Clinical & Research Reliable Trainings on the ADI-R & ADOS
Trainings for the ADI-R, ADOS and ADOS-2 are structured either as “clinical” training days where participants observe a UMACC-certified trainer administer the measure and be expected to complete consensus coding, or “research” training days where participants themselves administer portions of whichever measure they are being trained on. So for example, Clinical ADOS Trainings are usually conducted over 2 days and involve live administrations of the ADOS modules on each day of the trainings (one per module pair), with participants observing the trainer administer at least one of each module pair to a live volunteer and be expected to complete consensus coding. Research Reliable ADOS Trainings include two additional “research” training days where participants themselves administer portions of the ADOS protocol to live volunteers under the trainer’s supervision. Both pieces of training, the Clinical ADOS Training and the Research Reliability Training are required on-site for those who intend to use the ADOS in their research and pursue research reliability calibration. ADI-R Trainings are similar in that they begin first on day one with a demonstration by the trainer in the use of the interview with a live parent volunteer, followed on day two by each participant administering a portion of the interview themselves to additional parent volunteers.
A Word about Qualifications for ADOS & ADI-R Clinical Training
The authors of the ADOS, ADOS-2 and ADI-R clearly state that these instruments should be used by professionals who are very familiar with Autism and Autism Spectrum Disorders and who have education, training and experience in clinical interviewing and assessment of individuals with Autism and other developmental disabilities. As a diagnostic measure intended to aid in diagnosis, the ADOS and ADOS-2 (including the Toddler Module) should be used by professionals qualified to give medical, psychiatric or psychological diagnoses. When used to aid in treatment planning or evaluation, the ADOS and ADOS-2 can be used by a wider array of clinicians (e.g., school psychologists, speech and language pathologists, occupational therapists) who, prior to the workshop have education, training and experience in using individually administered test batteries and who have a background and experience in the treatment of Autism.
Note, however that simple attendance at an ADOS, ADOS-2 or ADI-R training alone is not sufficient to ensure competence in the use of these measures and does not alone qualify someone to administer and interpret findings yielded from the instruments. Learning the standardized methods of administration, beginning to calibrate one’s scoring, establishing competency or achieving the fine points of research reliability, in the long run these can only be achieved through repeated practice and in many cases ongoing support and supervision.
The authors note that examiners with considerable prior experience in making formal observations and administering individual assessments may come to complete familiarity with the activities and establish complete confidence they are applying the coding categories accurately in as few as 8 practice sessions (2 per module for a total of approximately 16 administrations). Others may take considerably more practice.
Clinical ADOS Trainings are usually conducted over 2 days and involve live administrations of the ADOS modules on each day of the trainings (one per module pair), with participants observing a UMACC-certified ADOS trainer administer at least one of each module pair to a live volunteer and be expected to complete consensus coding. A third day of training is now available for focus on the Toddler Module as part of the Clinical ADOS-2 Trainings with Toddler Module.
Training of this type require the following that the site provide the following:
- Two child volunteers for the live demonstrations (1 per day), each that fit the requirements appropriate for their days ADOS module to be administered and each with a previous diagnosis of ASD. Further description detailing which children are best for training is available upon request.
- A complete WPS ADOS-2 kit on hand for use during the training
- WPS ADOS-2 protocols and a manual for each attendee and should be purchased directly from WPS.
More advanced training is available including ADOS-2 Research Trainings, which along with the post-training process of obtaining research reliability are required for any clinical researcher intending to collect ADOS-2 data for use in research. These trainings involve 3 additional days of more intensive training (in addition to the aforementioned 2 days of clinical training) where trainee’s themselves are supervised administering live administrations of the all five ADOS-2 modules including the Toddler Module. Thus, these days like those of the Clinical ADOS-2 Training also require additional child volunteers as well as available use of an ADOS-2 kit and the appropriate protocols and manuals.
Some trainers do also provide other training models including Advanced Trainings and experienced and Refresher Trainings which are provided on an annual, bi-annual or quarterly basis accordingly and On-Site Reliability Training.
A similar structure exists for the ADI-R as well with both the Clinical ADI-R and ADI-R Research Trainings being conducted over 2 days and involving live administrations of the ADI-R on at least one, if not both days of the trainings.
Training of this type require the following that the site provide the following:
- Two parent volunteers for the live demonstrations (1 per day). These should be parents of a child already diagnosed with an autism spectrum disorder who would be willing to share with the group details about the child’s developmental history.
- WPS ADI-R administration guidebooks, algorithms and manuals are also required for each attendee and should be purchased directly from WPS.
Establishing Research Reliability on the ADI-R, the ADOS or ADOS-2 requires participants first complete both the Clinical Training and the Research Training. They then must establish research reliability on the instrument before beginning data collection for their research project. Two factors are considered in establishing reliability: 1) showing that one has learned the standardized administration procedures, and 2) showing that one understands coding rules and has achieved the necessary percent agreements with the authors or a UMACC/CADB-certified trainer (i.e., at least 80% agreement on the ADOS/ADOS-2 for both protocol and algorithm and at least 90% agreement on the ADI-R for both protocol and algorithm).
