Autism Diagnosis
Autism is diagnosed by obtaining a developmental history, behavioral observation, clinical interview(s), and standardized assessments. If the results of the assessment is consistent with the DSM-5-TR criteria for Autism Spectrum Disorder, a diagnosis of autism is made. Diagnosis of autism is made with and without intellectual and language disabilities. In addition, the DSM-5-TR requires the use of severity specifiers that clarify levels of support and interventions. For more information about remote autism testing , visit Testing for Children or Testing for Adults.
Severity Specifiers in Autism: Levels of Support and Interventions
On this page, we are going to explore the three Levels of Support and Treatment Options in Autism. DSM-5-TR specifiers help to determine how much support an individual needs to manage their daily lives and guide interventions. It’s important to understand that the severity specifier is a snapshot of you or your child at a moment in time. This means it can change over time as your or your child develop new skills, gain experience, and adapt to different situations. Support needs vary based on specific challenges or strengths.
Characteristics, Symptoms, Challenges, and Strengths of Severity Specifiers
Level 1: Requiring Support
When it comes to Autism Spectrum Disorder (ASD), there are three distinct levels that are used to describe the level of support an individual may require. Level 1 represents individuals who require support, but generally have good language and cognitive skills. Let’s take a closer look at the characteristics, symptoms, challenges, and strengths associated with Level 1 ASD. This information is taken from Yellow Bus ABA, but it is not an endorsement of ABA therapy.
Characteristics and Symptoms
Individuals with Level 1 autism, also known as “Requiring Support,” typically display mild symptoms that may affect their social interactions and communication abilities. Some common characteristics and symptoms include:
- Difficulty initiating social interactions and maintaining reciprocal relationships.
- Challenges with understanding nonverbal cues, such as body language and facial expressions.
- Narrow or intense interests in specific topics.
- Rigid adherence to routines or rituals.
- Sensory sensitivities, such as being overly sensitive or underreacting to certain stimuli.
Challenges and Strengths
While individuals with Level 1 autism face certain challenges, they also possess unique strengths. Some challenges that they may encounter include:
- Difficulties with social communication, which can lead to misunderstandings and difficulties forming friendships.
- Executive functioning challenges, such as organizing tasks, managing time, and transitioning between activities.
- Sensory sensitivities that can be overwhelming in certain environments.
Despite these challenges, individuals with Level 1 autism also possess notable strengths, including:
- Good language and cognitive skills, which can enable them to effectively express themselves and engage in academic pursuits.
- Exceptional attention to detail and a strong focus on specific interests, which can lead to expertise in certain areas.
- The ability to follow routines and adhere to rules, which can contribute to their sense of stability and predictability.
Understanding the characteristics, symptoms, challenges, and strengths associated with Level 1 autism is essential in providing the necessary support and interventions for individuals on the autism spectrum. By recognizing their unique abilities and challenges, we can create an inclusive and supportive environment that allows them to thrive.
Level 2: Requiring Substantial Support
Autism Spectrum Disorder (ASD) manifests in individuals across a wide range of abilities and challenges. Level 2 of the autism spectrum represents individuals who require substantial support in various areas of their lives. Understanding the characteristics, symptoms, as well as the challenges and strengths associated with Level 2 ASD is crucial for providing appropriate support and intervention.
Characteristics and Symptoms
Individuals at Level 2 of the autism spectrum exhibit significant difficulties in social communication and interaction. They may struggle with initiating and sustaining conversations, interpreting nonverbal cues, and building meaningful relationships. Additionally, they may engage in repetitive behaviors and have rigid adherence to routines. Other common characteristics and symptoms of Level 2 autism include:
- Limited flexibility in thinking and difficulty adapting to changes in routine or environment
- Challenges in understanding abstract concepts and interpreting others’ perspectives
- Sensory sensitivities, such as hypersensitivity or hyposensitivity to sounds, sights, textures, or smells
- Difficulties with executive functioning skills, such as planning, organizing, and problem-solving
- Delayed or atypical language development, including speech that may be repetitive or focused on specific topics of interest
Challenges and Strengths
Individuals at Level 2 autism face various challenges that require substantial support to navigate daily life. These challenges may include difficulties in:
- Forming and maintaining social relationships
- Participating in group activities and understanding social norms
- Managing transitions and adapting to changes in routine
- Self-regulating emotions and handling stress or anxiety
- Generalizing skills learned in one context to other settings
Despite the challenges, individuals at Level 2 autism also possess unique strengths that should be recognized and nurtured. Some common strengths observed in this group include:
- Strong attention to detail and focus on specific interests
- Exceptional memory and ability to retain vast amounts of information
- High level of honesty, reliability, and adherence to rules
- Unique problem-solving skills and thinking outside the box
Understanding the characteristics, symptoms, challenges, and strengths associated with Level 2 ASD can help shape appropriate support and intervention strategies. By recognizing and building upon the strengths of individuals at this level, while addressing their challenges, we can provide the substantial support they need to thrive in various aspects of their lives.
