ADOS is coming... ADOS is coming | Autism PDD
On October 22, my ds Zachary (Z) is going for his dx eval. He is scheduled for the ADOS. We know darn well that he is on the spectrum, but we aren't quite sure where he lies. I am thinking mild autism. Anyway, can anyone fill me in on what to expect at his eval? We had a LOUSY initial screening, and I hope this one goes better. Thank you.
The Autism Diagnostic Observation Schedule -Generic (ADOS-G) is a semi-structured assessment of communication, social interaction and play or imaginative use of materials for individuals suspected of having autism or other pervasive developmental disorders (PDD). It is a combination of two earlier instruments: the Autism Diagnostic Observation Schedule (ADOS: Lord et al., 1989), a schedule intended for adults and children with language skills at a minimum of the three-year-old level, and the Pre-Linguistic Autism Diagnostic Observation Scale (PL-ADOS: DiLavore, Lord & Rutter, 1995), a schedule intended for children with limited or no language, as well as additional items developed for verbally fluent, high-functioning adolescents and adults. The ADOS-G consists of four modules, each of which is appropriate for children and adults of differing developmental and language levels, ranging from no expressive or receptive language to verbally fluent adults. These modules are described in separate sections following this introduction. They are labeled with numerals 1 to 4, with each activity numbered within its module.
The ADOS-G consists of standard activities that allow the examiner to observe the occurrence or non-occurrence of behaviors that have been identified as important to the diagnosis of autism and other pervasive developmental disorders across developmental levels and chronological ages. The examiner selects the module that is most appropriate for a particular child or adult on the basis of his/her expressive language level and chronological age. Structured activities and materials, and less structured interactions, provide standard contexts in which social, communicative and other behaviors relevant to pervasive developmental disorders are observed. Within each module, the participant's response to each activity is recorded. Overall ratings are made at the end of the schedule. These ratings can then be used to formulate a diagnosis through the use of a diagnostic algorithm for each module. In effect, the ADOS-G provides a 30 to 45 minute observation period during which the examiner presents the individual being assessed with numerous opportunities to exhibit behaviors of interest in the diagnosis of autism/PDD through standard 'presses' for communication and social interaction. 'Presses' consist of planned social occasions in which it has been determined in advance that a behavior of a particular type is likely to appear (Murray, 1938).
The modules provide social-communicative sequences that combine a series of unstructured and structured situations. Each situation provides a different combination of presses for particular social behaviors. Module 1, based on the PL-ADOS, is intended for individuals who do not consistently use phrase speech (defined as non-echoed. three-word utterances that sometimes involve a verb and that are the child's spontaneous, meaningful word combinations). Materials for Module 1 have been selected for young children, but materials from other modules may be substituted if desired. Module 2 is a combination of the ADOS and PL-ADOS and is intended for individuals with some phrase speech who are not verbally fluent. Module 3 is based on the ADOS and is intended for children for whom playing with toys is age- appropriate, (usually under 12 - 16 years of age) who are verbally fluent. Verbal fluency is broadly defined as having the expressive language of a typical four year-old child: producing 4. range of sentence types and grammatical forms, using language to provide information about events out of context and producing some logical connections within sentences ( e.g., "but" or "though"). There may be some continued grammatical errors. Module 4 includes the socioemotional questions of the ADOS as well as additional tasks and some interview items about daily living. It is intended for verbally fluent adolescents and adults. The difference between Modules 3 and 4 lies primarily in whether information about social-communication is more appropriately acquired during play or a conversational interview. The modules overlap in activities, but together contain a range of tasks from observing how a young child requests that the examiner continue blowing up a balloon in Module 1 to a conversation about social relationships at school or work in Module 4. Modules 1 and 2 will often be conducted while moving among different places around a room, reflecting the interests and activity levels of young children or children with very limited language; Modules 3 and 4 take place sitting at a table and involve more conversation and language without a physical context. Though the superficial appearance of the different modules is quite varied, the general principles involving the deliberate variation of the examiner's behavior using a hierarchy of structured and unstructured social behaviors are the same.
