ADOS-2 Test: Comments on My ASD Assessment

My diagnosis consisted of a clinical interview of approximately 1 hour, ADOS-2 Module 4 assessment and interviews with my partner and mother. In this article, I will discuss the circumstances under which the ADOS-2 was conducted and the implications for my diagnosis.

The ADOS 2 is an assessment of social interaction, communication, imagination/repetitive interests which is used to assess people who are suspected of having an ASD.   Click here for further information about the ADOS-2 test.

Here follows a short conversation between me and my partner shortly after my diagnosis:

Me – I’ve got some comments on the way the test was conducted and the implications for the results

Neurotypical Partner – You didn’t say that to them did you?

Me – No

Neurotypical Partner (laughs) – That would have been another five points, ker-chhing!!

Me (laughs) – F*** off!

General Comments on the my ADOS-2 Assessment

I took the ADOS-2 test after a very intense clinical interview lasting about an hour. I was so nervous/tired that I could hardly think.  As I had been agonizing over the possibility that I was autistic/whether to get formally diagnosed for over a year, this assessment was incredibly important to me.  It was the culmination of countless hours of analysis, study and emotional upheaval.  I had finally plucked up the courage to go to my GP, tell my partner and close family and I felt like I had been fighting a series of exhausting battles and the end was just about in sight.

The assessment was consequently so important to me that by the time I reached the ADOS-2 test, I was a total mess. My brain had seized up, partly due to the full on emotional intenseness of the clinical interview and partly due to the overwhelming importance of my possible autism diagnosis.  I genuinely couldn’t think straight.  I remember looking at an unlabelled map of the USA and not even realizing what it was for ages, because I just couldn’t think properly.  Had the test had been conducted before the interview and not after, then the results would have been very different.  My conversational skills would have been excellent, with reasonable eye contact and probably more polite chit-chat.

It could also be argued that it made sense to conduct the test when my defenses were down, as the results more accurately reflected my true self. It is therefore possible that the ADOS-2 was conducted after the clinical interview deliberately.

My clinical interview was conducted by two clinicians. I much preferred Clinician A to Clinician B, but it was Clinician B who conducted the ADOS-2 test.  If it had been Clinician A that conducted the ADOS-2 assessment, I would have been naturally more interested in interacting with her and more interested in her conversation, consequently I would have been observed to be making more reciprocal conversation/small talk and probably more eye contact.

Comments on how the ADOS-2 was used in my Diagnostic Report

The session was videotaped and afterwards was scored by the two clinicians according to ADOS-2 protocol.

Re-reading my diagnosis report has reminded me that a lot of the statements given within it seem to have arisen because my behaviour has been misinterpreted.  As I believe that it was more or less obvious from my earlier clinical interview that I did have some form of autism, it is possible that this knowledge influenced the clinicians’ interpretation of my the test results to some degree.  It has occurred to me that there may possibly be an element of ‘seek and ye shall find’.  Here are various quotes from my diagnostic report and my comments upon them and how they were arrived at from the ADOS-2 assessment.

1)         “Cat did not use conventional gestures”

Just because I chose not to use gestures in this particular situation doesn’t mean that I am incapable of doing so. I use gesture when I am relaxed, but I consider it to be inappropriate in formal situations.  If you were to see me in the pub chatting to my friend, you would see me use plenty of gestures.

Although, perhaps you could argue that the fact that I have ‘tailor-made’ my mannerisms to fit the situation rather than acting ‘naturally’ is an indication that I do in fact have an ASD.

2)         “Cat adopted a puzzled/worried countenance”

As I was being asked to participate in a series of seemingly random and bizarre tasks, I hardly see that I could have been anything other than “puzzled”. This assessment was probably one of the most important and scary things I’ve ever done, so how could I possibly not be “worried”?

3)         Cat talked about her feelings for her partner and friend “but did not spontaneously comment about how THEY might feel”.

That’s mainly because you didn’t ask me. The assessment was so important to me that the last thing I wanted to do was to start waffling on.

4) “Cat expressed frustration about how others do not appear to want to spend time with her, assuming that this is because she is ‘pathetic’ or that something is ‘bad’ about her”

Although it has often appeared to me that others dislike me and it feels like they have negative opinions about me, that doesn’t mean that I share these negative opinions about myself. On the contrary, I’m quite fond of myself in many ways.  I don’t actually think that I am “pathetic” or that something is “bad” about me.  It can feel like I must be a ‘bad’ person when I am rejected by others, but I don’t actually believe this to be the case.  When I used these words, I was describing my feelings, not my beliefs.

5)         The most notorious part of the test consists of a child’s picture book depicting flying frogs on lily pads.  You are asked to describe the story in your own words.

“she struggled to infer the intentions of some of the characters”

I didn’t ‘struggle to infer’ their intentions I just didn’t care about their intentions. In fact, I didn’t care about the stupid frog book at all. I tried to force myself to do my best, but the whole thing made me feel so self-conscious that I just wanted the ground to swallow me up.  I was a 49 year old intelligent human being and being forced to tell stupid stories about flying frogs is my idea of torment.

6)         “Cat did not appear to find any humour in the story or the saying ‘pigs might fly’”

That’s because it wasn’t funny, in the same way that ebola, terrorism or child abuse isn’t funny. It’s just not funny.

7)         “Cat appeared to find it difficult to know how much information to give in response to a question or request to provide information about a book or picture”

Yes, of course I found it difficult. If you had told me roughly how long the assessment was going to last for and the number of tasks involved, I would have been able to calculate the approximate time to spend on each task, but you didn’t – I’m not psychic.

“Cat has some difficulties with non-literal language, such as metaphor”.

No, I don’t. I have absolutely no difficulty with non-literal language whatsoever.  I am fascinated by language, extremely verbal, highly literate, fluent in sarcasm, understand subtle humour and have a love of idiom and metaphor.

“Cat misinterpreted the saying, ‘a rolling stone gathers no moss’”

The misunderstanding arose because the clinician asked me if I understood idiom. I replied “yes” and proceeded to launch into full auto-babble (you could say that language is a ‘special interest’ of mine).  I mentioned that for years, I believed that the saying “a rolling stone gathers no moss” meant that if you keep moving/keep trying new things/kept young, free and single etc. , you would avoid stagnation and being bogged down by excess baggage, which is the meaning that I had inferred because of the name of the band ‘The Rolling Stones’.

I then recalled that someone had once told me that it means the opposite, i.e. that if you don’t settle down, you will never achieve the trappings of respectability eg house, spouse, children, job, car etc. – I find this fascinating.

My musings were interpreted as me having ‘difficulties’ with ‘metaphor’.

I decided to check the meaning once and for all, when I wrote this article and apparently, it can mean either.

I have no doubt whatsoever that I am autistic, but it didn’t seem that the ADOS-2 was a particularly good way of assessing it.  In my case, the behaviour observed during the test was influenced by external factors, if any of these had been different, the results probably would have been different too.  It makes me wonder if the ADOS-2 would still have diagnosed me with an ASD if I had been my usual lively, outspoken and ‘confident’ self.

In a way, it seems that I was diagnosed not because of the ADOS-2 test, but in spite of it.