Level 2 Autism in Toddlers: Signs and Support Needs

According to the American Psychiatric Association’s DSM-5TR, autism spectrum disorder, or ASD, is a neurodevelopmental condition. It involves ongoing differences in social communication and social interaction. 

It also involves restricted or repetitive patterns of behavior, interests, or activities. Every autistic toddler is unique. No single behavior confirms or rules out autism. If you have concerns about your child’s development, a qualified healthcare provider can help determine whether screening or an evaluation is appropriate.

What Is Level 2 Autism?

The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, Text Revision, or DSM-5-TR, does not identify different “types” of autism. Instead, it uses three support levels:

• Level 1: Requiring support
• Level 2: Requiring substantial support
• Level 3: Requiring very substantial support

These levels describe support needs in two areas. The first is social communication and social interaction. The second is restricted or repetitive behaviors (APA, 2022).

A child may need different amounts of support in each area. For example, a toddler may require substantial communication support but a different level of support with routines or transitions.

Support levels are clinical descriptions. They do not provide a complete picture of a child’s personality, abilities, or future. Two toddlers with Level 2 autism may communicate, play, learn, and respond to their surroundings in very different ways (APA, 2022; Hyman et al., 2020).

Possible Signs of Level 2 Autism in Toddlers

Toddlers diagnosed with Level 2 autism may have marked differences in social communication. They may also have repetitive or inflexible behaviors that affect daily functioning (APA, 2022).

The following examples are not a diagnostic checklist. A qualified professional must consider the child’s full developmental history and behavior across settings.

Social Communication Differences

Social communication includes spoken language and nonverbal communication. Nonverbal communication may include gestures, facial expressions, body movements, and eye contact.

Possible social communication differences may include:

• Starting fewer social interactions
• Using fewer gestures than expected
• Using gestures differently from other children of the same age
• Having delayed or different language development
• Finding back-and-forth social interactions difficult

These examples reflect the social communication differences described in the DSM-5-TR. Language and communication development can also vary widely among autistic children (APA, 2022; Hyman et al., 2020).

Some toddlers use words or short phrases. Others communicate through gestures, sounds, pictures, signs, or communication devices. The goal of support is meaningful communication, not requiring every child to communicate in the same way.

Restricted or Repetitive Behaviors

Toddlers with Level 2 autism may also show restricted or repetitive behaviors. These behaviors may affect play, routines, transitions, or participation in daily activities.

Examples may include:

• Repeating certain movements
• Having a strong preference for familiar routines
• Becoming distressed when a routine changes
• Finding transitions between activities difficult

The frequency and intensity of these behaviors vary from child to child. A clinician considers whether they interfere with participation or daily functioning across settings (APA, 2022).

Developmental Milestones and Autism

Developmental monitoring means observing how a child communicates, moves, learns, plays, and interacts over time.

According to the CDC’s milestones for children by age two, many children at this age can:

• Notice when another person is hurt or upset
• Combine at least two words
• Point to body parts when asked
• Use gestures, such as nodding
• Point to pictures in a book when asked

Developmental milestones are general guides. They do not diagnose or rule out autism. Missing one milestone does not mean that a child is autistic.

However, patterns of developmental differences may show that a child could benefit from additional screening or evaluation. The CDC’s clinical autism screening guidance recommends monitoring development and discussing concerns with a healthcare provider.

Families do not need to wait until every possible sign appears before asking for guidance.

How Is Level 2 Autism Identified?

Developmental screening can help identify children who may benefit from a full evaluation. Screening alone does not provide an autism diagnosis.

The CDC’s autism testing and diagnosis guidance explains that an autism diagnosis is based on a child’s developmental history and behavior. There is no single medical test, such as a blood test, that diagnoses autism.

A qualified professional may consider several sources of information during an evaluation:

• The child’s developmental history
• Communication and language development
• Social interactions
• Play and behavior
• Restricted or repetitive behaviors
• Functioning across settings
• Parent or caregiver observations

This information helps the evaluator understand the child’s overall developmental profile. It may also help identify strengths and current support needs.

The American Academy of Pediatrics recommends ongoing developmental monitoring and autism-specific screening during early childhood (Hyman et al., 2020). Level 2 should only be assigned as part of a professional diagnosis. Parents and caregivers should not try to determine an autism support level from an online list.

What Does “Requiring Substantial Support” Mean?

“Requiring substantial support” means a toddler may need regular, individualized help in one or both autism-related areas (APA, 2022).

That support might help a child:

• Communicate needs, choices, or discomfort
• Participate in play and family routines
• Move between activities
• Adjust to changes
• Build daily living skills
• Participate in social situations

For example, one child may need support to request help or make choices. Another may need help moving from playtime to mealtime. A third child may need support in both areas. This description does not predict what a child will be able to do later. It also does not mean every child needs the same services.

