Autism Levels
The levels of autism are used to describe the amount of support an individual requires, which is outlined in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5). These levels are:
- Level 1: “Requiring Support”
- Individuals at this level can communicate verbally and handle daily activities but struggle with social interactions. They may find it difficult to initiate social interactions and typically display inflexible behavior that interferes with functioning in one or more contexts. Support may include help with organization and planning.
- Level 2: “Requiring Substantial Support”
- Those at this level have more marked difficulties with social communication than those at Level 1 and also exhibit inflexible behavior. They may speak in simple sentences and have noticeable difficulty understanding both verbal and nonverbal communication during social interactions. The support here is more substantial and may include speech therapy and additional support in social settings.
- Level 3: “Requiring Very Substantial Support”
- Individuals at this level face severe challenges in verbal and nonverbal communication. Social interactions are limited to only the simplest clear-cut exchanges. Behavioral inflexibility is high, distress and/or difficulty changing focus or action is frequent. Support needed at this level is more intensive and often involves more comprehensive behavioral and communication-related interventions.
Reconsidering the DSM-5 Levels of Autism Support: A Call for a More Nuanced Approach
The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), outlines three levels of support for individuals with autism: Level 1 (“Requiring Support”), Level 2 (“Requiring Substantial Support”), and Level 3 (“Requiring Very Substantial Support”). While these levels aim to categorize the amount of assistance needed, they fail to capture the dynamic and context-dependent nature of autism, potentially hindering the progress and quality of life for those on the spectrum.
Flaws in Determining Support Levels
- Lack of Correlation with Brain Growth and Irregularities: The DSM-5 levels do not consider the underlying neurological variations in the autistic brain. Current research on brain development in autism is inconclusive and cannot be directly correlated with the DSM-5 support levels. By focusing solely on behavioral observations, the DSM-5 neglects the complexity and variability of brain growth and irregularities in autism.
- Context-Dependent Nature of Autism: Autistic individuals’ ability to cope and function can vary greatly depending on the circumstances. A person who appears to need minimal support on a good day might require substantial assistance on a bad day. The DSM-5 levels fail to account for this variability, potentially leading to inappropriate support plans that do not reflect the individual’s true needs.
The Divisive Nature of Support Levels
Labeling individuals with levels based on their behavior can create division within the autistic community. These levels can lead to:
- Misconceptions and Bias: Assigning a level to an individual may encourage those around them to treat them according to their level rather than their actual abilities and potential. For instance, a person labeled as Level 3 might be perceived as incapable, which can stunt their development and opportunities to learn and grow.
- Compliance Equals Value: The implication that lower levels of support (and thus more “compliant” behavior) are more desirable can be harmful. It suggests that the worth of an autistic individual is tied to their ability to conform to neurotypical standards, rather than recognizing and valuing their unique strengths and potential.
The Importance of Challenging the Autistic Brain
For neuroplasticity—the brain’s ability to adapt and change—to occur, the brain must be allowed to overcome challenges. This is particularly true for autistic individuals, who benefit from opportunities to develop their skills and coping mechanisms through real-life experiences.
- Encouraging Social Skills Development: Rather than sheltering autistic individuals from social interactions, we should encourage them to engage in environments where communication is necessary. Online gaming, for instance, can provide a platform for social interaction based on shared interests, fostering social skills in a supportive context.
- Inspiring Learning and Growth: Autistic individuals should be inspired to learn and grow, not smothered by restrictive support plans that underestimate their potential. By providing opportunities for meaningful engagement and challenges, we can help autistic individuals develop the skills they need to improve their quality of life.
Conclusion
The DSM-5 levels of autism support, while well-intentioned, are fundamentally flawed. They do not account for the nuances of brain development, the context-dependent nature of autism, and the importance of challenging the brain to foster neuroplasticity. Instead of relying on divisive and potentially harmful labels, we should adopt a more individualized and dynamic approach to supporting autistic individuals, recognizing and nurturing their unique strengths and potential for growth.