When someone discloses an autism diagnosis, one of the most common questions that follows is: “Are they high-functioning or low-functioning?” While these labels might seem like helpful shorthand for understanding someone’s needs, this complex dynamic has made functional labels in autism outdated — and potentially harmful.
This article explores why autism functioning labels are problematic, how they impact autistic individuals, and what alternatives experts and self-advocates recommend instead.
What Are Functioning Labels in Autism?
Functional labels in autism were never a part of formal diagnosis under the Diagnostic and Statistical Manual of Mental Disorders (DSM), the clinical guidebook used in the United States and many other parts of the world for diagnosing mental health conditions. “High” and “low” functioning were informal ways of labeling the perceived level of support needed for each individual with an ASD diagnosis.
Despite never being official diagnostic terms, these labels became widespread in clinical conversations, educational settings, and everyday discourse about autism.
Five Major Problems with Functioning Labels
1. They Oversimplify a Complex Spectrum
Scientifically, functioning labels in autism aren’t precise enough to be useful. The labels oversimplify the experiences and challenges people living with ASD encounter. “For instance, two individuals both labeled as high functioning may have vastly different struggles, with one facing social interaction difficulties and the other grappling with sensory sensitivities.”
Autism varies broadly in manifestations and autistic people have wide differences in support needs, although these have too much complexity to reduce to simple terms such as “profound autism” or “low-” or “high-functioning”.
2. “High-Functioning” Minimizes Real Struggles
Labeling ASD as “high function” can imply it’s less significant in someone’s life. It can minimize the challenges many people face internally. Autistic self-advocate Malorie Joy Feidner explains: “I am not ‘mildly autistic.’ I do not experience autism mildly like it is a salsa”.
People categorized as high functioning may face disbelief or inadequate support for their challenges, while those labeled as low functioning may experience low expectations that limit their growth and development opportunities.
Many autistic people labeled “high-functioning” are actually masking their difficulties — a behavior that comes at a significant cost to their mental health. Masking can be detrimental to an individual’s mental health and sense of identity – increasing risk of autistic burnout, anxiety and depression.
3. “Low-Functioning” Ignores Strengths and Capabilities
Individuals perceived as low-functioning face stigmatization and isolation. Their strengths are ignored, and they are often treated as incapable.
Some individuals who are almost incapable of verbal communication are excellent writers. They are perceived as “low-functioning” because they don’t talk and their facial expression is almost always flat or inappropriate, but if you take the time to try to communicate with them, they have a rich inner world that is often completely misunderstood.
4. Functioning Can Vary by Context and Time
The way in which we ‘function’ can vary from day-to-day. If everything is okay around us, we are fine. If something is on our mind or overloading us, we might find it harder to cope.
Someone might appear “high-functioning” in familiar environments but struggle significantly in challenging situations, or vice versa. These static labels don’t account for the dynamic nature of autistic experiences.
5. They Reinforce Harmful Stereotypes
Functional labels in autism tend to reinforce stereotypes and stigmatization. These labels can also contribute to harmful stereotypes related to intellectual ability. High and low functioning in autism were intended to indicate someone’s capacity to perform daily tasks, but these labels are often misinterpreted by those outside the autism community as a representation of intelligence quotient (IQ).
Labeling autistic people puts pressure to be ‘normal’ all the time. The word ‘functioning’ likens autistic people to machines, which is really offensive. Much like those who aren’t autistic, we have feelings, emotions, strengths and difficulties.
What Do Autistic Self-Advocates Say?
The Autistic Self Advocacy Network (ASAN) doesn’t use labels like “high-functioning” and “low-functioning”. Functioning labels aren’t a good way to think about autism. We all have things we are good at and things we need help with. Using functioning labels makes it harder for us to get the help we need, and for us to make the choices we want.
A 2024 research study found that the proposed best option for language preferences is not to find consensus but instead, opt for the optimal choice that people find the least offensive or disagreeable. This means using identity-first language and not using functioning labels.
Better Alternatives to Functioning Labels
Use Support-Based Language
Instead of “high-functioning” or “low-functioning,” experts recommend describing an individual’s specific support needs. Modern approaches recommend using descriptions focused on an individual’s specific support needs or the DSM-5’s levels of support, rather than broad functioning labels. A strengths-based perspective, emphasizing an autistic person’s capabilities and individuality, is a more respectful and informative way of understanding autism.
The DSM-5 recognizes three levels of support:
- Level 1: Requiring support
- Level 2: Requiring substantial support
- Level 3: Requiring very substantial support
Focus on Individual Strengths and Challenges
We should talk about people as individuals. Talk about what someone is good at, and what they need help with. This makes sure we can get what we need.
Respect Personal Preferences
One of the simplest rules is to ask autistic individuals (or their families, if appropriate) what language they prefer. Respecting personal preference helps ensure we’re not imposing labels that cause distress.
Conclusion
Persisting with these outdated labels will continue to harm autistic people, irrespective of their needs or talents. The autism community has been clear: functioning labels oversimplify complex experiences, minimize struggles, ignore capabilities, and reinforce harmful stereotypes.
By moving away from these binary labels and instead focusing on individual support needs, strengths, and preferences, we can create a more accurate, respectful, and helpful framework for understanding autism. Many autistic people with a wide range of needs go without any services, and even those with services too often lack the kind of robust, high-quality, individualized, and respectful supports that would truly enable us to live our best lives. To begin to address this, researchers and policymakers must focus on services that can improve quality of life.
It’s time to listen to autistic voices and retire functioning labels for good.
References
- Autistic Self Advocacy Network. (2021). Functioning Labels Harm Autistic People. https://autisticadvocacy.org/2021/12/functioning-labels-harm-autistic-people/
- Keates, N., Martin, F., & Waldock, K.E. (2024). Autistic People’s Perspectives on Functioning Labels and Associated Reasons, and Community Connectedness. Journal of Autism and Developmental Disorders, 55(4), 1318-1328. https://link.springer.com/article/10.1007/s10803-024-06316-3
- Bottema-Beutel, K. (2023). Profound Concerns about “Profound Autism”: Dangers of Severity Scales and Functioning Labels for Support Needs. Education Sciences, 13(2), 106. https://www.mdpi.com/2227-7102/13/2/106
- Healthline. (2023). Functioning Labels for Autism: Why They Are Outdated. https://www.healthline.com/health/autism/functioning-labels-autism
- Bristol Autism Support. (2024). Why functioning labels are damaging and irrelevant. https://www.bristolautismsupport.org/functioning-labels-damaging-irrelevant/
