How is autism classified?

Level One — Support Requirement

It is the mildest autism diagnosis. Autistic children in this diagnostic group generally experience social difficulties and require support in this regard. They may have difficulty initiating conversations with others, respond inappropriately, or get distracted easily. As a result, they may find it hard to make friends without help. At the same time, they strictly adhere to their routines. They may struggle to adapt to changing situations and new environments, and they require support for planning and getting organized.

Symptoms

• Decreased interest in social relationships and activities (for example, reluctance to participate in games or activities),
• Difficulty in initiating social interactions (for example, not being able to say “let's play” to a friend),
• Difficulties in maintaining a reciprocal conversation (e.g., cutting the conversation short, abruptly changing the topic),
• Signs of difficulty in communication (e.g., lack of eye contact, not understanding metaphors),
• Inability to adapt to changes in routine (e.g., becoming restless when seating arrangements change in the classroom),
• Difficulties in planning and organization (e.g., inability to prioritize tasks).

Individuals diagnosed with level one autism can lead a quality life by receiving support. The support provided mostly consists of behavioral practices. Thanks to these practices, social and communication skills increase, and these skills are exhibited in a more natural way.

Level 2 — Requiring Substantial Support

There is a need for support more intensive than that required at level one. Children with autism in this diagnostic group exhibit marked impairments in verbal and non-verbal communication skills. Even with support, they may experience difficulties in initiating and sustaining meaningful communication, and may give inappropriate, unusual responses. They may speak in short sentences and only about specific topics. They may also experience problems in non-verbal communication; for example, they may avoid making eye contact with the people they are talking to. Individuals diagnosed with autism at this level may display inflexible behaviors to an extent that makes it difficult to carry out the functions of daily life. They generally cannot adapt to changes and experience intense stress in such situations.

Symptoms

• Inability to adapt to changes in the environment or routine (e.g., becoming restless when the accustomed order is disrupted),
• Severe problems in verbal and non-verbal communication (for example, not making eye contact while speaking, not using gestures and facial expressions),
• easily noticed behavioral problems (such as unusual movements, shouting, or repetitive behaviors),
• Inability to respond appropriately to social cues (e.g., giving irrelevant answers to questions),
• Experiencing intense stress in the face of change (for example, crying or having a temper tantrum when entering a new environment),
• Communicating with very simple sentences (for example, using short expressions like “water” when thirsty),
• Narrow and intense focus on specific interests (only interested in trains, always talking about the same topic).

Level 3 — Requiring Very Substantial Support

Level three is the most severe autism diagnosis. Children with autism in this diagnostic group experience major problems in verbal and nonverbal communication. They generally avoid communicating with others, and if they need to respond to someone, their reaction may be very limited. Their behaviors are inflexible and highly repetitive. They may react strongly to changes and experience intense stress in situations that require them to shift their attention or stop what they are doing. They may require a continuous caregiver who can teach them basic skills in order to succeed at school, at home, or at work.

Symptoms

• Significant problems in verbal or non-verbal communication (for example, speaking very little or not speaking at all, avoiding eye contact),
• Very limited desire to establish social interaction (e.g., not approaching others, not participating in games),
• Repetitive and inflexible behaviors (such as continuously performing the same movement or repeating the same word),
• Overreacting to changes in routine (for example, tantrums or crying when the familiar route changes),
• Great difficulty in shifting attention (e.g., inability to stop what they are doing, unable to transition to another activity).

Individuals diagnosed with level 3 autism require more support than those at level 2. They generally have frequent and intense support needs regarding communication and behavioral issues. There is no medication or medical treatment that can cure autism, but they may benefit from medication treatments for conditions such as depression or attention deficit. Individuals with autism at this level may need someone to teach them the skills necessary to be successful at school, home, and work. Even with support, they have trouble adapting to changes in their environment.