ADOS MODULE 4 ASSESSMENT- insights?

I had the Ados Module 4 autism assessment yesterday & have no idea what to make of it. I've estimated that it'll probably be about a month until I get the results from it but the wait is going to kill me & I was wondering if anyone can help make sense of my answers & what the questions were looking for?

**** Please do not read this if you're waiting to be tested as knowing the answers could interfere with your results.

So the test went as follows:

1. I was asked to complete a puzzle-- to put M shaped foam pieces to match the patterns on a page to make a bigger picture. She only gave me 3 pieces at a time & said to ask her for more when I needed more. The first picture was unsuitable as the pieces didn't quite fit the shapes on the picture. I think my effort was reduced quite quickly when I realised they weren't fitting but nonetheless I remained calm. They said after a while that I could do another puzzle as the pieces weren't quite the right size for the original picture & I was quite relieved that I had another chance to do it properly. I asked for the pieces using the word please when I needed more so I think I probably scored NT on this one.

2. There was a picture book called 'Tuesday' it was completely bizarre & I think I struggled a bit with this one. It was mostly picture except for the occasional text that said something like "Tuesday, 9:15pm"- I didn't pay too much attention to that as I was trying to describe the pictures as she asked. She did the occasional page as well. I asked if I was supposed to focus on just one or both pages at the same time & she said whatever I wanted to do. I was asked to described what was happening in the picture book There were frogs flying on lily pads towards a house & into a house (I thought that this was some sort of infestation. They were also flying around blackbirds which I said seemed odd because frogs usually prey on insects. In another page, a man was looking rather perturbed eating a sandwich while frogs were outside his window-- I said I thought that maybe he was having a paranoid psychotic breakdown as he could see flying frogs & was quite hunched over which gave off suspicious vibes. I do feel I had to be prompted for the first few pages as I just couldn't make sense of it. There was also a picture of a woman sitting in a chair watching TV but she couldn't see the frogs & I suggested that maybe they were spirit frogs & only the man could see them? Then the frogs were chasing a dog & then being chased by a dog near the ground & on another page the dog chases the frogs. On the next page the frogs eventually flew into electricity lines & were falling- I was confused as to how the got up there when they were being chased near the ground (which in retrospect seems like a dumb thing to say as upwards would be a safer direction duhh). Then there was a crime scene investigation & the psychotic man was being interviewed I was confused by why they thought this was news worthy & why he wasn't just taken to hospital. There was also a sniffer dog in this scene & this confused me as sniffer dogs are only used in detecting illegal substances to the best of my knowledge l. There was also a page were the frogs were swimming in a pond- this seemed unrelated to them falling & when asked what this meant I said it's like they'd gone to heaven after falling. I was asked what this frog on one of the lily pads was feeling & I said he looked bored- they asked why & I said because he's leaning on one hand & looks annoyed & sort of did the leaning on one hand gesture. The next page though showed flying pigs & this confused me & when they asked what it meant I said that perhaps the frogs had reincarnated after dying & the pond page was like a purgatory. They then asked do you know what is meant by "when pigs fly?" I struggled to articulate but said I did know & it was on the tip of my tongue. Eventually I blurted out "fat chance"which they said was right. it's strange because that happens to be one of the very few idiomatic statements that I actually know--- my bf tested me on more saying later that day & I just couldn't answer them.

