High vs. Low Functioning Autism | What’s the Difference & Does it Matter?


When Lucas was young, I thought he had high-functioning
autism because he was included in typical toddler preschool classes, and was warm and
cuddly with me. But now most would consider Lucas low functioning. Here’s the thing, after two decades in the
autism world, I really don’t like the terms “high functioning” and “low functioning”. So today I’m going to get on my soapbox about
these terms, and tell you how to tell if it matters, and what to do about high-functioning
versus low-functioning autism. Hi. I’m Dr. Mary Barbera, autism mom, board certified
behavior analyst, bestselling author, and online course creator. Each week I provide you with some of my ideas
about turning autism around. If you haven’t subscribed to my YouTube channel,
you can do that now. As I said, when Lucas was really young I didn’t
think he had autism at all, and I was sure that if he was diagnosed with autism, it would
be very mild autism. That kept me in denial for over a year, which
was a very bad thing. I did do a video blog on denial many months
ago, so you may want to check that out now. Even after Lucas was diagnosed with autism,
with moderate to severe autism, one day before his 3rd birthday, I still considered him to
be high functioning because he was going to typical preschool with a shadow, he wasn’t
having many problem behaviors, or self stim behaviors. Then as Lucas got older, when he was about
six or seven years old, I thought he was kind of in the middle of the spectrum but definitely
not low functioning. That was until one day when I went to look
at an approved private ABA school for Lucas. This is where I saw a little boy, I’ll call
him “Nathan” who … I didn’t know his name. It was circle time at this ABA school. There was a boy sitting there. He flopped on the ground in the middle of
story time, and was throwing a tantrum. I wasn’t a behavior analyst at this point,
so I was just kind of looking on, and thinking. Lucas was used to going typical preschool. He was enrolled in our public school kindergarten
program with a shadow, with a special education teacher. He was still doing a home program for half
the day. So in my mind, even though he had moderate
to severe autism, and wasn’t conversational, I thought this boy was much lower functioning,
and I was kind of like thinking, “That’s it. Lucas does not belong here. I want him in typical, regular public school
where he can get role modeling.” The director talked to me at the end of my
short, one-hour visit, and she asked me if I thought this was a good fit for Lucas. I told her that I thought Lucas was higher
functioning than the kids I saw there. She told me that Nathan, who had flopped to
the ground during story time, was actually reading almost at grade level, and had much
more language than Lucas did. At that point I had an aha moment, and I really
realized that it wasn’t fair to call Lucas high functioning or low functioning, or to
call this boy Nathan, high functioning or low functioning because within each child
are their strengths and their needs. Lucas blended into the community a lot better,
blended into public school a lot better because he didn’t throw major tantrums or have problem
behaviors to that extent. He had language needs, and he had academic
needs, and a bunch of other needs. But in terms of taking him out into the community,
taking him to a restaurant, to a pool, on an airplane, those made look Lucas look a
little bit more higher functioning than other children who were more advanced in other different
areas. At this point I thought, “If you were a teacher,
and you had six or eight kids with autism in your classroom, and you were told to line
them up in terms of who’s the highest functioning and who’s lowest functioning, you would actually
have a really hard time.” Because are we talking about problem behaviors? Are we talking about going into the community? Are we talking about academics, language? Just a host of things that kids have issues
with. Some kids are more mild-mannered like Lucas,
and blend in more while other kids have high problem behaviors and those sorts of things. So within each child are their strengths and
needs. At this point I realized it was impossible
to really tell if a child had high-functioning or low-functioning autism, especially as they
were younger. Over the years I’ve really realized that a
lot of parents want to know that their two-year-old or even say their two-year-old, “Oh, my two-year-old
just has high-functioning autism,” or “You can’t tell how a two-year-old is going to
be at eight or 18.” The biggest thing I’ve learned over the years
is you need to treat early autism like the worst case of autism you’ve ever seen in order
to give your child or your client the best outcome possible. I did do another video blog a few months ago
on, can you predict how a two-year-old’s going to be at age eight, and so you might want
to check that out. But over the years this high functioning,
low functioning has really been a blurry line for me, and when people say, “Oh, my son just
has high-functioning autism or just has Asperger’s,” I think that’s really a disservice to the
child. And I think for other moms whose kids are
more impaired, it’s kind of like comparing cancer. Like you may have a better prognosis having
thyroid cancer than pancreatic cancer, but cancer is still life altering, and you never
know how everyone and how you are going to do. I think the whole high functioning, low functioning
gets even more complicated. In general, when people say kids have high
functioning autism, they tend to mean that the child has full language, are conversational. Many times these high functioning kids can
be included in general education settings, and may be high enough functioning to learn
how to drive, go to college, perhaps get married. But with high-functioning autism also comes
some co-morbid conditions like anxiety at a higher rate, and depression, and those sorts
of things. So it comes with additional stress at many
times. Low functioning, many people when they use
that term tend to think of kids that also have intellectual disability in addition to
their autism. They might have little to no communication
or language, they’re less likely to be fully included, and now the DSM-5, which gives a
diagnosis criteria for autism, has three levels of ASD. Level 1 is more mild autism, higher functioning,
and Level 3 would be kids like Lucas who need very substantial support. But over time these levels could change. You could start out as a Level 3, and with
the right therapy, you could move into Level 1. I’ve seen this many times with my own eyes. But obviously there’s a whole spectrum in
between going to college, and driving a car, and being completely in need of constant support
and supervision. Some high-functioning kids are fully conversational,
but they can’t hold a job due to that anxiety or depression, while there’s some low-functioning
kids who grow up and are gainfully employed and happy, living with only some minor support. In the end, it doesn’t matter if you call
someone “high functioning” or “low functioning”. It’s about each child or adult with autism
reaching their fullest potential, and using their strengths to bring up their weaknesses,
improving those deficits, and helping each child be as safe, as independent, and as happy
as possible, reaching their fullest potential always. When kids are really young, maybe not diagnosed
with autism or newly diagnosed, it’s impossible to tell how they are going to do long term. So as I said earlier, it’s best to treat autism
aggressively even if you think it’s very mild. Wherever you’re watching this video blog,
I would love it if you would leave me a comment, give me a thumbs up, and share this video
with others who might benefit. To learn more you can go to marybarbera.com/workshops
for a free workshop to help you get started turning autism around. I’ll see you right here next week.

