Autism Levels Explained: Levels 1, 2 and 3

Autism levels are a way doctors describe how much support an autistic person needs. The DSM-5-TR uses three levels: level 1 “requiring support,” level 2 “requiring substantial support,” and level 3 “requiring very substantial support.” Each is rated separately for social communication and for repetitive behaviors, describes needs right now, and can change over time [1][2].

Where autism levels come from

Before 2013, autism was split into separate diagnoses such as autistic disorder, Asperger syndrome, and PDD-NOS. The DSM-5 merged these into one diagnosis, autism spectrum disorder, and added a severity rating to show how much support a person needs [3]. The 2022 text revision (DSM-5-TR) kept this approach while clarifying the criteria [2].

The American Academy of Pediatrics (AAP) explains that the severity rating reflects how much autism affects a person and the services they need. It is not a score that can be used to track progress, and in practice it often reflects a child’s cognitive (thinking and learning) abilities [1].

The three autism levels explained

The descriptions below summarize the DSM-5 table reproduced in the AAP’s 2020 clinical report [1].

Level 1: “Requiring support”

• Social communication: Without support, differences cause noticeable difficulties. The person may find it hard to start social interactions or to respond in expected ways, and may seem less interested in socializing.
• Repetitive behaviors: Inflexibility interferes with daily life in one or more settings. Switching between activities and organizing and planning can be hard.

Level 2: “Requiring substantial support”

• Social communication: Clear differences in verbal and nonverbal communication are obvious even with support in place. The person starts few interactions and may respond in limited or unusual ways.
• Repetitive behaviors: Inflexibility, difficulty coping with change, or repetitive behaviors are frequent and obvious to a casual observer, and cause distress when interrupted.

Level 3: “Requiring very substantial support”

• Social communication: Severe differences in communication cause severe impairment. The person rarely starts interactions and responds minimally to others.
• Repetitive behaviors: Extreme difficulty coping with change, with repetitive behaviors that markedly interfere with everyday life. Great distress when changing focus or activity.

A child can have different autism levels in each area, for example level 2 for social communication and level 1 for repetitive behaviors. In one clinic sample, nobody was rated level 1 in one area and level 3 in the other, and higher levels went along with lower everyday living skills and more autism features [4].

Autism levels and ICD-11

If your child is diagnosed in the UK or another country using the World Health Organization’s ICD-11, you will not see levels. Instead, the diagnosis records two things [5]:

• Whether there is a co-occurring disorder of intellectual development (intellectual disability).
• The degree of functional language: mild or no impairment, impaired (no more than single words or simple phrases), or complete or almost complete absence of functional language.

ICD-11 also notes whether there has been a loss of previously acquired skills. These details are meant to guide individual support and treatment planning [5]. Read more in our guide to DSM-5-TR autism criteria and ICD-11.

Limits of autism levels

Levels can be useful shorthand, but they have real limits:

• No clear rules. The DSM gives only brief descriptions and no scoring method. Researchers warned early on that this could lead to inconsistent ratings that affect services [6].
• Used unevenly. A 2026 CDC analysis found that fewer than half (40%) of US children with an autism diagnosis had any level recorded, ranging from about 5% to 73% across sites [7].
• Mixed with other factors. Symptoms, thinking skills, and daily living skills do not always line up, so the same level can mean different things for different children [6].
• Not fixed. In a study following autistic children from diagnosis to middle childhood, about 27% showed decreasing severity, 24% increasing severity, and the rest stayed stable [8].

Many autistic people and researchers also prefer describing specific needs and strengths over labels such as “high-functioning” and “low-functioning” [9]. A child who is “level 1” can still struggle greatly in some situations, and a child who is “level 3” has abilities and a personality that a label cannot capture.

Autism levels do not predict the future

It is natural to want to know what a level means for your child’s future. The AAP is clear that the long-term path of a young child diagnosed with autism usually cannot be predicted at the time of diagnosis [1]. Across early childhood, communication and social skills often improve, and repetitive behaviors may change, possibly reflecting both maturation and support [1].

About 30% of autistic children also have an intellectual disability and about 30% are minimally verbal, according to figures cited by the AAP, and these factors affect support needs more than the autism levels alone suggest [1]. Thinking of the level as a snapshot of the support your child needs today, rather than a forecast, is closer to how clinicians intend it to be used.

What about “profound autism”?

In 2021, the Lancet Commission on the future of care and clinical research in autism proposed the term “profound autism” for autistic people who need 24-hour support [10]. A CDC study applying a version of this definition (being nonverbal or minimally verbal, or having an IQ below 50) estimated that about 27% of autistic eight-year-olds had profound autism [11]. This is not an official diagnosis in DSM-5-TR or ICD-11, and the term is debated within the autism community.

