Autism Diagnostic Observation Schedule™, Second Edition (ADOS™-2) NEW

By Catherine Lord, PhD, Michael Rutter, MD, et al.

Autism Diagnostic Observation Schedule™, Second Edition (ADOS™-2)

Benefits

Allows you to accurately assess and diagnose autism spectrum disorders across age, developmental level, and language skills

Ages

12 months through adulthood

Admin Time

40–60 minutes

Format

Standardized behavior observation and coding

Scores

Toddler Module provides ranges of concern reflecting the extent to which a child demonstrates behaviors associated with ASD. Modules 1 through 4 provide cutoff scores for autism and autism spectrum classifications. Modules 1 through 3 also provide a Comparison Score indicating level of autism spectrum-related symptoms compared to children with ASD who are the same age and have similar language skills.

Publish Date

2012

Qualifications

Level C required.
About Qualification Levels

Translation

Available in Czech, Danish, Dutch, Finnish, French, German, Italian, Norwegian, & Swedish

Published Translations
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Kits

ADOS-2 Hand-scored Kit

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Product #: W-605

ADOS-2 Hand-scored Kit

Includes ADOS-2 Manual; 50 Protocol Booklets (10 per Module); Test Materials (100+ stimulus items); all in a durable plastic container with handles and wheels. Please Note: ADOS-2 Kits shipped to Alaska, Hawaii, or internationally are subject to increased shipping rates. A customer service representative will confirm all charges with customers prior to processing orders including kits.

$1,995.00

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ADOS-2 Software Kit

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Product #: W-605S

ADOS-2 Software Kit

Includes ADOS-2 Manual; 50 Protocol Booklets (10 per Module); Test Materials (100+ stimulus items); plus Unlimited-Use Computer Scoring CD (W-605U); all in a durable plastic container with handles and wheels. Please Note: ADOS-2 Kits shipped to Alaska, Hawaii, or internationally are subject to increased shipping rates. A customer service representative will confirm all charges with customers prior to processing orders including kits.

$2,095.00

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Upgrade Kits

ADOS-2 Hand-scored Upgrade Package

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Product #: W-606

ADOS-2 Hand-scored Upgrade Package

Includes ADOS-2 Manual; 50 Protocol Booklets (10 for each Module); Additional Toddler Module Stimulus Items (15 items that when added to your existing ADOS Kit allow for Toddler Module administration)

$499.00

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ADOS-2 Software Upgrade Package

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Product #: W-606S

ADOS-2 Software Upgrade Package

Includes ADOS-2 Manual; 50 Protocol Booklets (10 for each Module); Additional Toddler Module Stimulus Items (15 items that when added to your existing ADOS Kit allow for Toddler Module administration); Unlimited-Use Scoring CD (W-605U)

$599.00

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Training Resources

ADOS-2 DVD Training Package

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Product #: W-605DVD

ADOS-2 DVD Training Package

Complete Training Resources on all five ADOS-2 Modules. For use in the U.S. and Canada. Includes Training Resources Progam DVDs; Training Resources Guidebook; and CD with printable PDFs of all Training Resources Protocol Booklets. (For CE credit, see W-605CE)

$999.00

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ADOS-2 DVD Training Package, PAL Format

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Product #: W-605DVDP

ADOS-2 DVD Training Package, PAL Format

Complete Training Resources on all five ADOS-2 Modules. For use outside the U.S. and Canada. Includes Training Resources Program DVDs; Training Resources Guidebook; and CD with printable PDFs of all Training Resources Protocol Booklets. (For CE credit, see W-605CE.)

$999.00

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ADOS-2 DVD Training Upgrade Package

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Product #: W-606DVD

ADOS-2 DVD Training Upgrade Package

For use with the ADOS-2 DVD Training Resources Package and the ADOS-2 DVD Training Resources Upgrade Package. Includes CD with printable PDFs of all Training Resources Protocol Booklets. ADOS-2 DVD Training Resources UPGRADE PACKAGE Training Resources on the ADOS-2 Toddler Module. For use in the U.S. and Canada. Includes Toddler Training Resources DVD; Training Resources Guidebook (for all Modules); and CD with printable PDFs of all Training Resources Protocol Booklets. (For CE credit, see W-606CE.)

$299.00

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ADOS-2 DVD Training Upgrade Package, PAL Format

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Product #: W-606DVDP

ADOS-2 DVD Training Upgrade Package, PAL Format

Training Resources on the ADOS-2 Toddler Module. For use outside the U.S. and Canada.Includes Toddler Training Resources Program DVD; Training Resources Guidebook (for all modules); and CD with printable PDfs of all Training Resources Protocol booklets. (For CE credit, see W-606CE.)

