Severity of Autism Spectrum Disorders: Current Conceptualization, and Transition to DSM-5.

Schertz et al. (2016) wrote a narrative review. They asked how DSM-5 autism severity levels should be set.

They looked at the new rule book. They said severity must reflect how much support a child needs, not just how many symptoms are present.

The authors listed tools that give this bigger picture. These include adaptive living scales, language tests, and behavior checklists.

The paper concludes that Level 1, 2, or 3 should describe daily-life support needs. Counting social-communication or repetitive behaviors alone is not enough.

Clinicians need extra data. Adaptive skills, spoken language, and problem behavior all feed into the final level.

McGarty et al. (2018) extends this idea. In a large clinic sample they showed that DSM-5 support levels line up with real cognitive and adaptive scores. Kids rated Level 3 had the lowest scores. The review’s advice now has numbers behind it.

Matson et al. (2013) and van Timmeren et al. (2016) seem to clash. L et al. found tuned toddler cut-offs kept sensitivity high. A et al. saw low specificity in preschoolers. The gap is age and method. L et al. used ROC tweaks; A et al. used plain DSM-5 rules. Both agree that young kids need careful re-checks, so the views fit together.

Craig et al. (2017) adds another layer. Their ACSF:SC social-communication tool moves in step with DSM-5 levels. Using both gives a clearer picture than either alone.

When you assign a severity level, look past the ADOS score. Add an adaptive scale, a language sample, and a sensory profile. This matches DSM-5 intent and keeps later teams from under- or over-estimating support needs.