Level 3: Requiring Very Substantial Support
At Level 3 on the autism spectrum, individuals require very substantial support to navigate daily life and engage in social interactions. This level is characterized by significant impairments in communication, social skills, and behavior. Understanding the characteristics, symptoms, as well as the challenges and strengths associated with Level 3 can help parents and caregivers provide the necessary support and resources.
Characteristics and Symptoms
Individuals at Level 3 of autism spectrum disorder typically exhibit the following characteristics and symptoms:
- Severe impairments in verbal and nonverbal communication skills.
- Limited or no speech, with communication primarily through nonverbal means.
- Difficulty initiating and maintaining social interactions.
- Lack of interest in social relationships or interactions with others.
- Highly restricted and repetitive behaviors, often resistant to change.
- Sensory sensitivities or aversions, such as extreme reactions to certain sounds, textures, or lights.
- Difficulty adapting to new environments or routines.
Challenges and Strengths
Level 3 individuals face significant challenges in their daily lives due to the severity of their symptoms. Some common challenges include:
- Difficulty expressing their needs and wants effectively.
- Limited ability to understand or interpret social cues and norms.
- Struggles with emotional regulation and managing sensory sensitivities.
- Challenges with self-care tasks and navigating daily routines independently.
Despite these challenges, individuals at Level 3 also possess unique strengths and abilities. Some of these strengths include:
- Exceptional attention to detail and ability to focus on specific tasks.
- Proficiency in areas of interest or talents, such as art, music, or technology.
- Genuine and authentic personalities that can positively impact those around them.
- Unique perspectives and ways of thinking that can contribute to problem-solving and creativity.
Understanding the characteristics, symptoms, challenges, and strengths associated with Level 3 of autism spectrum disorder is crucial for creating a supportive and inclusive environment for individuals at this level. By acknowledging their strengths and providing the necessary support, individuals with Level 3 autism can thrive and lead fulfilling lives.
Severity Specifiers and Interventions in Autism
Given the range of abilities and needs exhibited by individuals with autism, intervention strategies need to be tailored to each person’s specific level. What works well for one individual might not be as effective for another, even if they have the same level of autism. These are just some suggested therapies. If ABA isn’t for you, you can choose another intervention.
Effective interventions often involve a multidisciplinary approach, drawing upon the expertise of professionals from various fields including but not limited to medicine, psychology, speech and occupational therapy, and nutritionists. Parents, caregivers, educators, and healthcare providers collaborate to create a comprehensive plan that addresses the individual’s unique needs and goals.
Tailoring Support for Level 1 Autism
Individuals with Level 1 autism, once described as “high functioning,” may require minimal support to succeed in their daily lives. They might benefit from social skills training to navigate social situations more effectively, develop strategies for understanding and responding to social cues, and build meaningful relationships with their peers. Individuals with Level 1 autism may be good candidates for CBT, Relationship Based Interventions, and Play Therapy.
Furthermore, individuals with Level 1 autism can thrive in educational settings with appropriate accommodations and support from educators. These accommodations might include providing clear expectations, visual aids, or extra time for assignments. By fostering an inclusive and supportive learning environment, educators can empower individuals with Level 1 autism to reach their academic potential and develop the skills necessary for independence.
Strategies for Managing Level 2 Autism
Individuals with Level 2 autism need more structured support to address their challenges and promote their independence. Behavioral interventions, like the highly controversial ABA tailored to their specific needs, can be highly beneficial in managing their behaviors and teaching new skills. Alternatively, Relationship Based Therapies may prove to be just as effective. These interventions often involve creating clear routines, providing positive reinforcement for desired behaviors, and using visual supports to enhance communication and understanding. Individuals with Level 2 autism may also benefit from music therapy and art therapy.
