Table of ContentsView AllTable of ContentsUsing DSM LevelsLevel 1Level 2Level 3DiagnosisWhat Autism Levels Don’t Do
Table of ContentsView All
View All
Table of Contents
Using DSM Levels
Level 1
Level 2
Level 3
Diagnosis
What Autism Levels Don’t Do
There are three levels of autism spectrum disorder (ASD), which are described in the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-5). Each autistic person is diagnosed as Level 1, Level 2, or Level 3, with Level 3 requiring the most support.
While they once were interpreted as a level of function, the diagnosis of alevel of autismnow refers to support needs and a person’s independence in daily life, based onneurotypicalstandards.Keep in mind that the levels don’t fully capture autism traits that can change from day to day, or even within the same day, in the same autistic person.
How DSM Autism Levels Are Used
Autism affects how a person acts, experiences the world, and expresses themselves. While autistic people have similarities, each individual is different and so is their presentation of being autistic.
The three levels of autism help healthcare providers to identify a person’s unique needs and prescribe appropriateautism therapies.These therapies can help an autistic person to make the most of their strengths and improve their social, language, and occupational skills.
Autistic people have a wide mix of traits associated with multiple levels, though, so these levels may not be helpful outside of the medical context. Labelling an autistic person on the basis of a DSM-defined level can lead to neglect, hindered potential, and harmful misunderstandings.
Levels of Autism and the DSMUnlike previous versions, the 2013 update of theDSM-5combined all autism diagnoses into a single diagnosis of ASD, but with three different levels for support needs. This definition replaces five categories previously used. It’s important to remember that these medical categories may not reflect an autistic person’s description of self and their experiences ofneurodivergence.
Levels of Autism and the DSM
Unlike previous versions, the 2013 update of theDSM-5combined all autism diagnoses into a single diagnosis of ASD, but with three different levels for support needs. This definition replaces five categories previously used. It’s important to remember that these medical categories may not reflect an autistic person’s description of self and their experiences ofneurodivergence.
Level 1: Requires Support
Level 1 describes autistic people who require support but have low support needs. They may have a hard time communicating with neurotypical people, including their peers. For example, they may not say the right thing at the right time or be able to readsocial cuesand body language.
They may also have trouble moving from one activity to another or trying new things. It may be a struggle to organize and plan their lives, and independence for them may differ from neurotypical expectations for people their age.
Support needs for autistic people with low support needs may include:
It’s not uncommon for autistic people with Level 1 support needs to mask their autism fairly well, and this can lead to challenges accessing the care they do need.They also may have their autism diagnosed later in life, or exhibit similar traits without a formal autism diagnosis.
What Is Autism Burnout?A person diagnosed with Level 1 autism is likely to experience burnout from long-term masking, or working to hide autism traits and appear neurotypical.They are usually able to communicate in full sentences most of the time, but may have trouble engaging in extended, back-and-forth communication with neurotypical people. This can increase the risk of mental health issues.
What Is Autism Burnout?
A person diagnosed with Level 1 autism is likely to experience burnout from long-term masking, or working to hide autism traits and appear neurotypical.They are usually able to communicate in full sentences most of the time, but may have trouble engaging in extended, back-and-forth communication with neurotypical people. This can increase the risk of mental health issues.
Level 2: Requires Substantial Support
The DSM’s Level 2 expression of autism includes people who have very specific interests and who engage inrepetitive behaviorsthat veer far from accepted, neurotypical behaviors. Or, the behavior may appear in spaces that neurotypical people view as a mismatch with time and place.
Support needs for Level 2 autism can include:
Autistic people sometimes stim because they are in environments built with neurodivergent people in mind. They may have heightened sensitivity to noise, lighting, texture, environmental temperature, and more.Autistic people who express Level 2 and 3 traits have a larger burden of self-regulation.
