Autism is a disorder where people suffer from a range of social, communication, and behavioral problems. The disabilities occur on a spectrum, which is why autism is also known as autism spectrum disorder.
There are three general levels of autism, ranging from mild impairments that require minimal therapy and intervention, to severe impairments that need intensive, multidisciplinary guidance.
Regardless of the level, autism is a lifelong condition. Even those with only a mild form of the disability will require some degree of ongoing therapy and monitoring for many years.
There is no medication that can specifically address autism, so doctors prescribe drugs purely to manage specific symptoms. They rely on extensive therapy to speak to the autism itself.
In addition to medication, education and behavior therapy can focus on the particular areas that younger children find most challenging.
Therapists specializing in one area can work to improve social and language communication skills in a classroom setting. This can help a child with autism start and continue conversations with students and teachers, and then take those skills into other environments. This is all done with the idea of helping the children learn how to live independently.
Other forms of therapy involve family members or caregivers who have frequent contact with the child. Everybody being a part of the process can help those closest to the child understand the nature of the disability, and learn how they can offer support in the most beneficial and productive way.
The Levels of Autism
Doctors categorize autism by looking at two groupings of symptoms — one for impairment in social functioning; the other for the restriction and repetitiveness of certain behaviors. In this context, repetitive behaviors refer to doing the same action over and over again, whether that action is a physical gesture or a phrase that is constantly repeated. They then assign a level of 1, 2, or 3 based on the severity of the symptoms.
These levels are known as “levels of support,” because they help doctors, caregivers, therapists, and parents understand the patient’s ability to communicate, respond to new situations or environments, move past their restricted interests, and manage the unpredictability of daily life.
How severe the symptoms are will guide the doctor in assigning the appropriate levels.
A good autism diagnosis, one where the levels of severity match the extent of the symptoms, can help a treatment team provide the most appropriate care for the person, increasing the chances that their long-term prognosis will allow them to live the fullest possible life. Missing symptoms or misdiagnosing a level can mean that someone with debilitating symptoms receives only light care, for example, which can complicate the continuing treatment they will need.
Level 1 Autism
Level 1 is the least severe diagnosis of autism. Patients at the Level 1 tier have some social difficulties that need attention.
For example, it might be difficult for them to start or maintain a conversation. They might respond inappropriately, or they might not be able to make eye contact with the person they’re talking to. This can hinder developing friendships, getting a job, or even asking for help.
People at the Level 1 tier can also demonstrate “inflexible behaviors,” meaning that they struggle to adapt to changing situations or contexts. If they learn something at school, for example, they might not be able to apply that learning at home. A change in their schedule, moving to a new house, and trying a different kind of food are particularly challenging. These people will need help with organizing and planning their routines.
People who have Level 1 autism can maintain a high-functioning level of life, requiring only minimal behavioral therapy or other forms of support. With consistent work, behavioral therapy can help Level 1 patients acquire positive and lasting behaviors that they would otherwise not be able to develop.
Applied behavior analysis therapy is often considered the “gold standard” of autism treatments, but some clinicians argue that it might not be the best approach for those with Level 1 needs. These doctors claim that it is an intensive program that tends to work better with children who are at Level 2 or 3. They suggest that developmental therapy or play therapy, which focus on emotional growth, communication and interactivity, could better serve these individuals.
Other doctors counter, believing that every person with autism can benefit from the behavioral improvements offered by ABA.
Ultimately, the decision should be made on a case-by-case basis after careful observation and consultation with caregivers.
Level 2 Autism
People with Level 2 autism require substantially more support than those at Level 1. These individuals have more noticeable and severe social deficits, which makes holding conversation very difficult for them.
Even if they receive help, they will likely not be able to speak or communicate clearly, and there is a risk that they will respond or act inappropriately if asked a question or put into a social setting that they have not been prepared for. Alternately, they might not have any response at all to social cues or interactions.
People with Level 2 autism may not be able to say more than a few words, or they might be able to talk about a few very specific topics in minute detail. Making eye contact, or even looking at the person with whom they are communicating, will be very difficult for people at this level.
Level 2 autism also brings with it inflexible behaviors that can interfere with everyday life and functions. People at this level will struggle more with changes, experiencing significant distress if something unexpected happens.
Even with support, people with Level 2 autism have a hard time adjusting to any kind of change in their environments.
Therapies for Level 2 Autism
The therapies that are used at Level 2 are much more varied and involved than those deployed at Level 1.
Some Level 2 individuals might receive sensory integration therapy, which helps them understand how to deal with sensory inputs that can feel threatening and overwhelming.
Such outputs include:
- Strong smells.
- Flashing lights.
- Loud or unexpected noises.
