Understanding The Three Levels Of Autism: Everything You Need To Know

Autism spectrum disorder is a prevalent heterogeneous neurodevelopmental syndrome defined by social and communication deficits alongside stereotypical behaviors and interests. Due to the heterogeneity of the disorder, no two children or adults are considered identical in terms of impairments and their severity. According to the Diagnostic And Statistical Manual Of Mental Disorders, ASD is characterized under 3 levels to better understand the varying degrees of impairment and support required by autistic individuals. In this article, let’s take a look at the 3 levels of autism spectrum disorder, their limitations, and other types of autism to get a better sense of the severity of underlying impairments and support needs.

What Are The Three Levels Of Autism?

Levels of autism spectrum disorder, as defined in the DSM-5, are critical to clinicians and healthcare providers as they help them categorize patients based on their requirements for support. The levels allow healthcare providers to customize interventions that capitalize on their strengths and address challenging areas of their disorder. These 3 levels of autism are:

ASD level 1- requiring support
ASD level 2- requiring substantial support
ASD level 3- requiring very substantial support

These different stages of autism do not represent actual autistic individuals’ traits and experiences as the levels represent. Most individuals possess a mix of traits associated with all 3 levels of autism, making this classification hold substantial value only in a medical context.

ASD Level 1: Requiring Support

Level 1 refers to the high-functioning form of autism, where the individual needs little to no support to maintain an independent life. Individuals requiring level 1 support may have some of the following characteristics:

Difficulty understanding social cues
Some emotional or sensory dysregulation
Behavioral rigidity or inflexibility
Stress during changing routines
Attention span issues
Significant impairment in one or more contexts
Trouble organizing or planning

These individuals can learn to cope with their restricted or repetitive behaviors by learning self-regulatory strategies.

ASD Level 2: Requiring Substantial Support

Individuals classified under level 2 may have the same issues as level 1 individuals, but to a greater extent. Some particular characteristics of this group may include:

Nonchalance or use of different speech
Inability to understand non-verbal cues like facial expressions
Visibly atypical social behavior
Extreme interest in specific topics
Visible distress during life transitions or changing routines

Level 2 autistic individuals can benefit greatly from:

Speech therapy
Occupational therapy
Social skills therapy
Applied behavioral analysis

ASD Level 3: Requiring Significant Support

Autism level three symptoms happen to be extremely severe and pose a greater risk of neglect, abuse, and discrimination at the hands of society. They suffer from significant social communication impairments and stereotypical behaviors, which require substantial specialized support for their overall well-being and quality of life. Autism level 3 characteristics may include:

Severe social communication difficulties and echolalia
Limited verbal and nonverbal communication and relying on gestures, pictures, or assistive communication devices
Severe sensory sensitivities to sound, light, color, and textures
Little response to social interaction
Impaired adaptive functioning
Agitation over small issues
Engagement in self-harming activities
Reliance on others for support and care
Extreme distress during changes

Due to the severity of autism level 3 symptoms, these individuals require more comprehensive therapies and interventions with greater frequency as compared to the other two groups.

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Limitations of ASD Levels

The DSM-5 levels are highly beneficial in categorizing the different needs of autistic individuals; however, they fail to provide a full picture of the capacities, strengths, and needs of a person. Moreover, individuals with ASD have the capacity to evolve as they develop and refine their social skills with tailored interventions and therapies.

In addition, stage 3 autism can often overlap with other conditions such as intellectual disability, ADHD, anxiety disorders, and language disorders, which these levels do not fully account for.

Although assigning different levels of autism spectrum disorder can be valuable for medical professionals in providing the care that best fits each case, these levels cannot account for their unique personality traits, strengths, and behaviors. Hence, an autistic individual will need the kind of care that is highly individualized to their needs.

Other Types of Autism

Prior to the release of the DSM-5, autism was categorized under the diagnosis of pervasive developmental disorders known as PDD. In addition to 3 levels of autism, the previous PDD diagnoses have also been made part of ASD. These diagnoses are:

Asperger`s syndrome
Pervasive developmental disorder (PDD-NOS)
Autistic disorder
Childhood disintegrative disorder (CDD)
Rett syndrome

Asperger’s Syndrome

Individuals with Asperger’s syndrome are considered to have mild ASD symptoms with comparatively higher average intellectual abilities and language development. They might struggle with social difficulties and restricted interests, but they are mostly gifted in certain areas of interest.

Pervasive developmental disorders (PDD-NOS)

In DSM-4, individuals who displayed some signs of autism spectrum disorder but did not meet the full criteria of Asperger’s syndrome were categorized under PDD-NOS. These individuals are significantly impaired in communication skills and stereotypical behaviors. However, these symptoms are not severe enough as ASD level 3 for an early diagnosis.

Autistic disorder

Autistic disorder is a term coined in the previous DSM-4 for individuals who need comprehensive support. These individuals have similar symptoms as PDD-NOS but are more distinct.

Childhood disintegrative disorder (CDD)

CDD is a rare condition where children ranging in age from 2-10 years begin to significantly lose their previously acquired skills, such as language, social, and motor skills. Children diagnosed with CDD develop normally like others but suddenly start to regress in multiple areas of functioning, leading to autism spectrum disorder.

Rett syndrome

Rett syndrome is more prevalent among women and is characterized by loss of hand skills, repetitive hand movements, loss of language, and severe intellectual disability. Some Rett syndrome symptoms fall under the same category as ASD level 3 symptoms but are ranked under distinct neurodevelopmental disorders due to MECP2 genetic mutations.

Conclusion

ASD is a complex heterogeneous condition with a yet unknown etiology. The different levels of autism specify the support requirements of an individual based on their disabilities. It’s important to understand that these 3 levels of autism provide a framework for understanding and addressing the unique support needs of an autistic individual rather than categorizing them as limited.

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Dr. Svetlana

MD, Endocrinologist, Pediatrician, regenerative medicine specialist, R&D director