Autism Diagnostic Observation Schedule – Second Edition (ADOS-2)

Overview
The Autism Diagnostic Observation Schedule – Second Edition (ADOS-2) is an updated, semi-structured, standardized
observational assessment tool designed to assess autism spectrum disorders in children, adolescents, and adults (Lord,
Rutter, DiLavore, Risi, Gotham, & Bishop, 2012). The ADOS-2 assesses communication, social interaction, play, and
restricted and repetitive behaviors.

The instrument consists of five modules selected based on age and level of expressive language. The ADOS-2 has updated
protocols, revised algorithms, and a Toddler Module for children between 12 and 30 months. Observations are recorded
and scored by the examiner. Modules 1 through 4 provide cutoff scores to aid in interpretation. The Toddler Module
provides “ranges of concern” rather than cutoff scores. Administration time is 40 to 60 minutes.

Summary
Name of Screening/ Age Range* Method of Administration/Format Approximate Subscales
Tool/Author Diagnosis Time to
Administer
Autism D 1 year to adult Clinician engages the 40–60 min. Modules 1–4 yield
Diagnostic examinee in a range of algorithm cutoff
Observation activities using interactive scores for autism and
Schedule – stimulus materials autism spectrum.
Second Toddler Module yields
Edition** “ranges of concern” to
(Lord, assist in forming
Rutter, clinical impressions.
DiLavore,
Risi,
Gotham, &
Bishop,
2012)**.

*In years except where noted. **Instrument requires special training to administer.
Availability: Western Psychological Services, http://bit.ly/1mpz859

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 Autism Diagnostic Observation Schedule – Second Edition (ADOS-2)

Research
Author (Year) Age Range Sample Size Topic Addressed Outcome
(in years)
Gray, Tonge, 1.5–4.5 209 Discriminative ADI-R and AU = 0.46
& Sweeney validity ADOS and AU = 0.73
(2008) ADSO and AU = 0.62
ADI-R and ADOS = 0.35 (Cohen’s kappa)
Gotham, Risi, 1.2–16 1,630 Diagnostic validity Use of new algorithms: Sensitivity:
Pickles, &
Lord (2007) AU vs. Non-Spectrum = 85-96

Non-AU AU vs. Non-Spectrum = 61-90;

Specificity:

AU vs. Non-Spectrum = 50-97

Non-AU AU vs. Non-Spectrum = 12-79

(lowest for Module 1 – no words)

New algorithms increase specificity 12-31%

in classifying Non-AU AU in lower-
functioning subjects

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 Autism Diagnostic Observation Schedule – Second Edition (ADOS-2)

Lord, Risi, Module 1: 1.25-10 54 Interrater and (Interclass correlations, weighted kappas)
Lambrecht, Module 2: 2-7 55 Test-retest Interrater:
Cook, Module 3: 3-20 59 reliability and Social = 0.93
Leventhal, et Module 4: 10-40 45 discriminative Communication = 0.84
al. (2000) (223-Total) validity Social Communication = 0.92
Restricted Repetitive – 0.82
Test-Retest Social = 0.78
Communication = 0.73
Social Communication = 0.82
Restricted Repetitive = 0.59

Discriminative Validity:
95% for AU
92% for Non-Spectrum
33% for PDD-NOS as having Non-AU AU
(53% of PDD-NOS fell in the AU range);

Specificity:
AU vs. PDD-NOS and Non-Spectrum = 68-
79, AU and PDD-NOS vs. Non Spectrum =
87-94, AU to Non-Spectrum = 93-100,
PDD-NOS to Non-Spectrum – 88+94;

Sensitivity:
AU vs. PDD-NOS and Non-Spectrum = 87-
100, AU and PDD-NOS vs. Non-Spectrum =
90-97, AU to Non-Spectrum = 93-100,
PDD-NOS to Non-Spectrum = 80-94

deBildt, 5–20 184 Criterion validity Sensitivity:

