Level 2 Autism Guide: What Parents Need to Know

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Embarking on the journey of parenting a child with Autism Spectrum Disorder (ASD) can be a challenging and enlightening experience. If you find yourself questioning whether your child may have level 2 ASD or have recently received a diagnosis, it is important to understand that there is tailored support and information available to directly address your child’s unique needs. Recognizing the signs and nuances of a level 2 ASD diagnosis is crucial for parents, caregivers, and professionals alike.

As parents, you may wonder what symptoms to expect, whether level 2 can be cured, or what the prognosis will be for your child. This article will provide insight into Level 2 ASD, its characteristics and challenges, the diagnostic process, and effective treatment options.

What is Level 2 Autism?

ASD is a lifelong neurodevelopmental disorder that impacts how individuals communicate, socialize, behave, and learn. Individuals diagnosed with ASD experience varying levels of severity. The levels are characterized by assessing two areas of functioning: social communication and repetitive or restrictive patterns of behavior.

There are three levels of ASD, that reflect the amount of support an individual needs. They also allow doctors and other professionals to provide a more detailed diagnosis, leading to more effective and appropriate treatment plans and allowing parents to understand their child’s needs better.

Level 1 is the mildest form of ASD. These individuals can often participate in mainstream settings with minimal support. However, they struggle with understanding social cues, engaging in back-and-forth conversations, and maintaining interpersonal relationships. Individuals with level 1 ASD may also experience some inflexible behaviors such as difficulty transitioning between activities.

Level 2 ASD is characterized as somewhat severe and individuals at this level require substantial support when compared to level 1. These individuals have difficulty communicating verbally and nonverbally. Some will speak in short sentences or only communicate about special interests. They have difficulty providing eye contact and may walk away during conversations or have abnormal responses to social cues. The level of inflexibility is more pronounced than level 1 with displays of marked distress when dealing with changes in routines. Repetitive behaviors also occur more frequently and are noticeable to the layperson.

Level 3 is the most severe and individuals require very substantial support. This level is characterized by severe challenges in social communication, with some individuals being nonverbal or only having the use of a few understandable words. There is limited social interaction which can be depicted as abnormal or having the sole purpose of meeting their needs. At this level, restrictive or repetitive behaviors interfere with daily living.

Autism Level 2 Symptoms

Symptoms of ASD typically fall under three classifications: language and communication impairment, social impairment, and restrictive or repetitive behaviors including sensory sensitivities. The symptoms present and their severity will be different in everyone diagnosed with ASD.

The signs of ASD include the following:

  1. Avoid eye contact from as early as 3 to 6 months old.
  2. No response to name by 9 months old.
  3. Lack of facial expressions, such as happy or sad, by 9 months old.
  4. Does not play interactive games, such as peek-a-boo, by 9 months old.
  5. Uses few or no hand gestures, such as waving, by 12 months old.
  6. Does not share interests with others, like showing you their favorite toy, by 15 months old.
  7. Does not point to show you something they are interested in by 18 months old.
  8. Does not notice when others are hurt or upset by 2 years old.
  9. Does not engage in parallel play by 2 years old.
  10. Does not notice other children or engage in interactive play by 3 years old.
  11. Does not pretend to be someone else or engage in imaginary play by 4 years old.
  12. Does not sing, act, or dance for you by 5 years old.

How is Level 2 Autism Diagnosed?

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There are two phases of diagnosing children with ASD. The first phase is screening, which should be conducted during routine wellness visits with healthcare providers. All children should be routinely screened for developmental delays and disorders at their 9-month, 18-month, and 24-month checkups and specifically for ASD at their 18-month and 24-month checkups. Additional screening may be recommended for children who are considered high risk for ASD, such as siblings of a child diagnosed with ASD or premature babies.

Screening tools include:

  1. Ages and Stages Questionnaire (ASQ) – This is a general development screening tool that includes a parent questionnaire covering communication, gross motor, fine motor, problem-solving, and personal adaptive skills.
  2. Communication and Symbolic Behavior Scales (CSBS) – This is a one-page, parent-completed, standardized screening tool covering communication and symbolic abilities up to 24 months of age.
  3. Parent’s Evaluation of Developmental Status (PEDS) – This is a general development screening tool for development and behavioral problems that need further evaluation.
  4. Modified Checklist for Autism In Toddlers (MCHAT) – This is a parent-completed questionnaire designed to identify children who are at risk for ASD.
  5. Screening Tool for Autism in Toddlers and Young Children (STAT) – This is an interactive screening tool that consists of assessing play, communication, and imitation skills.

Many of the above screening tools include parent reports. It is important to involve parents and other family members in the screening process as research has shown they are a reliable source of information. The child’s behavior, development, and family history should be discussed with the parent or caregiver.

While screening tools provide useful information regarding developmental delays they do not always result in diagnoses. If a child receives a positive screening result, they move to the second phase of the diagnostic process which is a thorough assessment. These are conducted by neurodevelopmental or developmental-behavioral pediatricians, psychologists, child neurologists, and speech and language pathologists.

