What 'High-Functioning' Autism Means?

Table of ContentsView AllTable of ContentsWhy the Term ‘High-Functioning’ Is ProblematicWhat Is Autism?Autism and Asperger’sWhat Does “High Functioning” Mean?DiagnosisTreatmentHow Language Contributes to StigmaSocial Support

Table of ContentsView All

View All

Table of Contents

Why the Term ‘High-Functioning’ Is Problematic

What Is Autism?

Autism and Asperger’s

What Does “High Functioning” Mean?

Diagnosis

Treatment

How Language Contributes to Stigma

Social Support

High-functioning autism is sometimes used colloquially to describe autistic people who do not need much support to function in their daily lives. It often means that a person can speak, write, read, manage daily tasks, and live independently. It means that their traits and behaviors do not create too many disruptions in their relationships, occupation, or education.

However, it is crucial to recognize that the term “high-functioning autism” is not a recognized diagnosis or condition specifier.

At a Glance’High-functioning' autism is not a formal diagnosis. It is sometimes used informally to describe people with autism who do not need as much support. In the past, these individuals may have been diagnosed with Asperger’s syndrome; however, that diagnosis went away in the most recent edition of the “Diagnostic and Statistical Manual of Mental Disorder.“Today, an autism diagnosis also involves identifying a person’s level of functioning, which can range from Level 1 (often referred to as the mildest) to Level 3 (often referred to as more severe). However, it is important to remember that the level of support a person needs can vary. Access to treatments that emphasize individual strengths while helping people navigate the challenges of living in a neurotypical world is vital.

At a Glance

‘High-functioning’ autism is not a formal diagnosis. It is sometimes used informally to describe people with autism who do not need as much support. In the past, these individuals may have been diagnosed with Asperger’s syndrome; however, that diagnosis went away in the most recent edition of the “Diagnostic and Statistical Manual of Mental Disorder.“Today, an autism diagnosis also involves identifying a person’s level of functioning, which can range from Level 1 (often referred to as the mildest) to Level 3 (often referred to as more severe). However, it is important to remember that the level of support a person needs can vary. Access to treatments that emphasize individual strengths while helping people navigate the challenges of living in a neurotypical world is vital.

Today, an autism diagnosis also involves identifying a person’s level of functioning, which can range from Level 1 (often referred to as the mildest) to Level 3 (often referred to as more severe). However, it is important to remember that the level of support a person needs can vary. Access to treatments that emphasize individual strengths while helping people navigate the challenges of living in a neurotypical world is vital.

While the term is sometimes used informally, it is considered inaccurate and inappropriate. Research suggests the term does not accurately reflect the challenges that autistic people deal with in their daily lives. This can lead to unrealistic expectations about people’s social, academic, occupational, and self-care abilities.

A person is often described as “high-functioning” if they do not have an intellectual disability. However, evidence suggests that IQ and behaviors related to daily living are only weakly connected.

In reality, numerous factors affect a person’s ability to function with minimal support, including communication, social, motor, sensory processing, and information-processing abilities. People may possess skills that allow them to read, write, and speak effectively but struggle more with other functional abilities, such as emotional or social skills.

The term “high-functioning” also perpetuatesstigmaaboutneurodivergentpeople. Rather than labeling people as “high” or “low” functioning based on neurotypical expectations, focusing on an individual’s strengths, abilities, and support needs is more helpful.

Understanding Autism Spectrum Disorder

The “Diagnostic and Statistical Manual of Mental Disorders, 5th Edition” (DSM-5) maintains five criteria for a diagnosis of autism:

CommunicationLevel 1:Individuals might have difficulty initiating interactions or relationships or might have lower than average interest in these interactions.Level 2:Individuals might be unresponsive to social interaction or speak with limited vocabulary and might have “markedly odd nonverbal communication.“Level 3:Individuals might be nonverbal or only speak in quotes, and they are likely to exhibit minimal responses to social approaches from others.BehaviorsLevel 1:Inflexible routines might cause interfering with functioning, and individuals might struggle with transitions, organization, and planning.Level 2:Significant difficulty coping with change, frequent repetitive behavior, and distress or difficulty changing activities or focus.Level 3:“Extreme” inflexibility or difficulty with change, repetitive behaviors that interfere with functioning, and significant distress when the routine is interrupted.

Level 1:Individuals might have difficulty initiating interactions or relationships or might have lower than average interest in these interactions.

Level 2:Individuals might be unresponsive to social interaction or speak with limited vocabulary and might have “markedly odd nonverbal communication.”

