Level 3 Autism

Level 3 autism is a classification from the DSM-5 used primarily in the US to describe autistic individuals who need very substantial support. This may include limited or non-verbal communication, difficulty with daily activities, and significant sensory sensitivities. The UK focuses more on individual support needs than numerical levels.

The Full Answer

If someone close to you has recently been described as having “Level 3 Autism,” you might be feeling uncertain about what that means, especially if you’re based in the UK, where this type of terminology isn’t often used. It can feel confusing to come across a label that doesn’t appear in the NHS diagnostic process or in most UK autism services.

If you are exploring the different levels of autism because you are considering how these may apply to an undiagnosed individual such as yourself, your child or a loved one, we offer private autism assessments to people in London, Oxford and surrounding areas. 

The term “Level 3” comes from the American diagnostic system (DSM-5) and refers to someone who needs very substantial support in daily life. But that label only gives a small snapshot. It doesn’t tell you much about the person, their strengths, or what support will help them thrive. In the UK, professionals are more likely to talk about support needs or use specific descriptions of how autism affects someone’s communication, behaviour, and daily life.

This article is here to help you understand what people mean when they refer to “Level 3 Autism,” what kinds of challenges might come up for someone who needs this level of support, and most importantly how you can help them live a fulfilling and supported life. If you are looking for more information on autism that requires less substantial support, our article Level 2 Autism may be more relevant for you.

Understanding Why the UK Doesn’t Use Autism ‘Levels’

If you’ve been researching autism online, you’ve probably come across terms like Level 1, Level 2, or Level 3 Autism. These labels come from the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) – a classification system used mainly in the United States. In this system, autism is described according to how much support someone is likely to need in daily life, with Level 1 being the least and Level 3 the most.

Here in the UK, things work a little differently. The NHS and many clinical professionals use the International Classification of Diseases (ICD-11) or simply focus on a functional, needs-based approach rather than assigning a numbered level. UK clinicians and support teams are more likely to describe someone as having “high support needs” or note specific differences in communication, learning, and daily living, rather than using numerical labels.

This approach recognises that every autistic person is different. Some individuals may need intensive support in some areas but are highly independent in others. Support needs can also vary over time, depending on life stage, environment, or mental health.

So while you might hear the phrase “Level 3 Autism” in international contexts or on websites based in the US, it’s important to remember that here in the UK, the focus is less on labels and more on understanding each person’s unique strengths, challenges and what kind of help will be most beneficial.

Characteristics of Autistic People with Higher Support Needs

Autistic people who require higher levels of support often experience significant challenges in day-to-day life, especially with communication, social interaction, and adapting to change. But even when support needs are high, it’s important to remember that every individual is different, and that when well supported, autistic people often accomplish things in ways that work for them. For these reasons, its most helpful to use terms like ‘differences’ not ‘deficits’ when referring to autistic characteristics.

Communication Differences

Many people with high level support needs are non-verbal or may use only a few words. This doesn’t mean they don’t have things to say – it just means they may communicate in different ways. Some may use tools, others may rely on gestures, facial expressions, or behaviours to express their needs and emotions.

When speech is limited or absent, there are many alternative ways for children to communicate and engage. These include:

• PECS (Picture Exchange Communication System) – often used to build foundational communication by exchanging images for items or actions [1]
  
• Makaton – a simplified sign and symbol system that supports spoken language [2]
  
• AAC (Augmentative and Alternative Communication) – which may include communication books, apps, or speech-generating devices [3]
  

These tools don’t replace the need for connection, they facilitate it by allowing children to express needs, make choices, and share enjoyment with others in a way that feels accessible to them.

Sensory Differences and Behaviour

Many individuals with higher support needs experience sensory input differently to non-autistic people. Noises can seem louder, lights brighter, certain textures can be distressingly unpleasant (or extremely soothing), and smells can be stronger for many autistic people [4]. 

These experiences can make everyday environments feel overwhelming [4]. It’s also common to see repetitive movements like rocking, hand-flapping, or spinning – often called stimming – which can help regulate sensory input or express emotion [5].

A strong preference for routine is also common. Sudden changes in schedule or surroundings can be distressing, so predictability, preparation for changes in routine and structure are often key to creating a safe and supportive environment [6].

Co-occurring Conditions

People with higher support needs are more likely to experience co-occurring conditions, including:

• Learning disabilities [7]
• Epilepsy [8]
• Depression [8]
• Anxiety or sleep disorders [8]
• Gastrointestinal and immune function disorders [8]
  

These additional conditions can influence behaviour, communication, and how support is provided.

