DSM-5: The Three Levels of Autism

In 2013, the American Psychiatric Association (APA) published the 5th edition of the DSM, known as DSM-5. This edition included three severity levels for Autism Spectrum Disorder (ASD), which assist clinicians in customizing treatment and support to match the individual's requirements. These levels focus on enhancing social skills, communication, and behavior management, and are determined by the level of support an individual needs in the areas of social communication and restricted, repetitive behaviors (RRBs).

Jump to:

• ASD level 1: Requiring support
• ASD level 2: Requiring substantial support
• ASD level 3: Requiring very substantial support

Main Content

ASD Level 1: Requiring Support

Social Communication:

Individuals at this level experience noticeable impairments in social communication without supports in place. They may have difficulty initiating social interactions and show atypical or unsuccessful responses to social overtures from others. Notably:

• Difficulty initiating and maintaining conversations or relationships without support.
• Noticeable deficits in social communication, which can cause challenges in social interactions.
• May appear less interested in social interactions or have limited ability to respond to social cues.

Restricted, Repetitive Behaviors:

Inflexibility of behavior causes significant interference with functioning in one or more contexts. These individuals may have difficulty switching between activities and experience problems with organization and planning that hamper independence. Notably:

• Inflexibility in behavior or difficulty transitioning between activities.
• Problems with organization and planning, which hinder independence.
• Repetitive behaviors or adherence to routines that interfere mildly with functioning.

ASD Level 2: Requiring Substantial Support

Social Communication:

At this level, individuals show marked deficits in verbal and nonverbal social communication skills. Social impairments are apparent even with supports in place, and they demonstrate limited initiation of social interactions. Notably:

• Social impairments are apparent and significantly affect functioning.
• Limited initiation of social interactions and reduced response to social cues from others.
• Marked deficits in verbal and nonverbal communication skills, even with supports in place.

Restricted, Repetitive Behaviors:

Inflexibility of behavior, difficulty coping with change, or other restricted/repetitive behaviors appear frequently enough to be obvious to casual observers. These behaviors interfere with functioning in various contexts, and individuals may experience distress when changing focus or action. Notably:

• Greater distress when routines are disrupted.
• More frequent and obvious repetitive behaviors or fixated interests.
• Noticeable difficulty coping with changes in routine or environment.

ASD Level 3: Requiring Very Substantial Support

Social Communication:

Severe deficits in verbal and nonverbal social communication skills cause significant impairments in functioning. These individuals show very limited initiation of social interactions and minimal response to social overtures from others. Notably:

• Major impairments severely limit functional independence.
• Rarely initiates social interactions and only responds to others in highly restricted ways.
• Severe deficits in verbal and nonverbal communication, causing very limited or minimal social interaction.

Restricted, Repetitive Behaviors:

Extreme inflexibility of behavior, great difficulty coping with change, or other restricted/repetitive behaviors markedly interfere with functioning in all spheres. Individuals at this level experience significant distress when changing focus or action. Notably:

• Significant interference in all areas of life due to these behaviors.
• Extreme difficulty with change, inflexibility, and coping with environmental changes.
• High levels of distress and difficulty redirecting attention away from fixated interests or repetitive behaviors.

It is important to note that these severity levels are determined based on the individual's current functioning and may change over time or with intervention. The levels are intended to guide clinicians in determining appropriate support and treatment strategies for individuals with ASD.

Insights, Analysis, and Developments

In conclusion, understanding the nuances of the DSM-5 levels of Autism Spectrum Disorder (ASD) is crucial for providing appropriate support and fostering a more inclusive society. The levels—ranging from requiring support to requiring very substantial support—guide professionals in tailoring interventions that respect individual differences and promote personal autonomy. Despite the diagnostic criteria's focus on deficits, it's essential to recognize and celebrate the unique strengths and capabilities of autistic individuals. This perspective not only challenges the traditional narrative of disability but also emphasizes the importance of community acceptance and the creation of environments where all individuals can thrive. As we move forward, let's commit to an approach that values neurodiversity, ensuring that our societal structures and attitudes evolve to support the diverse spectrum of human experience

Author Credentials: Ian is the founder and Editor-in-Chief of Disabled World, a leading resource for news and information on disability issues. With a global perspective shaped by years of travel and lived experience, Ian is a committed proponent of the Social Model of Disability-a transformative framework developed by disabled activists in the 1970s that emphasizes dismantling societal barriers rather than focusing solely on individual impairments. His work reflects a deep commitment to disability rights, accessibility, and social inclusion. To learn more about Ian's background, expertise, and accomplishments, visit his full biography.