Contents:
- What is the ADOS-2 test?
- What does the ADOS-2 assessment involve?
- Who developed ADOS 2, the test used in the ASD diagnostic process?
- What does it mean that the ADOS-2 assessment is the gold standard?
- Diagnosis of autism spectrum disorders – can the ADOS-2 test confirm or rule out the disorder?
- How is the ADOS-2 assessment carried out – what does the patient need to know?
- Is the ADOS-2 reliable?
- Bibliography
- Related articles
A wide range of diagnostic tools are used in psychiatry and clinical psychology.
These may include questionnaires, psychological tests, structured interviews with the patient and their family, as well as observational tests that allow behaviour to be observed in specific situations.
The common aim of all these methods is to gather objective data that will help in making a diagnosis.
Against this background, we can now move on to a detailed discussion of the ADOS-2 (Autism Diagnostic Observation Schedule – Second Edition) – a tool that has come to be regarded as the gold standard in the diagnosis of autism spectrum disorders (ASD).
Do you need some help?
The ADOS-2 assessment at the Dialog Centre for Children and Families
The ADOS-2 is the gold standard in the diagnosis of autism — a precise tool for assessing your child’s communication, social interactions and behavioural patterns.
What is the ADOS-2 test?
The ADOS-2 is a multidimensional psychological test used to assess ASD in children, adolescents and adults. The tool is based on direct observation of the patient’s behaviour and an assessment of how they function in their interactions with others.
During the procedure, the specialist sets out a series of short tasks – these may include games, conversation or activities requiring cooperation. The aim is not to test skills, but to analyse how the person establishes contact, communicates and responds to emotions and changes.
What does the ADOS-2 assessment involve?
The test comprises five modules, which are selected according to age and level of language development. Different activities are suggested for children who are not yet speaking, and different ones for teenagers or adults who speak fluently.
This ensures that the observations are accurate and comparable across different age groups.
- Toddler Module – for the youngest patients (12–30 months) who are not yet able to speak fluently.
- Module 1 – for children who do not speak or who use single words.
- Module 2 – for people who speak in simple sentences.
- Module 3 – for older children and teenagers with a well-developed command of the language.
- Module 4 – for young people and adults who speak fluently.
The ADOS-2 score focuses on various areas – it classifies behaviours into two main categories:
- Social Affect (SA) – social communication and interactions,
- Restricted and Repetitive Behaviours (RRB) – repetitive behaviours, highly focused interests and difficulties in adapting to changes in the environment.
Each area is assessed on a points-based scale, and the total scores indicate whether the observed characteristics fall within the autism spectrum. In addition, the Calibrated Severity Score (CSS) – a scale of symptom severity (1–10) – is used, which is independent of age and the selected module.
Do you need some help?
The ADOS-2 assessment at the Dialog Centre for Children and Families
The ADOS-2 is the gold standard in the diagnosis of autism — a precise tool for assessing your child’s communication, social interactions and behavioural patterns.
Who developed ADOS 2, the test used in the ASD diagnostic process?
The ADOS-2 was developed by Professor Catherine Lord and her colleagues – Pamela C. DiLavore, Susan Risi, Katharine Gotham and Somer Bishop.
The first version of the tool (ADOS) was developed in the 1980s and 1990s. It was based on many years of research into early childhood development and the specific behavioural characteristics observed in people on the autism spectrum.
The ADOS-2 version, published in 2012, is an expanded and improved version of this test. Among other things, it includes the Toddler Module (for children from 12 months of age), improved diagnostic algorithms and the introduction of the Symptom Severity Scale (CSS). This has made it possible to increase the accuracy and comparability of the results.
What does it mean that the ADOS-2 assessment is the gold standard?
Procedures referred to as the ‘gold standard’ are those examinations, tests or questionnaires that yield the most reliable, accurate and credible results.
Why is the ADOS-2 considered the best tool for diagnosing autism (autism spectrum disorders)?
- The assessment procedure is strictly standardised. The specialist follows clearly defined steps, and the method of scoring behaviours is consistent.
- Results obtained at different centres can be compared with one another, and repeating the test allows accurate conclusions to be drawn.
- The ADOS-2 has high validity and sensitivity. The protocol for observing symptoms of autism enables the characterisation of symptoms that may form the basis for a diagnosis.
