Why “High Functioning” and “Low Functioning” Miss the Point

(and why these terms are considered outdated)

Many families hear the terms “high functioning” or “low functioning” early in their journey.

They’re often offered as a way to quickly explain what a child might need, how much support is required, or what to expect long term.

At first, these labels can feel helpful.
They sound simple. Reassuring, even.

But in modern, neurodiversity-affirming practice, these terms are now considered outdated, and increasingly unhelpful.

Not because families or professionals are doing something wrong by using them, but because we now understand development, disability, and nervous systems far more clearly than we once did.

Where these labels came from

Functioning labels grew out of older medical models of disability, where people were often categorised based on:

• How independently they could live

• How closely they appeared to function compared to neurotypical peers

• How much support they needed from others

In practice, this often meant judging a person’s “functioning” by how manageable they were within systems like school, healthcare, or work.

As our understanding has evolved, we’ve learned that this framework is too simplistic to accurately describe real human experience.

Functioning labels flatten complex humans

No child functions at one consistent “level”.

A child might:

• Speak articulately but experience intense anxiety and emotional shutdowns

• Excel academically while struggling deeply with friendships or sensory overload

• Appear calm and compliant in structured settings and completely unravel at home

Calling a child “high functioning” or “low functioning” collapses all of this complexity into a single label.

It tells us very little about:

• Emotional experience

• Effort required to cope

• Regulation capacity

• Sensory processing

• Or the type of support that would actually help

What it often reflects instead is how easy or difficult a child appears to others in a particular context.

They focus on appearance, not internal experience

One of the key reasons these terms are now considered outdated is that they prioritise external presentation over internal experience.

“High functioning” often means:

• Speaks well

• Meets academic expectations

• Appears independent

What it doesn’t capture is:

• The exhaustion of masking

• The anxiety beneath the surface

• The sensory overload being endured

• The emotional cost of “holding it together”

Many children labelled high functioning are coping at a significant personal cost, often unnoticed until burnout, anxiety, or school refusal appear.

“High functioning” can block access to support

Another reason these labels are being phased out is that they can actively limit support.

Families are sometimes told:
“They’re coping well enough.”
“They don’t need extra help.”
“They’re too high functioning for support.”

Coping, however, is not the same as thriving.

When we rely on functioning labels, we often wait for children to reach crisis point before offering help, rather than responding early to signs of stress and overload.

“Low functioning” underestimates capacity and growth

On the other end, the term “low functioning” can be just as damaging.

It often leads to assumptions about:

• Learning potential

• Communication ability

• Independence

• Future quality of life

Children may be spoken about rather than spoken to.
Strengths may be overlooked.
Expectations may be lowered unnecessarily.

Support needs do not equal limits.

Modern approaches recognise that all children have strengths, preferences, and the capacity to grow, even when support needs are high.

Support needs are dynamic, not fixed

One of the biggest problems with functioning labels is that they are static.

But children are not.

Support needs change depending on:

• Environment

• Stress levels

• Developmental stage

• Sleep, health, and sensory load

• Life transitions

A child may need significant support in one context and far less in another.

This is why contemporary practice now focuses on support needs, not functioning levels.

Support-based language allows care to flex with the child, rather than boxing them into a category that may no longer fit.

Language shapes identity and expectations

The language we use matters.

Children and adolescents hear how they are described.
Those words shape how they see themselves and what they believe is possible.

Being told you’re “too high functioning to need help” can lead to shame and self-doubt.
Being told you’re “low functioning” can quietly limit expectations placed on you.

Neurodiversity-affirming language keeps us curious instead of judgemental.
It centres dignity, accuracy, and responsiveness.

Moving away from “high functioning” and “low functioning” isn’t about being politically correct.

It’s about being developmentally accurate, clinically useful, and human.

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