What Are the Levels of Autism?

Autism Exists on a Spectrum

The Diagnostic and Statistical Manual of Mental Disorders, fifth edition (DSM-5), states that autism is a spectrum. This means that individuals have different support needs and strengths.

Many providers describe autistic people as “high functioning” or “low functioning,” but these terms are generally considered inaccurate because an individual can seem high functioning in one area but struggle in others. Additionally, someone who was previously higher functioning might struggle due to increased stressors or burnout.

Typically, autistic people talk about levels of support needs in various areas, as this reflects what the individual needs in order to have their best life rather than how their “functioning” impacts the people around them. Although limited, the levels associated with a diagnosis of autism spectrum disorder (ASD) can help with understanding the individual’s needs and how to best support them.

What Is Autism?

Autism is a neurodevelopmental difference that is marked by atypical behaviors and social interaction style.

A person’s support needs level might vary, and so determining an individual’s “level” can be tricky. An autistic person might have Level One behavioral symptoms but Level Two social communication symptoms.

In addition, those experiencing burnout might experience higher support needs than they previously required. Once appropriate supports are in place, symptoms may become less evident.

Autism Level One

The DSM-5 refers to those with Level One symptoms as “requiring support” in both the social communication domain and the restricted, repetitive behaviors domain.

Autistic people with Level One communication skills can typically engage in verbal communication and speak in full sentences. Level One symptoms in the social communication domain include:

• Difficulty initiating conversations or other social interactions
• Atypical responses to attempts by others to initiate conversations or relationships
• Possibly lower-than-average interest in social relationships
• Difficulty with back-and-forth conversations

Autistic people with Level One behavioral symptoms may function independently but have some difficulty related to their symptoms. These symptoms manifest as:

• Inflexibility surrounding behaviors and routines
• Difficulty transitioning or changing activities
• Difficulty with organization

Autism Level Two

Level Two autism symptoms manifest as “requiring substantial support” per the DSM-5. Symptoms typically cause more difficulties and require greater support than Level One but are not as debilitating as Level Three.

Level Two social communication symptoms manifest as the following:

• “Marked deficits” in both verbal and nonverbal communication skills
• Impairments will be evident even when the individual receives support
• “Reduced or abnormal” responses to social interactions
• The individual may have limited verbal communication abilities, including repeating quotes or speaking in shorter, more simple sentences
• “Markedly odd nonverbal communication”

Level Two behavioral symptoms include:

• Difficulty coping with change, particularly changes to routine
• “Restricted/repetitive behaviors” that are “obvious to the casual observer” and interfere with functioning
• Difficulty changing focus that manifests as distress

Autism Level Three

The DSM-5 indicates that autistic individuals with Level Three symptoms are those with symptoms that are “requiring very substantial support,” impairment, and high support needs.

Social communication differences seen in autistic individuals with a Level Three diagnosis include:

• “Severe deficits” in both verbal and nonverbal communication skills
• “Severe impairments” in functioning as a result of these impairments
• “Very limited” initiation of and response to social interactions
• Individuals with Level Three symptoms may be nonspeaking or have limited verbal expression

Behavioral symptoms seen in autistic people with Level Three symptoms include:

• “Extreme difficulty” coping with change
• Repetitive behaviors that “markedly interfere with functioning in all areas”
• “Great distress” when routines are disrupted or with transitions

Resources

For more information about autism, see the Autistic Self-Advocacy Network, the Autistic Women & Nonbinary Network, and the Asperger/Autism Network.