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Autism

The Problem With the Term "Functioning"

What does "functioning" mean?

Key points

  • Functioning labels and assessments can be highly arbitrary.
  • The term "high-functioning" can limit a person's supports and minimize their challenges.
  • Concepts including a person's lived experience, aspirations, and obstacles are more helpful than functioning.

"The difference between high-functioning autism and low-functioning autism is that high-functioning means your deficits are ignored while low-functioning means your assets are ignored." —Laura Tisoncik, Autism Advocate

What does it mean to function?

When I think of the word "functioning," an image of a factory comes to mind. The machine might be working or not. People are not so simple. We hold a variety of hopes, fears, relationships and perceived purposes. We are more than machines.

Tags like "high-functioning" and "low-functioning" are frequently used in mental health, education, and developmental disability services. Still, the subjective nature of what functioning is and what arena a person is supposedly functioning within are not acknowledged.

Assessments of Functioning

In systems of care, the declaration of level of functioning is usually made through standardized assessment tools, the most common of which might be the Global Assessment of Functioning or GAF instrument.

Scores on the GAF range from 0-100 with each number describing a higher functioning level. A score of 100 is described in the assessment's anchors as a "Superior functioning in a wide range of activities, life's problems never seem to get out of hand, is sought out by others because of his or her many positive qualities. No symptoms." (Hall, 1995). On the contrary, danger to self or others marks the lowest possible GAF score of 0.

Assigning a numerical score to a client's functioning with tools like the GAF is sometimes required to determine if someone qualifies for services and what services they qualify for. Yet, the diversity of people's abilities and needs rarely conform to numbers. Using assessments like this can easily exclude individuals from receiving the support they need to achieve their goals or dismiss someone's capabilities without grounds.

Every person's aspirations and values are unique. It's tricky to determine what support a person would need to meet their individually defined goals through any standardized instrument.

Neurodiversity

When a person is presented with a label for a permanent level of functioning, it is potentially more worrying. An example would be "high-functioning autism."

Neurodiversity advocates have expressed that autism and other neurodivergencies involve a rainbow of areas of impact, which can vary day to day and by what environment a person is in. Labels like high- or low-functioning or high or low support needs have capacity to reduce this complexity missing the full picture of a person in the process.

Closing

People are complex, and goals are multidimensional. I believe that when it comes to service provision, it is more useful to seek to understand a person's lived experience, aspirations, and what they need from their environment to achieve those wishes than to make broad-stroke attempts to chase this construct of functioning.

References

Hall RC. (1995)Global assessment of functioning. A modified scale. Psychosomatics.36(3):267-275.

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