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

The ADOS-2 is a widely recognised, standardised assessment used in the diagnosis of Autism Spectrum Disorder (ASD). It is considered one of the gold-standard tools in autism assessment and is typically carried out by a qualified professional, such as a psychologist, speech and language therapist, or developmental paediatrician.

The assessment involves a series of structured and semi-structured activities designed to observe how an individual communicates, interacts socially, plays, and responds to social cues. Depending on the person’s age and language ability, one of four modules is selected to ensure the assessment is tailored to their needs.

The Four Modules of the ADOS-2

Module 1 – Preverbal / Non-Phrase Speech

• Who it is for: Children aged 31 months and older who do not consistently use phrase speech (e.g., mainly use single words or sounds).

• Focus: Assesses early communication, social interaction, play skills, and restricted or repetitive behaviours.

• Activities: Play-based tasks such as free play, response to name, joint attention, and simple requests, allowing the assessor to observe how the child engages without relying heavily on spoken language.

Module 2 – Phrase Speech but Not Fully Fluent

• Who it is for: Children of any age who use short phrases or sentences but are not yet fully verbally fluent.

• Focus: Bridges early language development with more advanced social communication, looking at spoken language, gestures, and non-verbal communication.

• Activities: A mix of structured and play-based tasks, including pretend play, storytelling, answering questions, and demonstrating social reciprocity. This module allows observation of spontaneous language and emerging conversational skills.

Module 3 – Verbally Fluent Children and Young Adolescents

• Who it is for: Verbally fluent children and young adolescents who can engage in back-and-forth conversations.

• Focus: Examines more complex social communication, perspective-taking, flexible thinking, and restricted or repetitive behaviours.

• Activities: Less play-based and more conversational, tasks include discussing emotions, storytelling, problem-solving, and exploring how the individual interprets social situations and uses imagination.

Module 4 – Verbally Fluent Older Adolescents and Adults

• Who it is for: Verbally fluent older adolescents and adults.

• Focus: Assesses complex social communication, reciprocal conversations, relationships, and understanding of abstract concepts.

• Activities: Discussion-based tasks cover a wide range of topics, including relationships, emotions, work, friendships, and life experiences. The module also examines restricted interests, repetitive behaviours, and adaptability to change.

How the ADOS-2 is Scored

Throughout the assessment, the clinician carefully observes and records the individual’s communication, social responses, and behaviours. Using a standardised scoring system, they evaluate whether the observed patterns are consistent with autism.

The ADOS-2 is often used alongside other assessments, such as the Autism Diagnostic Interview-Revised (ADI-R), to provide a comprehensive evaluation of an individual’s strengths, needs, and potential support strategies.