Autism-pedia / Diagnosis / Support levelsbrianspringer.com
Diagnosis

Support levels

What DSM-5 Levels 1, 2 and 3 say, how clinicians choose one, how consistent the ratings are, what Level 1 does and does not tell you about a person's needs, and how ICD-11 handles the same question without levels. The research is almost all on children.

Doctors who diagnose autism in the US can add a level, 1, 2 or 3. This page explains what the levels say, how doctors pick one, and why Level 1 does not mean "mild". Most of the research is about children.

Last reviewed 12 October 2026 · one person's reading of the research · 40 research and 12 community sources

What the three levels say Established

DSM-5, the American diagnostic manual, added a severity rating to the autism diagnosis in 2013. There are three levels: Level 1, "requiring support"; Level 2, "requiring substantial support"; and Level 3, "requiring very substantial support". A clinician rates social communication and restricted, repetitive behaviors separately, so a person can be Level 1 in one area and Level 2 in the other. The 2022 text revision, DSM-5-TR, left the levels unchanged.33,1,2

Each level describes how marked the traits are and gives an example. At Level 1, "Without supports in place, deficits in social communication cause noticeable impairments"; the example is a person "able to speak in full sentences" whose "to-and-fro conversation with others fails" and whose "attempts to make friends are odd and typically unsuccessful". For repetitive behaviors, "Inflexibility of behavior causes significant interference with functioning in one or more contexts", with difficulty switching between activities, and "Problems of organization and planning hamper independence."33,1,2 At Level 2, social difficulties are "apparent even with supports in place", the example is "a person who speaks simple sentences", and repetitive behaviors are "obvious to the casual observer". At Level 3, "Severe deficits" cause "severe impairments in functioning", the example is "a person with few words of intelligible speech", and repetitive behaviors "markedly interfere with functioning in all spheres".33,1,2

The manual adds two cautions. Severity "may vary by context and fluctuate over time", and a person's current presentation "might fall below level 1".3 And the levels are not meant to decide who is eligible for services: people with "relatively better skills overall may experience different or even greater psychosocial challenges", so needs have to be worked out person by person.1 Russell and colleagues note that the levels were not validated before the manual was published.1

Doctors in the US use a rule book called the DSM-5. In 2013 it added three levels to an autism diagnosis.1,2 Level 1 means "requiring support". Level 2 means "requiring substantial support". Level 3 means "requiring very substantial support".

A doctor gives two levels. One is for talking and getting along with people. The other is for repeated actions and sticking to sameness. So a person can be Level 1 for one and Level 2 for the other. A newer version of the book, from 2022, kept the levels the same.1,2

At Level 1, the book gives the example of a person who speaks in full sentences. But their back-and-forth talk does not work well, and making friends is hard.1,2 At Level 3, the example is a person who speaks very few words.1,2

The book also says a person's needs can change from place to place and over time.3 It says the levels should not decide who gets help.1 One research team notes that nobody tested the levels before the book came out.1

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Established

This section reports the manual's own wording, confirmed in research papers that reproduce or quote it. It describes a document, not a finding.

Word
Restricted, repetitive behaviors

The second core area of an autism diagnosis: repeated movements or speech, insistence on sameness, intense interests, and unusual reactions to sensory input.

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Established

This part tells you what the doctors' rule book says. Two research papers copy its exact words.

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How a level is chosen Emerging

The manual gives no test or cut-off for choosing a level. European guidance for clinicians says it "is unclear on what exactly is meant by 'some', 'substantial' or 'very substantial' support".4 Working from the draft criteria, with registry data from 2010 and 2011, one team sorted 726 children aged 15 months to 17 years, 84% of them boys, into mild (or none), moderate and severe bands on three measures: autism traits, IQ and everyday adaptive skills. Only 0.3% were mild on all three, 3.4% moderate on all three, and 24.7% severe on all three; most children had high trait scores, while their IQ and adaptive scores were spread across all three bands. The authors warned that without an established method, levels assigned by "site- and provider-specific criteria" would be hard to interpret.5

