Autism Diagnostic Observation Schedule

Evaluation meeting

The Autism Diagnostic Observation Schedule, Second Edition (ADOS-2) is an evaluative tool that can make the process of diagnosis easier. Each individual on the autism spectrum is unique, but the test manages to present a standardized protocol for professionals to use in observations.

Autism Diagnostic Observation Schedule (ADOS-2)

ADOS-2 can be a valuable instrument when it comes to evaluating communication and socialization characteristics commonly associated with autism. The diagnostic tool uses target behaviors to gauge the child's responses during specific tasks. The test is both valid and reliable.

The test is a useful tool because it can accommodate people of different ages and different abilities. The test is as effective for nonverbal individuals as it is for those who speak fluently. It is appropriate for toddlers, children, and adults. This second edition retains most of the original ADOS format, but it now includes a Toddler Module and comparison scores for modules one through three so evaluators can make comparisons over time for an individual.

Who Uses the ADOS-2

The ADOS-2 is ideal for professionals who are familiar with autistic disorders that have training in administering the test. The test can be instrumental in clinical, medical, and evaluative settings. Professionals who use the assessment tool include:

The ADOS-2 Evaluation

ADOS-2 is an assessment measure that typically takes about 40 to 60 minutes to complete. The test evaluates the individual's responses in the realms of communication, imaginative use of objects, social interaction, and play skills. The evaluator presents different activities and measures responses.

The person administering the test engages the participant in a number of different activities while making demands. For example, the evaluator may set up a pretend birthday party using a doll and other toys. This activity tests the participant's ability to recognize what the activity represents, and how well he or she follows the evaluator's lead (symbolic imitation).

Each activity gives the evaluator an opportunity to observe the individual's responses. The test can gauge whether the participant is familiar with normal social interaction, natural play, communication, and so on. For example, a person would normally put a toy phone to his or her ear and pretend to talk, which demonstrates understanding. Concern arises if the individual pushes the same button on the phone repeatedly for no apparent reason.

Diagnostic and Neuropsychological Test Results

Parents awaiting test results may anticipate a confusing sheet of data filled with thick jargon. However, ADOS-2 is relatively straightforward and easy to digest. An evaluation may follow the following format in a narrative:

  • The evaluation usually states ADOS-2 is the assessment measure. It describes the patient and includes details about age as well as reasons for the evaluation (such as poor scores on other tests or parental concerns).
  • Communication observations include vocalizations and using words and phrases, but it also shows whether the individual uses functional, social, and gestural communication.
  • Reciprocal social interaction measures elements like eye gaze and facial expression. The evaluator notes if the participant responds to his or her name and whether he or she uses a social smile at appropriate times.
  • Stereotyped behaviors and restricted interests examine sensory processing issues and interests such as hand flapping and repetitive movements. The examiner may note whether the individual uses objects with purpose.
  • Imaginative play describes the participant's ability to use symbolic imitation. For example, the examiner may note whether the participant imitates pretending blocks are train cars.

Scoring Results

Scores relate to minimum required scores to meet the specified diagnostic cut-off in five domains. The scores measure impairments, so the higher the number, the more severe the impairment, according to the test.

Communication: The minimum score for autism is three, and the minimum score is two for the spectrum. If the child scores a seven, he or she would fall into "autism" in the realm of communication.

Reciprocal social interaction: The minimum score for autism is six, and the minimum for the spectrum is four. If the child scores a five, he or she falls into the spectrum (not necessarily classical autism) in this realm.

Communication and social: The minimum score for autism is 10, and seven for the spectrum.

The test also measures:

  • Imagination and creativity
  • Stereotyped behaviors and restricted interests

Following the scores is a summary that describes the nature of the assessment. For example, a summary may state the assessment results are for research purpose only and are not a clinical diagnosis if a researcher conducted the test.

Factors to Consider When Testing Young Children

If your child has received disappointing scores on the ADOS-2, there are some things to consider. A child or toddler may score poorly on the test if he or she hasn't gotten enough sleep. An acute illness can be a big distraction, and children can be apprehensive about interacting with unfamiliar people.

Children participating in research studies may take the ADOS-2 after participating in other research activities, which can lead to fatigue, frustration, and noncompliance. Often, the test occurs in a sterile setting that is strange and uncomfortable.

Diagnosing Autistic Disorders

There is no blood test that can detect pervasive developmental disorders, and parents and professionals rely on instruments like the ADOS-2 to help make an accurate diagnosis. The assessment tool can also help researchers who are exploring the nature of the autism spectrum, and it can detect developmental and social problems in participants taking the test.

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Autism Diagnostic Observation Schedule