3. They asked about feelings. They asked what it's like when I'm happy & I said usually it's sparked by one of my interests & it's like a "phwah" feeling with butterflies in my stomach. I said something like it's nice. Anxiety- I said hot flashes & butterflies in my stomach. when asked about anger I just didn't know what to say & went off on a tangent about how when past alcoholics in my life did things that annoyed or upset me I would just feel nothing (like the calm before a storm) & told myself "it will be alright" but knew that anxiety was coming the next day & that worried me as it would make me feel bad & exacerbate my OCD. In the end I think I just denied I ever get angry & said that I am "pretty even tempered & have never hit anyone". They also asked me how I knew when someone is friends with me & I said because they want to see you again & do shared interests with you. And they were like "but how do you know if they are your friend" & I said something like "because they are nice to you". I also said that I couldn't imagine being friends with someone who didn't have the same interests as me. They asked how I knew my bf was bf & I told the story of how we got together & said that one of us asked what this meant & the other one said that they'd like us to be in a relationship but can't really remember that accurately. They asked me why some people get married & I think I struggled on this one. I eventually said that it initially makes people feel good to be loved but that I don't really see the point as a lot of people get divorced & it seems like unnecessary paperwork. when pressed though I said it seems like a nice sentiment at first & when asked what I mean by sentiment I think I said something like it's a nice feeling to be loved. I think they also asked why some people would want to live together & I said that it might make you feel more secure/safe. I was also asked what annoyed other people. I said lots of things but I wasn't quite sure what & they eventually derived evidence from a later anecdote I told- I don't think I needed much encouragement to talk & go off on tangents.

4. I was shown a picture with lots of people in it doing activities. I was asked what I saw & I just said what the people were doing. There were people sailing on a boat. I was asked whether I'd done this & I came up with 2 anecdotes of trips I went on as a child were boats & sailing were involved. I also came up with an amusing anecdote of accidentally hitting my teacher over the head live on TV with a canoe paddle. I think they found this funny but can't really remember their reactions. There was also a plane & I was asked if I ever flew on a plane I said I did once in 2011 & went into detail about the trip & why we were there. There were two women running & smiling listening to music- this one was pointed out to me by the assessor who asked "why do you think they are happy"- to which I replied that the sun is shining as it is today & that makes you feel good & sometimes gives me more energy depending on the state of my mental health. I did recognise they were smiling which indicates happiness which is probably quite NT.

5. There was a mini break where one of the assessors went to get water & I spoke to the other one about an earlier conversation of how send lots of emails repetitively was really therapeutic for me & gave me a sense of satisfaction & contentment. I was also asked what irritated me & I came up with an anecdote about buying a bottle of juice from the chippy but it had been dropped on the floor before being sold to me. Things like that cause a visceral sense of disgust & I get stuck on that feeling & it ruins the enjoyment of the product so really annoys me. I don't like food mess or things being dropped on the floor/having to touch the floor etc. it's hard to get past that.

6. I then had to act out brushing my teeth. They pointed to a space & pointed out an invisible sink, where the cold tap, hot tap, toothpaste was etc. I quickly asked if I could rearrange the order of things as this is not how my setup is at home so I wouldn't be able to do it properly. I said I would ditch the cup of water because I learned that swilling your mouth out actually reduces the adheisive qualities of tooth paste & therefore prevents adequate medicinal effects. They said that was fine so I said where the hot tap was etc. I think I did ok in this. I picked up the toothbrush, gave a detailed & precise demonstration of how I brush my teeth & all of the routine surrounding it done the very last detail of which hand I use to prevent visceral disgust at sputum leakage etc.

8. The final task was to make up a story out of a select number of objects. The assessor went first & seemed to personify one of the items so I decided this must be the done thing. She acted this car (toy car) going along a shoelace (which was a rickety bridge). The car was was apprehensive but its friend (a personified umbrella was at the other end so the car continued until it reached the umbrella friend. There was a sponge with was used to signify the car wash (it seems innhindsight). I chose a lollipop stick, a sponge (because I liked the look of it- I didn't say this but I felt like I wanted to chew it); a rubber ball with tassel like things around it (as the texture appeared & felt pleasing); a candlestick (which i decided would be the thing that i would personify like the assessor did- i called it lucy); she chose one of the items which was a car again. I took a short while & the put the car on the sponge & said the car was driving on the moon. He (the car) had invented a new game where you whack a ball around with a stick. But then the ball knocked over Lucy the candlestick. Lucy asked if she could have a lift to the spaceship so that she could go to A&E to be checked over. That was the end of it. I read on a forum after it that people do voices for the characters but I don't recall doing this. Really, they did just seem like unrelated objects to me & these are not the sorts of games that I would play as a child. My games were more realistic almost like soap operas involving people & real life issues.

