“Autistic person” or “person with autism”? Choosing words with care

Two conventions

Person-first language puts the person before the diagnosis: “a person with autism”. It came out of disability self-advocacy, including the People First movement led by people with learning disabilities, and many still choose it. That choice deserves real respect. It aims to stress that someone is more than their diagnosis, and it became standard in most professional training. For some conditions, especially illnesses and acquired conditions, it does useful work.

Identity-first language names the neurotype as part of the person: “an Autistic person”. It treats autism as an integral part of who someone is: their perception, cognition, history and culture.

What most Autistic people prefer, and why

Surveys in the UK, Australia and the US find that most Autistic people prefer identity-first language (Bury et al., 2023; Kenny et al., 2016; Taboas et al., 2023), and the preference is strongest among Autistic adults and Autistic-led organisations.

The reasoning is that autism isn't a disease that exists separately from you, and it isn't a coat you can take off. It shapes how you see, hear, feel, think, communicate and relate. Saying “a person with autism” suggests autism is external, something sitting alongside the real person, and that a version of you without it would be more authentic or complete. Many Autistic people find that alienating, and some find it actively distressing, because it implies a hypothetical non-Autistic you that everyone would prefer.

There's a structural point too. We say “a Deaf person”, “a gay person”, “a Jewish person”. We say “a person with cancer”. The grammar tells us whether something is understood as part of who someone is, or as a condition they have, and most people sense that intuitively.

Ask, and follow the person's lead

Some Autistic people, and some families, prefer person-first language, and their reasons deserve respect. The kindest approach is to ask each person what they prefer and use it consistently, rather than imposing a convention because it's what professionals were trained to use or what feels more comfortable to non-Autistic people. Where no preference has been stated, in general writing or policy for example, identity-first is the appropriate default, because it's what the majority of the people being described have asked for. Language preferences also differ across cultures, countries and languages, and terms don't always translate directly.

We capitalise Autistic throughout, as many in our community do, in the same way Deaf is capitalised: to mark a community, a culture and a shared history, not only a neurological description.

Why “high-functioning” and “low-functioning” cause harm

Functioning labels, along with “mild” and “severe” autism and the newer “levels”, are meant to say something useful about support needs. In practice they can cause real harm and tell us very little that's accurate (Alvares et al., 2020; Bottema-Beutel et al., 2021):

• They describe behaviour, not experience. Someone who looks “high-functioning” may be masking intensely, in distress and heading towards burnout. The label shows the quality of the performance, not what it costs.
• They lead to support being denied. People labelled high-functioning are often told their needs aren't significant enough for adjustments, so support arrives only after they've deteriorated.
• They underestimate ability. People labelled low-functioning are assumed incapable of things they can do with the right communication access, such as AAC, and support. Presuming competence matters.
• They're unstable. The same person can appear high-functioning in one setting and unable to function in another, yet the label sticks everywhere.
• They measure closeness to a norm. “High-functioning” means, on inspection, “more like a non-Autistic person”. A person who masks constantly and is miserable scores higher than one who stims freely and is content.
• They squash independent areas into one word. Someone may need no help with study and a lot with eating, or the opposite.

“Profound autism”

You may also hear “profound autism”, proposed for people with very high support needs. Some families and researchers find it useful for securing support; many Autistic people worry it reintroduces a functioning split. Describing specific needs keeps the focus on what support is needed.

What to say instead

Describe specific support needs in specific areas: communication, sensory environment, daily living, executive function, emotional regulation, and when and why they change. That's more accurate, and it points straight at what should be done. Also note that nobody is “more Autistic” than anybody else. “Severe autism” usually means “high support needs”, and it's better to say that plainly. Some swaps you might find useful:

• “suffers from autism” → “is Autistic”
• “ASD” or “disorder” → “autism”, “Autistic”
• “symptoms” → “traits”, “characteristics”
• “comorbid” → “co-occurring”
• “high-functioning” → “lower support needs in [area]”
• “low-functioning” → “higher support needs”; “non-speaking”; “uses AAC”
• “intervention” → “support”
• For more, see Autistic Realms' glossary and language guide and David's book The Language We Use For Ourselves.

Common questions

Is it offensive to say “person with autism”?

Not to everyone. Some Autistic people and families prefer it. But many find it alienating, and most Autistic people surveyed prefer “Autistic person”. The safest approach is to ask and then use the person's own words.

Why is Autistic capitalised?

We capitalise it throughout this site, as many in our community do, in the same way Deaf is capitalised: to show that Autistic people form a community and culture with a shared history, not just a diagnostic category.

What's wrong with saying “high-functioning autism”?

The label describes how someone appears, not what it costs them, and it is used to deny support. It also measures how close someone looks to a non-Autistic person. Describing specific support needs is more accurate and more useful.

What should I say if I don't know someone's preference?

Identity-first (“Autistic person”) is a respectful default, and it's always fine to change if someone tells you they prefer something else.

References

• Alvares, G. A., Bebbington, K., Cleary, D., Evans, K., Glasson, E. J., Maybery, M. T., Pillar, S., Uljarević, M., Varcin, K., Wray, J., & Whitehouse, A. J. O. (2020). The misnomer of "high functioning autism": Intelligence is an imprecise predictor of functional abilities at diagnosis. Autism, 24(1), 221–232.
• Bottema-Beutel, K., Kapp, S. K., Lester, J. N., Sasson, N. J., & Hand, B. N. (2021). Avoiding ableist language: Suggestions for autism researchers. Autism in Adulthood, 3(1), 18–29.
• Bury, S. M., Jellett, R., Spoor, J. R., & Hedley, D. (2023). "It defines who I am" or "It's something I have": What language do [autistic] Australian adults [on the autism spectrum] prefer? Journal of Autism and Developmental Disorders, 53(2), 677–687.
• Kenny, L., Hattersley, C., Molins, B., Buckley, C., Povey, C., & Pellicano, E. (2016). Which terms should be used to describe autism? Perspectives from the UK autism community. Autism, 20(4), 442–462.
• Taboas, A., Doepke, K., & Zimmerman, C. (2023). Preferences for identity-first versus person-first language in a US sample of autism stakeholders. Autism, 27(2), 565–570.