Dividing lines between Mild, Miderate, and Severe autism?

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Is there anyone here with a special interest in the DSM-5 or psychology who is knowledgeable about how the dividing lines will be drawn between the new severity levels for autism? I find the descriptions of the severity to be very vague, not much better than saying an individual needs a little, a lot, or extensive support.

Whatever those lines are, they will be arbitrary because diagnosing autism is still very subjective. I think we must be ever mindful not to demand more precision from something than it is capable of rendering. For example, mathematics is more precise than the social sciences, and autism diagnoses tend more toward the latter than the former.

Bottom line: The lines of severity for autism will ultimately be up to the judgment of the medical professional, at least until more objective criteria can be established.

Or in short terms- former AS (and HFA)- mild

Autism- severe

PDD NOS- moderate... support will vary regarding on one's independency in everyday life activities starting with self care, mobility, social skills ( feeding, hygiene etc... needs caregiver inside an/or outside home... verbal-nonverbal etc) for me it is fair..

Severity Level for ASD
Social Communication - Restricted interests & repetitive behaviours

Level 3 - ‘Requiring very substantial support’
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.

Preoccupations, fixated rituals and/or repetitive behaviours markedly interfere with functioning in all spheres. Marked distress when rituals or routines are interrupted; very difficult to redirect from fixated interest
or returns to it quickly.

Level 2 - ‘Requiring substantial support’
Marked deficits in verbal and nonverbal social communication skills; social impairments apparent even with supports in place; limited initiation of social interactions and reduced or abnormal response to social overtures from others.

Ritual and repetitive behaviors (RRBs) and/or preoccupations or fixated interests appear frequently enough to be obvious to the casual observer and interfere with functioning in a variety of contexts.
Distress or frustration is apparent when RRB’s are interrupted; difficult to redirect from fixated interest

Level 1 - ‘Requiring support’
Without supports in place, deficits in social communication cause noticeable impairments. Has difficulty initiating social interactions and demonstrates clear examples of atypical or unsuccessful responses to social overtures of others. May appear to have decreased interest in social interactions.

Rituals and repetitive behaviors (RRB’s) cause significant interference with functioning in one or more contexts. Resists attempts by others to interrupt RRB’s or to be redirected from fixated interest.

in my opinion there should should be athird section about sensory issues because although some of my trailts may be mild my sensory issues are worse

@Ravenclawgurl - this is the official DSM-5 bit about sensory issues.

4. Hyper-or hypo-reactivity to sensory input or unusual interest in sensory aspects of environment; (such as apparent indifference to pain/heat/cold, adverse response to specific sounds or textures, excessive smelling or touching of objects, fascination with lights or spinning objects).

And you're right: they don't make a distinction as to its severity. Right now, for instance, all this sunlight makes my eyes water. That's mild compared to some others who have to wear blackened shades because the sunlight gives them severe headaches.

Aren't the two domains supposed to be evaluated separately? I currently have an Asperger's diagnosis, but I am level 1-2 in the social domain, and level 2-3 in RRBs. If they were to just chuck me into level 1 because I can talk and got diagnosed with Asperger's, they would be ignoring the bigger problems I have with totally non-social cognitive aspects of autism.

I don't really think of this as being "more severe", really; it is more like being "father from neurotypical". Because the current resources available are designed for NTs, the gap between what I can do and what's expected is bigger for me than it would be for someone correctly described as "level 1" in both domains. I sometimes need someone to prompt me to enable task-switching. I don't naturally initiate social contact. Some things I can't do without help. Even with supports, I don't look normal and never will. This is okay by me; that is who I am.

Here's the actual final levels from the published DSM-5.


Social Communication

Level 3:

Severe deficits in verbal an nonverbal social communication skills cause severe impairments in functioning, very limited initiation of social interactions, and minimal response to social overtures from others. For example, a person with few words of intelligibly speech who rarely initiates interaction and, when he or she does, makes unusual approaches to meed needs only and response to only very direct social approaches.


Level 2:

Marked deficits in verbal and nonverbal social communication skills; social impairments apparent even with supports in place; limited initiation of social interactions; and reduced or abnormal responses to social overtures form others. For example, a person who speaks simple sentences, whose interaction is limited to narrow special interests, and who has markedly odd nonverbal communication.


Level 1:

Without supports in place, deficits in social communication cause noticeable impairments. Difficult initiating social interactions, and clear examples of atypical or unsuccessful responses to social overtures to others. May appear to have a decreased interest in social interactions. For example a person who is able to speak in full sentences and engages in communication but whose to-and-fro conversation with others fails, and whose attempts to make friends are odd and typically unsuccessful.



Restricted, Repetitive behaviors:

Level 3:

Inflexibility of behavior, extreme difficulty coping with change, or other restricted/ repetitive behaviors markedly interfering with functioning in all spheres. Great distress/difficulty changing focus or action.


Level 2:

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 functioning in a variety of contexts. Distress and/or difficulty changing focus or action.


Level 1:

Inflexibility of behavior causes significant interference with functioning in one or more contexts. Difficulty switching between activities. Problems of organization and planning hamper independence.


Also - yes, it can fall below level 1 in severity.

Very glad they kept that part. I still have Asperger's on my record, but hopefully soon they'll change it to ASD. I don't have anything against the idea of Asperger's; it served its purpose, teaching us that people with autism can be verbal and independent, but I think we've gotten what good we can out of it now. It just has a lot of assumptions with it, about what you can and can't do if you're an Aspie, and many of those aren't true about me or about many other people diagnosed as AS. Hopefully now that we know autistic people can be very competent and independent, and have potential that isn't immediately apparent, we'll be able to say "ASD" and recognize that some people who can talk have some of the same problems as the people who can't, and that some people who can't talk have some of the same talents as the people who can. If it results in less of pushing us into little boxes, I'll be very happy.

Ah well, I was diagnosed before Asperger was known in NL, so I can keep my original official diagnosis (PDD NOS). No one bothered to update it officially, since that would serve no purpose as I got the proper help already. In some papers I was called an Aspie however.

What if you were thought to have AS, and did not gain much daily self help skills to become independent?

For these severity levels - you can go up them or down them in your life. They're not meant to be static things where you always have the same severity level, they're meant to explain your current situation.

In know people with Aspergers Syndrome or High functioning Autism have scored mild to moderate for the Autism criteria, done by a professional. That is true.

I know a person with Aspergers Syndrome probably scored severe on an autism scale. Maybe some people with Aspergers Syndrome don't score enough to fit in the Autism criteria.
However, I know those with high functioning autism diagnose tested as being mild to moderately autistic, were as people with Aspergers diagnose don't. That is my impression but I could be wrong.