You may have come across the term Level 2 Autism while reading about autism or looking into a possible diagnosis. It’s a phrase often used in American resources, based on the DSM-5, to describe the level of support someone with autism might need. But in the UK, the way autism is understood and described can be quite different.
Rather than assigning a numbered “level,” clinicians here tend to focus on the individual – their strengths, their challenges, and the specific support that could help them thrive. That said, many people still search for information using terms like “Level 2 autism,” so it’s useful to understand what it means and how it might apply to real-life experiences.
In this article, we’ll explain what Level 2 autism refers to, what the signs and traits might look like in both children and adults, and how support can make a difference. We’ll also answer common questions about communication, independence, and what daily life can look like for someone who needs moderate support. And if you’re considering a private autism assessment for London, Oxford or surrounding areas, we’ll outline how Oxford CBT can help. If you’re wondering about treating problems arising from certain autistic traits, such as sleep issues, you may also be interested in reading our article Medication for Autism.
What Does Autism Level 2 Mean?
The term Level 2 Autism comes from the DSM-5 (Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition), a widely used guide published by the American Psychiatric Association [1]. In this manual, autism is diagnosed as a single condition – Autism Spectrum Disorder (ASD) – and is described in terms of support needs rather than subtypes like Asperger’s or PDD-NOS, which were used in earlier versions.
Instead of categorising autism based solely on symptoms, the DSM-5 places individuals into one of three levels based on how much day-to-day support they require:
How Levels Are Defined in the DSM-5
- Level 1 – Requiring Support: Individuals may have noticeable difficulties with social communication and flexibility, but can often manage with minimal help.
- Level 2 – Requiring Substantial Support: People at this level have more marked challenges with verbal and nonverbal communication, social interaction, and adapting to change. They may need regular, structured support to manage daily life.
- Level 3 – Requiring Very Substantial Support: This level is associated with severe difficulties in communication and behaviour. Individuals often require intensive, ongoing support across most areas of life.
Level 2 specifically refers to people who are significantly affected in their functioning, but who may not meet the criteria for Level 3. They may struggle with social situations, rigid routines, or sensory overload, and typically benefit from consistent support both at home and in structured environments like school or work.
Why the UK Takes a Needs-Based Approach Instead
In the UK, especially within the NHS, professionals tend not to use numbered levels to describe autism. Instead, clinicians focus on each individual’s unique profile of strengths and difficulties, alongside the context in which those needs appear – whether that’s at home, school, work, or in social situations.
Rather than assigning a specific level, support is offered based on what someone needs to function well and feel understood in their day-to-day life. For example, two people with similar traits may receive different kinds of help depending on their environment, routines, or co-occurring conditions.
So while “Level 2” can be helpful when reading or researching, it’s important to remember that in the UK, the focus is always on the person, not the label.
Autism Level 2 Symptoms
People described as having Level 2 Autism typically experience a range of traits that can make daily life more challenging without structured support. These individuals may not require constant one-to-one assistance, but they do often need regular and consistent help to manage social interaction, adapt to change, and navigate sensory environments.
It’s important to note that levels of autism are not linked to intelligence or cognitive ability. Someone with Level 2 autism may have an average or above-average IQ, while another person with the same level of support need might also have a learning disability. The classification is based on how much support is needed for everyday functioning, not on intellectual capability.
Here are some of the more common features associated with Level 2 autism:
Social Communication Challenges
People with Level 2 autism often find back-and-forth conversations, social cues, and unspoken rules of interaction especially difficult. It is important to note that no two people with autism will experience exactly the same challenges, or experience them to the same degree. For example purposes, however, they might:
- Take things very literally and miss sarcasm or humour
- Struggle with eye contact, facial expressions, or tone of voice
- Find it hard to initiate or maintain friendships
- Become overwhelmed in group conversations or crowded environments
These challenges are usually noticeable to others and may cause difficulties in school, work, or social settings without appropriate support or accommodations.
Repetitive Behaviours and Routines
A strong preference for routine is common. Many individuals with Level 2 autism rely on structure and predictability to feel comfortable and in control. They might:
- Follow daily routines rigidly and feel distressed by unexpected changes
- Repeat certain movements (like hand-flapping or rocking) or phrases (known as echolalia)
- Focus intensely on specific interests or topics
- Organise or line up objects in a particular way
These behaviours often serve as a coping mechanism for managing anxiety or overstimulation.