Many tools can be used to screen for ASD, but no single tool should be used as the basis of a diagnosis. These tools rely on two main sources of information: a parent’s description of the child’s behavior and development and a professional’s observation of the child’s behavior. Some examples of diagnostic tools include:

  1. Autism Diagnosis Interview-Revised (ADI-R) – This tool focuses on reciprocal social interaction, communication and language, and repetitive and restrictive behaviors and interests.
  2. Autism Diagnostic Observation Schedule, 2nd Edition (ADOS-2) – This tool collects standardized and objective information about social communication skills, restricted interests, and repetitive behaviors.
  3. Childhood Autism Rating Scale (CARS) – This tool assesses social interaction, communication skills, and repetitive behaviors through direct observation of the child’s behavior.
  4. Gilliam Autism Rating Scale – Second Edition (GARS-2) – This tool is used to assess individuals ages 3 to 22 years and can determine the severity of the symptoms.

To receive a diagnosis of level 2 ASD a child must have lasting difficulties in social communication and social interaction in multiple environments, restricted interests, and repetitive patterns of behavior. These traits must be evident from infancy or early childhood and must significantly impact the child’s daily life.

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Characteristics of Level 2 Autism

A diagnosis of level 2 ASD indicates a child needs substantial support to navigate daily life. Some characteristics of this level are:

  1. Social Interaction: Children with level 2 ASD find nonverbal interactions particularly complicated and are more likely to respond in ways that neurotypical people see as inappropriate. They find it challenging to understand social cues, gestures, and facial expressions. For example, they may not notice someone is no longer interested in or comfortable with what they are saying. Those with level 2 ASD may have difficulty initiating and sustaining a conversation with others or developing friendships. For example, they may turn away from the person talking, stand too close to them, or they may walk off mid-conversation.
  2. Language and Communication: Children with level 2 ASD have a limited vocabulary and use shorter or incomplete sentences when they speak. It can be challenging to maintain back-and-forth communication, due to difficulties remaining on topic, speaking about diverse interests, or an inability to reciprocate questions. In addition, they may use repetitive language such as phrases learned from their favorite TV shows. However, these phrases are typically used in the correct context.
  3. Repetitive behavior: Level 2 ASD children frequently engage in repetitive behavior that is noticeable and impacts their daily lives. These behaviors can include hand-flapping, rocking, or lining up items. They commonly experience severely fixated interests and struggle to focus on other thoughts or activities. For example, a child may only speak about planets regardless of what is being said by others.
  4. Adaptability: Children with level 2 ASD experience visible distress when there are changes in their routines or environments. For example, they may find it difficult to eat a different brand of the same flavor of chips they like. They may find it difficult to transition from one activity to another, even if the second activity is a preferred activity.

Impact on Daily Life

The characteristics of level 2 ASD can significantly impact a person’s daily life. However, with the right accommodations and support, this impact can be lessened.

Educational Considerations

Level 2 Autism’s impact on social communication, adaptability, executive functioning skills, and motor control can create developmental obstacles to learning. It may be challenging to understand and follow directions. For example, following 2 or 3-step instructions within the classroom can be challenging when organization and planning skills are weak. Students with level 2 ASD may also have an inability to make connections between abstract concepts and ideas.

While children with level 2 ASD may struggle in traditional education settings, with the right accommodations, they can succeed. Accommodations can include scribing or reading support where an educational assistant (EA) or paraprofessional writes or reads for the students. Providing sensory breaks or fidget toys as a sensory outlet can increase a student’s ability to focus.

Providing longer breaks between activities and using a visual schedule can help with transition challenges. Having clear expectations and having the student paraphrase the instruction after receiving it increases the likelihood of understanding and following directions. Preferential seating can allow students to sit in quiet areas of the classroom where they are least likely to be distracted.

Modifying academic work, such as reducing the quantity of the assigned tasks or allowing students to use assistive technology to complete tasks is essential for a student with level 2 ASD to succeed. Ensuring each student has an individualized education plan (IEP) will allow them to learn at their own pace and in line with their abilities.

Socialization and Relationships

Children with level 2 ASD develop language later, use language differently, or have limited use of verbal language. They have difficulty engaging in conversations and making eye contact with their peers. They will often miss or misinterpret social cues, facial expressions, and gestures. These social communication challenges make it difficult to develop interpersonal relationships.

Some accommodations can make it easier for children with level 2 ASD to connect with others and build friendships. Having peer mentors is a great way to raise awareness and increase understanding of ASD, while also providing support and guidance for those students with ASD. An EA/paraprofessional can also be near to assist with social interactions during breaks like lunchtime.

Lunchtime and recess can be specifically structured with games and activities that promote student interaction. Teachers can also plan inclusive classroom activities like group projects that will provide opportunities for students to work together and build connections.

Social skills training groups that bring neurotypical and neurodiverse individuals together can be created. This would provide a safe space for level 2 ASD students to practice social skills. In addition, explicit friendship education geared towards teaching students about diversity, acceptance, and the unique qualities of each student can promote a culture of inclusion and understanding in school.

