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Mild ASD

Mild autism, often referring to Autism Spectrum Disorder (ASD) Level 1, is characterized by milder social and communication challenges compared to higher levels of ASD, but can still present unique difficulties. The problem with diagnosis is that these challenges can be subtle and easily masked, leading to delayed or missed diagnoses, especially in adulthood. 

  • Mild Autism is not a “formal” diagnosis.  In 2013, the Diagnostic Statistical Manual of Mental Disorders, 5th edition (DSM5), combined the old sub-diagnoses (Autistic Disorder, Asperger Syndrome, Pervasive Developmental Disorder Not Otherwise Specified, Disintegrative Disorder, etc.) into one diagnosis (ASD). 

  • Autism is considered a spectrum.

  • Mild autism- individuals with autism who have an IQ of 70 or above and no intellectual deficits.

  • Formerly known as Asperger’s syndrome.

  • Females with average or above average IQs are less likely to be identified with ASD and/or more likely to be misidentified. 

  • ASD is typically diagnosed in early childhood.

  • Mild autism may not be diagnosed until late childhood, adolescence, or even adulthood.

  • The ability to do well in school, communicate effectively, and do well on standardized tests can lead parents, teachers, etc. to miss ASD signs.

  • Many people with mild autism - "masking" skills to hide their symptoms.

Diagnosis

An Autism diagnosis involves a multi-faceted process, including developmental screening, comprehensive evaluations, and potentially specialized assessments, with the goal of identifying persistent deficits in social communication and interaction, as well as restricted and repetitive patterns of behavior, interests, or activities. 

Initial Concerns and Screening:

Developmental Monitoring: Parents, caregivers, and healthcare providers should be vigilant in monitoring a child's development and developmental milestones.

Early Intervention: If concerns arise about a child's development, early intervention services should be initiated as soon as possible.

Screening Tools: Pediatricians and other healthcare professionals can use developmental screening tools to identify children who may be at risk for developmental delays, including autism.

Examples of Screening Tools: The Modified Checklist for Autism in Toddlers (M-CHAT) and the Childhood Autism Rating Scale (CARS) are examples of screening tools used to identify potential signs of autism.

Comprehensive Evaluation:

Referral to Specialists: If screening suggests a potential autism diagnosis, a referral to a specialist, such as a developmental-behavioral pediatrician, child psychologist, or psychiatrist, is recommended. 

Diagnostic Interview: A thorough interview with parents or caregivers is conducted to gather information about the child's developmental history, social-emotional functioning, and any behavioral concerns. 

Behavioral Observations: Professionals observe the child's behavior in various settings to assess their social interaction, communication, and play skills. 

Standardized Assessments: Standardized assessments, such as the Autism Diagnostic Observation Schedule (ADOS) and the Autism Diagnostic Interview-Revised (ADI-R), are used to evaluate the child's social communication, social interaction, and repetitive behaviors. 

Other Assessments: Depending on the child's age and developmental level, other assessments, such as cognitive assessments or speech and language evaluations, may be conducted.

Diagnostic Criteria:

DSM-5: The American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) provides the diagnostic criteria for autism spectrum disorder (ASD).

Key Criteria: The DSM-5 identifies two broad diagnostic criteria for autism: persistent deficits in social communication and social interaction, and restricted and repetitive patterns of behavior, interest, or activities. 

Ongoing Assessment and Support:

Functional Behavioral Assessment: After a diagnosis of autism, a functional behavioral assessment may be conducted to identify the causes of specific challenging behaviors.

Intervention Planning: Based on the assessment results, an individualized intervention plan is developed to address the child's specific needs.

Ongoing Monitoring: Regular monitoring of the child's progress is essential to ensure that the intervention plan is effective.

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Long-Term Outcomes

Long-term effects of autism can include challenges with social interaction, communication, and learning, potentially leading to difficulties in education, employment, and independent living, as well as an increased risk of mental health issues like anxiety and depression.

Challenges in Social Interaction and Communication:

  • Difficulty with social skills: Struggle to understand social cues, build and maintain relationships, and engage in reciprocal interactions.

    • This may cause the individual to become anti-social or become depressed or create anxiety.

  • Communication difficulties: May have delays in speech development or difficulty with verbal and nonverbal communication.

    • May cause peers or community members to treat them differently because they don't communicate the way others do.

  • Social isolation: Lack of social skills and difficulties in forming relationships can lead to social isolation and loneliness.