50 thoughts on “High vs. Low Functioning Autism | What’s the Difference & Does it Matter?

  1. Hey Mary I enjoy your blogs so much! My 6 yr old grandson was diagnosed at 2 and I cannot convince his mother to use his SSI for ABA. He is a level one but I so agree about treating him as if he is level 3 or lower to get the best outcome as he ages. I wonder if there is such a way to force her to use the check for what it’s intended for? He’s never been in an ABA program, just benefited from PK therapies at school and is now in an regional autism classroom for kindergarten. He is in Pittsburgh PS system. I ha e very loosely used high functioning, but I truly understand what you’re saying in this blog. Keep up the fantastic blogs, if they don’t help anyone else, know that these blogs do me a world of good. Hand Tied Grandma!

  2. I have 3 year old daughter and she's autistic she can do 100 pcs puzzle at her age she know her abc no. 1-20 14kind of geometry but she's nono verbal all she can say is mama dadada and bubbling hope she will talk 😢

  3. We still have 'categorization' like "Level 1","Level 2",etc in DSM! So,what is the point!!! They have just given a different title and a bit more broad descriptions to the old 'high functioning','low function' thingy!

  4. Such a helpful post – helps me also in explaining when people get stuck on the 'high-low' functioning of Autism. Look forward to your next post!

  5. OMG! As you were stating people in the high functioning autism, who can drive and go to college. Also have severe depression and anxiety and can't really hold a job. This is me. I have lost so many jobs and missed so many job opportunities because my anxiety and depression got in the way which made it difficult for me to even support myself. I recently saw a therapist for the first time (i'm 26) recently for anxiety and severe depression. He thought after talking to me for a half hour that I showed all the signs of H.F.A. I was stunned. I never thought that I would be even remotely autistic. I always thought I was just weird.

  6. My daughter is 3years old . Till age 2 she didn't speak . So we decided to send her to preschool. After going school she learn everything whatever school taught but she don't know how to speak in our language (Assamese).but speak in some other language . It sounds like Chinese. Can't u please suggest me what to do

  7. Mary, I believe someone who is a very close to me is on the spectrum. I have not said anything to the parents but I do think the mother suspects something and is in denial. Her child is 5yrs old now and she is considering homeschooling. Like you say you think the earlier the better but I’m not sure if it’s my place and then I think of this beautiful child. Any advice?