- The test is versatile (as its modules can be adapted to the patient’s age and level of speech development).
- The ADOS-2 assessment itself is based on direct play with the assessor and observation of the young patient’s behaviour. The account provided by the parent or carer serves to supplement this.
Diagnosis of autism spectrum disorders – can the ADOS-2 test confirm or rule out the disorder?
Describing a test as the ‘gold standard’ does not mean that the test results always provide a certain and unambiguous diagnosis. Nevertheless, given all the characteristics of the ADOS-2, many official recommendations from international psychological associations (in nearly 20 countries) emphasise that no other single tool has such high clinical value.
However, it is still necessary to take a broader view of the ADOS-2 assessment results – the test results are always considered in conjunction with the family history and other psychological assessments.
At the Dialog Centre for Children and Families, the entire diagnostic process is carried out in stages, in accordance with international standards and based on the work of a team of specialists who bring together a range of perspectives.
Do you need some help?
The ADOS-2 assessment at the Dialog Centre for Children and Families
The ADOS-2 is the gold standard in the diagnosis of autism — a precise tool for assessing your child’s communication, social interactions and behavioural patterns.
How is the ADOS-2 assessment carried out – what does the patient need to know?
The assessment of autism spectrum disorders using the ADOS-2 takes place during a psychological consultation. The average time taken to complete the test depends on the module selected and, above all, on the subject’s responses.
- The ADOS-2 assessment usually takes between 40 and 60 minutes. In the youngest patients, the observation of autism-related behaviours tends to be shorter, whilst in older children and adults it is more extensive.
Once the session has ended, the diagnostic psychologist does not provide the results straight away. The specialist must first analyse the data collected in conjunction with other diagnostic information.
At the Centre for Children and Families ‘Dialog’, the ADOS-2 assessment is preceded by an initial consultation and a detailed interview with a parent or carer (ADI-R). Following this, the patient undergoes further psychological assessments, standardised developmental tests (ASRS) and an analysis of their behaviour at home and in the wider community. A full diagnosis (in the form of a report), which forms the basis for drawing up a comprehensive care plan, is provided by a psychiatrist.
Toddler Module – for children aged 12 to 30 months
During the assessment, the psychologist checks whether the child’s development and skills are in line with the norms for their age group. During this period, even a few months can make a difference to a child’s level of development – the interpretation of the ADOS-2 test results depends heavily on age.
During the assessment, the specialist creates situations in which they check whether the child reacts spontaneously to the presence of another person. These may involve playing with simple objects (e.g. building blocks or toys that make sounds). In certain situations, the psychologist may cause a slight surprise (e.g. by changing the rules of the game) and observe how the child reacts to the change.
A diagnostic psychologist checks whether the toddler looks in the direction indicated by an adult, whether they hand over an object, and how they express their emotions. A great deal of attention is paid to spontaneous non-verbal communication – gestures, facial expressions and making eye contact.
Module 1 – for children who do not speak or who use single words
In this module, the psychologist encourages the child to engage in simple interactions. These may include imitation games, looking at a picture book together, or activities with toys that require the child to ask an adult for help.
The specialist carefully observes whether the child signals their needs and how they respond to attempts to make contact. They analyse how the child uses gestures and facial expressions instead of speech. They also check whether the child is able to show interest in an object, point at something with their finger or look in the direction suggested by an adult.
Module 2 – for those who use simple sentences
The diagnostic process using Module 2 of the ADOS-2 is aimed at children who are already able to use short sentences, but whose language is not yet fluent or fully developed. Here, the activities become slightly more challenging, though the assessment still consists of simple conversations and playing together with a qualified assessor. These may include situations requiring cooperation, such as building with blocks or discussing simple pictures.
The specialist checks whether the child is able to use speech to make contact, ask for something, share information or describe basic emotions. They pay attention to whether the child’s utterances are understandable, whether the child spontaneously initiates a conversation, and whether they respond to the other person’s suggestions. They also assess the child’s ability to use their imagination, non-verbal communication (gestures, eye contact, facial expressions), as well as the presence of repetitive behaviours or unusual interests.
