Can my child's autism level change?
A Reddit parent described their son going from Level 3 to Level 1, and 92 people argued about whether that is real. This page explains what a level measures, how often it changes, and what a 1,269-child study found.
Every claim is checked against the DSM-5 and the primary research, and reviewed by Rachel Blackburn, BCBA.
Yes. A level measures current support needs, not a fixed severity. In the largest study, 84% of toddlers kept the diagnosis, but most who changed moved to a milder level.
The Reddit post
One parent, a psychologist, reported their son moving from Level 3 at 18 months to Level 1 after early intervention. Another was told a three-year-old's Level 3 looked too severe and asked whether a label can do harm.
My son was diagnosed with Level 3 autism at 18 months. We were told he showed symptoms of profound autism during his original assessment. I cannot believe I am writing this post.
Read the original thread on r/Autism_Parenting · posted 2026-08-04 · 92 comments
My three year-old son, who is primarily speech delayed, was just diagnosed with level three autism. His speech therapist looked at me incredulously and asked where I got the diagnosis. Could this over diagnosis hurt my son in the long run?
Read the original thread on r/Autism_Parenting · posted 2026-07-29 · 39 comments
Top comments at a glance
| Comment | Upvotes | Core claim | Our take |
|---|---|---|---|
| “In general, the more severe the diagnosis, the more resources insurance will pay for” | 95 | A higher level unlocks more funded services | Partly true |
| “Assessments at such an early age can be wildly inaccurate, hence why its recommended to also reassess every 3 years or so across development” | 59 | Early assessments are unreliable | Not what the evidence shows |
| “It's much better to over-diagnose a 3 year old, get him maximum benefits, and have him improve to a level one” | 49 | Clinicians inflate levels on purpose to unlock benefits | Not what the evidence shows |
| “levels are not a required part of the diagnosis BUT are required by insurances as an indicator of how much support someone may need” | 4 | Levels serve insurers more than they serve clinicians | Accurate |
Does a higher level get you more hours?
Partly true
A level can influence what a plan authorizes, but it is not the mechanism. Hours come from the medical necessity a BCBA documents through assessment, and in practice the mean course of ABA runs 13.96 months regardless of the number on the report (Linstead et al., 2017).
Evidence: Linstead et al., 2017, n=1,468
Are diagnoses at 18 months reliable?
Not what the evidence shows
More reliable than the thread believed. Across 1,269 toddlers first evaluated between 12 and 36 months, diagnostic stability was 0.84, higher than for language or developmental delay, and only 1.8% later tested as typically developing (Pierce et al., 2019). Stability was 0.50 at 12 to 13 months but 0.79 by 14 months, so an 18-month diagnosis is well inside the reliable range.
Do evaluators inflate a level deliberately?
Not what the evidence shows
We would not assume so, and the data does not need that explanation: when toddlers in the Pierce cohort changed category, the most common move was to a milder presentation after early treatment, which is what improvement looks like. A level that does not match the child produces goals that do not match the child.
Evidence: Pierce et al., 2019
Why does the level matter so much to insurance?
Accurate
The lowest-scoring comment is the most accurate one. The DSM-5 defines levels as descriptors of required support across social communication and restricted behaviors, and funders lean on them because they need a number to authorize hours against.
Evidence: APA, DSM-5-TR
What to do this week
- Ask the evaluator to walk you through the two support domains they scored. Social communication and restricted behaviors are rated separately.
- Stop watching the level once therapy starts. Watch the assessment data instead. It moves months before any label does.
- Schedule the reassessment rather than waiting for one. Schools re-evaluate on a three-year cycle; therapy assessments run far more often.
- If the level feels wrong, say so in writing. Goals get built from the assessment behind it.
What we have actually seen
The families we work with in Colorado tend to stop watching the level once therapy starts, because the goals in the plan are what change day to day. Our BCBAs measure with VB-MAPP and ABLLS-R and re-run them on a schedule, which shows movement in specific skills long before any label is revisited. When a reassessment does change a level, it usually confirms something a parent noticed months earlier.
The Colorado numbers
- Health First Colorado authorizes ABA on documented medical necessity, not on a level alone, and Budding Futures is enrolled under Provider Types 83 and 84. Most Medicaid families pay nothing out of pocket.
- Colorado identified 13,654 autistic students in 2024, up from 4,881 in 2012, which means evaluators here are under volume pressure. Ask for the scoring, not just the level.
- There is no assessment waitlist at Budding Futures, so a second look at a level that feels wrong does not cost you months.
Quick answers
Can my child's autism level go down? Yes. In a 1,269-toddler cohort, most children whose category changed moved to a milder presentation after early treatment (Pierce et al., 2019).
Can a child lose the diagnosis entirely? Rarely. Only 1.8% of toddlers diagnosed with autism in that cohort later tested as typically developing, so plan for support that changes shape rather than disappears.
Does a lower level mean services stop? Not automatically. Authorization rests on documented medical necessity, and a change usually prompts a review rather than an ending.
How early is a diagnosis reliable? Stability was 0.79 by 14 months and 0.83 by 16 months in the Pierce cohort, so an 18-month diagnosis is inside the reliable range.
Do I need a level to start ABA in Colorado? You need an autism diagnosis and a medical necessity assessment, not a specific level. Budding Futures assesses without a waitlist.
More from this series
Sources
Pierce et al., 2019
Diagnostic stability of early ASD diagnosis, 1,269 toddlers. JAMA Pediatrics.
American Psychiatric Association, DSM-5-TR
Defines the three severity levels as support descriptors.
Linstead et al., 2017
Dose and duration of ABA in 1,468 children.
Colorado HCPF
Health First Colorado behavioral therapy benefit.
Budding Futures
Autism support levels 1, 2 and 3 explained.
Who we are
Budding Futures ABA provides in-home ABA therapy across Colorado for children 18 months to 18 years. Care is play-based and assent-based, built on Natural Environment Teaching, with BCBA supervision targeted at about 20% of hours, which is four times the BACB minimum. Parent coaching is part of every plan and there is no assessment waitlist. We accept Health First Colorado and major insurance, and most Medicaid families pay nothing out of pocket. Our clinical director is Rachel Blackburn, BCBA, and the practice is led by director Mark Hirsch.
Not sure what your child's level means for services?
We can walk through what an assessment looks at and what Health First Colorado or your plan would likely authorize.