Beyond Stereotypes: Understanding Atypical High-Functioning Autism in Children and Young Teens

As a doctoral pediatric psychologist with a specialization in pediatric neuropsychology, I am frequently asked by legitimately concerned parents, “Do you think it might be Autism?”

And sometimes it is.  And many times, it’s not.

Let’s face it. As we learn more about a condition and it begins to take on more significance in society, two things occur. 

One occurrence is children and young teens who never would have been correctly identified finally get the care and supports they need and deserve.

The second occurrence is children and teens are incorrectly diagnosed as having this condition and might receive incorrect or even inappropriate care.

Complex conditions are not as simple as a regulatory “cut score” on one “mandated” psychological test and a rating scale. Nor are correct diagnoses made by giving a plethora of psychological assessments until you get what you’re looking for.

Clinical correlation based on your child’s doctor’s training and experience and their willingness to “leave no stone unturned”, to observe, and to listen are critical elements in both the sensitivity and specificity of your child’s diagnosis and subsequent treatment.

It is my hope that the parents who trust their children in my care respect this.

The term “neurodiversity” is very popular. But neurodiversity in all its nuanced presentations is complicated.

Genetics, neurodevelopment, medical history, social influences, experiences and environment all must be factored in our understanding of neurodiversity.

When we hear "autism," in children and teens, many folks conjure a specific image. However, the autism spectrum is incredibly diverse, and one fascinating, often misunderstood, presentation in children and young teens is “atypical high-functioning autism”.

This isn't your typical portrayal and understanding of what everyone calls “the spectrum”.  But it sheds amazing light on the rich tapestry and complexity of our human neurology.

Imagine a young teen with intellectual skills comfortably above average. They might possess a truly remarkable memory, recalling facts, figures, or entire conversations with uncanny accuracy.

On the surface, they might seem to navigate daily life with relative ease if it is predictable, making good grades and with the potential to have a fulfilling adult life.  But they may have difficulty making friends or even carrying on a conversation with a classmate if it regards a topic that’s not on their mind. But they may desperately wish they could.

Beneath this veneer lies a unique neurological wiring. One of the hallmark features of atypical high-functioning autism is a deficit in social-emotional reciprocity. This isn't a lack of desire for connection; in fact, they usually do desire it. But a different way of processing and responding to social cues creates significant anxiety.

Conversations might feel like a script, with difficulty understanding nuances, unspoken expectations, or the give-and-take of typical banter.

Empathy, while present, might be more cognitively understood than intuitively felt, leading to misunderstandings and feeling like they don’t “fit in”. 

This difficulty with nuance in communication may appear as the child or teen being “very literal” and have difficulties with the complex and ever changing “language of adolescence”.

Another key characteristic is a significant restricted and repetitive range of interests. For individuals with atypical high-functioning autism, these interests aren't just hobbies; they are often deeply immersive, highly specific, and central to their identity and safety in the world.

Think of someone who can recite every detail about a particular historical period, an obscure scientific field, or a complex fantasy world.

These interests provide comfort, predictability, and a sense of mastery in a world that can often feel chaotic and overwhelming. They might spend hours, days, even years meticulously researching, categorizing, or engaging with their chosen subject.

The Unseen Distress: When Interests are Disrupted

This is where the unique vulnerability of atypical high-functioning autism often becomes apparent. Because these restricted interests are so integral to an individual's sense of self and safety in the world, any disruption or interference with these interests can cause significant distress.

Imagine:

• A highly specialized collection being misplaced or damaged. For a child or young teen whose peace of mind is intricately linked to the order and completeness of their collection, this isn't just an annoyance; it can be deeply unsettling, triggering anxiety or even significant meltdowns.
• Being forced to deviate from a meticulously planned routine that revolves around their interest. If their day is structured around dedicated time for their passion, an unexpected change can feel like a fundamental disruption to their internal equilibrium.
• Dismissal or invalidation of their passionate pursuits. Being told their deep interest is "silly," "obsessive," or a "waste of time" can be profoundly invalidating, leading to feelings of isolation and misunderstanding.
• Lack of access to their chosen interest. If resources, information, or opportunities related to their specific interest are suddenly unavailable, it can feel like a part of them has been cut off.

This distress isn't a tantrum, and it isn’t a child or young teen being oppositional or defiant.  It is a genuine neurological response to a perceived threat to their internal order and sense of self.

It can manifest as heightened anxiety, irritability, withdrawal, or even complete emotional and behavioral dysregulation. For those around them, understanding this connection between restricted interests and emotional well-being is crucial.

Fostering Understanding and Support

Recognizing atypical high-functioning autism means looking beyond superficial social presentation. It requires appreciating unique cognitive strengths, acknowledging distinct social challenges, and, most importantly, respecting the profound significance of their specialized interests. 

Instead of trying to "break" these interests, a more supportive approach is now considered “best practice”.  This can include:

• Validating their passions: Acknowledging the depth and importance of their interests.
• Providing opportunities for engagement: Supporting their ability to pursue and expand on their chosen subjects.
• Understanding the impact of disruption: Recognizing that changes to routines or access to interests can cause genuine distress and working to minimize these where possible or prepare for them effectively.
• Focusing on building bridges: Helping them navigate social situations on their terms, perhaps by incorporating their interests into social interactions.

Atypical high-functioning autism is not a lesser form of autism; it is a different expression of neurodiversity. By moving beyond preconceived notions and embracing a more nuanced understanding, we can better advocate and support these remarkable young people.  And some may change the world for the better of us all.

As always, if I can be of assistance, please reach out.

Dr. M