Module 3 – for older children and teenagers with well-developed speech
In Module 3, the specialist may focus more on assessing verbal and non-verbal communication. The assessment is based mainly on a conversation about everyday life, relationships with peers or plans for the future. The psychologist may ask the person to tell a story, describe a picture or act out a short scene.
At this stage, the way in which the child conducts a conversation is analysed – the fluency of their speech, the appropriateness of their responses and their ability to keep a conversation going on various topics. The specialist observes how the child interprets the behaviour and emotions of others, whether they recognise the other person’s perspective, and how they react when the topic changes suddenly. They also assess the range of gestures, tone of voice and facial expressions, as these form part of social communication.
Do you need some help?
The ADOS-2 assessment at the Dialog Centre for Children and Families
The ADOS-2 is the gold standard in the diagnosis of autism — a precise tool for assessing your child’s communication, social interactions and behavioural patterns.
Is the ADOS-2 reliable?
The reliability of psychological tests is described from two perspectives.
- The first is validity – that is, the extent to which the tool measures what it was designed to measure.
- The second is reliability – that is, the consistency of results when the test is carried out in accordance with the procedure.
Numerous scientific publications have confirmed that the ADOS-2 meets both requirements to a very high standard – in many studies, sensitivity values reach 90–95 per cent. The test’s reliability is also rated highly – provided the diagnostician is properly trained, the results are comparable.
However, like any tool, the ADOS-2 also has its limitations. It is emphasised that the specificity of the ADOS-2 – that is, its ability to distinguish autism from other disorders – is lower. This applies in particular to adult patients with anxiety disorders or schizophrenia.
Bibliography
- Rynkiewicz, A., & Kulik, M. (2013). Standardised, interactive tools for the diagnosis of autism spectrum disorders and the new DSM-5 diagnostic criteria. Psychiatria, 10(2), 41–48.
- Rea, H. M., Øien, R. A., Shic, F., Webb, S. J., & Ratto, A. B. (2023). Sex differences on the ADOS-2. Journal of Autism and Developmental Disorders, 53(7), 2878–2890.
- Kostecka, A. (2024). The diagnosis of autism spectrum disorders: past and present, and the possibilities for early intervention in children’s development. Studia Edukacyjne, (73), 149–167.
- Bishop, S. L., & Lord, C. (2023). Commentary: Best practices and processes for the assessment of autism spectrum disorder – the intended role of standardised diagnostic instruments. Journal of Child Psychology and Psychiatry, 64(5), 834–838.
- Bołtuć, I., Dworzańska, M. (2022). The Autism Spectrum – Perspectives. Częstochowa: Formy Foundation.
- Pereira, T., & Lousada, M. (2023). Psychometric properties of standardised instruments used to measure the effects of pragmatic interventions in children with developmental language disorder: A systematic review. Journal of Autism and Developmental Disorders, 53(5), 1764–1780.
- McCrimmon, A., & Rostad, K. (2014). Test review: Autism Diagnostic Observation Schedule (ADOS-2) Manual (Part II): Toddler Module. Journal of Psychoeducational Assessment, 32(1), 88–92.
- Lord, C., Rutter, M., Goode, S., Heemsbergen, J., Jordan, H., Mawhood, L., & Schopler, E. (1989). Autism Diagnostic Observation Schedule: A standardised observation of communicative and social behaviour. Journal of Autism and Developmental Disorders, 19(2), 185–212.
- Chojnicka, I., & Płoski, R. (2012). Polish version of the ADOS (Autism Diagnostic Observation Schedule – Generic). Psychiatria polska, 46(5), 781–789.
- Greene, R. K., Vasile, I., Bradbury, K. R., Olsen, A., & Duvall, S. W. (2022). Elevated scores on the Autism Diagnostic Observation Schedule (ADOS-2) in a clinical sample of children and adolescents without autism: Phenotypic profiles of false positives. The Clinical Neuropsychologist, 36(5), 943–959.
- Hus, V., & Lord, C. (2014). The Autism Diagnostic Observation Schedule, Module 4: revised algorithm and standardised severity scores. Journal of Autism and Developmental Disorders, 44(8), 1996–2012.
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Do you need some help?
The ADOS-2 assessment at the Dialog Centre for Children and Families
The ADOS-2 is the gold standard in the diagnosis of autism — a precise tool for assessing your child’s communication, social interactions and behavioural patterns.
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