Introduction
If you've noticed clinicians, articles, and autistic adults moving away from the term "high-functioning autism," there are substantive reasons for the shift. This piece walks through what changed in 2013, what's used now in current clinical practice, why the autistic community has been central to pushing for the change, and how to think about the many people who still use the term meaningfully.
The short version: "high-functioning autism" was never a formal diagnostic category, and the framework it represented has been moved away from for reasons that include real concerns about how it misrepresented support needs and conditioned worth on cognitive performance. But the move isn't a simple "wrong vs. right.” It's a clinical and cultural evolution that deserves the same nuance as the people the term once described.
What Actually Changed in 2013
In May 2013, the American Psychiatric Association published the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), which substantially changed how autism is categorized.
The most relevant change for this topic:
Before DSM-5, autism was diagnosed under several separate categories: Autistic Disorder, Asperger's Syndrome, Pervasive Developmental Disorder-Not Otherwise Specified (PDD-NOS), Childhood Disintegrative Disorder, and Rett's Disorder. "High-functioning autism" wasn't a formal category in the previous DSM-IV either, but it was widely used informally to describe individuals with autism who had average or above-average IQ and developed language.
After DSM-5, all of these separate categories were folded into a single diagnosis:
Autism Spectrum Disorder (ASD), with
three specified support levels:
- Level 1: Requiring support
- Level 2: Requiring substantial support
- Level 3: Requiring very substantial support
The World Health Organization's ICD-11, which went into effect in 2022, uses a similar single-diagnosis-with-specifiers approach.
The change reflected an understanding that the previous categories, including the informal "high-functioning" label, didn't accurately capture how autism actually presents. The new framework acknowledges that autism is a single condition that varies in how it shows up, what support it requires, and how it changes across someone's life.
Why the Change Mattered
The shift away from "high-functioning autism" and the broader move away from functioning labels generally happened for several substantive reasons, many of which the autistic community has been articulating for years.
The Label Hid Real Support Needs
People described as "high-functioning" often had substantial support needs that weren't obvious from their cognitive performance or language abilities. Many struggled significantly with executive function, sensory regulation, social exhaustion, mental health, masking-related fatigue, and other challenges that the "high-functioning" label minimized or hid.
Schools, employers, and even families sometimes treated "high-functioning" as meaning "doesn't need accommodations", leading to inadequate support and contributing to documented mental health crises (anxiety, depression, autistic burnout), particularly in adolescence and adulthood.
The Label Conditioned Worth on Cognitive Performance
The "high-functioning vs. low-functioning" hierarchy implicitly valued autistic people by their cognitive performance and ability to appear non-autistic. This framing treated some autistic people as more worthy of inclusion in society than others—a position the autistic community has consistently and substantively rejected.
The autistic adult community's perspective has been clear: an autistic person's worth doesn't depend on whether they can mask, whether they can speak, whether they test well, or whether they appear "typical." Functioning labels were participating in conditioning worth based on factors that have nothing to do with personhood.
IQ, Language, and Support Needs Aren't the Same Thing
The "high-functioning" label often conflates several separate dimensions:
- Cognitive ability (IQ)
- Spoken language development
- Executive function
- Daily living skills
- Social functioning
- Sensory regulation
- Masking capacity
These don't move together. An autistic person can have a high IQ and significant executive function challenges. Strong language and substantial sensory dysregulation. Excellent academic performance and severe social exhaustion. Collapsing all of these into a single "high-functioning" descriptor produced inaccurate pictures of what individuals actually needed.
The Label Was Particularly Damaging to Autistic Girls and Women
Many autistic women, particularly those diagnosed late, particularly those who masked effectively in childhood, were either undiagnosed entirely under the "high-functioning" framework or labeled "high-functioning" in ways that hid significant underlying support needs and contributed to mental health deterioration.
For more on how autism presents in girls and why they're frequently underdiagnosed, see our piece on autism in girls.
The "Low-Functioning" Counterpart Caused Real Harm, Too
The "high-functioning" label only makes sense as part of a hierarchy with "low-functioning" at the other end. The "low-functioning" label has caused genuine harm, assumptions about cognitive ability, presumption of incompetence, denial of communication tools, and lower expectations across the board. Many nonspeaking autistic adults have written substantively about being treated as if they didn't understand because they couldn't show comprehension in ways adults expected.
The whole hierarchy was the problem, not just one end of it.