Sensory Sensitivities and Daily Struggles
People with Level 2 autism are often more sensitive to sensory input. This might include:
- Discomfort with loud noises, bright lights, certain textures, or strong smells
- Difficulty with clothing labels, food textures, or brushing teeth
- Becoming quickly overwhelmed in busy places like shopping centres or classrooms
These sensitivities can make everyday activities feel exhausting or even distressing, and often contribute to anxiety or emotional shutdown if not recognised and supported.
Understanding these symptoms can help parents, teachers, employers, and others around the individual provide more effective support – not by trying to “fix” behaviours, but by creating environments where the person can feel safe, respected, and able to thrive.
Level 2 Autism in Adults and Children
While the core traits of autism may remain consistent throughout life, how they appear and affect day-to-day life can change with age. Level 2 autism can look very different in a toddler compared to a teenager or an adult, especially as individuals develop coping strategies or receive support.
Below is a general overview of how Level 2 autism may present across different life stages.
Level 2 Autism in Children (Toddlers to Teens)
Children with Level 2 autism typically show clear differences in communication, social interaction, and behaviour early on. These may be picked up by parents, teachers, or health professionals during routine development checks or school observations. Some signs may include:
- Delayed or limited speech or use of language in unusual ways (e.g. repeating phrases)
- Difficulty engaging in back-and-forth play or sharing attention with others
- A tendency to focus on one specific interest or topic intensely
- Resistance to change, becoming distressed if routines are disrupted
- Physical behaviours such as hand-flapping, spinning, or pacing
- Trouble making or maintaining friendships, especially as social demands increase in school
- Emotional outbursts when overwhelmed by sensory input or change
As children grow into their teenage years, social expectations become more complex. Many young people with Level 2 autism continue to find peer relationships difficult, may experience increased anxiety, and may struggle with transitions such as starting secondary school or preparing for exams.
Early recognition and structured support – such as tailored educational plans, speech and language therapy, or CBT – can make a real difference in helping a child build confidence and navigate these challenges.
Level 2 Autism in Adults
In adults, Level 2 autism may present in more subtle or internalised ways, especially if the person has learned strategies to mask or manage their traits. However, the need for consistent support remains.
Common traits may include:
- Persistent difficulties with social communication, such as maintaining small talk, understanding sarcasm, or knowing when to enter or exit a conversation
- A need for structure and predictability in daily routines
- Difficulty coping with unexpected changes or transitions (e.g. a change in work schedule)
- Intense focus on specific interests or tasks, sometimes at the expense of other responsibilities
- Sensory challenges in public or work environments, such as bright lights, loud noises, or crowded spaces
- Feelings of burnout, anxiety, or exhaustion from trying to “mask” autistic traits in social or professional settings
Some adults with Level 2 autism may struggle with employment or independent living unless they have access to ongoing support, workplace adjustments, or therapy.
Many people are not diagnosed until adulthood, especially those who were previously mislabelled or whose traits were overlooked in childhood. A diagnosis later in life can often bring clarity and a sense of relief, helping individuals access the tools and understanding they need to live more comfortably.
At any age, the key is recognising that support should be tailored to the person, not their label, and that with the right support and reasonable adjustments, individuals with Level 2 autism can lead fulfilling and meaningful lives.
Can Someone with Level 2 Autism Speak, Live Independently, or Have a Normal Life?
There are often a lot of questions around what life can look like for someone with Level 2 autism – particularly when it comes to speech, independence, and what’s considered “normal.” These are understandable concerns, especially for parents, but the answers aren’t always simple. That’s because autism affects each person differently, and there’s no one-size-fits-all outcome.
In fact, some individuals with Level 2 autism may go undiagnosed until adulthood, particularly if their traits were subtle, masked, or misunderstood earlier in life. Adults in this situation may have spent years feeling different or struggling with certain aspects of life without knowing why. They may have been misdiagnosed with anxiety, depression, or personality disorders [2] when autism was the underlying cause of their difficulties with social interaction, routine, or emotional regulation.
Let’s take a closer look at three of the most common questions.
Can People with Level 2 Autism Speak?
Yes, many people with Level 2 autism are verbal and able to communicate using spoken language. However, speech and communication may still be significantly affected. For example, someone may:
- Speak fluently but struggle with tone, volume, or timing
- Repeat phrases or use language in a literal or unusual way
- Find it difficult to express emotions clearly or understand figurative language
- Avoid conversations or group settings due to social anxiety
Others may have delayed speech development in early childhood and benefit from early intervention like speech and language therapy. The ability to speak doesn’t necessarily reflect how easily someone communicates, which is why tailored support is so important.
