The Three Severity Levels of ASD Explained

We know that autism is a spectrum, but categorizing children with ASD can be helpful when it comes to deciding what levels of support they need.

The American Psychiatric Association (APA) has laid out some criteria in order to group children with autism based on the intensity of certain behaviors. Symptoms usually occur in early development and cause considerable impairment to function.

One stipulation of an autism diagnosis is that the behaviors should not be better explained by another diagnosis, such as intellectual developmental disorder or global developmental delay.

Autism Diagnosis Criteria:

Social Communication

Social Communication

This includes the ability to maintain a conversation, share interests or emotions, and establish and maintain relationships. Signs of difficulties in this area include:

  • Not using words to communicate with others
  • Not speaking at all
  • Rarely responding when spoken to
  • No shared interests with others
  • Inability to use or understand common gestures, such as pointing or waving
  • Using limited facial expressions to communicate
  • No interest in making friends or having difficulties making friends
  • Rarely engaging in imaginative play
Repetitive Patterns of Behavior

Repetitive Patterns of Behavior,
Interests, and/or Activities

Signs of difficulties in this area include:

  • Lining up objects in a particular way, over and over again
  • Frequently flicking switches or spinning objects
  • Speaking in a repetitive way
  • Having very narrow interests
  • Needing things to always happen in the same way
  • Distress over changes in schedule or transitioning between activities
  • Sensory sensitivities, such as not liking the feel of clothing labels or sniffing objects
Requiring Support

Level 1: “Requiring Support”

At this level, without supports, it can be difficult for a child to initiate social interactions. They may also have little interest in social interactions. For example, a child may be able to speak in full sentences but cannot continue in a back-and-forth conversation. They may make unsuccessful attempts to have friendships. This child also has a hard time switching between activities.

Requiring Substantial Support

Level 2: “Requiring Substantial Support”

There may still be issues with communication and social interactions at this level, even with supports in place. Initiation of social interactions is very limited, and responses to others are reduced. For example, a child who speaks simple sentences but whose interaction with others is very limited. They may also rely on nonverbal communication instead. This child will become visibly distressed by changes in routine in a variety of contexts.

Requiring Very Substantial Support

Level 3: “Requiring Very Substantial Support”

This child has severe deficits in verbal and nonverbal communication and very limited social interactions or responses. For example, a child who uses few words of intelligible speech and uses unusual approaches solely to meet their needs. The child also has extreme difficult coping with change, and behaviors interfere with functioning in all contexts.

Social Communication Disorder

Social Communication Disorder

Social communication disorder is similar to autism, with the main difference being that children diagnosed with SCD don’t have repetitive patterns of behavior. Children with SCD often have deficits in areas such as following conversational rules and understanding what isn’t being explicitly stated. Like ASD, SCD must also not be better explained by another diagnosis.

Requiring Support

Level 1: “Requiring Support”

At this level, without supports, it can be difficult for a child to initiate social interactions. They may also have little interest in social interactions. For example, a child may be able to speak in full sentences but cannot continue in a back-and-forth conversation. They may make unsuccessful attempts to have friendships. This child also has a hard time switching between activities.

Requiring Substantial Support

Level 2: “Requiring Substantial Support”

There may still be issues with communication and social interactions at this level, even with supports in place. Initiation of social interactions is very limited, and responses to others are reduced. For example, a child who speaks simple sentences but whose interaction with others is very limited. They may also rely on nonverbal communication instead. This child will become visibly distressed by changes in routine in a variety of contexts.

Requiring Very Substantial Support

Level 3: “Requiring Very Substantial Support”

This child has severe deficits in verbal and nonverbal communication and very limited social interactions or responses. For example, a child who uses few words of intelligible speech and uses unusual approaches solely to meet their needs. The child also has extreme difficult coping with change, and behaviors interfere with functioning in all contexts.

Social Communication Disorder

Social Communication Disorder

Social communication disorder is similar to autism, with the main difference being that children diagnosed with SCD don’t have repetitive patterns of behavior. Children with SCD often have deficits in areas such as following conversational rules and understanding what isn’t being explicitly stated. Like ASD, SCD must also not be better explained by another diagnosis.

Getting the Right Support

Getting the Right Support

Determining the appropriate amount and type of supports is something that will be ongoing as your child grows up. At The Cardinal Center, we offer Individual ABA Therapy in which we help develop the best supports for your child.

Getting the Right Support

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