What ‘High-Functioning Autism’ Means (and Why You Shouldn’t Call It That)

The way we talk and think about autism spectrum disorder (ASD) is complicated. And if you’re new to the topic, it can be pretty overwhelming. It’s hard enough learning a new vocabulary, but every turn of phrase also seems to have a backstory or controversy attached to it. Sometimes, both!

So, it’s little wonder if your eyes start swimming a bit when you encounter the phrase “high-functioning autism.” What is that, exactly? We asked developmental pediatrician Mary Wong, MD.

What does ‘high-functioning autism’ mean?

“High-functioning autism” isn’t a medical diagnosis, so it doesn’t come with its own set of symptoms or treatments. In fact, you shouldn’t encounter that phrase in a healthcare setting at all.

Dr. Wong explains that “high-functioning” is an informal term some use to describe people living with milder forms of autism. “Mild,” in this case, means that their autistic characteristics have only a minimal impact on their daily lives. They don’t cause substantial impairment. At least, that’s the assumption.

But making assumptions about other people’s lives and abilities isn’t a great practice. There’s a good chance you’ll be wrong. And you could cause problems or hurt feelings without meaning to.

As our understanding of neurodiversity changes, so does the language we use to discuss it. These days, many autistic activists want descriptors like “high-functioning” to go the way of the dinosaur. To understand why, we need a little medical history lesson.

Related terms

“Most people equate high-functioning autism to Asperger syndrome,” Dr. Wong notes. But Asperger’s no longer exists as a medical diagnosis. Most people who had that diagnosis are now described as having level one ASD.

So, what happened, exactly?

The American Psychiatric Association released the fifth edition of their Diagnostic and Statistical Manual of Mental Disorders (DSM-5) in 2013. Up to that point, autism and Asperger’s were two different conditions. But the DSM-5 changed that. It brought them (and several other developmental conditions) under the umbrella of autism spectrum disorder (ASD).

“Autism is a spectrum condition because our ability to function — our cognitive, language and math skills, for example — exist on a continuum,” Dr. Wong explains. “It’s not straightforward. Two people with the same diagnosis can have extremely different functional abilities.”

To make things clearer, the DSM-5 specifies three different levels of autism severity:

• Level one means you require support.
• Level two means you require substantial support.
• Level three means you require very substantial support.

When people use the phrase “high-functioning autism,” they’re typically describing level one ASD. That means an autistic person can perform most activities of daily living (ADLs) without needing help. But they have some traits — like difficulty reading social cues or hypersensitivity to sensory stimuli — that impact their lives.

Why you shouldn’t use that term

If you’ve been using the phrase “high-functioning autism” to describe yourself (or someone else), you might be feeling a bit confused right now. Don’t we all want to be high-functioning? How could calling an autistic person high-functioning be dehumanizing? How could it be anything other than a compliment?

These are fair questions. And if you asked them in a room full of autistic people, you’d get a wide range of different — and, at times, contradictory — answers. Some folks like being referred to as “high-functioning.” But others, especially within the neurodiversity movement, find that descriptor offensive. Let’s dive into the reasons why.

It’s inaccurate and imprecise

Dr. Wong explains that we describe autism as a spectrum because what it looks like can vary so widely from person to person. And while developmental specialists can roughly categorize ASD severity using the three levels, it’s not an exact science. It’s a subjective measurement.

According to a 2019 study, labeling somebody high- or low-functioning doesn’t accurately predict what they can and can’t do because every person is different. For example, you may be able to hold down a rigorous full-time job but lack the coordination and fine motor skills needed to drive to and from the office. Whether you qualify as high-functioning in that scenario depends entirely on who you ask and what skills they consider important.

Making blanket assumptions about what a person can and can’t do based on intelligence measures and support needs is a mistake. Broad labels can both minimize very real struggles and overlook meaningful skills and personality traits.

It can impact support and accommodations

We’ve demonstrated how using function labels oversimplifies the experience of autism. Now, we need to talk about the very real consequences those generalizations can have.

