Are the severity levels of autism used consistently by professionals?

Since 2013, healthcare professionals have had a tool to describe the support needs of children with autism spectrum disorder. This system classifies needs into three levels, ranging from the lightest to the most significant support requirement. However, a recent analysis reveals that less than half of diagnosed children have this level specified in their medical records. This essential information for tailoring care often remains absent or varies depending on location and population.

The study examined over 15,000 American children aged 4 and 8, followed between 2018 and 2020. It found that only 40% of records mentioned a severity level. The disparities are striking: in some states, fewer than 5% of children had this information, compared to over 70% in others. Children aged 4, those from ethnic minorities such as non-Hispanic Black families, or those whose records did not specify the presence of an intellectual disability, were less likely to have a severity level indicated. Conversely, non-Hispanic Black children, younger children, those followed in 2020, or those with an intellectual disability were more often assigned a high severity level.

These differences raise questions about the uniformity of practices. Professionals do not appear to apply the same criteria for assessing needs. Some children receive a high level of support due to associated intellectual difficulties, while others, without these additional challenges, may be underestimated. For example, non-Hispanic Black children are more often classified at the most severe level, even after accounting for other factors. This could reflect inequalities in access to comprehensive evaluations or biases in the interpretation of symptoms.

The use of these levels also remains uneven across years and regions. In 2020, their mention was more frequent than in 2018, suggesting gradual but still insufficient adoption. Experts point out that the lack of clear guidelines in diagnostic manuals contributes to this variability. Some clinicians hesitate to assign a level, unsure whether they should base it solely on autism symptoms or also on other associated difficulties.

This situation limits the usefulness of these levels for planning services and support. Without more rigorous and uniform application, their potential to improve the lives of affected children remains underutilized. The observed disparities highlight the importance of training professionals and clarifying evaluation criteria. The goal is to ensure that every child receives support tailored to their actual needs, without their background, age, or environment influencing the quality of their care.

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Study Citation

DOI: https://doi.org/10.1007/s10803-026-07292-6

Title: Prevalence of Autism Spectrum Disorder Severity Levels From the Fifth Edition of the Diagnostic and Statistical Manual (DSM-5) in the Autism and Developmental Disabilities Monitoring Network

Journal: Journal of Autism and Developmental Disorders

Publisher: Springer Science and Business Media LLC

Authors: Lauren A. Russell; Sarah C. Tinker; Kelly A. Shaw; Matthew J. Maenner; Monica Dirienzo; Anne V. Kirby; Ellen M. Howerton; Sandra B. Vanegas; Maya Lopez