Understanding the Levels of Autism

As the name implies, autism spectrum disorder (ASD) encompasses a range of traits and challenges. It can impact how a child communicates, behaves, and interacts with others. When a child is diagnosed with autism, it’s natural for their family to want to know where they fall along that spectrum and how it will impact their life.

This is especially true since it is such a broad diagnosis that ranges from kids who are hyperverbal but socially awkward to those who are nonverbal and will require lifelong care. This is why the levels of autism were developed.

Previously, what is now known as autism spectrum disorder was four different diagnoses. Now there is one umbrella diagnosis with three levels of autism, which are based on the amount of support an individual requires in daily life.

Clinicians and autistic advocates have mixed feelings about the levels of autism. On the one hand, they can provide a helpful shorthand to give a sense of a person’s support needs. On the other, assigning a level is subjective and can oversimplify a complex condition.

Ultimately, it is often the families who crave the certainty of a level. “Parents are trying to figure out, if my child is on the autism spectrum, what does that mean for our family?” observes Alexis B. Bancroft, PhD, a psychologist at the Child Mind Institute Autism Center.

Ultimately, each child should be viewed as an individual with unique strengths and challenges. But the levels of autism can provide a general sense of the intensity of their needs.

The levels of autism were introduced in 2013, in the Diagnostic and Statistical Manual of Mental Disorders 5 (DSM-5). This was part of a consolidation of the autism diagnosis. What were previously four separate diagnoses — autistic disorder, Asperger syndrome, childhood disintegrative disorder, and pervasive developmental disorder-not otherwise specified — became one single diagnosis of ASD. They were combined because researchers argued that all the old diagnoses reflected the same underlying neurodevelopmental differences. The earlier diagnoses were overlapping and not consistently applied — two doctors might give different diagnoses to the same person. Once they were combined, the levels were added to indicate that individuals within the broad diagnosis have different degrees of impairment that call for different services.

“The reason they were created was because we wanted clinicians to be on the same page, and we wanted to differentiate between the levels of support that’s needed for each individual,” explains Dr. Bancroft. “But then there was no operationalized definition of what those categories mean.”

These levels are not based on intelligence or verbal ability, but on how much help someone generally needs to function in everyday life:

• Level 1 autism: requiring support
• Level 2 autism: requiring substantial support
• Level 3 autism: requiring very substantial support

Understanding these levels of autism can help parents, caregivers, and professionals create more effective, individualized care plans. But critics argue that the criteria for these categories are not standardized and are therefore subjective. Plus, the levels of autism can paint too broad a picture, leading people to make inaccurate assumptions about a person’s ability and cognition.

One receives a level of autism along with their autism diagnosis, regardless of age. And while an autistic person will always be autistic, their support needs — and therefore their level — may change as they mature and receive accommodations and services. One study found that 30 percent of autistic children had lower support needs at age six than they did at age three; it also can go the other way around as well, though that’s less common.

Children and adults at Level 1 may appear neurotypical in some settings but often struggle in specific situations. They may:

• Have difficulty initiating conversations or maintaining back-and-forth communication
• Misread social cues or facial expressions
• Prefer routines and resist change
• Show inflexible thinking patterns

These individuals — sometimes colloquially called “high functioning” — typically have strong verbal skills and average to above-average intelligence. However, they may have sensory sensitivities, social challenges, or have trouble with transitions. Still, they are often able to access mainstream educational settings with minimal support.

People diagnosed with Level 2 autism need more significant assistance in both social communication and daily living. Common traits include:

• Limited verbal and nonverbal communication skills
• Trouble coping with changes in routine or environment
• More noticeable repetitive behaviors (e.g., hand-flapping, rocking)
• Difficulty initiating or responding to social interaction, even with support

Individuals with level 2 autism may benefit from structured programs and therapeutic support that address both behavioral challenges and communication needs. But with accommodations like a 1:1 aide, they are often able to be placed in mainstream classrooms.

Level 3 autism represents the highest level of need and is sometimes referred to as profound autism. Children and adults at this level often have severe impairments in communication and behavior. They may:

• Be nonverbal or use very limited speech
• Display intense repetitive behaviors
• Struggle significantly with change or transitions
• Need assistance with self-care tasks like toileting or getting dressed
• Require 24/7 supervision or highly structured settings

This level of autism requires ongoing, intensive support, often involving a team of specialists such as behavioral therapists, occupational therapists, and special education professionals.

While the levels of autism are included in the DSM-5, in practice it can be tricky for clinicians to apply them. “We will use the levels, but we don’t love the levels,” explains Dr. Bancroft. She says that because definitions have not been codified, assigning an autism level is subjective and can be inconsistent across practitioners.

Having an identified level can be a starting point for families who are beginning to understand where their child falls on this spectrum. But ultimately, it’s more complex than that.

When speaking with caregivers about an autism diagnosis, Dr. Bancroft prefers to discuss a matrix of support needs based on a range of circumstances. For example, an autistic child may have intense sensory sensitivities, high intellectual ability, occasional aggressive behavior, and difficulty communicating and interacting in some but not all situations. The levels of autism — in this case probably a Level 2 — would not capture this nuance but could act as a general summary.

“I do think the levels of autism provide something tangible and definitive for parents that could potentially be helpful if we were better at using them,” says Dr. Bancroft.

The levels of autism can also be necessary in school settings and IEP meetings, where a level may be required to qualify for specific services. Educators may also benefit from a general sense of a student’s support needs. “One would assume that a child with Level 3 autism would require very substantial supports across all areas and more intensive intervention — meaning more services through an IEP — than a child with Level 1,” explains Dr. Bancroft. A child with Level 1 autism, meanwhile, could probably be placed in a general education setting with minimal related services.

Ultimately, understanding the different levels of autism can empower parents and caregivers to better advocate for their children. Recognizing early signs, seeking a professional autism diagnosis, and tailoring support to a child’s needs can make a lasting difference. The levels can be a helpful snapshot as long as we recognize the nuance of the individual experience. “I think we need to be careful to not assume a child’s ability or capability based off of the level of support that they need,” urges Dr. Bancroft. “We need to assume that they are capable, and we want to support them to become as independent and capable as they are able.”