If your child was recently diagnosed, the report may say something like "autism spectrum disorder, Level 2 for social communication, Level 2 for restricted and repetitive behaviors." Parents often hear these as a grade, or as a prediction of what their child will be able to do. They are neither. This page explains what the levels mean, why Florida's insurance law still uses older names, and why your child's level does not, by itself, decide how many hours of ABA they get.
What are the autism levels?
Since 2013, the DSM-5 (the diagnostic manual used by US clinicians, now in its text revision, DSM-5-TR) has used one diagnosis, autism spectrum disorder, instead of several separate ones. To capture how different autistic people's needs are, clinicians add a severity level describing how much support a person needs. The CDC summarizes the three levels as:
- Level 1: "requires support"
- Level 2: "requires substantial support"
- Level 3: "requires very substantial support"
The level is given separately for each of the two core areas of autism: social communication, and restricted, repetitive behaviors. A child can be Level 1 in one area and Level 2 in the other.
What does each level look like?
The DSM's severity table (reproduced in a University of Florida diagnostic training checklist) describes each level with examples. In plain language:
| Level | Social communication | Restricted, repetitive behaviors |
|---|---|---|
| Level 1: requiring support | Without supports, differences in social communication cause noticeable difficulties: trouble starting conversations, unusual or unsuccessful responses to others. The DSM's example is a person who speaks in full sentences but whose back-and-forth conversation does not flow and whose attempts to make friends are typically unsuccessful. | Inflexibility significantly interferes in one or more settings; difficulty switching between activities; problems with organization and planning. |
| Level 2: requiring substantial support | Marked differences in verbal and nonverbal communication, apparent even with supports; limited starting of interactions. The DSM's example is a person who speaks in simple sentences, whose interaction centers on narrow interests. | Inflexibility, difficulty with change or repetitive behaviors are frequent enough to be obvious to a casual observer and interfere in a variety of settings; distress or difficulty changing focus. |
| Level 3: requiring very substantial support | Severe differences in verbal and nonverbal communication cause severe impairments in functioning; very limited starting of interactions. The DSM's example is a person with few words of intelligible speech. | Inflexibility, extreme difficulty coping with change, or repetitive behaviors markedly interfere with functioning in all areas; great distress or difficulty changing focus. |
The levels sit alongside other "specifiers" a clinician may add, such as with or without intellectual impairment, with or without language impairment, and whether autism is associated with a known medical or genetic condition or another neurodevelopmental condition (such as ADHD).
What do the levels not tell you?
The DSM-5-TR itself warns against reading too much into them. It says severity "may vary by context and fluctuate over time," and that "the descriptive severity categories should not be used to determine eligibility for and provision of services; these can only be developed at an individual level and through discussion of personal priorities and targets" (DSM-5-TR, p. 59, as quoted in a 2025 California administrative decision).
In other words, a level is a snapshot of support needs at the time of the evaluation. It does not measure intelligence, predict your child's future, or tell you what your child is capable of. A child's level can change as they grow, learn skills, or as their environment changes. Many families find the more useful parts of a diagnostic report are the detailed descriptions of strengths and needs and the recommendations.
Why does Florida's insurance law use different names?
Florida's autism insurance mandate, the Steven A. Geller Autism Coverage Act, was written in 2008 and still defines autism spectrum disorder with the older DSM-IV labels: "1. Autistic disorder. 2. Asperger's syndrome. 3. Pervasive developmental disorder not otherwise specified" (Fla. Stat. 627.6686(2)(b)). The same definition says these disorders are as defined in "the most recent edition" of the DSM. The DSM-5 folded all three into autism spectrum disorder and says people with a well-established DSM-IV diagnosis of autistic disorder, Asperger's disorder or PDD-NOS "should be given the diagnosis of autism spectrum disorder."
The statute does not mention levels at all. In practice, insurers review a current autism spectrum disorder diagnosis under DSM-5 or DSM-5-TR. Cigna's policy, for example, asks for a confirmed diagnosis under DSM-5-TR from a qualified professional, with the diagnostician's name and the date. For the full story on the label mismatch, read DSM-5 vs Florida law autism labels.
Florida schools use yet another standard. A student's eligibility for exceptional student education under Rule 6A-6.03023 depends on the school's own evaluation of social interaction, social communication and restricted or repetitive behaviors across settings, and on whether the student needs special education. It does not depend on a DSM level.
Does a higher level mean more ABA hours?
Not on its own. ABA hours are set by an assessment of your child's skills and needs, the goals in the treatment plan, and your plan's medical policy. A few examples from current insurer policies:
- Aetna requires a DSM-5 autism diagnosis plus a standardized assessment, such as the Vineland-3, ABAS, VB-MAPP or ABLLS, done within the past 12 months, showing impairment (at least one standard deviation below the mean) or significant risk of harm. It describes "comprehensive" programs for children up to age 7 at 10 to 25 hours a week and "focused" programs at 1 to 20 hours a week, and reviews progress every six months.
- Cigna (Evernorth) requires a standardized assessment within 60 days before treatment starts, and a clinical rationale and data for any increase in hours.
Neither policy sets hours by severity level. Two children who are both "Level 2" may need very different programs, and a child described as "Level 1" may still have safety needs that call for a lot of support. Our guide on focused vs comprehensive ABA hours explains how hours are chosen.
What should I do with my child's level?
- Read the whole report. The descriptions of your child's strengths and challenges matter more than the number.
- Ask the evaluator why they chose each level and what supports they recommend.
- Keep the report handy. Insurers and schools will ask for the full diagnostic report, not just the level. UMR, for example, asks for current documentation if the report is more than 4 years old.
- Do not let a level limit expectations. Focus on what your child needs now and what would make daily life better.
Still waiting on a diagnosis? See how to get an autism diagnosis in Florida. Hope Center offers diagnostic evaluations through our clinical director with a supervising licensed psychologist, as well as ABA assessments. Visit our new families page or call 561-337-8865 for a free consultation and benefits check.