As many of us know, autism spectrum disorder (ASD) is a complex neurodevelopmental condition characterized by a range of symptoms and challenges. And the term “spectrum” reflects the wide variation in strengths and difficulties individuals with autism can experience. With this, an individual is oftentimes (but not always) grouped into an autism “level” upon diagnosis. Whether you have a child that’s been diagnosed or are looking into receiving a diagnosis for your child, you may be wondering what these levels of autism mean.
This blog post will provide a comprehensive overview of the three levels of autism, helping to clarify how they impact the lives of those on the spectrum.
Background and Prefacing of Autism Levels
Before we jump right into the characteristics and “meaning” of autism levels, we want to provide some general background information along with some insight from Kristofer (Kris) Picano, MA, LLP, BCBA, LBA., a Psychologist in our Diagnostic Department.
In 2013, the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) introduced a new classification system, grouping autism into three levels based on the behavioral and social support needs of the individual. This means that upon diagnosis, an individual should be assigned a level 1, 2 or 3 for each support criterion (two level numbers total).
According to Kris, the level system is a very general way of defining restrictive repetitive behaviors and social communication ability in those diagnosed with autism. Kris said that most parents, upon receiving an autism diagnosis for their child, simply want to know what the future looks like. “When they see, for example, their child is a ‘level 3’, they interpret that as meaning ‘my child is severely autistic’,” said Kristofer. “The issue with that is that it sounds very drastic and typically that’s not the case, especially for a child that is really young.”
The autism level a child is given signifies the behavioral and social skill level a child is at the time of diagnosis. Therefore, a child under the age of 5 or 6 (“school age”) is extremely likely to default to a level 3 simply because they have not received much exposure or opportunity to work on social or behavioral skills. With that said, the autism level given to a child can shift or change over time as the child learns more skills and any challenging behaviors decrease. And the older the child is, the more meaning an autism level might hold.
“There’s such large gaps between levels 1, 2, and 3 that it’s pretty subjective to the interpretation of the evaluator,” said Kristofer. “But as the child develops and there’s more skills to measure, then that number, a lot of times, can change.” This means that, for example, it’s not rare for a child to shift from a Level 3 to a 2, or even Level 2 to a 1 over time.
Generally, Kris urges parents to refrain from investing great emotional energy into the level number their child may receive at the time of their diagnosis because it is simply “not reflective of a child’s capabilities, future, or anything else definitive.”
Now, we will jump into a standard guide of the 3 autism levels.
The 3 Levels of Autism
Level 1: Requiring Support
Level 1 autism is often referred to as “high-functioning autism”, though this term is outdated, and not preferred by many as it doesn’t necessarily reflect the true need for support individuals with Level 1 autism possess. Individuals at this level typically benefit from some support to navigate social situations and daily activities, but they may possess strong verbal skills and an understanding of language. For this reason, Level 1 autism is the most likely of all levels to not be diagnosed until later in childhood, when the child is expected to expand upon social skills (around age 10 to pre-teen years).
Characteristics
- Social Communication: People may struggle with initiating and maintaining conversations. They might have difficulty understanding social cues, such as body language or tone of voice.
- Repetitive Behaviors: While these behaviors may be present, they are often less pronounced than in lower levels. Individuals may exhibit rigid thinking patterns or a need for routine.
- Adaptability: Individuals may find it challenging to adjust to changes in routine or unexpected events.
Support Needs
Those with Level 1 autism benefit from interventions that focus on social skills training, communication strategies, and coping mechanisms for dealing with change. Support may come from therapists, educators, and family members who can help them navigate social environments and develop independence.
Level 2: Requiring Substantial Support
Individuals classified as Level 2 autism face more pronounced challenges in social communication and exhibit more significant repetitive or challenging behaviors. They require substantial support in various areas of life.
Characteristics
- Social Communication: Individuals may engage in limited conversations, often requiring prompts to initiate interactions. They might not respond to social cues effectively and may appear aloof or withdrawn.
- Repetitive Behaviors: These individuals may display more intense and frequent repetitive behaviors, such as hand-flapping, rocking, or adherence to specific routines.
- Adaptability: Level 2 individuals typically struggle more with changes in routine and may become visibly distressed in new or unstructured situations.
Support Needs
Support for Level 2 autism often involves structured interventions such as applied behavior analysis (ABA) therapy, social skills groups, and speech and occupational therapy. Families may need to work closely with schools and community resources to ensure that the individual receives the necessary accommodations to thrive.
Level 3: Requiring Very Substantial Support
Level 3 autism is characterized by severe challenges in social communication and a significant presence of repetitive behaviors. Individuals at this level require very substantial support in nearly all areas of their lives and are more likely to have a dual diagnosis of intellectual developmental disorder or other medical conditions.
Characteristics
- Social Communication: Individuals may have minimal verbal communication skills, relying on gestures or alternative communication methods. They often struggle to engage in any form of social interaction.
- Repetitive Behaviors: These behaviors can be extreme and may interfere with daily functioning. Individuals may engage in persistent motor movements, self-injury, or intense focus on specific interests.
- Adaptability: Changes in routine or environment can lead to significant anxiety and distress. Individuals may have difficulty transitioning from one activity to another.
Support Needs
Support for Level 3 autism is typically more intensive, and like Level 2, benefits from a multidisciplinary approach of ABA, Speech and Occupational therapies. Children diagnosed with Level 3 autism are often in specialized educational programs. As they age, if they remain within this level, they will require more support from caregivers.
Understanding the three levels of autism spectrum disorder is essential for promoting awareness, acceptance, and effective support for individuals on the spectrum. Each level presents distinct challenges and strengths, highlighting the importance of tailored interventions to meet individual needs. By fostering an inclusive environment, we can ensure that everyone, regardless of where they fall on the spectrum, has the opportunity to thrive.
It is important to note that the levels of autism are a general guide created to help those, particularly parents of children with autism, best understand an individual’s needs at the time of an autism diagnosis. It is not representative of the whole person, and it is possible for children to decrease in needed support over time when provided with appropriate interventions, such as ABA Therapy.
If you or someone you know is navigating the complexities of autism, seeking support from healthcare professionals, educators, and community resources can make a significant difference in improving quality of life and promoting independence. For further reading on this subject, you can check out this article over on Metro Parent.