Autism Spectrum Disorder: Levels of Severity

No knowledgeable person would argue with the contention that the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) is the most authoritative guide for evaluating and diagnosing mental health disorders in the United States.
And, after defining the characteristics — behavioral and otherwise — usually associated with ASD, the manual goes on to describe the three clinical levels of ASD according to their severity.

The Hughes Brothers hope that the following recap of the DSM’s discussion of those three levels will prove helpful to the extended family of young people dealing with ASD. The DSM uses social communication, restricted interests, and repetitive behaviors as the primary indicators of the severity of ASD in individual cases.

We begin with Level 3, the most troubling, and we quote the DSM’s precise language.

Level 3:
– Requiring Very Substantial Support
– Severe deficits in verbal and nonverbal social communication skills
– Severe impairments in functioning
– Very limited initiation of social interactions
– Minimal response to social overtures from others
– Preoccupations, fixated rituals and/or repetitive behaviors that markedly interfere with functioning in all spheres
– Marked distress when rituals or routines are interrupted
– Very difficult to redirect from fixated interest

Level 2:
– Requiring Substantial Support
– Marked deficits in verbal and nonverbal social communication skills
– Social impairments apparent even with supports in place
– Limited initiation of social interactions
– Reduced or abnormal response to social overtures from others
– Rituals and repetitive behaviors] and/or preoccupations or fixated interests frequent enough to be obvious to the casual observer and to interfere with functioning in a variety of contexts
– Distress or frustration apparent when rituals and repetitive behavior are interrupted
– Difficult to redirect from fixated interest

Level 1:
– Requiring Support
– Without supports in place, deficits in social communication
– Noticeable impairments
– Difficulty initiating social interactions
– Demonstrates clear examples of atypical or unsuccessful responses to social overtures of others
– Decreased interest in social interactions
– Rituals and repetitive behaviors with significant interference with functioning in one or more contexts
– Resists attempts by others to interrupt these behaviors or to be redirected from fixated interest