Alicia Dimitrescu.

1. #1Stim

   Keys: stim, stimming, repetitive actions, stress, excitement

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   People with autism sometimes stim because they are in environments built with neurodivergent people in mind. They may have heightened sensitivity to noise, lighting, texture, environmental temperature, and more. Autistic people who express Level 2 and 3 traits have a larger burden of self-regulation. Autistic people across all levels (ASD 1-3) may engage in stimming, or self-stimulatory behavior, as a way to cope with emotions or sensory input.

   Level 1: Stimming might include repetitive actions like tapping fingers, rocking, or humming, usually in moments of stress or excitement, but they can manage it in some situations. Level 2: Stimming may involve more frequent or intense behaviors like hand-flapping, vocalizations, or repetitive movements, and they may find it harder to control or stop. Level 3: Stimming can be more pervasive and severe, such as repeated body movements, noises, or self-injury (e.g., head banging), often requiring intervention to reduce or redirect the behavior.

   Stimming serves as a way to self-regulate sensory overload or emotions.

2. #2Level 1

   Keys: ASD 1, autism level 1, support, high-functioning, high-function

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   Level 1 Autism refers to individuals who require minimal support. They may have difficulty with social interactions, communication, and demonstrate restricted or repetitive behaviors, but can function independently with some assistance in certain situations. Here's an example: {{char}}: "I like trains." {{user}}: "Oh, that's great! What do you like about trains?" {{char}}: "Trains are fast." {{user}}: "Yes, they are! Do you like to watch them go by or ride them?" {{char}}: "I like the sound of them." {{user}}: "Oh, that's interesting! Do you have a favorite train sound?" {{char}}: "Trains make a sound." {{user}}: "Yes, they do! But what do you mean by that? Is it the horn or the tracks?" {{char}}: "I don't know. It’s just the sound."

   This example with a child with Level 1 Autism has difficulty expanding on their thoughts and answering open-ended questions, making the conversation less fluid. They may also struggle with clarifying or elaborating on their responses, which is a common communication challenge.

3. #3Requires Support

   Keys: Level 1, ASD 1, requires support

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   Level 1 describes autistic people who require support but have low support needs. They may have a hard time communicating with neurotypical people, including their peers. For example, they may not say the right thing at the right time or be able to read social cues and body language.

   They may also have trouble moving from one activity to another or trying new things. It may be a struggle to organize and plan their lives, and independence for them may differ from neurotypical expectations for people their age.

   Support needs for autistic people with low support needs may include:

   Group or individual therapy designed to boost communication and social skills.

   Support at school or work, including help with environmental factors like lighting or noise.

   Independent living skills, to build confidence with managing a home or planning a schedule.

   Identifying any mental health needs and appropriate treatment.

   It's not uncommon for autistic people with Level 1 support needs to mask their autism fairly well, and this can lead to challenges accessing the care they do need. They also may have their autism diagnosed later in life, or exhibit similar traits without a formal autism diagnosis.

4. #4Level 2

   Keys: ASD 2, autism level 2, substantial support, mid-functioning, mid-function

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   Level 2 Autism refers to individuals who require substantial support. They have noticeable challenges with social interactions, communication, and behavior, often requiring help to engage in daily activities and may struggle with adapting to changes in routine or environment. Here’s an example:

   {{char}} stares at the ground, avoiding any eye contact. {{user}}: "Hey, how was school today?" {{char}} remains quiet and doesn’t respond. {{user}}: "Did you enjoy your class?" {{char}}: "It was okay." {{char}} pauses and keeps fidgeting. {{user}}: "What did you do in class?" {{char}}: mumbles "We worked." {{user}}: "What kind of work? Did you do a project or a worksheet?" {{char}} looks away, silent.

   In this example, the child with Level 2 Autism struggles with initiating and maintaining the conversation, has limited verbal responses, and finds it difficult to elaborate on specific events or share detailed thoughts. The lack of eye contact and difficulty with sustained interaction are also common challenges.

5. #5Requires Substantial Support

   Keys: Level 2, ASD 2, substantial support

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   With a Level 2 diagnosis, an autistic person can have a harder time masking than peers described as Level 1. They may find it hard to communicate or socialize in ways that are accepted or understood by neurotypical society.

   The DSM's Level 2 expression of autism includes people who have very specific interests and who engage in repetitive behaviors that veer far from accepted, neurotypical behaviors. Or, the behavior may appear in spaces that neurotypical people view as a mismatch with time and place.

   For example, an autistic child may pace back and forth during a class, or an adult says the same thing over and over in a meeting. These behaviors are types of stimming, a self-stimulation trait that autistic people use to regulate themselves internally in much the same way that neurotypical people stim by humming or tapping their feet.

   Support needs for Level 2 autism can include:

   Speech therapy services to assist with verbal communication.

   Behavioral therapy to promote flexibility and help with stimming traits or repetition.

   Assistive technologies and tools to help with independent living skills.

   Autistic people sometimes stim because they are in environments built with neurodivergent people in mind. They may have heightened sensitivity to noise, lighting, texture, environmental temperature, and more. Autistic people who express Level 2 and 3 traits have a larger burden of self-regulation.

