Autism is a developmental disorder. It affects a person’s behaviors and communication skills. The symptoms range from mild to severe. They often make it hard to engage with others.

To reflect the range of potential symptoms and their severity, autism is now called autism spectrum disorder (ASD).

This change in terminology happened in 2013 when the American Psychiatric Association updated its diagnostic manual. This manual is called the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). Healthcare professionals use it to help them diagnose people with a variety of conditions.

The DSM-5 also includes new guidelines for categorizing autism by level. These levels replaced other neurodevelopmental disorders that shared symptoms with autism, such as Asperger’s syndrome. There are three levels, each reflecting a different level of support someone may need.

To determine levels of autism, doctors take two things into account:

  • abilities of social communication
  • restricted, repetitive behaviors

The lower the level, the less support someone may need. For example, people with level 1 autism have mild symptoms and may not require much support. Those with level 2 or 3 autism have moderate to severe symptoms and require more substantial support.

Keep in mind that there aren’t any guidelines regarding the specific type of support someone might need.

While these levels allow for a more accurate diagnostic description, they aren’t perfect. Some people don’t clearly fit into one of the three levels. Autism symptoms can also change over time, becoming more or less severe.

Read on to learn about the symptoms and outlook of each level of autism.

People with level 1 autism have noticeable issues with communication skills and socializing with others. They can usually have a conversation, but it might be difficult to maintain a back-and-forth banter.

Others at this level might find it hard to reach out and make new friends. According to the DSM-5, people who receive a diagnosis of level 1 autism require support.

Symptoms

  • decreased interest in social interactions or activities
  • difficulty initiating social interactions, such as talking to a person
  • ability to engage with a person but may struggle to maintain a give-and-take of a typical conversation
  • obvious signs of communication difficulty
  • trouble adapting to changes in routine or behavior
  • difficulty planning and organizing

Outlook

People with level 1 autism often maintain a high quality of life with little support. This support usually comes in the form of behavioral therapy or other types of therapy. Both of these approaches can help improve social and communication skills. Behavioral therapy can also help develop positive behaviors that might not come naturally.

The DSM-5 notes those with level 2 autism require substantial support. The symptoms associated with this level include a more severe lack of both verbal and nonverbal communication skills. This often makes daily activities difficult.

Symptoms

  • difficulty coping with change to routine or surroundings
  • significant lack of verbal and nonverbal communication skills
  • behavior issues severe enough to be obvious to the casual observer
  • unusual or reduced response to social cues, communication, or interactions
  • trouble adapting to change
  • communication using overly simple sentences
  • narrow, specific interests

Outlook

People with level 2 autism generally need more support than those with level 1 autism. Even with support, they may have a hard time adjusting to changes in their environment.

A variety of therapies can help. For example, sensory integration therapy may be used at this level. It helps people learn how to deal with sensory input, such as:

  • off-putting smells
  • loud or annoying sounds
  • distracting visual changes
  • flashing lights

Those with level 2 autism tend to also benefit from occupational therapy. This type of therapy helps people develop the skills they need to complete daily tasks, such as decision-making or job-related skills.

This is the most severe level of autism. According to the DSM-5, those at this level require very substantial support. In addition to a more severe lack of communication skills, people with level 3 autism also display repetitive or restrictive behaviors.

Repetitive behaviors refer to doing the same thing over and over, whether it’s a physical action or speaking the same phrase. Restrictive behaviors are those that tend to distance someone from the world around them. This might involve an inability to adapt to change or narrow interests in very specific topics.

Symptoms

  • highly visible lack of verbal and nonverbal communication skills
  • very limited desire to engage socially or participate in social interactions
  • trouble changing behaviors
  • extreme difficulty coping with unexpected change to routine or environment
  • great distress or difficulty changing focus or attention

Outlook

People with level 3 autism often need frequent, intensive therapy that focuses on a variety of issues, including communication and behavior.

They may also benefit from medication. While there’s no medication that treats autism specifically, certain drugs can help manage specific symptoms or co-occurring disorders, such as depression or trouble focusing.

Someone with this level of autism may also need a caregiver who helps them learn basic skills that will allow them to be successful in school, at home, or at work.

There’s no blood test, imaging test, or scan that can diagnose autism. Instead, a doctor will take into account many factors. These include behavioral symptoms, communication issues, and family history to help rule out any potential genetic conditions.

Next, they’ll ask a variety of questions about someone’s daily habits and aspects of their social life. They may refer the client for psychological testing. Diagnosis is based on the level with which the symptoms are most consistent.

Keep in mind that autism levels aren’t black and white. Not everyone with autism clearly fits into one level. But they can provide a useful baseline to help doctors come up with an effective management plan and set achievable goals.

If you think that you or your child may have autism, discuss your concerns with your family doctor. Consider making an appointment with an autism specialist. The nonprofit organization Autism Speaks has a tool that can help you find resources in your state.

The idea of breaking down autism into three distinct levels is relatively new. While the levels categorize people with autism by how much support they need, there aren’t any guidelines for what that support should look like.

In the future, experts may adjust the levels or make specific recommendations about treatment. Until then, these levels provide a starting point for determining the type of treatment someone may need.