Autism Severity Ratings: What are they?

Autism Severity Ratings: What are they?

Over the years, doctors and researchers have devised different ways of describing the support needs of autistic people.  For a variety of reasons, some of those systems have fallen out of common use and others have found their way into popular culture.  These days, doctors usually describe autism using levels of severity.  Severity levels describe autism in terms of the support needs of an autistic individual.  Below, we discuss the history of autism classification systems and what severity ratings are.

History of Classifying Autism

Throughout its history, modern psychiatry has tried to describe the different ways that developmental disorders can present using an assortment of methods.  At one point, several developmental disorders that would ultimately be included on the autism spectrum were diagnosed as their own disorders.  For example, Asperger disorder, childhood disintegrative disorder, and pervasive developmental disorder-not-otherwise-specified (PDD-NOS) were all different diagnostic terms for childhood neurodevelopmental disorders.  However, in 2013 The American Psychiatric Association revised the DSM, the manual that outlines the diagnostic criteria for different psychiatric disorders (including neurodevelopmental disorders like autism).  In the new revision (the DSM-5), those individual terms were removed as diagnostic labels and are now all considered to be Autism Spectrum Disorder (ASD).

Over the years, doctors have created different ways to group autistic people according to how extreme their behaviors were.  Because the autism spectrum contains so many variations in how autism can present, creating these groups was intended to give doctors and easy way to describe the abilities of individual patients.  One example of how patients were grouped was “high functioning” and “low functioning” autism.  Originally, these terms were meant to include many aspects of an individual’s autism – a person’s social skills, language skills, cognitive ability, and more.  However, over time, these terms fell out of favor.  In some professional circles, high or low functioning simply became a shorthand for a person’s intellectual ability.  Additionally, many autistic people and their loved ones found that the terms were too broad and poorly defined to accurately describe any one person’s autism.  Autistic people have many varying strengths and weaknesses, and using such terms was oversimplifying the complexity of autism.

Levels of Severity According to the DSM-5: 

These days, the medical community has sought to define autism according to the level of support that an individual might need.  Some find this approach to be helpful because it provides information about an autistic person’s needs but does not attempt to describe a person’s individual strengths or weaknesses.  The DSM-5 lists three levels of severity for autistic people.  Those levels are:

• Level 1 – requiring support
• Level 2 – requiring substantial support
• Level 3 – requiring very substantial support

When an autistic person is being evaluated by a doctor, the doctor will assign the level of severity based on the person’s social-communication ability and the restricted / repetitive behaviors they engage in.

Common features of each severity level include:

Level 1 Clinical features: 

• Social impairments, even with support.  For example: difficulty with initiating social interactions such as small talk.
• Inflexibility in behavior.  For example: Difficulty switching between activities.

Level 2 Clinical features: 

• Deficits in verbal and nonverbal communication.  For example: difficulty reading social cues.
• Social impairments, even with support.  For example: limited initiation of social interactions such as small talk.
• Inflexibility in behavior.  For example: difficulty coping with change.
• Repetitive behaviors interfere with daily functioning.  For example: hand flapping.

Level 3 Clinical features: 

• Severe deficits in verbal and nonverbal communication.  For example: absent eye contact or limited facial expression.
• Very limited initiation of social interactions.  For example: failure to share interests.
• Inflexibility in behavior.  For example: extreme difficulty with coping with change.
• Repetitive behaviors interfere with daily functioning.  For example: fixated interest in unusual objects or echolalia (repeating words just spoken by another person).

*Note: An autistic child can be diagnosed with a Level 1 Severity Rating for social communication and a separate Level 2 Severity Rating for repetitive behaviors.

Article by: Avery Meeks and The Autism ToolKit

Resources:

Autism Speaks

Autism Research Institute