36 Neurodevelopmental DisordersSevere Attainment of conceptual skills 
is limited. The individual gen-
erally has little understanding 
of written language or of con-
cepts involving numbers, 
quantity, time, and money. 
Caretakers provide extensive 
supports for problem solving 
throughout life. Spoken language is quit e limited in terms of 
vocabulary and grammar. Speech may be sin-
gle words or phrases and may be supple-
mented through augmentative means. Speech 
and communication are focused on the here 
and now within everyday  events. Language is 
used for social communication more than for 
explication. Individuals understand simple 
speech and gestural communication. Relation-
ships with family members and familiar others 
are a source of pleasure and help. The individual requires suppo rt for all activities of 
daily living, including meals, dressing, bathing, and 
elimination. The individual requires supervision at 
all times. The individual cannot make responsible 
decisions regarding well-being of self or others. In 
adulthood, participation in tasks at home, recre-
ation, and work requires ongoing support and assis-
tance. Skill acquisition in all domains involves long-
term teaching and ongoing support. Maladaptive 
behavior, including self-injury, is present in a signif-
icant minority. 
Profound Conceptual skills generally 
involve the physical world 
rather than symbolic pro-
cesses. The individual may use 
objects in goal-directed fashion 
for self-care, work, and recre-
ation. Certain visuospatial 
skills, such as matching and 
sorting based on physical char-
acteristics, may be acquired. 
However, co-occ urring motor 
and sensory impairments may