Level 3: Requires Very Substantial Support
Autistic people with Level 3 diagnoses need the most support. They may have many of the same traits as their autistic peers but are unable to mask and have very high burdens of self-regulation. Challenges with repetitive behavior and communication can make it hard to complete daily living tasks, interact socially, and deal with a change in focus or location.
Keep in mind that different levels can exist within the same person, who may have low support needs in one sphere and high in another.Generally, autistic people withhigh support needsmay require:
An autistic person with a Level 3 diagnosis is more likely to have communication difficulties and may rarely initiate interactions, especially with neurotypical people. When they do, they are likely to be perceived as awkward.They may prefer parallel play instead of interactive hangouts, or might prefer to interact with other based upon lessons fromsocial storiesand scripts.
As yet, there is no blood or medical test for autism diagnosis. It’s completed on the basis of observation, questionnaires, and interviews with parents, teachers, and others close to the autistic person. Many people are diagnosed in childhood, but not all are.
Tests can include theAutism Diagnostic Interview-Revised (ADI-R), used in children age 2 or older. The Social Communication Questionnaire (SCQ) and Screening Tool for Autism in Toddlers & Young Children (STAT) are other ways of assessing child development, communication, and social skills.
Although the DSM’s ASD levels are useful for figuring out a person’s support needs, the categories don’t give a full picture of the capacities, strengths, and needs of each individual autistic person.
The three levels do not entirely encompass the traits and lived experiences of all autistic people, and the DSM-5 offers little specificity regarding the types of support that individuals need or situations when support is needed. For example:
Assigning people to one of the three levels of autism can be useful for understanding what types of services and supports would serve them best. It won’t, however, predict or account for unique details in their personality and behavior, which means the support and services they receive will need to be highly individualized.
Summary
Level 1 describes the lowest support needs likely for an autistic person to navigate daily life, and Level 3 describes the highest support needs to meet communication and self-regulation challenges.
The three ASD levels give a basic outline of the ways autistic people may communicate, socialize, and behave. This way of diagnosing autistic people does not, however, fully address the diverse array of lived experiences autistic people have.
9 SourcesVerywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Harvard Medical School.The Language of Autism.Centers for Disease Control and Prevention.Screening for Autism Spectrum Disorder.Masi A, Demayo MM, Glozier N, et al.An overview of autism spectrum disorder, heterogeneity and treatment options.Neurosci Bull.2017;33(2):183-193. doi:10.1007/s12264-017-0100-yHong J, DaWalt LS, Taylor JL, Haider A, Mailick M.Autism through midlife: trajectories of symptoms, behavioral functioning, and health.J Neurodev Disord. 2023 Nov 3;15(1):36. doi:10.1186/s11689-023-09505-wO’Loghlen JJ, Lang CP.High Autistic Traits or Low Social Competence? Correlates of Social Camouflaging in Non-Autistic Adults.Autism Adulthood. 2024 Mar 1;6(1):60-71. doi:10.1089/aut.2022.0094Mantzalas J, Richdale AL, Adikari A, Lowe J, Dissanayake C.What Is Autistic Burnout? A Thematic Analysis of Posts on Two Online Platforms.Autism Adulthood. 2022 Mar 1;4(1):52-65. doi:10.1089/aut.2021.0021NHS National Autistic Society.Social care for children in England.de Vries B.Autism and the Right to a Hypersensitivity-Friendly Workspace.Public Health Ethics. 2021 Aug 1;14(3):281-287. doi: 10.1093/phe/phab021Seattle Children’s Hospital.Autism and “Levels of Support."
