Did you know that autism is a wide spectrum and can present quite differently from person to person?
Each individual falls on a different level of the autism spectrum which means that the assumption that all people with autism will have the same abilities is incorrect. Use this article to understand these levels and why they might matter.
What Is Autism?
According to the Center for Disease Control and Prevention, 1 in 36 children has an autism spectrum disorder (ASD) diagnosis.ASD is a neurodevelopmental disability that consists of patterns of differences in the areas of social communication, interests, routines, and sensory processing. It can affect how someone:
Communicates: People with autism use different communication styles and as a result present with differences in verbal and non-verbal communication skills, including their social communication, social cues, eye contact, facial expressions, body language, etc. People with autism often use direct and blunt communication, which can appear “rude” to others, may overshare personal information or be “overly friendly,” and may enjoy sharing a lot of information about their favorite topics of interest.
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Learns: People diagnosed with autism often have different learning styles, such as benefitting from visual support to aid verbal learning, movement combined with learning, and strengths-based approaches that build off of special interests. Children with autism can have delayed, average, or advanced learning abilities, and it’s possible for people to be autistic and gifted, or have multiple disabilities such as autism and attention-hyper deficit disorder (ADHD), learning disabilities, dyslexia, developmental delays, intellectual disabilities, or motor delays.
Behaves: Autism can impact how a person perceives and experiences their environment, which can in turn, impact how they act. For example, differences in sensory processing or unexpected changes in routine can cause a child to become dysregulated. When a person is dysregulated, their brain interprets the change or sensory input as dangerous and can trigger a fight or flight response, which often looks like a meltdown. People with autism often stim, or move their body in repeated motions, such as hand flapping, body rocking, shaping fingers in tight forms, vocalizing repeated sounds, study items close to their eyes, and more. Stimming helps people stay regulated and should not be blocked or discouraged.
People with ASD also commonly have comorbidities, such as incontinence (loss of bladder or bowel control), anxiety, ADHD, eating / digestive issues, sensory sensitivities, and eilepsy.
Causes of Autism
There is no one single cause of autism. There is a strong genetic component, with autism also occurring more in babies born prematurely, and children with older parents.
Characteristics of Autism
Each person diagnosed with autism is unique and characteristics can vary significantly from person to person. Autism is a constellation of characteristics, and not just one or two things. Someone with autism may present with some, but not all listed characteristics and common signs of autism include:
- Delay or difference in language development.
- Delay or difference in social communication.
- Early interest or strength with letters, numbers (hyperlexia).
- Strives with routines and struggles with unexpected changes.
- Repeated motor movements and / or stimming.
- Sensory seeking or avoidance behaviors.
- Highly preferred toys, objects, people, or topics.
- Anxiety
- Dysregulation resulting in tantrums or meltdowns.
- Hyperactivity
- Seizures or epilepsy.
- Difficulty sleeping.
- Selective or picky eating.
- Incontinence (urinary and bowel).
- Delays in potty training.
- Gastrointestinal problems.
How Has the Autism Diagnostic Criteria Changed?
Many years ago, autism was categorized in the following ways:
- Autistic Disorder: People who demonstrated classic autism characteristics with high support needs and language delay.
- Asperger’s Syndrome: People who demonstrated differences in social communication and interests and routines without language delay or intellectual disabilities.
- Pervasive Developmental Disorder- Not Otherwise Specified: People with some autism characteristics, but not enough to meet autism or Asperger’s.
In 2013, DSM-5, or the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders, was released by the American Psychiatric Association. The DSM-5 is what healthcare professionals currently use to diagnose Autism. There are currently 3 levels of autism according to the DSM-5.
Note: Autism levels can be helpful for many caregivers to understand and prepare for what kind of support and needs a child may require. However, it is important to note that functioning levels are not always helpful as a person’s needs can vary over time, including long term and short term. It’s also common for a person to need substantial support in one area, but not others and as a result don’t fit well into a three level system.
Three Levels of Autism
Under the DSM-5, autism is diagnosed based on the following criteria:
- Differences in social communication and interaction: Examples include the ability to maintain a back-and-forth conversation, differences in eye contact, and the ability to develop, maintain, and understand social relationships.
- Presence of Restricted or repetitive behaviors: Examples include repetitive movements or use of objects, strong preference for sameness and predictability, special interests, use of echolalia or scripted language, and hyper or hypo-activity based on sensory input.
To fall into a certain level of ASD, individuals are required to display lasting deficits in 3 areas of social communication and interaction as well as 2 out of 4 types of restricted, repetitive behaviors.
As part of the DSM-5 diagnostic criteria, each category is labeled around the level of support an individual with ASD may need.
