functioning
What to know
People with mental health issues, substance use disorders, and/or developmental disabilities are often categorized as “low functioning” or “high functioning.” Which label they get depends on how well they can perform activities of daily living like cleaning their living space and cooking meals. Researcher and doctor Sidney Katz coined the concept of “activities of daily living” (ADL) in 1950, and it is still used today as part of Medicare criteria.
However, functionality labels do not capture everyone’s experiences. Just because a person struggles with certain activities does not mean they are incapable of doing well on other tasks or contributing to their communities. Likewise, someone described as having “high functioning” depression or substance use disorder can have severe symptoms that affect their quality of life.
Notice the difference between a line like “X works with a volunteer at a local nonprofit to prepare a monthly grocery budget” versus something more generic like “X, who’s low-functioning, has a hard time with basic tasks.” Specific person-language frames someone’s relative functionality on their terms and as just one aspect of their identity that doesn’t define them.
The National Center on Disability and Journalism discourages use of the terms “low functioning” and “high functioning,” urging careful and consensual reference to medical diagnoses and descriptions of a person’s abilities and challenges over generic labels.
At the sentence level, using phrasing that emphasizes a person’s agency — e.g., saying someone is “dealing with declining functionality” and then describing what that means in concrete terms— reinforces that they are managing a situation that affects but doesn’t encompass all that they are. This level of nuance is especially important for conditions in which symptom severity vacillates over time.
Additional resources
- Why High-Functioning Autism Is Hard to Define (Verywell Health)
Summary
Functioning refers to a person’s ability to engage in activities of daily living (ADL), such as maintaining personal hygiene, shopping for food, managing finances, and developing social relationships with other people. However, functionality labels can be reductive and misleading; the National Center on Disability and Journalism discourages use of “low functioning” and “high functioning,” calling instead for accurate medical terms and descriptions of a person’s specific abilities and challenges, which are aspects of someone’s identity but don’t define them.