Autism Diagnostic Observation Schedule (ADOS-2)
About the ADOS 2
Modules 1 through 4
by Catherine Lord, Ph.D., Michael Rutter, M.D., FRS, Pamela C. DiLavore, Ph.D., Susan Risi, Ph.D., Katherine Gotham, Ph.D., and Somer L. Bishop, Ph.D.
by Catherine Lord, Ph.D., Rhiannon J. Luyster, Ph.D., Katherine Gotham, Ph.D., and Whitney Guthrie, B.A.
The ADOS-2 is set to be released by WPS May 12th 2012 and will continue the ADOS’ long history as the “gold standard” observational method of assessment for autism symptomatology. A revision of the ADOS, it provides updated protocols, revised algorithms for Modules 1-3, a new “Comparison Score” (known in the literature as a severity metric score) and the inclusion of the long-awaited Toddler Module, a downward extension of sorts of the ADOS module 1 for toddlers down to 12-months of age not yet using phrase speech.
Updated protocols with clearer administration and coding guidelines and a more comprehensive manual are also included. Researchers and clinicians already trained in the use of the ADOS will find no functional difference in the administration or coding procedures between the ADOS and the ADOS-2. All of the Module 1 through 4 activities and codes remain the same as they were in the original ADOS-WPS, though you will find some additional clarity offered & the inclusion of a few new codes as well.
Like the ADOS before it, the ADOS-2 is a semi-structured standardized observational method used for assessing communication, reciprocal social interaction, play and the presence of restricted or repetitive behaviors or interests in individuals of all ages who have been referred because of a possible Autism Spectrum Disorder. One of the five different modules (Modules 1,2,3,4 or the Toddler Module) is chosen based upon the child’s expressive language level and chronological age. The clinician creates a standardized social context and observes behaviors directly related to a diagnosis of ASD including the quality of the child’s engagement with the examiner, their patterns of communication, appropriateness of play, as well as the presence of stereotypic, repetitive, or atypical behaviors and interests. Behaviors are then coded, interpreted and then compiled on algorithms that yield classifications of Autism Spectrum or Non-Spectrum. The results are then used to support diagnosis, identify behaviors for intervention, monitor growth or progress, and/or develop individualized educational goals.
Similar to the ADOS, the algorithms themselves in providing different classifications inform clinical judgment about severity. By adding the new Comparison Score for Modules 1-3 the authors have provided a severity metric that allows clinicians to compare a child’s overall level of autism spectrum-related symptoms to that of other children diagnosed with ASD of the same age and expressive-language level. Having this continuous metric will prove especially helpful with the release of the DSM-V, allowing clinicians to monitor children’s symptoms over time and interpret behavior using evidence-based descriptive categories based on the presence or absence of autism-related symptoms.
ADOS-2 trainings, both Clinical and Research remain essentially consistent in format to those of the original ADOS, with the now inclusion of an additional days training to allow focus on the Toddler Module.
3-Day ADOS-2 Clinical Introductory Trainings are intended as an introduction to the ADOS-2 and are also a required first step for those seeking to obtaining reliability for use in research. Using a combination of lecture, live demonstration and large group scoring discussions, participants are introduced to each module pair (1 per day) of the ADOS-2, with a third day devoted to use of the Toddler Module.
Individuals, groups or sites whose work involves older individuals and who know in advance they will not benefit from exposure to the specifics of the Toddler Module may be able to seek 2-day ADOS Clinical Introductory trainings without inclusion of the Toddler Module.
5-Day ADOS-2 Research Trainings are required for anyone who seeks to use the ADOS-2 to collect data for inclusion in research studies, as this is a required step in the process of establishing research reliability on the ADOS-2. Much like the clinical introductory training, the first two days involve live demonstrations where participants observe each module pair. In subsequent days, participants receive direct “hands on” instruction and individualized supervision as they each begin to apply knowledge learned through administration themselves of portions of the ADOS-2 with additional live volunteers. The final fifth day of training involves both demonstration and administration by participants of the Toddler Module.
Those seeking to use the ADOS-2 in research are required to receive training in all five modules of the ADOS-2, however training and subsequent achievement of research reliability on the five modules can be done simultaneous or concurrent to one another.
Over the course of these trainings, attendees will:
- Be introduced to the standardized administration procedures of all five modules including the Toddler Module.
- Be introduced to the standardized procedures involved in recording and coding behaviors observed.
- Observe standardized administration of both module pairs (Modules ½ and ¾) as well as the Toddler Module.
- Learn to calculate classifications from completed algorithms.
- Understand how the ADOS-2 can assist in the diagnosis of Autism Spectrum Disorders.
- Recognize the usefulness of the ADOS-2 in targeting behaviors for intervention and/or in the development of individualized education plans.
- Take part in scoring discussions that are both (1) designed to enhance their understanding of the standardized scoring procedures and (2) intended to facilitate accurate coding of behaviors observed.
- Administer and score sections of the modules themselves to live child volunteers with autism spectrum disorders (5-Day ADOS Research Training Only).
- Receive supervision and feedback of their administration (5-Day ADOS Research Training Only).
- Discuss the usefulness of the results in the context of the comprehensive autism assessment and for determining differential diagnosis.
- Understand the procedures involved in achieving research reliability on the ADOS-2.
ADOS-2 DVD training packages are available through WPS and are especially useful as a supplemental aide for those seeking to learn more or achieve greater competence. As always, those who intend to use the ADOS-2 (including the Toddler Module) in research must attend in-person training for all portions of the training (both the clinical and research days as well as now the toddler module).
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