Once clinicians began using the levels, studies found the levels tracking IQ and daily skills as well as autism traits. In 158 people diagnosed at one developmental disabilities clinic, adaptive skills fell and autism trait severity rose step by step from Level 1 to Level 3, in both areas, and no one was rated Level 1 in one area and Level 3 in the other.6 A later study from the same group, of 136 children referred for specialist assessment, linked levels to IQ, adaptive skills, autism traits and age; it detected no difference by sex.7 In 248 children at six Autism Treatment Network sites, higher levels went with younger age, lower IQ and higher scores on the ADOS-2 observation, but not with emotional or behavioral problems; the authors suggested clinicians may be folding cognitive ability into the level.8 In 405 autistic children diagnosed under DSM-5 at one specialist service in Singapore, those rated Level 3 for social communication had about 15 times the odds of intellectual impairment of those rated Level 1, with a wide margin of uncertainty; the repetitive behavior level did not predict it.9

In US surveillance records of 4- and 8-year-olds, children documented as not having intellectual disability who had a social communication level were most often rated Level 2 (52.6%); 29.7% were rated Level 1 and 17.8% Level 3.1 In those records, a child without intellectual disability was usually not rated Level 1.

The book gives no test for picking a level.4 Before the levels were used, one team looked at 726 children.5 They checked three things: autism traits, IQ and everyday skills. Very few children scored "mild" on all three. Most children's three scores did not match.5

Later studies looked at the levels doctors gave. Children with higher levels tended to have a lower IQ and weaker everyday skills.6,7,8 Some researchers think doctors may be mixing IQ into the level.8 In Singapore, children at Level 3 were much more likely to also have an intellectual disability.9

In US records, children without an intellectual disability were most often rated Level 2, not Level 1.1

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Emerging

Single clinic and registry studies, almost all of children, and two of them come from the same clinic group. They agree on what the levels go along with, but no review has pooled them, and none tests whether a level predicts later needs or outcomes.

Word
Adaptive skills

Everyday skills such as dressing, cooking, getting around and talking with others, usually measured with a parent or carer interview such as the Vineland scales.

Emerging

These are single studies, mostly of children. Two come from the same team. They agree, but nobody has combined them yet.

Word
Everyday skills

Things like getting dressed, cooking, getting around and talking with others. Scientists call these adaptive skills.

How often levels are recorded, and how consistent Emerging

Many diagnostic reports leave the level out. In US surveillance records of 15,450 autistic children aged 4 and 8, from 2018 and 2020, only 40.4% had any level recorded, from 4.8% to 73.2% depending on the site. Levels were more often missing for Black children than for white children.1 Among children with a social communication level, 21.3% were Level 1, 47.9% Level 2 and 30.8% Level 3; for repetitive behaviors the figures were 25.9%, 50.9% and 23.2%. Eight-year-olds were more often rated Level 1 than 4-year-olds (29.0% against 16.1% for social communication), though these were different children, not the same children re-rated.1 Black children were less often rated Level 1 for social communication than white children (14.3% against 24.3%) and more often Level 3 (41.7% against 28.2%), differences that held after allowing for intellectual disability, sex, age, year and site. Among records with a level, Level 3 was more common in 2020 than in 2018.1

When 49 toddlers aged 16 to 31 months were each assessed by independent clinicians, once by telehealth and once in person, the levels agreed only fairly for social communication (kappa 0.32) and slightly for repetitive behaviors (kappa 0.20), even though an earlier report on the same children found high agreement on the diagnosis itself. The uncertainty ranges for both include zero, so chance agreement cannot be ruled out. Ratings did not differ by clinician, team or type of assessment, and the authors suggest that factors beyond the two core areas may influence the level.10 As of October 2026, this is the only study found that reports an agreement statistic for the levels.

Many reports leave the level out. In US records of 15,450 autistic children, only about 4 in 10 had a level written down.1 It changed a lot from place to place, from about 5% to 73%.1

Levels were left out more often for Black children. Black children were also less often rated Level 1 than white children, and more often Level 3.1

In one small study, 49 toddlers were checked twice: once by video call and once in person. Doctors mostly agreed the toddlers were autistic. But they often did not agree on the level. The study was small, so this result is uncertain.10

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Emerging

One large records study and one small study of toddlers. The records come from US surveillance sites that were not chosen to represent the country, and fewer than half of the records gave a level. The agreement study is small and its uncertainty ranges include chance-level agreement.

