ADOS - Autism Diagnostic Observation Schedule
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Authors
Catherine Lord, Michael Rutter, Pamela DiLavore, Susan Risi
Training Requirements
Level 3 (training tapes available)
Used for
Accurate assessment and diagnosis of autism and pervasive development disorder across ages, developmental levels and language skills.
Suitable for
Toddlers to adults.
Description
The ADOS is a semi-structured assessment that can be used to evaluate anyone suspected of having autism; from toddlers to adults; from children with no speech to adults who are verbally fluent. Cut-off scores are provided for the diagnosis of Pervasive Development Disorders, Autism Spectrum Disorders and atypical autism as well as the traditional narrower conceptualisation of autism.
The ADOS consists of four modules each requiring 35 to 40 minutes to administer. The individual being evaluated is given just one module depending on his or her expressive language level and chronological age. Module 1 is used with children who do not consistently use phrase speech. Module 2 is used with those who use phrase speech but are not verbally fluent. Module 3 is used with fluent children and Module 4 is used with fluent adults. The one group that ADOS does not address is non-verbal adolescents and adults.
Modules 1 and 2 require the test user and the child to move around the room. Modules 3 and 4, both of which involve more conversation, can be administered at a table. Activities included in each module are listed below:
MODULE ONE: for children who do not consistently use phrase speech.
Free Play
Response to name
Response to joint attention
Bubble play
Anticipation of a routine with objects
Responsive social smile
Functional and symbolic imitation
Birthday party
Snack
MODULE TWO: for those who use phrase speech but who are not verbally fluent.
Construction task
Make-believe play
Joint interactive play
Conversation
Response to joint attention
Demonstration task
Description of picture
Looking at a book
Free play
Response to name
Birthday party
Snack
Anticipation of a routine with objects
Bubble play
MODULE THREE: for verbally fluent children
Construction task
Make-believe play
Joint interactive play
Demonstration task
Description of a picture
Telling a story from a book
Cartoons
Reporting a non-routine event/conversation
Emotions
Social difficulties/annoyance
Break
Friends/loneliness/marriage
Creating a story
MODULE FOUR: for fluent adults
Construction task
Telling a story from a book
Description of a picture
Demonstration task
Cartoons
Creating a story
Conversation
Current work/school
Social difficulties/annoyance
Break
Emotions
Daily living
Friends/marriage
Loneliness
Plans and dreams
Each module presents numerous opportunities for the individual being assessed to exhibit behaviours of interest in the diagnosis of ASDs through standard ‘presses’ for communication and social interaction.
Notes are taken during the administration of the module. Overall ratings are completed immediately after administration, even if the session is taped. These ratings can then be used to formulate a diagnosis through the use of a diagnostic algorithm which is provided for each module.
Reliability
| Inter-rater reliabilities at item level | |||
|
Module |
Mean % Exact Agreement for all items | Range of % Exact Agreement | Kappa (Cohen's kappa is generally thought to be a more robust measure than simple percent agreement calculation since κ takes into account the agreement occurring by chance.) |
| 1 |
91.5 |
80 - 100 |
All but two items showed inter-rater reliabilities of 0.60 or greater. Two items had reliabilities of 0.55 and 0.57 |
| 2 |
89 |
78 - 98 |
15 of 26 Kappas exceeded .60, 7 more exceeded .50, the other 4 ranged from .38 to .49 |
| 3 |
88.2 |
77 - 100 |
17 items showed kappas of 0.60 or better. The rest ranged from .46 to .54 |
| 4 |
88.5 |
80 - 100 |
Kappas exceeded 0.6 for 22 items with the remainder at .50 or higher except two items which were .41 and .48 |
• Intraclass correlations were computed across pairs of raters for each module separately. The range of reliabilities was:
- Social Interaction .88 to .97
- Communication .74 to.90
- Communication-Social Interaction total .84 to.98
- Stereotyped Behaviours and Restricted Interests .75 to .90
• Intraclass correlations were computed across pairs of raters for the four modules combined. The range of reliabilities was .82 to .93
• Interrater agreement in diagnostic classification for autism vs. non-spectrum comparisons was 100% for modules 1 and 3, 91% for module 2 and 90% for module 4.
• Test-retest reliabilities (N=27) with an average interval of 9 months and administration by two different assessors were:
- Social Interaction .78
- Communication .73
- Communication-Social Interaction total .82
- Stereotyped Behaviours and Restricted Interests .59
Validity
• Correlation matrices are available for all items for each module for each diagnostic group separately and together.
• Exploratory factor analyses were run for each module with one major factor emerging in each.
• Fixed effect analyses of variance (ANOVASs) were performed comparing verbally equivalent samples of autism and non-spectrum participants. Items that did not yield significant differences were excluded except in cases where such items might affect an observation of a particular group. Further ANOVAs were conducted to compare the three matched groups on the retained items.
• Lists of items that match diagnostic criteria in DSM-IV and ICD-10 were generated.
• Item-Total correlations have been calculated:
- between individual items,
- between domain scores,
- between each item and the domain score to which it contributes,
- between each item and chronological age, verbal mental age or Verbal IQ.
• Internal consistencies, assessed using Cronbach’s alpha show the following ranges:
- Social Interaction .86 to .91 (for all modules)
- Communication .74 to .84 (for all modules)
- Stereotyped Behaviours and Restricted Interests .47 to .56 (modules 3 and 4), .63 to.65 (modules 1 and 2)
- Stereotyped Behaviours and Restricted Interests .91 to .94 (for all modules).
• ROC have been to provide information about where to set cut-offs.
Duration
35 to 40 minutes
Available to buy
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