Autism is a complex neurodevelopmental condition that affects how a person communicates, interacts, behaves, and learns. It is called a “spectrum” disorder because there is wide variation in the type and severity of symptoms people experience. There are three main levels of autism spectrum disorder (ASD): Level 1, Level 2, and Level 3.
Level 1 Autism
Level 1 autism, sometimes still referred to as high-functioning autism or Asperger’s syndrome, represents the mildest and highest-functioning end of the autism spectrum. People with level 1 autism tend to have average or above-average intelligence and relatively strong language and communication skills compared to those with more severe forms of autism.
Some key characteristics of level 1 autism include:
- No significant delay in language development or cognitive skills
- Ability to speak fluently with advanced vocabulary by age 5
- Strong reading and writing skills, though handwriting may be poor
- Average or above-average IQ
- Difficulty with social communication and interaction
- Challenges making and maintaining friendships
- Poor nonverbal communication skills like abnormal eye contact and body language
- Difficulty understanding social cues
- May be seen as awkward, eccentric, or isolated from peers
- Repetitive behaviors or intense interests in specific subjects
- Sensory sensitivities – for example, to light, sound, touch, smell, or taste
- Need for consistency and difficulties with transitions or changes
While language and cognitive abilities are relatively strong in level 1 autism, social skills and communication typically remain impaired to some degree. Challenges interacting with others and fitting in socially are hallmark signs. Special interests and repetitive behaviors may also be present.
Diagnosing Level 1 Autism
Level 1 autism is generally diagnosed between the ages of 2 and 10 years old. Many children may receive an initial diagnosis of Pervasive Developmental Disorder – Not Otherwise Specified (PDD-NOS) before later being diagnosed with autism.
To receive an autism diagnosis, a child must meet criteria outlined in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). These include:
- Ongoing deficits in social communication and social interaction, such as abnormal social approach, failure to understand social cues, lack of conversational skills, and difficulties making friends.
- Restricted, repetitive patterns of behavior, interests, or activities, such as repetitive speech or motor movements, excessive adherence to routines, highly restricted interests, and hyper- or hyporeactivity to sensory input.
- Symptoms must be present in early childhood development.
- Symptoms cause significant impairment in social, occupational, or other important areas of functioning.
In level 1 autism, there is no language delay early in life and no significant delay in cognitive development, self-help skills, curiosity about the environment, or adaptive behavior (other than in social interaction).
Assessing Severity
Within the diagnosis of autism spectrum disorder, clinicians also assess the severity of an individual’s symptoms in two core domains – social communication and restricted/repetitive behaviors. There are 3 levels of severity for each domain:
Social Communication Severity Levels
- Level 1: Difficulty initiating social interactions and demonstrates clear examples of atypical or unsuccessful responses in social situations. May appear to have decreased interest in social interactions.
- Level 2: Marked deficits in verbal and nonverbal social communication skills. Limited initiation of social interactions and reduced or abnormal social response.
- Level 3: Severe deficits in verbal and nonverbal social communication skills cause severe impairments in functioning, very limited initiation of social interactions, and minimal response to social overtures from others.
Restricted, Repetitive Behaviors Severity Levels
- Level 1: Inflexibility of behavior causes significant interference with functioning in one or more contexts. Difficulty switching between activities. Problems with organization and planning may impede independence.
- Level 2: Marked inflexibility of behavior, difficulty coping with change, or other restricted/repetitive behaviors appear frequently enough to be obvious to the casual observer and interfere with functioning in a variety of contexts.
- Level 3: Rigidity of behavior, extreme difficulty coping with change, or other restricted/repetitive behaviors markedly interfere with functioning in all spheres. Great distress when rituals or routines are interrupted.
By combining an individual’s severity levels in these two domains, clinicians determine the overall severity level of an autism diagnosis – Level 1, Level 2, or Level 3.
Unique Abilities
Despite challenges, many people with level 1 autism possess unique abilities in areas such as:
- Math, science, technology, engineering, visual arts
- Music and the arts
- Academics and memorization
- Focusing intently on areas of interest
- Noticing details others miss
- Advanced vocabulary and language skills
Strengths like these allow many people with high-functioning autism to thrive academically, socially, and professionally with the right support in place. Many view their autism as an integral part of who they are.
Treatment and Support
There is no medical “cure” for autism spectrum disorder. However, early diagnosis and intervention can make a huge difference in helping children with level 1 autism develop skills for living a rewarding, independent life.
Recommended treatment options may include:
- Behavioral Therapies: Applied behavior analysis (ABA), speech therapy, and social skills training can improve communication, social, academic, and adaptive skills.
- Medications: May be used to treat co-occurring conditions like anxiety, depression, OCD, ADHD, sleep issues, and more. Currently, there are no medications that specifically treat the core symptoms of autism.
- Educational Support: Individualized education programs (IEPs), accommodations, learning supports, speech/language services, and more can provide a critical foundation for lifelong learning and achievement.
- Assistive Technology: Communication devices, computer software, organizers, visual supports, and more can augment abilities and teach new skills.
As they grow up, continued support services and interventions can help teens and adults with level 1 autism live independently, make and maintain friendships, handle anxiety, find meaningful work, and fully participate in their community.
Prognosis
Outcomes for individuals with level 1 autism vary widely depending on the person’s abilities, challenges, support systems in place, and other factors. Many people with high-functioning autism are able to complete high school, pursue higher education, live independently, maintain relationships and employment, and significantly contribute to society in ways that utilize their often remarkable talents and skills.
However, others may continue to require high levels of support and care throughout their lives due to greater difficulties with communication, social skills, self-care, and independent living skills. Mental health conditions like anxiety and depression may also impact functioning and require ongoing monitoring and treatment.
Controversies
There are some controversies surrounding level 1 autism and its diagnosis:
- Some argue it is no longer a valid diagnosis and that abolishing Asperger’s as a separate label has made it harder for higher-functioning individuals to access services and support.
- There are concerns about the large number of children, particularly boys, being diagnosed with autism spectrum disorder in recent years.
- Differentiating between mild ASD and other conditions like ADHD, learning disabilities, and anxiety can be challenging.
- There is debate around linking autism severity levels to the amount of support needed, as needs vary greatly by individual.
More research is needed to better understand how those with level 1 autism fare across their lifespan. Improving assessment tools, biomarkers, and personalized treatment approaches also remain important goals moving forward.
Key Takeaways
- Level 1 autism, also known as high-functioning autism, represents the mildest end of the autism spectrum with no intellectual disability.
- Individuals have strong language, cognitive, and academic skills but marked challenges with social communication and interaction.
- With appropriate behavioral, educational, technological, and mental health supports, many people with level 1 autism can live independent and fulfilling lives.
- Outcomes vary greatly based on an individual’s unique abilities and challenges.
- There remains debate around the validity of level 1 as a diagnosis and how to differentiate it from similar conditions.
Conclusion
Level 1 autism encompasses those with milder symptoms who are still significantly impaired socially without an accompanying intellectual disability. Understanding the unique features and variability within this level of the spectrum is key to ensuring access to appropriate support services tailored to individual needs. While debate exists around the diagnosis itself, improved awareness, early intervention and lifelong supports enable many people with level 1 autism to thrive personally and professionally.