Is It Serious?

The term “high support needs” is sometimes interpreted as implying something negative or fixed, but it simply means that ongoing support is needed across several areas of daily life, such as communication, safety, and self-care. 

Support needs might be significant, but this doesn’t limit someone’s potential for learning, growth, or enjoyment. What matters most is that the right support is in place – tailored to the individual, responsive to their environment, and delivered with respect for their preferences and autonomy.

Education, Communication and Social Development

Autistic children with higher support needs are likely to require specialist support to access a suitable education for their needs. The type of setting and support they receive will vary depending on their individual profile, the resources available to the local council and parental preferences.

School and Educational Support in the UK

Children with substantial support needs are often educated in Special Educational Needs (SEN) schools, where staff and environments are tailored to provide more intensive support. Others may attend mainstream schools with an Education, Health and Care Plan (EHCP) in place to ensure the right adjustments and one-to-one support are provided. 

Some families also choose home education, particularly if a child finds formal settings overwhelming or if suitable placements are unavailable. There’s no single ‘right’ path,  the goal is to find the environment where the child feels safe, supported, and able to learn in a way that suits them.

Can Autistic Children with Higher Support Needs Interact Socially?

Yes, though how they interact might look different from what people expect. Social connection doesn’t always involve words or typical eye contact. It might be shown through shared activities, body language, or being present with someone in a calm, familiar way.

Many autistic children seek connection, even if they communicate it differently. With patience, curiosity and the right support, social development can flourish – not by forcing someone to conform to typical behaviours, but by embracing their unique way of relating to others.

Why Needs Can Change Over Time

Support needs aren’t fixed. They can change over the course of a person’s life, sometimes gradually, sometimes suddenly, depending on a wide range of factors, some of which we’ll look at below.

Development, Puberty and Life Transitions

As children grow, their needs often shift. For example, during early development, some may begin using more words, show new interests, or become more independent with routines. Later on, puberty can bring physical and emotional changes that affect sleep, mood, anxiety levels, or behaviour.

Transitions like moving school, changes at home, or new health challenges can all impact how much support someone needs day to day. These changes don’t reflect a regression or failure, they’re part of how humans respond to their surroundings.

Stress and the Environment

Autistic people often experience heightened sensitivity to their environments. Loud sounds, crowded spaces, unpredictable routines, or social pressure can all increase distress. At times of stress, a person may need more help to feel regulated and secure, and their communication or behaviour may change.

With the right environment and support, many challenges can be reduced. For example, someone who struggles in busy classrooms might thrive in a quiet, low-arousal setting with a predictable routine.

Is Progress Possible for Those with Higher Support Needs?

Yes, though its important to stress that progress doesn’t always mean becoming more like non-autistic people. It might mean learning a new way to communicate, becoming more comfortable with transitions, or feeling calmer in a particular setting.

Progress isn’t always linear either. Some periods may bring rapid change, while others feel like a plateau. That’s completely normal. What matters is that the person is supported to develop in ways that are meaningful to them, with their wellbeing always at the centre.

Supporting Autistic People and Their Families

With the right support in place, many challenges experienced by autistic individuals can become less intense or more manageable over time. In an understanding environment where communication is supported and stress is reduced, autistic individuals are best positioned to improve emotional regulation, quality of life, and achieve greater independence.

Getting an Autism Assessment and Accessing Support in the UK

If you’re seeking help for someone who may be autistic, the first step is usually to speak to your GP or health visitor. They can refer you for an autism assessment, often via a community paediatrician (for children) or specialist mental health services (for adults). Waiting times can be several years, but support may still be available while you wait through your local authority, school, or voluntary sector.

Once a diagnosis is confirmed, you may be entitled to an Education, Health and Care Plan (EHCP), social care support, or tailored interventions depending on the person’s needs. Please note that there is a highly structured and lengthy application process to determine EHCP eligibility, so its advisable to contact your child’s school or Local Education Authority as soon as possible to get the ball rolling. 

Therapeutic Support and Multidisciplinary Care

Autistic people with higher support needs may benefit from input from a range of professionals, including:

• Occupational therapists, who can help with sensory processing, daily living skills and routines
  
• Speech and language therapists, especially for non-verbal communication and feeding concerns
  
• Psychologists or CBT therapists, when adapted approaches are used to help with anxiety, sleep, and behavioural distress
  

At Oxford CBT, we understand the value of taking a person-centred approach, adapting therapy to suit the individual’s communication style and cognitive profile.

