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Autism Diagnostic Observation Schedule (ADOS)
Please visit this website for more information about the instrument: Autism Diagnostic Observation Schedule
Supplemental: Mitochondrial Disease (Mito)
Short Description of Instrument
The Autism Diagnostic Observation Schedule(TM) (ADOS-2) is a semi-structured observational instrument used to diagnose and assess autism and consists of a series of tasks which involve interaction between the researcher and participant.
The ADOS has 5 modules (Toddler, Module 1-few to no words, Module 2-phrase speech, Module 3-fluent speech and Module 4-fluent speech in adolescents or adults), one of which is selected for administration based upon the child's age and/or expressive language ability.
Scoring and Psychometric Properties
Scoring: The Administrator rates behaviors including communication, reciprocal social interaction, play or imagination/creativity, and stereotyped behaviors and restricted interests. Scores are then transformed using a standardized algorithm to yield a total score, with specific cutoffs for autism spectrum and autism designation, or below clinical cutoff, with associated levels of severity.
Psychometric Properties:  ADOS-2 sensitivity ranged from .89-.92, with specificity ranging from .81-.85 in meta-analysis of clinical and research settings. Test/retest reliability is good, and there are few practice effects.
Strengths: Gold standard diagnostic tool for autism spectrum disorders (ASD). Able to provide severity scores within each domain that may change over time.
Weaknesses: The assessment tool is long and needs to be administered by a licensed provider. In addition, it is strongly recommended that practitioners complete specialized ADOS-2 training before use of this instrument. Difficulty in distinguishing symptoms of ASD and intellectual disabilities in children and adults. May use revised algorithms to improve the sensitivity and specificity of the tool in individuals with intellectual disabilities.
Mitochondrial Disease-Specific:
Autism spectrum disorders have been reported in individuals with mitochondrial disorders. The ADOS-2 is one of two gold standard diagnostic tools for ASD and can also be used to assess severity of symptoms over time. There have been no studies to validate the assessment in individuals with mitochondrial disorders.
Key References:
Lord C, Rutter M, DiLavore P, Risi S, Gotham K, & Bishop S (2012). Autism diagnostic observation schedule-2nd edition (ADOS-2). Los Angeles, CA: Western Psychological Corporation, 284.
Lord C, Risi S, Lambrecht L, Cook EH, Leventhal BL, DiLavore P, Pickles A, Rutter M. The Autism Diagnostic Observation Schedule --Generic: A standard measure of social and communication deficits associated with the spectrum of autism. Journal of Autism and Developmental Disorders. 2000;30(3):205-23.
Additional References:
Gray KM, Tonge BJ, Sweeney DJ. Using the Autism Diagnostic Interview-Revised and the Autism Diagnostic Observation Schedule with young children with developmental delay: evaluating diagnostic validity. J Autism Dev Disord. 2008 Apr;38(4):657-67.
Lebersfeld JB, Swanson M, Clesi CD, O'Kelley SE. Systematic Review and Meta-Analysis of the Clinical Utility of the ADOS-2 and the ADI-R in Diagnosing Autism Spectrum Disorders in Children. J Autism Dev Disord. 2021 Nov;51(11):4101-4114.
Sappok T, Diefenbacher A, Budczies J, Schade C, Grubich C, Bergmann T, Boelte S, Dziobek I. Diagnosing autism in a clinical sample of adults with intellectual disabilities: how useful are the ADOS and the ADI-R? Res Dev Disabil. 2013 May;34(5):1642-55.
Document last updated March 2024