Levels of Autism: What They Are & How to Find Support

What Is Autism?

Autism Spectrum Disorder (ASD) is a neurological condition that impacts how a person interacts with the world. There are many different theories about what causes autism. However, some research supports that the cingulate gyrus area in the brain may be either primarily or heavily responsible for the development of this condition.³

Symptom presentation can vary widely in autistic individuals. Typically, symptoms are grouped into three categories–communication deficits, social difficulties, and restricted interests. It is worth noting that the terms “deficits” and “difficulties” are often stigmatizing for autistic individuals. Therefore, referring to symptoms as “differences” is preferred as it highlights the diversity in how autistic people interact with others.

Common symptoms of autism include:

• Repetitive motor movements or sounds
• Difficulty with eye contact
• Autistic scripting 
• Specified interests
• Focusing on one topic or object to detriment of focusing on anything else (hyperfocusing)
• Challenges socializing with peers
• Showing limited emotional response in emotional situations
• Limited change in tone of voice or facial expression
• Rigid ways of thinking
• Anger outbursts

The Different Levels of Autism Spectrum Disorder

In the newest edition of the DSM, autism was officially categorized into three levels of severity that are associated with two areas of functioning. Social and communication challenges are rated together, while repetitive behaviors and restricted interests are rated separately. Ratings of severity are based on how much one’s symptoms are interfering with their daily functioning.

Rating severity was included in the diagnostic picture as a way of reflecting the variability in how autism symptoms exhibit. Research shows that these ratings correlate highly with the results of more detailed autism evaluation measures.⁴ This means that the three levels structure provides a consistent and recognized way of reflecting an autistic person’s diagnosis. It can also help communicate the amount of support the individual may need.

The three levels of autism are:

Level 1: Requires Support

Level 1 reflects the “mildest” form of autism. Individuals in this level display some difficulties initiating social interactions. Their tendency to become focused on certain topics or objects can result in challenges with organizing material and following instructions. They are able to function in social and school settings if they have support to help with social skills and keep them on track.

Previously, Level 1 represented a type of autism known as “Asperger’s Disorder.” This diagnosis is no longer used in the DSM-5, although it is still included in some other diagnostic systems. Level 1 is also referred to informally as “High-Functioning” autism. However, there is stigma regarding this term in the autistic community.

Symptoms that may be associated with autism Level 1 include:

• Trouble conversing with others⁵
• Ability to communicate with others, but may struggle to understand others’ emotions⁶
• Shows ability to make interests known, but those interests may be unusual or not age-appropriate.
• Understands what others are saying, but tends to be very literal in interpretation

Level 2: Requires Substantial Support

The biggest difference between Levels 1 and 2 is that those in the second category struggle more noticeably in social situations. Sometimes, Level 1 autistic individuals are able to mask their symptoms so much that others may not be aware that a person is autistic. Those in Level 2 are typically unable to do so, but may still be motivated to appear neurotypical. Constant masking can be exhausting, and these individuals may be more vulnerable to autistic burnout.

Level 2 autistic folks require more support than Level 1 individuals, as it is difficult for them to complete tasks without having someone nearby to help. When they come across challenges or concepts that they do not understand, they may express anger or frustration. This could be in the form of yelling or aggression. Autistic individuals in Level 2 are also more likely to experience extreme distress from changes to routine or attempts to redirect their focus from their interests.

Symptoms indicative of Level 2 autism may include:

• Participating in conversation, but then walking away
• Inability to redirect focus from special topics or interests
• Yelling when facing challenges that are not obvious to others
• Refusing to accept even small changes in routine
• Repeating phrases from favorite movies or shows without showing clear recognition of what they mean (Echolalia)
• Preferring to be alone even when around others who show some interest in interacting (in children, this is called “parallel play”)

Level 3: Requires Very Substantial Support

Level 3 autistic individuals require the most support for managing symptoms and performing daily activities. They typically have very little, if any, verbal communication skills. They may need to use special devices to express their needs if they are nonverbal.

