In the current method for diagnosing autism spectrum disorder, three levels of autism are identified. The term "levels" is used in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) to describe the severity of autism spectrum disorder (ASD) based on the level of support an individual may require.
What is the DSM-5?
The DSM-5, or the Diagnostic and Statistical Manual of Mental Disorders, 5th edition, is a widely used diagnostic manual published by the American Psychiatric Association (APA). It provides a standardized classification and diagnostic criteria for mental disorders.
The DSM-5 was released in 2013 as an update to the previous edition, DSM-IV-TR. It is used by healthcare professionals, psychologists, psychiatrists, and researchers to diagnose and classify different mental health conditions based on specific criteria. It aims to provide a comprehensive framework, including descriptions, symptoms, prevalence, and effective treatment options for various mental disorders including depression, anxiety disorders, autism spectrum disorder, ADHD, schizophrenia, and many others.
The DSM-5 employs a categorical approach, in which each disorder is defined by a set of specific diagnostic criteria that must be met for a formal diagnosis. It also includes information regarding different specifiers, severity levels, and associated features for specific disorders.
Levels in the DSM-5 ASD Criteria
The DSM-5 describes three levels of severity based on the intensity of support needs and level of social communication impairments and restricted, repetitive patterns of behavior:
Level 1 (Requiring Support)
Individuals with Level 1 ASD, previously referred to as "high-functioning" autism, may require some support to navigate social situations or cope with changes. They may exhibit challenges in social communication, such as difficulty initiating and maintaining conversations or interpreting social cues. They may have noticeable social communication challenges. They may experience difficulties in social interactions, such as participating in back-and-forth interactions. They may also demonstrate inflexible behaviors and have difficulty adapting to changes in routine or environment.
Level 2 (Requiring Substantial Support)
Individuals with Level 2 ASD may have more pronounced social communication difficulties and a greater need for support. They may struggle with social interactions and demonstrate restricted, repetitive behaviors or interests that impact their daily functioning. They have more significant difficulties in social communication compared to Level 1. They might exhibit marked impairments in verbal and non-verbal social communication, limited social initiation, or reduced response to social interactions. They require substantial support to navigate daily life.
Level 3 (Requiring Very Substantial Support)
Individuals with Level 3 ASD, previously referred to as "low-functioning" autism, typically require significant support across multiple areas of life. They may have severe social communication impairments and exhibit intense restricted, repetitive behaviors that can interfere with daily functioning. They may have limited or no verbal communication and significant challenges in social interaction, such as minimal response or avoidance of others.
Understanding the Levels of Autism
These levels were designed to provide a general understanding of support needs and are not necessarily indicative of an individual's abilities, intelligence, or potential. They were meant to assist clinicians in determining appropriate services and support.
It is also important to acknowledge that autism is a spectrum disorder, meaning it encompasses a wide range of strengths, challenges, and support needs. Each person with autism is unique, and their experiences and needs cannot be solely captured by a one-size-fits-all level system.
It's best to view autism as a diverse and multifaceted condition that requires personalized understanding and support. It is most beneficial to take an individualized approach that takes into account the specific strengths, challenges, and support needs of each person.
Complexity of Autism
The levels mentioned above do not capture the full complexity and diversity of autism, and the approach to diagnosis and support has evolved to focus on individualized assessments and support plans. Currently, the diagnostic criteria for ASD in the DSM-5 consider a range of factors, including the presence of social communication deficits, restrictive/repetitive behaviors, sensory sensitivities, and the impact on daily functioning. The emphasis is on understanding each person's unique strengths, challenges, and support needs, even if levels are used to further characterize the disorder.
Support Needs of People with Autism
The levels of autism refer to the level of support needs that people with ASD may experience. Let’s consider some examples of support needs of people with autism, depending on their individual strengths and challenges. Here are some common areas where individuals with autism might benefit from support:
Many people with autism may require assistance with communication skills. This can include speech therapy, alternative communication methods (e.g., picture-based communication systems), social skills training, or applied behavior analysis to improve interaction and understanding of non-verbal cues.
Individuals with autism often have sensory sensitivities or differences, so support may involve managing sensory input. This can include providing sensory breaks or spaces, offering accommodations for noise or lighting, and using specific sensory tools or techniques to regulate sensory experiences.
Social skills support
Some individuals with autism may need help developing social skills and understanding social interactions. This can involve social skills training, group therapy, social stories, or opportunities for socialization with peers.
In academic settings, individuals with autism might benefit from specialized education plans, accommodations, or modifications tailored to their unique needs. This can involve individualized instruction, structured routines, visual supports, or assistive technology to support learning.
Individuals with autism may exhibit challenging behaviors due to difficulties with self-regulation or communication. Behavioral interventions, like applied behavior analysis (ABA), can help address challenging behaviors and teach constructive alternatives.
Occupational and life skills support
Support in building independent living skills, vocational training, and occupational therapy can help individuals with autism develop the skills needed to live more independently and attain employment. Life skills can also be taught in applied behavior analysis.
Mental health support
Individuals with autism may have co-occurring mental health conditions like anxiety or depression. Access to mental health professionals, therapists, or counselors who understand autism and can provide appropriate support is important.
Support should be extended to family members to assist them in understanding and supporting the individual with autism. This can include providing education, counseling, and resources to help families navigate the challenges and celebrate the strengths associated with autism.
Support needs can vary widely among individuals with autism. Each person is unique, and the support provided should be individualized, person-centered, and based on their specific strengths and challenges. Collaboration with healthcare professionals, educators, therapists, autism specialists, and behavior analysts (BCBAs) can help identify and implement appropriate support strategies. Contact Behavioral Innovations for more guidance on supporting people with autism.