  8. I have Autism and learning disabilities and intellectual impairment and extreme Anxiety and extreme panic attacks and depression

  9. Agree dump the high and low. It’s very individual to each person. I love how society claims people are all unique individuals except when it comes to autism as all autistic “should be” this one way and no variety exists.

  10. Hello mam my son 3year old had low function autism. Is there any supportive medicine wich can cure my son.he is non verbal.?

  11. Pls reply me offenly my son wants to see spinning things And he is doing flapping his hands when he see spinning things is this high functioning autism

  12. Thank you for this video (and all your others, too!) I am new to the world of autism and I haven’t known what to make of the high/ low functioning terminology. My daughter is 2 1/2 and advanced physically and academically but very delayed in speech as well as social skills and community. How the heck could I call her high or low functioning?! It’d be a guess or just perception. 😛
    I appreciate your take on it, thanks!

  13. I have autism and anxiaty is a high for me unless i have a drink 21 now i should add xD but i remember i never hugged people at a young age and when i think back to primary school i think my autism stood out like hell but i dont trust myself with driving eventhough im very self aware of my suroundings but i get distacted out the corner of my eye alot aswell

  14. I was diagnosed in late 2017, just before my 53rd birthday. Early detection is key!

    After testing, my therapist diagnosed me as being with "High-Functioning Autism." I said that I didn't feel very "High-Functioning," since I usually go at least 3 years between jobs.

    Suddenly, my past makes sense. Teachers hating me, other kids hating me, being the social outcast, reading and spelling at a college level before first grade, and dropping boundaries quickly while being gullible with "friends."

    But since the diagnosis, I've heard many different things from many different people. It is frustrating, so I'm considering dropping this "ASD" diagnosis, and instead going back to just being that really weird guy that nobody likes.

  15. I hate the whole high vs low functioning classification! I have aspergers. I was diagnosed before the DSM changed it to ASM (Autism Spectrum Disorder). I really don’t like that name! It’s offensive! I don’t think disorder should be in our title at all! I have noticed though that my mom uses high functioning and aspergers when telling someone about me and I really hate it! It’s like she can’t stand that her daughter is autistic because when people give her that face you get when you do tell someone she quickly says but she is high functioning like it’s ok she isn’t severely mentally disabled. To me being autistic is being autistic! I will always stand up for my lower functioning brethren!! It’s a hard topic though because when I’m around other aspie’s (asperger diagnosed individuals) we talk about this and we do like having the distinction because it is very different. But at the same time we all agree that we don’t have any problem with everyone no matter your level of autism is equal and that we are all just people who are autistic. Sorry this was a long rant and I’m not sure if it will even make sense to someone else. I just wanted you to know that it’s a current debate in the autistic community right now and it’s a tuff one that I don’t fully know the answer to.

  16. I watched this and another of your videos because my 37 year old son was diagnosed in the past year (after the most comprehensive diagnosis I’ve ever heard of) and I knew little about autism period, but was confused as I had only known of the form that didn’t communicate much or at all as young children. My son talked young, fluently and a LOT. When at a recruiter’s office he tested higher than the recruiter had ever seen. School always came easy except he’d get bored and talk. He thinks analytically and logically and researched everything he does before he does it. Most things seemed to come easy to him, to the point he was a bit judge mental even with his siblings and parents. But also himself. I thought he took after my father in being a perfectionist (my father had an IQ of 158.) He worked since 16, kept jobs. Excelled and was very social, popular and had a lot of fun with friends and girlfriends. He did suffer a lot of anxiety about 3 years ago when he got hurt doing commercial A/C work and decided not to keep getting hurt, to return to college and get a degree in mechanical engineering. He got married in the next year as long planned. He was diagnosed as low testosterone years ago. Then when back in school as ADHD. Then he must still have had much difficulty as he went through an extensive diagnosis that I don’t know what all it entailed but he said counseling, couples counseling and took weeks. He is super sensitive to light, smell and sound but the last surprised me as his tv is always cranked and music was same but he lost some hearing when shooting in ROTC in high school. He described it for me as in some ways too connected or in touch. I could understand that as I am empathetic as opposed to sympathetic only to the point it can cause me great pain if I can’t turn it off. Had to learn that. I don’t know what was bothering him to get such a diagnosis done but I guess after two videos I will guess the anxiety and depression but the depression part was news to me, beyond that which everyone goes through. I’m still trying to understand what he’s going through now, if there’s anything I can do to help him (there rarely has been, at least according to him, all his life). I wonder if there was a cause or if when he was born it “just happened “ once ina while, or were there outside factors like vaccines. He didn’t get many vaccines at his age. I wonder if this can go undetected or not diagnosed for so long very often. Did I miss signs because he was achieving so early and well? Did he internalize so much that he suffered before my eyes unknown to me? Did he “grow into “ it? Still so many questions. I’ll keep watching and researching. Thank you for putting this info out here!

