Autism is a spectrum disorder that affects how a person perceives the world and interacts with others and their surroundings. The disorder can make it difficult to participate in daily life. Doctors use three levels to describe autism.
According to the Centers for Disease Control and Prevention (CDC), about 1 in 54 children receive a diagnosis of autism. It is usually noticeable from a young age, but some people do not receive confirmation until adulthood.
According to the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), doctors categorize autism by assigning level 1, 2, or 3 to two areas of functioning: social communication and restricted, repetitive behaviors.
The level that the doctor assigns will reflect how much outside assistance a person is likely to need in their daily life.
Assessing this correctly can help doctors and other specialists work with the individual to provide the right support. In this article, learn more about the levels of autism.
The DSM-5 states that there are three levels of autism:
Level 1: Requiring support
A person who meets the criteria for level 1 may face social challenges that require some support.
They may find it difficult to:
- initiate conversations with others
- respond as others would expect
- maintain interest in the conversation
As a result, it can be hard to make friends, especially without the right support.
The person may also:
- feel a need to follow rigid behavioral patterns
- feel uncomfortable with changing situations, such as a new environment
- need help with organization and planning
Level 2: Requiring substantial support
People who meet the level 2 criteria need more support than those with level 1 autism. Social challenges can make holding a conversation very difficult.
Even with support, the person may find it hard to communicate coherently, and they are more likely to respond in ways that neurotypical people consider surprising or inappropriate.
The person may:
- speak in short sentences
- only discuss very specific topics
- have difficulty understanding or using nonverbal communication, including facial expression
For example, they may face away from the person with whom they are communicating.
People with level 2 autism may also find daily functioning difficult due to the challenges of coping with change. Facing change might cause them to experience significant distress.
Level 3: Requiring very substantial support
Among autistic people, those with level 3 autism will need the most support. They will find it very difficult to use or understand verbal and nonverbal communication.
The person may:
- avoid or limit interaction with others
- find it difficult to join in imaginative play with peers
- show limited interest in friends
- have difficulty forming friendships
- face extreme difficulty in changing their daily activities or routine
- follow repetitive behavioral patterns, such as flipping objects, to the point that it affects their ability to function
- experience a high level of distress if a situation requires them to alter their focus or task
Autism can have both social and behavioral effects on an individual.
In social situations, they may find the following difficult:
- initiating or maintaining a conversation
- responding appropriately to others
- discussing their interests in detail
- maintaining eye contact
- using facial expressions that match the context of communication
- understanding another person’s perspective
The person’s behavior may include:
- performing repetitive actions, such as rocking from side to side or saying the same thing over and over again
- distancing themselves from others
- having an intense interest in a specific topic
- developing a high level of skill in certain areas, such as mathematics or art
- having difficulty coping with changes to their routine or environment
- becoming preoccupied with specific parts of an object, such as the wheels on a car
- being more or less sensitive to sensory stimulation — such as loud noises — compared with neurotypical people
- having problems sleeping
In some cases, autism may affect a person’s balance, coordination, and motor skills.
Autism can be challenging to diagnose because it is a spectrum disorder.
The features of a spectrum disorder can differ between individuals, some of whom will have high functioning autism while others will need a lot of support. In some people, the features of autism may be difficult to detect.
Early diagnosis is essential for providing support to autistic people and giving them a high quality of life.
In children, the most obvious signs of autism are usually detectable by the age of 2 years, although they can appear at any age.
Diagnosing an autistic child involves two stages:
- Developmental checkups: All children should receive routine developmental screening at each checkup as they age. A doctor will typically assess a child for signs of autism at about 18 or 24 months of age. They will also discuss the child’s behavior, development, and family medical history with a parent or caregiver.
- Additional evaluation: If a doctor believes that a child may be autistic, they will arrange for a team of healthcare professionals to carry out further assessments. Child psychiatrists and speech-language pathologists will likely assess cognitive and language skills. Further tests may also be necessary to rule out other conditions.
In older children, it is possible that teachers, caregivers, parents, or others who interact with the child may notice signs of autism. A doctor can then carry out an evaluation.
Autism can be more difficult to identify in adults, as the features can overlap with those of obsessive-compulsive disorder (OCD) and other mental health issues.
In some cases, an individual may seek professional help for themselves.
An autistic person will always have autism, but treatment and therapy can help them manage the challenges that it poses. For example, treatment can help reduce:
- obsessive behavior
- attention deficits
- mood changes
- anxiety problems
No medications are available for autism, but educational and behavioral therapies can help, especially with younger children. These interventions can focus on the particular areas that the child is finding challenging.
For example, a specialized therapist may help an autistic child learn communication and social skills, as well as strategies that will help them maintain conversations with others and develop the skills that they need to live independently.
Some forms of therapy will involve family members or others who have regular contact with the child. Participating in therapy can help family members and caregivers understand the condition and learn constructive ways to provide support.
Autism can be challenging for a person to live with, but an early assessment can help the individual get the support that they need to maximize their quality of life.
The three-level definition can help educators and healthcare professionals provide a suitable level of support for the individual:
Level 1: The person may be able to live a relatively independent life with minimal support.
Level 2: Substantial support is necessary to help the person communicate and deal with change.
Level 3: The individual may need to depend on others to help them cope with daily life, but medication and therapy can help manage some of the challenges.
An early assessment and individualized approach can help an autistic child or adult develop skills that allow them to live as independently as possible.