Word
Kappa

A measure of how far two ratings agree beyond what chance would produce: 0 is chance, 1 is perfect agreement. The study's authors call 0.32 fair agreement and 0.20 slight.

Emerging

One big study of records and one small study of toddlers. Fewer than half of the records gave a level. The toddler study was small, so its results are uncertain.

Do levels change? Emerging

No study found as of October 2026 has assigned DSM-5 levels to the same people twice and compared them; the large surveillance study notes that its design cannot show individual change.1 What is known comes from autism trait scores on the ADOS, which measure something narrower than a level. In 339 of 345 children assessed between ages 2 and 15, 84% stayed in persistently high or moderate groups; scores rose over time in 9% and fell in 7%.11 In 125 children, 36 of them girls, assessed at about 3 and again at about 6, scores fell in 28.8%, held steady in 54.4% and rose in 16.8%; girls' scores tended to fall more often than boys', and children whose scores fell had higher IQs than those whose scores rose.12 In 421 preschoolers followed to age 6, trait scores fell in 11.4%, and everyday skills followed their own separate paths.13 A narrative review of 33 such studies, led by the same first author as the study of 125 children, concluded that change in severity "appears common, though stability of symptoms is also frequent."14

A level given to a 3-year-old may not describe the same person at 10 or at 30, and the manual itself expects severity to vary with context.3

No study has rated the same people's level twice and compared.1 But some studies have measured autism traits in the same children over years.11,12,13

Most children stayed about the same. Some had scores that went down, and some had scores that went up.11,12 In one study, girls' scores tended to go down more often, but there were only 36 girls.12 Everyday skills changed in their own way, separate from autism traits.13 One review says change is common, but staying the same is common too.14

So a level given at age 3 may not fit the same person at 10 or 30.3

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Emerging

No study has re-rated DSM-5 levels in the same people. The evidence comes from studies of autism trait scores, mostly in young children and mostly boys, which may not carry over to support levels.

Emerging

Nobody has given the same people a level twice. So this part uses studies of autism trait scores instead, mostly in young boys.

Level 1 and everyday skills Emerging

"Level 1" is often heard as "mild". Studies of people diagnosed at Level 1, or without intellectual disability, show why the reading misleads. In 81 school-aged children given a first diagnosis at Level 1, the average IQ was about 104, in the typical range, but the average adaptive score was about 77, and lowest for social skills, at about 73.15 The same gap between IQ and everyday skills appears in larger samples of autistic children without intellectual disability.16

Outcomes in adulthood are mixed. In a US group first referred for possible autism in early childhood, the 43 young adults who had an autism diagnosis at some point and a verbal IQ of 70 or more, nearly all men, were similar on many outcomes to 17 referred peers who were never diagnosed, and families supported adults at all levels of ability. Their parents rated their well-being and positive mood lower, and they reported more depression and negative mood than their parents reported for them.17

Often saidLevel 1 is mild autism.
Evidence

Level 1 is defined as "requiring support". Children diagnosed at Level 1 can have average IQ alongside everyday skills well below it.1,15

Many people hear "Level 1" and think "mild". Studies show why that can be wrong. In 81 children diagnosed at Level 1, IQ was average.15 But their everyday skills were well below their IQ. Social skills were lowest.15 Bigger studies of autistic children without an intellectual disability find the same gap.16

One US study followed a group into their twenties. The young men with higher IQs were doing about as well as others in many ways. But they reported more sadness than their parents noticed.17

Often saidLevel 1 is mild autism.
Evidence

Level 1 means "requiring support". A child at Level 1 can have an average IQ but find everyday tasks much harder.1,15

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Emerging

One clinic chart review of children diagnosed at Level 1, using a brief IQ test, and one small cohort followed into adulthood. The broader gap between IQ and daily skills is better established and is covered in Language and labels.

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Emerging

This comes from one clinic's records and one small group followed into adulthood.