Given that communication deficits are often more pronounced in individuals with Level 2 autism, speech therapy plays a crucial role in supporting their language development. Speech therapists work on improving articulation, expanding vocabulary, and developing pragmatic language skills, which are essential for effective communication in various social contexts.
Additionally, individuals with Level 2 autism may require support in managing their daily lives, such as developing self-care skills, organizing their belongings, or navigating community settings. Occupational therapists can be instrumental in teaching these skills, adapting tasks to meet the individual’s abilities, and promoting their independence in meaningful ways.
Intensive Support Needs for Level 3 Autism
Individuals at this level often need intensive care and support across multiple environments to ensure their well-being and foster their development. Communication is a key focus area for individuals with Level 3 autism, and augmentative and alternative communication (AAC) methods can be transformative in providing them with a voice.
AAC methods encompass a wide range of tools and strategies, from low-tech options like picture exchange systems (PECS) to high-tech devices that generate speech. These tools can significantly enhance communication, allowing individuals with Level 3 autism to express their needs, share their thoughts, and engage more meaningfully with the world around them.
Furthermore, creating a structured, predictable environment is essential for reducing anxiety and promoting a sense of security for individuals with Level 3 autism. Sensory sensitivities are common at this level, and it’s crucial to be mindful of environmental factors, such as lighting, noise levels, and textures, that might trigger sensory overload. By providing appropriate sensory input and regulating the environment, caregivers and educators can create a calming and supportive space for individuals with Level 3 autism to learn and thrive.
Interventions Defined
Autism professionals craft personalized treatment plans . These efforts aid children in cultivating crucial skills, reducing challenging behaviors, and building meaningful connections. Some of the primary early intervention treatments for autism include:
- Applied Behavior Analysis (ABA)
- Relationship Based Interventions
- CBT
- Play Therapy
- Sensory integration therapy
- Music Therapy
- Occupational Therapy
- Speech and Language Therapy
- Social Skills Training
- Art Therapy
1. ABA Therapy for the Different Levels of Support
Applied Behavior Analysis has become a controversial intervention for helping with difficulties experienced by children with autism. Many people have good experiences with autism, but many critics feel that it focuses too much on trying to change autistic behaviors to fit neurotypical norms as well as focusing on eliminating behaviors instead of building skills. In essence, the argument is that ABA attempts to “cure” autism.
Proponents of ABA argue that ABA is highly individualized to the child, helps them to develop life skills, facilitates better language and communication skills, helps children learn to make friends, and teaches children to better cope with their emotions.
Applied Behavior Analysis (ABA) therapy is an approach that offers individualized treatment for children at various levels of the spectrum. For children with Level 1 autism, ABA therapy focuses on enhancing social interactions, communication skills, and addressing specific challenges to promote meaningful connections with others.
In cases of Level 2 autism, ABA therapists develop personalized strategies to target repetitive behaviors, resistance to change, and communication difficulties. These interventions are designed to facilitate adaptive behaviors and help children navigate social complexities more effectively.
For those with severe autism (Level 3), intensive ABA therapy aims to address core deficits, develop independence, and promote effective communication. By adapting techniques to the unique needs of each child, ABA therapy empowers children across the spectrum to make meaningful progress and achieve their goals.
2. Relationship-Based Interventions
Relationship-based interventions center on the power of connection. Therapies like Relationship Development Intervention (RDI) and Floortime emphasize fostering strong emotional connections between the autistic child and their caregivers. The premise lies in the understanding that secure attachments create a foundation for social, emotional, and cognitive growth.
Through playful interactions and shared experiences, these interventions aim to enhance communication, flexibility, and social understanding. By nurturing a sense of trust and emotional safety, relationship-based interventions provide a supportive environment for children to thrive.
3. Cognitive Behavioral Therapy (CBT)
Cognitive Behavioral Therapy (CBT) is a widely recognized therapeutic approach that focuses on understanding the connection between thoughts, behaviors, and emotions. It is also considered controversial in the treatment of autism, because critics feel it emphasizes conformity to neurotypical standards and and does not take into account the unique characteristics of the child. Generally, these criticism show a lack of understanding of CBT and how it is utilized. CBT is often adapted to meet the individual needs and communications style of neurodivergent and neurotypical children. It helps individuals develop coping strategies, improve emotional regulation, and enhance social skills. These benefits are accomplished by helping children to recognize and label their thoughts and feelings and role-play social skills. CBT in autistic children is not about curing autism. The focus of CBT is often on secondary issues that are related to the experience of life on the autism spectrum: depression, bullying, stress, anger, aggression, anxiety, social skills deficits, and limited social support.
