Autism Spectrum Disorder (ASD) can vary widely from person to person, with symptoms appearing most notably as deficits in communication and social interactions, and the presence of repetitive and restricted patterns of behaviours. Also, symptoms are usually present in the early developmental years and can be diagnosed as early as 2 years of age.
According to the Diagnostic Statistical Manual 5 (DSM-V), the diagnostic criteria of ASD are:
Restricted, repetitive patterns of behaviour, interests, or activities, as manifested by at least two of the following:
Repetitive motor movements, use of object, or speech.
Insistence on non-functional routines, inflexible or shows extreme distress to small changes, difficulties with transitions.
Highly restricted, fixated interests with unusual objects.
Hyper or hyporeactivity to sensory inputs such as being indifferent to pain, excessive smelling or touching of objects, visual fascination with lights or movements.
Persistent deficits in social communication and social interaction across multiple contexts, as manifested by the following:
Difficulties in having a conversation, shows reduced interests, emotions, fails to initiate or respond to social interactions.
Poor understanding of verbal and non verbal communication e.g. poor eye contact and odd use of gestures, to a total lack of facial expressions and nonverbal communication.
Difficulties in developing, maintaining and understanding relationships.
(American Psychiatric Association, 2013)
Besides identifying the symptoms, the DSM-V also allows clinicians to provide an additional diagnosis, Level 1, 2, or 3, indicating the severity and the amount of support required for a person with autism to function in the general community. When considering the level of severity, clinicians usually take into account:
Restricted, repetitive behaviour
A child diagnosed with “Level 1” autism has some social communicative skills, may be able to speak in full sentences and engage in communication, but may not be able to have full conversations with others and may struggle at making friends.
He/she may also have problems following tasks in a group setting due to some inflexibility in behaviour. Support and intervention usually focus more on increasing the use of appropriate social communication skills, as well as correcting inappropriate behaviours to help the child become more independent in class.
A child with a “Level 2” diagnosis may still be able to communicate but uses very simple sentences, and tends to have odd body language or gestures. Interactions are also kept limited to a specific set of interests. The child will also struggle to cope with changes and tends to show more restricted/repetitive behaviours which can interfere with classroom learning.
More intervention is usually required for a child with “Level 2” autism, focusing on increasing verbal behaviours such that the child can make more requests, and building good sitting tolerance and attention to tasks such that the child will eventually be able to integrate into a group setting.
A child who has “Level 3” autism may have very few words of intelligible speech and rarely engages in interaction. Social approaches may be unusual and normally only initiated to meet needs. Responses are also usually only made to direct social cues.
He/she may be extremely resistant to changes, and have other stereotypical behaviours that interferes greatly with daily functioning. In such cases, intensive intervention is required to teach the child more functional behaviours, such as responding to verbal prompts and making requests, as well as to reduce non-functional ones, such as aggressive or screaming behaviours.
Summarised in table below:
Although a psychologist may initially place the child at a certain level, it is important to note that these levels only serve as a guide for parents and caregivers when seeking appropriate services. It does not necessarily indicate that a child will be permanently kept at that level. With the right interventions, many children do eventually learn the skills and behaviours that help them cope with more challenging demands in and out of school to become more independent overtime.