Sytema, and reliability PDD: ADOS-G = .874
Ketelaars, PDD: ADI-R = .716
Kraijer, AD: ADOS-G = .917
Molder, et al. AD: ADI-R = .771
(2004) Specificity:
PDD: ADOS-G = .472
PDD: ADI-R = .787
AD: ADOS-G = .647
AD: ADI-R = .632
Agreement (percentage):
Age 5-8 = 83.4 for AD, 81.0 for PDD
Age 8+ = 57.8 for AD, 58.5 for PDD Total =
63.6 for AD, 63.6 for PDD

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 Autism Diagnostic Observation Schedule – Second Edition (ADOS-2)

Overton, 1.67–16 26 ADOS algorithm +/-

Fielding, & scores compared
Garcia (2008) to new algorithm Revised algorithm resulted in better
scores accuracy for more severe group

LeCouter, 2–4 101 Concurrent validity Agreement with ADOS: AU Social

Haden, Interaction = 78%, AU Communication=
Hammal,& 74%; Above/below AU cutoff = 81%;
McConachie Above/below spectrum cutoff = 78%
(2008)

Risi, Lord, 1.5–14 1,297 Diagnostic Strict autism criteria used in combination
Gotham, sensitivity and with ADI- R: 80% or higher for U.S. sample,
Corsello, specificity 75% or higher for Canadian sample; lower
Chrysler, et for single use and use for other PDDs
al. (2006)

Mazefsky & 2–8 78 Discriminative 77% agreement with team diagnosis

Oswald validity
(2006)

References
deBildt, A., Sytema, S., Ketelaars, C., Kraijer, D., Mulder, E., Volkmar, F., & Minderaa, R. (2004). Interrelationship between
Autism Diagnostic Observation Schedule –Generic (ADOS-G), Autism Diagnostic Interview – Revised (ADI-R), and the
Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR) Classification in children and adolescents with
mental retardation. Journal of Autism and Developmental Disorders, 34(2), 129–137.

Gotham, K., Risi, S., Pickles, A., & Lord, C. (2007). The Autism Diagnostic Observation Schedule: Revised algorithms
for improved diagnostic validity. Journal of Autism and Developmental Disorders, 37(4), 613–627.

Gray, K. M., Tonge, B. J., & Sweeney, D. J. (2008). Using the Autism Diagnostic Interview-Revised and the Autism
Diagnostic Observation Schedule with young children with developmental delay: Evaluating diagnosis validity.
Journal of Autism and Developmental Disorders, 38(4), 657–667.

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 Autism Diagnostic Observation Schedule – Second Edition (ADOS-2)

LeCouteur, A., Haden, G., Hammal, D., & McConachie, H. (2008). Diagnosing autism spectrum disorders in pre-school
children using two standardized assessment instruments: the ADI-R and the ADOS. Journal of Autism and
Developmental Disorders, 38(2), 362–372.

Lord, C., Risi, S. Lambrecht, L., Cook, E. H., Leventhal, B. L., et al. (2000). 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, 30(3), 205–233.

Lord, C., Rutter, M., DiLavore, P. C., Risi, S., Gotham, K., & Bishop, S. (2012). Autism diagnostic observation schedule (2nd ed.).
Torrance, CA: Western Psychological Services.

Mazefsky, C. A., & Oswald, D.P. (2006). The discriminative ability and diagnostic utility of the ADOS-G, ADI-R, and GARS
for children in a clinical setting. Autism, 10(6), 533–549.

Overton, T., Fielding, C., & Garcia, D. (2008). Brief report: Exploratory analysis of the ADOS Revised Algorithm: Specificity and
predictive value with Hispanic children referred for autism spectrum disorders. Journal of Autism and Developmental
Disorders, 38(6), 1166–1169.

Risi, S., Lord, C., Gotham, K., Corsello, C., Chrysler, C., Szatmari, P. et al. (2006). Combining information from multiple
sources in the diagnosis of autism spectrum disorders. Journal of the American Academy of Child and Adolescent
Psychiatry, 45(9), 1094–1103.

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