Individuals with severe autism have intense symptoms that require very substantial levels of support. Classified as Level 3 ASD (Autism Spectrum Disorder) in diagnostic criteria, people with severe autism face the most pronounced challenges and disabilities. And they need regular, round-the-clock supervision and support.
Also referred to as classic or profound autism, severe autism is a complex condition that has a severe impact on communication, social interaction, and behaviour. Autism or ASD exists on a spectrum and different levels of severity or intensity define each level. For instance, people with Level 1 ASD can have difficulty initiating conversations while Level 3 individuals have severe deficits in communication skills.
In this post, we’ll explain more about severe autism. But it’s also worth highlighting the positives from ASD, for instance where employees with autism can be 90% more productive than their peers when supported in the workplace.
Level 3 autism is the highest support level under DSM-5 criteria for Autism Spectrum Disorder. People with Level 3 autism rely on intensive support for social communication, daily living, self-care, and managing restricted/repetitive behaviours.
When it comes to diagnosis, Level 3 autism requires a comprehensive assessment by qualified professionals, often involving multidisciplinary teams made up of psychologists, speech therapists, and occupational therapists.
The exact causes of Level 3 autism are difficult to pinpoint, but most researchers agree that it stems from complex interactions between genetic predisposition and environmental factors during early brain development.
According to the National Autistic Society, ASD or autism assessments use criteria laid out in the diagnostic manual ICD-10, and the DSM-5.
The DSM-5 defines Level 3 as “Requiring very substantial support” while categorising autism characteristics and symptoms in two areas – communication and behaviours. So let’s take a closer look at both.
According to DSM-5 criteria, individuals classed in need of very substantial support display severe deficits in verbal and nonverbal communication. They will be very limited in initiating any social interactions and give minimal responses to others.
Individuals at Level 3 will often be nonverbal or nonspeaking. Those who do speak may use limited words. These deficits will cause them to have problems initiating conversations or responding to others. And this can manifest in problems in certain areas:
Level 3 severe autism symptoms also show up in the form of repetitive behaviours. Some examples include opening and closing doors, and violent rocking or spinning. Behaviours can also include a general sense of inflexibility, difficulty coping with change, sleeplessness, and epilepsy.
Environmental sensitivity is also a prominent behaviour, where individuals show extreme sensitivity to large crowds, bright lights, and loud noises.
Individuals categorised at this level may also be more prone to autism meltdown, where they experience involuntary overwhelm or overload in their Central Nervous Systems as a response to an emotional situation, a stimulating environment, or other sensory triggers.
Autistic meltdowns are dramatic, intense experiences. Sufferers describe a feeling of being out of control of their body and their body’s responses. Symptoms of an autistic meltdown can include:
There can be differences between Level 3 autism in children vs adults, and the way symptoms play out can shift with age. Young children may display severe autism through delayed speech, sensory meltdowns, and solitary play rituals, while adults might wrestle with things like maintaining employment, managing independent living tasks, and navigating complex social expectations that weren’t present in childhood.
In terms of coping strategies, children tend to rely heavily on structured routines, visual supports, and intensive therapeutic interventions like speech therapy and occupational therapy. This can help them to establish crucial life skills and develop better ways of communicating and coping with their environment.
Adults with Level 3 autism often continue needing these same supports but may also benefit from vocational training, long-term residential or day programme services, and assistive technology for communication. For instance, using dictation software allows those who find typing difficult to communicate their thoughts in writing more easily.
It’s important to be aware that while both children and adults with Level 3 autism may require extensive support with basic tasks, this is not a reflection of their intelligence. Some autistic individuals may display above-average abilities in certain areas while experiencing significant challenges in others. This is a pattern often referred to as a “spiky profile”.
For a person with Level 3 autism, their condition can impact every aspect of daily living, creating challenges that require ongoing support and understanding. This includes the need for strict routine. People with Level 3 autism depend heavily on highly structured environments and predictable schedules, with even minor changes triggering intense distress. This makes flexibility extremely difficult.
For people with severe autism, independence is limited across most areas. Basic self-care tasks like dressing, eating, and personal hygiene usually require assistance or supervision, and many individuals struggle to safely navigate their community alone or manage household responsibilities independently.
In educational settings, children with Level 3 autism often need specialised support through Health and Care Plans (EHCPs). They may attend specialist schools or require one-to-one support in mainstream settings.