The support level describes a child’s needs at the time of an evaluation. Support levels should be viewed as clinical descriptors rather than complete descriptions of a child’s abilities or future outcomes (APA, 2022; Hyman et al., 2020).

Autism Is a Spectrum

Autism presents differently in every child. Two toddlers with the same Level 2 diagnosis may have different communication abilities, learning styles, play skills, interests, and support needs (APA, 2022; Hyman et al., 2020).

For example:

• One toddler may communicate with spoken words.
• Another may use gestures, pictures, or a communication device.
• One child may need significant help with transitions.
• Another may need more support during social interactions.

These differences do not make one communication style or developmental profile more valid than another. The American Academy of Pediatrics’ guidance on identifying, evaluating, and supporting autistic children explains that care should reflect each child’s strengths, needs, and family priorities. Support levels should not be used as measures of intelligence, worth, personality, or potential.

Support Options for Toddlers With Level 2 Autism

Early identification can help families access evaluations, intervention, and support services when appropriate. Evidence-based early intervention may support communication, social interaction, adaptive functioning, and participation in daily activities (Hyman et al., 2020).

Depending on a child’s needs, a care team may discuss:

• Early intervention services
• Speech therapy
• Occupational therapy
• Applied Behavior Analysis, or ABA
• Developmental services
• Family or caregiver support

No single therapy is right for every autistic toddler. A child may benefit from one service or several coordinated services. Support should reflect the child’s strengths, needs, meaningful goals, and family priorities.

Speech Therapy

Speech therapy may support spoken language and other forms of communication. A speech-language pathologist may help a toddler understand language, express needs, make choices, or develop social communication.

Speech therapy may address areas such as:

• Understanding words and directions
• Expressing needs and ideas
• Using gestures, pictures, or signs
• Developing functional communication
• Learning to use a communication device

Some children use augmentative and alternative communication, often called AAC. AAC includes communication methods beyond speech, such as gestures, pictures, signs, and communication devices.

A review by Hryntsiv and colleagues found that speech-language approaches for autistic children may include speech therapy, AAC, imitation-based strategies, behavioral techniques, and multisensory approaches (Hryntsiv et al., 2025). The goal is not only to increase spoken words. The goal is to help each child communicate in a meaningful way that works for them. 

Occupational Therapy

Occupational therapy may support a child’s participation in meaningful daily activities. The word “occupation” refers to activities people need or want to do in everyday life.

For a toddler, occupational therapy may focus on:

• Feeding or dressing routines
• Play and participation
• Motor development
• Sensory needs
• Transitions between activities
• Growing independence in daily routines

An occupational therapist may help a family practice a skill, adjust a routine, or identify tools that support participation. Mishra and Mishra describe occupational therapy for autistic children as support that may address self-care, sensory processing, motor development, adaptive functioning, and everyday participation (Mishra & Mishra, 2025).

Applied Behavior Analysis

Applied Behavior Analysis, or ABA, is an intervention approach based on principles of learning and behavior. ABA programs should be individualized to the child’s needs and meaningful goals.

Depending on the child, an ABA program may focus on:

• Communication
• Play
• Daily routines
• Adaptive skills
• Learning readiness
• Safety
• Participation in everyday activities

A meta-analysis by Makrygianni and colleagues found improvements associated with ABA-based interventions in several developmental areas among children with autism. These areas included communication, language, adaptive behavior, and socialization (Makrygianni et al., 2018).

This does not mean that every child will have the same response. It also does not mean ABA is the appropriate choice for every toddler. ABA goals should be respectful and useful in daily life. 

What Should You Do If You Are Concerned?

Speak with your child’s healthcare provider if you have concerns about:

• Communication or language development
• Social interactions
• Play
• Repetitive behaviors
• Strong responses to changes
• Developmental milestones
• Participation in daily routines

Share specific examples of what you notice. You might describe how your child communicates at home, responds during play, handles changes, or participates in childcare activities. A healthcare provider can determine whether developmental screening or a comprehensive autism evaluation may be appropriate (CDC, 2025a; Hyman et al., 2020).

A medical autism diagnosis is different from educational eligibility for school services. A clinical or medical provider makes a medical diagnosis. A school team determines whether a student qualifies for educational services under an autism eligibility category. Early identification does not change who a child is. It can help families better understand the child and explore supports that match current needs.

About Easterseals Southern California’s Autism Services

Easterseals Southern California provides individualized autism services for people and families. Services may support communication, daily activities, adaptive skills, participation, and independence.

Depending on individual needs, services may include ABA, speech therapy, occupational therapy, physical therapy, social skills support, or coordinated care. ESSC’s internal autism treatment content emphasizes individualized goals and meaningful participation in daily life.