Parental Role and Support

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Parents play a crucial role as primary caregivers and educators to their children with ASD. Providing nurturing environments, early intervention, and ongoing support and treatment will impact their child’s overall development and quality of life.

Parents are typically the first to notice developmental differences and play an important role in seeking early intervention services. Early diagnosis and intervention can lead to substantial improvements in social communication skills and behavior management.

Parents know their child’s strengths, challenges, and triggers better than anyone else. Knowing these allows parents to advocate for their children to receive the support and services they need. This knowledge also puts parents in a position to provide insight to professionals and be better able to collaborate with them to create effective individualized support plans.

Parents are critical in teaching essential life skills such as good hygiene routines and communication methods. These will enable their children to be more independent and set the stage for greater autonomy in adulthood.

Parenting a child with ASD can be mentally and physically demanding. While it is important for parents to advocate for their children and teach them life skills, it is equally important for parents to engage in self-care and create a support system. Engaging in peer support groups and counseling sessions can help alleviate stress and create a more resilient environment for parents to raise their children.

Treatment For Autism Level 2

Early intervention can improve the prognosis for a child diagnosed with level 2 ASD. Children’s brains are most malleable during the first three years of life. This means they have a greater ability to learn new skills and will experience the biggest impact from available treatment options. Early intervention programs help children with ASD learn the skills they would typically learn during the first two years of life.

The following is a list of treatment options for level 2 ASD:

  1. Occupational therapy – This treatment should be geared towards daily living activities, such as learning to perform everyday tasks like teeth brushing independently. Occupational therapy should also help children learn to process sensory information, such as loud noises or bright lights.
  2. Speech Therapy – This treatment should help children comprehend verbal and nonverbal communication. This can include recognizing and correctly responding to body language and facial expressions. Speech therapy can also teach children with level 2 ASD how to spontaneously initiate and sustain communication with peers. They should be taught specific strategies for discussing topics outside of their special interests to better enable them to interact and build friendships.
  3. ABA Therapy – This treatment is essential for addressing communication barriers and social skills deficits at level 2 ASD. It can help children learn how to effectively interact with their environment and peers. Treatment should focus on improving nonverbal and verbal communication, fostering peer interactions, and reducing repetitive or restrictive behavior patterns.

Positive Aspects of Level 2 Autism

People with ASD often have exceptional memory, attention to detail, and problem-solving skills. Their fixation on special interests can also be turned into a strength. By recognizing and building on these strengths, people with level 2 Autism can achieve great things and contribute to society in meaningful ways.

Matt Cottle, diagnosed with ASD, is an accomplished baker. His passion for baking began in a high school cooking class. He began to obsess over baking, thinking about it all the time. Despite being rejected from culinary school multiple times, he persevered and found a chef who was willing to give him one-on-one lessons. He was able to learn new skills and bring a new level of creativity to baking. Cottle, with support from his family, currently owns his own catering business and bakery.

Jason McElwain started off helping his basketball team by fetching water and moping up sweat. However, during one particular game, his coach decided to put McElwain in for the final 4 minutes. He ended up scoring 20 points. He co-authored a book where he stated the game gave him the confidence he needed to accomplish anything. He is now the assistant coach at his old high school.

Understanding your child’s unique journey through level 2 ASD is crucial to providing them with the most appropriate and effective support and resources they need to be able to thrive. By understanding the signs and symptoms, parents can detect these in their children and obtain early intervention services. By understanding the characteristics and differences of level 2 ASD, parents can better advocate for their children and help them navigate daily life. Every child is different, parents should be patient and flexible as they learn to overcome challenges and celebrate achievements.

Frequently Asked Questions

Is Autism Level 2 a Disability?

Level 2 ASD is considered a disability due to the impact it has on daily life, the level of interference with learning, and the requirement of substantial support.

Is Autism Level 2 Curable?

There is no cure for any level of ASD, as it is a life-long disorder. The goal of treatment is not to cure ASD, it is to provide individuals with the tools needed to manage their symptoms and improve their ability to function in multiple environments.

References

Autism spectrum disorder. (2018).
https://www.nimh.nih.gov/health/topics/autism-spectrum-disorders-asd/index.shtml#part_145436

Committee on Children and Disabilities, American Academy of Pediatrics. Developmental surveillance and screening for infants and young children. Pediatrics 2001;108(1):192-195.

Glascoe FP. An evidence-based approach to developmental and behavioral surveillance using parents’ concerns. Child: Care, Health, and Development 2000;26:137-149.

Hyman, S. L., et al. (2020). Identification, evaluation, and management of children with autism spectrum disorder.
https://pediatrics.aappublications.org/content/145/1/e20193447

Smith, M., et al. (2019). Does my child have autism?
https://www.helpguide.org/articles/autism-learning-disabilities/does-my-child-have-autism.htm/

Squires J, Nickel RE, Eisert D. Early detection of developmental problems: strategies for monitoring young children in the practice setting. Journal of Developmental and Behavioral Pediatrics 1996;17:420-427.

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