Understanding the Three Levels of Autism

When a child is diagnosed with autism spectrum disorder (ASD), they are diagnosed at a level of 1, 2, or 3. Each level indicates a different severity, with ASD1 being the mildest and ASD3 being the most severe. 

Though no child should be defined by their autism, a formal diagnosis can help parents and educators better understand the child’s strengths and limitations. A formal diagnosis can also help adults provide appropriate support.  

The Epiphany School has put together this article to offer parents more information about the different levels of autism. This baseline information can be helpful as parents begin the journey of understanding autism. 

Contents:

• What Is Autism? 
• Level 1: Requires Support 
• Level 2: Requires Substantial Support
• Level 3: Requires Very Substantial Support 
• Limitations of ASD Levels 
• Outdated Autism Diagnoses 
• The Importance of a Formal Diagnosis 

What Is Autism?

Autism spectrum disorder (ASD) is a complex developmental condition defined by challenges with social skills, communication, relationships, and self-regulation. Symptoms of ASD are typically visible by the time a child is two or three years old. However, some people aren’t diagnosed until adulthood.  

Since autism is considered a “spectrum condition,” the learning and problem-solving abilities of individuals with ASD can range from gifted to severely challenged. As such, the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) classifies autism using three levels. Each level offers insight into the severity of the condition. 

Level 1: Requires Support

Level 1 ASD, or ASD1, is the mildest form of autism. Children diagnosed with ASD1 may have average or above-average intelligence but struggle to decipher social cues like hand gestures and facial expressions. 

Symptoms of ASD1 

Individuals with ASD1 will show noticeable impairments in social communication. Common behaviors or traits include:

• Difficulty multitasking or switching between activities
• Inability to maintain eye contact
• Difficulty initiating and maintaining a conversation
• Atypical response in social situations 
• Trouble adapting to changes in routine or schedule
• Low frustration tolerance

Common Challenges at Home and School

Children with ASD1 are often misunderstood. In the classroom, they may become excessively nervous when exposed to environmental stimuli such as bright fluorescent lights or colorful posters. At home, they may have difficulty nurturing relationships with siblings or even a parent.

Children may also:

• Experience profound anxiety in response to changes (e.g. a snow day, modified assignment, substitute teacher)
• Struggle to participate in class discussions or group projects
• Require inflexible rules and clear guidelines 
• Not understand unwritten social rules (e.g. entering a sibling’s room without knocking)
• Require special rituals (e.g. drinking from a specific cup, sitting in one seat at the dining table)
• Have challenges with time management and organization

What Support Is Needed? 

Individuals with ASD1 are high-functioning and require minimal daily support. Many clinicians advocate for cognitive behavioral therapy, a type of “talk therapy” that can help a child on the spectrum regulate his or her emotions and impulses. Others suggest speech-language therapy to help teach idiomatic phrases, gestures, and facial expressions. 

Children with ASD1 also benefit from a structured social emotional learning curriculum. At The Epiphany School, for instance, students learn how to express empathy and build friendships during the daily Friends and Feelings™ class. However, educators across all subjects take advantage of teachable moments. If a student has a moment of frustrationduring class, for example, a teacher will pause his or her lesson to discuss different effective strategies and expected behaviors.

Outlook for Children With ASD1

The majority of children with level 1 ASD grow into independent adults who have families and successful careers. Many individuals with ASD1 become prolific film directors, like Anthony Hopkins, or scientists, like Temple Grandin.

However, some adults on the spectrum may find it hard to live a neurotypical life, struggling to hold down a job and nurture romantic relationships. This can contribute to loneliness, anxiety, and depression in adulthood.  

Level 2: Requires Substantial Support

Children diagnosed with level 2 ASD, or ASD2, experience all the developmental challenges of someone with ASD1, just more intensely. These individuals display more marked problems with social communication, often speaking in simple sentences and misunderstanding nonverbal communication like facial expressions. 

Those with ASD2 may have normal intelligence. However, some children score below average on an IQ test. 

Symptoms of ASD2

Individuals with ASD2 will exhibit some degree of difficulty socializing. He or she may be aware of others, but maintain a sense of aloofness or disinterest. Other common behaviors of someone with ASD2 include:

• Avoidance of social situations 
• Hypersensitivity to sights, sounds, smells, and other stimuli
• “Stimming” behaviors like pacing, rocking, or hand flapping
• Insistence on sameness and routine
• Self-harming behaviors (e.g. banging head on wall, picking at skin) 

Common Challenges at Home and School 

Students who have been diagnosed with ASD2 struggle to interact with their peers, often preferring to communicate through signs or technological devices as opposed to words. At home, they may have trouble expressing their wants and needs, like what they would like to eat for dinner. 