3. Play Therapy
In the realm of childhood, play is not just a form of entertainment; it’s a powerful tool for learning and growth. Play therapy harnesses this natural instinct, providing a safe and engaging space for autistic children to express themselves, develop social skills, and process emotions.
Through play, therapists can observe the child’s unique communication style, identify areas of difficulty, and gently guide them towards developing essential skills. Play therapy enhances creativity, problem-solving abilities, and motor skills, fostering a sense of joy and accomplishment.
4. Sensory Integration Therapy
Sensory Integration Therapy focuses on addressing the sensory processing challenges often experienced by autistic children. Sensory input – such as sights, sounds, textures, and movement – can be overwhelming or distressing for some individuals on the spectrum. Sensory integration therapy provides a safe and controlled environment for the autistic child to engage with sensory experiences.
Through tailored activities, therapists help children develop strategies to process sensory information more effectively. This, in turn, can reduce sensory overload, promote self-regulation, and improve participation in daily activities.
5. Music Therapy
Music possesses a unique ability to transcend barriers and touch the soul. Music therapy leverages the power of music to enhance communication, emotional skills, and social interaction in autistic individuals. By engaging with music, children can explore self-expression, improve motor coordination, and develop a sense of rhythm and timing.
Music therapists create a therapeutic environment where children feel safe to explore their creativity and connect with others through shared musical experiences. Music therapy can be particularly beneficial for non-verbal children, providing an alternative avenue for communication and emotional release.
6. Occupational Therapy
Occupational Therapy (OT) focuses on developing essential life skills that enable individuals to participate fully in everyday activities. For autistic individuals, OT addresses fine motor skills, coordination, sensory processing, and self-care routines.
Therapists work with children to improve their ability to dress themselves, eat independently, engage in play, and participate in school activities. By enhancing these practical skills, occupational therapy fosters independence, builds self-esteem, and empowers individuals to navigate their daily lives with greater confidence.
7. Speech and Language Therapy
Communication is the cornerstone of human connection. Speech and Language Therapy plays a vital role in supporting the development of communication skills in autistic children, regardless of their verbal abilities. Speech therapy addresses a range of communication challenges, including articulation, language comprehension, and social pragmatics (the unspoken rules of communication).
Therapists work with children to improve their ability to understand and express themselves, fostering meaningful interactions with others. They employ various techniques, including visual supports, sign language, and augmentative and alternative communication (AAC) devices, to facilitate communication and enhance social engagement.
8. Social Skills Training
Social Skills Training is the newest controversy for interventions in autism. Critics argue loudly that teaching children social skills causes them to “mask” who they really are, a process that is exhausting and undermines the development of their sense of self. Some say that it “attempts to train the autism out of the individual.” Feelings run high on this issue. The research suggests though that social skills training enhances the social competence of children with autism, which reduces anxiety related to social interaction; improves communication, increase emotional regulation and socialization. So how can we make it more neurodivergent friendly?
Social skills are shaped by a combination of factors including cultural norms, societal expectations, and societal values (which change over time). What is considered a good social skill can vary depending on the context and group of people involved. A social skill is really just a skill in interacting and communicating verbally and nonverbally with others effectively so that you can build relationships all within the cultural context of the society that you live in. They provide a common foundation for interaction.
Good social skills training is about group based in game play, exploration of thoughts and ideas, group discussions, role-play, and nonjudgemental feedback, which creates a safe space for children and adolescents to learn and be themselves. Probably the best place to learn social communication and friendship building for autistic children and adolescents is at Outschool. They have an area dedicated to Neurodiverse Social Skills. Classes involve improvisation, online games, peer discussions, social clubs, and groups that play video games together online while learning social skills. Many of the classes have the values of building an inclusive community and appreciating each others values, abilities, and beliefs. Probably the best course offered is the Neurospicy Creative Club.
9. Art Therapy
Art therapy provides a unique and expressive outlet for emotions, thoughts, and experiences. For autistic individuals who may struggle with verbal communication, art becomes a powerful tool for self-expression and emotional regulation. Through various art materials and creative processes, children can communicate their inner world, explore their senses, and develop fine motor skills.
Art therapy fosters self-awareness, emotional regulation, and cognitive development. It provides a safe and non-judgmental space for children to process their experiences, express their creativity, and build self-confidence.