  17. I am 78, in my mid 5o's i was diagnosed with
    Tourette's Syndrome. My language skills are super [according to college entrance exams.] I have my BS, double major. My major problems have been that i seem unable to pick up social clues. I am very open and truthful but accept other folks' masks as real. In spite of my inabilities, i have outlived 3 husbands. I have had a very full life but still can't tell when other people don't like me. Yes, i am under treatment for depression.

  18. First step: Don't call it High Functioning Autism.
    A lot of people, including me, hate the term along with Low Functioning Autism because both are ableist language aimed at controlling what help we get. Low Functioning is used to bar some autistic people from living their life to full or doing things they want to do without an ever watching eye, High Functioning Autism is used to bar people from getting help 'because they're not that bad.'
    For a real-life example of this: I was called a High Functioning Autistic and was constantly refused any sort of help in school because I could go outside without embarrassing the school or my parents. I ended up dropping out of school.

  19. I just want to know if my son (almost 3) will ever talk.. he has said stuck when his blanket was stuck.. he has said yuk when he had something on his hands.. so he seems to understand some things.. but if I say "you want to go outside" he doesn't understand.. he doesn't understand yes.. he does shake his head no if you try to feed him something he doesn't want… I keep trying to see hints of what he will be capable of.. it's just so hard.. he doesn't have emotional outbursts.. he doesn't get bad when he doesn't get his way he might cry but not have a "meltdown".. how can you tell if they will talk without studying them and consulting a crystal ball????

  20. Bingo! Thus the term SPECTRUM .. an autistic mama, my son, 18yo, continues to run the gamut HIGH MED LOWish functions

  21. Hy, I am very confused as there are times when I am convinced my child has some kind of form of autism and there are times when I am convinced he has nothing to do with autism and he has only language delay. For example, I watched your video of 2 year old signs of autism and he didn't match them. Now he is nearly 3 years old but no talking no mama,no word nothing without some sounds, just recently he started very little babbling, but he is pointing at what he needs also he pointing to the airplabe or trees or to anything he wants to share with me, and he has times like days when he looking to me and he doing some things then looking to me to see my reaction. I mean he has days when he has the typical child eye contact in each and every aspect but then there are days that he is not doing much eye contact with me even if I'm talking to him. Plus he has problems with the other kids in general like he has soci problems but he follows simple comands and his receptive language is good he understands us, also he has pretend play like he would drink water and all of a sudden give it to the bear as well to drink. But he likes things which are round or spinning, he looking to the washing machine when spinning or he likes the mills when rotating, he likes spinning by himself also that is his favourite thing but in the same time he doesn't do it obsessively, like doing it for short time then going and playing with other thing, no repetitive body movements or behaviours. So is really hard and strange as I feel there are 2 different boys in my child, he gets scared of normal things sometimes, like he looks having some sensory troubles but once he gets used with and cross his limits of fears then he is very good. Give me some advice please, he looks very stubborn as well because every time he tries to bubble or produce some sounds if I'm trying to copy him he stops and this is since he was very baby. If I'm telling him to say something he will keep silent even not try to say it. Is very confusing, please help me

  22. each autism kid is different very unique my son is diagnosed high functioning autism and he acts like any other kid ive seen whos considered normal he has and good understanding he can do things on his own such as brushing teeth bathing washing his face etc he can read well in sometimes certain things is hard for him but working with him enough he soon get it and yes high functioning and low are very different my son is in a class with kids who are not the same as him the hit people scream and act out my son dosent do those things my son also get to go to regular class at school main stream

  23. Whether you get support or are diagnosed really depends on money and whether your parents care. What can you say about kids who are autistic and abused, or do not have parents who will bring them to doctors?

