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If you're curious to see Jane in action, head to Jane app mentalhealth Us to book a free one on one demo. You can also mention the code DCPOD at Signup for a 2 month free grace period on your new Jane account. Hey everyone. You are listening to the Divergent Conversations podcast. We are two neurodivergent mental health professionals in a neurotypical world. I'm Patrick cassell.
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And I'm Dr. Neff.
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And during these episodes we do talk about sensitive subjects, mental health. And there are some conversations that can certainly feel a bit overwhelming. So we do just want to use that disclosure and disclaimer before jumping in. And thanks for listening. All right, so yeah, welcome back to Divergent Conversations. And today we are talking about the terminology and usage of functioning labels in the autistic spaces and know this is a hot topic.
A
Yeah, yeah, I'm like looking forward to this conversation. Breaking it down.
B
So you mentioned off air that you have a lot of nuance to this and understandably. So I think that's important when we're having this specific conversation. And I think what happens, right, we've talked about this a lot, where people discover that they're autistic later in life and immediately jump into all the things. But sometimes we get it wrong or sometimes we say things that might hurt people or offend people and have to walk it back. And there's a lot of deconstruction work that happens with internalized ableism in general.
A
Yeah, yeah, I think that's really well said. It's like it's part of the learning arc that we're all on. And so I think when we first learn we're autistic or adhd, especially if we're coming at it later of life, it's there's so many new ideas we're learning and it's, it's really empowering. And I think it's also easy to fall into kind of core ideas that is helping us name some, some invalidation we've had throughout our life and so we can get really attached to them. And then in that process, especially if we've not like fully dived into the nuances of like, differences of support needs and differences of know, intersectionality, then it's easy to kind of get over attached to some of those. It's what Tiff Hammond, when we had on the podcast, gosh, it was probably a year and a half ago, she talked about the autistic starter pack kind of. She sees all these typically white creators coming in and it's like they've got their autistic starter, starter pack of like to be affirming. We don't use functioning labels. We don't use asd. We use identity first. And it's like the checklist of to be a good autistic advocate. Here's, here's the things you do.
B
Yep. Yep. To be a good autistic advocate. To be a good autistic person in this space. Here are the things I say, Here are the things I believe. Here are the things that I adhere to. Here are the things that I kind of like glom onto in a way I know myself. Like, I definitely did said things that I regret and have had to have accountability about language and just unlearning a lot because for me, I was like going full steam ahead in my life. And then all of a sudden, brick wall, burnout, et cetera, diagnosis, discovery. And all of a sudden it was like, oh, life has now changed in the blink of an eye. But until that time four and a half years ago, I didn't know what I didn't know.
A
Yeah, yeah. I mean, same like I, I. It was really funny when Tiff said that. Cause I looked back at all my early posts and I was like, yep, I had a post about like, don't use the puzzle pieces and don't use functioning labels. And again, it's not like that stuff is wrong to say. It's just, it's so classic. It's so classic that that's the first thing we do. And again, that doesn't make it bad. And it's good to have like thoughtful, searching, nuanced conversations. And I think that's kind of what this series is about is let's talk about the basics of like, when people are walking into the door and talk about why these are. Like, there's a reason we say things like, hey, actually, can you please not use functioning labels? Or if you're an affirming provider, maybe don't lead with that. So there's a reason that that's there. And then can we also nuance some of these autistic starter pack phrases?
B
I'm so tiff, if you ever listen to this episode, big shout out to you, because I think you make both of us think very differently about the nuances of all things autism. I mean, I love her post so much and just her perspective reframes, but I think we're going to go with the autistic starter pack for this series. And I think that the reality is, right, you're trying to learn and both unlearn so much. And I think that there's so much emotion built up in this experience where there's unlearning, there's grief, there's. There's relief, there's potential. Like, just that, aha, epiphany moment. There could be clarity, there could be frustration, and it all swirls around. And then you jump into, like, advocacy spaces because you want to feel seen and connected to people who get it. And then if you get it wrong, that can feel so demoralizing of, like, I still haven't found my people.
