Why We No Longer Say High or Low Functioning for Autism

The functioning diagnoses for autism spectrum disorder (ASD) are thought to be out of date and do not form part of an official diagnosis.

A neurodevelopmental disorder is an autism spectrum disorder (ASD). It results from alterations in brain development that impact learning, behaviour, communication, and social interactions.

ASD is a disorder that manifests itself in a wide range of ways, both in terms of severity and symptom diversity. Functional classifications in autism have become antiquated and possibly detrimental due to this intricate interaction.

Why are functional labels for autism no longer used?

The Diagnostic and Statistical Manual of Mental Disorders (DSM), the clinical reference used in the US and many other countries for diagnosing mental health issues, has never included functional labels for autism as part of a formal diagnosis.

"High" and "low" functioning were ad hoc classifications used to indicate how much support each person with an ASD diagnosis was thought to need. Although these names were once widely used in the language of autism, they are no longer acceptable.

Scientifically Imprecise

Functional diagnoses of autism are not accurate enough to be helpful from a scientific standpoint. The classifications, according to board-certified psychiatrist Dr. Ryan Sultan, a professor at Colombia University in New York City, oversimplify the difficulties and experiences that persons with ASD face.

He states, "For example, two people who are both classified as high functioning may struggle in very different ways; one may struggle with social interaction, while the other may struggle with sensory sensitivity."

Person-centred care and tailored therapy are not aided by lumping these similar experiences under one heading.

Sultan claims that ambiguity and misinterpretation result from these terms' absence of precise and uniform definitions. According to him, "they don't effectively convey an individual's strengths, challenges, or specific needs."


Restricting the classification of ASD to exterior functions may also minimise the significance of symptoms that do not manifest as overt functional challenges.

The functioning designations associated with autism, according to Beret Loncar, owner of Body Mechanics Orthopaedic Massage in New York City and a person with ASD, don't account for how a person interacts with the outside world, whether they are happy, or how they feel.

"You cannot be in the world with any comfort personally, but you could be classified as high functioning because you get up every day, brush your teeth, and go to work at a very demanding job," the expert explains. "That is not working for you internally."

ASD may be viewed as less significant in a person's life if it is classified as "high function." It may downplay the struggles that many people have on the inside.

Malorie "I am not mildly autistic,'" asserts Joy Feidner, a neurodiversity consultant from Las Vegas, Nevada, who has an ASD. Autism is not something I deal with on a mild basis like salsa. I get overstimulated and burned out easily. However, you just slightly experience my autism since I internalise those experiences.


According to Sultan, stigmatisation and prejudices are often reinforced by functional designations for autism.

"Those who are classified as low functioning may encounter low expectations that restrict their opportunities for growth and development, while those who are classified as high functioning may encounter incredulity or insufficient support for their struggles," he says.

Additionally, these designations may reinforce negative preconceptions about intellectual capacity. Although the terms "high" and "low functioning" in autism were meant to describe a person's ability to carry out daily duties, people outside the autism community frequently mistake these designations for measures of intelligence quotient (IQ).

What can you use instead of functioning labels?

Referring to someone else's experience with autism as "living with ASD" or "living with autism spectrum disorder" is appropriate. In the end, functional ability and particular symptoms are highly personal matters that are typically shared with a physician, mental health specialist, carer, or close relative.

According to Sultan, the autistic community has adopted more person-centred and detailed language if you need to elaborate on someone else's experience with ASD.

He says, "This method stresses using precise language to describe an individual's unique strengths and challenges." For instance, it is more accurate to characterise someone as having high assistance requirements rather than low functioning. This acknowledges that individuals might need particular kinds of help, but it doesn't mean they are incapable.

Fiedner suggests that you adapt your language to the needs and preferences of the person who has an ASD.

"You could say in a conversation that Malorie has autism and typically doesn't need much help," she continues.

How does the DSM categorize ASD?

The most recent edition of the DSM, the DSM-5-TR, classifies ASD according to the degree of support an individual requires to manage their symptoms. The three categories account for how Autism Spectrum Disorder (ASD) influences social communication, both verbally and nonverbally, and how it influences repetitive, restricting behaviours.

ASD severity is broken down as follows in the DSM-5-TR:

Level 3: Requiring very substantial support

  • Severe functional challenges arise from communication deficits, both verbal and nonverbal.
  • virtually little socialisation is initiated
  • limited reaction to other people's social attempts
  • rigidity in conduct
  • severe challenges in accepting change
  • extreme anxiety when focusing or altering the course
  • repetitive or limiting habits that seriously impair many facets of functioning

Level 2: Requiring substantial support

  • Significant challenges with social communication, both verbally and nonverbally
  • Social challenges persist even in the presence of support.
  • restricted socialisation initiation
  • diminished or unusual reactions to other people's social initiation
  • rigidity in conduct
  • inability to adapt to change
  • distress while shifting one's attention or course of action
  • Others notice that you engage in repetitive or restricting behaviours.

Level 1: Requiring support

  • When supports are not in place, communication problems both verbal and nonverbal occur.
  • having trouble establishing socialisation
  • abnormal or ineffective reactions to other people's social attempts
  • Function is impacted by behaviours that are rigid in one or more contexts.
  • moving between activities is difficult
  • Organisational and planning issues impact independence

Bottom line

In the past, autistic spectrum disorder functioning labels were used to indicate how much your daily functioning was impacted by ASD. Functional labels were a common component of autism language in clinical settings and conversations, even though they were never formally included in an ASD diagnosis.

But these phrases are out of date because of their inaccuracy and stigmatising, dismissive tone. It is increasingly more common to use terminology that is person-centric and that highlights both specific areas of strength and problem.


Is high and low-functioning autism outdated?

The words "high-functioning autism" and "low-functioning autism" are no longer used to describe the various stages of autism spectrum disorder (ASD).

Is there such a thing as high and low-functioning autism?

There are still many people with autism who are classified as "low-functioning" or "high-functioning."

Can Level 3 autism get better?

Level 3 autism cannot be cured

Is it OK to have high-functioning autism?

A person who has "high-functioning" autism does not always require assistance; rather, their needs may be lower than those of another autistic person.

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