Mental Health & Psychiatry

Is high-functioning autism increasing?

Rising HFA diagnoses: what’s driving the trend—and how to get the right support.

Reported diagnoses of high-functioning autism (HFA) have risen across many regions, but that doesn’t necessarily mean a sudden biological surge in autism. This in-depth guide explains how broader diagnostic frameworks, improved access to assessments, and recognition of social camouflaging—especially in women—are bringing long-overlooked adults into care. You’ll learn what support is appropriate via online consultations, when in-person evaluation is essential, practical steps to prepare, and how Doctors365 connects you to experienced psychiatrists, neurologists, psychologists, and pediatricians through secure telemedicine. Includes featured clinicians, clear CTAs, and Vancouver-style references to the sources you supplied.

Disclaimer

This article is for educational purposes only and is not a substitute for professional medical advice, diagnosis, treatment, or emergency care. If you or someone you care for is in immediate danger, experiencing a medical emergency, or having thoughts of self-harm, call your local emergency number now.

Author: Dr. Diellza Rabushaj

1. Is high-functioning autism really increasing globally?

The short answer: reported diagnoses have risen, but that rise is best understood as a complex mix of broader diagnostic criteria, greater awareness, better access to assessment, and increased recognition of adult presentations—rather than proof of a sudden, universal biological surge. Evidence highlights the growing role of social camouflaging in adults (especially women), which has historically delayed diagnosis and is now being more actively identified, further contributing to recent upticks in adult ASD recognitions [1–4].

2. What we mean by “high-functioning autism” (HFA) today

“HFA” is not an official DSM-5 label; it’s a conversational shorthand often used to describe autistic people with average or above-average intellectual ability who nonetheless experience marked challenges in social communication, sensory processing, executive function, and mental health. After DSM-5 merged previous categories (e.g., Asperger’s syndrome) under the single diagnosis of Autism Spectrum Disorder (ASD), many individuals who would previously have received different labels now fall under one umbrella, altering how trends are counted and compared over time [2,4].

3. Why reported rates keep rising: the four biggest drivers

3.1 Broader diagnostic frameworks and harmonization
Post-DSM-5 harmonization pulls formerly distinct labels into one category, increasing capture of people with “milder” profiles and adults who may have been missed earlier in life [2,4].

3.2 Awareness and access
Parents, teachers, primary care clinicians, HR teams, and adults themselves are more familiar with the autism spectrum than a decade ago. More people seek assessments, and more clinicians are trained to recognize non-stereotyped, adult, and female presentations [2–4].

3.3 Recognition of social camouflaging
Camouflaging—masking or compensating for social-communication differences—has been increasingly studied and is now explicitly queried in assessments. As clinics screen for it, previously missed adults (particularly women) are being identified [1,3].

3.4 Service and pathway effects
Where screening programs, adult ASD clinics, or workplace referral pathways exist, diagnoses rise because access drives ascertainment—not necessarily because incidence changed [2,4].

4. Camouflaging: the hidden factor behind many late diagnoses

A 2023 literature review emphasizes that camouflaging is common in adults with high-functioning autism, is particularly prevalent among females, and is linked to anxiety, depression, burnout, and elevated suicidality risk [1].
Pragmatically, camouflaging delays recognition: people may appear “socially fluent” by rehearsed scripts or mimicry, yet pay a steep mental-health cost. As clinicians add targeted questions about camouflaging to assessments, more adults meet criteria—and that alone can raise the number of recorded diagnoses without implying a biological epidemic [1].

5. Adults, universities, and the workplace: why visibility ≠ incidence

Bibliometric and employment-focused evidence shows steep growth in autism diagnoses over ~30 years, with more autistic people reaching tertiary education and entering the workforce [4]. That visibility, combined with adult-specific screening and occupational health referrals, pushes diagnoses later in life—again inflating apparent prevalence without proving a true spike in incidence.
At the same time, adults with HFA face structural barriers (stigma around disclosure, unstructured communication expectations, sensory stressors), keeping employment rates lower than they should be. Evidence-informed reasonable accommodations can improve outcomes without major costs [4].

6. What the general ASD evidence says (and doesn’t) about a “biological surge”

A 2023 JAMA review provides a comprehensive overview of ASD but does not argue a recent global biological jump in high-functioning autism. Rather, it summarizes the heterogeneous etiologies, the evolution of diagnostic practice, and the wide variability of presentations across the lifespan [2]. In short: better counting and broader categories can alone raise reported figures.

7. Mental-health comorbidity in HFA: a crucial part of the story

Adults with high-functioning profiles often experience anxiety, depression, and burnout, particularly when prolonged camouflaging is involved [1]. This burden can be invisible to families and employers, and it warrants proactive screening. Identifying HFA more accurately ensures earlier access to tailored psychosocial supports, which can reduce distress and improve daily functioning [3].

