The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition Text Revision (DSM-5-TR; American Psychiatric Association, 2022) categorizes autism into three levels – Level 1, Level 2, and Level 3 – which are designed to indicate the level of support an individual needs in day-to-day life.

 

• Level 1 Autism – “Requiring Support” – indicates an individual who, without supports in place, may demonstrate social communication differences that are apparent to others (e.g., difficulty initiating social interactions, inconsistent responses to the social initiations of others, difficulty maintaining back-and-forth play and/or conversation, etc.) and have difficulties engaging in flexible behavior (e.g., difficulty transitioning activities, challenges with organizing and planning things, etc.).
   

• Level 2 Autism – “Requiring Substantial Support” – indicates an individual who, even with supports in place, demonstrates verbal and nonverbal social communication differences (e.g., may have delayed speech/language abilities, show differences with regard to eye contact and gesture use, interactions may often be focused on special interests, etc.) as well as difficulties with flexible behavior (e.g., difficulty tolerating change, frequent engagement in repetitive or unexpected behaviors, experiencing distress during transitions, etc.).
   

• Level 3 Autism – “Requiring Very Substantial Support” – indicates an individual who demonstrates verbal and nonverbal social communication differences that significantly impact functioning across domains (e.g., may have limited speech/language abilities, may infrequently initiate interactions with others, may only respond to very direct social approaches of others, etc.) as well as marked difficulties with flexible behavior (e.g., significant difficulty coping with change, repetitive/unexpected behaviors that may interfere with functioning, high levels of distress in changing focus or action, etc.).

 

There are variable opinions in the field about the use of levels when diagnosing autism. Some practitioners, including myself, feel that levels tend to be more helpful for older adolescents and adults but can oftentimes be less helpful for younger children. Specifically, it is expected that young children will need a lot of support to function independently across day-to-day activities. Early childhood is a very fluid and dynamic time, meaning that there is no way to predict what a child’s development will look like and what level of support they may need as they continue to develop. Furthermore, the research support behind the levels of autism is not well supported, meaning that an individual’s assigned level of autism may not be stable over time. For example, a young child may be assigned “Level 2,” but with the implementation of services and supports early on, the child may require less supports over time and may be better conceptualized as “Level 1” as they get older. In addition, particularly for children assigned “Level 1,” there is the possibility that they may not qualify for as many services, even if the need for intervention is there, due to other providers/organizations conceptualizing their needs as less compared to other children.

 

Reference:

American Psychiatric Association. (2022). Neurodevelopmental disorders. In Diagnostic and statistical manual of mental disorders (5th ed., text rev.). 

https://doi.org/10.1176/appi.books.9780890425787