Level 3:Individuals might be nonverbal or only speak in quotes, and they are likely to exhibit minimal responses to social approaches from others.

BehaviorsLevel 1:Inflexible routines might cause interfering with functioning, and individuals might struggle with transitions, organization, and planning.Level 2:Significant difficulty coping with change, frequent repetitive behavior, and distress or difficulty changing activities or focus.Level 3:“Extreme” inflexibility or difficulty with change, repetitive behaviors that interfere with functioning, and significant distress when the routine is interrupted.

Level 1:Inflexible routines might cause interfering with functioning, and individuals might struggle with transitions, organization, and planning.

Level 2:Significant difficulty coping with change, frequent repetitive behavior, and distress or difficulty changing activities or focus.

Level 3:“Extreme” inflexibility or difficulty with change, repetitive behaviors that interfere with functioning, and significant distress when the routine is interrupted.

Pathological Demand Avoidance in Autism and Beyond

In the past, people with what was then known as Asperger’s syndrome may have been described as being “high-functioning.”

Before the publication of the DSM-5, psychologists distinguished autism fromAsperger’s syndrome, and there is a long history of research surrounding ASD.However, psychologists disagreed on the difference between Asperger’s syndrome and autism, and research showed that individuals' diagnoses depended more on which provider granted the diagnosis than on specific symptoms.

Although some individuals continue to prefer the diagnostic language around Asperger’s, the term is generally considered problematic due to Hans Asperger’s ties to eugenics in Nazi Germany.

Psychologists disagreed on the difference between Asperger’s syndrome and autism, and research showed that individuals' diagnoses depended more on which provider granted the diagnosis than on specific symptoms.

So, what does it mean if you are autistic and “high functioning?” It depends. Typically, someone diagnosed with ASD: Level 1 is considered “high functioning.” However, someone’s social skills might be Level 1, and their behavioral issues might be Level 2.

Because autism is often diagnosed in childhood, many may wonder if high-functioning autism might become better with age. Autism is a lifelong diagnosis that an individual does not “grow out of.” Rather, an individual might experience autistic burnout, which causes increased functional deficits.

Factors that contribute to labeling an autistic person as “high-functioning” include how well they can hold a job, form and maintain relationships, communicate, and mask their autistic traits. Essentially, the better someone can blend in with a neurotypical society, the higher functioning they are. Because of this, many high-functioning autistic people do not get diagnosed until later in life.

Diagnosing High-Functioning Autism

Typically, a psychologist with specialized training in ASD diagnoses autism through aspecialized evaluation. Some commonly used measures used to diagnose autism include:

Treatment for High-Functioning Autism

Treatment options for autism include occupational therapy, physical therapy, and talk therapy. Although Applied Behavior Analysis (ABA) is sometimes referred to as the “gold standard” of autism treatment,the autistic community has largely reported that the treatment is abusive.

Since approximately 70% of autistic people have at least one comorbid diagnosis,including attention-deficit/hyperactivity disorder (ADHD), anxiety, depression,bipolar, psychotic disorders, and suicidal behavior,an autistic individual might want apsychological evaluationto determine what other diagnoses they might have. This information helps determine the most appropriate course of treatment.

High-functioning autistic individuals are typically able to live independently but benefit fromindividual therapyto manage challenges from existing in a world with neurotypical expectations. If they have difficulty forming and maintaining relationships, they could participate in an age-appropriate social skills group.

RecapApproximately 70% of autistic people have at least one comorbid diagnosis.Getting an appropriate diagnosis for each condition is important in order to find an effective treatment approach.

Recap

Approximately 70% of autistic people have at least one comorbid diagnosis.Getting an appropriate diagnosis for each condition is important in order to find an effective treatment approach.

What to Know About Autism and Life Expectancy

Much of the language around autism is focused on the deficits and struggles that autistic people might face, and deficit-based language has been shown to increase stigma.Autism is associated with different cognitive strengths, and research has shown that a strengths-based approach to treatment can be effective.

For example, although the DSM frames autistic people’s social interaction style as a deficit, many autistic people can successfully mask it when interacting with neurotypical individuals, and most autistic people socialize well with other autistic people.

Addressing and reducing stigma is key in supporting and advocating for autistic individuals.

Peer Support for Autistic Individuals

These organizations include information about getting diagnosed, treatment options, advocacy, and social support for autistic people and their loved ones.

Takeaways

The challenges that people with autism face stem from difficulty in navigating a world that is built around neurotypical expectations. That’s why it’s important to remember that someone labeled as ‘high functioning’ still needs support. Their needs may be different, but they may still benefit from extra support with things like academics, self-care, emotional regulation, and social support.

