Recent changes in diagnosing have led to Asperger’s no longer being a diagnosis. Now Asperger’s is considered part of Autism Spectrum Disorder (ASD). Autism Spectrum Disorder is a cluster of symptoms related to difficulties in social interactions and restricted/repetitive behaviors or interests that occurs from infancy or toddler years and continues throughout the lifespan. ASD may or may not include cognitive and language impairment. The cause of ASD is not fully known, though research indicates it is likely a combination of genetic and environmental factors. ASD is diagnosed on three different levels depending on the presenting symptoms and how they impact the individual’s functioning.
Social-emotional: Symptoms in this cluster refer to an abnormal approach to social interactions leading to awkward interactions or even no interest in interacting with others. Symptoms may include limited eye contact, difficulty expressing emotions, difficulty combining body language and gestures with speech, and difficulties in developing and maintaining friendships.
Restricted/repetitive: Symptoms in this cluster refer to a need for sameness or a tendency to engage in repetitive, almost compulsive behaviors. Symptoms may include difficulty with transitions, repetitive body movements, obsessive interest, and/or sensory sensitivities.
Understanding the Levels of ASD:
It is helpful to think of the three levels of ASD as a set of wide steps, because even individuals at the same level (or “step”) can have widely differing presentations. This is not to say symptoms progress from one level to the next, but that on each level there can be a range of presentations.
Level 1: High Functioning
Individuals on this level are considered high functioning, but require certain supports. Social symptoms: Without supports in place individuals with ASD, level 1 are likely to have difficulty with social interactions, with awkward and/or unsuccessful attempts at interacting with others. Restrictive/repetitive: They may be inflexible with behaviors and routines.
Level 2: Moderate Functioning
Individuals on this level are considered moderate functioning and require significant support. Social symptoms: limited initiation of social interactions and reduced reactions when others initiate social interactions. Individuals may have limited speech and/or may have difficulty talking about things beyond what they’re interested in. Restrictive/repetitive: Extreme difficulty coping with change. Repetitive behaviors are likely readily obvious to a casual observer and interfere with completing responsibilities.
Level 3: Low Functioning
Individuals on this level are considered low functioning and require continuous, highly substantial support. Social symptoms: very limited interactions with very minimal responses to social interactions. Individuals at this level likely only speak few words or may not respond to social overtures at all. Restrictive/repetitive: Likely to have great distress at transitioning tasks. Repetitive behaviors interfere with the ability to accomplish many tasks, even taking care of themselves.
For sensory concerns, Occupational Therapy with sensory integration is recommended. If the individual presents with behavior concerns related to self-harm (i.e. banging their head on walls, skin picking), disruptive behaviors, aggression, or tantruming during transitions, supervision and Applied Behavior Analysis (ABA) is recommended. For most persons on the spectrum, Applied Behavior Analysis (ABA) is recommended. Some agencies providing ABA counselors can provide this within the home.
Social skills training, whether in individual therapy or in group therapy, is recommended to target the social concerns related to ASD. For children diagnosed with ASD it is recommended that a child study be completed (applicable to public schools) and that the child be assessed for accommodations to assist with their performance in the school setting.
Book and Online Recommendations:
Atypical by Jesse Saperstein (for adults)
Autism Spectrum Disorder from the Inside Out by Michael John Carley (for adults)
Autism Spectrum Disorder Syndrome: A Guide for Parents and Professionals by Tony Attwood
Autism Spectrum Disorder Syndrome: An Owner’s Manual—What You, Your Parents, and
Your Teachers Need to Know by Ellen Helen Korin (for teens)
Can I Tell You About Asperger Syndrome by Jane Welton. For Children Aged 6-12
Cognitive-Behavioral Therapy for Adult Autism Spectrum Disorder Syndrome by Valerie Gaus (for adults)
Freaks, Geeks, and Asperger Syndrome by Luke Jackson (for teens)
The Aspie Teen’s Survival Guide by J.D. Kraus (for teens)
The Autism Spectrum Disorder Couple’s Workbook by Tony Attwood (for adults)
The OASIS Guide to Autism Spectrum Disorder by Patricia Bashe
The Out-of-Sync Child and The Out-of-Sync Child has Fun by Carol Kranowitz (for children)
Web-based resources can be found at:
This document was prepared by Cynthia Kokoris, Psy. D., licensed clinical psychologist at Genesis Counseling Center. Diagnostic information was gathered from the American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: American Psychiatric Publishing.
Edited 2017 by Sarah Warner, MS and Trina Young Greer, PsyD/Licensed Clinical Psychologist.