$299.00

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ADOS-2 Training DVD Guidebook

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Product #: W-605CV

ADOS-2 Training DVD Guidebook

For use with the ADOS-2 DVD Training Resources Package and the ADOS-2 DVD Training Resources Upgrade Package. Includes CD with printable PDFs of all Training Resources Protocol Booklets.

$99.00

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Forms

ADOS-2 Protocol Booklet Toddler Module (Pack of 10)

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Product #: W-605A

ADOS-2 Protocol Booklet Toddler Module (Pack of 10)

$51.00

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ADOS-2 Protocol Booklet Module 1 (Pack of 10)

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Product #: W-605B

ADOS-2 Protocol Booklet Module 1 (Pack of 10)

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ADOS-2 Protocol Booklet Module 2 (Pack of 10)

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Product #: W-605C

ADOS-2 Protocol Booklet Module 2 (Pack of 10)

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ADOS-2 Protocol Booklet Module 3 (Pack of 10)

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Product #: W-605D

ADOS-2 Protocol Booklet Module 3 (Pack of 10)

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ADOS-2 Protocol Booklet Module 4 (Pack of 10)

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Product #: W-605E

ADOS-2 Protocol Booklet Module 4 (Pack of 10)

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Manuals & Resources

ADOS-2 Manual

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Product #: W-605M

ADOS-2 Manual

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Software

ADOS-2 Unlimited-Use Scoring CD

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Product #: W-605U

ADOS-2 Unlimited-Use Scoring CD

Unlimited use. PC with Windows 8, 7, Vista, or XP. For use with all 5 Modules. Free U.S. Shipping.

$225.00

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Continuing Education

ADOS-2 Manual CE Questionnaire and Evaluation Form

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Product #: W-605MCE

ADOS-2 Manual CE Questionnaire and Evaluation Form

Includes Questionnaire and Evaluation Form. To receive 6 continuing education (CE) credits for mastering the ADOS-2 Manual (W-605M, sold separately), complete and return these materials.

$75.00

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ADOS-2 DVD Training Package CE Questionnaire and Evaluation Form

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Product #: W-605CE

ADOS-2 DVD Training Package CE Questionnaire and Evaluation Form

Includes Questionnaire and Evaluation Form. To receive 30 continuing education (CE) credits for mastering the ADOS-2 DVD Training Resources Package (W-605DVD, sold separately), complete and return these materials. This continuing education (CE) test covers the 5-Module DVD Training Resources.

$375.00

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ADOS-2 Toddler Training CE Questionnaire and Evaluation Form

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Product #: W-606CE

ADOS-2 Toddler Training CE Questionnaire and Evaluation Form

Includes Questionnaire and Evaluation Form. To receive 12 continuing education (CE) credits for mastering the ADOS-2 DVD Training Upgrade Package (W-606DVD, sold separately), complete and return these materials. Covers Toddler Training only. This continuing education (CE) test can also be used with the Toddler DVD/Guidebook included in ADOS-2 clinical workshop materials.

$150.00

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Autism Diagnostic Observation Schedule™, Second Edition (ADOS™-2) NEW

Autism Diagnostic Observation Schedule™, Second Edition (ADOS™-2)

 Safety Warning Choking Hazard CHOKING HAZARD - Small parts. Not for children under 3 years.

MODULES 1 THROUGH 4 BY CATHERINE LORD, PHD, MICHAEL RUTTER, MD, FRS, PAMELA C. DILAVORE, PHD, SUSAN RISI, PHD, KATHERINE GOTHAM, PHD, AND SOMER L. BISHOP, PHD

TODDLER MODULE BY CATHERINE LORD, PHD, RHIANNON J. LUYSTER, PHD, KATHERINE GOTHAM, PHD, AND WHITNEY GUTHRIE, MS

This revision improves an instrument already viewed as the “gold standard” for observational assessment of autism spectrum disorders (ASDs). With updated protocols, revised algorithms, a new Comparison Score, and a Toddler Module, the ADOS-2 provides a highly accurate picture of current symptoms, unaffected by language. It can be used to evaluate almost anyone suspected of having ASD—from 1-year-olds with no speech to adults who are verbally fluent. 

Like its predecessor, the ADOS-2 is a semistructured, standardized assessment of communication, social interaction, play, and restricted and repetitive behaviors. By observing and coding these behaviors, you can obtain information that informs diagnosis, intervention, treatment planning, and educational placement.

Five Modules

The ADOS-2 includes five modules, each requiring just 40 to 60 minutes to administer. The individual being evaluated is given only one module, selected on the basis of his or her expressive language level and chronological age. 

