Autism is now diagnosed as a single condition, autism spectrum disorder (ASD), rather than as separate types. The labels people used to receive, such as Asperger’s syndrome and PDD-NOS, were combined into that one diagnosis in 2013. Clinicians now describe each person’s autism using support levels and specifiers.
The older names are still widely used. Many adults were diagnosed under them, reports written before 2013 still use them, and some autistic people identify strongly with them.
Why did autism become one diagnosis?
Australian clinicians diagnose autism using the DSM-5, a diagnostic manual published by the American Psychiatric Association. The previous edition split autism into several conditions, grouped together as pervasive developmental disorders.
In practice, that split didn’t work well. Research showed that two experienced clinicians could assess the same child and give different labels, and a person’s label could change from one assessment to the next. Treating autism as one spectrum solved that problem and better reflected how autistic people actually differ.
In Australia, the National Guideline for the assessment and diagnosis of autism sets the standard for how assessments should be done. It was updated in 2023, and its recommendations are approved by the National Health and Medical Research Council.
What did the old autism types mean?
Four diagnoses were merged into autism spectrum disorder:
- Autistic disorder, often called classic autism or Kanner’s autism
- Asperger’s syndrome
- Pervasive developmental disorder not otherwise specified (PDD-NOS)
- Childhood disintegrative disorder
Autistic disorder was usually diagnosed when differences in communication, social connection and behaviour were clear in early childhood, often with late or limited speech. Asperger’s syndrome was used for people with autistic traits whose early language and thinking skills developed on time. PDD-NOS covered people who had some autistic traits but didn’t fit the other categories. Childhood disintegrative disorder described the rare situation where a child lost skills after about two years of typical development.
Rett syndrome was once part of the same group. It’s now recognised as a separate genetic condition.
What happened to Asperger’s syndrome?
Asperger’s syndrome stopped being a separate diagnosis when the DSM-5 was introduced. Someone assessed today with the traits once called Asperger’s would be diagnosed with autism spectrum disorder, often at Level 1.
An Asperger’s diagnosis made before 2013 is still valid. Some people keep the term because it’s part of how they understand themselves, while others now prefer to say they’re autistic. Either is fine, and it’s best to follow the person’s own choice.
How do the three support levels work?
The DSM-5 rates support needs in two areas, social communication and restricted or repetitive behaviour, using three levels:
- Level 1 (requiring support)
- Level 2 (requiring substantial support)
- Level 3 (requiring very substantial support)
Because the two areas are rated separately, a diagnosis might say “Level 2 for social communication and Level 1 for restricted and repetitive behaviour”. A level reflects support needs at the time of assessment. It doesn’t measure intelligence, and a later reassessment can give a different level as a person’s skills and circumstances change.
For example, a child with ASD Level 2 might speak in short phrases and become very distressed when the usual route to school changes. In babies and toddlers, early signs of Level 2 autism can include not pointing to share interest and rarely responding to their name.
What are specifiers in an autism diagnosis?
Specifiers are extra details that make a diagnosis more precise. A clinician can note whether autism occurs with or without an intellectual disability, and with or without a language disability. They can also record a link to a genetic or medical condition, such as fragile X syndrome or epilepsy, or to another condition such as ADHD or anxiety.
In everyday life, these details often matter more than the level. Two people at Level 2 can need very different support if one speaks in full sentences and the other communicates using a tablet.
Are “high-functioning” and PDA types of autism?
No. Several common terms sound like types of autism but aren’t part of the diagnosis.
“High-functioning” and “low-functioning” are informal terms that roughly match Level 1 and Level 3. Many autistic adults dislike them. “High-functioning” can hide how much effort daily life takes, and “low-functioning” can lead people to underestimate what someone understands. “Mild” and “severe” autism have the same problems.
Nonspeaking autism describes autistic people who communicate mainly without spoken words. It describes how someone communicates rather than a separate diagnosis.
Pathological demand avoidance, or PDA, refers to an extreme need to avoid everyday requests and expectations. Families and some clinicians discuss it widely, but it isn’t a diagnosis in the DSM-5.
Autism can also look different in girls, women and adults who have learned to mask, or hide, their autistic traits to fit in. Masking is one reason some people aren’t diagnosed until adulthood.
Does the autism level affect NDIS access?
The level affects how much evidence the NDIA needs. Autism diagnosed at Level 2 or Level 3 is on the NDIA’s list of conditions likely to meet the disability requirements, so a diagnosis report that states the level usually carries a lot of weight. People with a Level 1 diagnosis can still become participants, but they normally need reports showing how autism affects daily life, such as self-care, learning or coping at school or work.
Under Australian law, autism is a disability at every support level. For young children, support through the NDIS early childhood approach can begin before a formal diagnosis is made.
Why does the person matter more than the label?
A diagnosis is a starting point. What really shapes support is how the person communicates, what they find hard, what they enjoy and what they want to work on.
That’s why support looks different for every autistic person. One person might use ABA therapy to learn to ask for a break or get dressed on their own. Another might need Positive Behaviour Support because shutting down or lashing out at school is getting in the way. A young child might start with early childhood intervention that involves the whole family.
Autism support that fits the person
Helping Hands Behaviour Support (HHBS) is an NDIS-registered provider of Positive Behaviour Support, ABA therapy and early childhood intervention. We work with autistic children and adults at every support level, whether they were diagnosed recently or years ago under an older name like Asperger’s. Support happens at home or at school, and we work with NDIA-managed, plan-managed and self-managed plans.
If you or a family member is autistic and has NDIS funding for therapy, ring our team on 0406 920 296 or get in touch online, and we’ll help you find support built around the person’s strengths and goals. Support coordinators with an autistic participant who needs therapy or behaviour support are welcome to refer them through our website, and our team will be in touch.
This article explains how autism is classified and diagnosed in Australia. It doesn’t replace an assessment, and only a qualified health professional can diagnose autism.