Level 1: Requiring Support
People diagnosed with Level 1 autism can generally function in daily life with minimal support and accommodations. They may find it hard to maintain relationships or switch from one activity to the next.
Social communication and Interaction:
- May have decreased interest in social interaction, not recognize subtle social cues or inferred boundaries, may want to interact with others but not know how to initiate or maintain interactions.
- May have differences with back-and-forth conversation.
Restricted and Repetitive Behaviors:
- May become upset or question unexpected changes in routines.
- Differences with planning and organization.
Level 2: Requiring Substantial Support
People diagnosed with Level 2 autism require substantial support in order to interact with others and may feel distress when changing to a new activity.
Social communication and Interaction
- Noticeable differences with communication (verbal and non-verbal).
- May need support with how to begin social interactions.
- Difficulty maintaining reciprocal conversations.
Restricted and Repetitive Behaviors
- Changes may cause dysregulation.
- May have difficulty maintaining attention to things outside of areas of interest.
- Difficulty coping with emotions.
- Repetitive behaviors may impact day-to-day activities.
Level 3: Requiring Very Substantial Support
Individuals diagnosed with Level 3 autism need a great deal of support in their everyday activities. Communication of any type may be a challenge and changes in routine or activities may cause extreme distress.
Social communication and Interaction
- Significant delays in verbal and non-verbal communication.
- Preference to be alone, does not often seek out social interactions.
- Significant difficulty or disinterest in conversational skills.
Restricted and Repetitive Behaviors
- Extreme preference for routine, difficulty changing activities or behaviors.
- Repetitive behaviors and special interest are highly preferred.
How to Support Someone With ASD
All people diagnosed with autism have value and a right to be accepted into society. Most people benefit from support and accommodations, and these can be supported in many ways. Doing so may help them access their community as equals, feel more comfortable at home, support their emotional health, and set them up for success.
Support Options
- Early diagnosis:An early diagnosis can lead to early intervention which may help an individual access support to increase communication, cope with sensory differences and emotional regulation, develop self-advocacy skills, and more. Knowing a child’s diagnosis can help caregivers, teachers, and the individual themself better understand their individual needs.
- Provide accommodations: Individuals with an autism diagnosis can benefit from accommodations to support their needs. These can range from providing visual support, noise canceling headphones, sensory and movement breaks, fidgets, alternative means of communication, advanced notice of changes in routine, and more.
- Incontinence products: Many children and adults with ASD experience some form of incontinence during their lives. Some children may have potty training delays, and some adults may manage bladder and bowel leaks throughout their life depending on their unique condition. If you have a loved one with incontinence and autism, they may be eligible to receive bladder and bowel control products for free through Medicaid.
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Andi Putt
Andi Putt is a Neurodivergent Speech Language Pathologist and Reviewer for Aeroflow Urology, specializing in autism evaluation. She is an Autism and disability advocate and loves teaching others about Autism from a neurodiversity affirming lens and breaking down stigmas attached to Autism and disability. Andi received her Bachelor's Degree in Psychology and Child Learning and Development from the University of Texas at Dallas. She received her Master's Degree in Communication Disorders from the University of Texas at Dallas in 2008.
She has worked in schools and private practice settings and has also worked with children from 18 months to 21 years old with a variety of communication needs. Andi is known as Mrs. Speechie P on social media and helps support families and speech language pathologists better recognize, understand, and support Autistic children.
Center, L. R. M. (2021, May 7). The 3 Levels of Autism Explained. Www.lanermc.org. https://www.lanermc.org/community/lane-health-blog/the-3-levels-of-autism-explained
Centers for Disease Control and Prevention. (2016, April 18). Diagnostic Criteria. Centers for Disease Control and Prevention. https://www.cdc.gov/ncbddd/autism/hcp-dsm.html
Autism Speaks. (2013). Autism Diagnosis Criteria: DSM-5 | Autism Speaks. Autism Speaks. https://www.autismspeaks.org/autism-diagnosis-criteria-dsm-5
Autism Fact Sheet | National Autism Association. (n.d.). Nationalautismassociation.org. https://nationalautismassociation.org/resources/autism-fact-sheet/?gclid=CjwKCAjwlcaRBhBYEiwAK341jR9iBJjnuR-X5thDQzHzA-Sm4X0TkCnPyLyu5E37rw9Ln7u-SZsWmRoCDdgQAvD_BwE
Information provided on the Aeroflow Urology blog is not intended as a substitute for medical advice or care from a healthcare professional. Aeroflow recommends consulting your healthcare provider if you are experiencing medical issues relating to incontinence.
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