High-functioning autism refers to autistic people whose living skills, including communication skills, enable them to live independently. However, the term is problematic, and it is not a clinical diagnosis.

High-functioning autistic people can usually live independently and have successful careers. However, the use of the term remains controversial, with many autism advocates asserting it is ableist and misleading.

Keep reading to learn more about high-functioning autism, including the causes, symptoms, and diagnosis.

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While autism is a clinical diagnosis based on specific diagnostic criteria, the specification of high-functioning autism is not. Instead, it is a judgment of a person’s ability to function in society. Therefore, different medical professionals may disagree about who is high-functioning and who is not.

In the past, some clinicians called people with Asperger’s syndrome “high-functioning” because they are less likely to have language issues and often have fewer noticeable signs of autism. Because “high-functioning” is a subjective judgment, based on cultural norms and not a diagnosis, the criteria vary depending on who defines the diagnosis.

Some people may use the term when a person:

  • receives their autism diagnosis as an adult, or relatively late in childhood
  • does well in school or at work
  • does not have language differences or clear developmental delays
  • can live independently

However, opponents of the term cite several problems with it, offering the following arguments:

  • It prioritizes some types of functioning, such as language skills, over others, such as the ability to understand social norms.
  • It is ableist and judges some people as better or less successful than others.
  • It relies heavily on cultural norms that prioritize academic success and language.
  • It may ignore the need of people labeled “high-functioning” to get support.
  • It prioritizes the experiences of society with the autistic person rather than the experience of the autistic person in society.
  • Some people use the term “high-functioning” to dismiss the concerns of autistic adults about how society treats autistic children. When this happens, an autistic child’s parent or caregiver might argue that a “high-functioning” person does not fully understand the autistic experience.

Rather than applying functioning labels, doctors now talk about autism as a spectrum. A person might be highly successful in one area, such as their academic life, but struggle with being in crowds or coping with sensory overload. This spectrum perspective does not prioritize certain functions over others.

Additionally, the autism spectrum approach collapses several once-distinct diagnoses, such as Asperger’s syndrome, into one spectrum of conditions.

Learn more about the levels and spectrum of autism here.

The neurodiversity movement

In recent years, the terminology around autism has changed dramatically due in part to the neurodiversity movement. This campaign calls for rethinking how we define autism by looking at the condition through the lens of human diversity.

The movement aims to encourage people to value diversity in neurobiological development in the same way as in ethnicity, race, religion, gender, and sexual orientation.

Researchers do not know what causes autism. Preliminary research links several genes to a higher risk of the condition, but scientists have not found a single genetic cause, nor a single gene or combination of genes that inevitably leads to autism.

However, there is some evidence that the interaction between genes and the environment may lead to the condition. For instance, a person with a genetic mutation that increases the risk of autism may only develop the condition in certain circumstances, such as following an infection or exposure to certain toxic substances.

There is also ongoing research into how other biological factors may increase the risk of autism. Changes in the brain’s metabolism, brain connections, or the body’s immune system may elevate the likelihood of its development.

It is important to note:

Vaccines do not cause autism.

The doctor who originally popularized this outrageous theory had to retract his research due to potential fraud, financial conflicts of interest, and bad data. He eventually lost his license to practice medicine.

Autistic people, including those considered high-functioning, may have a wide range of differences. To qualify for an autism diagnosis, a person must have difficulties with each of the following:

Differences with social and emotional reciprocity

Autistic people with differences in social and emotional reciprocity may, for example, struggle to initiate or respond to communication, finding it difficult to participate in its typical back-and-forth nature. They may also face challenges in speaking about non-preferred topics.

People used to think it was an inability to empathize that lead to this. However, newer research has changed how we think about autism and empathy. It is almost the opposite, where autistic people may even be hyper empathetic.

It is just that their experiences and neurotypes are different. There is not a lack of empathy, simply another way of understanding and processing it. For example, autistic people may isolate themselves, but it is not because they prefer to be alone. Instead, it could be because they may feel they are annoying or causing trouble for others.

Differences with nonverbal communication

A person might struggle with reading others’ body language, identifying nonverbal emotional cues, maintaining eye contact, or making age-typical facial expressions such as smiling.

Challenges with relationships

They may struggle to develop or maintain friendships. Autistic people may not engage in imaginary play, may not want to make friends, or may have great difficulty fitting in with others.

Additional differences

Autistic people must also have at least two of the following four differences:

  • Stereotyped or repetitive behaviors or interests: They may become intensely fascinated with certain objects, repeat things people say, have verbal or motor tics, or engage in repetitive movements.
  • An intense need for routine and consistency: They may engage in rituals that seem obsessive or compulsive, struggle with change more than is typical for someone their age, or be unable to manage even minor adjustments, such as a shift in the brand chicken nuggets parents buy.
  • Restricted and intensely focused interests in specific topics: They may be dedicated collectors, memorize long strings of facts, and be unable to stop talking about a minimal range of subjects. Others may perceive these interests as unusual or strange.
  • Changes in sensory processing: They may be very sensitive to sensory input, such as loud noises or scratchy clothing textures. Or they might have very blunted sensory reactions, not noticing when things are very loud or distracting.

These symptoms must be present early in development, although it is possible for them to change or become more severe with time.

Autism must also present as the best explanation for these symptoms, rather than another diagnosis, such as brain injury. Finally, the symptoms must occur in multiple situations, not just at home, school, or in stressful situations.

High-functioning autistic people may have less severe versions of the same symptoms.

There is no blood test or other lab test that can detect autism. However, depending on a person’s symptoms, a doctor may recommend certain tests to rule out other conditions. For example, a healthcare professional might advise carrying out blood work to look for signs of an infection in a child or performing scans of a child’s brain to look for injuries.

To diagnose autism, a doctor will ask about a person’s medical history, then assess them for common symptoms of autism. They must meet certain diagnostic criteria to qualify for a diagnosis. Having one or two signs and behaviors associated with autism is not enough, even in people with pronounced behaviors.

Autism is not curable, but it may change throughout a person’s life. Some children may even appear to grow out of the behaviors leading to their diagnosis in adulthood. In other cases, a person might not realize they have autism symptoms until they are an adult.

Support focuses on helping the person with autism to have a better quality of life. Early intervention services for children can help them gain emotional awareness, language skills, and other hallmarks of typical development. Many states offer free or low-cost intervention programs for babies and toddlers.

Parents comparing support options should know that one of the most popular support options, applied behavioral analysis, is the subject of ongoing controversy. Adults with autism often claim the practice is abusive.

Medication may also help autistic people manage specific symptoms, such as anxiety or obsessive thoughts.

Additionally, academic and employment accommodations can help them thrive at work and school.

Learn more about autism, including management and support for the condition, here.

High-functioning autism is a judgment of a person’s skills and success, but it is not a formal diagnosis.

It is better practice to think of levels of autism as a spectrum, where autistic individuals have unique behavioral differences of varying degrees.

No matter how well an autistic person with autism functions, they need and deserve support and accommodations so they can reach their full potential.