Neurological Disorders What Are the Levels of Autism? By Amy Marschall, PsyD Amy Marschall, PsyD Dr. Amy Marschall is an autistic clinical psychologist with ADHD, working with children and adolescents who also identify with these neurotypes among others. She is certified in TF-CBT and telemental health. Learn about our editorial process Updated on June 18, 2022 Medically reviewed Verywell Mind articles are reviewed by board-certified physicians and mental healthcare professionals. Medical Reviewers confirm the content is thorough and accurate, reflecting the latest evidence-based research. Content is reviewed before publication and upon substantial updates. Learn more. by Steven Gans, MD Medically reviewed by Steven Gans, MD Steven Gans, MD is board-certified in psychiatry and is an active supervisor, teacher, and mentor at Massachusetts General Hospital. Learn about our Medical Review Board Print NickyLloyd / Getty Images Table of Contents View All Table of Contents Autism Exists on a Spectrum Level One Level Two Level Three Resources Language note: Although individual preferences exist, surveys of the autistic community consistently show that autistic people prefer identity-first language rather than person-first language (i.e., “autistic person” rather than “person with autism”). This article reflects that community language preference. 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. When someone is diagnosed with autism, the provider who conducted the evaluation will often provide information about their level in order to inform treatment plans and needed areas of support. What Is Autism? Autism is a neurodevelopmental difference that is marked by atypical behaviors and social interaction style. The diagnostic criteria for the levels of autism include social differences and behaviors but do not specify sensory needs and differences. The levels also do not require specific developmental delays in early childhood or cognitive abilities. 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 interactionsAtypical responses to attempts by others to initiate conversations or relationshipsPossibly lower-than-average interest in social relationshipsDifficulty 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 routinesDifficulty transitioning or changing activitiesDifficulty with organization What Is Mild Autism? 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 How to Get Better at Dealing With Change 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 changeRepetitive behaviors that “markedly interfere with functioning in all areas”“Great distress” when routines are disrupted or with transitions How Autism Is Treated Resources For more information about autism, see the Autistic Self-Advocacy Network, the Autistic Women & Nonbinary Network, and the Asperger/Autism Network. More Women Are Getting Diagnosed With Autism Than Ever Before 3 Sources Verywell Mind uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy. Rosen NE, Lord C, Volkmar FR. The diagnosis of autism: From Kanner to DSM-III to DSM-5 and beyond. J Autism Dev Disord. 2021;51(12):4253-4270. doi:10.1007/s10803-021-04904-1 American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, 5th ed. American Psychiatric Publishing. American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. 5th ed, text revision. American Psychiatric Publishing. By Amy Marschall, PsyD Dr. Amy Marschall is an autistic clinical psychologist with ADHD, working with children and adolescents who also identify with these neurotypes among others. She is certified in TF-CBT and telemental health. 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