- Vivid visual changes.
Level 2 patients may also receive occupational therapy, which helps them develop necessary skills to carry out and continue daily tasks. This is especially useful to help individuals learn how to make decisions on their own or to carry out job functions.
Applied behavior analysis is more commonly used with Level 2 individuals than it is for those with Level 1 autism. While occupational therapy is its own form of treatment, it can work very well with ABA therapy to help Level 2 patients learn how they can function while understanding how to interact with their environment and the people in it.
Level 3 Autism
Level 3 is the diagnosis for the most severe form of autism. People at this tier have the most debilitating and disruptive impairments to both their verbal and nonverbal communication, going so far as to avoid interacting with other people if they can help it. If these individuals feel they have to respond, their interactions may be very limited.
This level of autism compels very repetitive and inflexible behaviors. People will react very negatively to changes, even resorting to violence. They might become deeply distressed and inconsolable if they have to act in a way that requires them to change their focus.
Those with Level 3 autism require frequent, intensive therapy. Unlike Levels 1 and 2, the treatment of Level 3 will have to cover a wide range of the limitations the person has, not only communication and behavior. Those at Level 3 might also be prescribed medication as a way of managing their more dangerous and harmful symptoms
A person with Level 3 autism will likely also need a caregiver who can work with them on a close basis, sometimes even teaching them rudimentary skills to help them at home.
ABA Therapy & Level 3 Autism
Applied behavior analysis therapy is effective for people with all levels of autism, but it’s especially useful for Level 3 individuals. It can be used in any setting, making it much easier to meet the client where they are (both physically and in terms of meeting their exact needs).
The therapy starts by creating a positive association between the client and the provider. No matter how debilitating the Level 3 autism is, the seeds are planted to help the client move past these limitations.
The registered behavior technician (RBT) who is applying the ABA therapy will use assistive communication devices, specialized tools that can support and enhance communication for clients, regardless of the speech abilities or limitations imposed on them by their autism. These methods can assist the client toward independence, help them grow their communication abilities, and increase their platform for social interactions.
Additionally, a registered behavior technician will know how best to change the environment for the betterment of the client. This professional knows how to consistently apply positive reinforcement and consequences to guide the client through their therapy.
If the client isn’t progressing as intended, the RBT will consult with the board certified behavior analyst (BCBA) who assessed the client and crafted the treatment plan. The BCBA will design changes to the treatment approach as needed, and the RBT will implement these changes.
Diagnosing the Levels
To determine the appropriate level of autism a person has, clinicians have to perform a variety of evaluations. Looking at behavioral symptoms, communication struggles, environmental keys, family history, and many other data points will help doctors eliminate possible genetic conditions or other mental health imbalances that might be causing the problem. There is no scan or imaging test that can diagnose autism.
Clinicians will ask patients and their family members a number of questions about their social lives and their daily behavior and activities. Psychological testing will help clinicians find the right level to assign to the individual, which will guide the treatment plan.
Even then, autism levels are not neatly defined categories. Many people will not perfectly fit a Level 1, 2 or 3 diagnosis, and it is very possible for a person to move from one level to another as more is understood about their unique manifestation of autism.
Still, the levels are important. They give everyone a working baseline from which a treatment plan is designed and achievable goals are set.
Other Forms of Autism
Not all forms of autism are reflected in the three levels. As a spectrum disorder, there are some presentations of the disability that don’t fit into these set levels.
An example of this is Asperger’s syndrome, which falls on the milder side of the spectrum. A person with Asperger’s syndrome normally presents with high intelligence and daily functioning capabilities. They usually display hyper-focused obsession with certain topics, and they struggle in social situations. Asperger’s syndrome is often undiagnosed because people do not recognize its symptoms as those of an autism spectrum disorder.
Another example is atypical autism, which used to be known as pervasive developmental disorder not otherwise specified (PDD-NOS), before that term was retired. This describes those who had autistic disorder that was more severe than standard Asperger’s syndrome, but not as debilitating as classic autistic disorder.
The Right Treatment Plan
The level of autism a person is diagnosed with gives therapists a basic structure for their treatment approach. Someone with Level 1 autism who has only mild symptoms of the disorder will receive very different treatment than someone with Level 3 autism who is nonverbal.
The level of autism will influence the treatment approach, but even then, treatment plans are highly customized to the individual. For example, no two people with Level 2 autism will have the same treatment plan.
The good news is that people with all levels of autism greatly benefit from therapy. Most often, ABA therapy, speech therapy, and occupational therapy are used to treat autism. While they can’t cure the disorder, these therapies can help clients learn to manage autism symptoms, reduce problematic behaviors, and build skills that aid them in daily life.
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