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Mental health without intellectual disability Established

Research rarely groups people by level, but it does group them by intellectual disability, and on mental health, autistic people without intellectual disability do not fare better. In a meta-analysis of 35 studies of autistic adults, current depression was found in about 26% of samples without intellectual disability and 14% of samples with it; for anxiety the difference was not significant. The authors note that self-report measures may miss depression in people with intellectual disability.18 A meta-analysis limited to autistic and possibly autistic people without intellectual disability, 36 studies and 48,186 people, found suicidal thoughts in 34.2% and suicide attempts or other suicidal behavior in 24.3%.19 One Swedish register study reported that the odds of death by suicide, including deaths of uncertain intent, were 9.40 times those of matched controls for autistic people without intellectual disability and 2.41 times, based on only 7 deaths, for those with it.20 A later study by the same group, in the same registers, found the risk highest in those without intellectual disability who also had ADHD. Risk was also raised in autistic people with intellectual disability, women without intellectual disability generally had a higher risk of suicidal behavior than men, most clearly for suicide attempts, and the estimates shrank when other psychiatric conditions were taken into account.21

These are associations: the studies do not show that the absence of intellectual disability causes poorer mental health.

Studies rarely sort people by level. But they often sort people by whether they have an intellectual disability. Autistic adults without one were more often depressed in many studies.18 About 1 in 3 had thought about suicide.19

One study in Sweden found that deaths by suicide were raised most in autistic people without an intellectual disability.20 The same team found risk was highest when they also had ADHD. Risk was raised for autistic people with an intellectual disability too.21 These studies show a link. They do not show that one thing causes the other.

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Established

Two meta-analyses support the rates; the comparison with intellectual disability rests on one meta-regression, and both meta-analyses report high heterogeneity between studies. The suicide-death figures come from one Swedish research group and are worded as single findings. All of these studies group people by intellectual disability, not by DSM-5 level.

If you are thinking about suicide

Please talk to someone now: a doctor, a person you trust, emergency services, or a crisis line where you live.

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Established

Studies that combine many other studies support this. The numbers about deaths come from one team in Sweden.

If you are thinking about suicide

Please talk to someone now: a doctor, a person you trust, or a crisis line where you live.

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Support and services Emerging

In some places a level is used to help decide who can get services, despite the manual's caution. As of October 2026, Australia's National Disability Insurance Scheme lists autism assessed at Level 2 or Level 3, and not Level 1, among the conditions likely to meet its disability requirements (the guideline carrying the list is dated 26 August 2026).22 The scheme's rules are changing. From October 2026, Australia began rolling out Thriving Kids, a program for children aged 8 and under with developmental delay or autism and low to moderate support needs, in stages, with all supports to be rolled out by January 2028.36,40 Children in that age group with high support needs stay eligible for the NDIS, which from 1 January 2028 will assess new applicants on functional capacity.38 No study found as of October 2026 has measured how much an assigned level changes the services a person ends up receiving.

Two analyses of US national Medicaid records describe who receives support. In 2022 data covering 1.4 million adults with intellectual and developmental disabilities, 68.3% received home and community based services, one optional Medicaid benefit that varies by state; after adjustment, autistic adults without intellectual disability were 18.3 percentage points less likely to receive any of them than adults with intellectual disability without autism, and autistic adults with intellectual disability were 4.6 points more likely. The authors suggest the gap may reflect different service needs, or a lower chance that autistic adults without intellectual disability qualify for these services.34 In 2019 data, SSI participation among working-age people with autism or intellectual disability was higher than average, with many aged 18 to 25, and they used outpatient psychiatric services more often than others even though their overall service use was similar.35

Studies of autistic people without intellectual disability describe gaps. In an early US study of 66 young adults followed out of school, the 17 without intellectual disability were about three times as likely as the others to have no regular daytime activity (4 of 17 against 4 of 49), numbers too small for firm conclusions; the authors wrote that the service system may be inadequate for youth without intellectual disability as they leave school.23 In a US national survey from 2007 to 2008, parents reported that 39.1% of autistic young adults aged 19 to 23 had received none of four services (mental health care, medical evaluation, speech therapy and case management) since leaving high school; the odds of no services were higher for Black participants and those with low incomes, and a case manager was less likely for those with stronger everyday skills.24 In an online survey of 200 UK autistic adults without intellectual disability, most of them women, 76 of the 159 who wanted support of any kind received none, and 26 said they had been dismissed as coping, or as too "high-functioning", to need it.25 A survey across the European Union and the UK, of 2,322 autistic people and family carers, found many unable to get services: therapeutic help for 13.5% and mental health support for 11.9%, most often because a service was unavailable, the person was judged ineligible, or the wait was too long.39

