In 1952, the first introduction of the DSM, autism was not recognized as a separate condition but was instead described as “childhood schizophrenia,” reflecting an outdated belief that it was an early form of psychosis caused by emotional disturbance.
In 1980, the 3rd edition DSM introduced “Infantile Autism” under Pervasive Developmental Disorders, recognizing it as a distinct neurodevelopmental disorder with early onset and characteristic social, communication, and behavioral differences.
In 2000 the the 4th edition of the DSM,The DSM-IV, was revised as the first edition to categorize autism as a spectrum, the manual grouped autism-related conditions under the broader category of “Pervasive Developmental Disorders (PDD)” which, at that time, was considered the autism spectrum.
The five conditions included under Pervasive Developmental Disorders (PDD) in the DSM-IV:
- Autistic Disorder (✓– Still a diagnosis, now with levels 1, 2, & 3)
- Asperger’s Disorder – Asperger Syndrome (✖– No longer a diagnosis)
- Pervasive Developmental Disorder – PDD-NOS (✖– No longer a diagnosis)
- Childhood Disintegrative Disorder – CDD (✖– No longer a diagnosis)
- Rett’s Disorder – Rett Syndrome (✓ – Still a diagnosis, but NOT apart of Autism, now it’s own genetic neurodevelopmental disorder)
And finally, In 2013, with the release of DSM-5, the autism diagnoses were reorganized. The DSM eliminated separate labels such as Asperger’s, and instead introduced three levels of Autism based on support needs:
- Level 1 (requiring support)
- Level 2 (requiring substantial support)
- Level 3 (requiring very substantial support)
These levels are not about “stronger” or “weaker” autism, they are about how much help someone needs in everyday life. This often correlates to what symptoms they show and the severity of those symptoms. However, severity of symptoms is not always consistent day to day with every autistic person.
What Makes Support Needs Shift
The level of support needed tends to have a large variability throughout the autism spectrum. Many things may impact how we perceive levels, including masking. In truth, support needs are often influenced heavily by stress levels, sensory overload, and unmet needs. Many individuals may appear relatively independent until they are pushed into high stress or new environments and the demands become overwhelming.
- An autistic person might function well at home but struggle deeply in a new or noisy restaurant.
- A movie at home may be tolerated fine, whereas a crowded movie theatre with a bigger screen and louder audio may be intolerable.
- An autistic person’s daily routine may go smoothly one day, or cause meltdowns the next based on unmet needs such as poor night’s sleep or reduced food intake.
Because of this, someone’s level is not as fixed as the clinical perspective may want it to be. It can vary day to day or shift over time depending on stress, environment, and self care.
Two Core Domains: Social Communication & Restricted Behavior
Every autism diagnosis under DSM-5 is based on two core domains:
- Social communication and interaction
- This involves initiating or maintaining conversations, reading social cues, understanding others’ perspectives, and adapting communication across settings.
- Deficits may range from a mild struggle to make friends to profound difficulty connecting verbally or nonverbally.
- This involves initiating or maintaining conversations, reading social cues, understanding others’ perspectives, and adapting communication across settings.
- Restricted, repetitive behaviors (RRBs), interests, or sensory traits
- These include rigid routines, intense interests, repetitive movements or stimming, resistance to change, or sensory sensitivities.
- The severity of these can affect daily functioning significantly and may range from mild resistance to change to a severe inability to cope outside of a very rigid daily routine.
- These include rigid routines, intense interests, repetitive movements or stimming, resistance to change, or sensory sensitivities.
Each of these domains is rated separately, so someone might need more support in social communication than in coping with routines or vice versa. This also means someone may have different levels for each criteria. Such as level 1 in social communication and level 2 in RRBs.
The three autism levels in DSM-5 provide a framework to think about support needs, not value or capability. They parse how much help someone needs in social communication and in handling restricted or repetitive behaviors.
The Atypical View, we understand for many late diagnosed autistic individuals, knowing your level can be a helpful tool when advocating for services, accommodations, therapy, or coaching. Someone who is technically Level 1 might still need substantial support on certain days or in certain settings. Supporting authenticity and flexibility helps make the levels more useful rather than limiting. Those supports should be responsive, individualized, and rooted in a respectful, strength-based lens of neurodiversity.
Research:
American Psychiatric Association. (1952-2022).
Diagnostic and statistical manual of mental disorders (1st–5th ed., text rev.; DSM-I–DSM-5-TR). American Psychiatric Publishing. https://doi.org/10.53053/UUXK4243
Weitlauf, A. S., Gotham, K. O., Vehorn, A. C., & Warren, Z. E. (2014).
Brief report: DSM-5 “levels of support”: A comment on discrepant conceptualizations of severity in ASD. Journal of Autism and Developmental Disorders, 44(2), 471–476. https://doi.org/10.1007/s10803-013-1882-z
Rosen, N. E., Lord, C., & Volkmar, F. R. (2021).
The diagnosis of autism: From Kanner to DSM-III to DSM-5 and beyond. Journal of Autism and Developmental Disorders, 51(12), 4253–4270. https://doi.org/10.1007/s10803-021-04904-1
Zeldovich, L. (2018). The evolution of ‘autism’ as a diagnosis, explained. Spectrum. https://doi.org/10.53053/UUXK4243
