High-functioning Autism: The Difficulties of Managing HFA Symptoms

People with autism who have low support needs (previously called high-functioning autism or Asperger's syndrome) may not need as much support as other autistic people; however, they may still find some day-to-day activities a challenge. Since autism is a spectrum disorder, this means people have a wide range of needs and abilities.

Autistic adults and children with low support needs share traits that can lead to differences with their neurotypical peers. These include experiencing sensory overload, not understanding social cues, and difficulty controlling emotions.

This article discusses the common challenges for autistic people with low support needs.  

What Is High Functioning Autism?

Autism with low support needs describes what was once known as high-functioning autism (HFA), an unofficial term used for people whose autism traits appear mild. The official diagnostic term is autism spectrum disorder (ASD) level 1.

Is Asperger's the Same as HFA?

Asperger's syndrome is no longer used as a diagnosis or a way to categorize autism.1

In the past, people who were told they had "Asperger’s” had some features of autism but had an average or higher-than-average IQ and age-appropriate language skills. 

Asperger's was removed from the Diagnostic and Statistical Manual of Mental Disorders in 2013 when the fifth edition (DSM-5) was published. Now, people with autism labeled as “high functioning” are usually diagnosed with Level 1 ASD.2

Today, the severity of autism spectrum disorder is described by a level from 1 to 3, based on how much support a person needs:

• Level 1 requires some support.
• Level 2 requires substantial support.
• Level 3 requires very substantial support.

People with autism now are evaluated and described on the basis of these support needs rather than a level of function. In the autism community, functioning labels are discouraged because they can be misleading. A person can be able to function independently in some areas but require significant support in other areas.

People labeled as high-functioning can often have significant needs that are overlooked. It's preferred to describe people in terms of their support needs rather than function.

Educators and professionals should be made aware of the invisible challenges for autistic people with low support needs. These include sensory issues, emotional regulation, social skills, executive functioning, verbal communication, and mood disorders.

It’s also important to remember that autistic children with low support needs grow into adults with low support needs. Even adults with ASD-1 who are mostly independent can still have support needs. 

Symptoms of High-Functioning Autism

The symptoms of autistic adults and children with low support needs vary but generally fall into certain categories.2

• Experiencing sensory overload
• Having trouble figuring out or picking up on social cues
• Anxiety or mood disorders
• Challenges with organization
• Difficulty controlling emotions
• Differences in verbal communication
• Challenges with back-and-forth conversation
• Trouble with social relationships
• Repetitive actions and self-stimulating behaviors (stimming or stims) 
• Limited interests
• Highly sensitive

Some people with high-functioning autism only experience mild challenges in their lives because of these symptoms. Others find that these symptoms make certain aspects of their lives, like socializing and work, more difficult to undertake without help. 

Sensory Differences

Many autistic people have sensory processing disorder, which is also called sensory overload.3

Noise, crowds, bright lights, strong tastes, smells, and being touched can all be unbearable to a person with HFA.

Activities like going to restaurants, movies, and shopping malls can be difficult or even intolerable for people who experience sensory overload. Relatively simple acts like putting on socks or being hugged can be also challenging for someone with sensory processing differences.

These sensory differences are not something that an autistic person will outgrow. If an autistic person had sensory sensitivities as a child, they’ll still have them as an adult. 

However, they may learn coping strategies that make them a little easier to navigate. For example, some people with autism learn to tolerate sensory challenges in their environments by using skills they learn in sensory occupational therapy.

Social Awkwardness

People with HFA can have a hard time recognizing social cues and body language.4

National Institute of Mental Health. Autism Spectrum Disorder.

People with HFA may find interacting with others confusing or challenging because they have a hard time:

• Understanding appropriate greetings
• Knowing when to let someone else talk
• Regulating the tone and volume of their voice

Social awkwardness can be a major obstacle to making friends, finding and keeping a job, and dating for autistic people.

Anxiety and Depression

Anxiety, depression, and other mental health conditions are common in people with autism, including people who have been labeled “high-functioning.” In fact, studies suggest that people with HFA are more likely to be diagnosed with a mood disorder than the general population.5 

It’s not clear why these disorders are connected. Some researchers think autism and mental health conditions could have certain things in common, like genetics or environment. It’s also possible that the social rejection and discrimination autistic people face lead to anxiety and depression. 

Executive Planning Challenges

Executive functioning is a term for the skills people use to organize and plan their lives. This includes tasks like making and sticking to schedules or following a timeline to complete a long-term project.6

Many people with HFA have trouble with executive functioning. They may face challenges in caring for things in their living space (like chores and grocery shopping) and have a hard time coping with even minor schedule changes at school or work.

Emotional Dysregulation

People with autism can feel extreme emotions. They may appear to overreact in some situations yet under-react in others.7

When something unpredictable happens, it can be hard for an autistic person to control their response because the change makes them feel strong emotions. The transition from one setting or activity to the next can be challenging for them to get through. 

For example, a person with high-functioning autism may burst into tears if there's an unexpected change in plans or get agitated if their routine is thrown off.