A
Yeah. Yeah. So that's actually, like, that's kind of why I started the Nook, is because I was seeing a lot. So my. My first part into the community was Facebook groups. And, like, I'm forever grateful for that because I. I learned, like, I made really meaningful connections, and I learned so much. And then the more time I spent in those kinds of groups, I was like, oh, I'm so nervous about using the wrong word. Like, I used ASD once because it was in the context of a clinician was asking for a referral for an asd. And then someone was like, we don't use that language in here. And I. And I felt so much shame. I was like, but it literally is an ASD assessment. And. And so. And I've seen that in so many people of, like, they're coming to know, and then they maybe go into a community, but they don't have the right. Like, they don't have. They don't have the language that is the most affirming. And then they can experience a lot of shame when they, like, misstep in that. And again, back to that idea of, like, the learning arc of we have to be able to have Compassion for wherever we are in the learning arc and compassion for one another of where other people are at.
B
That's so well said. And actually you using the learning arc terminology around reminds me that several people on our Instagram did request, like, could we go over Dr. Neff's entire learning arc of like all of Megan Anna's posts? And I was like, damn, that's a good idea. So, but I think, and maybe we'll put this in our intro that we record, but we want to just say like, if you catch this episode or a clip of social media and only see 60 seconds of us sitting here saying, like, this language is, you know, nuanced and there's a lot of complexity here. It's really easy to potentially take offense to that and to be like, you two are not being affirming. But in reality I think it's important to acknowledge, like, just like there's a spectrum of neurodiversity, there's a spectrum of where people are at on the learning arc, and there's going to be learning unlearning and missteps along the way.
A
Yeah, yeah. And it doesn't mean to say that we, like, we don't have it right right now. Like, this is a snapshot of us in 2025 with what we know with. And I imagine a year from now, 2026, Patrick and Megan Anna might have different views. And so it's evolving. Okay, well, let's get into it though. So first of all, let's talk about, like, why are functioning labels problematic? Because I do agree with that statement. I do think they're problematic. The thing I think of, like, how weird would it be like, if Patrick, I was just meeting you or meeting an allistic person if I was just like, hey, like, how functional are you? Like, that's just a weird ass question.
B
You would never ask it.
A
You would never ask it.
B
No, but like, and it, you would never even think to ask that question though. That's the thing.
A
Right, right. And yet when you think about how many of us, when we've perhaps disclosed our autism, it can be common to get a response like, oh, you must be really high functioning, or, or when someone's like, you know, I've got an autistic kid or I'm autistic, it's like, are they lower, high functioning? It's like, like, yeah. So it's also the, there's also, I mean, it also points to kind of capitalistic instincts that our society is so obsessed with. Like, well, how functional are you sure so there's. It, I think it taps into some things that are kind of deep seated things in our society and it becomes a reflection of that.
B
Because yeah, when we start to examine it through a capitalistic lens, right. We are basically saying, and placing inherent value on productivity. How much productivity do you offer society? And that feels really shitty. I think like when the registry conversation was ongoing for a month and it's died out now, but I'm sure it will resurface its ugly head at some point. You know, I think a lot of the conversation was, and I'm just using air quotes now, geared towards what people and that side of things would, would classify as like low functioning autistic people. But you know, we would say high or moderate support needs in our, our spheres of influence and conversation. But what they're saying, right, is like these people who have moderate or high supports needs are not positively impactful on society. They don't offer anything, they don't contribute financially. That's kind of what the messaging was.
A
Yeah, yeah. Which is deeply problematic. And we even saw some of that. So when I always mess up his initials rfk Robert Kennedy, when he made his statements and then there was a lot of responses in the community and some of the hurtful responses were like, yeah, well I'm not that kind of autistic person. And then creating a hierarchy of like we're still tapping into that mindset. If it's saying, well, I do pay taxes, I guess I should back up. His statements were about how autistic people are like a leech on society. And so then there was a lot of posts around look at how productive I am, look like I do pay taxes. And how that like we're still falling into that capitalistic mindset. Or that, that it's not even just a capitalistic mindset, it's a mindset of like human value is assigned and human worth is assigned by how much you produce. And so yeah, that would be an example of where this obsession with functioning reflects something deeply disturbing in our society that negatively impacts all of our human humanity.
