Autism Levels and Severity? What Parents Need to Know

Let's talk about autism diagnostics and the severity levels, what you need to know. And just a quick disclaimer, I am not a person who can diagnose about autism. I can comment on it, but I'm not someone who can do the diagnosis. Right. I know this is kind of a bummer because most people, most parents will ask in the comments, is my kid on the spectrum or not? And they want me to answer that. I cannot do that. I'm going to stick to my professional scope, which I'm a speech therapist. So anyways, let's begin. My name is Ming from agents of speech.com and today we'll talk about levels and severity of ASD, Autism Spectrum Disorder. Okay, so I want to draw attention to this website and it's called Autism Speaks. Right. There are people who do not like Autism Speaks. Right. But what they have on the website is good. So it's just a really quick, what are the diagnosis DSM 5 criteria for autism. So DSM 5 for if you didn't know what it is? It's just a booklet for all the mental disorders. No matter. They put language, social, all these disorders into this booklet and people like a clinical psychologist, sometimes a pediatrician, depending on where you are geographically, it depends on the rules set by law and so, so and so on. Who can make this diagnosis. Right. According to these criteria. Okay, so I want to talk about just what the criteria are and then we'll talk about the levels which is right here. You can read this yourself right now if you don't want to listen to me talk. The link is right below. So the first one is like, I'll just talk about like a here. Persistent deficits in social communication and social interaction across multiple contexts. Right. What does that mean? So for instance, this is where a lot of parents will ask me, oh, there's no back and forth communication. The deficits in social emotional reciprocity. Okay, that means they don't really answer the name when you talk to them. They don't talk back, they don't look back at you, they don't smile back, that kind of stuff. There might be deficits in non verbal communication which might be. Yeah, see, no eye contact, no body language. You know, they don't understand your languages, they don't use them themselves. They don't understand facial expression expressions and they don't use facial expression themselves either. Right. So and also they don't really have a relationship with you. It's very difficult to adjust behavior according to social contexts. Right. So these are all like and also there's deficit in play as well. So in a already you can see a whole bunch of things that parents would ask me a lot. No eye contact, no social interaction. No play is limited. You know, we'll have difficulties adjusting to various social contexts. You know, that kind of stuff. So the severity is based on like. We'll talk about the. The table below later on. B here is restricted repetitive patterns of behavior, interest or activities. So basically just being rigid and also have some stimming. Right. Stereotype repetitive motor movements. Right. So these are stimming, right. Meaning self stimulation, activity, instance of sameness and flexibility to routines. So this might happen a lot. They like to put things in the line. But this is not only for autistic children. Right. We've talked about this before. These type of repetitive stuff. All children, like people love routines. Not only like autistic people. Right. So fixated interests. Right. Are abnormal intensity or focused. You know, like some children, only like a certain brand of a toilet. I've seen that before as well. And they won't go to the toilet if it's a different brand. Yeah. And then the last one here is something that people don't really talk about is hyper or hypo reactivity to sensory input. So if you see that a child's sensitive to, like, they might cover the ears when something is loud. They might not like certain textures. They might hit you if you touch them a certain way. You know, not being like talk about sexually, you know, I. I don't mean that. Don't get me wrong. But you might be just touching them on the arm or somewhere that they find very sensitive. Might might be the neck and they would already be freaking out. Right. Okay. So these ones are not really that important in my own opinion. Okay, that's my own opinion. Right. So let's go to here. Usually you have to make sure that they are accompanying with intellectual impairment and language impairment. Intellectual impairment is quite difficult because most of the time ASC children are masked, meaning if you tell them to do like an IQ test is very hard. Just their behavior is very hard to manage already. So I think from what I see, right. Usually it's inconclusive. Right. And sometimes they might be able to do it from just watching them play. And which most of the time, from what I see, at the very least, intellectually speaking, most ASD children from like the cases I see are sound. Okay. But this is where my line of work comes together. Right? You do asd and then there's a language impairment, and that's Usually the case, most of them have a language impairment just because of all the lack of social interaction and the stuff