Level 2 autism

Page summary

Level 2 autism describes autistic people who need substantial support each day, the middle of three levels. The level rates the support a person needs, rather than how autistic they are. Speaking little or not at all is a separate question from the level. Parents and adults get plain answers on what the label means at home, school and work. The answers also compare the three levels and set out the support that can follow. AuDHD Psychiatry assesses adults and children living in the UK for autism, online.

Reviewed by Dr Darren O’Reilly. Dr Darren O’Reilly is a Chartered Psychologist and Clinical Director.

Published date: 19 March 2026

Review and publication details

Clinically reviewed by Dr Darren O’Reilly, DPsych, Chartered Psychologist (CPsychol), HCPC registered practitioner psychologist, registration number PYL041661 (check the HCPC register).

AuDHD Psychiatry is the trading name of ADHDdegree Ltd, a company registered in Scotland, company number SC822923. Registered office: 3f1 Third Floor, Hill Street, Edinburgh, EH2 3JP. Registered with the ICO, number ZB823033.

Seeing “level 2” on a report can feel like a verdict on your child, or on you, and it isn’t one. Many families meet the label with nobody on hand to explain it, so this guide sets it out in plain words. If your child speaks little or not at all, that has its own answer below.

At a glance

  • What level 2 means: “requiring substantial support”, in DSM-5, the American diagnostic manual [1].
  • What it rates: the support someone needs in social communication and in restricted or repetitive behaviour, with a level for each area [2].
  • Speech is separate: the manual notes language difficulties apart from the level [1].
  • In the UK: clinicians diagnose autism using DSM-5 or ICD-11 criteria [3].

➨ Table of Contents

What does level 2 autism mean?

Level 2 autism is the middle of the three autism levels in DSM-5, the American diagnostic manual [1]. The manual labels level 2 “requiring substantial support” [1]. The levels were meant to help clinicians describe the help a person needs around them in daily life [2]. Every autistic person has their own mix of strengths and needs, the National Autistic Society says [4]. If you’re new to all this, start with what autism is.

What does level 2 look like day to day?

At level 2, autistic differences are clear enough for other people to notice [1]. They sit in two areas, and they still show when help is already in place [1]:

  • Communicating and connecting: big differences in spoken and unspoken communication, and starting contact with others less often. Replies to others can be brief or unexpected.
  • Routines and change: fixed ways of doing things, or repeated behaviours, that show up often and get in the way at home, school or work. Switching focus or activity can be very hard, or cause real distress.

In an ordinary week, a change of plan at school or work can knock the whole day off course. A busy shop or a cancelled bus can cost you far more energy than it seems to cost others. Those moments point to the support that helps, not to a lack of effort or care.

Level 2 autism in children and adults

Children and adults at level 2 show the same kinds of signs as other autistic people. Signs the NHS lists in children include speaking later than others, saying very little and repeating words or phrases [5]. At level 2, signs like these come with a greater need for support at home, at nursery and at school.

For adults, the listed signs include finding it hard to talk to people and keeping to fixed routines [6]. A change to that routine can be very upsetting. Some autistic adults also struggle to stay in college or keep a job [6]. Some also have mental health problems [6]. What the level adds is how much support someone needs, not a different set of signs.

Is non-verbal autism level 2?

Not necessarily, because speech and level are recorded separately. Some autistic people have speech that comes and goes, is unreliable or limited, or isn’t there at all [4]. Many communicate in other ways instead, such as writing, signing, gesture, sounds, picture cards or high-tech devices [4]. Communicating without words is still communicating.

The manual adds a separate note on language, apart from the level itself [1]. A 2023 research paper notes that level judgments rest on the two core areas, so language difficulties don’t usually count [7]. Even so, limited spoken language can affect everyday life a great deal [7].

So speech alone doesn’t set the level. A child who talks a lot could still be at level 2, because the level also covers routines and change.

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What is augmentative and alternative communication (AAC)?

AAC is a way of helping someone communicate, or communicate more clearly [8]. “Augmentative” means adding to speech, and “alternative” means communicating instead of speech [8]. AAC comes in two broad kinds [8]:

  • Unaided AAC needs no equipment: signing, gesture, facial expressions, or keyword signing such as Makaton.
  • Aided AAC uses something to point at or press: communication boards, books, charts, apps, tablets or computers, on paper or powered.