Autistic folks in level 3 find even the slightest changes in routine extremely upsetting, and may become disruptive when these occur. Difficulties handling certain textures and tastes (referred to as Sensory Processing Disorder) is common for many autistic people. However, those in Level 3 may experience frequent meltdowns or outbursts when they come in contact with unfavorable sensory stimuli. Additionally, dealing with loud noise or a lot of activity can be especially challenging for Level 3 autistic individuals.

Symptoms consistent with Level 3 autism may include:

• Total or almost total inability to verbally communicate
• Need for devices to help with any type of communication
• Responsive only to very basic verbal and nonverbal instructions
• Anger outbursts at the slightest changes in noise or activity level
• Unwillingness to eat any food of certain texture
• Responding very little or not at all to their social environment

How Are the Levels of Autism Diagnosed?

The levels of autism can be helpful when diagnosing autism, but do not account for every symptom variation in or personal characteristics of autistic people. However, when put into practice, this diagnostic structure can offer physicians a quick and reliable way to identify the amount of support a person may need.

Identifying specific observable abilities or strengths is often one method of determining an autistic person’s severity level. For example, an individual who is able to maintain stable employment or receive passing grades, with or without special modifications or support, would most likely be diagnosed as Level 1. An autistic person who is unable to communicate verbally, requires constant support and care, or experiences frequent outbursts may be diagnosed as Level 3.

Typically, a diagnostic exam for autism includes a clinical interview during which a person’s medical and education history may be reviewed. If the person is a child or teenager, the evaluation process might include interviewing family members and observing the child’s behaviors in a classroom or social setting. These tests can also help determine which services and interventions an autistic person would benefit from.

Below are psychological tests commonly used for diagnosing autism:

• Autism Diagnostic Treatment Schedule
• Diagnostic Interview For Social and Communication Disorder
• Gilliam Autism Rating Scale
• Vineland Behavior Rating Scale

What Are the Limitations of the 3 Levels of Autism?

The shift in diagnostic criteria for autism from the fourth edition of DSM (DSM-IV) to the fifth edition (DSM-5) was controversial. Primary among the criticisms was that the changes would reduce the number of people who fit an autism diagnosis and would be eligible for special services.⁷ This was particularly a concern for individuals who had been diagnosed with autism under DSM-IV and then lost that diagnosis.

In the DSM-IV, there were three categories of autism diagnoses, including “high functioning autism.” When it was determined that all three would be housed under the autism spectrum disorder umbrella in the DSM-5, this left out the other two previous diagnoses. This resulted in some confusion among previously diagnosed autistic individuals regarding their diagnosis. So, while the levels of autism helped address some of the problems associated with the DSM-IV criteria for autism, it also created new ones.

Another limitation of the levels classification system is that it does not provide much clarification about the differences among individuals classified in the same level. Autism affects every person differently, so believing that a person’s experience can be lumped into one distinguishing group is unrealistic.

Support for Autistic Individuals

Autism does not necessarily require treatment or support. When certain symptoms or behaviors begin to negatively impact a person’s life, seeking professional help would be beneficial. Locating appropriate services can help an autistic person learn useful tips for navigating their unique challenges and strengths. There are many beneficial forms of therapy, but it can be particularly helpful to find a neurodivergent-affirming therapist before determining which one is best for you.

Therapy options to consider include:

• Cognitive-behavior therapy (CBT):  CBT focuses on helping autistic people adopt better coping skills for when difficulties arise.
• Art therapy: Art therapy is a particularly effective approach to autistic individuals as it allows them to better express themselves in non-verbal ways.
• Speech and language therapy: Learning how to communicate more effectively is the focus of speech and language therapy.
• Music therapy: Music therapy can be helpful for an autistic person who struggles with communication, as it allows them to express themselves non-verbally.
• Family therapy: Family therapy focuses on working with families on how they better interact with and support autistic loved ones. It can be particularly helpful for Level 3 autistic individuals as family members are often the ones providing daily support.
• Play therapy:  Learning how to socialize and communicate through play is particularly helpful for autistic children. Play therapy is also beneficial for those who are bored by traditional therapy settings.

Final Thoughts

Receiving an autism diagnosis may seem daunting at first, but there is support available to help you better understand your new identity. It is important to recognize that the autism severity levels exist as a way to identify the manner of support a person needs. Receiving an accurate diagnosis can provide you with new avenues for growth and support.