The Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-5), conceptualizes autism as a spectrum, in which people with low support needs are considered to be “mildly” autistic and those with high support needs as “severe.” Mild autism is also sometimes referred to as high-functioning autism.
Characteristics of Mild Autism
The DSM-5 details five diagnostic criteria for Autism Spectrum Disorder. Because the DSM-5 conceptualizes diagnoses as disorders and disabilities that cause functional problems, these symptoms are framed as deficits:
Social deficits: Autistic people might approach conversations and social interactions in an “abnormal” way and have difficulty expressing and interpreting nonverbal cues. This can cause difficulty “developing, maintaining, and understanding relationships.” Repetitive or fixated behaviors, interests, or activities: Autistic people often repeat movements or words as a way to self-regulate, a behavior often referred to as “stimming.” They may also adhere to specific routines and have specific and intense interests. Finally, autistic people often have atypical reactions to sensory experiences, including being either very sensitive to touch, smell, light, or sound, or seeming to not notice these sensations. Early onset: Neurodivergence begins before birth. Although symptoms might not manifest until later in life (especially for those with low support needs), autistic people have been autistic their entire lives. Symptoms cause functional deficits: A clinical diagnosis of autism requires a person to experience difficulty at school, at work, in social situations, or in other settings. This is why many autistic people with low support needs might not be diagnosed until later in life. Symptoms are not due to another diagnosis: Some genetic conditions or trauma can cause behaviors that can look like autism.
Before autism was considered a spectrum, the DSM-IV-TR differentiated autism from Asperger’s Syndrome, which was considered “mild” autism. However, psychologists struggled with differentiating autism and Asperger’s Syndrome. An individual was considered autistic if they did not acquire verbal language prior to three years of age, but other symptoms were the same. In addition, research showed that a diagnosis of autism versus Asperger’s depended on which provider performed the assessment rather than specific symptoms. The International Classification of Diseases, 10th Revision (ICD-10) still recognizes Asperger’s Syndrome as a diagnosis. Although some still use the term Asperger’s Syndrome, the term is considered dated and problematic by many because Hans Asperger was a eugenicist and a member of the Nazi party in Germany during World War II. His research around autism aimed to identify which children were “high functioning” enough to be “useful.”
What Makes Autism “Mild”?
According to the DSM-5, a diagnosis of autism spectrum disorder can be specified as Level 1, Level 2, or Level 3 based on “severity.”
Level 1 Autism
For an autistic person to be considered Level 1, they must have low support needs for both communication and behaviors. Regarding communication, Level 1 autistic people might struggle with initiating conversations or relationships with other people, and they might not seem as interested in these relationships as their neurotypical peers. Behaviorally, Level 1 autistic people may adhere to very specific routines that can interfere with functioning, struggle with transitions, and have difficulty with organization and planning. The DSM-5 does not specify how sensory issues impact Level 1 autistic individuals. It is important to note that autistic people’s support needs can change, just like non-autistic people’s needs can change. During times of high stress, an autistic person might need more support than during low-stress times. Autistic burnout refers to when an autistic person’s support needs increase due to exhaustion and long-term stress. Autistic people who had low support needs and were identified as “mild” might exhibit more “severe” symptoms during burnout due to higher needs.
Diagnosing Mild Autism
Many psychological tests created to identify autism are specifically designed for children and teens. However, because “mild” autism is marked by fewer functional difficulties and lower support needs, many autistic people whose symptoms are considered “mild” are not identified as autistic until adulthood. Psychological assessments used to identify autism include:
Diagnostic Interview. Any psychological evaluation will include a diagnostic interview during which the evaluator gathers information about your personal and family history as well as your symptoms. Since autism is a neurodevelopmental diagnosis, this interview will likely include information about early development.Autism Spectrum Rating Scale (ASRS). The ASRS is an observational measure with parent and teacher forms that can be used to identify symptoms of autism in children from ages two to eighteen. The child’s scores are compared to other autistic children as well as the DSM-5 diagnostic criteria for autism. Autism Diagnostic Interview-Revised (ADI-R). The ADI-R is a structured interview that assesses symptoms of autism from age four through adulthood.Autism Diagnostic Observation Schedule-2 (ADOS-2). The ADOS-2 evaluates social and communication skills. Some modules are only used in identifying autistic children, but it has a module that can assess adults.Diagnostic Interview for Social and Communication Disorders (DISCO). The DISCO is a structured interview with questions about behavior and functioning, and it can be used with children and adults.
Causes of Mild Autism
Although we do not fully understand why some people are autistic and others are not, research shows that various genes can impact whether or not someone is autistic. Autistic people are born autistic and remain autistic for their entire lives.
Treatment and Support for Mild Autism
Autistic people might benefit from talk therapy, occupational therapy, and physical therapy. Autistic individuals with low support needs might be able to live independently and work, but they might attend individual therapy to cope with stress and any comorbid diagnoses they might have.
Coping With Mild Autism
Many autistic individuals benefit from support from their autistic peers. Organizations exist to advocate for autistic people’s rights and provide accurate information about getting diagnosed, treatment options, and social support.
