ADOS-2 Test

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. There are five different modules (modules 1- 4 and a ‘toddler module’).  The module used to do the assessment depends on the person’s age, developmental stage and linguistic ability, with Module 4 being the one used to diagnose adults with fluent speech.  The test involves a series of puzzles and activities which are completed while being observed by a clinician.  I won’t go in to too much detail, as I would be worried that knowing too much about the test beforehand would compromise the results of prospective candidates.

In modules 1-4, the scores obtained from the test are compared with cut-off scores to produce one of three classifications. The ADOS-2 classifications are ‘Autism’, ‘Autism Spectrum’ and Non-Spectrum, with ‘Autism’ indicating ‘more advanced symptoms’.  These classifications appear to be internal ADOS-2 classifications, as they do not relate directly to the formal diagnostic categories found in either the DSM-IV, DSM-V or ICD-10.

The scoring depends upon which module is chosen. Here is a very useful link

The  ADOS-2 Module 4 test is divided into four sections – Communication, Social Interaction, Imagination and Stereotyped Behaviour and Restricted Interests. Each section was scored, although according to the text of my own report, the scores for ‘Imagination’ and ‘Stereotyped Behaviour and Restricted Interests’ are not used to determine the presence or absence of autism.

Here are the cut-off scores for Module 4

Communication Social Interaction Communication + Social Interaction
Autism 3 6 10
Autism Spectrum 2 4 7

In order to receive an ADOS-2 classification of ‘Autism’, all three of the scores must be equal to or greater then the cut-off score for ‘Autism’. In order to receive an ADOS-2  classification of ‘Autism Spectrum’, all three scores must be equal to or greater than the cut-off for ‘Autism Spectrum’, but not also equal to or greater than the cut-off for ‘Autism’.

I will use my own scores on this test as an example:

Communication – 2

Social Interaction – 7

Total (Communication + Social Interaction) – 11

Thus giving me an ADOS-2 classification of ‘Autism Spectrum’.  I’m sure that you have noticed a slight discrepancy here, two plus seven does not equal 11.  My first thought was that the clinicians had added it up wrong, but this is definitely not the case, as I have come across  similar discrepancies when viewing other people’s ADOS-2 results.

My current conclusion is that the total of 11 includes not just the scores from ‘Communication’ and ‘Social Interaction’, but also from ‘Imagination’ and ‘Stereotyped Behaviour and Restricted Interests’, despite the report stating that they are not used to determine the presence or absence of autism.  If this were the case, it would give me another 2 points, making 11.

I have been so far unable to confirm this.

I have written a further article commenting on the use of the ADOS-2 in my own diagnosis and how I believe that the test results were influenced by the circumstances under which it was conducted.