Because the focus of the ADOS-G is on observation of social behavior and communication, the goal of the activities is to provide interesting, standard contexts in which interactions occur. Standardization lies in the hierarchy of behavior employed by the examiner and the kinds of behaviors taken into account in each activity during the overall ratings. The activities serve to structure the interaction; they are not ends in themselves. The object is not to test specific cognitive abilities or other skills in the activities, but to have tasks that are sufficiently intriguing that the child or adult being assessed will want to participate. What the examiners do not do (such as deliberately waiting to see if the participant will initiate an interaction or try to maintain it) is often as important as what they do.
In general, each module should stand on its own in providing a range of tasks and social presses. However, an examiner may need to shift from one module to another if the language level of the individual is different than expected or, if for another reason, the tasks seem generally inappropriate. If in doubt, it is better to err in choosing a module that requires fewer language skills than an individual possesses than to risk confounding language difficulties with the social demands of the instrument. As is discussed later within the four modules, the order of tasks, pacing and materials can be varied, depending on the needs of the individual being assessed.
Many of the ratings made at the end of each schedule are similar across modules, with some identical items and some that are relevant only for a subset of modules. Separate algorithms for the different modules have been generated and are presented at the end of each section. Adequate inter-rater reliability for items has been established. However, this work has been carried out in small samples; thus, replication from independent samples will be very important.
In the following pages, the manual is organized around the four modules. Within each module, there is a general introduction, a description of tasks, a list of the materials needed and guidelines for overall ratings. Separate coding sheets contain the ratings and provide a recording form for notes made during each activity. These sheets include a summary of the purpose of each activity and the focus of observations targeted during each task. Notes should be taken during administration of each schedule. All modules, even if videotaped, should be rated immediately after they are administered. Earlier research with the PL-ADOS and ADOS showed that ratings of items made after live administration of the scales were equal or greater in reliability (and never less) than ratings from videotapes because the ratings involve social nuances of behavior that are not always observable or interpretable on a screen (such as distinguishing appropriate eye contact from looking over one's shoulder). Within a clinic or research group, examiners should obtain inter-rater reliability with each other before using the instruments for research. Our recommendation has been for 80 percent agreement on individual items and mean kappas greater than .60 (when sample sizes and distributions permit) for raters for three consecutive joint scorings.
The examiner needs to be sufficiently familiar with the ratings and the activities that she can focus her attention on observation of the individual being assessed, rather than on administration of the tasks. This requires practice in administering the activities, scoring, and observation. Notes need to be sufficiently detailed to be interpretable but not so lengthy that they interfere with administration.
The ADOS-G offers clinicians and researchers the opportunity to observe social behavior and communication in standardized, well-documented contexts. These contexts are defined in terms of the degree to which the examiner's behavior structures the individual participant's response and social initiative. For purposes of diagnosis, use of this instrument should be accompanied by information from other sources, particularly a detailed history from parents whenever possible (see Lord, Rutter & Le Couteur, 1994). Its goal is to provide standardized contexts in which to observe the social-communicative behaviors of individuals across the life span in order to aid in the diagnosis of autism and other pervasive developmental disorders. For this reason, it may not be a good measure of response to treatment or developmental gains especially in the later modules. On the other hand, some items have been deliberately included across several modules, even though they have diagnostic utility only in one (e.g., response to joint attention). It may be that developmental or treatment gains will be measurable using these items. An alternative strategy to measure absolute gains is to re-administer the same modules over time, as well as administering the developmentally appropriate module.
5 out of 8 communication a score of 2 or more indicates the possibilty of ASD
6 out of 14 social interaction a score of 4 or above indicates the possabilty of ASD
imagination 8 out 14 a score of 4 or more indicates a possibilty
aspergers will only be diagnosed if there has never been any speech delay
pdd/nos is given when not all of the diagnostic criteria is present but enough problems to cause impairments
if speech problems = HFA
I would definately make a list of behavours you are concerned about - it's easy to forget something. Also, if you think your child will not display these behavours in the meeting, maybe video tape them if you can.
