Understanding Level 2 Autism: A Comprehensive Guide

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Autism is often defined in two ways. From a medical point of view, Autism Spectrum Disorder (ASD) is a neurodevelopmental condition characterized by challenges with social communication skills, repetitive behaviors, and restricted interests. Others think of autism as another neurotype with unique ways of perceiving, processing, and interacting with the world.

In an effort to define ASD, the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-5), created three levels based on the severity of its presentation.

In this article, we focus on explaining how level 2 autism is understood and how it differs from levels 1 and 3.

Key Takeaways

The DSM-5 introduced three ASD levels of severity: level 1 autism (requiring support), level 2 autism (requiring substantial support), and level 3 autism (requiring very substantial support). 

Level 2 autism is characterized by challenges in verbal and nonverbal communication that are more noticeable compared to level 1, but not as severe as those in individuals with level 3 autism. Common signs of Level 2 autism include prominent repetitive behaviors, difficulty switching between tasks, and increased distress during changes in daily routines.

Autism is a spectrum which means every individual will vary in presentation. Differentiating between level 1, level 2, and level 3 involves a great degree of subjectivity.

Levels of ASD in a Nutshell

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An autism diagnosis based on DSM-5 criteria requires evidence of enduring social communication deficits (verbal and/or nonverbal) and at least two of these four behavioral patterns: repetitive movements, adherence to routines, special interests, and sensory sensitivity.

Meanwhile, the three diagnostic levels of ASD are based on the severity and the amount of support needed for activities of daily life:

  • Level 1 requires support (read more about Level 1 autism)
  • Level 2 requires substantial support
  • Level 3 requires very substantial support

It is important to note that Autism Spectrum Disorder differs from other developmental conditions, like intellectual disability. Individuals with ASD may exhibit cognitive impairments, language difficulties, or an associated medical or genetic condition, but they can also present without these accompanying diagnoses.

Signs of Level 2 Autism

Communication and Social-Emotional Skills

Individuals assigned with level 2 autism may have difficulty reading facial expressions or struggle to understand social cues. They typically have a limited vocabulary and speak in shorter or incomplete sentences. Even with supports in place, they may struggle to maintain conversations and are more likely to stray off-topic, have difficulties reciprocating questions or emotions, and walk away from social interactions.

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Repetitive and Restrictive Behaviors

Echolalia, or the repetition of phrases, may be observed more in level 2 autistic individuals compared to level 1. Some might respond in conversations using phrases they learn from movies or videos, although the language is used in context. 

Repetitive behaviors such as hand flapping, lining up items, or rocking on their feet may be more prominent in level 2 autism. These behaviors are also referred to as stimming or self-stimulation which serves a purpose in expressing or regulating their emotions. 

Compared to people with level 1 autism, individuals categorized under level 2 also have more difficulty adjusting to changes in their routines. Even the smallest change can cause distress that may require additional support to help with emotional regulation. 

Sensory Processing Difficulties

Individuals with autism spectrum disorder exhibit heightened aversions or sensitivities to certain sensory stimuli. They may crave or be easily overwhelmed by visual, auditory, gustatory, olfactory, tactile, and vestibular input. Exposure to certain stimuli may result in heightened stress levels affecting performance in daily activities, social interactions, school performance, and other community engagements.

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Examples of sensory sensitivities:

Visual: Children with level 2 autism may find bright lights, such as fluorescent lighting, overwhelmingly causing discomfort or headaches. 

Auditory: People with level 2 ASD may have heightened sensitivity to loud or sudden noises like sirens, vacuum cleaners, or crowded environments. They may struggle to concentrate in public places due to difficulties filtering out background noise.

Gustatory: Children with level 2 autism may experience discomfort or aversion to certain food textures, such as crunchy or slimy foods. Strong flavors or spices may also be overwhelming or unpleasant.

Olfactory: People diagnosed with level 2 ASD might be sensitive to strong chemical odors from perfumes, cleaning products, gasoline, or smoke.

Tactile: Certain textures like shaving cream, sand, and soap may be uncomfortable to touch. Clothing tags, seams, or rough fabrics may cause discomfort or irritation.

Proprioceptive: Sensory processing difficulties may make it hard to focus on handwriting, sports, and other tasks that require body coordination. Some people might seek or avoid the sensation of deep pressure on the body, such as hugs or tight clothing.

Vestibular: People with level 2 ASD may feel dizzy, nauseous, or anxious in high-motion situations like riding a car, spinning, or swinging. They may also find it hard to balance on unstable surfaces like moving escalators or balance beams.

While it’s usually clear when an autistic child shows hypersensitivity or heightened reactions to stimuli, they can also experience hypo-reactivity or underresponsiveness. For instance, they might appear indifferent or unresponsive to spoken instructions or conversations, even when directly addressed. They might not react to pain from cuts or bruises as expected, or may not feel nausea or discomfort from extreme motions such as in amusement park rides.

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Educational Accommodations

Level 2 autism spectrum disorder have implications to a child’s ability to engage in learning and other school activities. Here are some accommodations that can help students with level 2 ASD succeed in their academic environment:

  • Sensory breaks
  • Extended time
  • Visual aids and clear instructions
  • Flexible seating
  • Assistive technology

More Resources

Centers for Disease Control and Prevention

ADHD Vs. Autism: What’s The Difference?

Are There Different Types Of Autism?


The autism levels outlined in the DSM-5 describe the severity of ASD based on medical diagnostic criteria. While these levels provide a general understanding of autism, categorizing individuals within these three profiles is not foolproof.

Every person is unique, and the support requirements of an autistic individual will differ based on their individual skills, strengths, special interests, and areas of challenge.


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