Should We Still Use ‘High-Functioning’ and ‘Low-Functioning’ Autism Labels?

The “high-functioning” and “low-functioning” labels assigned to autism grew out of an attempt to describe how much an autistic person can navigate daily life independently. But are they still helpful—or even accurate?

In recent years, many autistic individuals, parents, and professionals have questioned these terms. This article explores the origins of “high-” vs “low-functioning” autism labels, why they’re controversial, and what alternative approaches are emerging.

Understanding What “High-” and “Low-Functioning” Mean

In everyday use, “high-functioning autism” usually refers to autistic people who can generally function in society independently (often those with average or above intelligence and speech).

“Low-functioning autism” typically refers to those who cannot function independently and may need more support with basic living skills​.

For example, someone might be labeled “high-functioning” because they speak fluently or hold a job, whereas “low-functioning” might be used for a non-speaking autistic person who needs full-time care​.

However, these terms were never official medical diagnoses. The Diagnostic and Statistical Manual of Mental Disorders (DSM), widely used by clinicians, has never included “high” or “low functioning” as formal criteria.​

Over time, the labels caught on as a kind of shorthand for “mild” vs “severe” autism in clinical conversations and pop culture.

Why the Labels Are So Controversial

Over time, a growing chorus of autistic individuals, families, and experts have pointed out serious problems with describing autism as simply “high-” or “low-functioning.” Some even question whether we should use these labels at all.

Here are some of the main criticisms:

They Oversimplify a Complex Spectrum

Autism isn’t a single-line spectrum from “a little autistic” to “very autistic.” Every autistic person has a unique profile of strengths and challenges.

“Two individuals both labeled as ‘high functioning’ may have vastly different struggles,” explains psychiatrist Dr. Ryan Sultan – “one facing social interaction difficulties and the other grappling with sensory sensitivities.”​

In other words, calling them both “high-functioning” tells us little about their actual needs. It’s an overly broad brush.

Masking Can Hide Real Challenges

Those deemed “high-functioning” are often just adept at masking their autism – suppressing traits to appear “normal.”

This comes at a cost. Autistic writer Jessica Penot described: “Every time someone says ‘you are so high-functioning,’ I want to scream. I am not high-functioning – I am exhausted and constantly overwhelmed.”

The label can pressure autistic people to keep up a masking routine that harms their mental health (contributing to burnout, anxiety, even high suicide rates).

“Low-Functioning” Stigma and Dismissal

On the flip side, being labeled low-functioning can be dehumanizing. It often leads others to underestimate the person and ignore their abilities.

An autism therapist shared, “Individuals perceived as low-functioning face stigmatization and isolation. Their strengths are ignored, and they are often treated as incapable.”​

For example, she had clients who could not speak but were excellent writers – with rich inner worlds that outsiders completely misunderstood​. Simply calling them “low-functioning” erased those talents.

Autistic advocates note these labels can trap people in low expectations, where society gives up on their growth.

Support Needs vs. Labels Mismatch

Perhaps most crucially, functioning labels don’t reliably predict the support someone actually requires.

Many autistic people dubbed “high-functioning” still struggle with everyday life skills like organizing, cooking, or personal care.

A large 2019 study of over 2,000 autistic individuals found that those without an intellectual disability still had poor adaptive skills on average – often struggling with basic tasks like brushing teeth or taking a bus.

“The term completely disregards the difficulties these individuals have on a day-to-day basis,” says lead researcher Dr. Andrew Whitehouse.

He noted that policymakers have sometimes used a “high functioning” label to deny services, assuming those individuals don’t need help​.

Meanwhile, some labeled “low-functioning” might excel in certain areas if given the right support.

Conflating “Functioning” with Intelligence

The high/low labels are also often (mis)interpreted as measures of intelligence or worth. Originally, “high-functioning” just meant no intellectual disability (IQ ≥ 70)​.

But many people hear “high-functioning” and assume the person is highly intelligent or “almost normal,” and hear “low-functioning” as “low intelligence.” This is not only inaccurate but harmful.

As Dr. Sultan points out, these labels “don’t effectively convey an individual’s strengths, challenges, or specific needs.”​

Instead, they can reinforce stereotypes – people labeled high-functioning may face disbelief about their difficulties, while those labeled low-functioning may face patronizing low expectations​.

Not Static or Context-Dependent

Autism traits can vary day to day and depend on the environment. Someone might cope fine at home (appearing “high-functioning”) but be unable to function in a chaotic workplace without support. Or vice-versa.

As one autistic commenter noted, “‘Functioning’ levels are dynamic rather than static”​ – yet calling someone high or low-functioning freezes them in place.

Harm to Self-Identity

Many autistic individuals report that these labels make them feel misjudged. If called high-functioning, they worry their very real challenges will be invalidated—“it reminds us that what people want is for us to continue to appear normal, despite the hardship,” wrote one autistic adult​.

If called low-functioning, they often feel written off or spoken about as if they aren’t present. Neither is empowering.

One autistic person states: “They say it as if I’m somehow superior to others they consider low functioning, as if my struggles are not as valid. I’m not ‘high functioning’ – I’m just better at acting like you, pretending to be ‘normal.’”

Emotional and Mental Health Toll

Continuously masking to live up to a “high-functioning” label can lead to exhaustion and identity crises.

Autistic people often internalize the idea that they must appear neurotypical to be valued. This is linked to autistic burnout and mental health struggles​.

On the other side, being seen as “low-functioning” can erode self-esteem; a person may be aware of their own intellect or personality but feel the world only sees their disability. Neither label fosters acceptance or well-being.

Are Functioning Labels Ever Useful?