B
Absolutely, absolutely. And it's, it's a, it's tied to this movement or mindset, right. Of placing inherent value and self worth based on what you can produce. And I think that is so damaging, so toxic. We live in a capitalist society. We experience a lot of autistic burnout collectively because we live in a capitalist society because we have to feel like we have to grind, we have to do the next thing, we have to keep being productive. And it's like we are not designed for that. I know myself like being in the throes of autistic burnout as we record this and I fall into that. You know, I think you and I fall into like creator types and we work a lot and we produce a lot. But I don't like to tie my value and self worth to what I put out into the world. And I think it also reduces like it minimizes the support needs that we have and the accommodations that we build in as low support needs autistic people.
A
Yeah, well that's the other critique or like one other like huge critique I think is that it doesn't capture the reality of the lived experience of autistic people in the sense that like it doesn't capture those of us with lower support needs. Our functioning ebbs and flows so much. Like, yeah, we can be recording a podcast and look pretty high functioning and then look at one of us after a day of like being out in the world. And access to speech is hard access to like accomplishing our activities of daily living, which is literally how we measure functioning in some of the, you know, measurements we look at is going to be very diminished. And on the flip side, those deemed low functioning are often minimized. Their functioning is often minimized. For example, for a long time it was assumed that all non speaking autistic people had intellectual disabilities. We know that's not true. Like, we like books. The reason I jump right, a beautiful book written by a non speaking autistic person. And it's, we're gaining more and more access to the internal world of many non speaking, non speaking autistic people. They've, their functioning's often been like, like the opposite where it's been assumed they're less functional than they are.
B
Right. And then when we put the right supports and accommodations in place, things can really shift. And I think that if we're just gauging everyone's quote unquote using air quotes again, for those of you not watching on YouTube, on our channel, which we do have when we're gauging everything by like this one standard, it's very supremacist and ableist based of like, if you speak then you have more worth or you're more quote unquote functional. If you don't use these specific supports, you're quote unquote more functional. And it's all, it all ties into that mindset of like there's just this one mentality of specific thought processes or focuses on functionality equates to inherent self Worth and also cultural self worth and cultural worth in general. And that's just simply not true.
A
Yeah. Yeah. And I think this is also where like our community has a lot to thank for like the movements around disability justice of like, a lot of this taps into things that people from the disability justice movement have been saying for a long time of like, human worth is so much bigger than how our society tends to look at it. And I think you just see it crystallized so clearly in this functioning label. Like the use of functioning label is. You see all these values our culture has placed on them.
B
And I think there's a long way to go in so many spaces and how as I slam my mic into my face in so many spaces, but like one, one area for sure is therapist referral groups. That really irks me. But I don't really, I can't jump into every conversation. It's just not, I don't have the spoons or the capacity. But what you'll see a lot of is like have a referral for a high functioning ASD kiddo or have a referral for a low functioning person with autism. And it's then I'm like nails on the chalkboard. But who am I to educate every single human out there who uses language when they're just trying to access support?
A
Yeah, yeah, well, and, and this is, and this. Maybe we'll start getting us into the nuance. But like language is important in the sense that clinicians like, I'm not trained to work with a high support need autistic person and I would be outside of my scope to, to do so. And, and so language does matter. And especially when it's like quick, like who, who can. When you're trying to access support and it's like, who can do this? We do need language that differentiates the experience because the experience across the spectrum is vastly, vastly different. And so. But maybe we can get more into that in a minute because I do think I agree with you with the clinical space of. Even in research papers I see HFA or high functioning Autism referenced a lot, even though it's not DSM language. But it's definitely been the language of clinicians. And again, I get it in the sense of partly, I think we started using this language when we got rid of Asperger's and that was one of the changes to the DSM 5 was to get rid of Asperger's and then to include everything in the spectrum and, and a lot of families with higher support needs children did not like that they didn't like the fact that we were now including all of it under this one label. And I think the more, the more people like you and me have gotten more visible on social media, I think there's even more of that experience of, particularly from family members, of people supporting high support needs. It's this. You are not representing our family's experience or my child's experience. And so there is a need to be able to have language to talk about the fact that these are very different realities.
