High functioning autism (or HFA) isn’t an official medical label, and doctors don't use it as a proper diagnosis. Instead, it’s just a phrase some people use to describe autistic people who seem to face less obvious difficulties.
Oftentimes, an autistic person may hide these difficulties using a coping technique called masking – where they hide their autistic traits to fit in with their neurotypical surroundings.
Today, many experts disagree with using the term ‘high functioning’. Some even want doctors and teachers to stop using it completely, as it can hide how much help a person actually needs.
What is high functioning autism?
Autism is a neurodevelopmental condition that affects how a person’s brain works. Autism will often be described as a spectrum because it can affect every person in a different way.
For a long time, doctors only diagnosed people who had obvious signs of autism, usually with some learning disabilities. That changed in the 1990s when they started noticing less obvious signs, too.
Today, we know that someone is simply autistic or they aren't. But because every autistic person is unique, no two people will experience it in the exact same way.
This is why ‘high functioning autism’ isn't an official medical diagnosis. It’s just a label some people use for autistic individuals who don't appear to others as though they need as much support in daily life.
Characteristics of high functioning autism
Because ‘high functioning autism’ isn't a separate type of autism, the symptoms of high functioning autism are the same as autism in general. These can include:
- Finding it tricky to read body language, make friends, and fit in with groups.
- Being extra sensitive to certain noises, temperatures, or bright places.
- Preferring fixed daily routines and feeling upset when they are disrupted.
- Taking words literally and finding it hard to spot sarcasm.
- Having deep, intense interests in specific topics.
The main difference for someone labelled ‘high functioning’ is how these traits look to other people. They are often very good at hiding - or masking - their struggles, making it look like they don't need as much help.
When an autistic person masks, they might force themselves to make eye contact, copy how others behave, or pretend they aren't bothered by loud noises or bright lights.
While masking helps them blend in with non-autistic people, it takes a massive amount of energy. Pretending all day can lead to extreme mental and physical tiredness, known as autistic burnout.
Is the term high functioning autism useful?
In short, most modern experts and autistic people say no.
Calling someone ‘high functioning’ makes it sound like they don't face challenges or don’t need help, simply because they are good at masking. But this can cause real harm in a few key ways:
- It ignores a person's struggles: When someone is labelled ‘high functioning’, others might assume they are doing fine. This can make autistic people feel as though their daily struggles aren't real, or that they shouldn't complain because ‘others have it worse.’
- It stops people getting support: Autistic people who seem to cope well on the outside often miss out on the help they need at school, at work, or elsewhere in daily life.
- It splits people into unfair groups: Describing some autistic people as ‘high functioning’ implies that others are ‘low functioning.’ This isn't fair or accurate - every autistic person has a mix of things they are good at and things they find hard.
Instead of using labels that judge how ‘well’ an autistic person appears to fit into the world, it is much more helpful to ask what specific support they need to feel comfortable and happy.
How ProblemShared can help
If you think you may have autism and would like to seek an assessment, we can help.
We’ve been assessing patients for autism and ADHD for over half a decade; our assessments are completely remote, allowing you to access clinical support from the comfort of your own home.
As an approved NHS Right to Choose provider, you can ask your GP to refer you to our service. Our current autism wait times are available on our Right to Choose page.
You can also check out our free autism screener - a short online test intended to help you understand whether your current experiences tally with the symptoms of autism.
While the screener cannot replace the clinical rigour of a professional autism diagnosis, it may help you understand whether an assessment would be in your best interests.
