What Is High-Functioning Autism

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.

High-Functioning Autism

High-functioning autism isn’t an official medical diagnosis. It’s often used to refer to autistic people who read, write, speak, and manage life skills without much assistance.

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High-functioning autism isn’t an official medical diagnosis. It’s often used to refer to autistic people who read, write, speak, and manage life skills without much assistance.

Autism is a neurodevelopmental disorder that’s characterized by difficulties with social interaction and communication. Some autistic people need minimal support, while others require substantial support on a daily basis. This is why autism is now referred to as autism spectrum disorder (ASD).

High-functioning autism is often used to refer to those with lower support needs. Read on to learn more about it.

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The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) was updated and released in 2013. Before its most recent update, the DSM used to detail a condition known as Asperger’s syndrome.

People diagnosed with Asperger’s syndrome had several symptoms in common with autistic people, but they didn’t have delays in:

• the use of language
• cognitive development
• the development of age-appropriate self-help skills
• the development of adaptive behavior
• the development of curiosity about their environment

Their symptoms were often milder and less likely to affect their daily lives than the symptoms of autistic people. They may even have been perceived as “high-functioning.”

However, high-functioning autism has never been an official clinical diagnosis, and Asperger’s syndrome was eliminated from the DSM-5 along with some other neurodevelopmental disorders.

People who have these types of difficulties with social interaction and communication or who display repetitive or restrictive behavior would now simply be diagnosed with ASD. This is regardless of how much support they may need.

ASD is divided into three levels:

• Level 1. People at this level may have symptoms that don’t interfere too much with their work, school, or relationships. This is what most people are referring to when they use the terms high-functioning autism or Asperger’s syndrome.
• Level 2. People at this level require some outside support on a daily basis. Examples of outside support include speech therapy and social skills training.
• Level 3. People at this level require substantial outside support on a daily basis. In some cases, support may include full-time aides or intensive therapy.

While it’s difficult to determine a person’s ASD level, trained psychologists have some tools that can help them accomplish this, such as the Autism Diagnostic Observation Schedule, Second Edition (ADOS-2). This assessment is typically paired with a thorough developmental history.

ASD can be diagnosed as early as 18 months . However, many children, and even some adults, may not be diagnosed until much later.

Being diagnosed at a later age can make support more difficult. If you or your child’s pediatrician think they may be autistic, consider making an appointment with an ASD specialist. Learn more about testing for ASD.

There aren’t any standardized recommendations for different levels of ASD. Support depends on each person’s unique symptoms.

People with different levels of ASD may all need the same kinds of support, but those with level 2 or level 3 ASD will likely need more intensive, long-term support than those with level 1 ASD.

Potential ASD support includes:

• Speech therapy. ASD can cause a variety of speech issues. Some autistic people might not be able to speak at all, while others might have trouble engaging in conversations with others. Speech therapy can help to address a range of speech problems. Learn more about speech disorders.
• Physical therapy. Some autistic people have trouble with motor skills. This can make actions such as jumping, walking, or running difficult. Physical therapy can help to strengthen muscles and improve motor skills.
• Occupational therapy.Occupational therapy can help you learn how to use your hands, legs, or other body parts more efficiently. This can make daily tasks and working easier.
• Sensory training. Autistic people are often sensitive to sounds, lights, and touch. Sensory training helps people become more comfortable with sensory input.
• Applied behavioral analysis (ABA). This is a technique that encourages positive or helpful behaviors while decreasing behaviors that interfere with functionality. There are several types of applied behavioral analysis (ABA), but most use a reward system.
• Medication. While there aren’t any medications designed to treat ASD, certain medications can help to manage specific symptoms, such as depression or emotional lability.

High-functioning autism isn’t a medical term, and it doesn’t have a clear definition.

People using this term are likely referring to something similar to level 1 ASD. It may also be comparable to Asperger’s syndrome, a condition not currently recognized by the APA.

If you think that you or your child have any of the symptoms of ASD, see a doctor or specialist. Blogs can be another great source of support.

Last medically reviewed on July 23, 2021

What Is ‘High-Functioning’ Autism?

Dr. Amy Marschall is an autistic clinical psychologist with ADHD, working with children and adolescents who also identify with these neurotypes among others. She is certified in TF-CBT and telemental health.

Updated on October 18, 2022
Medically reviewed

Verywell Mind articles are reviewed by board-certified physicians and mental healthcare professionals. Medical Reviewers confirm the content is thorough and accurate, reflecting the latest evidence-based research. Content is reviewed before publication and upon substantial updates. Learn more.

David Susman, PhD is a licensed clinical psychologist with experience providing treatment to individuals with mental illness and substance use concerns.

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Table of Contents
Table of Contents

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.

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 at 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 perpetuates stigma about neurodivergent people. 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.