Support for Families and Carers

Caring for someone with high support needs can be emotionally and physically demanding. It’s essential that families and carers also have access to both practical and emotional support. This might include respite care, parent training, local support groups, or mental health support for family members themselves. Being well-supported as a parent or carer not only helps you cope, it helps you feel more equipped to meet your loved one’s needs.

Where to Find Help

Here are some starting points:

• NHS services – for assessment, therapy, and medical care
• Your local authority – for EHCPs, short breaks, or social care assessments
• Charities such as the National Autistic Society, Ambitious about Autism, and Contact – which offer resources, helplines, and peer support
• Specialist schools and educational psychologists – for tailored learning support
• Local carer support groups – in our region, this is Carers Oxfordshire
  

No one has to figure it all out at once. Take it one step at a time and build a team around you that understands and responds to your family’s needs.

Planning Ahead: Quality of Life, Independence and Long-Term Support

When someone requires substantial support, it’s important to think about the future with hope and intention. With the right approach, many autistic people live fulfilling lives that reflect their personality, interests, and goals.

Fostering Autonomy Within Support

Independence doesn’t always mean doing everything alone. It can also mean making choices, having a say in daily routines, or developing skills in a supported environment. This might involve choosing what to eat, expressing preferences through a communication device, or learning to participate in activities at home or in the community.

Autonomy is about being heard and respected, even when full independence isn’t possible.

Support That Builds on Strengths

Each person has their own way of experiencing and engaging with the world. Some may be drawn to music, patterns, animals, or hands-on activities. Tailoring support to these interests doesn’t just improve learning, it helps the person feel recognised and understood.

A strengths-based approach focuses on what someone can do, not just what they struggle with, and allows them to build confidence over time.

Planning for Adulthood

As children grow older, families often begin thinking about what adult life will look like, including housing, education, healthcare, and daily support. This can feel overwhelming, but it doesn’t have to be rushed.

Start by exploring options such as:

• Further education or supported internships (EHCPs provide education up to age 25 [9])
  
• Supported living or residential care options
  
• Adult social care assessments
  
• Personal budgets or disability trust funds to fund tailored support throughout adult life
  

Planning ahead helps families make informed decisions and can reduce stress later on.

Conclusion

Terms like “Level 3 Autism” may offer a broad description of support needs, but they don’t capture the whole person. No single label can reflect someone’s personality, strengths, preferences, or potential.

That’s why it’s so important to look beyond the terminology and focus on the individual in front of you: how they communicate, what brings them comfort, where they feel safe, and how best to support their wellbeing.

Providing the right support takes time, patience, and understanding. There’s no one-size-fits-all approach, just a shared commitment to helping someone live a life that feels meaningful to them.

At Oxford CBT, we take a person-centred, neuroaffirming approach to care. We work closely with individuals, families, and schools to provide tailored support that respects each person’s unique way of experiencing the world. Our team includes psychologists and therapists who can help with anxiety, emotional regulation, communication challenges, and family wellbeing.

If you’re seeking a private autism assessment or compassionate, informed support – we’re here to help, so contact us at Oxford CBT to discuss suitable support options available.

References

1. PECS UK. ‘Picture Exchange Communication System’.  https://pecs-unitedkingdom.com/pecs/ 
2. The Makaton Charity. https://makaton.org/ 
3. Communication Matters ‘What is AAC?’ https://www.communicationmatters.org.uk/what-is-aac/ 
4. National Autistic Society. ‘Sensory Differences’ https://www.autism.org.uk/advice-and-guidance/topics/sensory-differences/sensory-differences/all-audiences 
5. National Autistic Society. ‘Stimming’ https://www.autism.org.uk/advice-and-guidance/topics/behaviour/stimming/all-audiences 
6. National Autistic Society. ‘Dealing with Change’ https://www.autism.org.uk/advice-and-guidance/topics/behaviour/dealing-with-change/all-audiences 
7. Autistica. ‘Learning Disability and Autism’ https://www.autistica.org.uk/what-is-autism/learning-disability-and-autism 
8. National Autistic Society. ‘Co-Occurring Conditions and Autism’ https://autism.org/comorbidities-of-autism/ 
9. Gov UK ‘Extra SEN Help’ https://www.gov.uk/children-with-special-educational-needs/extra-SEN-help 

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. 

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