What you can do at home

• Ask what the level means in practice. Which situations are hardest for your child? What help makes the biggest difference?
• Focus on needs, not numbers. Describe your child’s needs to schools and services in concrete terms, such as “needs visual supports to transition” or “uses an AAC device to communicate.”
• Track change. Keep notes about new skills and new challenges. These help when plans are reviewed.
• Use the level to access support, but do not let it limit expectations. Children keep learning.

For broader next steps, see after an autism diagnosis.

When to talk to a professional

Talk to your child’s clinician if you do not understand the level in the report, if you think it does not match your child’s needs, or if your child’s needs have changed a lot. A review can update the picture. If your child’s skills are going backward, ask for a prompt medical check [12].

Frequently asked questions

What are the 3 levels of autism?

In the DSM-5-TR, level 1 means requiring support, level 2 means requiring substantial support, and level 3 means requiring very substantial support. Each level describes how much autism features affect daily life in two areas: social communication and restricted or repetitive behaviors. A child receives a separate rating in each area, and the ratings can differ.

Can a child’s autism level change?

Yes. Levels describe current support needs, and these often change with age, development, support, and life demands. Research following autistic children through childhood found that roughly a quarter became less severe and a quarter more severe, while about half stayed stable. Ask for a review if your child’s needs seem different from their report.

Is level 1 autism the same as Asperger’s?

Not exactly. Asperger syndrome was a separate diagnosis before 2013 and is no longer used for new diagnoses. Many people who would once have been diagnosed with Asperger syndrome might now be described as level 1, but levels are about support needs, not language or intelligence. Some people still choose to describe themselves as having Asperger’s, which is their choice.

Does my child’s level decide what services they get?

It can influence services in some places, but it should not be the only factor. Schools in the US base special education eligibility on how a condition affects learning, and good services look at a child’s specific needs. Because levels are recorded inconsistently, a clear description of your child’s needs in the report is often more useful than the level alone.

References

1. Hyman SL, Levy SE, Myers SM; Council on Children With Disabilities, Section on Developmental and Behavioral Pediatrics. Identification, Evaluation, and Management of Children With Autism Spectrum Disorder. Pediatrics. 2020;145(1):e20193447. Link
2. American Psychiatric Association. DSM-5-TR Fact Sheet: Autism Spectrum Disorder. Washington, DC: APA; 2022. Link
3. American Academy of Pediatrics Council on Children With Disabilities Autism Subcommittee. Understanding Autism: Information for Families. HealthyChildren.org. Last updated February 20, 2026. Link
4. Gardner LM, Campbell JM, Keisling B, Murphy L. Correlates of DSM-5 Autism Spectrum Disorder Levels of Support Ratings in a Clinical Sample. J Autism Dev Disord. 2018;48(10):3513-3523. Link
5. World Health Organization. Clinical descriptions and diagnostic requirements for ICD-11 mental, behavioural and neurodevelopmental disorders (CDDR). Geneva: WHO; 2024. ISBN 9789240077263. Section 6A02 Autism spectrum disorder. Link
6. Weitlauf AS, Gotham KO, Vehorn AC, Warren ZE. Brief report: DSM-5 “levels of support:” a comment on discrepant conceptualizations of severity in ASD. J Autism Dev Disord. 2014;44(2):471-476. Link
7. Russell LA, Tinker SC, Shaw KA, Maenner MJ, Dirienzo M, Kirby AV, et al. Prevalence of Autism Spectrum Disorder Severity Levels From the Fifth Edition of the Diagnostic and Statistical Manual (DSM-5) in the Autism and Developmental Disabilities Monitoring Network. J Autism Dev Disord. 2026 (online ahead of print). Link
8. Waizbard-Bartov E, Ferrer E, Heath B, Rogers SJ, Nordahl CW, Solomon M, et al. Identifying autism symptom severity trajectories across childhood. Autism Res. 2022;15(4):687-701. Link
9. Bottema-Beutel K, Kapp SK, Lester JN, Sasson NJ, Hand BN. Avoiding Ableist Language: Suggestions for Autism Researchers. Autism Adulthood. 2021;3(1):18-29. Link
10. Lord C, Charman T, Havdahl A, Carbone P, Anagnostou E, Boyd B, et al. The Lancet Commission on the future of care and clinical research in autism. Lancet. 2022;399(10321):271-334. Link
11. Hughes MM, Shaw KA, DiRienzo M, Durkin MS, Esler A, Hall-Lande J, et al. The Prevalence and Characteristics of Children With Profound Autism, 15 Sites, United States, 2000-2016. Public Health Rep. 2023;138(6):971-980. Link
12. National Institute for Health and Care Excellence. Autism spectrum disorder in under 19s: recognition, referral and diagnosis. Clinical guideline CG128. Published 28 September 2011; last updated 20 December 2017 (minor changes 2021-2025). Link

Professional review: this guide is waiting for review by a qualified clinician. It was written and checked against the published sources listed above. How we check our guides.

This guide is general education, not medical advice. Always talk to your child’s doctor or care team. Last checked: October 2026.