8. Evidence-based psychosocial supports for adults with HFA

A 2024 paper focusing on adults with high-functioning autism synthesizes psychosocial approaches—for example adapted CBT, skills-based social coaching, and psychoeducation—as core components of individualized care plans [3]. While it doesn’t present epidemiologic trend data, it underlines an important consequence of rising recognition: more adults are eligible for, and benefit from, tailored supports.

9. So… is high-functioning autism “increasing” globally? A balanced conclusion

Yes: Recorded diagnoses are increasing in many regions.
But: The best synthesis of current evidence points to diagnostic and ascertainment effects—not a proven, sudden biological surge.
Moreover: Better recognition of camouflaging and adult presentations is bringing long-overlooked people into care, which is a positive trend for access, accommodations, and mental-health support [1–4].

10. What’s appropriate for online care vs in-person evaluation

Well-suited to online care (Doctors365):

First-step screening discussions and referral planning for formal ASD assessment.
Psychoeducation (for individuals and families).
Follow-up for mental-health support (e.g., adapted CBT strategies, coaching on sensory and executive-function supports).
Workplace/education strategy sessions and documentation for reasonable accommodations.

Prefer in-person / urgent care if any of the following apply:

Self-harm risk, suicidality, or acute psychiatric crisis.
New or worsening seizures, loss of consciousness, or concerning neurological symptoms.
Abrupt, severe behavior change or inability to self-care.
When in doubt, seek urgent or emergency evaluation immediately.

11. How Doctors365.org works (fast, secure, international)

Browse our verified clinicians by specialty (psychiatry, neurology, psychology, pediatrics).
Pick a time that suits you.
Confirm & pay securely online.
Join your encrypted video visit from any device.
Receive a clear visit summary, personalized plan, and prescriptions (when appropriate).

12. Why patients choose Doctors365

24/7 availability across time zones.
Privacy first: end-to-end encrypted visits and secure records.
Reduced costs (no travel, less time away from work/school).
Continuity of care with coordinated follow-ups.
Multidisciplinary input (psychiatry, neurology, psychology, pediatrics).

13. Featured Doctors365 specialists for autism-related care

Dragan Mitrovic — Neurology & Cognitive Disorders
Dejan Dimitrijevic — Psychiatry
Dr. Valerie Beliard Leng — Clinical Psychology
Dr. Vittorio Catalano — Neurology & Mental Health
Dr. Rajendra Midha — Pediatrics & Neurodevelopment

14. Pricing & availability

We offer transparent pricing for initial consultations, focused follow-ups, and multi-disciplinary reviews. Appointments are often available within 24–48 hours depending on specialty and time zone. See live availability and fees directly on doctors365.org.

15. How to prepare for your online consultation (practical checklist)

List your top three goals for the visit.
Bring a brief timeline (first concerns, school/work reports, prior evaluations).
Note examples of camouflaging or social/communication challenges.
Prepare a quiet space, a stable connection, and headphones if helpful.
Invite a support person if you’d like collateral history.
After the visit, calendar your next step (referrals, tests, follow-ups).

16. Book today

17. FAQs (quick answers)

1) Is high-functioning autism actually increasing?
Reported diagnoses are increasing in many regions. The most plausible drivers are diagnostic broadening, awareness, better adult pathways, and recognition of camouflaging, rather than a proven biological jump [1–4].

2) What’s the difference between Asperger’s and HFA?
Asperger’s is no longer a separate DSM-5 diagnosis; many individuals who would previously have had that label now meet criteria for ASD. “HFA” remains a descriptive term used informally for autistic people without intellectual disability [2,4].

3) Why are so many adults being diagnosed now?
Because adult-focused assessment pathways, workplace/education referrals, and awareness of camouflaging are catching profiles that were missed in childhood, especially among women [1,4].

4) Can online care help if I’m exploring a diagnosis?
Yes—screening, education, care planning, and therapy follow-ups are all well-suited to online care. Parts of a formal diagnostic assessment (e.g., neuropsychological testing) may still require in-person steps.

5) What supports help most for adults with HFA?
Evidence supports tailored psychosocial approaches such as adapted CBT, skills-based social coaching, and environmental/accommodation strategies matched to sensory and executive-function needs [3].

18. References

Cremone IM, Carpita B, Nardi B, Casagrande D, Stagnari R, Amatori G, Dell'Osso L. Measuring social camouflaging in individuals with high functioning autism: a literature review. Brain Sci. 2023;13(3):469.
Hirota T, King BH. Autism spectrum disorder: a review. JAMA. 2023;329(2):157-68.
Schweizer T, Endres D, Dziobek I, Tebartz van Elst L. Psychosocial therapeutic approaches for high-functioning autistic adults. Front Psychiatry. 2024;14:1265066.
Loison A. Literature review on high-functioning autistic employees. DBS Appl Res Theory J. 2024;1:77-105.