and lack of play and, you know, limited interest and so on. Right. So let's go on and talk about the levels. So you know how some parents will say, oh, my kid is level one, autist autism, level two, whatever. So the basic one you just need to read level one is requiring support, which is everyone, whoever has autism needs support. But it's the degree of support that they would need. Right. So level two is requiring substantial support. And then level three is very substantial support, which the wording is quite hard to understand. So what they would talk about. I'll just read some of this out and maybe you'll understand a little bit more. With supports in place, deficits this level run right. Difficulty initiating social interactions and clear example atypical and successful response to social overtures of others. So may appear have decreased interest in social interactions. Okay, so basically there are some noticeable impairments, but it's not something that will totally break the communication. So here it says, for example, a person who is able to speak in full sentence, engaged in communication, but who's to and fro conversation with others fail. So they can start talking with you, but they cannot just keep on going. All right? And it's. It's to make friends are all typically unsuccessful. That's rather mean. But. Yeah. So it doesn't mean that they. They just. It's more of a. The language isn't that bad. It's just that socially speaking, they're kind of odd. Right. And they also have inflexibility of behavior and cannot inference interference, like inference, what we call usually functioning with one or more contexts. Right. So what that means is that whenever there's a change in something, they cannot flexibly go according to plan. So let's say suddenly it rains today. And I say, hi, man. I can't. We can't go anymore. It's raining. And then you might see some behavior going on or you might see them getting anxious and so on. Right. That's level one. It means that they don't need that much help. Usually the help is in like group therapy, teaching them how to do social stuff and so on. Right. So they're still quite verbal. It's just that they don't know how to use it correctly. That's level one. Okay. They might be able to. Most of these kids in level one, when they're older, they're going to be able to work. Okay. And it's quite obvious who are level One, because they're talking, they're playing, they're doing a lot of things, but just to an extent where it's just not that successful in terms of like holding a social interaction. Okay, let's talk about level two. Basically it says marked deficits and verbal and non verbal social communication. So you see the verbal is already one level lower when they talk. It might be like the grammatical incorrect or they're using the wrong words or they need to use some sort of like gestures to compensate for a lot of the stuff they say. And non verbal communication skills, meaning they might be standing too close to you. They might be like playing with your, your hair, looking at things that they're not supposed to, you know, these kind of things. Social impairments apparent even with supports in place, meaning maybe you're already giving them some cues and prompts saying oh, that's not what you're supposed to do, but they're still sitting next to you and looking at you and hugging you and so on. And you also see limited initiation of social interactions, which is very different from level one. Level one, they can come over and tell you, hey, have you seen a new spider man movie? Like when they're older, right? Not talk about three year old. But level two might be like you really need to prompt them. So this is what you might see reduce or abnormal responses from like stuff from other people. So what I mean by that is if you ask them something, most of them, they just ignore you, you know. So for example, a person who speaks simple sentences whose interaction is limited to narrow special interests and how has markly odd non verbal communication. Okay, so you would see some like, basically some stimming at the wrong timing. Talking in very simple sentences. Sometimes the grammar is a little incorrect. Interaction is very limited to only talk about maybe like the stuff that they like, maybe buses, cars, dinosaurs, you know, like Marvel comic stuff, you know. And yeah, that's pretty much level two. But they do need a lot of support, especially when they're young because although verbal their language isn't very good, you know, so it's the same. The behavior is a little bit more challenging. So you might see that it's frequent enough for the obvious casual observer and to interfere with functioning. Right. So you might see that they might get physically angry. Right. You see some visible jumping and coping mechanisms that they do with their behavior whenever something happens they don't like. Right. So I've seen this quite frequent with, you know, adult ASD children or adults ASD just in general, don't call them Children. Right. Level two would see them like just visually, just spinning on the floor, just playing with the hands, eye cornering, muttering stuff whenever they get unhappy about things. So, you know, like, although