9 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Harvard Medical School.The Language of Autism.Centers for Disease Control and Prevention.Screening for Autism Spectrum Disorder.Masi A, Demayo MM, Glozier N, et al.An overview of autism spectrum disorder, heterogeneity and treatment options.Neurosci Bull.2017;33(2):183-193. doi:10.1007/s12264-017-0100-yHong J, DaWalt LS, Taylor JL, Haider A, Mailick M.Autism through midlife: trajectories of symptoms, behavioral functioning, and health.J Neurodev Disord. 2023 Nov 3;15(1):36. doi:10.1186/s11689-023-09505-wO’Loghlen JJ, Lang CP.High Autistic Traits or Low Social Competence? Correlates of Social Camouflaging in Non-Autistic Adults.Autism Adulthood. 2024 Mar 1;6(1):60-71. doi:10.1089/aut.2022.0094Mantzalas J, Richdale AL, Adikari A, Lowe J, Dissanayake C.What Is Autistic Burnout? A Thematic Analysis of Posts on Two Online Platforms.Autism Adulthood. 2022 Mar 1;4(1):52-65. doi:10.1089/aut.2021.0021NHS National Autistic Society.Social care for children in England.de Vries B.Autism and the Right to a Hypersensitivity-Friendly Workspace.Public Health Ethics. 2021 Aug 1;14(3):281-287. doi: 10.1093/phe/phab021Seattle Children’s Hospital.Autism and “Levels of Support."
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
Harvard Medical School.The Language of Autism.Centers for Disease Control and Prevention.Screening for Autism Spectrum Disorder.Masi A, Demayo MM, Glozier N, et al.An overview of autism spectrum disorder, heterogeneity and treatment options.Neurosci Bull.2017;33(2):183-193. doi:10.1007/s12264-017-0100-yHong J, DaWalt LS, Taylor JL, Haider A, Mailick M.Autism through midlife: trajectories of symptoms, behavioral functioning, and health.J Neurodev Disord. 2023 Nov 3;15(1):36. doi:10.1186/s11689-023-09505-wO’Loghlen JJ, Lang CP.High Autistic Traits or Low Social Competence? Correlates of Social Camouflaging in Non-Autistic Adults.Autism Adulthood. 2024 Mar 1;6(1):60-71. doi:10.1089/aut.2022.0094Mantzalas J, Richdale AL, Adikari A, Lowe J, Dissanayake C.What Is Autistic Burnout? A Thematic Analysis of Posts on Two Online Platforms.Autism Adulthood. 2022 Mar 1;4(1):52-65. doi:10.1089/aut.2021.0021NHS National Autistic Society.Social care for children in England.de Vries B.Autism and the Right to a Hypersensitivity-Friendly Workspace.Public Health Ethics. 2021 Aug 1;14(3):281-287. doi: 10.1093/phe/phab021Seattle Children’s Hospital.Autism and “Levels of Support."
Harvard Medical School.The Language of Autism.
Centers for Disease Control and Prevention.Screening for Autism Spectrum Disorder.
Masi A, Demayo MM, Glozier N, et al.An overview of autism spectrum disorder, heterogeneity and treatment options.Neurosci Bull.2017;33(2):183-193. doi:10.1007/s12264-017-0100-y
Hong J, DaWalt LS, Taylor JL, Haider A, Mailick M.Autism through midlife: trajectories of symptoms, behavioral functioning, and health.J Neurodev Disord. 2023 Nov 3;15(1):36. doi:10.1186/s11689-023-09505-w
O’Loghlen JJ, Lang CP.High Autistic Traits or Low Social Competence? Correlates of Social Camouflaging in Non-Autistic Adults.Autism Adulthood. 2024 Mar 1;6(1):60-71. doi:10.1089/aut.2022.0094
Mantzalas J, Richdale AL, Adikari A, Lowe J, Dissanayake C.What Is Autistic Burnout? A Thematic Analysis of Posts on Two Online Platforms.Autism Adulthood. 2022 Mar 1;4(1):52-65. doi:10.1089/aut.2021.0021
NHS National Autistic Society.Social care for children in England.
de Vries B.Autism and the Right to a Hypersensitivity-Friendly Workspace.Public Health Ethics. 2021 Aug 1;14(3):281-287. doi: 10.1093/phe/phab021
Seattle Children’s Hospital.Autism and “Levels of Support."
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