    • Depression and anxiety are possible.

Challenges in Learning and Education:

  • Learning difficulties: Can impact learning abilities, including:

    • processing information

    • attention and focus

    • executive functioning.

    • Teachers and staff have difficulty understanding the student and choose to disengage with them because they don't know how to work with them.

  • Educational challenges: Struggle in traditional educational settings. 

    • Potentially requiring specialized support and interventions.

    •  Teachers and administration may feel that the student doesn't need to be in the general education setting because they aren't learning on the same level.

  • Employment difficulties: Challenges in social interaction and communication can make it difficult to find and maintain employment.

    • Adults with ASD may want to work in a position that makes them feel like they are helping others, however, the job may be overwhelming.

    • May cause anxiety and stress in the workplace.

Mental Health Complications:

Increased risk of mental health conditions: at higher risk of developing anxiety, depression, and other mental health conditions. 

Emotional regulation difficulties: can impact emotional regulation, leading to difficulties in managing emotions and responding appropriately to situations. 

Increased risk of burnout: May experience burnout due to the demands of daily life, leading to exhaustion, loss of skills, and reduced tolerance to stimuli. 

Other Potential Long-Term Effects:

Sensory sensitivities: May experience heightened or diminished sensory sensitivities, impacting daily functioning and social interactions. 

Gastrointestinal issues: A significant percentage experience chronic gastrointestinal problems, which can lead to discomfort, pain, and other health complications. 

Sleep disturbances: Sleep problems are common and can persist into adulthood, impacting daily functioning and overall well-being. 

Challenging behaviors: May exhibit challenging behaviors, such as aggression or self-injury, which can impact their relationships and overall well-being.

Increased risk of bullying and victimization: May be at higher risk of being bullied or victimized due to their social and communication differences.

Substance use:There is an increased risk of substance use disorders.

Characteristics of Mild Autism

Individuals with mild autism, often referred to as Level 1 autism, may exhibit subtle social communication challenges, restricted and repetitive behaviors, and sensory sensitivities, which can manifest differently in various settings.

Social Interaction and Communication:

  • Difficulty with Social Cues: May struggle to understand nonverbal cues, such as:

    • body language

    • facial expressions

    • leading to misunderstandings in social interactions.

Limited Eye Contact: Avoiding eye contact or having difficulty maintaining it can be a common characteristic.

  • Social Anxiety: Overwhelming social situations lead to:

    • anxiety

    • difficulty navigating social settings.

Literal Interpretation: They may struggle with sarcasm, idioms, or figurative language, taking things literally.

Blunt Communication: Their communication style might seem blunt or direct, potentially causing misunderstandings.

Difficulty with Empathy: They may struggle to understand or share the emotions and perspectives of others.

Repetitive Behaviors and Interests:

  • Repetitive Movements or Actions: May engage in repetitive movements, such as:

    • hand-flapping

    • rocking

    • finger-flicking 

Adherence to Routines: May have a strong preference for routines and rituals, and find it difficult to adapt to changes in plans or unexpected events. 

Intense Interests: May develop intense interests in specific topics or objects, spending a significant amount of time exploring them. 

Sensory Sensitivities:

  • Sensory Overload: May be hypersensitive to certain sensory stimuli, such as:

    • loud noises

    • bright lights

    • specific textures

    • leading to discomfort or sensory overload

  • Sensory Seeking: May seek out specific sensory experiences, such as:

    • repetitive movements

    • visual stimuli

    • to regulate their sensory input

Sensory Avoidance: They may avoid certain sensory experiences that they find overwhelming. 

Varied Settings and Manifestations:

School: May struggle with social interactions in the playground, understanding classroom rules, or keeping up with the pace of lessons. 

Workplace: May find it challenging to navigate social interactions with colleagues, understand workplace expectations, or manage unexpected changes in their schedule. 

Home: May struggle with household chores, maintaining a clean space, or following family routines. 

Community: May find it difficult to navigate public transportation, shop for groceries, or attend social events.

Important Considerations:

Individual Variation: It's crucial to remember that autism is a spectrum, and individuals with mild autism can exhibit a wide range of characteristics and strengths. 

Masking: May "mask" their autistic traits, which means they try to hide or suppress their behaviors to fit in with neurotypical individuals. 

Support and Accommodations: Providing appropriate support and accommodations, such as sensory breaks, visual aids, and social skills training, can help individuals with mild autism thrive. 

