Autism is a complex and heterogeneous neuro developmental disorder characterized by difficulty with social communication, restricted interests or activities, and repetitive behaviors.[1] While before 2013, the Diagnostic and Statistical Manual of Mental Disorders (DSM) described four levels of autism severity, the fifth DSM edition released in 2013 instituted three levels: requirements for clinical diagnosis at each level are detailed according to existing diagnostic criteria.

This article explains the three current levels of autism diagnoses based on either their functional impact or symptom expression.

Understanding the Three Levels of Autism

The Diagnostic and Statistical Manual of Mental Disorders (DSM) is the primary guide for diagnosing autism, where the disorder may be classified into three levels. Level 1 is considered mild, level 2 moderate, and level 3 severe. Autistic individuals at all levels share similar traits, such as difficulty with social and communication skills but present to varying degrees of severity in these areas.

Level 1: Requires Support

Level 1 autism, or requiring support, is considered the mildest form of autism. Individuals diagnosed with this level of autism may show difficulty with communication and social situations. This could include challenges understanding non-verbal cues such as body language or facial expressions, trouble making conversations, and awkwardness when interacting with others. Other signs of Level 1 autism could include repetitive behavior, restricted interests or activities (such as a fixation on specific topics), and difficulty transitioning between tasks.

People at this level typically need some guidance and support to achieve success in everyday life but are generally able to function relatively independently without professional assistance. Depending on their specific needs, they may require support like speech therapy, occupational therapy, access to special education services, or even psychological counseling. With the right support and interventions, many individuals with Level 1 autism can go on to lead independent lives and even excel in their areas of interest.

Level 2: Requires Substantial Support

Level 2 autism, requiring substantial support, is a moderate form of autism. Individuals diagnosed with this level of autism may show more difficulty in communication and social skills than those classified under Level 1. This could include significant delays in language abilities such as speaking or understanding, difficulty initiating conversations, inability to sustain a conversation even if initiated by someone else, and difficulties reading non-verbal cues from others.

Other signs of Level 2 autism could include more intense repetitive behavior or restricted interests or activities than at Level 1 (such as exhibiting very fixed behaviors), self-injurious behavior, aggression, or mood swings that can be hard to control. People at this level typically need more guidance and support to succeed.

Level 3: Requires Very Substantial Support

Level 3 autism, which requires substantial support, is considered the most severe form of autism. Individuals diagnosed with this level of autism may show significant difficulty in communication and social skills with delays far beyond those classified under Level 1 or 2. This could include an inability to initiate or sustain conversations, extreme difficulty understanding non-verbal cues from others, such as body language or facial expressions, and speaking with abnormal intonation, pitch, volume, and pronunciation.

Other signs of Level 3 autism could include more intense repetitive behavior than at Levels 1 or 2 (such as significant self-injurious behavior, aggression, or mood swings that can be hard to control). People at this level typically need a great deal of guidance and support to

Limitations of ASD Levels

Despite providing a helpful framework for understanding and diagnosing autism spectrum disorder (ASD), the three current levels of diagnosis have some limitations. One limitation is that they are primarily based on functional impact or symptom expression, and do not consider other important factors, such as an individual’s specific characteristics and abilities.

Furthermore, these categories can be seen as rigid in that it may be difficult to accurately place someone within one of them: individuals may present with features from multiple levels or symptoms that straddle two levels.

In addition, while diagnoses can provide useful information to guide treatment approaches, they cannot capture all the complexities of ASD. It is important to remember that each individual has unique strengths and needs, which should be considered when developing a treatment plan. Finally, the criteria used to diagnose ASD levels can be subject to interpretation by medical professionals and change over time, making it difficult to ensure an accurate diagnosis.

Overall, the three current levels of autism diagnoses provide helpful guidance for healthcare providers and families in understanding ASD; however, they cannot capture all aspects of an individual’s condition. Diagnostic labels must be seen as just one part of a larger picture considering other factors, such as personal strengths and needs. This helps ensure that individuals receive tailored interventions tailored to their specific situation.

Outdated Autism Diagnoses

Before the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM), released in 2013, autism was classified into four levels. The first three levels were mild, moderate, and severe, while the fourth included unspecified cases. These categories focused primarily on functional impact or symptom expression, without considering other important factors, such as individual characteristics and abilities.

While these classifications provided a helpful framework for diagnosing autism spectrum disorder (ASD), they had some limitations. One limitation is that they did not consider personal strengths or needs, which can be essential in providing tailored interventions to individuals with ASD.

Furthermore, these categories could be rigid in that it may not be possible to accurately place someone within one of them: individuals may present with features from multiple levels or symptoms that straddle two levels.

Additionally, the criteria used to diagnose ASD at these four levels could be subject to interpretation by medical professionals and change over time, making it difficult to ensure an accurate diagnosis. As a result, in 2013, the fifth edition of DSM introduced three current levels (requiring support, requiring substantial support, and requiring very substantial support) and additional criteria for diagnosing autism.

FAQs

What does level 1 autism look like?

Level 1 autism, or requiring support, is the mildest form of autism. Individuals diagnosed with this level of autism may show some difficulties in communication and social skills but do not display significant delays. These individuals typically need minimal guidance or assistance to succeed in their activities.

What is the lowest level of autism?

The lowest level of autism is Level 1, also known as requiring support. Individuals diagnosed with this level of autism may show some difficulties in communication and social skills but do not display significant delays. These individuals typically need minimal guidance or assistance to succeed in their activities.

How long does autism last?

Autism is a lifelong condition, and its impact can vary greatly from person to person. Factors like the severity of autism symptoms, access to interventions and supports, and an individual’s strengths and needs can affect the overall progression of the disorder. While some individuals may experience some improvement with age or intervention, others may experience more difficulty as they enter adulthood.

Conclusion

The three current levels of autism diagnoses provide helpful guidance for healthcare providers and families in understanding ASD; however, they have some limitations. These categories may be too rigid to accurately place someone within one of them, and criteria used to diagnose ASD levels can be subject to interpretation by medical professionals and change over time.