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An Overview of ADOS-2 Testing for Individuals with Autism

What Is the ADOS-2?

The ADOS-2 (Autism Diagnostic Observation Schedule–Second Edition) is an activity-based assessment administered by trained clinicians to individuals suspected of having Autism Spectrum Disorder (ASD). It assesses social and communication skills. Additionally, it measures the imaginative use of materials by the individual taking the test. As of now, the ADOS-2 is the “gold standard” in testing for autism.

How Does the ADOS-2 work?

The ADOS-2 was designed to be used on individuals aged 12-months through adulthood. Its span of applicability makes this test comprehensive and informative to the clinicians who administer it. Its results are consistently measurable and reliable. There must be no significant sensory or motor impairment. For example, someone blind, deaf, or experiencing challenged mobility may not be a good fit for the test.

The ADOS-2 can accommodate individuals of all ages due to its developmental modules, which are specific. Clinicians carefully select the relevant module based on the individual’s language skills, ranging from nonverbal communication to verbal fluency.

Who Does ADOS-2 Testing?

Clinicians who conduct ADOS-2 undergo vigorous training to be qualified to perform the assessment. The clinician administering this test will be a Psychologist, Psychiatrist, Speech Therapist, Pediatrician, or Board Certified Behavior Analyst.

When Was the ADOS-2 developed?

Dr. Catherine Lord developed the ADOS-2 along with her colleagues to provide an opportunity to observe symptoms and behaviors most commonly expressed by someone with autism. Published by Western Psychological Services in 2000, it is now available in 15 languages. Since its publishing, it has become the standard diagnostic tool employed by school systems and other professionals in the autism field who screen for potential developmental disabilities.

Can ADOS-2 Be Done Online?

The ADOS-2 mandates administration by a trained examiner physically in the room with the person being tested. Both individuals must interact in close proximity and use the same materials. Therefore, it is not possible to conduct the assessment remotely.

What Should I Expect During the ADOS-2 Evaluation?

Many clinicians use the ADOS-2 alongside a comprehensive evaluation. Often a clinician will interview the family and caretakers in addition to the ADOS-2 assessment. The clinician may gather other information such as medical and developmental history, birth information, current areas of delay, standardized measurements, and listen to any concerns. It depends on the clinician and agency if this evaluation concludes in one session.

In terms of the ADOS-2, expect the assessment to take 30-60 minutes. A clinician who has no history of the individual’s behavior or symptoms will conduct the evaluation. If the clinician is assessing a child, it is not uncommon to suggest the parent stay for the review duration. In this instance, the parent’s primary role is to observe objectively. The clinician may call on them for interactions, but this is not always necessary.

If the person is older, the test is typically done with just the individual and the clinician in the room. The test is usually recorded on video for analysis by a larger team. The video process also ensures that there are no biases in the clinician’s testing.

The clinician reviews the assessment with families not long after its completion. In many cases, the clinician will determine scores in the same appointment. In other cases, parents will schedule follow-up appointments to review the results. Your follow-up is an excellent time to ask questions when you receive your results. You will also receive a written report with detailed recommendations within one-to-two weeks after the assessment.

What Happens During the Test?

The ADOS-2 is composed of four different modules. Each one is designed to provide the individual with the test most appropriate for their age or function level. Below are the modules:

Module 1

This module is for individuals who do not possess consistent verbal communication skills. They may also use entirely non-verbal scenarios.

Module 2

This module is created for individuals who have few communication skills. It will be most relevant to young children at age-appropriate skill levels. This assessment will consist of scenarios that require moving about the room and interacting with physical materials.

Module 3

This module is designed for verbally fluent individuals capable of playing with age-appropriate toys and games. The clinician and individual will do this at a large desk or table.

Module 4

This module is designed for verbally fluent individuals who seem to play with toys beyond their age. This session will incorporate some of Module 3’s characteristics and more conversational elements regarding daily living experiences.

Each module is composed of standardized scenarios that the tester guides the individual through. For example, the clinician will lay out a picture that provides a template for the individual to stack blocks on top of. The child is not offered sufficient blocks to complete the task. At this point, the clinician will display that they have more blocks. How the individual copes with the scenario is observed, evaluated, and measured. Does the child make a polite request for the remaining blocks? Do they point? Do they scream? Do they refuse to continue the activity? Each reaction will serve as a data point for understanding the child’s capabilities.

Other components of the test include structured conversation and social scenarios. The child may be asked to pretend to be at a birthday party or recess. The clinician will observe the child facing minor obstacles created by the clinician to understand the child’s coping skills better.

While this test can be difficult for some parents to watch because they want to assist, the provider must observe the children functioning independently. In some ways, the entire point of the assessment is to understand how a child does without assistance. When conducting the ADOS-2, some examiners strongly discourage parents from attending because of the strong impulse to help. It has also been noted that parents can sometimes provide a distraction.

How Long Does the ADOS-2 Take?

Each module takes roughly 40 minutes to complete. Still, because individuals have different behavioral and cognitive issues, the clinician may decide not to use all modules. However, it is not uncommon for the examiner to choose another module after discovering that the one initially selected does not match the individual’s functional capabilities. The clinician may select a module that will be more effective for an accurate score.

ADOS-2 Is Only Part of an Autism Diagnosis

Many in the field of autism consider ADOS-2 to be the “gold standard” for autism testing and diagnosis. However, it is essential to keep in mind that it is just one source of information. On its own, it does not diagnose autism. It is part of the autism diagnosis, not a standalone tool. A full assessment would include a person’s development history observations made by parents and clinicians inside and outside the assessment administration.

If you’re interested in having your child or loved one tested using the ADOS-2, contact ABA Centers of America. We have an experienced diagnostic team and a free, no-obligation consultation. Give us a call at 844- 923-4222, and one of our friendly counselors can answer all your questions.