*** If anyone could provide some insight into what my answers could've meant that would really help me as I'm scared of being invalidated in some sort of way & it just being a fault with my character. I understand no one on here can diagnose me but just an indication maybe from your own experiences of the ADOS MODULE 4 assessment would really provide comfort to me right now.

*** also for the cognitive assessment I think I struggled on recreating a picture with blocks but the pattern recognition one with the mini-blocks I got the hardest one right despite taking a long time & getting a migraine.

Parents
  • Interesting experience.  I can't give any clinically valid opinion on what your responses meant, but I will note somethings that stick out to me.  Please don't take offense to any of it.  I'm merely contrasting your responses from how I *think* NTs would respond.  Also, take into account that I'm autistic too.

    1) I think you seemed extraordinarily worried that you couldn't replicate the first picture.  NTs would probably just brush it off or be embarrassed that they are inadequate and come up with an excuse for why they couldn't do it or point out a strength elsewhere in their mental capacity.  Either way, they wouldn't be so worried.

    2) Your description of the Tuesday book seems highly focused on details that made it difficult for you to comprehend why that would be happening, to the point that you resolved the conflict by assuming the guy was psychotic.  NTs would probably not be so concerned with the pictures making sense.  Rather, they would come up with a fantasy description that wasn't tied to the constraints of reality.

    3) Your descriptions of emotions were mostly based on physical sensations.  NTs would probably give emotional descriptions.  Your description of marriage was focused on the initial personal benefit, then covered the practical difficulties with paperwork should you divorce.  NTs would probably discuss love, symbolic gestures, having a deep connection with their partner, being with someone forever, and family when describing marriage.  Paperwork and hassle would be a minor topic if at all because it would be inappropriate in NT culture.

    4) Aside from your description of the pictures, the evaluator was likely looking at how you looked while describing the pictures.  Did you use gestures, have eye contact, and notice any social cues.

    5) I find it funny that you have such a strong and long-lasting reaction to that.  NTs probably would just brush it off.

    6) One, you had to reorganize the invisible sink to brush your teeth like you do at home instead of just brushing your teeth with the current made-up setup.  Really, all you had to do was pretend to put toothpaste on an invisible toothbrush and brush your teeth.  Two, you asked for permission to rearrange the non-existing setup.  NTs would intuitively know if they can or not from social cues or normal expectations.  But since you asked, it tells me that you likely ask for permission a lot because you are unsure of the other person's disposition or expectations.

    7) A mystery.

    8) I remember seeing a video on YouTube in which a lady described her experience with this portion of the assessment.  She said that she thought she did a great job coming up with a good story and was proud of herself.  The evaluator's feedback wasn't so much about the story, but how she told it: like there was no one else there in the room and she was telling the story to an imaginary audience instead.

    I was administered the ADOS-2 about 2 weeks ago, and had a very different experience.  I didn't have to complete any puzzles, act anything out, describe a picture, or come up with a story.  She did ask me about feelings and a lot of childhood questions (I'm 41 y/o).  She also asked me about sensory experiences, work, friends, family, and romantic relationships.  I probably went on a bunch of tangents, which were sufficient enough to meet the needs of the pictures and story questions.  The final report is not complete, but here are the preliminary results of the assessment:

    "The results of the ADOS-2 are consistent with high functioning autism. [All  My Friends Are Autistic] is verbal and articulate, and he is able to have a conversation, though he does not display many gestures.  He was observed to have difficulty with eye contact. His eye contact was not coordinated with his speech when talking to the examiner. He displayed some social awkwardness and social anxiety. He does not look for cues that others are not interested. He is very distracted by people’s eyes and then cannot focus on what is being said. He tends to look at peoples’ mouths. He had elevations on the Communication and Reciprocal Social Interaction scales."

