Did you know that 1 in 36 children have autism spectrum disorder (ASD) in the US (CDC, 2024)? ASD is also reported in all ethnic, racial, and socioeconomic groups. But it’s nearly four times more common among boys than girls.
We know these things because of ADOS-2 (Autism Diagnostic Observation Schedule, Second Edition). This is the standard autism assessment tool used for all ages.
As an autism diagnostic tool, it consists of structured and semi-structured tasks. Professionals use these tasks to observe and assess children’s core autism-related behaviors. Repetitive patterns of behaviors, sensory sensitivities, and limited eye contact are a few signs.
Parents, educators, and early childhood specialists must have a basic understanding of the ADOS-2 guide. You’ll have a better appreciation of its importance as an early childhood autism evaluation tool. In turn, you can be a more active participant in your child’s management plan.
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- Interpreting ADOS-2 Scores: What Clinicians Need to Know
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- Best Online Special Education Endorsement Programs
- Most Affordable Online Master’s in Special Education Degree Programs
What Is ADOS-2?
Let’s first ask the all-important question, “What is ADOS-2? This is among the most widely used autism assessment tools for toddlers, teens, and adults. When used by trained professionals, ADOS-2 contributes to accurate early childhood autism diagnosis.
ADOS-2 provides trained professionals with the tools to observe a child’s:
- Social behaviors and interactions, such as making conversations and responding to social cues
- Communication skills in verbal and nonverbal ways
- Imagination, creativity, and play skills
As an autism observation tool, it decreases the risk of making diagnostic mistakes. The keywords here are “observation tool.”
Trained professionals also rely on their professional judgment based on other information. These include clinical observations and parent interviews that add context. There’s then less risk of overreliance on the ADOS-2 for an accurate diagnosis.
The Importance of ADOS-2 in Early Childhood Interventions
The crucial importance of ADOS-2 lies in its use in early autism intervention. Remember that autism spectrum disorder early diagnosis and intervention contribute to improved outcomes among children, including:
- Enhanced communication skills
- Improved social skills and personal relationships
- Gain adaptive skills like self-care and independent thinking
- Foster emotional regulation
- Promote academic success
However, diagnosing autism in young children is only the first step. Even more important is creating an individualized intervention plan. While there are common signs, there’s no one-size-fits-all template.
Every child’s intervention plan will have different types of therapies, among others. Your child, for example, may have more speech and language sessions. Physical therapy, Occupational therapy, and ABA therapy are also common.
Understanding the ADOS-2 Modules
The ADOS-2 modules have a flexible structure. Here, we’ll discuss the five autism assessment modules in the current ADOS-2. Every module is intended for specific age groups, developmental stages, and language abilities.
Every module shares similarities in the autism diagnosis process. The scoring and interpretation are the same across all modules. But, the tasks and observations are different based on the age group.
Toddler Module
This is the most appropriate module for early childhood autism diagnosis. Young children 12-30 months old with little to no verbal skills are its target audience. Play-based activities are used to observe early indicators of autism, such as repetitive behaviors.
Module 1 (Pre-verbal/Single Words)
This is intended for children 31 months and older who are pre-verbal or use single words. Assessment is based on activities like bubble play and peek-a-boo.
Module 2 (Phrase Speech)
The module is for children of any age with phrase-level language skills (e.g., go outside). Activity-based assessments are also used in skills determination. Activities include describing pictures and engaging in play.
Module 3 Fluent Speech (Younger Children)
This is for younger children with fluent speaking skills, usually 4-10 years old. Structured and semi-structured tasks are used in the diagnosis. Telling a story, creating imaginary scenarios, and maintaining conversations are common.
Module 4 Fluent Speech (Older Children and Adolescents)
The module is for older children, adolescents, and adults with more advanced language skills. Tasks include discussing daily event routines and discussing abstract concepts.
Step-by-Step ADOS-2 Assessment Process
The ADOS-2 assessment steps have a standard structure that ensures a comprehensive evaluation. There’s also the fact that many disorders, such as ADHD, mimic autism, so an accurate diagnosis is a must.
Here are the basic autism evaluation steps.
Step 1: Selecting the Module
The first – and most important – of the autism assessment steps is module selection. This will depend on the age and language skills of the child.
