Understanding ADOS scores in relation to my daughter's new Autism diagnosis

From the Lorna Wing Diagnostic Centre:

ADOS-2 Assessment

What is it?

The Autism Diagnostic Observation Schedule (ADOS-2) is a semi-structured assessment of communication, social interaction, and play (or imaginative use of materials) for individuals suspected of having autism or other pervasive developmental disorders. The ADOS-2 has four possible modules which are selected for use based on developmental and language levels, ranging from nonverbal to verbally-fluent.

Structure and purpose of assessment

The ADOS consists of standardized activities that allow the examiner to observe the behaviours that are important to the diagnosis of autism across developmental levels and chronological ages. The examiner selects the module that is most appropriate for a particular child or adult on the basis of his/her expressive language level and chronological age. Structured activities and materials, as well as less structured interactions, provide standardized contexts in which social, communicative and other behaviours relevant to pervasive developmental disorders are observed. Within each module, the participant's response to each activity is recorded.

The ADOS provides a 30- to 45-minute observation period during which the examiner has numerous opportunities to observe relevant behaviours through standard 'presses'. 'Presses' consist of planned social occasions in which it has been determined in advance that a behaviour of a particular type is likely to appear (Murray, 1938).

Each situation provides a different combination of presses for particular social behaviours.

Module 1 is intended for individuals who do not consistently use phrase speech. Materials for Module 1 have been selected for young children, but materials from other modules may be substituted if desired.

Module 2 is intended for individuals with some phrase speech who are not verbally fluent.

Module 3 is intended for verbally fluent children for whom playing with toys is age-appropriate (usually up to 12 - 16 years of age). Verbal fluency is broadly defined as having the expressive language of a typical four-year-old child: producing a range of sentence types and grammatical forms, using language to provide information about events out of the context of the ADOS, and producing some logical connections within sentences (e.g., "but" or "though").

Module 4 includes many of the tasks in Module 3 (some of which are optional), as well as additional interview items about daily living. It is intended for verbally-fluent adolescents and adults. The difference between Modules 3 and 4 lies primarily in whether information about social-communication is more appropriately acquired during play or a conversational interview.

The four modules overlap in activities, but together contain a variety of tasks ranging from observing how a young child requests that the examiner continue blowing up a balloon in Module 1 to a conversation about social relationships at school or work in Module 4. Modules 1 and 2 will often be conducted while moving among different places around a room, reflecting the interests and activity levels of young children or children with very limited language; Modules 3 and 4 take place sitting at a table and involve more conversation and language without a physical context.

The object is not to test specific cognitive abilities or other skills in the activities, but to have tasks that are sufficiently intriguing that the child or adult being assessed will want to participate.

Overall ratings are made at the end of the schedule. These ratings can then be use to formulate a diagnosis through the use of a diagnostic algorithm for each module. The scores for the items in the algorithm vary between 0 and 2. A score of 0 indicates that behaviour/communication in that area showed no differences or difficulties. A score of 1 indicates some differences which may reflect an Autism Spectrum Disorder. A score of 2 indicates clear differences or difficulties that may be reflect an Autism Spectrum Disorder. These scores are then calculated in relation to the ADOS-2 algorithm to identify whether that child or adult presents with an ADOS score that reflects Autism/Autism Spectrum Disorder.

In all modules an overall score of 7 or more is considered to be indicative of an ADOS diagnosis of Autism/Autism Spectrum Disorder.

How do we use this assessment?

At the Lorna Wing Centre the ADOS-2 is not used as a primary diagnosis tool, our primary tool is the DISCO. Clinicians may use the ADOS-2 if they have been formally trained and are experienced in its use. They may use it with children or adults to provide a structured basis on which to assess a range of communication, imaginative and play skills.

In general it is less likely that scores from the ADOS-2 will be discussed in reporting as clinicians will be using it to gather qualitative information and recognise the limitations of this process. However, there may be occasions where they feel that reporting on scoring will be valuable to an individual’s report and future care, in which case this is likely to be discussed during assessment.