Key Terms & Concepts

Abelism and ASD:

Ableism, a form of discrimination, impacts autistic individuals by perpetuating the idea that being neurotypical is superior and that autistic traits should be suppressed or "fixed".

Girls on the Spectrum:

Girls frequently displaying a stronger desire for social interaction and a greater ability to mimic social behaviors, leading to a higher tendency to "mask" their autistic traits. 

Executive Functioning:

Executive functioning difficulties are common in individuals with autism spectrum disorder (ASD), impacting areas like planning, decision-making, and impulse control. These challenges can lead to difficulties with communication, completing tasks, managing time, and self-care. While executive function deficits are not autism-specific, they are often associated with the disorder and can significantly impact daily life. 

Theory of Mind:

The Theory of Mind (ToM) suggests that people with autism spectrum disorder (ASD) have difficulty understanding the mental states of others, including their thoughts, feelings, and intentions.​

Mind Blindness:

​Refers to the difficulty or inability to attribute mental states like thoughts, desires, and intentions to oneself and others.​

Social Thinking:

A teaching framework designed to help individuals, particularly those with autism spectrum disorder, understand and navigate social situations by focusing on the thoughts, intentions, and emotions of others.

Co-Occurring Conditions:

​Autism Spectrum Disorder (ASD) often co-occurs with other conditions, including mental health conditions like anxiety, depression, and ADHD, as well as medical conditions like gastrointestinal issues, sleep disorders, and epilepsy. 

Emotional Vulnerability:

Autism spectrum disorder (ASD) is often associated with heightened emotional vulnerability due to challenges in understanding and regulating emotions, social communication, and sensory processing.

Sensory Differences:

​These differences can range from hypersensitivity (over-reactivity) to hyposensitivity (under-reactivity) across various sensory modalities, including sight, sound, touch, smell, taste, and balance. 

Meltdowns:

Autistic meltdowns are intense reactions to overwhelming situations, often characterized by a loss of control and distress. 

Giftedness:

​Giftedness and autism can co-occur, often referred to as twice exceptional (2e). This means an individual possesses both intellectual gifts and characteristics of autism.

Functional Academics:

Functional academics focus on teaching students with autism practical, real-world applications of academic skills, such as literacy and numeracy, to enhance daily living and independence. 

Enhancing Communication in the General Education Setting

Enhancing communication in general education for autistic students involves providing clear and direct instructions, using visual supports, and adapting communication styles to individual needs.

Resources

Autism Speaks

Offers a wide range of resources, including a state-by-state resource guide, family support toolkits, and information on research and advocacy.

Autism Society

Provides advocacy, education, referrals, and support at national, state, and local levels

CDC (Centers for Disease Control and Prevention)

Provides information on ASD, including symptoms, risk factors, screening, and treatments.

References:

Centers for Disease Control and Prevention. (2024, May 16). Clinical Testing and Diagnosis for Autism Spectrum Disorder. Autism Spectrum Disorder (ASD). https://www.cdc.gov/autism/hcp/diagnosis/index.html ‌

Autism Research Institute. (2024). Screening & Assessment. Autism Research Institute. https://autism.org/screening-assessment/ ‌

Autism Society. (2023). Screening & Diagnosis. Autism Society. https://autismsociety.org/screening-diagnosis/

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Okoye, C., Obialo-Ibeawuchi, C. M., Obajeun, O. A., Sarwar, S., Tawfik, C., Waleed, M. S., Wasim, A. U., Mohamoud, I., Afolayan, A. Y., & Mbaezue, R. N. (2023). Early Diagnosis of Autism Spectrum Disorder: A Review and Analysis of the Risks and Benefits. Cureus, 15(8). https://doi.org/10.7759/cureus.43226

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NYU Langone Health. (2019). Diagnosing Autism Spectrum Disorder in Children. Nyulangone.org. https://nyulangone.org/conditions/autism-spectrum-disorder-in-children/diagnosis

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NYU Langone Health. (2019). Diagnosing Autism Spectrum Disorder in Children. Nyulangone.org. https://nyulangone.org/conditions/autism-spectrum-disorder-in-children/diagnosis

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National Autistic Society. (2024). Criteria and tools used in an autism assessment. Www.autism.org.uk. https://www.autism.org.uk/advice-and-guidance/topics/diagnosis/assessment-and-diagnosis/criteria-and-tools-used-in-an-autism-assessment ‌