Children may also:

• Become extremely upset or agitated when exposed to bright lights or loud noises  
• Fall behind academically
• Be easily distracted by stimuli (e.g. fluorescent lights flickering, another student tapping their pencil, a sibling playing in the other room)
• Have trouble adapting to changes in routine
• Elope or engage in self-harming behavior when anxious or sad  

What Support Is Needed? 

Children with level 2 autism require substantial daily support. Communication therapies can help address the range of social, language, and behavioral difficulties associated with autism, affording more independence. However, these individuals may still need help with self-care and daily activities like cooking or cleaning. 

At school, students with ASD2 often spend much of their time in the mainstream classroom but are pulled out for extra help in core subjects like reading and math. These students may also need to wear noise-canceling headphones in common areas like the gym or cafeteria or be provided with a quiet space to take a time-out if necessary. 

Outlook for Children With ASD2

No two children on the spectrum are alike, even if they have the same diagnosis. With that being said, it’s challenging to determine if a child with ASD2 will be able to live independently as an adult. However, as a parent, you can work to develop and improve skills that will foster more independence. 

These skills include:

• Self-care and hygiene (e.g. showering, getting dressed)
• Functional communication (i.e. the ability to express desires, feelings, and concerns)
• Domestic care (e.g. cooking, cleaning, mowing the grass, washing clothes)
• Money management

Level 3: Requires Very Substantial Support 

Level 3 ASD, or ASD3, is the most severe form of autism. Children diagnosed with ASD3 cannot handle daily tasks by themselves and therefore require intensive support. 

Symptoms of ASD3

Many individuals with ASD3 are non-verbal, meaning they can only say a few words or they cannot speak at all. Other behaviors or traits include:

• Diminished cognitive functioning
• Social aloofness; rarely engages in social interaction
• Fixation on atypical behaviors like rocking or hand flapping
• Inability to complete daily tasks like making the bed or getting dressed

Common Challenges at Home and School 

A child with ASD3 typically requires 24/7 support and supervision. At home, they may need help dressing or feeding themselves. They may also struggle to develop and nurture relationships with parents or siblings. 

At school, students with ASD3 often fall behind academically. Though these students may spend some of their day in a mainstream classroom, much of their time will be spent receiving intensive instruction. During these small group or one-on-one sessions, teachers will focus on basic skills like reading and speaking.

What Support Is Needed? 

As previously noted, children with ASD3 require very substantial support. Parents often fill a caregiver role, helping with daily tasks like toileting and eating. To provide relief, some families pay for respite care, which is a service in which an aide provides support in the home. 

Some clinicians advocate for speech-language therapy as a way of helping children with ASD3 better understand nonverbal cues. Occupational therapy can also teach these children self-reliance skills like feeding, grooming, and toileting. 

Outlook for Children With ASD3

Most children with ASD3 cannot live independently as adults. Instead, many of these individuals live with family members who can provide full-time support. Others live in residential homes that offer needed support and supervision. 

Limitations of ASD Levels 

Though the ASD levels are useful for diagnosing autism, the DSM-5 is a fairly rigid, black-and-white metric that can be difficult to apply in real-life situations. 

For example, a child may speak in simple sentences at school—a behavior indicative of ASD2—but engage in deep conversation with their siblings and parents at home. This begs the question: Should the child be diagnosed with ASD2 or ASD1?   

Autism also isn’t static. As a child receives necessary support, their diagnosis may change. A non-verbal child with ASD3 may begin to speak in simple sentences, for instance. However, the DSM-5 doesn’t mention the evolution of an individual’s autism diagnosis. 

Outdated Autism Diagnoses 

Published in 1994, DSM-IV-TR defined autism and ASD-1 (formerly known as Asperger’s Syndrome) as pervasive developmental disorders (PDDs). Other subcategories of PDDs included:

• Rett syndrome
• Childhood disintegrative disorder (CDD) 
• Pervasive developmental disorder, not otherwise specified 

Released in 2013, DSM-5 redefines autism based on empirical data and clinical experience. Rett syndrome and CDD are no longer considered part of the spectrum. Other subtypes of ASD-1 have also been eliminated. 

The DSM-5 provided other diagnostic changes, including:

• Symptoms of ASD are now limited to two domains: social interaction/communication and restricted/repetitive behaviors
• Language delay is no longer a diagnostic symptom
• Hyper- or hypoactivity to sensory stimuli is now a symptom
• DSM-IV-TR required the onset of symptoms before the age of three; DSM-5 requires the onset of symptoms in early childhood  

The Importance of a Formal Diagnosis 

At The Epiphany School, we believe every child on the spectrum is more than their diagnosis. However, a formal diagnosis is still critical as it helps parents and educators determine appropriate levels of support, whether that be cognitive behavioral therapy or more one-on-one instruction in the classroom. 

Though The Epiphany School doesn’t require a formal diagnosis for admission, it can help parents decide whether or not our school is a good fit. As a social emotional learning school in Charlotte, we provide a unique learning environment that is designed to meet the needs of children in grades 3 through 8 who have ASD1. 

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