_&_hfa.pdf by Tony Attwood...

5) Aspergers Syndrome has no clinically significant delay in age-appropriate selfhelp skills, adaptive behaviour and curiosity about the environment whereas HFA does.

6) Aspergers Syndrome is less likely to include Stimming (I think that is what he means by motor mannerisms), whereas HFA is more likely to include it.

7) Aspergers Syndrome is less likely to include a preoccupation with parts of objects, whereas HFA is more likely.

8 ) A child with Aspergers Syndrome is more likely to try and socialize albeit in a one-sided and eccentric manner, whereas the HFA will more likely adopt self-isolation and rigid social approaches.

9) The signs of Aspergers Syndrome may be very subtle and easilly camouflaged and both home and school whereas HFA is more obvious. (Dr Searle when DXing me did comment twice how very obvious my Autism was).

Because of the question of precidence asked earlier, here's a quote from Dr Attwood...

Should the child's profile of abilities and developmental history be consistent with the criteria for both autism and Asperger's syndrome, the authors of the DSM state that a diagnosis of autism should take precedence.

And another interesting quote...

If one was to use the DSM criteria, Asperger's syndrome would be a very rare condition.

It is important for me to include Dr. Attwoods conclusion...

Having reviewed the literature, we may be able to answer the question, is there a difference between Asperger's syndrome and High Functioning Autism? The reply is that the research and clinical experience would suggest that there is no clear evidence that they are different disorders. Their similarities are greater than their differences. We appear to be taking, particularly in Europe and Australia, a dimensional view of autism and Asperger' syndrome rather than a categorical approach. (Leekam, Libby, Wing Gould and Gillberg 2000). At present both terms can be used interchangeably in clinical practice.

I disagree... however Dr. Attwood is by far the greater authority.

[SomethingElse]

Cheers, Noc. That was a very interesting read. I still haven't opened the second link because I haven't updated that programme on my computer so it can cause me some issues, but I'll definitely be having a look later. It'll give me something to think about, I'm sure.

[Noctivagus]

I still haven't opened the second link because I haven't updated that programme on my computer so it can cause me some issues, but I'll definitely be having a look later.

No updated Adobe Acrobat

Here's a Google HTML version link
http://216.239.59.104/search?q=cache:0e ... cd=6&gl=uk

Hope that helps

[SomethingElse]

I'm a lazy bum when it comes to updates and fixing things when they go wrong.

Eeyyy, cheers. That's a lot of reading.

[Sophist]

When it comes to the differences between AS and HFA by human definition (not what they are but are said to be) there is no single agreed upon trait. There is no agreement across the board that AS should be a separate diagnosis from HFA, although, by country, there are some generalizations one can make.

In the US and slightly less so the UK and Australia, more serious deficits in language are usually used to separate HFA from AS. This of course is poorly defined so it's inevitably up to the clinician as to what "serious" means. Many clinicians may also adhere to the DSM criteria, however they may also act upon the assumption that AS and HFA are not separate labels but variations of the same condition (the HFA study I'm assisting in now, while calling it an "HFA study"-- as in Autistic Disorder-- is willingly including Aspies as well because the researchers believe they are not different enough to separate). I should point out that, while it's called the Autism Spectrum, the DSM does not officially consider the two labels related; this is why the larger category is called Pervasive Developmental Disorders and not Autism Spectrum Disorders.

The UK and Australia, however, are more prone than the US is to diagnose based on current conditions rather than earlier development (although not all, as Noc can attest). So you will more likely see diagnosed Aspies who had language delay but were given the AS dx later on because they just seemed more like a stereotypical aspie than you would see in the US. I believe this tradition has sprung from researchers such as Lorna Wing and Tony Attwood who do not consider a language delay indicative of HFA. Dr. Wing also considers AS to be related to Autistic Disorder and not a separate label in the sense that the two are genetically unrelated but only share behavioral traits.

I think everybody here would agree (I assume) that HFA and AS are very related and lie on the same spectrum (at least WITHIN families). However, because of their relatedness and because each person is different from the next, I don't think there will ever be a quantitative, concrete means of differentiating the two because one blends right into the next and there are people in those border regions who are going to be candidates for both labels at the same time.

For instance, if you simply use "language delay", this does not take into account children who talked on time but whose communication had severe deficits. If you use the broader term "serious deficit in language" then there may be those auties who spoke a little late but began speaking in fullblown sentences and their language is no more lacking than an officially dxed aspie at that age. Also, it's very difficult to define all aspects of "serious deficit in language".

So, renaeden, I don't disagree with your diagnosis. While HFA and AS are so poorly separated, there's no STANDARD basis to retract your diagnosis of Autistic Disorder. Potata potota.