Understanding The Spectrum Levels In ASD

Autism spectrum disorder (ASD) is often classified using three specific levels for diagnostic purposes and access to resources. However, some people may use theories outside of diagnostic purposes to explain their experiences with the spectrum of autism and neurodiversity. Learning about these levels and classification systems can be a way to further understand how autism might be classified in communities and clinical settings. 

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What is autism spectrum disorder (ASD)? 

The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-V), published by the American Psychiatric Association, uses the diagnosis of autism spectrum disorder to describe a cluster of neurodevelopmental conditions previously known as autistic disorder, pervasive developmental disorder, Asperger’s syndrome, and childhood disintegrative disorder. Note that the term “Asperger’s” is no longer used clinically and has been associated with harmful origins, although some Autistic individuals may still identify with the term. 

The word “spectrum” is included in this diagnostic category out of recognition that autism can present differently for each person, existing on a spectrum of varying support needs, symptoms, and challenges. These factors include age, levels of symptom severity, developmental stage, and strategies a person may have developed to address or navigate symptoms or brain differences. 

Neurodiversity and ASD 

Some people with autism may identify as neurodivergent and consider autism a difference in ways of seeing the world, thinking, and processing sensory information. 

Autism is a form of neurodiversity, meaning it cannot be “cured” or “treated.” Therapeutic support options for ASD often focus on managing difficulty in daily life, as well as accommodating areas where neurodivergent individuals may struggle due to differences in support needs from neurotypical people in their environment. 

The phrase “on the spectrum” has become commonplace to describe an Autistic child or Autistic person, which could be a sign that autism and other neurodevelopmental conditions and forms of neurodiversity are becoming increasingly understood by the general public. Other ways to conceptualize autism traits have emerged, such as the autism wheel. Understanding more about autism and what it means to be on the spectrum could create a more inclusive environment for neurodivergent individuals. 

DSM-V ASD severity levels

The DSM-V acknowledges autistic symptoms occur on a spectrum and offers three “levels” for categorizing autism severity. These levels are defined by the two main symptom categories: difficulties with certain social communication and social interactions and patterns demonstrating restricted repetitive behaviors or interests. After a person has met diagnostic criteria in both areas, they may receive one of the following classifications. 

Level one: “requiring support”

People meeting the criteria for level one ASD in the DSM-V demonstrate noticeable difficulties in certain social settings and sensory environments. They may experience lower levels of interest in social communication than neurotypicals and struggle to initiate conversations with others or respond to social interaction. 

An Autistic person’s desire for routine and order may also cause functional concerns, as they may experience difficulty deviating from their routine. Some people might have challenges with executive function and organization that could lead them not to be as independent as expected for their age.

Level two: “requiring substantial support”

The level two classification is made when a person demonstrates more substantial differences in verbal and non-verbal communication, such as being able to speak only in short sentences. Even when accommodations are made for them, they may experience significant social difficulties. Their inflexibility in deviating from routines and coping with change may be noticeable to others and can lead to functional concerns in multiple contexts. The person might also become visibly upset when addressing unexpected events or occurrences.

Level three: “requiring very substantial support”

Level three is the highest marker of functional impairment in the DSM-V’s criteria for autism spectrum disorder. A person with this classification level may only be able to speak a few words, and they may limit their social interactions to only those who help them meet their basic needs, like food, water, and shelter. 

These Autistic individuals may demonstrate inflexibility and resistance to change, experiencing severe distress when deviating from their routine. According to the DSM-V, people with this level of autism may benefit from lifelong support structures and may find it highly difficult to live independently. 

Redefining the spectrum

The levels listed in the DSM-V are often used in medical and therapeutic settings to streamline communication and provide a consistent standard of care regardless of provider. The level system can help some people with ASD receive adequate support and effectively describe their specific needs. 

However, some people with ASD may prefer to refer to a spectrum without specific levels in recognition of the fact that autism can encompass a wide range of experiences and skill sets. A person may require more support in a particular area of functioning but be classified on the opposite end regarding another quality they do not struggle with. For example, an Autistic adult might strive in their friendships and relationships but have extreme sensory difficulties that make it challenging to have a job, leave home, or partake in certain activities. 

The linear spectrum model tends to define people with ASD as “high-functioning or low-functioning” categories that can both come with drawbacks. If someone is described as high-functioning or on the “low” end of the spectrum, they may not be granted access to accommodations or support systems they could benefit from and may be invalidated by healthcare providers and caregivers. If someone is diagnosed as low-functioning or on the “high” end of the spectrum, they may be restricted from certain activities they are capable of doing, like specific professions or the ability to make their own decisions about their healthcare. 

The “autism wheel” 

In response to the level system, some people with ASD are embracing an alternative concept of explaining autism called the “autism wheel.” With the autism wheel, several traits associated with autism are grouped in a pie chart to represent how varied autistic experiences can be. Examples of these traits include:

• Language
• Motor skills
• Sensory filtering
• Executive functioning
• Perception
• Aggression
• Depression
• Fixations
• Flat speech
• Noise sensitivity
• Social difficulty
• Anxiety
• Atypical postures, hand gestures, or facial expressions
• Low levels of eye contact
• Use of tics, fidgets, or “stims”

Some Autistic and neurodivergent people believe that the wheel is a more accurate representation of each person’s unique experience with autism. For example, one person with autism may have high levels of executive functioning but be extremely sensitive to sensory stimuli. 

A person may be determined to be “higher” on the spectrum based on a spectrum or level classification because they become visibly upset in public spaces when they are overwhelmed with sensory input. However, using a wheel model can make it clearer that sensory stimuli are difficult for them while they experience less functional impairment in other areas of life. This wheel may consider the many unique ways autism can appear, as each individual is different. 

The DSM-V also labels autism as a disorder marked by social impairment. Autism spectrum disorder can often cause social difficulties, but new studies have found that Autistic individuals communicate as effectively with other Autistic people as non-autistic people communicate with each other. This study showcases that Autistic people may communicate differently than their neurotypical peers, not necessarily at a deficit. However, these abilities can also vary, as many Autistic children and adults are non-verbal or selectively-verbal. 

Support options 

No matter how a person identifies based on the DSM-V levels, the autism spectrum, or the autism wheel, living with autism may be challenging for some in a world focused on neurotypical patterns. It can be difficult to navigate a society generally designed for neurotypical people who may not make accommodations for your needs. If you are experiencing complicated feelings or stress related to living with ASD or identifying as Autistic, talking to a therapist may be beneficial. 

Autism can make attending a traditional in-person therapy session difficult. Sensory overwhelm, and the stress of reading social cues can detract from the therapeutic experience. For people with ASD, online therapy through a platform like BetterHelp may be more accessible. With online therapy, you can attend sessions from the comfort of your home. If you are nervous about a therapy session's social interaction, you can turn off your camera or talk to your therapist via phone or in-app messaging. 

Online therapy may be as effective as traditional in-person therapy in improving outcomes and addressing mental health concerns, research indicates. Researchers found that participants with ASD who completed a course of online therapy reported consistent benefits and improvements. Online therapy could be a helpful alternative to traditional therapy for people with ASD.