Can People with Level 2 Autism Live Independently?
Some individuals with Level 2 autism can live independently, particularly with the right support in place. Others may need help managing certain aspects of life, such as:
- Keeping track of routines, bills, and appointments
- Navigating work environments or social expectations
- Dealing with unexpected changes or challenges
- Managing sensory sensitivities in shared or public spaces
Independence looks different for everyone. For one person, it might mean living alone with minimal support. For another, it might involve supported housing, flexible employment, or help with daily planning. With the right tools, planning, and understanding, many people with Level 2 autism find a way of living that works for them.
Can People with Level 2 Autism Have a Normal Life?
This is a common question – but it’s worth pausing on the word “normal.” The reality is, there’s no single version of a normal life, for autistic or non-autistic people. Everyone has their own challenges, strengths, and version of what a fulfilling life looks like.
With the right support, many individuals with Level 2 autism can access everyday experiences – meaningful work, friendships, hobbies, travel, relationships, and independence – though they may have to approach them differently, and sometimes need more structure or flexibility to thrive.
Some autistic people prefer routine, solitude, or specific interests over socialising or career ambition. Others may enjoy highly social settings but find them exhausting. It all depends on the person. What matters most is understanding what works for them and creating an environment that supports their well-being and self-confidence.
Diagnosis, understanding, and tailored therapy, like that offered at Oxford CBT, can play a powerful role in helping people move forward with clarity and the support they need.
Can Level 2 Autism Improve to Level 1?
This is a question that often comes up, especially from parents or individuals newly diagnosed: Can Level 2 autism improve to Level 1?
The idea behind this question is understandable. It reflects hope for progress, growth, and a more manageable experience of daily life. But it’s also important to be mindful of the language we use – especially words like improve. Autism isn’t something a person needs to “get better” from. It’s a neurodevelopmental condition, not an illness, and every autistic person has a unique set of strengths and challenges.
That said, support, understanding, and the right environment can absolutely make a big difference. With tailored interventions (such as speech and language therapy, occupational therapy, CBT, or school-based support) many people with Level 2 autism may:
- Communicate more comfortably
- Handle changes and transitions more confidently
- Develop strategies to manage anxiety, sensory overload, or rigid routines
- Increase their ability to cope in different settings (e.g. school, work, public spaces)
As a result, their day-to-day support needs may reduce over time. In practical terms, someone who once needed regular structured help might eventually manage many situations independently. But this doesn’t mean their autism has gone away, it means they’ve found tools that help them navigate life more effectively.
It’s also worth noting that support needs aren’t fixed. Someone may require more help at certain points (like during big transitions or times of stress), and less at others. The DSM-5 levels are not permanent labels, but a snapshot of what kind of support a person needs at the time of assessment.
So rather than focusing on whether someone can “move” from Level 2 to Level 1, it’s more helpful to ask:
‘What does this person need to feel safe, understood, and able to thrive and how can we support them in that?’
Level 2 Autism vs Level 1 and Level 3
The DSM-5 [1] describes autism according to levels of support needed: Level 1 (requiring support), Level 2 (requiring substantial support), and Level 3 (requiring very substantial support). These levels help clinicians understand the impact of autism on daily functioning at the time of diagnosis.
However, these levels aren’t fixed categories. They are based on a snapshot in time – a reflection of current support needs, which can change depending on age, environment, stress levels, and access to help.
Here’s a brief overview of how the levels compare:
What Is Level 1 Autism?
Level 1 autism describes individuals who require support, but are often able to manage many aspects of daily life with some adjustments. They may:
- Have difficulty initiating or maintaining social interactions
- Struggle with planning, organisation, or coping with change
- Mask their traits in public, which can lead to burnout or anxiety
- Need support in high-pressure or unfamiliar environments
Because their traits can be subtle, people with Level 1 autism are sometimes mislabelled as “high-functioning,” though this term is falling out of favour. It doesn’t reflect hidden challenges like sensory overwhelm, fatigue, or emotional regulation.
What Is Level 3 Autism?
Level 3 autism describes individuals who require very substantial support across most areas of life. This may include:
- Very limited verbal communication or being non-speaking
- Significant difficulty understanding or using social cues
- Intense distress in response to change or sensory input
- Repetitive behaviours that interfere with daily functioning
- A need for one-to-one or specialist support in most settings
People with Level 3 autism may also have learning disabilities or physical health challenges, but not always. Again, support needs can vary depending on the person’s environment and access to appropriate help.