As an Autistic Therapist, Here Are 6 Things in My Sensory Bag That Just Make Sense

15 SourcesVerywell Mind uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Alvares GA, Bebbington K, Cleary D, et al.The misnomer of ‘high functioning autism’: Intelligence is an imprecise predictor of functional abilities at diagnosis.Autism. 2020;24(1):221-232. doi:10.1177/1362361319852831American Psychiatric Association (APA).Diagnostic and Statistical Manual of Mental Disorders. 5th ed, text revision. Washington, D.C.; 2022.Fitzgerald MM.The history of autism in the first half century of the 20th century: New and revised.JRTDD. 2019;1(2):70-77. doi:10.26407/2018jrtdd.1.13Lord C, Petkova E, Hus V, et al.A multisite study of the clinical diagnosis of different autism spectrum disorders.Arch Gen Psychiatry. 2012;69(3):306-313. doi:10.1001/archgenpsychiatry.2011.148Czech H.Hans Asperger, National Socialism, and “race hygiene” in Nazi-era Vienna[published correction appears in Mol Autism. 2021 Jun 21;12(1):45. doi: 10.1186/s13229-021-00433-x].Mol Autism. 2018;9:29. doi:10.1186/s13229-018-0208-6Raymaker DM, Teo AR, Steckler NA, et al.“Having all of your internal resources exhausted beyond measure and being left with no clean-up crew”: defining autistic burnout.Autism in Adulthood. 2020;2(2):132-143.Adamou M, Johnson M, Alty B.Autism Diagnostic Observation Schedule (Ados) scores in males and females diagnosed with autism: a naturalistic study. AIA. 2018;4(2):49-55. doi:10.1108/AIA-01-2018-0003Zander E, Willfors C, Berggren S, et al.The interrater reliability of the Autism Diagnostic Interview-Revised (ADI-R) in clinical settings.Psychopathology. 2017;50(3):219-227. doi:10.1159/000474949Simek AN, Wahlberg AC.Test review: autism spectrum rating scales.Journal of Psychoeducational Assessment. 2011;29(2):191-195. doi:10.1177/0734282910375408Peterson T, Dodson J, Strale F Jr.Impact of applied behavior analysis on Autistic children target behaviors: A replication using repeated measures.Cureus. 2024;16(2):e53372. doi:10.7759/cureus.53372Kirkham P.‘The line between intervention and abuse’ – autism and applied behaviour analysis.History of the Human Sciences. 2017;30(2):107-126. doi:10.1177/0952695117702571Hossain MM, Khan N, Sultana A, et al.Prevalence of comorbid psychiatric disorders among people with autism spectrum disorder: An umbrella review of systematic reviews and meta-analyses.Psychiatry Res. 2020;287:112922. doi:10.1016/j.psychres.2020.112922Bottema-Beutel K, Kapp SK, Lester JN, Sasson NJ, Hand BN.Avoiding ableist language: Suggestions for autism researchers.Autism Adulthood. 2021;3(1):18-29. doi:10.1089/aut.2020.0014Bal VH, Wilkinson E, Fok M.Cognitive profiles of children with autism spectrum disorder with parent-reported extraordinary talents and personal strengths.Autism. 2022;26(1):62-74. doi:10.1177/13623613211020618Rodda A, Estes A.Beyond social skills: Supporting peer relationships and friendships for school-aged children with autism spectrum disorder.Semin Speech Lang. 2018;39(2):178-194. doi:10.1055/s-0038-1628369

