Autism Spectrum Disorder (ASD) is a neurodevelopmental condition characterized by persistent differences in social communication and restricted, repetitive patterns of behavior or interests. The term “spectrum” reflects the wide diversity in traits and support needs among individuals. Diagnostic criteria have evolved, leading to the current clinical framework which moves away from older, less precise labels. This article clarifies the modern designation of Level 1 Autism and addresses its relationship to the common, but outdated, term “high-functioning.”
Understanding the DSM-5 Support Level Framework
The current standard for diagnosing ASD is defined by the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-5). The DSM-5 consolidated several separate diagnoses into the single category of Autism Spectrum Disorder. This framework evaluates individuals based on two core domains: deficits in social communication and the presence of restricted, repetitive behaviors. Instead of previous categorical diagnoses, the DSM-5 uses three levels of severity to quantify the amount of support an individual requires in daily life.
These three levels—Level 1, Level 2, and Level 3—measure the impact of autistic traits on daily functioning and the corresponding intervention needed. Level 1 indicates “Requiring Support,” Level 2 indicates “Requiring Substantial Support,” and Level 3 indicates “Requiring Very Substantial Support.” The levels focus on functional support needs, ensuring the diagnostic label relates directly to the resources an individual should receive.
Specific Characteristics of Level 1 Autism
Level 1 Autism is clinically defined by deficits in social communication that cause noticeable impairments without supports in place. Individuals at this level often struggle with initiating social interactions and may demonstrate unsuccessful or atypical responses to social overtures from others. They may appear to have a decreased interest in social interactions, although they often desire connection but lack the skills to navigate complex social situations.
In the domain of restricted and repetitive behaviors (RRBs), Level 1 individuals exhibit inflexibility that can interfere with functioning. This may manifest as difficulty switching between activities or a strong resistance to interrupting rituals or fixated interests. Level 1 individuals often possess average or above-average intellectual abilities and have fluent language skills, though they may struggle with the pragmatic use of language, such as understanding nonverbal cues or the rhythm of conversation.
Why the Term “High-Functioning” is Misleading
The term “high-functioning autism” (HFA) is not a medical diagnosis and is considered outdated, though it was historically used to describe autistic individuals without an intellectual disability. Most individuals diagnosed with Level 1 ASD would have received the HFA label under older terminology, or the former diagnosis of Asperger’s Syndrome, which was retired with the adoption of the DSM-5. The problem with the HFA label is that it focuses on perceived visible abilities, such as verbal skills or IQ, and ignores the significant, often internal, challenges faced daily.
Referring to someone as “high-functioning” inaccurately implies they do not require support or that their autism is a “milder” version. This label can be harmful because it may lead others to minimize their struggles, potentially denying access to necessary accommodations. Many Level 1 individuals engage in extensive “masking”—the effort to suppress autistic traits to appear neurotypical—which leads to extreme mental fatigue and increased anxiety. The Level 1 designation corrects this by focusing on the need for support rather than intelligence alone.
Necessary Supports for Level 1 Individuals
The classification of Level 1 emphasizes that intervention is necessary even for those with minimal challenges. Supports often focus on practical skills that are not intuitive, such as assistance with executive functioning. This includes strategies for time management, task initiation, organization, and planning, which are common areas of difficulty regardless of intellect.
Targeted social skills training is a frequent and beneficial intervention, helping individuals decipher complex social cues and navigate relationship building. Accommodations for sensory sensitivities, such as noise or light, are often needed to prevent overwhelming daily experiences that can lead to distress or meltdowns. These interventions, which can include behavioral therapies and speech and language support, are tailored to the individual to ensure they can thrive in various environments.