The word “functional” gets thrown around constantly in occupational therapy. Goals are written to improve “functional performance.” Progress is measured by “functional outcomes.” But I’ve been sitting with a question lately that I think is worth naming out loud: whose definition of functional are we actually using?

In traditional OT frameworks, functional often means something like: able to complete ADLs independently, able to hold down a job, able to manage a household. These aren’t bad goals. But when we apply them uncritically to neurodivergent clients, we can end up measuring people against a neurotypical standard that was never designed with them in mind.

The problem with a single benchmark

For a lot of ND folks, the question isn’t “can they do this task?” — it’s “what does doing this task cost them?” Someone might be completely capable of completing a multi-step work project but spend the next two days unable to function due to the executive load it required. Technically functional. Practically unsustainable.

Functional capacity isn’t just what someone can do — it’s what they can do and recover from.

This is something I keep coming back to in my own practice. Recovery time matters. Sensory aftermath matters. The hidden labor of masking, compensating, and self-regulating through a task matters. If we’re only measuring outputs, we’re missing most of the picture.

What I’m learning to ask instead

I’ve been experimenting with reframing goal-setting conversations around what the client actually wants their life to feel like, rather than what it looks like from the outside. That shift changes everything. Some questions I’ve found useful:

What does a good day look like for you — not a perfect day, just a good one? What are the things you’re doing when you feel most like yourself? What would you stop doing tomorrow if you could, and what would you never want to give up?

These aren’t replacements for clinical assessment. But they create a context for understanding what “functional” should even mean for this particular person.

Still figuring it out

I don’t have a tidy conclusion here. This is genuinely something I’m still working through — both in how I practice and in how I think about what occupational therapy is for. I’d love to hear how others are navigating this. Do you have frameworks or questions that have helped? Drop them in the comments.