Many people use more than one kind, often both unaided and aided [8]. AAC isn’t only for getting a message across. It can also help someone understand what others say [9]. The right system depends on the person, so choosing one starts with an individual assessment [9]. A speech and language therapist is the professional to ask about AAC for you or your child.

Where does level 2 sit among the three levels?

Level 2 sits between levels 1 and 3 in how much day-to-day support someone needs. Level 1 carries the label “requiring support” [1]. At that level, social communication differences cause noticeable difficulties when support isn’t in place [1].

Level 3 carries the label “requiring very substantial support” [1]. At level 3, communication differences shape most of daily life, and coping with change is extremely hard [1]. For more on each, read our pages on level 1 autism and types of autism and the three levels.

What does a level leave out?

A level leaves out a lot, and the labels themselves are loosely defined. The levels weren’t tested before DSM-5 was published [2]. The manual also gives little guidance on applying them [2]. Studies of whether clinicians agree on a level have found mixed results, and in one, clinicians often disagreed or felt unsure [2]. A large US records study found most autistic children had no level written down at all [2].

A learning disability, limited spoken language or anxiety can shape daily life as much as the core features [7]. None of them sits inside the level, though. Needs can also shift over time, so a level given years ago may not fit today [10].

What support helps at level 2?

Support at level 2 follows the person’s needs, not the label alone. NICE, which sets care standards for the NHS in England, has guidance for both children and adults. For children and young people, the guidance says to consider a social-communication approach from a trained professional [11]. Through play with parents, carers and teachers, it builds shared attention, engagement and back-and-forth communication [11]. That way, the work happens with the adults a child already knows.

For autistic adults who find social interaction hard, NICE says to consider a social learning programme [12]. This applies if any learning disability is mild to moderate [12]. People who find groups hard can do it one to one instead [12]. Communication support, including AAC, belongs in the plan as well. Help can also come from a GP, a local autism team, your council and national charities [13]. Schools, colleges, workplaces and local support services are part of that picture too. Our guide to autism support and treatment goes further.

What’s the route to an assessment?

A GP can often refer you to a local NHS autism team [14].

An assessment may help if:

  • the differences go back to early childhood.
  • they get in the way at home, school or work.
  • you want to know whether autism explains how your child communicates.

It might not be right today if:

  • you need urgent help now. Call NHS 111 and choose the mental health option, or in Northern Ireland call Lifeline free on 0808 808 8000, any time. In an emergency, call 999 or go to A&E [15].
  • your child is under 6, as we assess children aged 6 to 17.

At AuDHD Psychiatry, the adult autism assessment is two online appointments: the assessment, and an interview with someone who knows you well. If no one can join, we still assess you. The child autism assessment has three, and a parent can be present. An outcome letter follows the day after the assessment, and the full report within two weeks. You can also try the free autism test, a screen, not a diagnosis, or a free 15-minute call for questions.

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Questions people ask

No. “Moderate” isn’t a term the manual uses for any of the three levels [2]. Level 2 rates the support someone needs each day with communication, routines and change [2]. Two people at level 2 can still look very different, each with their own strengths, struggles and interests.

ASD level 2, or autism level 2, means a clinician has recorded level 2 as a description of someone’s support needs [2]. The level is added to an autism diagnosis, not given as a diagnosis of its own. A level can be given for each of the two core areas, so one report may show two different levels [2].

Yes, because autistic people’s abilities and needs can change over time [10]. A 2023 research paper brought together findings from studies that followed autistic people for years [7]. Between 11 and 58 in every 100 changed in how severe their autism symptoms were [7]. The figure depended on the group and the measures used [7].

Not always. UK services can diagnose autism using DSM-5 or ICD-11 criteria [3], and support levels come from DSM-5 [1]. Whether a report names a level varies from one service to another. AuDHD Psychiatry’s autism reports do state a support level. If yours doesn’t, the autism diagnosis is still complete without one. If it does, the level describes the support needed when the assessment took place.

Both words describe autistic people who speak little or not at all, and for some, speech comes and goes [4]. Many communicate in other ways, such as signing, writing, a communication board or an app [8]. We use “non-speaking” because not speaking isn’t the same as having nothing to say. If you’re unsure which word to use, ask the person or their family.