Dr. Wong notes that designations like high- and low-functioning can impact access to resources and accommodations.

“Part of the challenge I see as a pediatrician is the expectation these terms set,” she shares. “All children with ASD need support, but if a kid gets labeled ‘high-functioning,’ they may get less help than they need from their school.”

And the opposite is also true. Dr. Wong points out that defining people by their (perceived) ability to function both shames and underestimates autistic people who don’t meet those standards.

“If a child isn’t considered high-functioning, then what are they? Low-functioning? That way of talking might make kids think they aren’t as smart or capable as their peers,” she says.

And labeling an autistic child “low-functioning” can rob them of opportunities other kids get as a matter of course. For example, many people incorrectly assume that being nonspeaking makes a person unintelligent or unable to communicate. But a 2024 study shows that many nonspeaking autistic people, with proper instruction, can learn to read, write and type.

It encourages masking

How often do you describe neurotypical people as high- or low-functioning? Probably never, or close to it. But why not?

Simply put, we see neurotypical people as “normal.” So, what we’re really saying when we say an autistic person is “high-functioning” is that they behave like a “normal” person.

This isn’t only true of autism. People living with mental health diagnoses like addiction or anxiety also get labeled “high-functioning.” And you don’t earn that label by being well — it’s all about looking well.

Many members of the autistic community rightly ask: Why should “normal” be the goal? What’s wrong with understanding and interacting with the world in a different way? Why is being your authentic self a bad thing?

Advocates also point out that high-functioning behaviors aren’t necessarily healthy. Many autistic people use a tactic called masking to meet social expectations. Masking is when you hide or compensate for behaviors that mark you as neurodivergent. A 2024 study found that people who mask tend to do it because they’ve been shamed, teased or harmed in the past because they were different.

Not only is it exhausting to pretend you’re somebody you aren’t, but it can also be unhealthy. The same 2024 study reported a correlation between masking and anxiety, depression and low self-esteem.

Function labels reward and encourage masking and discourage authenticity. They also reinforce the idea that being neurotypical is good — and being autistic isn’t.

What to say instead

There are lots of reasons that the world’s shifting away from using terms like “high- and low-functioning” to describe autistic individuals. But what’s the alternative? How can you be sure you’re accurately and respectfully discussing abilities and impairments, be they yours or someone else’s?

Here are some good rules of thumb:

• Consider why it matters. There are some occasions where it’s important to describe functional abilities, like when you’re planning a trip or meeting with your child’s Individualized Education Plan (IEP) team. But the rest of the time, those details are unnecessary.
• Be specific. If you do need to talk about somebody’s functional abilities, precision is key. Describe, in detail, the activities they can do independently and the areas where they require additional support.
• Ask the person. It’s never a good idea to assume you know how someone identifies, what they can and can’t do, or what kinds of support they need. Instead, ask them directly. If the person you’re talking to is nonspeaking, use writing, visual supports and Augmentative and Alternative Communication (AAC) devices before relying on a guardian.
• Use the clinical terms. The phrase “high-functioning” doesn’t have a clear definition. Dr. Wong prefers sticking with the medical terminology because it’s defined in the DSM-5. “I try to educate parents so that they use the term ‘level one autism’ instead,” she says.

The bottom line

“High-functioning autism” isn’t a medical diagnosis. It’s an informal term laypeople use to describe what the DSM-5 currently calls “level one autism spectrum disorder.” People with level one ASD require minimal support to navigate their daily lives. And remember, level one ASD no longer goes by the name “Asperger’s syndrome.”

The neurodiversity movement rejects functional labels for many reasons. Descriptors like “high- and low-functioning” are dehumanizing and vague, and suggest autism is a deficit or disease. But that’s not right. Autism is a difference. And differences aren’t bad.

Outside of a medical context, it’s best to be specific about a person’s capabilities and needs. When in doubt, ask respectful questions.