B
Yeah, yeah. Because it would be, it would also not be accurate to just lump every single autistic person into one referral request. Like, it would not be like, hey, I have a referral for an autistic client. And like, oh, that, that felt like affirming language. But in reality it's like, I don't know anything else about the situation or the case or the context or the support needs in place or, and maybe I won't be the right fit because I don't have the training or the knowledge base to support that person.
A
And that's where I think, like, our community has kind of evolved the conversation to the language of like, low support needs, mid support needs, high support needs, which perhaps kind of parallel. So in the, in the dsm, like you are like, typically diagnosed with level one, two or three autism. And so it kind of, I think roughly, I mean, I don't think it's a direct comparison, but I think it kind of roughly parallels that when we use the language of support needs.
B
For sure.
A
And, but that might be other language that people see sometimes too. Although even clinicians don't always know about the levels. But so, but that could be a referral, like level one autism or level two or level three. And it gets so confusing because it's like high functioning is the opposite. So high functioning equals low support needs. The way we classically talk about that, which is level one, and then level three is low functioning, high support needs. Like my, my brain just trying to map it out is getting in a pretzel.
B
It's, it's challenging. Yeah, for sure. And I think also I want to say that with any of this. Right. Self determination is also a, a big part because if you are autistic, you do get to decide how you want to talk about your autistic experience and your autistic identity. Within reason. Let me add the context of an asterisk. Within reason.
A
Yeah, I, I, I would say within reason because I, I feel like I, there might be some people, I feel anxious saying this, but like, if they don't fully understand the experience of what autism level three looks like, they might say, well, my support needs feel pretty big, so I'm a high support needs autistic.
B
Right.
A
And I actually do think, I mean yes to self determination, but I do think it is important that the, the way we talk about certain experiences gets to like, if, if we start. If like words need a map, like words need to mean something. Am I making sense?
B
You are making sense. Yeah, absolutely. Words need to mean something. Let me clarify and back up. I mean more like I have autism or I am autistic when we're talking, oh, okay. Person identity, first language. I think it's important to have self determination in that at first because I understand I would place that on the arc of discovery and deconstruction. Now fast forward to what you are saying. Yes, words need to mean something.
A
And it's interesting. This is the critique. When autism became more of a buzzword. The critique was, and again, this often came from families supporting high support need children is if, if autism becomes this buzzword or everyone's autistic, it's going to lose the meaning and then like access to services that we desperately need. Like, what's going to happen there? And I remember first seeing that when I was early in the space and being like, like, I, I kind of brush that aside of like, no, there's, there's space for all of us and, and here's why it matters and like, and maybe I should give that perspective. I think it really does matter that we're also including autistic level one in the conversation. Because one thing I often say, those of us with lower traditional support needs tend to have very high mental health needs. And identification becomes so core for us in supporting us in how we navigate our mental health journeys. And so I absolutely think we belong in the conversation. And I also am understanding the tension of what those early voices were saying of like, we can't dilute this word to mean nothing. Like, it can't just mean, oh, it's just a difference. Like, we've got to hold onto it as a disability. I feel strongly about that. I know not everyone agrees and I'm blending disability models when I say that. So yeah, yeah, this is where it gets nuanced, it gets complex.
B
Yes, it is where it gets nuanced and where it gets complex. And I think that's absolutely accurate to say holding onto that word and not allowing for it to be used in all sorts of different spaces to define different characteristics. Because when we are talking about accommodations that need to be built in, not only for quote, unquote, why do I keep saying that? It's going to be stuck in my head all day. Level 1, slash, low support needs autistic people, Accommodations that need to be built in for moderate or medium or high support needs, autistic people. And they're all going to look a little bit different. And some of them are absolutely, absolutely necessary to get through the day for daily living.