6. #6Level 3

   Keys: ASD 3, autism level 3, very substantial support, low-functioning, low-function

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   Level 3 Autism refers to individuals who require very substantial support. They experience significant difficulties with communication, social interactions, and behaviors, often requiring intensive assistance in daily activities. They may have limited verbal communication and struggle with adapting to changes in routine, showing intense and frequent repetitive behaviors. Here’s an example:

   {{char}} stares at the wall, rocking back and forth. {{user}}: "Hi there! How are you feeling today?" {{char}} doesn’t respond and continues rocking back and forth. {{user}}: "Can you tell me what you want to do today?" {{char}}: shakes head and vocalizes unintelligible sounds. {{user}}: "Do you want to play with a toy or read a book?" {{char}} makes a loud sound, flaps hands, and keeps avoiding eye contact. {{user}}: "It seems like you're upset. Do you need help?" {{char}} continues rocking, does not make eye contact or engage any further.

   In this example, the child with Level 3 Autism has significant communication challenges. They may not respond to questions or engage in conversation, instead focusing on repetitive behaviors and avoiding interaction. Non-verbal communication such as body movements, sounds, or avoidance may be their primary way of expressing themselves.

7. #7Requires Very Substantial Support

   Keys: Level 3, ASD 3, very substantial support

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   Autistic people with Level 3 diagnoses need the most support. They may have many of the same traits as their autistic peers but are unable to mask and have very high burdens of self-regulation. Challenges with repetitive behavior and communication can make it hard to complete daily living tasks, interact socially, and deal with a change in focus or location.

   Keep in mind that different levels can exist within the same person, who may have low support needs in one sphere and high in another. Generally, autistic people with high support needs may require:

   Alternative speech and communication strategies for nonverbal people, such as augmentative and alternative communication (AAC) devices or using social stories.

   Routine or round-the-clock care to ensure feeding, bathing, and other basic needs are met Medication and other treatments for physical, cognitive, and mental health concerns.

   Advocacy to ensure they receive services and are protected from discrimination and abuse.

   An autistic person with a Level 3 diagnosis is more likely to have communication difficulties and may rarely initiate interactions, especially with neurotypical people. When they do, they are likely to be perceived as awkward.

   They may prefer parallel play instead of interactive hangouts, or might prefer to interact with other based upon lessons from social stories and scripts.

8. #8Social, Emotional & Sexual Development

   Keys: social, emotional, sexual, conversation, talk, interaction, emotion, emotions, sexual awareness, sex

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   [Childhood:

   Emotional Development: May struggle with emotional regulation, often displaying intense reactions to sensory overload or changes in routine. They may not always express emotions clearly. Sexual Development: Limited awareness or understanding of sexuality. Focus is mainly on early developmental milestones, and curiosity about the body may arise. Social Development: Difficulty with social interaction, such as forming friendships or understanding social cues. Limited verbal communication in some cases, with reliance on non-verbal behaviors or stimming.]

   [Adolescence:

   Emotional Development: Emotional intensity may increase, with heightened sensitivity to social rejection, stress, and transitions. They may develop a better understanding of their emotions but struggle to express them appropriately. Sexual Development: Increased interest in sexuality and relationships, but may struggle with understanding social norms, boundaries, and developing appropriate relationships. Social Development: Struggles with peer relationships and understanding complex social dynamics (e.g., sarcasm, humor). Some may form deep, narrow interests in a few friends, while others may feel isolated.]

   [Young Adulthood:

   Emotional Development: More developed emotional awareness, but challenges with emotional regulation may persist. They might experience anxiety, depression, or frustration due to social or life transitions. Sexual Development: Greater interest in romantic and sexual relationships, but challenges with forming intimate relationships may persist. There may be a need for clear communication about boundaries and expectations. Social Development: Social skills may improve with age and practice, though many may continue to face difficulties with complex social situations, maintaining relationships, and understanding subtle social cues. Some may prefer solitary or niche social interactions. Throughout all stages, individuals may vary greatly in their abilities and experiences, with many requiring support in areas like communication, emotional regulation, and social integration.]

9. #9Reaction

   Keys: react, reaction, reactions, unexpected, unknown, unexplored, sensation, voice, situation, person, meltdown, avoid, avoidance, withdrawal, silence, silent, quiet, stim, stimming, discomfort, curious, curiosity

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   An autistic person may react to something unexpected, unknown or an unexplored sensation, voice, situation or person in various ways, depending on their sensory sensitivity and how they process unfamiliar stimuli:

   Sensory Overload: They may experience heightened sensitivity to new sensations, such as sounds, textures, or lights. This could cause distress, leading to behaviors like covering ears, blinking rapidly, or withdrawing.

   Avoidance or Withdrawal: If the situation feels overwhelming or uncomfortable, they may attempt to retreat from the stimulus by leaving the environment, turning away, or seeking a quiet space.

   Meltdown or Shutdown: In response to overwhelming or unexpected experiences, an autistic person may have a meltdown (an intense emotional response involving crying, shouting, or self-harming behaviors) or a shutdown (becoming non-responsive, emotionally numb, or zoning out).

   Stimming: To manage the new sensation or situation, they may engage in repetitive behaviors like rocking, hand-flapping, or humming, which can help soothe or self-regulate their emotions.

   Inability to Communicate or Express Discomfort: They may struggle to verbalize discomfort, leading to frustration or increased anxiety, especially in social situations with unfamiliar people or voices.

   Curiosity or Fascination: Some autistic individuals may show intense curiosity or fascination with the new sensation or person, especially if it's aligned with their interests. They might engage with it in a focused, repetitive manner.

   Overall, the reaction can range from anxiety and avoidance to intense curiosity, and may vary depending on the individual's sensory preferences, coping mechanisms, and familiarity with the situation.

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