The phrase "high-functioning autism" is frequently used to describe autistic individuals who others perceive to function in society, whether that's because they speak verbally, hold a job, or live independently. However, this term is misleading, and many autistic individuals and clinicians now avoid the label because it hides real needs and can be stigmatizing.
Where Did High-Functioning Autism Come From?
“High-functioning autism” is an informal phrase people have used to describe autistic people who don’t have intellectual disability and who can manage many day-to-day tasks. Historically, many of the people called “high-functioning” would previously have been diagnosed with Asperger’s syndrome.
This old diagnosis was rooted in the work of the Austrian pediatrician Hans Asperger in the 1940s. He described children with “autistic psychopathy” who showed strong verbal and cognitive skills despite social difficulties. However, Asperger’s legacy is ethically troubling. Historical evidence shows that he collaborated with Nazi eugenics programs, referring disabled children to clinics where many were killed (Maher, 2021). His framing of “high-functioning” children as more valuable or redeemable has left a lasting and painful imprint on how society ranks human worth by ability.
In 2013, the American Psychiatric Association revised the diagnostic manual (DSM-5) and removed Asperger’s as a separate diagnosis, folding it into Autism Spectrum Disorder (ASD) (American Psychiatric Association, 2013). The change reflected research showing that the distinctions weren’t consistently reliable, and autism is better understood as a spectrum with varied strengths and challenges rather than neatly separate categories (Rosen et al., 2021). Today, advocates encourage retiring labels like “high-functioning” in favor of describing specific support needs (Levels 1–3), which better reflect an individual’s lived experience without implying value judgments.
Why Many Autistic People and Advocates Dislike “High-Functioning”
There are several reasons autistic self-advocacy groups discourage the label “high-functioning”:
It emphasizes what a person appears to do or not need, and minimizes what the person does need. Someone who appears independent might still struggle greatly with executive functioning, sensory processing, social fatigue, or mental-health comorbidities.
The term creates a two-tiered hierarchy: “high” vs. “low” functioning, which implicitly assigns more value to those labeled “high,” even though “functioning” doesn’t capture an individual’s lived experience or the effort they put forth to get through the day.
The historical root of the label is interwoven with the story of Asperger’s syndrome and issues around diagnosis, ableism, and eugenics history. It furthers the idea that individuals who are perceived as “less disabled” because of their contribution to society are deemed more valuable than those who are “more disabled.”
It creates unfair expectations. People assume someone labeled “high-functioning” doesn’t struggle. That can cause shame and pressure to mask real difficulties.
This term also ignores context. Functioning depends on the environment (supports, stressors, sensory demands, and life changes). A person who manages fine in a quiet job may struggle in a noisy, unpredictable setting, or manage for a time before burning out from constant masking.
Autistic organizations and self-advocates emphasize neurodiversity and prefer language that centers access and supports rather than vague functioning labels. The Autistic Self Advocacy Network (ASAN), for example, advocates for autistic individuals' rights, access to supports, and disability justice.
What to Use Instead?
Currently, individuals are diagnosed with one of three levels of autism (Children's Hospital of Philadelphia Research Institute, 2020).
Level 1 — “Requiring support.” The person may have social communication challenges and inflexible behavior that interfere with functioning, but they can often manage with supports.
Level 2 — “Requiring substantial support.” Social and behavioral differences are more pronounced and need more consistent help.
Level 3 — “Requiring very substantial support.” The individual needs intensive, frequent supports to function day-to-day.
This system focuses on how much support someone needs in specific areas, such as social communication and restricted/repetitive behaviors, instead of labeling the person as “high” or “low” functioning.
What Does Level 1 Autism Mean?
Level 1 ASD is the closest DSM-5 category to the old concept of Asperger’s or “high-functioning autism.” However, it’s important to be specific about what that means in practice:
Social communication: People at Level 1 may have noticeable difficulties initiating or responding to social interaction (reading social cues, making small talk, understanding implicit rules). They might appear awkward in conversation or misread others’ intentions.
Flexibility and routines: They may struggle with changes, transitions, or disruptions in plans; rigid thinking or routines can cause significant stress.
Executive functioning and sensory needs: Difficulties with planning, organization, time management, and sensory processing (sound, light, touch) can cause daily challenges, even if tasks can be completed independently.
Mental health comorbidity: Anxiety, depression, ADHD, and sensory overload are frequent and often compound functional difficulties.
A person at Level 1 might hold a job, study, and live independently, yet still require meaningful supports (workplace accommodations, coaching, sensory strategies, therapy) to thrive. The “high-functioning” label obscures those needs and can prevent people from getting appropriate accommodations.
Needs Often Vary and Change Over Time
A key reason the term “high-functioning” is misleading is that needs are dynamic. Support needs can increase or decrease across the life span depending on:
Life transitions (starting college, becoming a parent, a new job).
Stressful circumstances (loss, illness, economic pressure, discrimination).
Aging and health changes.
Access to supports (therapies, accommodations, community connection).
For example, someone who managed in early adulthood may struggle after becoming a parent, or a student may encounter more challenges when they move into a loud, busy classroom than they faced in the previous school year.
Moving Forward With Empowerment
If you’re describing yourself or someone you support, consider these alternatives:
Talk about specific strengths and challenges (e.g., “strong verbal skills, needs sensory accommodations, faces challenges with time management”).
Use the level of support if a clinical context requires it (e.g., “ASD Level 1, requiring support”).
Ask autistic people how they prefer to be described. Many individuals have strong preferences about identity-first language (“autistic person”) vs. person-first language (“person with autism”).
Language that describes needs and accommodations leads to better support and less stigma.
Seattle Autism Treatment and Support
If you want compassionate, neurodiversity-affirming care, Dr. David Zacharias at Existential Psychiatry offers patient-centered treatment with psychotherapy and medication management. Dr. Zacharias has provided care to patients from all walks of life for over 20 years and provides supportive, holistic mental health care for neurodivergent individuals. To begin therapy or psychiatry services in Seattle or virtually in Washington state, please reach out to schedule a free consultation.
Written by Existential Psychiatry Staff
References
- American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). https://doi.org/10.1176/appi.books.9780890425596
- Children's Hospital of Philadelphia Research Institute. (2020, June 9). Diagnostic criteria for autism spectrum disorder in the DSM-5 | CHOP research institute. www.research.chop.edu. https://www.research.chop.edu/car-autism-roadmap/diagnostic-criteria-for-autism-spectrum-disorder-in-the-dsm-5
- Maher, E. (2021) “Review of Asperger's Children: The Origins of Autism in Nazi Vienna by Edith Sheffer”, Disability Studies Quarterly 41(1). doi: https://doi.org/10.18061/dsq.v41i1.7862
- Rosen, N. E., Lord, C., & Volkmar, F. R. (2021). The Diagnosis of Autism: From Kanner to DSM-III to DSM-5 and Beyond. Journal of Autism and Developmental Disorders, 51(12), 4253–4270. https://doi.org/10.1007/s10803-021-04904-1