From the Lorna Wing Diagnostic Centre:

ADOS-2 Assessment

What is it?

The Autism Diagnostic Observation Schedule (ADOS-2) is a semi-structured assessment of communication, social interaction, and play (or imaginative use of materials) for individuals suspected of having autism or other pervasive developmental disorders. The ADOS-2 has four possible modules which are selected for use based on developmental and language levels, ranging from nonverbal to verbally-fluent.

Structure and purpose of assessment

The ADOS consists of standardized activities that allow the examiner to observe the behaviours that are important to the diagnosis of autism across developmental levels and chronological ages. The examiner selects the module that is most appropriate for a particular child or adult on the basis of his/her expressive language level and chronological age. Structured activities and materials, as well as less structured interactions, provide standardized contexts in which social, communicative and other behaviours relevant to pervasive developmental disorders are observed. Within each module, the participant's response to each activity is recorded.

The ADOS provides a 30- to 45-minute observation period during which the examiner has numerous opportunities to observe relevant behaviours through standard 'presses'. 'Presses' consist of planned social occasions in which it has been determined in advance that a behaviour of a particular type is likely to appear (Murray, 1938).

Each situation provides a different combination of presses for particular social behaviours.

Module 1 is intended for individuals who do not consistently use phrase speech. Materials for Module 1 have been selected for young children, but materials from other modules may be substituted if desired.

Module 2 is intended for individuals with some phrase speech who are not verbally fluent.

Module 3 is intended for verbally fluent children for whom playing with toys is age-appropriate (usually up to 12 - 16 years of age). Verbal fluency is broadly defined as having the expressive language of a typical four-year-old child: producing a range of sentence types and grammatical forms, using language to provide information about events out of the context of the ADOS, and producing some logical connections within sentences (e.g., "but" or "though").

Module 4 includes many of the tasks in Module 3 (some of which are optional), as well as additional interview items about daily living. It is intended for verbally-fluent adolescents and adults. The difference between Modules 3 and 4 lies primarily in whether information about social-communication is more appropriately acquired during play or a conversational interview.

The four modules overlap in activities, but together contain a variety of tasks ranging from observing how a young child requests that the examiner continue blowing up a balloon in Module 1 to a conversation about social relationships at school or work in Module 4. Modules 1 and 2 will often be conducted while moving among different places around a room, reflecting the interests and activity levels of young children or children with very limited language; Modules 3 and 4 take place sitting at a table and involve more conversation and language without a physical context.

The object is not to test specific cognitive abilities or other skills in the activities, but to have tasks that are sufficiently intriguing that the child or adult being assessed will want to participate.

Overall ratings are made at the end of the schedule. These ratings can then be use to formulate a diagnosis through the use of a diagnostic algorithm for each module. The scores for the items in the algorithm vary between 0 and 2. A score of 0 indicates that behaviour/communication in that area showed no differences or difficulties. A score of 1 indicates some differences which may reflect an Autism Spectrum Disorder. A score of 2 indicates clear differences or difficulties that may be reflect an Autism Spectrum Disorder. These scores are then calculated in relation to the ADOS-2 algorithm to identify whether that child or adult presents with an ADOS score that reflects Autism/Autism Spectrum Disorder.

In all modules an overall score of 7 or more is considered to be indicative of an ADOS diagnosis of Autism/Autism Spectrum Disorder.

How do we use this assessment?

At the Lorna Wing Centre the ADOS-2 is not used as a primary diagnosis tool, our primary tool is the DISCO. Clinicians may use the ADOS-2 if they have been formally trained and are experienced in its use. They may use it with children or adults to provide a structured basis on which to assess a range of communication, imaginative and play skills.

In general it is less likely that scores from the ADOS-2 will be discussed in reporting as clinicians will be using it to gather qualitative information and recognise the limitations of this process. However, there may be occasions where they feel that reporting on scoring will be valuable to an individual’s report and future care, in which case this is likely to be discussed during assessment.