The Autistic Community's Role
It would be inaccurate to credit the DSM-5 change entirely to clinical researchers. The autistic community, particularly autistic adults who lived under these labels, has been central to articulating why the framework didn't work and what alternatives might.
Organizations like the Autistic Self Advocacy Network (ASAN) and the Autistic Women & Nonbinary Network (AWN) have been clear for years about the harms of functioning labels. Late-diagnosed autistic adults, particularly women like Sarah Hendrickx, Devon Price, and many others, have written substantially about how the "high-functioning" framework failed them.
The clinical and academic literature increasingly cites this lived-experience research as central to the rationale for moving away from the terms. When current clinicians explain why they don't use "high-functioning autism," they're typically reflecting positions the autistic community articulated first.
For more on the broader autistic community framework, see our piece on the neurodivergent pride movement.
What's Used Now
Current best practice in autism description uses several approaches, often in combination:
Formal Diagnostic Language
The DSM-5 ASD diagnosis with specified support level:
- "Autism Spectrum Disorder, Level 1 (requiring support)"
- "Autism Spectrum Disorder, Level 2 (requiring substantial support)"
- "Autism Spectrum Disorder, Level 3 (requiring very substantial support)"
Levels can apply to specific domains (social communication, restricted/repetitive behaviors) and can change across someone's life as support needs change. A child diagnosed at Level 1 may have different support needs at age 5, age 12, and age 25.
Functional Descriptions
Increasingly, clinical reports and educational documents describe specific support needs in specific contexts rather than applying global labels. For example: "Susan requires substantial support during unstructured social time and minimal support during academic tasks. She uses AAC supplementally during emotional regulation challenges."
This descriptive approach is more accurate, more useful for accommodation planning, and more respectful of individual variation than functioning labels.
Identity-First Language
Many autistic adults and advocacy organizations prefer identity-first language, "autistic person" rather than "person with autism." This treats autism as integral to identity rather than as something separate from the person. For more on this preference, see our piece on the neurodivergent pride movement.
(Some autistic individuals and some families prefer person-first language. Asking what someone prefers is respectful; assuming one or the other can be unintentionally exclusionary.)
Specific Descriptive Language
For practical conversations about an autistic person's experience and needs, specific descriptive language is often most useful:
- "She masks effectively in academic settings but is exhausted at home"
- "He communicates primarily through AAC and benefits from sensory accommodations"
- "They have strong language skills and significant executive function challenges"
- "She experiences sensory overwhelm in busy environments"
This kind of description is more useful than any label.
The People Who Still Use "High-Functioning Autism"
This is the part most articles on this topic skip, and it matters: many autistic adults still use the term "high-functioning autism" meaningfully, and that deserves respect.
Reasons people may continue using the term:
They were diagnosed under the previous framework. Many adults received "high-functioning autism" diagnoses before 2013, and the term has been part of their identity for years or decades. Asking them to abandon a label that's been meaningful is often more harm than help.
It captures something about their experience. Some people find that "high-functioning autism" describes their lived experience better than "ASD Level 1", even when "Level 1" is the formal designation. The term has community history; the formal term doesn't yet.
They're communicating with people who recognize the term. "High-functioning autism" remains in wide cultural circulation. For practical communication, using language that other people understand often matters more than using language that's formally correct.
They're connected to communities organized around the term. Online communities, books, and resources organized around "high-functioning autism" have built a community for people who identify with the term. Membership in those communities is meaningful.
They have specific objections to the alternative framing. Some people find "ASD Level 1" clinical and impersonal. Some find the broader move-away movement preachy or invalidating of their own experience.
None of these reasons makes using "high-functioning autism" wrong for the people who choose it. The contemporary recommendation is about how the term is used in current clinical practice and in conversations that affect autistic people who don't choose the term, not about overriding individual identification.
The honest framing: current best practice moves away from "high-functioning autism" as clinical language, while respecting people who continue to use it for themselves.
What This Means for Families
For families navigating these terms:
If you're seeking a diagnosis now, you'll receive an ASD diagnosis with a support level, not "high-functioning autism." That's the current diagnostic reality regardless of how the clinician personally talks about autism.
If you've been told your child "would have been high-functioning autism", that's a clinician translating current diagnostic categories into older language. The current label (typically "ASD Level 1") is more accurate; the translation may be more familiar.
If you or a family member was diagnosed pre-2013 with "high-functioning autism," that diagnosis remains valid. You don't have to "update" it. How you talk about it now is your choice.
