The Emotional Cost of Being ‘High-Functioning’: The Reality Behind the Label

Bridgette Hamstead

The term “high-functioning” is often used to describe autistic and ADHD individuals who, on the surface, appear to be managing their daily lives with little difficulty. It is a label that suggests capability, independence, and success, but in reality, it is one of the most harmful and misleading designations a neurodivergent person can receive. Rather than providing support and understanding, the label often erases the very real struggles that neurodivergent individuals face. It reinforces the idea that as long as someone can outwardly perform well enough to meet societal expectations, their internal battles are insignificant or nonexistent. Over time, this erasure has profound emotional consequences, leaving many “high-functioning” neurodivergent individuals feeling unseen, unsupported, and exhausted from constantly maintaining a mask of competence.

The concept of high- and low-functioning labels originates from an ableist framework that ranks disability based on how much inconvenience it causes to others, rather than how much difficulty the individual experiences. A person deemed “high-functioning” is assumed to have fewer struggles because they can hold a job, complete daily tasks, or maintain relationships. Meanwhile, someone labeled as “low-functioning” is seen as needing significant assistance with basic life skills. But these labels fail to acknowledge that neurodivergence is not a binary experience. Struggles are not always visible, and capabilities can fluctuate depending on energy levels, stress, and the presence of accommodations. Just because someone is able to function in certain areas does not mean they are not struggling tremendously in others.

For those labeled high-functioning, one of the biggest emotional costs is the expectation to perform at a neurotypical standard at all times. Many neurodivergent individuals work tirelessly to mask their struggles in order to fit into workplaces, educational institutions, and social settings. They script conversations, suppress stimming, force themselves into rigid schedules, and push through sensory overload because they know that showing their true selves could lead to misunderstanding, exclusion, or outright dismissal. When they inevitably reach a breaking point—whether through burnout, shutdowns, or emotional exhaustion—they are often met with disbelief or blame. They hear phrases like “But you’ve been fine before,” or “You don’t seem autistic,” as if their struggles are suddenly invalid because they were not obvious to others.

Another damaging consequence of the high-functioning label is the lack of access to necessary support. Many neurodivergent individuals are denied accommodations, therapy, or workplace flexibility simply because they appear to be managing on their own. Teachers may assume a high-functioning student does not need extra time on assignments, even if they are struggling with executive dysfunction. Employers may dismiss requests for flexible schedules or sensory-friendly work environments, believing that someone who has performed well in the past should be able to continue without assistance. This leads to a cycle where neurodivergent individuals must overextend themselves just to be taken seriously when they say they are struggling. The constant effort required to appear functional drains emotional and mental resources, often resulting in deep burnout.

The social pressure associated with the high-functioning label can also be isolating. Many neurodivergent individuals feel like they must hide their difficulties to maintain relationships and professional standing. They may struggle with maintaining friendships, engaging in social interactions, or managing the invisible labor that comes with navigating a neurotypical world. But because they do not “look disabled” or outwardly struggle in ways that society recognizes, their experiences are often dismissed. They may be accused of exaggerating, seeking attention, or making excuses. This invalidation fosters self-doubt, reinforcing the internalized belief that their struggles are not real or that they are simply not trying hard enough.

For late-diagnosed autistic and ADHD individuals, the impact of being perceived as high-functioning can be especially profound. Many grow up believing that their struggles are personal failures rather than signs of an underlying neurotype. They are told they are too sensitive, too lazy, too scattered, or too intense. Without the language to understand their neurodivergence, they internalize these criticisms, carrying a deep sense of inadequacy into adulthood. Even after diagnosis, many late-identified neurodivergent people continue to grapple with impostor syndrome, feeling as though they are not “autistic enough” or that they do not deserve accommodations because they have always been expected to function independently. The weight of these expectations can make self-acceptance incredibly difficult.

The reality is that functioning is not a fixed state. A person labeled as high-functioning may be able to excel in one environment but completely shut down in another. They may have periods of hyper-productivity followed by weeks of burnout. They may appear socially adept in one-on-one conversations but find group interactions impossible to navigate. The high-functioning label fails to capture the complexity of neurodivergent experiences, reducing them to a single, static measure of external performance rather than acknowledging the dynamic nature of strengths and challenges.

The way forward is not just about rejecting functioning labels but about replacing them with a more nuanced understanding of neurodivergence. Instead of determining support needs based on how well someone appears to be managing, we must listen to what they actually express about their struggles. We must recognize that masking does not mean thriving, and that competence does not negate the need for accommodations. Employers, educators, and medical professionals must move away from outdated models of functioning and instead provide flexible, needs-based support that respects the lived experiences of neurodivergent individuals.

At the personal level, unlearning the damage caused by the high-functioning label requires self-compassion. Many neurodivergent individuals have spent their entire lives being held to neurotypical standards that do not align with how their brains work. Undoing this conditioning means allowing ourselves to take breaks without guilt, to ask for help without shame, and to stop measuring our worth by how well we can keep up with expectations that were never designed for us. It means recognizing that struggling does not make us failures and that our worth is not determined by how much we can endure before breaking.

The emotional cost of being labeled high-functioning is heavy. It forces neurodivergent individuals to push themselves beyond their limits, denies them necessary support, and isolates them from the understanding they deserve. But we do not have to accept this label as truth. By challenging the systems that prioritize appearance over reality and advocating for a world that sees and supports neurodivergent people as they truly are, we can begin to dismantle the harmful expectations that keep so many of us trapped in cycles of exhaustion and self-doubt. True inclusion begins when we recognize that every neurodivergent person, regardless of how they present on the outside, deserves to be heard, supported, and valued.