  • Toddler Module—for children between 12 and 30 months of age who do not consistently use phrase speech
  • Module 1—for children 31 months and older who do not consistently use phrase speech
  • Module 2—for children of any age who use phrase speech but are not verbally fluent
  • Module 3—for verbally fluent children and young adolescents
  • Module 4—for verbally fluent older adolescents and adults

Each module engages the examinee in a series of activities involving interactive stimulus materials (all included in the ADOS-2 Kit). To illustrate, activities in Module 3 are listed below:

Construction Task

Make-Believe Play

Joint Interactive Play

Demonstration Task

Description of a Picture

Telling a Story From a Book

Cartoons

Conversation and Reporting

Emotions

Social Difficulties and Annoyance

Break

Friends, Relationships, and Marriage

Loneliness

Creating a Story

Standardized Administration, Coding, and Scoring

Each ADOS-2 module has its own Protocol Booklet, which structures the administration and guides you through coding and scoring. As you administer activities, you observe the examinee and take notes. Immediately afterward, you code the behaviors observed. Then you use the algorithm form for scoring.

In Modules 1 through 4, algorithm scores are compared with cutoff scores to yield one of three classifications: autism, autism spectrum, or non-spectrum. The difference between autism and autism spectrum classifications is one of severity, with the former indicating more pronounced symptoms. In the Toddler Module, algorithms yield “ranges of concern” rather than classification scores.    

Improved Protocol Booklets, Revised Algorithms, and a New Comparison Score

Administration and coding procedures for the ADOS-2 are functionally identical to those for the ADOS. Modules 1 through 4 retain the same basic activities and codes, though some codes have been expanded and several new codes have been added. Protocol Booklets for these modules have been significantly improved—they now provide clearer, more explicit administration and coding instructions.

Algorithms for Modules 1 through 3 have been revised to achieve more accurate and useful results and to provide a more uniform basis for comparing results across the three modules used with children and young adolescents. 

A new Comparison Score for Modules 1 through 3 allows you to look at a child’s overall level of autism spectrum–related symptoms in relation to those of children diagnosed with ASD who are the same age and have similar language skills. This score also makes it easier to monitor an individual’s symptoms over time. 

The New Toddler Module

The Toddler Module is designed specifically for children between 12 and 30 months of age who do not consistently use phrase speech. Observations are coded immediately following administration, and the codes are converted to algorithm scores. Toddler Module algorithms provide “ranges of concern” rather than cutoff scores. These ranges help you form clinical impressions, but they avoid formal classification—which may not be appropriate at such a young age. The Toddler Module quantifies risk for ASD and provides guidance if continued monitoring is needed.

The Most Accurate Picture of Current ASD Symptoms

With improved algorithms, the ADOS-2 demonstrates strong predictive validity. It gives you a highly accurate picture of current ASD-related symptoms, based on real-time observations. Physicians, clinical psychologists, school psychologists, speech–language pathologists, and occupational therapists can use ADOS-2 results to inform diagnosis, intervention, educational placement, and treatment planning. Because it can be used with a wide range of children and adults, the ADOS-2 is an essential addition to any hospital, clinic, or school that serves individuals with developmental disorders.

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Case Examples

Chapters 3 and 7 of the ADOS-2 Manual present case examples for using Modules 1 through 4 and the Toddler Module. The case examples include a variety of completed ADOS-2 protocols/algorithms and examples of how to include ADOS-2 results in written reports. Cases range from a toddler exhibiting delays in physical development and social communication to an adult experiencing academic and social difficulties in college. Below is an excerpt from the case example for Module 2.

Module 2: “Harry”

Harry is a 6-year-old boy who received a diagnosis of ASD from a statewide early intervention project when he was 2 years old. Harry and his family were recruited to participate in a genetics study of ASD. As part of the study protocol, Harry’s family participated in a research evaluation to confirm Harry’s diagnosis of ASD. Harry’s parents completed a parent interview and a number of questionnaires. Harry was administered a cognitive test (Differential Ability Scales, Second Edition [DAS-2; Elliot, 2007]) and the ADOS-2.

On the DAS-2, Harry received a Verbal Cluster score of 70 and a Nonverbal Cluster score of 90, indicating Borderline verbal abilities and Average nonverbal abilities. He was observed to use primarily phrase speech. Although Harry often used sentences that included several words, such as “Where are you going, Daddy?” or “I don’t want to go to school,” he did not use complex sentences that included multiple clauses (e.g., “I don’t want to go to school tomorrow because I am too tired”). Module 2 was selected as the appropriate module on the basis of Harry’s expressive language level.

Harry’s mother was present for the administration of Module 2 while Harry’s father met separately with another clinician to complete the parent interview portion of the research evaluation. A description of Harry’s social and communicative behavior during the ADOS-2 is provided in the excerpt from his evaluation report, presented next.