A
Yeah, yeah. And I think so. I think going back to the problematic nature of functioning labels like that is a big piece of the conversation that often happens is level one autistic folks, especially those who mask and are late and identified, we've often experienced a lot of invalidation throughout our life around our needs. And we've. Because of that, we've interpreted it as character stuff like I'm lazy or I'm oversensitive. And so we can have a really hard time taking our needs seriously. We can have a really hard time asking for our needs or accommodations. And people around us have a really hard time seeing our needs, especially our disability needs, as valid. And this language of high functioning doesn't help with that because I think. And it taps into all of the stress of invisible disability, of if I can't see your disability, then society tends to discount it and then we're prone to discount it ourselves. And so this really is a huge part of the problematic nature of functioning labels is it makes it so hard for so many of us to build lives that are functional, like to build lives that work for us.
B
Absolutely, it really does. And I think that coincides with like just unpacking sometimes our internalized ableism too, like pushing ourselves beyond our limits and capacity because our needs aren't often taken seriously. So we can start to really internalize that as if these needs don't really exist or we're making them up, or they're more than I'm making them out to be, which is a.
A
Yeah, I mean, I see that. So, like, you know, yeah, I'm in a community with a lot of fairly newly identified. And that is a constant theme that comes up is it is so hard to finally take our needs seriously. And like, that. That is a legit sensory need deserving of accommodation. You're allowed to leave because for so many of us, we've just like powered through and believe we're still supposed to. And. And then there's so much second questioning of, like, did I really have to take disability? Like, couldn't I have stayed and did I really have to leave that event? Couldn't I have just stayed and pushed through?
B
Yep, yep. And then it again turns into this, like, character defect, personality struggle or issue. And then it's like, it's just me. Like I'm. I'm the one that's creating this or manifesting this almost. Yeah, it's really challenging. And it's again, just so nuanced because when we say that. Right. And we're talking about this, it's like, I know there's a lot of people who are gonna be. Who are moderate or medium or high support needs, autistic people who are like, in some of these spaces, but these struggles and conversations to talk about low support needs, accommodations and needs is. It gets really murky. I'm not saying this well, but it gets really murky, actually. Yeah.
A
And it's. Sojourner Truth talked about this so well that whenever you have a marginalized group, what often happens is they end up fighting for the breadcrumb versus, like, pointing the direction toward the oppressor. And I think it just makes sense that when there are so many needs in the autistic community and so much complexity and so much spectrum of needs. Right. Like, the needs look different. The need for kind of basic daily living and then the need to support someone with really complex mental health, those look really different. And so it's really easy to, like, talk over one another or invalidate one another. And it's like, we, we all deserve to be here. We all deserve to, like, have our experiences matter. And it's really easy to fall into fighting over the breadcrumb when the resources are so little.
B
It's really well said. Yeah, that's. That's so, so true.
A
I, I feel that. I don't know how you feel, but I feel like. I feel. I don't know, there's part of me that, like, can own. I, I speak for my lived experience and that tends to be, therefore, who connects with my work. But yeah, every time I write a book or write a resource, it, like, it. It weighs on me of like, I know this is for, like, a very specific part of the spectrum. And, and, and, and I am. I'm stretching to learn more from, from those with higher support needs as much as I can. But it's. It, like, it, It, I guess irks me. I, I just realized that, like, yeah, my, my content is. If it feels. I don't know, I guess maybe discomfort with privilege might be the emotion I'm trying to. Or the experience I'm Trying to name. I don't know if you ever experienced that in your content, but yeah, you.
B
Know, I was going to say preaching to the choir. I think it's trying to learn as much as we can from people with high support needs and also acknowledging that that's not our reality or day to day or lived experience. I think both of those can be true. But I think what you're experiencing, and correct me if I'm wrong, there is feelings of tension almost of putting this out there and having the acknowledgement of the audience is going to be very different and who's going to be consuming the information is going to potentially be very different.
A
And will this, like, will this apply, like, will this apply to someone in a different.
B
Yeah, yeah, yeah, yeah.
