When a parent receives an autism diagnosis for their child, it often brings mixed emotions. On one hand there may be relief in understanding why their child behaves differently than other children. On the other hand, the terminology that goes along with the diagnosis can be confusing and concerning. In this article we discuss what DSM levels mean, and how they can help a child get the support they need.
What Are DSM Levels?
The Diagnostic and Statistical Manual of Mental Disorders (DSM) is the fundamental reference book for diagnosing conditions like autism. It is used by healthcare professionals in the United States and much of the world. Published by the American Psychiatric Association (APA), the DSM defines symptoms and standardized criteria that clinicians use for diagnosing autism. These criteria primarily focus on two areas – social communication and social interaction, and restricted, repetitive patterns of behavior.
Social communication and social interaction describe how an individual interacts with others. A person with autism has persistent differences in social-emotional reciprocity, nonverbal communication used for social interaction, and developing, maintaining, and understanding relationships.
Restricted, repetitive behaviors refer to specific patterns, interests, and activities. Repetitive movements (stimming) can include spinning, arm flapping, rocking, or licking. Other hallmarks can include insistence on sameness and inflexible adherence to routines, highly fixated interests, and exaggerated or diminished reactivity to environmental sensory input.
A DSM autism diagnosis also requires that these traits have been present in the child’s early developmental period, pose significant obstacles to social and occupational functioning, and cannot be explained by intellectual disability or a global developmental delay.
Taken together, this information is used by Developmental Behavioral Pediatricians and other specialists during a diagnostic evaluation to assign a DSM level, from level 1 to level 3. Beyond an overall diagnostic level, some providers may also assign sub-levels to social communication and interaction, or repetitive, restricted behaviors.
How Are DSM Levels Used?
The assigned DSM level tells a clinician, based on the presence and severity of symptoms or traits, how much support a patient and their family needs. For example, Applied Behavioral Analysis (ABA) is a common autism intervention that often benefits young children across levels. The intensity or duration of ABA may differ significantly for a child with level 3 autism versus a child with level 1. A child with minimal support needs can benefit from individual or group speech therapy to improve their social communication, while an individual with substantial support needs and limited verbal capacity may need therapy with Augmentative and Alternative Communication (AAC).
DSM level designations can also help parents recognize characteristics commonly found in autism, and provide strategies to address or adapt to them. In the United States, the level assigned by a provider may affect insurance coverage for services like speech therapy, ABA, or occupational therapy. Support levels can change over time, especially when proper interventions are introduced.
Keeping Things In Positive Perspective
At Coralis Health, we understand that the terminology used with DSM levels can create concern and negative emotions for parents and caregivers. It is important to remember that this is strictly a clinical designation, used to create a common reference point for clinicians, support and therapy providers, and insurance companies, to provide optimum care and appropriate financial support.
A DSM level is simply a snapshot in time. The levels do not define your child; they are so much more than a number, and the number does not capture their strengths, their personality, or their potential. It indicates what a child’s needs are right now. These needs can change over time due to clinical intervention and therapy, as well as natural support systems from family, friends, school, and extracurricular activity. It is also important to understand that a higher DSM level does not mean that a child will not improve or realize their full potential.
We are optimistic that with future updates, the DSM terminology will move toward more neurodiversity-affirming language. Until then, if you have received an autism diagnosis with a DSM level and have questions, please reach out to us here at Coralis Health. We are always here to help provide the support and care your child needs to thrive!