Results

The Autism Diagnostic Observation Schedule, Second Edition (ADOS-2), Module 2 was administered to Harry for diagnostic purposes as part of a research protocol for a study of the genetics of autism. The ADOS-2 is a semi-structured, standardized assessment instrument that includes a number of play-based activities designed to obtain information in the areas of communication, reciprocal social interactions, and restricted and repetitive behaviors associated with a diagnosis of ASD. Module 2 of the ADOS-2 is designed for children with phrase speech whose speech is not yet “fluent” (that is, who are not yet consistently combining two relatively complex ideas together in sentences to talk about objects or events that are not present). Module 2 includes activities such as a construction task, interactive play with a family of dolls, a demonstration task, looking at a book and pictures, a pretend birthday party, bubbles, and a snack.

Harry was excited to transition into the more play-based tasks of the ADOS-2 from the cognitive tests that were administered first. He immediately began exploring the various toys that were set out for him. Harry’s language during the ADOS-2 consisted primarily of short phrases. He said things like, “It’s a cat,” as he was pointing to a picture of a cat on the music box, and “I like more,” and “I like two,” when he was requesting things. Harry sometimes echoed things that other people said, such as “Ooh, nice!” or “Alright.” At times, it was quite easy to understand what Harry was saying, but at other times his articulation made it difficult to understand him. He also occasionally mixed up his pronouns, such as saying, “You do it,” to mean that he wanted to do it. Harry had difficulty participating in conversational exchanges with the examiner. Although he was able to answer simple questions about familiar topics (e.g., How old are you? Do you have any pets?), he did not elaborate on his brief answers or ask questions of the examiner when provided opportunities to do so. This made it difficult to build a conversation with Harry.

Harry sometimes integrated his verbal communication with other modes of nonverbal communication, such as looking at the examiner, smiling, and saying, “Wow,” when he saw something he liked. At other times, he did not use eye contact when talking to people or interacting with them. Harry used a few gestures, such as pretending to brush his teeth when asked to teach this activity to the examiner and blowing a kiss to a baby doll when his mother prompted him to do so. He did not spontaneously use gestures at other times when communicating with the examiner or his mother. 

In terms of Harry’s social reciprocity during the ADOS-2, he was sometimes quite interested in interacting with the examiner or his mother. He made a variety of overtures to ask for things and occasionally to express interest or draw attention to something that he was enjoying. Harry had a tendency to be repetitive when initiating interactions with other people, however, such as by saying the same phrase in the same way (e.g., saying “You do it, mommy?” with an exaggerated sing-song intonation to ask for permission). Harry also exhibited a strong interest in University of Michigan football, and he insisted on bringing up things about the football team, even when it was clear that the examiner was trying to change the subject. 

While Harry was often responsive to the examiner’s attempts to talk to him or play with him, he showed less interest in social interaction when he was involved in repetitive play activities. At one point, Harry became very interested in putting small objects into a teapot, then dumping them out and starting over again. When the examiner tried to join Harry and put something into the teapot, he stomped and yelled, “No!” and took it out. On another occasion, Harry spent several minutes putting blocks into a box repetitively. He became quite distressed and frustrated when the examiner tried to interrupt him; he flapped his hands while protesting loudly. 

Harry exhibited some imaginative play during the ADOS-2. He enjoyed the “Birthday Party” and spontaneously pretended to feed cake to the baby doll. He also rocked the baby doll in a blanket and hugged her as he pretended to put her to bed. Harry had more difficulty playing creatively with the family of dolls. He became so engrossed in playing repetitively with the teapot and the small objects that the repetitive play may have prevented him from using the objects in a more imaginative way.

Summary and Recommendations

Harry’s Overall Total score on the ADOS-2 Module 2 algorithm for children aged 5 years or older was consistent with an ADOS-2 Classification of autism. His ADOS-2 Comparison Score further indicated that, on the ADOS-2, he displayed a high level of autism spectrum–related symptoms as compared with children who have ASD and are of the same chronological age and language level. For the genetics research project protocol, diagnostic classification of the participants was based on the results of the ADI-R, the ADOS-2, and the clinical impression of the principal investigator (a developmental pediatrician experienced in ASD assessment and diagnosis). Harry’s scores on the ADI-R met cutoffs for autism as well. The senior research clinician reviewed Harry’s charts (including the results of cognitive testing), read the results of the ADI-R, watched a video of the ADOS-2 Module 2 administration, and met with the clinicians who conducted the parent interview and child assessment. On the basis of all of the available information, the clinician gave Harry an overall diagnosis of autism and assigned him to the ASD (as opposed to the non-ASD) diagnostic group in the genetics research project. Behavioral observations from the ADOS-2 were used to identify specific intervention targets for Harry’s speech therapy program, such as responding to others’ comments to improve conversational skills. The ADOS-2 was also important in highlighting that Harry’s interests were quite restricted, leading to the goal of increasing his variety of play behaviors.

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