A
The other thing that shifted for me and this also came out of the April, like cluster. Cluster month. You know, last April was just autism got hit with a lot of stuff is I'm also starting to listen more to parents of high support children. And there's, there's been historically and I, I used to even have this like sassy matte mug I sold on my website that was like crossed out autism mom with like autistic mom. And like I used to be really kind of sassy and again like, like us versus them mentality. And I'm realizing like, no, that's an experience I also want to learn from and because there is, that might be part of the autistic starter pack because there's. There has been a history of like parents and caregivers talking for autistic people. And, and then now there's a lot more autistic people like talking for ourselves. But that created this like, don't talk for us, which again comes from an understandable history. But, but that's another way that I think I've, I'm softening of like actually I, I think I have something to learn from parents and caregivers of, of high support autistic humans. And so that's another shift I've noticed as well.
B
Yeah, I hear you. Just trying to be really intentional and open to all perspectives and just acknowledging that it's not just our own. So that's what I'm hearing from you is like curiosity and thoughtfulness and intentionality.
A
But then it leads me to these unpopular opinions. Patrick.
B
I think sometimes we just have to stand behind some of those though. You know, it's. Yeah, I think it's always about nuance and the both and, and it's really hard to find like things for me that are 100% one way or another in, in any conversation or any topic and just trying to be really curious about them and really open to different experiences and thoughts and perspectives and also cultural perspectives as well that are not just like Western perspectives, you know. Yeah, yeah, so that's what I'm hearing. But I know how we both are when we talk and how we overanalyze everything we say. So it's also get all black.
A
Yeah, comes with the territory.
B
Yeah, comes with the territory for sure.
A
So yeah, I think to synthesize it. Yeah. Functioning labels not helpful. I think there's much more affirming language out there that's accessible. And when we critique functioning labels, remembering that the spectrum is not all the same and it's important to retain language that helps to honor the different experiences.
B
I think that's said very well. So we're going to wrap up and we're going to do awkward wrap ups per usual because all of you seem to really enjoy our awkwardness and our playfulness. So we'll see where that comes in throughout the next couple episodes. But you know, find us on all the platforms, YouTube, all the things you know and also go check out our sponsor James Jane app for your electronic medical records needs for therapy practices and medical practices alike. You can use D code DC pod for two months off and you know, the links will be in the show notes and we'll see you next week. So Goodbye.
A
Hey, it's Dr. Neff here. This season we are clearly talking about autistic burnout, a topic that neurodivergent Insights has covered extensively. So if you would like more resources to supplement your learning, we've put together a page where we've curated all of our autistic burnout resources freed and paid resources. We have lots of articles on autistic burnout. We have a upcoming free email course. It's going to be released soon. We have workbooks on autistic burnout. So if you'd like to check out our resources again, both free and paid, you can go to neurodivergentinsights. Com Burnout Resources. It's linked below and in the show notes. I hope you don't need these resources, but if you do, they are there for you.
Hosts: Dr. Megan Anna Neff (A) & Patrick Casale (B)
Date: October 24, 2025
This episode addresses the complex and often contentious topic of "functioning labels" in autistic advocacy—terms like "high-functioning" and "low-functioning" autism. Dr. Megan Anna Neff and Patrick Casale, both AuDHD (Autistic-ADHD) therapists, candidly explore the harm these labels can cause, their roots in ableism and capitalism, the importance of nuance, support needs language, and the evolving nature of self-advocacy. Throughout the discussion, they infuse personal stories, acknowledge their own learning arcs, and highlight the ongoing evolution in the neurodivergent space.
Nuances of Self-Discovery:
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Learning & Unlearning:
The Fear of Missteps:
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Social Awkwardness & Social Value:
Ties to Capitalism & Worth:
Stigmatization & Lost Nuance:
Notable Quote:
Toward Nuanced Language:
Limits of Self-Determination:
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Mental Health Needs & Invisible Disability:
Internalized Ableism:
The “Breadcrumb” Effect:
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Summary Conclusion:
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The episode is conversational, honest, and self-reflective, with both hosts modeling vulnerability and openness about their own growth and changing perspectives. The tone is supportive, sometimes playful, but also willing to challenge mainstream advocacy norms and acknowledge discomfort, privilege, and ongoing uncertainty.
This well-rounded exploration provides valuable context and insight for anyone interested in the lived realities and ongoing debates within autistic advocacy—particularly around the pitfalls of functioning labels and the importance of nuanced, affirming language.