For talking about your child with extended family, schools, and others, specific descriptive language about your child's actual needs is usually most useful, more than either "high-functioning" or "Level 1." "He has strong language skills and significant sensory regulation needs" is more useful than any label.
For your child's self-understanding, exposing them to language used by autistic adults (rather than just clinical labels) is generally helpful. Reading children's books and content from autistic creators models language flexibility.
Conclusion
The move away from "high-functioning autism" reflects substantive lessons learned about how the framework misrepresented autistic experience, particularly the experiences of autistic adults who lived under the label and articulated its harms. Contemporary recommendations align with that learning: ASD with specified support level in formal diagnosis, descriptive language about specific needs in practical conversation, and identity-first language in many community contexts.
At the same time, people who still identify with "high-functioning autism", particularly those diagnosed before 2013, aren't doing something wrong. The contemporary recommendation is about current clinical practice and broader community conversation; it doesn't override individual identification.
At Steady Strides ABA, we work with autistic children across Texas, and approach each child as the individual they are, rather than through outdated categorical labels.
If you'd like to talk through what kind of support might fit your specific family member, contact us for a conversation with a BCBA.
Frequently Asked Questions
Is "high-functioning autism" really no longer used?
In current clinical practice, the formal diagnosis "high-functioning autism" hasn't been part of the DSM since the 2013 transition to DSM-5. Diagnoses now use ASD with specified support level (Level 1, 2, or 3). However, the term remains in wide cultural circulation, in everyday conversation, popular media, older medical records, and among many autistic adults who were diagnosed before 2013 and continue to identify with it. So the more accurate framing is: "high-functioning autism" is no longer current diagnostic terminology, but it's still in active use among many people for various legitimate reasons.
What replaced "high-functioning autism"?
In formal diagnosis, the DSM-5 ASD diagnosis is made with a specified support level (typically Level 1 for what would have been called "high-functioning"). In everyday discussion, identity-first language ("autistic person"), specific descriptive language about individual needs, and acknowledgment of the full range of autistic presentations. The change isn't just about swapping one label for another. It's a broader shift toward describing individuals' specific support needs and characteristics rather than sorting people into hierarchical categories.
Why was "high-functioning autism" considered problematic?
Several reasons: it hid real support needs (people labeled "high-functioning" often had substantial unmet needs); it conditioned worth on cognitive performance; it conflated several different dimensions (IQ, language, executive function, sensory regulation, masking) that don't actually move together; it was particularly damaging to autistic girls and women, who were often undiagnosed under the framework or labeled in ways that hid significant struggles; and it only made sense as part of a hierarchy with "low-functioning" at the other end, which caused its own harms. The autistic community has articulated these concerns substantively for years, and current clinical practice has increasingly reflected this critique.
If I were diagnosed with high-functioning autism, am I still autistic?
Yes. The diagnostic category changed in 2013, but your underlying diagnosis remained valid. You don't have to "update" your diagnosis or your language. Many people who received pre-2013 diagnoses continue using the term they were diagnosed with; others have shifted to the current language. There's no required answer. What matters is that your autism is real, regardless of which label was applied at the time of diagnosis.
Is it disrespectful to use "high-functioning autism"?
It depends on context. Using the term to describe yourself if you identify with it is your choice and is generally respected. Using the term to describe other people, particularly people who don't use the term themselves, or in clinical/educational contexts where current language matters, is increasingly considered outdated and can feel disrespectful to the autistic community. The most flexible approach is being fluent in the current language while not invalidating people who use older terms meaningfully for themselves.
What should I use to describe my autistic child?
For formal clinical and educational contexts, current language (ASD, Level 1/2/3 if relevant) tends to work well. For everyday conversation, specific descriptive language about your child's actual needs and characteristics is usually most useful, more useful than any single label. "He's autistic, has strong language skills, and needs sensory accommodations at school" gives schools, family, and others much more useful information than any single category label. As your child grows, including them in the conversation about how they want to describe themselves is important. Their preference should ultimately guide language.
SOURCES:
https://www.psychiatry.org/psychiatrists/practice/dsm
https://www.cdc.gov/ncbddd/autism/data.html
https://autisticadvocacy.org/about-asan/about-autism/
https://awnnetwork.org/
https://reframingautism.org.au/
https://health.clevelandclinic.org/high-functioning-autism
https://www.healthychildren.org/English/health-issues/conditions/Autism/Pages/default.aspx