Despite widespread criticism, some autistic people, caregivers, and clinicians acknowledge that functioning labels can occasionally be practical.

Parents might briefly use them when quickly communicating a child’s general support needs to teachers or healthcare providers unfamiliar with autism.

One autistic person noted, “Sometimes it’s faster and clearer to say ‘high-functioning’ than spend five minutes explaining all my strengths and struggles.”

Clinical psychologist Dr. Susan Epstein agrees that, although imperfect, these terms can quickly frame someone’s abilities when immediate understanding is necessary.

Still, even when used briefly, functioning labels require caution; they’re best accompanied by more detailed, individualized context to avoid oversimplification and to respect the complexity of each autistic person’s experiences and needs.

Where Did These Labels Come From?

To appreciate why the shift away from these labels is happening, it helps to know their origin and intent. The roots go back to how autism has been defined over time:

Early Distinctions in Autism

In the 1940s, psychiatrist Leo Kanner first described “classic” autism in children who had severe communication and social difficulties (many also had intellectual disabilities).

Shortly after, pediatrician Hans Asperger described a different profile: autistic traits in children with fluent speech and average or high IQ.

For decades, “Asperger syndrome” was seen as a form of “high-functioning” autism (though that exact term wasn’t used yet).

This created an implicit hierarchy: Asperger’s = mild/high functioning, Kanner’s autism = severe/low functioning.

Tragically, historical research revealed that Asperger himself may have used this distinction under the Nazi regime to determine which children could be educated and which might be institutionalized​– a dark reminder of how functioning labels were entangled with value judgments from the start.

The 1980s – Birth of the Term

The actual phrases “high-functioning autism” and “low-functioning autism” started appearing in scientific literature around the late 1980s​.

Researchers coined them to differentiate autistic people by cognitive ability – whether or not they had an intellectual disability (commonly defined by IQ score)​.

The idea was to tailor expectations and services. For instance, an autistic child with IQ 130 might be described as “high-functioning” to indicate they could handle a mainstream academic curriculum, whereas an autistic child with IQ 50 and no language might be “low-functioning” and need intensive lifelong care.

These labels then filtered into clinical practice and everyday language.

Moving Toward Support-Based Descriptions

So if we stop saying “high-functioning” or “low-functioning,” what do we say instead? Around the world, a shift is underway toward more nuanced, respectful language and frameworks that focus on support needs and individual strengths.

Here are some alternatives that autistic people and experts are encouraging:

Describe Support Needs Specifically

Rather than a broad label, state what kind of help the person requires (if relevant to the context).

For example, instead of saying “low-functioning autistic,” one might say “autistic and has significant support needs with daily activities and communication.”

As Dr. Sultan suggests, “rather than using low functioning, it is more accurate to describe someone as having significant support needs. This recognizes they may require specific assistance but does not imply incapability.”​

Likewise, what used to be called “high-functioning” could be described as “requires minimal support” in daily life.

One autistic advocate gave this example: you might say “Malorie is autistic and generally requires little support,” instead of saying Malorie is high-functioning​. The focus is on the level of support, not a judgment of the person’s overall functioning.

Use the DSM-5 Levels of Support

Clinically, doctors now often refer to Level 1, Level 2, or Level 3 Autism. These correspond to how much support a person needs: Level 1 – requiring some support; Level 2 – requiring substantial support; Level 3 – requiring very substantial support​.

Unlike “high/low,” these levels at least frame support as a continuum and don’t carry the same stigma (Level 1 roughly replaces what people meant by high-functioning, and Level 3 replaces low-functioning).

However, even the levels aren’t perfect or fully precise – many autistic self-advocates caution that individuals don’t always fit neatly into one level for all aspects of life.

Still, it’s a more standardized way to indicate severity when needed, used in diagnostic settings internationally.

Strengths-Based Approach

A strengths-based approach means emphasizing what an autistic individual can do and what they enjoy or excel at, rather than defining them by what they struggle with.

For example: “He’s an autistic adult who lives independently, holds a job, and has a passion for programming, but he does need some support with organizing his household chores.”

This gives a fuller picture than just stamping “high-functioning” on him. It acknowledges both strengths and support needs.

Autism as a Spectrum, Not a Ladder

Instead of picturing autism like a ladder from low to high, think of it as a color wheel or profile.

Different autistic individuals have different combinations of traits and challenges in areas like social communication, sensory processing, motor skills, anxiety, etc.

Some visualize it as a circular chart where each autistic person has a unique “spiky profile” of higher and lower support needs in various areas.

In this view, saying someone is “more autistic” or “less autistic” makes no sense – each person simply has their own pattern.

This framework urges us to talk about specific traits (“has difficulty with change,” “high sensory sensitivities,” “strong memory skills,” “non-speaking,” etc.) rather than an overall functioning rank.

Listening to Individuals’ Preferred Terms

Finally, one of the simplest rules is to ask autistic individuals (or their families, if appropriate) what language they prefer.

Some adults diagnosed with Asperger Syndrome before may still identify with that term; others might prefer just “autistic.”

“We should call people what they want to be called,” notes psychologist Inge-Marie Eigsti, reflecting the push from autistic self-advocates​. Respecting personal preference helps ensure we’re not imposing labels that cause distress.

References

Alvares, G. A., Bebbington, K., Cleary, D., Evans, K., Glasson, E. J., Maybery, M. T., … & Whitehouse, A. J. (2020). The misnomer of ‘high functioning autism’: Intelligence is an imprecise predictor of functional abilities at diagnosis. Autism, 24(1), 221-232. https://doi.org/10.1177/1362361319852831