In the world of autism discourse, phrases such as “high-functioning,” “low-functioning,” or “Level 1 Autism” are frequently used. These terms are often intended to clarify the amount of support a person on the autism spectrum might require.
They can also be confusing, misleading, or even harmful. The debate over “autism severity vs. functioning labels” reflects broader concerns about how society understands, categorizes, and responds to the needs of autistic individuals.
This article explores the distinctions between autism severity levels and functioning labels. We’ll dive into their origins, meanings, criticisms, and the consequences of using such labels.
Along the way, we’ll listen to the perspectives of autistic individuals, explore alternative language, and suggest ways to communicate with greater respect and accuracy.
Whether you’re a parent, educator, clinician, or an autistic person yourself, understanding this topic can help promote a more compassionate and informed conversation around autism.
What Is Autism Spectrum Disorder?
Autism Spectrum Disorder (ASD) is a neurodevelopmental condition characterized by differences in social communication, sensory processing, and patterns of repetitive behavior or restricted interests. It is called a “spectrum” because autistic people vary widely in how they experience and express these characteristics.
Autistic individuals may be verbal or non-verbal, highly sensitive to sensory input or not sensitive at all, socially outgoing or reserved, and so on. Because of this diversity, it’s essential to avoid one-size-fits-all definitions.
Autism Severity Levels
DSM-5 and Autism Levels
In 2013, the American Psychiatric Association introduced the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), which redefined how autism is diagnosed.
Rather than having separate diagnoses like Asperger’s Syndrome or Pervasive Developmental Disorder – Not Otherwise Specified (PDD-NOS), all were consolidated into a single diagnosis: Autism Spectrum Disorder.
To assist in diagnosis and service planning, the DSM-5 introduced three levels of severity:
- Level 1: Requires Support
- Level 2: Requires Substantial Support
- Level 3: Requires Very Substantial Support
These levels are intended to reflect the level of support an autistic individual might need in two main domains:
- Social Communication: How well the person can initiate and sustain social interactions.
- Restricted and Repetitive Behaviors: The degree to which these behaviors interfere with daily functioning.
Purpose of Severity Levels
Severity levels aim to help clinicians and service providers determine the kind of support an autistic person needs.
For instance, someone at Level 3 might require intensive one-on-one assistance, while someone at Level 1 might need social skills coaching or occasional support at work.
These levels are not always reliable indicators of how an autistic person experiences the world. They often fail to account for co-occurring conditions like anxiety, ADHD, epilepsy, or learning disabilities.
What Are Functioning Labels?
Common Functioning Labels
In everyday conversation, people often refer to autistic individuals as either:
- High-functioning: Typically used to describe people who can speak, attend school or work independently, and mask their autistic traits.
- Low-functioning: Used to describe individuals who may be non-verbal, need continuous support, or have intellectual disabilities.
These labels, although widely used, are not medically recognized and lack consistent criteria. They’re based more on societal perceptions of ability rather than a nuanced understanding of support needs.
Problems with Functioning Labels
Functioning labels are problematic for several reasons:
- Oversimplification: Autism is complex and multidimensional. Functioning labels reduce it to a binary framework.
- Inconsistency: A person may appear high-functioning in one context (e.g., writing or technical work) but struggle greatly in another (e.g., social interaction or self-care).
- Masking: Many autistic individuals, particularly women and nonbinary people, mask their traits to fit in. This can lead to misclassification as “high-functioning,” resulting in overlooked support needs.
- Stigmatization: Calling someone “low-functioning” can be demeaning and lead to assumptions about their potential or intelligence.
- Barrier to Services: Functioning labels can influence whether a person gets access to needed services, often unfairly excluding those labeled as “too capable.”
Autism Severity vs. Functioning Labels
| Feature | Severity Levels (DSM-5) | Functioning Labels (Colloquial) |
|---|---|---|
| Source | Diagnostic manual (DSM-5) | Informal, public perception |
| Purpose | Clinical, service planning | Social categorization |
| Basis | Support needs in two domains | Observed independence |
| Examples | Level 1, 2, or 3 ASD | High-functioning, low-functioning |
| Criticism | Rigid, lacks nuance | Simplistic, stigmatizing |
| Alternatives | Descriptive support profiles | Individualized strengths/needs |
Real-Life Impact of These Labels
On Autistic Individuals
Functioning labels and severity levels can affect how autistic people see themselves and are treated by others:
- Self-Esteem: Being labeled “low-functioning” can diminish self-worth; “high-functioning” individuals may feel their struggles are invalidated.