15 Sources

Verywell Mind uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Alvares GA, Bebbington K, Cleary D, et al.The misnomer of ‘high functioning autism’: Intelligence is an imprecise predictor of functional abilities at diagnosis.Autism. 2020;24(1):221-232. doi:10.1177/1362361319852831American Psychiatric Association (APA).Diagnostic and Statistical Manual of Mental Disorders. 5th ed, text revision. Washington, D.C.; 2022.Fitzgerald MM.The history of autism in the first half century of the 20th century: New and revised.JRTDD. 2019;1(2):70-77. doi:10.26407/2018jrtdd.1.13Lord C, Petkova E, Hus V, et al.A multisite study of the clinical diagnosis of different autism spectrum disorders.Arch Gen Psychiatry. 2012;69(3):306-313. doi:10.1001/archgenpsychiatry.2011.148Czech H.Hans Asperger, National Socialism, and “race hygiene” in Nazi-era Vienna[published correction appears in Mol Autism. 2021 Jun 21;12(1):45. doi: 10.1186/s13229-021-00433-x].Mol Autism. 2018;9:29. doi:10.1186/s13229-018-0208-6Raymaker DM, Teo AR, Steckler NA, et al.“Having all of your internal resources exhausted beyond measure and being left with no clean-up crew”: defining autistic burnout.Autism in Adulthood. 2020;2(2):132-143.Adamou M, Johnson M, Alty B.Autism Diagnostic Observation Schedule (Ados) scores in males and females diagnosed with autism: a naturalistic study. AIA. 2018;4(2):49-55. doi:10.1108/AIA-01-2018-0003Zander E, Willfors C, Berggren S, et al.The interrater reliability of the Autism Diagnostic Interview-Revised (ADI-R) in clinical settings.Psychopathology. 2017;50(3):219-227. doi:10.1159/000474949Simek AN, Wahlberg AC.Test review: autism spectrum rating scales.Journal of Psychoeducational Assessment. 2011;29(2):191-195. doi:10.1177/0734282910375408Peterson T, Dodson J, Strale F Jr.Impact of applied behavior analysis on Autistic children target behaviors: A replication using repeated measures.Cureus. 2024;16(2):e53372. doi:10.7759/cureus.53372Kirkham P.‘The line between intervention and abuse’ – autism and applied behaviour analysis.History of the Human Sciences. 2017;30(2):107-126. doi:10.1177/0952695117702571Hossain MM, Khan N, Sultana A, et al.Prevalence of comorbid psychiatric disorders among people with autism spectrum disorder: An umbrella review of systematic reviews and meta-analyses.Psychiatry Res. 2020;287:112922. doi:10.1016/j.psychres.2020.112922Bottema-Beutel K, Kapp SK, Lester JN, Sasson NJ, Hand BN.Avoiding ableist language: Suggestions for autism researchers.Autism Adulthood. 2021;3(1):18-29. doi:10.1089/aut.2020.0014Bal VH, Wilkinson E, Fok M.Cognitive profiles of children with autism spectrum disorder with parent-reported extraordinary talents and personal strengths.Autism. 2022;26(1):62-74. doi:10.1177/13623613211020618Rodda A, Estes A.Beyond social skills: Supporting peer relationships and friendships for school-aged children with autism spectrum disorder.Semin Speech Lang. 2018;39(2):178-194. doi:10.1055/s-0038-1628369

Alvares GA, Bebbington K, Cleary D, et al.The misnomer of ‘high functioning autism’: Intelligence is an imprecise predictor of functional abilities at diagnosis.Autism. 2020;24(1):221-232. doi:10.1177/1362361319852831American Psychiatric Association (APA).Diagnostic and Statistical Manual of Mental Disorders. 5th ed, text revision. Washington, D.C.; 2022.Fitzgerald MM.The history of autism in the first half century of the 20th century: New and revised.JRTDD. 2019;1(2):70-77. doi:10.26407/2018jrtdd.1.13Lord C, Petkova E, Hus V, et al.A multisite study of the clinical diagnosis of different autism spectrum disorders.Arch Gen Psychiatry. 2012;69(3):306-313. doi:10.1001/archgenpsychiatry.2011.148Czech H.Hans Asperger, National Socialism, and “race hygiene” in Nazi-era Vienna[published correction appears in Mol Autism. 2021 Jun 21;12(1):45. doi: 10.1186/s13229-021-00433-x].Mol Autism. 2018;9:29. doi:10.1186/s13229-018-0208-6Raymaker DM, Teo AR, Steckler NA, et al.“Having all of your internal resources exhausted beyond measure and being left with no clean-up crew”: defining autistic burnout.Autism in Adulthood. 2020;2(2):132-143.Adamou M, Johnson M, Alty B.Autism Diagnostic Observation Schedule (Ados) scores in males and females diagnosed with autism: a naturalistic study. AIA. 2018;4(2):49-55. doi:10.1108/AIA-01-2018-0003Zander E, Willfors C, Berggren S, et al.The interrater reliability of the Autism Diagnostic Interview-Revised (ADI-R) in clinical settings.Psychopathology. 2017;50(3):219-227. doi:10.1159/000474949Simek AN, Wahlberg AC.Test review: autism spectrum rating scales.Journal of Psychoeducational Assessment. 2011;29(2):191-195. doi:10.1177/0734282910375408Peterson T, Dodson J, Strale F Jr.Impact of applied behavior analysis on Autistic children target behaviors: A replication using repeated measures.Cureus. 2024;16(2):e53372. doi:10.7759/cureus.53372Kirkham P.‘The line between intervention and abuse’ – autism and applied behaviour analysis.History of the Human Sciences. 2017;30(2):107-126. doi:10.1177/0952695117702571Hossain MM, Khan N, Sultana A, et al.Prevalence of comorbid psychiatric disorders among people with autism spectrum disorder: An umbrella review of systematic reviews and meta-analyses.Psychiatry Res. 2020;287:112922. doi:10.1016/j.psychres.2020.112922Bottema-Beutel K, Kapp SK, Lester JN, Sasson NJ, Hand BN.Avoiding ableist language: Suggestions for autism researchers.Autism Adulthood. 2021;3(1):18-29. doi:10.1089/aut.2020.0014Bal VH, Wilkinson E, Fok M.Cognitive profiles of children with autism spectrum disorder with parent-reported extraordinary talents and personal strengths.Autism. 2022;26(1):62-74. doi:10.1177/13623613211020618Rodda A, Estes A.Beyond social skills: Supporting peer relationships and friendships for school-aged children with autism spectrum disorder.Semin Speech Lang. 2018;39(2):178-194. doi:10.1055/s-0038-1628369