Autism Spectrum Disorder

Autism spectrum disorder (ASD) is a neurodevelopmental condition marked by social skills, behavior, and sensory sensitivity not seen in neurotypical individuals.

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

1. Social difficulties may include “abnormal” approaches to conversations or social interaction or difficulty initiating or maintaining social interactions. It may also involve issues expressing and interpreting nonverbal communication, such as tone, body language, or eye contact. Also, autistic people may have difficulty “developing, maintaining, and understanding relationships.”
2. Repetitive or fixated behaviors, interests, or activities: Repetitive movements or speech, such as “stimming” behavior or repeating words or phrases. Someone may experience difficulty with flexibility around routines or rituals or show intense fixation in some interests. Additional symptoms may include atypical responses to sensory experiences, such as a preference for deep pressure or an inability to tolerate physical touch.
3. Symptoms begin early in life though severity can increase over time as “social demands exceed limited capacities, or may be masked by learned strategies.”
4. Symptoms cause difficulty in areas of functioning: For example, symptoms that interfere with school, work, and other interactions/environments.
5. Other diagnoses are not probable: Someone may also be diagnosed with autism if another diagnosis does not explain the above issues better.

The “severity” can be based on either the individual’s social skills or patterns of behavior and is determined by the amount of support an individual needs. Per the DSM, an autistic individual’s level of functioning is labeled as Level 1, Level 2, or Level 3. Level 1 is often described as the ‘mildest,’ while level 3 is described as more ‘severe.’

• 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.

• 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.

Autism and Asperger’s

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 from Asperger’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.

What Does “High Functioning” Mean?

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 a specialized evaluation. Some commonly used measures used to diagnose autism include:

• The Autism Diagnostic Observation Schedule (ADOS): The ADOS is sometimes referred to as the “gold standard” for autism assessment and includes a standardized assessment of an individual’s social interactions and imaginative play in children to determine whether someone meets the criteria for autism spectrum disorder. There are sections of the ADOS that are specifically for children, but they can also sometimes be used in evaluating adults.
• The Autism Diagnostic Interview, Revised (ADI-R): The ADI-R is a structured interview used to assess autism in those aged four and older.
• The Autism Spectrum Rating Scale (ASRS): The ASRS uses observational data from guardians and teachers to determine whether an individual meets the diagnostic criteria for autism. It is used for those between the ages of one and a half and 18 years old.

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 a psychological evaluation to 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 from individual therapy to 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.

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.

Autism and Stigma

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. In fact, 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

Peer support and advocacy are key for autistic individuals. Those looking to connect with organizations run by and for autistic people can refer to the Autistic Women & Nonbinary Network and the Asperger/Autism Network.

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

15 Sources

Verywell Mind uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.

1. 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:10.1177/1362361319852831
2. American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. Fifth Edition. American Psychiatric Association; 2013.
3. Fitzgerald MM. The history of autism in the first half century of the 20th century: new and revised.JRTDD. 2019;1(2):70-77.
4. Lord C. A multisite study of the clinical diagnosis of different autism spectrum disorders. Arch Gen Psychiatry. 2012;69(3):306.
5. Czech H. Correction to: Hans Asperger, national socialism, and “race hygiene” in Nazi-era Vienna. Molecular Autism. 2021;12(1):45.
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.
7. Adamou, M., Johnson, M. and Alty, B. (2018), “Autism Diagnostic Observation Schedule (ADOS) scores in males and females diagnosed with autism: a naturalistic study”, Advances in Autism, Vol. 4 No. 2, pp. 49-55.
8. 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.
9. Simek AN, Wahlberg AC. Test review: autism spectrum rating scales. Journal of Psychoeducational Assessment. 2011;29(2):191-195.
10. Axelrod S, McElrath KK, Wine B. Applied behavior analysis: autism and beyond: applied behavior analysis: autism and beyond. Behav Intervent. 2012;27(1):1-15.
11. Kirkham P. ‘The line between intervention and abuse’ – autism and applied behaviour analysis.History of the Human Sciences. 2017;30(2):107-126.
12. 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 Research. 2020;287:112922.
13. Bottema-Beutel K, Kapp SK, Lester JN, Sasson NJ, Hand BN. Avoiding ableist language: suggestions for autism researchers.Autism in Adulthood. 2021;3(1):18-29.
14. Bal VH, Wilkinson E, Fok M. Cognitive profiles of children with autism spectrum disorder with parent-reported extraordinary talents and personal strengths.Autism. Published online June 4, 2021:136236132110206.
15. 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(02):178-194.

By Amy Marschall, PsyD
Dr. Amy Marschall is an autistic clinical psychologist with ADHD, working with children and adolescents who also identify with these neurotypes among others. She is certified in TF-CBT and telemental health.