In a survey of caregivers of 238 autistic adolescents aged 12 to 16 in four US states, caregivers reported an unmet need for 28 of the adolescents and for 174 of themselves, most often dental care for the adolescents and a limited social life for the caregivers. Adolescents who met any of the three "profound autism" criteria the study assessed were more likely to be expected to need supervised housing (an unadjusted prevalence ratio of 8.30), yet 11 of the 28 with an unmet need met none of the criteria.37

Autistic burnout, defined in an autistic-led study as long-term exhaustion, loss of skills and lower tolerance of stimulation that follows chronic stress and a mismatch between what is expected and what a person can do without support, has been described mainly by adults who could take part in interviews and surveys; the authors note that people with higher support needs were missing from their sample.26

In Australia, one big disability program uses levels. As of October 2026, Levels 2 and 3 are likely to qualify for support. Level 1 is not on that list.22 Australia also began a new program in October 2026. It is for children aged 8 and under with low to moderate support needs.36 The new program is being added in stages.40 Children with high support needs can still get help from the older program.38 No study has checked, as of October 2026, whether a level matches the help a person actually gets.

In 2022, US records showed that most adults with autism or an intellectual disability got home support.34 But autistic adults without an intellectual disability got less of it than adults with one.34 SSI is a government payment. Adults with autism or an intellectual disability used SSI more than average, especially those aged 18 to 25.35

Other studies looked at autistic people without an intellectual disability. Some young adults had nothing to do during the day.23 Many got no services after high school.24 In a UK survey, about half of those who wanted support got none.25 Some were told they were coping too well to need it.25 A survey in Europe found that many autistic people could not get the services they needed.39

One US survey asked caregivers of 238 autistic teenagers about unmet needs. Many caregivers and teenagers had unmet needs. The survey used certain criteria to spot the highest support needs. Almost 4 in 10 of the teenagers with an unmet need did not match them. So a label does not catch everyone who needs more help.37

Autistic adults also describe burnout. That means long-lasting exhaustion and losing skills they used to have.26

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Emerging

US and Australian records and surveys, a European survey, and one small caregiver survey, none of which grouped people by DSM-5 level. The policy example is a document, not a finding.

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Emerging

These are big records and surveys from the US, plus small studies and a UK survey. None sorted people by level.

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ICD-11's different approach Established

The WHO's ICD-11, used in much of the world, has no severity levels for autism. It divides the diagnosis by two things measured outside autism itself: whether there is also a disorder of intellectual development, and how much functional language a person has (mild or no impairment, impaired, or absent).27,28,29 Intellectual disability is diagnosed separately, with its own severity grade.27 The current list has no category for absent language without intellectual disability, though early versions did.29,4 ICD-11 also says that some autistic people "are able to function adequately in many contexts through exceptional effort, such that their deficits may not be apparent to others", and that the diagnosis still applies.27 European guidance notes that the validity and stability of the ICD-11 subgroups "are still to be demonstrated".4

Researchers have criticized the DSM-5 levels. Waizbard-Bartov and colleagues argue that the levels rest on the two core areas alone and propose describing intellectual ability, language, other conditions, daily living skills and support needs as separate dimensions, as is done for intellectual disability.30 Rosen, Lord and Volkmar write that the severity metric "has shown questionable validity".31 The Lancet Commission on autism found the DSM-5 specifiers and the ICD-11 subcategories "not easily or consistently used in practice or in research", and proposed "profound autism" for people who need care around the clock.32 That proposal, and how many people it would cover, is described in Language and labels; the arguments over it are in Neurodiversity.

