High-functioning autism: Symptoms, diagnosis and support

A controversial term used to describe autistic people with normal to high intellect

High-functioning autism isn’t an official medical diagnosis, but is often used to pin down a complicated set of behaviours. Yet the term itself is not without controversy. Commonly used to describe autistic people with normal to high intellect, and no speech or language delay, many feel the term itself is both unhelpful and even harmful.
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“Many find the label offensive,” says Dr Rachel Moseley, an autism researcher at Bournemouth University. “It simplifies the complexity of an individual person and gives no actual impression of what they struggle and excel at, and where they need help.” On the other hand, those perceived as being low-functioning often have their autonomy and independence written off which leaves them marginalised in society.
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Dr Moseley explains that a ‘high-functioning’ autistic person might well excel in a field that plays to their strengths, like science or mathematics, but still be incapacitated by anxiety and feel overwhelmed in the face of navigating the social world. 
Some have IQs in the average range (or above), while others have learning disabilities and/or are non-speaking. Yet the specific support needs for many can range from needing help with sensory sensitivities or communication to self-care or independent living skills.
“The person might maintain a challenging job, but it may take all of their energies and they may struggle with all the social complexities of it – such that they need a lot of emotional and practical support at home,” she says.
Instead of using what they term a ‘functioning label’, the National Autistic Society refers to autistic people in terms of having high or low support needs.
Dr Moseley says that when a person receives their diagnosis, it will assign them a level of one to three, where level one means they require some support, while level three indicates the need for very substantial support.
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Some of the most common characteristics include:
Studies have shown that sound is one of the most commonly experienced examples of sensory overload. 
“Many autistic people will experience sounds as unusually intense or intrusive, possibly even physically painful,” says Dr Moseley. She adds that sounds may “also trigger strong emotions, like anxiety or anger, and many struggle to tune out the sounds in the environment – for example, when trying to listen to one person while conversation is going on around them.” 
But this is just one of many sensory sensitivities which can be experienced. 
According to the National Autistic Society, autistic people can experience under or over sensitivities to light, touch, smell, taste and balance.
“An important flip side is that sensory sensitivities can, in some circumstances, be experienced as joyful,” says Dr Moseley. “Autistic people may experience feelings of peace or delight when able to touch a certain texture, see coloured lights or moving objects, as well as from saying or hearing a particular sound.”
Many autistic people experience issues when it comes to reading social or nonverbal cues, as well as having a tendency to interpret language literally.
Dr Moseley, who herself is autistic, says that this often contributed to her own struggles while growing up. “My difficulties were always around understanding other people,” she says. “Since I was a very small child I was often confused by what was going on around me. I didn’t always understand when adults asked me to do things, or forbade me from picking up fragile objects or trying to hide in crowded places. Later on, I’d sometimes struggle to understand what teachers wanted from me, even though I was academically quite bright.”
Research has also found that autistic people can sometimes struggle with initiating and completing tasks, managing time effectively, and staying organised, which can lead to them feeling overwhelmed – both at school and in the workplace. 
Dr Rebecca Flower, a psychologist at La Trobe University in Melbourne says that while it is very possible for many autistic people to work in any role, employers need to communicate their expectations clearly.
“Make it clear what needs to be prioritised,” she says, “and what might be unpredictable in a role, why this is the case and what to do when something comes up unexpectedly.”
According to the National Autistic Society, around 40-50 per cent of autistic people will go on to receive a diagnosis of anxiety. Shockingly, almost 32 per cent of autistic women are hospitalised with some kind of mental illness by the age of 25.
Dr Moseley says her own mental health became progressively worse as she reached adulthood. “Mental illness and suicidality are especially severe in autistic women without intellectual disability, who society will often deem high-functioning,” she says. “My mental health worsened along with my growing awareness of how different I was.”
Some autistic people will engage in repetitive behaviours such as finger-flicking, arm or hand flapping and head banging. There are thought to be a number of reasons for this, which range from enjoyment from the behaviour, a coping mechanism for dealing with stress and anxiety, or an attempt to modulate sensory input; as focusing on one particular sound can reduce the impact of an excessively noisy environment.
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The current diagnosis procedure involves a clinician asking questions about a person’s experiences and making assessments about their behaviour.
The autism assessment involves
Dr Suzi Sapiets, a researcher at the University of Kent, who was diagnosed with autism in her 20s, feels that many of the diagnostic tools need to be broadened to take into account the fact that autistic people can have multiple forms of neurodivergence, from dyslexia to learning disabilities and Tourette’s.   
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Dr Flower says that common forms of support which can help autistic people, especially in the workplace, involve being aware of sensory sensitivities and being very clear about communication. 
“This can include asking about sensory preferences and needs, changing a lightbulb to a warmer or yellow bulb, fitting a window blind, or allowing employees to wear noise cancelling headphones,” she says.
With research showing that mental health difficulties and suicidal thoughts are most common in autistic people who would have been described as ‘high-functioning’, Dr Moseley says it is important to be aware that an autistic individual excelling at their job may also be struggling in other areas of their life. 
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Psychologists at the University of Nottingham have found that improving access to mental health support, such as counselling, is particularly important to prevent self-harm and suicide in autistic people.
“The person might be channelling all their energies into their work and activities, but struggle to maintain their home and finances, and take care of their health,” says Dr Moseley. “For me, however well I appear to be coping, I would likely have died long ago if not for my family’s intervention. My mother still helps me with everything from social worries and issues at work, to understanding bills and staying on top of my house.” 
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Looking back, Dr Sapiets says that growing up prior to her autism diagnosis was one of the most challenging times of her life. “I thought there was something wrong with me, due to bullying and trauma I’ve experienced,” she says. “But discovering I am autistic, and my subsequent journey to understand and accept myself as I am, has been one of the biggest things that’s helped me.” 
During her teenage years and early 20s, she describes attempting to alter her behaviour to fit in with others, something which had a negative impact on her mental health. However, since being diagnosed she has been able to take steps to understand her strengths and needs more acutely, as well as receiving trauma therapy from an autistic therapist.
“There are some challenges I experience – for example, I can get extremely anxious in social situations – and I sometimes find it difficult to articulate myself,” she says. “I often struggle with lots of different noises at once and strong smells and I can easily get overwhelmed with unexpected changes.”
She describes one of the biggest things which has helped her has been being assigned a mentor through the Government’s Access to Work scheme. The mentor helps plan her work, prepare for and process stressful situations, and provide emotional coping strategies in the workplace.
“From personal experience, most of the difficulties I have experienced in my life have not been due to me being autistic, but due to a lack of understanding, acceptance and support from others,” she says. “It’s so important to understand each autistic person’s individual needs and strengths to enable them to thrive.”
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