  24. Just discovered your channel. So much useful information. My son is 5 years non verbal on the spectrum and is in an intensive program. You remind and reinforce everything we see being taught…now we have videos to back it up! Thank you!

  25. My son is 3 years old no verbal he can count 1 to 10 and say bye bye and green and blue that is it i am so worried about him and about his future i hope oneday he start talking

  26. Great video!
    The whole high vs low functioning is so subjective.
    My son has level 1 ASD, diagnosed at a preteen after living for years with a ADHD diagnosis, and people throw the term high functioning around which really does a disservice to the challenges my son faces due to his ASD. I love that you addressed this subject matter with such finesse.

  27. How can I as a homeschool mom help my undiagnosed girls they are struggling to understand math it’s very very slow and memory is a huge problem for our 11 yo she also has issues with aggressive behavior

  28. Thank you for this video and bringing awareness to these terms. My 5 yo old son is on the spectrum and I felt when he was diagnosed at 2 years old, friends and families would respond to the news and diagnosis with "I know an autistic coworker of mine or someone that they knew on the spectrum and they are really smart, intelligent, or gifted". It made me feel like there was some sort of pressure my son should become all of the above or people would think he's dumb, incompetent, etc.

    Turns out my son is highly intelligent as it relates to his memory, his fascination with numbers, letters, shapes, math and reading beyond his age (3rd grade level) and he will be starting Kindergarten this fall. On the flip side, he also is still learning to manage how to regulate his body and his emotions. He can say a bajillion words, but cannot carry on a conversation or get a meal on his own and be able to feed himself completely with utensils.

    Going back to what you addressed, I think the terms of high functioning and low functioning does a disservice to the child on the spectrum as each child has their own area/s of focus and how can one determine one focus area trumps another to say someone is high functioning or not? Feels like another standard put out there to try and diminish your child being on the spectrum like it's more acceptable if they are considered high functioning vs low functioning.

    Another term I struggle with as well is "savant". By definition, it's similar to a prodigy with the exception the individual with savant syndrome has some type of a developmental disability. I struggle with this as why can it not be a prodigy across the board instead of having to differentiate by calling out the developmental disability which would put that individual as having savant syndrome.

    Just my thoughts, would love to hear your reaction and if you feel the same about the other terms I mentioned. Thanks!

  29. I have mild autism: PDD what they diagnosed me with. I'm not super intelligent but I can drive my car even I can drive a semi truck. I still have struggles dealing with my autism. But I'm living my life to the fullest!

  30. Thank you for this video. It raises important points. I was diagnosed as an adult when I sought treatment for depression. I’m 50 so as a child, in that era, I was just considered awkward because I could do well in school classes but not socially.

    I have some things I’m pretty good at and some things that I struggle with. I agree the high/low functioning is too broad. I was always good in school and can live independently, which might mean high functioning under the normal terms. However, I also struggle with some tasks that would indicate more low functioning. Things like going to the grocery store unless I go right when it opens and there are few people there. I just get sensory overload in a crowded grocery store. Just an example—there are many more things I have trouble with.

    I think most of us have high functioning aspects and low functioning aspects to the extent that the terms don’t really mean anything.

  31. I hate when people use the term non verbal for kids who are one or two. I think it’s too early to tell where your child will be and many people are non verbal until 3 or 4.

  32. Please do not use the term, "tantrum" low or high functioning children on the autistic spectrum don't have tantrums. Meltdowns, anxiety, frustrations and more are part of those behaviours you described as a tantrum. My son started off "low function" and after ABA and IBI and our constant support of his passion, singing/music he has now been described by NT's as perfectly "normal." Thanks for what you're doing to help our community!

  33. Thank you. My daughter is on the spectrum and ppl take away from the hard work and progress when using the terms high or low functioning. We all have different challenges in life i like the term on the spectrum.

  34. Some kids with austism can function in a regular classrooms but some others it's just not a fit. If the child becomes violent, loud, not verbal. It just doesn't seem fair to the kid not getting the therapy and education they need in a structured and stress free environment. Also it's not fair for the kids in the classroom

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