Much of the world uses a different rule book, the ICD-11. It has no autism levels.27,28,29 Instead it asks two questions. Does the person also have an intellectual disability? And how much can they use language to communicate?27,28

The ICD-11 also says some autistic people manage only through great effort. Their difficulties may not show, but they are still autistic.27

Some researchers think the DSM-5 levels do not work well.30,31,32 One team suggests describing several separate things instead, such as IQ, language and other conditions.30 Another group suggested a new term, "profound autism", for people who need care all day and night.32

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Established

This section describes the WHO classification and named authors' published views. The ICD-11 subgroups have not themselves been tested for validity.

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Established

This part describes a rule book from the World Health Organization and what some experts have written about the levels.

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In the community Community

Many autistic writers prefer to talk about support needs rather than functioning. Eric Garcia describes autistic people like himself, who may live on their own or work full time, as having "lower support needs", and those who cannot speak or need care around the clock as having "higher support needs".c6 Megan Anna Neff applies this to the levels: people at Level 3 need more support, while people at Level 1 "may have fewer intensive daily living-support needs but tend to have high mental health support needs".c1 She also writes that functioning labels "dismiss the challenges of Autistic people who mask".c1

Writers given the lighter label describe being told they are barely autistic. Daniel M. Jones lists what people say on hearing he is autistic: "You don't look autistic", or "Well, if you are, then you must be very high-functioning." Such remarks, he writes, "can make us feel like imposters trying to prove to someone a condition that we have."c2 Bianca Toeps took the first of those phrases as the title of her book.c3 She writes that burnout is the biggest danger of "high-functioning" autism, in quotation marks because the person who seems to be doing fine is often struggling to keep their head above water.c4 One of Megan Griffith's respondents, Sherry S., says people do not believe she is disabled because she works full time and cares for a family member: "They don't see the cost, just the actions."c5 Devon Price writes that "masking as outgoing and sociable can lead to an Autistic person's struggles being underestimated or erased."c7

Writers also point to the support behind apparent ease. Julia Bascom, interviewed by Garcia about her advocacy work, says she can do it "not because my disability doesn't impact it but because I have this elaborate scaffold of supports that is invisible to people who aren't involved in it."c8 Research on the support and mental health of autistic adults without intellectual disability is in the sections above.

Others object to a level fixed at diagnosis. Luke Beardon, who writes for autistic adults, argues that it is "a bit of a stretch" to judge at the point of identification a level of support that will hold afterwards, notes that there is no guidance for when needs change, and treats support levels as functioning labels in effect.c11 Orion Kelly, diagnosed as an adult, writes that he needs daily support and that "the support needs of all Autistic people can fluctuate daily."c12 Research on whether levels change is in the section above.

Many autistic writers talk about "support needs" instead of levels or labels. Eric Garcia says people like him have "lower support needs".c6 Megan Anna Neff writes that people at Level 1 often need a lot of mental health support.c1

Writers say people often tell them they do not seem autistic. Daniel M. Jones hears "You don't look autistic" and "you must be very high-functioning".c2 He says this can make autistic people feel like fakes.c2 Bianca Toeps used the same words for the title of her book.c3 She writes that people who seem fine are often struggling hard.c4 Devon Price writes that friendly, chatty autistic people often have their struggles missed.c7

Julia Bascom says she can do her job because of help that other people cannot see.c8

Some writers say a level should not be fixed. Luke Beardon says one level given at diagnosis may not fit later. There are no rules for when needs change.c11 Orion Kelly says autistic people's support needs can change from day to day.c12

Suggest a correction
Community

How autistic writers describe being given a level or a functioning label. Not a research finding.

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Community

This is how autistic writers describe being given a level or a label. It is not a research finding.

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From nonspeaking writers Nonspeaking

Writers given the heavier label describe being written off. Amy Sequenzia, a nonspeaking autistic writer who types to communicate and also has cerebral palsy and epilepsy, writes that functioning labels are neither accurate nor helpful, and that "Being called 'low-functioning' and dismissed as a lost cause did enormous harm to my self-esteem."c9 Peyton Goddard, who was supported to type at 22, describes being labeled "low-functioning autistic", among other labels, and judged incapable of learning in the years before she had a dependable way to communicate.c10

Some writers were given the "low-functioning" label. Amy Sequenzia does not speak. She types to communicate. She says being called "low-functioning" hurt her self-esteem a lot.c9 Peyton Goddard began typing with support at 22. She was given labels like "low-functioning". People thought she could not learn.c10

Suggest a correction
Nonspeaking

In their own words, written by typing, spelling, handwriting or AAC, some with a communication partner's support. Researchers dispute whether some partner-supported methods let the writer, not the partner, choose the words; the pedia reports these accounts as their writers' and does not settle that question here. The methods and the evidence about who authors the words are set out in Facilitated communication and spelling to communicate.