Step 2: Observing Social and Communication Skills
This step focuses on social and communication skills by observing the child’s:
- Social interactions
- Verbal and nonverbal communication (e.g., body language)
- Use of social skills, such as starting and maintaining conversations
Step 3: Engaging in Play-Based Activities
Trained professionals use play-based autism assessment techniques because of their usefulness. These provide valuable insights into imagination and creativity as well as play skills. In general, children with autism are less interested in playing with others.
Step 4: Scoring and Evaluation
Then, the final step is ADOS-2 scoring and evaluation. Here, standardized scores, qualitative observations, and professional judgment are applied.
The trained professional can suggest appropriate interventions upon an autism diagnosis.
Who Conducts the ADOS-2 Assessment?
Here are the best autism assessment professionals who use ADOS-2 in their work.
Psychologists
Often, the first ADOS-2 assessor that comes to mind is a licensed psychologist. Among their roles in autism evaluation are:
- Administering the tasks and activities
- Observing the child during these tasks and activities
- Making a diagnosis based on their observations
Speech-Language Pathologists
Among the roles that SLPs play in ADOS-2 assessments are:
- Evaluating the child’s communication skills during the tasks
- Observing the child in their social interactions and language use
- Identifying delays or deficits in their use of speech and language
Certified Autism Specialists
The roles of a certified autism specialist are limited to support roles. Unless they have a professional license, such as a psychologist, they cannot diagnose autism. Instead, their roles include:
- Collecting data and documents about a child being assessed
- Using screening tools under supervision
- Working with other professionals and families in the interest of clients
Other professionals that can be involved in ADOS-2 evaluation are developmental pediatricians and special educators. Every one of these professionals must be certified. Certification is crucial to ensure that the ADOS-2 is used according to quality standards.
How ADOS-2 Results Inform Developmental Therapies
The best ADOS-2 therapy planning results in effective individualized therapy because it:
- Identified the child’s unique needs, challenges, and strengths during the assessment
- Enabled professionals to create personalized therapy plans, including interventions based on these unique needs
- Involved the family, including the parents and siblings, particularly in home strategies
No, the ADOS-2 isn’t an autism intervention guide per se. But it’s a useful tool when choosing developmental therapies by:
- Identifying areas that need more focus, such as communication
- Determining the type and intensity of interventions
- Personalizing the intervention goals
- Using it as a baseline for tracking progress and making adjustments
In ABA therapy and ADOS-2, for example, a trained professional can determine the problematic behaviors that must be addressed first.
Case Study Example
Here’s a simple ADOS-2 case study.
Ethan, a five-year-old boy, was referred to a psychologist by his parents. He was observed to engage in repetitive behaviors and with language delays.
Then, the parents experienced ADOS-2 in practice when the psychologist performed these steps.
- The initial assessment where Ethan’s clinical and medical history was considered. His parents’ input was also considered.
- The ADOS-2 assessments where the psychologist used Module 2. Construction, conversation, and play tasks were used.
- The psychologist confirmed an autism diagnosis.
- The parents and psychologist engaged in therapy planning, including the identification of interventions.
This is only an autism diagnosis example. You’re likely to have unique experiences with the ADOS-2 process.
The Role of ADOS-2 in Long-Term Support for Children with Autism
Early ADOS-2 assessments are a critical aspect of long-term autism support because of these:
- Result in an accurate diagnosis, including a comprehensive evaluation report. Your child’s unique symptoms, challenges, and strengths are clearly identified.
- Contribute to the development of personalized intervention plans. Your child will likely experience positive improvements because their interventions address their unique needs.
- Boost the effectiveness of tracking autism progress, particularly as a baseline. Your child’s psychologist can use ADOS-2 for ongoing assessment and adjustments.
- Provide parents and caregivers with insights into effective strategies to support their child’s progress at home, school, and other environments.
Conclusion
Our ADOS-2 summary is as follows:
- It’s among the best autism diagnostic tools that enable professionals and parents to detect ASD in children and adults.
- It may be the best for early intervention for autism, but it’s also crucial for long-term support.
So, if you’re concerned about your child showing signs of autism, seek professional support and early intervention now. You want your child to have the best possible chance at a healthy and happy life.
