What to Expect During an Autism Diagnostic Observation Schedule-Second Edition (ADOS-2) Assessment

Charity Mills, MA, LIMHP, LPC

The Autism Diagnostic Observation Schedule-Second Edition assessment, or ADOS-2, is one of a handful of tools for diagnosing Autism Spectrum Disorder (ASD). In some states, this assessment alone is sufficient to qualify as a diagnosis. In other states, it is used in conjunction with other assessments to provide a diagnosis. The requirement can also vary by insurance plan. The ADOS-2 is designed for individuals as young as 12-18 months and can be used across the lifespan and into adulthood. 

What is the ADOS-2, and who conducts the assessment?

The ADOS-2 is a semi-structured, standardized assessment of communication, social interaction, play, and restricted and repetitive behaviors. During the assessment, the administrator will engage the participant through a variety of interactions based on play, storytelling, and interactive discussion. During these activities, the administrator measures and notes specific verbal and nonverbal responses. ADOS-2 assessments are often conducted by a psychologist, developmental-behavioral pediatrician, or neurologist. They are usually requested after meeting certain criteria on a screening assessment, such as an MCHAT, or after parents, the primary care physician, or a teacher have noticed significant delays. If you believe your child needs to be assessed for ASD, please click here to view MCHAT, a helpful tool for parents looking to receive help in receiving an autism diagnosis. 

How are ADOS-2 modules categorized?

To categorize the ADOS-2, there are four modules, plus a specialized toddler module that can be utilized to assess the participant. The module chosen to assess your child will vary based on their verbal ability, expressive language level, and chronological age. Each module requires a set amount of specified activities and tools to be used during the assessment, ensuring that the protocol will remain almost exactly the same no matter where your child is assessed. The four modules and toddler specific module are detailed below:

How is the ADOS-2 administered?

The time allotted for administering the test is 45-60 minutes. 

To start, the administrating clinician will meet with the parents to gather initial information about the child’s medical history, which may include details on:

• Hearing impairments
• Information on their birth
• Other pertinent medical or social information that could impact the assessment
• If a language translator is needed*
• Allergies**

*If you know your child will need a language interpreter, it is important that you let the assessor know in advance, as it typically takes some time to schedule this resource.

**Allergies should also be noted prior to testing, as a snack is provided during some of the modules as part of the assessment. 

If the child does not have what the administrator considers fluent speech, then a parent or caregiver must be present in the room during the test's administration. This would typically be up to the age of 5. A child with fluent speech typically does not require the parent to be present in the room, which allows the administrator to measure social responses more clearly. This determination can be made at the time of the test. 

If a parent will be present in the room during the assessment, the clinician will provide instructions on how they will interact with the child and when it is appropriate to be involved. Oftentimes, the clinician may also inform the parent what type of response they may be watching for from the child so the parent can understand why some of the interaction is happening as it is. For example, this could include times when the clinician moves away from the child and does not engage to see how the child will respond. 

Some of the engagements a parent would potentially see during an assessment would include:

• A birthday party or social setting enactment
• Storytelling, using a book or cartoon cards
• Free play time with a variety of toys
• Social interaction play time with the administrator

How is my child’s ADOS-2 scored? Will I receive the results immediately?

Directly following the end of your child’s assessment, the clinician will not be able to give you a definitive answer on the scoring outcome for your child’s assessment. The results need to be placed into an algorithm that provides a range of scores. The clinician should provide a time frame (typically 2 weeks) of when to expect a copy of the scoring report and clinical recommendations. It can be appropriate for a child to be tested or re-tested annually if symptoms change. 

What if my child receives an Autism diagnosis?

Your diagnosis will note the severity or level of ASD and also contain recommendations for which services your child may benefit from.  

According to the CDC, Autism impacts 1 out of 36 children in the U.S. We understand that this new diagnosis will signal a change in your family’s everyday routines. ABA is considered the only evidence-based best practice treatment by the US Surgeon General and by the American Psychological Association for children with autism.

Powerback Pediatrics is here to help your family navigate this transition with the help of ABA Therapy after you have received your diagnosis.  For more information on therapy services with Powerback Pediatrics, check out our website: https://www.powerbackpediatrics.com/