Nonspeaking

These are the words of people who do not speak and write by typing or spelling. Some use a helper. Researchers disagree about some of those methods. You can read about these methods in Facilitated communication and spelling to communicate.

Sources

Research

  1. 1Russell LA, Tinker SC, Shaw KA, 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. Journal of Autism and Developmental Disorders, 2026. https://doi.org/10.1007/s10803-026-07292-6
  2. 2Wiggins LD, Durkin M, Esler A, et al. Disparities in Documented Diagnoses of Autism Spectrum Disorder Based on Demographic, Individual, and Service Factors. Autism Research, 2020. https://doi.org/10.1002/aur.2255
  3. 3Amoretti MC, Lalumera E, Serpico D. The DSM-5 introduction of the Social (Pragmatic) Communication Disorder as a new mental disorder: a philosophical review. History and Philosophy of the Life Sciences, 2021. https://doi.org/10.1007/s40656-021-00460-0
  4. 4Fuentes J, Hervás A, Howlin P, et al. ESCAP practice guidance for autism: a summary of evidence-based recommendations for diagnosis and treatment. European Child and Adolescent Psychiatry, 2021. https://doi.org/10.1007/s00787-020-01587-4
  5. 5Weitlauf AS, Gotham KO, Vehorn AC, et al. Brief Report: DSM-5 "Levels of Support:" A Comment on Discrepant Conceptualizations of Severity in ASD. Journal of Autism and Developmental Disorders, 2014. https://doi.org/10.1007/s10803-013-1882-z
  6. 6Gardner LM, Campbell JM, Keisling B, et al. Correlates of DSM-5 Autism Spectrum Disorder Levels of Support Ratings in a Clinical Sample. Journal of Autism and Developmental Disorders, 2018. https://doi.org/10.1007/s10803-018-3620-z
  7. 7Gardner L, Gilchrest C, Campbell JM. Intellectual, Adaptive, and Behavioral Functioning Associated with Designated Levels of Support in a Sample of Autistic Children Referred for Tertiary Assessment. Journal of Autism and Developmental Disorders, 2024. https://doi.org/10.1007/s10803-023-06141-0
  8. 8Mazurek MO, Lu F, Macklin EA, et al. Factors associated with DSM-5 severity level ratings for autism spectrum disorder. Autism, 2019. https://doi.org/10.1177/1362361318755318
  9. 9Wong CM, Koh HC, Agarwal P, et al. Diagnostic patterns and predictors of cognitive outcomes in autistic children in Singapore. Annals of the Academy of Medicine Singapore, 2025. https://doi.org/10.47102/annals-acadmedsg.2024385
  10. 10Morrier MJ, Schwartz AJ. DSM-5-TR Severity Levels for Autism Spectrum Disorder (ASD): Agreement Between Clinicians Using Telehealth and In-Person Assessment Procedures. Autism Research, 2026. https://doi.org/10.1002/aur.70351
  11. 11Gotham K, Pickles A, Lord C. Trajectories of Autism Severity in Children Using Standardized ADOS Scores. Pediatrics, 2012. https://doi.org/10.1542/peds.2011-3668
  12. 12Waizbard-Bartov E, Ferrer E, Young GS, et al. Trajectories of Autism Symptom Severity Change During Early Childhood. Journal of Autism and Developmental Disorders, 2021. https://doi.org/10.1007/s10803-020-04526-z
  13. 13Szatmari P, Georgiades S, Duku E, et al. Developmental Trajectories of Symptom Severity and Adaptive Functioning in an Inception Cohort of Preschool Children With Autism Spectrum Disorder. JAMA Psychiatry, 2015. https://doi.org/10.1001/jamapsychiatry.2014.2463
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