It is important to reconcile the process of achieving scoring calibration (for both the ADI-R and the ADOS/ADOS-2) – it is truly a process, one that will require your time, effort and dedication along with continuous supervision to achieve. Research Reliable Training days, though intense as they serve really just as the beginning of the calibration process. Commitment and self-determination are required following training if one is to be successful in achieving their goal. Self-directed teaching is also an important part of the process.
- Take the time to review the training manuals and each of the accompanying protocols – the ADI-R booklet and each of the modules ADOS (1-4) and Toddler prior to the start of the training and upon completion of your training. Pay special attention to the administration procedures and coding items.
- For those who have access to the WPS Training tapes, it is very useful to have viewed these tapes prior to and following training (either/both the ADI-R and/or the ADOS/ADOS-2 tapes). These can be a valuable resource post-training as additional examples to further solidify your understanding of the coding.
The emphasis during research reliable trainings is often on administration of the items and conceptualizations to help you in coding. Many of you will have carried out your own assessments that overlap considerably with both the ADI-R and the ADOS/ADOS-2 and may feel quite comfortable with parts of them. In that case, the focus of training is in remembering the standardized methods of administration and then “calibrating” judgments for reliability. In the long run, nothing can accomplish this task more than practice. Our goal at the time of training is to get you off to a good start administering the protocols, operationalizing truly the differences in an investigator-based, semi-structured interview method, and making observations that are similar to those of other people. However, the fine points of achieving reliability are something that you will need to achieve through practice, and then formalize through our scoring of your post-course tapes (and your scoring of ours). You will receive post-training tapes of ADI-R and ADOS/ADOS-2 administrations at the end of each workshop for you to code and check your own reliability & these will serve as the beginning steps of that reliability calibration process.
Following on-site training, you will begin the formal procedures for establishing research reliability. Remember there are two factors considered when establishing reliability: 1) showing that one has learned the standardized administration procedures, and 2) showing that one understands coding rules and has achieved the necessary percent agreements with the authors or a UMACC-certified trainer. Both of these factors are demonstrated across three separate administrations of either the ADI-R or each of the ADOS-2 Module pairs (Modules ½, Modules ¾ and Toddler Module). The administration you complete during the Research Training workshop counts towards one of the three. Therefore two additional administrations are required to 1) demonstration standardized administration procedures and 2) establish reliability in coding.
- Prior to the workshop, we want you to videotape yourself administering an ADOS module 1 or 2, AND an ADOS module 3 or 4, which you will bring with you to the workshop along with scored protocols. These videos must be in standard size DVD and able to be viewed on a laptop. In most cases trainers are not able to watch mini-DVDs or mini-tapes. We will review your videos and provide brief feedback on administration and tape quality (room set-up, sound, etc.). These administrations do not need to be with children with autism, although that is ideal if it is possible. The purpose is to get you familiar with the measure prior to coming to the training and to provide us with an opportunity to observe your administration skills. Our review of your administration(s) on this tape accomplishes the first step in achieving reliability.
- Whichever administration(s) you complete during the Research Training workshop accomplishes the second step in achieving reliability, regardless of your percent agreement.
- Following the on-site training you are given a post-course administrations which serve as post-tests and allow you to demonstrate you have reached the necessary coding calibration. When you feel prepared to do so, use this tape to test yourself and see if you achieved the necessary percent agreements each instrument requires. Doing so accomplishes the second step in achieving reliability.
- The final step in achieving reliability involves you sending in a post-course tape of the ADI-R or ADOS/ADOS-2 which we then review in consideration of those same two factors 1) demonstration of standardized administration procedures and 2) establishing the required inter-rater reliability percent agreements necessary of at least 80% agreement on the ADOS/ADOS-2 for both protocol and algorithm and at least 90% agreement on the ADI-R for both protocol and algorithm. Once you submit a tape(s) which reach this level of agreement you will have established reliability.
Detailed informational sheets that outline further the process of obtaining research reliability are available upon request.
Some other caveats to consider:
- There are procedures that allow researchers to establish reliability with someone at their own research lab who has already attended all necessary trainings and themselves established research reliability with UMACC, CADB or one of the UMACC-certified trainers. Please contact us for more information.
- Attending ADI-R or ADOS/ADOS-2 training (clinical or research) does not allow attendees to train other individual users or groups. Procedures are available for becoming a trainer on the measures and include completing and achieving research reliability with UMACC, CADB or one of the UMACC-certified trainers, and then again completing the process as a Trainer in Training. Please contact us for more information.
- Both the ADI-R and ADOS have been translated and made available in over a dozen countries. Please contact WPS for additional information.
- Photocopying, adapting or translating the ADI-R or ADOS/ADOS-2 is expressly prohibited unless explicit permission is granted by WPS. Discounts are available through WPS for use in research. Please contact WPS directly for additional information.
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