If you spend any time in the autism world, you will hear these terms constantly. “Oh, he is high-functioning.” “She is quite low-functioning.” They are used by doctors, teachers, family members, and well-meaning strangers. They sound like they mean something. But according to Dr Luke Beardon, they are some of the most unhelpful and potentially harmful labels we use.
In his book What Works for Autistic Children, Dr Beardon makes a compelling case for dropping these terms entirely. Not because language does not matter, but because it matters too much to get wrong.
What people think they mean
When someone says “high-functioning,” they usually mean: this person can speak, appears to cope in social situations, can attend mainstream school, and looks mostly “normal” to the outside world.
When someone says “low-functioning,” they usually mean: this person does not speak or speaks very little, needs significant daily support, and has visible differences in how they move, communicate, or interact.
On the surface, these seem like useful categories. A quick shorthand that tells you what to expect. But the problem is that they tell you almost nothing about the actual person, and what they do communicate is often dangerously wrong.
What “high-functioning” actually means for the child
For many autistic people, being labelled “high-functioning” does not mean life is easy. It means their struggles are invisible.
A child who can speak clearly, make eye contact when required, follow classroom routines, and hold conversations may still be in constant distress. They may be masking for every single hour of the school day, suppressing their natural responses, copying the behaviour of their peers, and performing a version of “normal” that is utterly exhausting.
When they get home, they fall apart. The meltdowns, the shutdowns, the tears, the rage. And the adults around them are confused because “they were fine at school.”
They were not fine at school. They were masking at school. And the label “high-functioning” is part of the reason nobody noticed.
Because if a child is “high-functioning,” the assumption is that they do not need much support. The funding is harder to access. The adjustments feel unnecessary. The struggles are dismissed with “but they seem so capable.” And the child internalises a devastating message: if you are struggling this much and nobody can see it, the problem must be you.
What “low-functioning” actually means for the child
On the other end, “low-functioning” carries its own set of harms. When a child is labelled “low-functioning,” expectations collapse. People stop presuming competence. They talk about the child in front of them as though the child cannot understand. They simplify everything. They stop trying to find ways to communicate, because they have already decided there is not much going on inside.
But a child who cannot speak may understand everything. A child who cannot sit still may be paying close attention. A child who does not respond to their name may be processing the question and simply need more time. The label “low-functioning” gives people permission to stop looking, stop expecting, and stop trying. And for the child, that is devastating.
Dr Beardon is clear: a lack of visible output does not mean a lack of internal experience. Presuming competence must be the starting point, regardless of how a child presents.
Functioning is not fixed
Here is the other critical point: functioning is not a stable trait. It is not like height or eye colour. It changes. Constantly.
The same child can appear “high-functioning” on a calm, predictable, well-rested Tuesday morning, and “low-functioning” on a chaotic, noisy, sleep-deprived Friday afternoon. The difference is not the child. The difference is the environment, the energy, the sensory load, the social demands, and the level of support available.
Sticking a fixed label on something that moves is not just inaccurate. It is actively misleading. It tells parents, teachers, and clinicians that this is who the child IS, rather than how the child is presenting in this moment, in this context, under these conditions.
The real harm
Functioning labels do not just describe. They prescribe. They determine what support a child gets, what expectations adults hold, and how the child comes to see themselves.
“High-functioning” says: you do not need help. Cope. Perform. Keep masking. Your struggles are not real enough to count.
“Low-functioning” says: you cannot do much. We will decide things for you. We will lower the bar and keep it there.
Both labels remove the child from the conversation about their own life. Both reduce a complex, dynamic human being to a single word. And both prevent the adults around them from seeing what the child actually needs right now, in this moment.
What to say instead
Dr Beardon suggests moving away from functioning labels entirely and instead describing specific strengths and specific support needs.
Instead of “he is high-functioning,” try: “He communicates verbally and manages well in structured environments, but he finds unstructured social time very stressful and needs support with transitions.”
Instead of “she is low-functioning,” try: “She communicates using AAC and needs support with daily living tasks, but she has a strong understanding of routine and responds well to visual schedules.”
This takes more words. It requires more thought. But it does something that functioning labels never can: it sees the whole child. It acknowledges both what they can do and what they need help with. And it leaves room for change, because needs change.
A better way to describe autistic children:
Name specific strengths, not just visible ones.
Name specific support needs, not assumptions.
Recognise that both can change depending on the day and the environment.
Always presume competence, especially when you cannot see evidence of it.
Remember: a label should open doors, not close them.
Why this matters for how children see themselves
Children hear how adults talk about them. They absorb the labels. And those labels shape their identity.
A child who hears “high-functioning” learns that their value lies in appearing normal. They learn that asking for help means they have failed. They learn to hide their struggles, which leads to anxiety, burnout, and mental health difficulties that can last a lifetime.
A child who hears “low-functioning” learns that adults do not expect much from them. They learn that their potential has already been decided. They stop trying, not because they cannot do more, but because nobody believes they can.
Neither of these outcomes is acceptable. Both are entirely preventable. And it starts with the language we choose.
The bottom line
“High-functioning” hides the struggle.
“Low-functioning” hides the potential.
Every autistic child deserves to be seen
for who they actually are,
not sorted into a box
that was never big enough to hold them.