    This cracked me up because I thought I nailed it with my social comfort, communication, and reciprocity lol.  I agree with it though.  I expect someone to tell me if they want me to stop talking about something.  If I try to assess their engagement, then I can't properly focus on what I want to say and mess it all up.

    If anyone here knows what an elevated score on the Communication and Reciprocal Social Interaction scales mean, I'd be happy to learn about it.

Reply
  • Interesting experience.  I can't give any clinically valid opinion on what your responses meant, but I will note somethings that stick out to me.  Please don't take offense to any of it.  I'm merely contrasting your responses from how I *think* NTs would respond.  Also, take into account that I'm autistic too.

    1) I think you seemed extraordinarily worried that you couldn't replicate the first picture.  NTs would probably just brush it off or be embarrassed that they are inadequate and come up with an excuse for why they couldn't do it or point out a strength elsewhere in their mental capacity.  Either way, they wouldn't be so worried.

    2) Your description of the Tuesday book seems highly focused on details that made it difficult for you to comprehend why that would be happening, to the point that you resolved the conflict by assuming the guy was psychotic.  NTs would probably not be so concerned with the pictures making sense.  Rather, they would come up with a fantasy description that wasn't tied to the constraints of reality.

    3) Your descriptions of emotions were mostly based on physical sensations.  NTs would probably give emotional descriptions.  Your description of marriage was focused on the initial personal benefit, then covered the practical difficulties with paperwork should you divorce.  NTs would probably discuss love, symbolic gestures, having a deep connection with their partner, being with someone forever, and family when describing marriage.  Paperwork and hassle would be a minor topic if at all because it would be inappropriate in NT culture.

    4) Aside from your description of the pictures, the evaluator was likely looking at how you looked while describing the pictures.  Did you use gestures, have eye contact, and notice any social cues.

    5) I find it funny that you have such a strong and long-lasting reaction to that.  NTs probably would just brush it off.

    6) One, you had to reorganize the invisible sink to brush your teeth like you do at home instead of just brushing your teeth with the current made-up setup.  Really, all you had to do was pretend to put toothpaste on an invisible toothbrush and brush your teeth.  Two, you asked for permission to rearrange the non-existing setup.  NTs would intuitively know if they can or not from social cues or normal expectations.  But since you asked, it tells me that you likely ask for permission a lot because you are unsure of the other person's disposition or expectations.

    7) A mystery.

    8) I remember seeing a video on YouTube in which a lady described her experience with this portion of the assessment.  She said that she thought she did a great job coming up with a good story and was proud of herself.  The evaluator's feedback wasn't so much about the story, but how she told it: like there was no one else there in the room and she was telling the story to an imaginary audience instead.

    I was administered the ADOS-2 about 2 weeks ago, and had a very different experience.  I didn't have to complete any puzzles, act anything out, describe a picture, or come up with a story.  She did ask me about feelings and a lot of childhood questions (I'm 41 y/o).  She also asked me about sensory experiences, work, friends, family, and romantic relationships.  I probably went on a bunch of tangents, which were sufficient enough to meet the needs of the pictures and story questions.  The final report is not complete, but here are the preliminary results of the assessment:

    "The results of the ADOS-2 are consistent with high functioning autism. [All  My Friends Are Autistic] is verbal and articulate, and he is able to have a conversation, though he does not display many gestures.  He was observed to have difficulty with eye contact. His eye contact was not coordinated with his speech when talking to the examiner. He displayed some social awkwardness and social anxiety. He does not look for cues that others are not interested. He is very distracted by people’s eyes and then cannot focus on what is being said. He tends to look at peoples’ mouths. He had elevations on the Communication and Reciprocal Social Interaction scales."

    This cracked me up because I thought I nailed it with my social comfort, communication, and reciprocity lol.  I agree with it though.  I expect someone to tell me if they want me to stop talking about something.  If I try to assess their engagement, then I can't properly focus on what I want to say and mess it all up.

    If anyone here knows what an elevated score on the Communication and Reciprocal Social Interaction scales mean, I'd be happy to learn about it.

Children
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