American Psychiatric Association (APA).Diagnostic and Statistical Manual of Mental Disorders. 5th ed, text revision. Washington, D.C.; 2022.

Fitzgerald MM.The history of autism in the first half century of the 20th century: New and revised.JRTDD. 2019;1(2):70-77. doi:10.26407/2018jrtdd.1.13

Lord C, Petkova E, Hus V, et al.A multisite study of the clinical diagnosis of different autism spectrum disorders.Arch Gen Psychiatry. 2012;69(3):306-313. doi:10.1001/archgenpsychiatry.2011.148

Czech H.Hans Asperger, National Socialism, and “race hygiene” in Nazi-era Vienna[published correction appears in Mol Autism. 2021 Jun 21;12(1):45. doi: 10.1186/s13229-021-00433-x].Mol Autism. 2018;9:29. doi:10.1186/s13229-018-0208-6

Raymaker DM, Teo AR, Steckler NA, et al.“Having all of your internal resources exhausted beyond measure and being left with no clean-up crew”: defining autistic burnout.Autism in Adulthood. 2020;2(2):132-143.

Adamou M, Johnson M, Alty B.Autism Diagnostic Observation Schedule (Ados) scores in males and females diagnosed with autism: a naturalistic study. AIA. 2018;4(2):49-55. doi:10.1108/AIA-01-2018-0003

Zander E, Willfors C, Berggren S, et al.The interrater reliability of the Autism Diagnostic Interview-Revised (ADI-R) in clinical settings.Psychopathology. 2017;50(3):219-227. doi:10.1159/000474949

Simek AN, Wahlberg AC.Test review: autism spectrum rating scales.Journal of Psychoeducational Assessment. 2011;29(2):191-195. doi:10.1177/0734282910375408

Peterson T, Dodson J, Strale F Jr.Impact of applied behavior analysis on Autistic children target behaviors: A replication using repeated measures.Cureus. 2024;16(2):e53372. doi:10.7759/cureus.53372

Kirkham P.‘The line between intervention and abuse’ – autism and applied behaviour analysis.History of the Human Sciences. 2017;30(2):107-126. doi:10.1177/0952695117702571

Hossain MM, Khan N, Sultana A, et al.Prevalence of comorbid psychiatric disorders among people with autism spectrum disorder: An umbrella review of systematic reviews and meta-analyses.Psychiatry Res. 2020;287:112922. doi:10.1016/j.psychres.2020.112922

Bottema-Beutel K, Kapp SK, Lester JN, Sasson NJ, Hand BN.Avoiding ableist language: Suggestions for autism researchers.Autism Adulthood. 2021;3(1):18-29. doi:10.1089/aut.2020.0014

Bal VH, Wilkinson E, Fok M.Cognitive profiles of children with autism spectrum disorder with parent-reported extraordinary talents and personal strengths.Autism. 2022;26(1):62-74. doi:10.1177/13623613211020618

Rodda A, Estes A.Beyond social skills: Supporting peer relationships and friendships for school-aged children with autism spectrum disorder.Semin Speech Lang. 2018;39(2):178-194. doi:10.1055/s-0038-1628369

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At a Glance#

Understanding Autism Spectrum Disorder#

Diagnosing High-Functioning Autism#

Treatment for High-Functioning Autism#

Recap#

Peer Support for Autistic Individuals#

Takeaways#