Why Labels Don’t Always Reflect the Full Picture
It’s important to remember that these levels are not a reflection of intelligence, potential, or value. They are simply a way to help clinicians and families understand what type of support is likely needed, and even then, only at the time of diagnosis.
Support needs are not static. Someone assessed as Level 2 during a period of stress may later need less help, while another person diagnosed at Level 1 may struggle more when they encounter major life changes.
That’s why many professionals in the UK prefer to take a needs-based approach, focusing on the individual rather than the label. Everyone on the autism spectrum is different and with the right understanding, environment, and support, each person can find ways to live in a way that works for them.
How Oxford CBT Can Support Individuals with Autism
At Oxford CBT, we understand that autism is experienced differently by everyone. That’s why our approach is tailored, thoughtful, and focused on the individual, not just the diagnosis. Whether you’re seeking an autism assessment for your child, looking to better understand your own traits as an adult, or searching for therapeutic support, our experienced clinicians are here to help.
Autism Assessments
We offer private autism assessments for both children and adults, carried out by qualified Clinical Psychologists. Our assessments are based on evidence-based tools and clinical judgement, including structured interviews, questionnaires, developmental history, and behavioural observation. While we’re familiar with the DSM-5 framework (including terms like Level 2 autism), our focus is on understanding your personal strengths, challenges, and support needs, not assigning a number.
For children, the process usually begins with an initial 60-minute consultation involving parents and the child, followed by further sessions and formal assessment where needed. For adults, the process is adapted to explore life history, current challenges, and any co-occurring conditions such as anxiety or ADHD.
Therapy and Support
We also offer therapeutic support for autistic individuals who may be struggling with anxiety, low mood, sensory overload, or navigating relationships and routines. Cognitive Behavioural Therapy (CBT) can be particularly helpful in managing anxiety or social discomfort, improving health-related quality of life and developing practical strategies for managing daily challenges [3].
Therapy is always tailored to the individual, taking into account communication preferences, sensory sensitivities, and personal goals.
Support for Families and Schools
Parents, carers, and teachers often play a key role in helping an autistic child thrive. That’s why we also provide guidance and support for families, helping you better understand your child’s behaviour and how best to respond. We can also work alongside schools and educational settings to ensure consistent, appropriate support in the classroom.
Autism is not something to fix, it’s something to understand and support. Whether you’re exploring a diagnosis or looking for ongoing help, you can contact us at Oxford CBT for clear, compassionate, and practical support every step of the way.
Conclusion
Level 2 autism is often associated with noticeable challenges in communication, routine, and daily life, but it’s only one way of describing the support someone might need at a particular point in time. It doesn’t define who a person is, what they’re capable of, or what kind of life they can lead.
In the UK, the focus is shifting away from rigid labels and toward a more personalised, needs-based approach. With the right support, many autistic individuals – whether diagnosed in childhood or adulthood – can build routines, relationships, and experiences that feel fulfilling and meaningful to them.
At Oxford CBT, we offer thoughtful, tailored assessments and therapy for both children and adults, helping individuals and families understand autism in a way that’s practical, respectful, and empowering. If you’re ready to explore support or simply want to understand more, we’re here to help.
References
- American Psychiatric Association. (2013). Diagnostic and Statistical Manual of Mental Disorders (5th ed.). Arlington, VA: American Psychiatric Publishing.
- Kentrou et al. (2024) Perceived misdiagnosis of psychiatric conditions in autistic adults. EClinicalMedicine. https://pubmed.ncbi.nlm.nih.gov/38596613/
- Fordham et al. (2021) Cognitive-behavioural therapy for a variety of conditions: an overview of systematic reviews and panoramic meta-analysis. Health technology assessment (Winchester, England). https://pubmed.ncbi.nlm.nih.gov/33629950/
Author – Tom Murfitt
With over a decade’s experience in providing Cognitive Behavioural Therapy, Tom has worked in both the NHS and private sector to help adults and children to overcome a range of difficulties and improve their mental wellbeing. In addition to being an experienced CBT therapist, Tom is also an accredited Mindfulness teacher, providing courses locally, in businesses and schools. You can read more about us here.
DISCLAIMER: The information provided in this article is intended for general informational purposes only and should not be construed as medical advice, diagnosis, or treatment. The products and methods mentioned are not a substitute for professional medical advice from a trained healthcare specialist. Always seek the guidance of your doctor or other qualified health professional with any questions you may have regarding your health or a medical condition. Never disregard professional medical advice or delay in seeking it because of something you have read on this website. Use of the information and products discussed is at your own risk.
