Autism Resources

Compassionate Care: What is High vs. Low Functioning Anyways?

December 22, 2022

The blog post that I decided to touch upon today is within the realm of compassionate care of the clients with which we work. One such item within this realm is the use of various terminology to describe the “functioning level” of a client that we work with. The terms “high functioning” VS “low functioning” are a commonly used comparison within society when referring to people who are impacted by disabilities and can have detrimental effects within practice.

It is important to consider client dignity with respect to utilization of these terms, and uphold Trumpet’s core value of integrity with the clients we serve. For example, it is important to engage in perspective taking and identify how you may feel if someone referred to you as a “low-functioning” person: likely not good.

Understanding “High Functioning” VS “Low Functioning”

Another example of a common use of this terminology is with people with mental health disorders, such as depression or anxiety. One that has high levels of anxiety or depression, but is able to “function in their day-to-day life” may have the label of a “high-functioning person with depression.” This can have detrimental effects as it thus means that that person is less likely to get the further support or intervention that they need.

In addition, within this example as well, society might view the person as being able to “function in their day to day life just fine,” when in reality, that is not how the person feels and internally they are struggling with their demons. This example is provided to help reach even more of an audience to engage in perspective taking of these situations and the detrimental effects of this type of terminology.

How Do We Express Functional Levels Diagnostically?

There has been a push to refer to the level of autism based on the person’s diagnostic reports in which it details the areas of concern on a three-point level scale; one being the “most mild form,” and three being “the most severe form.” While this is more objective and provides more dignity to the person than “high vs low functioning,” it can still have the same implications and detrimental factors as above. (I.e., that may not be how the person feels internally; is still a label from a diagnosing doctor and also does not describe the person by their strengths.) 

Although autism is a “spectrum disorder,” with regards to compassionate care of clients that we work with, I urge you all to consider alternative terminology. Remember to not only utilize the golden rule to always treat people how you want to be treated, but to remember the platinum rule of treating others how they would want to be treated as well.

Improving Terminology

One such method of terminology that could be a suggestion of what to utilize instead is by saying “a person with strengths in the areas of ___ and seeking support within the areas of __.” Using this format, practitioners could detail certain domains where their clients need support. It is important that we also describe the person’s strengths, first and foremost, before any areas of support, as it is important to empower the person and not define them by their weaknesses.

What this might look like if you were describing a case is you could say “I have a new client named Sam who has great strengths in the areas of expressive communication, listener responding, and classroom routines, however, he is seeking support within the areas of decreasing problem behaviors and social skills with his peers.” This statement does a great job of providing objective details to describe the case, but does so while ensuring to put people first as humans and their strengths and values, thus to not define them as their weaknesses as well. 

How Do High VS Low Functioning Labels Impact Our Clients?

In addition, another issue that arises with the use of “functioning labels” is that the labels of function reflect how society sees the person, rather than how the person may see themselves.

For example, the term “high-functioning” with relation to clients with higher assessment scores can also hinder the amount of support provided to them. By utilizing the term “high-functioning,” this indicates to people that they may not need as much support or that their deficits are not as important, which is likely not the case to them.

In the example above with relation to the mental health diagnosis is a “higher functioning person with depression,” this could have implications such that that person is potentially less likely to get the supports they need. They may even be unable to access therapy, because the rest of society sees them as not needing supports because of their “functioning level.” However, internally this may not be the case and in the case of someone with a disability, they may be struggling deep down. It is not fair for society to attach the labels to them that they do not have a say in.

On the contrary, “low functioning” is typically deemed with a negative connotation, which focuses on the stigma of what the person cannot do, rather than focusing on all of the good that they can do and their personal strengths This thus goes back to the point made above in which it is important to lead with describing someone by their strengths and then listing areas of support requested; rather than deeming them “low functioning.” Everyone has strengths, it is important to highlight those and empower the clients that we work with.