What Makes Severe Autism So Challenging?

Severe Autism Isn't an Official Diagnosis, But Has It's Unique Challenges

Brain Scan
Brain Scan. Don Farrall

There is no such diagnosis as "severe autism." When the term is used, therefore, it's really just a way of describing a person's level of functioning and need. Severe autism is sometimes called low-functioning autism, classic autism, "Kanner's" autism, or profound autism. Simply put, it describes those autistic people with the most significant symptoms.

Severe or "Level 3" Autism

Another way to describe severe autism is to talk about the level of support required for a person with the diagnosis to function safely.

  The current diagnostic manual (DSM-5) provides three levels of autism, with more support required at each level. People with severe autism would usually be diagnosed as having "Level 3" Autism Spectrum Disorder, meaning they need a great deal of support. It is not unusual for a person with severe autism to require 24/7 support.

What Makes Severe Autism Different?

What makes severe, or level 3, autism different? There are really two categories of differences. The first is the severity of symptoms: people with severe autism have many of the same issues as anyone else on the spectrum, but more so. The second category includes symptoms that are relatively rare in higher functioning autism, but which are common among people who are more severely affected.

  1. Speech and Language Challenges:  While everyone with an autism spectrum disorder has a difficult time with social skills and communication, people with severe autism are most likely to be entirely unable to use spoken language. They may also appear to take no notice of the people around them.
  1. Cognitive Challenges: Many people with autism have high IQ's. Some have IQ's at or near 75 -- the cut off for what used to be called mental retardation. Generally speaking, however, people with severe autism have low to very low IQ's, even when tested using non-verbal testing tools. It's important to know, however, that appearances can be deceiving: some people with severe autism have learned to communicate using sign, spelling boards or other tools. Some of those people are quite articulate, and they make it clear that at least some people with severe autism are more capable than they appear to be.
  1. Sensory Dysfunction. Many people on the autism spectrum have sensory dysfunction (they're too sensitive or not sensitive enough to light, sound, touch, taste or smell). People with severe autism tend to be extremely sensitive, such that going out into crowds, bright lights or loud noises can be overwhelming.
  2. Repetitive Behaviors Including Self-Injury. Most people on the autism spectrum have repetitive behaviors and self-stimulatory behaviors. Higher functioning individuals may flap their hands, rock, or flick their fingers. Often, they can control these behaviors for a period of time when necessary. People with severe autism are likely to have many such behaviors, and those behaviors can include self-injury (head banging, hair pulling, etc.). 
  3. Aggressive and Anti-Social Behaviors. Aggression is relatively rare in autism, but it is certainly not unheard of, particularly among people with more severe autism (or among people with autism and other issues such as severe anxiety). People with severe autism may act out by hitting, biting, or kicking. They may also have behaviors such as fecal smearing, door banging, etc. which require a quick and effective response.
  1. Wandering and Eloping. "Eloping" (running away with no obvious cause and no particular destination) is also common among people with severe autism. Unlike higher functioning individuals, people with severe autism don't have the tools to communicate with first responders. This can, of course, increase the likelihood that the individual will wind up in a dangerous situation. In some cases, special locks, alarms, and identification tools are necessary to ensure the safety of a person with severe autism.
  2. Physical and Emotional Symptoms. People with severe autism may also have physical symptoms that sometimes appear with less profound autism. These may include sleeplessness, epilepsy, mood disorders, and, according to some sources, gastrointestinal issues. Because of their difficulties with communication, such issues can go undetected or undiagnosed.

Treatments for Severe Autism

There are no treatments that alleviate or cure severe autism as a disorder. There are, however, a wide range of medical and non-medical options for addressing the symptoms of severe autism.

Treatments for severe autism usually include medications for anxiety and related issues. Other options may include Applied Behavior Analysis (ABA) along with speech, occupational therapy, physical therapy and, sometimes, play therapy. Parents should be sure that their doctor checks their child with severe autism for any physical problems which could be contributing to difficult behaviors.

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