Speaking later than other children can be one sign of autism, among several others [5]. A GP is a good first stop, and can often refer a child to a local autism team [14]. Meanwhile, a speech and language therapist can help with communication. At AuDHD Psychiatry, our child autism assessment starts at age 6, so it isn’t the route for a younger child.

In short

Level 2 describes how much day-to-day help someone needs, and it says nothing about how autistic they are. Speech is a separate matter, so how much a person talks never settles the level. The right support, communication support included, counts for more than the label does. If you’d like a clearer view for yourself or your child, AuDHD Psychiatry can talk the options through with you.

Related

Sources

  1. Masi A, DeMayo MM, Glozier N, Guastella AJ, “An Overview of Autism Spectrum Disorder, Heterogeneity and Treatment Options”, Neuroscience Bulletin, 2017, 33(2):183-193, https://pmc.ncbi.nlm.nih.gov/articles/PMC5360849/ (read 01/10/2026)
  2. Russell A, Tinker SC, Shaw KA, Maenner MJ, “Prevalence of Autism Spectrum Disorder Severity Levels From the Fifth Edition of the Diagnostic and Statistical Manual (DSM-5) in the Autism and Developmental Disabilities Monitoring Network”, Journal of Autism and Developmental Disorders, 2026, https://pmc.ncbi.nlm.nih.gov/articles/PMC13267130/ (read 01/10/2026)
  3. National Autistic Society, Criteria and tools used in an autism assessment, https://www.autism.org.uk/advice-and-guidance/diagnosis/assessment-and-diagnosis/criteria-and-tools-used-in-an-autism-assessment (read 01/10/2026)
  4. National Autistic Society, What is autism?, https://www.autism.org.uk/advice-and-guidance/what-is-autism (read 01/10/2026)
  5. NHS, Signs of autism in children, https://www.nhs.uk/conditions/autism/signs/children/ (read 01/10/2026)
  6. NHS, Signs of autism in adults, https://www.nhs.uk/conditions/autism/signs/adults/ (read 01/10/2026)
  7. Waizbard-Bartov E, Fein D, Lord C, Amaral DG, “Autism severity and its relationship to disability”, Autism Research, 2023, https://pmc.ncbi.nlm.nih.gov/articles/PMC10500663/ (read 01/10/2026)
  8. Royal College of Speech and Language Therapists (RCSLT), Augmentative and alternative communication (AAC) overview, https://www.rcslt.org/speech-and-language-therapy/clinical-information/augmentative-and-alternative-communication/ (read 01/10/2026)
  9. Communication Matters, About AAC Systems, https://www.communicationmatters.org.uk/what-is-aac/ (read 01/10/2026)
  10. World Health Organization, Autism, fact sheet, 17 September 2025, https://www.who.int/news-room/fact-sheets/detail/autism-spectrum-disorders (read 01/10/2026)
  11. National Institute for Health and Care Excellence (NICE), guideline CG170, Autism spectrum disorder in under 19s: support and management, published 28 August 2013, last updated 14 June 2021, https://www.nice.org.uk/guidance/cg170/chapter/Recommendations (read 01/10/2026)
  12. NICE, guideline CG142, Autism spectrum disorder in adults: diagnosis and management, published 27 June 2012, last updated 14 June 2021, https://www.nice.org.uk/guidance/cg142/chapter/Recommendations (read 01/10/2026)
  13. NHS, Help and support for autistic people and their families, https://www.nhs.uk/conditions/autism/support/ (read 01/10/2026)
  14. NHS, Autism assessments, https://www.nhs.uk/conditions/autism/assessments/ (read 01/10/2026)
  15. nidirect, Mental health emergency: if you’re in crisis or despair, https://www.nidirect.gov.uk/articles/mental-health-emergency-if-youre-crisis-or-despair (read 01/10/2026)

About AuDHD Psychiatry

AuDHD Psychiatry is the trading name of ADHDdegree Ltd, a company registered in Scotland. The company number is SC822923. Our registered office is 3f1 Third Floor, Hill Street, Edinburgh, EH2 3JP.

Registered with the ICO, number ZB823033.

Last updated: 13 October 2026

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