I cannot give a diagnosis, but because I know their diagnosis, I make observations. I'm telling you as on a personal level, how it would look like. Okay, so level three is anything that is worse. All right, so from level two to level three, sometimes the gap can be huge. Can be huge. Okay, so we're talking about from verbal to non verbal. That meaning they cannot really talk. Very, very limited initiation of social interactions. So level three, you'll be very, very like if they're level three and you can find things that they like, then most of most, probably their behavior and general efficacy of. Of treatment would actually go up. Right. But for some level three, meaning they don't really have things that will motivate them that much. Right. So let's see about what the example says. A person with few words of intelligible speech, that's pretty bad. So most of the time you cannot really hear what they're saying. Rarely initiates interaction, and when he or she does, makes unusual approaches to meet needs only. So meet needs only now needs. Need based. It might be pulling your head, it might be screaming, shouting, might be hitting their head, whatever. Right. And responds to only very direct social approaches. Meaning which that means is going to the toilet, you know, wanting something from you, wanting something very specific. Yeah. And maybe that they have problems with like wearing a shoe, wearing a hat, wearing whatever. And they need your help. Very direct. Okay, so let's talk about the restricted repetitive behaviors. So here extremely difficult in coping with change. You know, like the stimming is so crazy that it will interfere with functioning of in all spheres. Meaning they cannot eat properly if they stim too much. They cannot like sleep properly and stuff. We'll talk about that later. And they. You see great distress when changing focus or action. So these are levels. So I hope this gives you a little more understanding about how we look at severity. And now I want to talk about some other things that maybe that will also determine the severity. Okay, there are two that I want to talk about in particular. Number one is sleep disturbances. No matter which level of severity your child is at, there will be sleep. Sleep disturbances. There's like, you know, according to a study, I'll also put the study link below, 96 of preschoolers with an autism diagnosis showed signs of sleep issues. Right. So compared to the typical developing peers, which is like 20 to 40%. So it's a lot more than normal. While we say normal. Okay, so these sleep disturbances will affect the person's mood. The. The person on the spectrums will and motivation and their focus during the day, which you. You will see that maybe like, the severity of ASD goes up and down every day. You know, like, sometimes they're fine and then they're not. Like, and. And when parents say, oh, according to the mood, sometimes it's not totally wrong. You know, sometimes it's okay to say that and it's because of these things. And the second of all is, like, their gastrointestinal symptoms. So the gi, what they call, like, a lot of parents will go into, like, biomedical things, and GI is something that is quite real. So three times more likely to have GI symptoms than typically developing peers. Again, the link for the study that quotes that is down below. And at the same time, for, like, for these two things, it will actually affect how severe it will look like and how hard therapy will be. Determining these two things, I believe, are the most important when you're looking for therapy. Okay, so these are the levels for autism. There are only three. It's a little bit too much of a generalization, of course. At the very least, when you talk about it, it's just a way for, you know, for people to know, oh, it's a level one. I know around what it would be at this age. Right. Just a generalization just to help people understand when they hear it. I was like, okay, that's something. That's what I need to deal with. Right. When they come over, what I need to think about, what I need to, like, prepare in my mind when they come over to my clinic, at least for me. Right. And at the same time, the three levels of autism will also tell, like, other professionals what type of therapy, what kind of professional work that the child will need. Right. And getting the severity level diagnosed has its merits. And why I say this is because some parents just don't want to do it, just don't want to see it, what's the point, so on and so forth. But they will give you more service if your child is more severe. Right. And that's what you need to know. So that's all for today's video. I hope I answered some questions. I can't go too deep about autism because. Because I am not an expert about this. I'm not supposed to talk too much about this either. And if you have any more questions, just put it down below. Maybe we can ask someone who is of an expert to talk about this on this channel. And if you haven't, please go to agents of Speech.com checklist to see a list of tools and toys that I recommend you to get when you start therapy at home. All right, so that's all for today's video. I will see you next week. Bye. Bye.