Autism Spectrum Disorder (ASD) is a complex neurodevelopmental condition that manifests differently in each individual. The term "spectrum" reflects the wide variation in challenges and strengths possessed by individuals with autism. No two individuals with autism share the same strengths and challenges. Within this spectrum, there are different levels of severity, often referred to as "levels of autism."  As a parent or guardian, when your child receives an initial autism diagnosis, you may have questions on what the level of severity means for them.  

The DSM-5 defines the three levels of autism based on the level of support an individual needs. When an individual receives their diagnosis of autism, the diagnosing professional will note the level of severity.  These levels help professionals and caregivers understand the support needs of individuals with ASD, but they often leave caregivers and parents with questions - let's explore each level and their differentiators.

Level 1: Requiring Support

Individuals with Level 1 autism require relatively mild support. They may experience difficulties in social situations, communication, and flexibility but can generally function independently with some assistance.

Social Interaction: They may struggle with initiating and maintaining social interactions. Difficulty understanding social cues, body language, and non-verbal communication may hinder their ability to form friendships or engage in group activities. They may initiate parallel play, which is playing side-by-side, but without interacting with a peer. 

Communication: While individuals at this level can communicate effectively, they may have trouble with subtle nuances in language, such as sarcasm or metaphors. They might also exhibit repetitive speech patterns or struggle with initiating conversations. They may struggle with reciprocating conversation or asking questions in response to information shared by others and only focus on their own interests or personal information. 

Rigidity and Repetitive Behaviors: They may display rigid behaviors or adherence to routines but can usually cope with changes with some support. Changes in routine can cause distress or behaviors. Repetitive movements or fixations on specific interests are common.  

Level 2: Requiring Substantial Support

At Level 2, individuals with autism require more substantial support in various areas of life. Challenges may be more pronounced and may significantly impact daily functioning. 

Social Interaction: Individuals at this level often struggle more significantly with social interaction. They may have difficulty understanding others' perspectives, expressing empathy, or engaging in reciprocal conversation. 

Communication: Communication challenges may be more pronounced, with difficulty in both verbal and non-verbal communication. Expressive language skills may be limited, and they may rely on alternative communication methods such as gestures or augmentative and alternative communication (AAC) devices. 

Sensory Sensitivities: Sensory sensitivities, such as heightened sensitivity to lights, sounds, textures, or smells, may significantly impact daily life. These sensitivities can lead to sensory overload, tantrum behavior, or withdrawing from situations. 

Level 3: Requiring Very Substantial Support

Individuals with Level 3 autism require very substantial support and may have significant impairments in multiple areas of functioning. They may exhibit severe deficits in communication, social interaction, and behavior, requiring intensive intervention and support. Children with Level 3 autism will often have a more comprehensive treatment plan with multiple targeted areas of functioning and a higher hour recommendation or treatment intensity. 

Social Interaction: Individuals at this level may have minimal to no interest in social interaction and may prefer solitary activities. They may struggle to understand social cues entirely and have difficulty forming relationships.  They may have limited eye contact and rarely seek out interactions with peers or family members. 

Communication: Communication difficulties are severe, with limited or absent verbal communication. They may rely heavily on non-verbal communication or may not communicate at all, leading to significant challenges in expressing needs and understanding others.  They may not respond to their name or verbal prompting. 

Restricted and Repetitive Behaviors: Repetitive behaviors and restricted interests are pronounced and may interfere significantly with daily functioning. These behaviors may be self-stimulatory, such as hand-flapping or rocking, and can be challenging to manage. They may engage in self-injurious behaviors such as head banging, digging into their skin, or hitting themself. 

Understanding the levels of autism is crucial for providing appropriate support and interventions tailored to the individual's needs. While these levels offer a framework for understanding the severity of autism symptoms, it's essential to recognize that each person with autism is unique, with their strengths, challenges, and support requirements. 

At Powerback Pediatrics, our Board Certified Behavior Analysts carefully craft treatment plans using observations, caregiver interviews, and review of the client’s diagnostic report.  We create goals to help with skill acquisition and behavior modification specific to each client and their needs.  By embracing neurodiversity and providing person-centered support, we can create inclusive environments that enable individuals with autism to thrive. Contact us today to find out if our ABA program is right for you and your child!

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