Posar, A., & Visconti, P. (2019). Long-term outcome of autism spectrum disorder. Türk Pediatri ArÅŸivi, 54(4), 207–212. https://doi.org/10.14744/turkpediatriars.2019.16768

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Cleveland Clinic. (2023, September). Autism Spectrum Disorder (ASD) Symptoms & Causes. Cleveland Clinic. https://my.clevelandclinic.org/health/articles/autism

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Orzel, F. (2024, November 6). Mild Autism Symptoms in Adults | Connect n Care. Connectncareaba.com. https://www.connectncareaba.com/blog/mild-autism-symptoms-in-adults

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Andersen, R. (2022, August 19). Mild Autism in Adults: Can You Really Be “Mildly Autistic”? Autism Parenting Magazine. https://www.autismparentingmagazine.com/mild-autism-adults/

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Mead, K. (2024, December 29). What is ableism and how can we tackle it? Bristol Autism Support. https://www.bristolautismsupport.org/ableism/#:~:text=Every%20time%20we%20talk%20about,of%20the%20way%20they%20are.

Autism First Signs and Checklist in Girls | Autism SA. (2024, May 14). Autism SA. https://autismsa.org.au/autism-diagnosis/autism-symptoms/signs-of-autism-in-girls/

Bennie, M. (2020, April 21). Executive function: what is it, and how do we support it in those with autism? Part I - Autism Awareness. Autism Awareness. https://autismawarenesscentre.com/executive-function-what-is-it-and-how-do-we-support-it-in-those-with-autism-part-i/#:~:text=Some%20sources%20say%20that%20up,very%20complicated%20or%20seemingly%20impossible.

Fletcher-Watson, S., McConnell, F., Manola, E., & McConachie, H. (2014). Interventions based on the Theory of Mind cognitive model for autism spectrum disorder (ASD). Cochrane Library, 2020(2). https://doi.org/10.1002/14651858.cd008785.pub2

Kenroberson. (2021, March 3). Mindblindness In Adults with Autism Spectrum Disorder. Kenneth Roberson, Ph.D. https://kennethrobersonphd.com/mindblindness-in-adults-with-autism-spectrum-disorder/#:~:text=The%20theory%20of%20mind%20difficulties%20seems%20to,creates%20significant%20barriers%20to%20communication%20and%20closeness.&text=It%20is%20as%20though%20they%20are%20blind,intentions%2C%20thoughts%2C%20feelings%2C%20and%20desires%20they%20have.

Social Thinking®: A Developmental Treatment Approach for Students with Social Learning/Social Pragmatic Challenges. (n.d.). https://www.socialthinking.com/evidence/peer-reviewed/developmental-treatment-approach-students-learning-issues#:~:text=Social%20Thinking%20and%20Teaching%20Related,programmed%20generalization%20and%20ongoing%20practice

Vulnerability, mental health and autism - Autism Research Centre. (2024, November 21). Autism Research Centre. https://www.autismresearchcentre.com/projects/vulnerability-and-mental-health/#:~:text=Autistic%20people%20have%20social%20and,both%20autistic%20children%20and%20adults.

National Autistic Society. (n.d.). Sensory differences - a guide for all audiences. https://www.autism.org.uk/advice-and-guidance/topics/sensory-differences/sensory-differences/all-audiences#:~:text=Sight-,UNDER%2DSENSITIVE,as%20sensitive%20to%20the%20light.

Sharon_Admin. (2024, February 1). All about Autistic Meltdowns: A Guide for Allies - Reframing Autism. Reframing Autism. https://reframingautism.org.au/all-about-autistic-meltdowns-a-guide-for-allies/

Dlugosz, M. (2025, April 7). Gifted, on the spectrum, or both? Davidson Institute. https://www.davidsongifted.org/gifted-blog/gifted-on-the-spectrum-or-both/#:~:text=The%20child%20may%20also%20be%20both%20gifted,some%20tasks%20while%20being%20challenged%20by%20others.&text=An%20estimated%200.7%%20to%202%%20of%20autistic,up%20to%201%%20of%20the%20general%20population.

Gilson, M. (2024, July 16). The Role of Functional Academics for Students with Disabilities. TeachTown Inc. https://web.teachtown.com/blog/functional-academics/

Autism in the classroom: Strategies for success | Autism Speaks. (n.d.). Autism Speaks. https://www.autismspeaks.org/tool-kit-excerpt/autism-classroom-strategies#:~:text=Strategies%20for%20success%20when%20teaching,pairs%20and/or%20small%20groups

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