In terms of employment, opportunities are generally limited to supported work environments or day programmes focused on skill-building rather than traditional employment. However, some individuals may excel in specific areas of interest when given appropriate support structures.
Relationships tend to be challenging, too. Due to severe communication difficulties and limited social understanding, family relationships often revolve around providing care and support, while friendships can be difficult to form and maintain without significant facilitation.
Although Level 3 autism is a lifelong condition, individuals can make meaningful progress through appropriate support and intervention. Early intervention programmes, particularly those started before age five, can lead to significant improvements in communication skills, adaptive behaviours, and overall quality of life.
It’s crucial to understand that improvement doesn’t necessarily mean moving to a lower support level or being “cured”. Instead, progress may come in the form of developing functional communication methods, learning to tolerate changes in routine, or gaining basic self-care skills. Each person’s journey is unique – some individuals make substantial gains while others may have more modest but still impactful improvements.
Support for Level 3 autism requires a comprehensive, multidisciplinary approach tailored to individual needs. This often involves:
Developing behavioural and communication skills: Applied Behaviour Analysis (ABA) is a common method of teaching new skills and reducing challenging behaviours through structured learning techniques. This focuses on helping individuals to learn new skills while minimising behaviours that limit participation. Speech and language therapy is also used and is focused around developing functional communication, whether through spoken language, sign language, picture exchange systems, or assistive technology devices. Many individuals use communication apps that help them to express their needs and wants more effectively.
Sensory challenges and motor skills: Occupational therapy addresses sensory processing issues, fine motor skills, and daily living abilities. This can include sensory integration techniques to help manage overwhelming sensory experiences or learning practical skills like using cutlery or getting dressed.
Professional care: Care plans are comprehensive and usually involve multiple professionals working together. This includes special education teachers, social workers, and healthcare providers. These plans outline specific goals, strategies, and support systems tailored to the individual’s unique profile of strengths and challenges.
Family care: Family support and respite care are equally important, helping carers to manage intensive demands while maintaining their own wellbeing. Support groups, training programmes, and access to specialist services all play vital roles in creating sustainable, effective support systems that can adapt as needs change over time.
Moderate autism is also known as Level 2 of the DSM-5 criteria.
Unlike Level 3 or severe autism, people with Level 2 moderate autism require substantial support to manage their condition. They may display similar challenges that are less pronounced than severe autism.
People with moderate autism will still have challenges that impact their daily lives. And the key differences between moderate autism and severe autism include:
Severe autism and moderate autism make up two levels in a bigger picture of autism diagnosis, as defined by the DSM-5 guidance in their formal criteria. Across each category of severity level–including autism Level 1, autism Level 2, and autism Level 3–sits a set of guidance.
So let’s look at each level of autism in greater detail:
As highlighted, autism Level 3 is an intense condition requiring very substantial levels of support and management. People with autism Level 3 will face some of the following challenges in their lives:
Autism Level 2 or moderate autism and requires substantial levels of support. People with autism Level 2 will show the following behaviours and patterns:
Level 1 autism relates to
It wasn’t until the 1970s that autism was widely diagnosed in society. And many of the children who received a diagnosis are in middle age now. Of course, other people have received autism or ASD diagnoses in their adult lives. However, it is still a new area with fairly limited available data on the severity of autism over time.
One person who has collected data on the demographic and cognitive profile of ASD in adulthood is Professor Rebecca Charlton at Goldsmiths University in London. A 2016 report analysed 146 participants – 100 people with an ASD diagnosis and 46 without. Results showed a link between age and severity of ASD in terms of more severely autistic demonstrated autistic traits in social situations, communication, and flexible thinking.
The report also suggests older people with ASD prefer structured, rule-based situations they can follow as a routine. And it suggested that adults with ASD may have more time to develop more effective coping skills to help mitigate the negative impact over time.
More recent research suggests there is a significant change in autism severity between the ages of 3 and 11 years old. These changes don’t suggest a worsening of symptoms but a change in severity, since more than a quarter of children decreased in severity and a similar amount increased in severity during this time frame.
In conclusion, it’s difficult to answer the question of does autism gets more severe with age. Evidence shows severity changes as someone ages but this includes a decrease in severity as well as an increase. Plus, it may be that older people have developed coping strategies that lessen their perception of autism severity.
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