The Three Different “Levels” of Autism Defined in the DSM-5: Here’s What They Mean

In 2013, the DSM-5 shook up the labels of autism as we knew them. Individual sub-disorders such as Asperger’s Syndrome; Pervasive Developmental Disorder, Not Otherwise Specified (PDD-NOS); and Classic Autism were all united under the term “Autism Spectrum Disorder.”

Just one problem: how do you define the degree to which a person is affected when the spectrum itself is so broad? The American Psychiatric Association’s answer was to create three different “levels” of autism.

Even with these distinctions, however, the whole “defining autism severity” thing is still really confusing, and hopefully further versions of the DSM will clarify those issues.

But I’m getting ahead of myself, here. Why don’t we first talk about what exactly these levels mean?

Adobe Stock/Oksana Kuzmina
Adobe Stock/Oksana Kuzmina

Level 1 is “Requiring Support.” There are noticeable issues with the person’s social communication skills, and inflexibility and repetitive behaviors impair function in “one or more contexts.” In other words, the person is probably verbal yet struggles in various social contexts, such as back-and-forth conversation and making friends, and they may have trouble transitioning between tasks.

Level 2 is “Requiring Substantial Support.” These individuals struggle with verbal and nonverbal social communication skills. They may be unlikely to initiate social interaction and respond abnormally—or not at all—to interaction initiated by others. In other words, the person may be a bit aloof and struggle with communicating. Additionally, repetitive behaviors are obvious to outside observers, and they interfere with daily life “in a variety of contexts.”

Level 3 is “Requiring Very Substantial Support.” These individuals have severe difficulties with verbal and nonverbal social communication and are less likely to initiate and reciprocate social interaction. They may be nonverbal or minimally verbal, and their struggles with inflexibility and repetitive behaviors affect “functioning in all spheres.”

However, even with these autism “levels,” there are definite problems that arise, and many of them seem to boil down to one thing: autism is not a linear scale.

Adobe Stock/bst2012
Adobe Stock/bst2012

Levels of “functioning” can vary on a day-by-day basis, and they can also vary in different contexts. For example, some autistic kids do great at home but struggle in the classroom. On the flip side, others do fantastic in school but fall apart when they come home. And some autistic kids do great with adults and poorly with peers.

There is also a wide variation of symptoms and symptom expressions in autistic people. Individuals who can’t button a shirt may also have the mind-blowing talents of a savant and may be wildly successful, rich, and famous in the public sphere due to their abilities. Individuals who can live independently, however, may struggle with crippling anxiety or depression and have trouble holding down a job and paying rent from month to month.

Needless to say, the DSM-5’s definition of autism and its “levels” raises a great deal of questions—perhaps as many questions as answers, even. We can hope that in the future, the DSM-5 will further redefine these levels or find a better method of indicating what individuals on the spectrum need.

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