- Misjudgment: A non-speaking person may be wrongly assumed to have low intelligence, while a speaking person may be assumed to have no struggles.
- Access to Services: Many services are tied to certain labels or levels, creating inequity in access.
On Parents and Families
Parents may rely on these labels to understand their child, but over time, labels can become confining or inaccurate.
A child labeled “high-functioning” might still experience meltdowns, while one labeled “low-functioning” might surprise others with unique abilities.
On Education and Employment
Schools may underestimate or overestimate students based on their label. Employers might decline to accommodate someone who “seems fine” on the surface but struggles with executive function, sensory input, or social dynamics.
What Autistic Advocates Say
Many self-advocates and autistic adults have spoken out against the use of functioning labels. Here are a few common themes from their perspectives:
- Functioning is contextual and variable. Someone may be articulate and composed at home but overwhelmed in a crowded store.
- Labels ignore the invisible. Mental health challenges, sensory overload, and burnout are often hidden from view.
- Support should be flexible. An individual may require more support in one area of life and less in another. Labels don’t account for that variability.
Voices from the Community
“Calling me high-functioning erases the daily battles I face with anxiety, sensory overload, and executive dysfunction.”
— Autistic adult, age 28
“I use a communication device. That doesn’t mean I don’t think deeply. It just means I communicate differently.”
— Nonspeaking advocate
“These labels divide us. We need support based on individual needs, not an arbitrary category.”
— Autistic parent and speaker
Why These Labels Persist
Despite widespread criticism, severity levels and functioning labels remain prevalent. Reasons include:
- Ease of Communication: They’re shortcuts for describing complex conditions.
- Institutional Use: Schools, insurance companies, and government agencies often require categories to approve services.
- Lack of Education: Many people don’t know the problems with these terms.
- Cultural Habits: Society has long used labels to organize people—changing that takes time and effort.
Moving Beyond Labels
So how can we move past labels and towards more meaningful understanding and support?
1. Describe Specific Needs
Instead of calling someone “low-functioning,” describe their actual challenges and strengths:
- “Needs assistance with communication and daily living skills.”
- “Can read and write fluently but experiences intense sensory overload in loud environments.”
2. Use Support-Based Language
Support-based descriptions focus on what a person needs to thrive, rather than how they’re perceived to function.
- “Requires support for transitions and social interaction.”
- “Uses AAC for communication and benefits from a calm environment.”
3. Honor Individual Preferences
Ask the person how they prefer to be identified. Some prefer identity-first language (“autistic person”); others prefer person-first language (“person with autism”). Respecting these preferences shows empathy and consideration.
4. Acknowledge the Spectrum’s Complexity
Remember that autism is not linear. A rainbow or color wheel is a better metaphor than a line from mild to severe. Each individual has unique traits, challenges, and capacities that intersect in complex ways.
5. Educate Others
If you’re a parent, teacher, therapist, or friend, you can help shift the conversation by modeling respectful language and challenging outdated terminology when it comes up.
Alternatives to Functioning Labels
Here are some examples of more respectful and informative alternatives:
| Instead of Saying… | Say This… |
| “High-functioning” | “Needs minimal support in daily tasks” |
| “Low-functioning” | “Requires full-time assistance with communication and care” |
| “Mild autism” | “Experiences sensory sensitivities but communicates verbally” |
| “Severe autism” | “Needs intensive support across multiple domains” |
Conclusion
Autism is a rich and diverse spectrum, not a hierarchy of functioning or severity. Labels like “high-functioning” or “low-functioning,” and even severity levels from clinical manuals, often fall short of capturing an individual’s full humanity. They can obscure more than they reveal.
We can do better.
By embracing nuanced, strength-based, and support-focused language, we create space for autistic individuals to be seen and understood as they truly are. We foster inclusion, reduce stigma, and build systems that are responsive to real human needs—not artificial categories.
If you’re navigating this journey as a parent, professional, or someone on the spectrum, remember this: every person deserves to be understood on their own terms.
Let’s move beyond the labels—and toward a future of informed empathy, equitable support, and authentic connection.