Sam's first eval was also a comedy of errors, probably more tramatic for me than Sam. Despite clearly testing in the range of ASD the Ped. took abit of a dislike to me and told me that she has seen some parents just after the money
Our second eval was exactly what it should have been. Professional, respectful and as accurate a result as possible. The Dr. engaged Sam with bubbles, a remote control car, they moved about the room. I felt listened to and believed. He gave Sam the dx of PDD NOS which I think is accurate, especially when I see how far Sam has come in `1 1/2 yrs. I know some parents who feed their child a box of Smarties just before the eval. With all the sugar and preservatives, the child is likely to have a meltdown when the sugar crashes, giving the doc a better understanding of what the parents go through on the extreme end of the scale. Wishing you a professional and respectful evaluation. mama to Sam,8yrs PDD NOS OCD ODD PPD and Alex 2yrs. It does not matter how he behaves the ADOS looks at imagunation communication and interaction with lucas he was shown some pictures a cow eating a crab smiling and so on and he was asked how did he feel thety were EG happy sad they also asked about friends and why he thought his friends were his freinds it is a very good asessment and 98%right then they do a pretend break where they have a bag of toys and they see if he will initiate interaction either by asking for the toy or touching the interviewer. they also usually have a a radio with no batteries to see if the child will initiate communication by asking for them. it is all play based and no matter what his behaviour is like the triad will overshine it I would videotape as well. Make a list of all behaviors but also of all questions you have. Do this over a period of time because I know I seem to think of questions in the weirdest places (like the shower!). So, if you keep a list going - you will probably get all of the covered. Fred - I didn't mean to offend - it's just that 12 was much higher than what the doc thought he should be scoring. It is not high in general - you are correct. But the doc saw my ds as more in the ASD symptom range (7-10) as opposed to the autism range. Mostly because my ds was so verbal and communicative (not social with other kids, but very social with adults). The doc also made a big deal about ds' score because even with that score being in the autism range, the school was trying to deny him services! Thankfully, we are out of that school district and hopefully done with fighting for every little thing that ds needs! The modules provide social-communicative sequences that combine a series of unstructured and structured situations. Each situation provides a different combination of presses for particular social behaviors. Module 1, based on the PL-ADOS, is intended for individuals who do not consistently use phrase speech (defined as non-echoed. three-word utterances that sometimes involve a verb and that are the child's spontaneous, meaningful word combinations). Materials for Module 1 have been selected for young children, but materials from other modules may be substituted if desired. Module 2 is a combination of the ADOS and PL-ADOS and is intended for individuals with some phrase speech who are not verbally fluent. Module 3 is based on the ADOS and is intended for children for whom playing with toys is age- appropriate, (usually under 12 - 16 years of age) who are verbally fluent. Verbal fluency is broadly defined as having the expressive language of a typical four year-old child: producing 4. range of sentence types and grammatical forms, using language to provide information about events out of context and producing some logical connections within sentences ( e.g., "but" or "though"). There may be some continued grammatical errors. Module 4 includes the socioemotional questions of the ADOS as well as additional tasks and some interview items about daily living. It is intended for verbally fluent adolescents and adults. The difference between Modules 3 and 4 lies primarily in whether information about social-communication is more appropriately acquired during play or a conversational interview. The modules overlap in activities, but together contain a range of tasks from observing how a young child requests that the examiner continue blowing up a balloon in Module 1 to a conversation about social relationships at school or work in Module 4. Modules 1 and 2 will often be conducted while moving among different places around a room, reflecting the interests and activity levels of young children or children with very limited language; Modules 3 and 4 take place sitting at a table and involve more conversation and language without a physical context. Though the superficial appearance of the different modules is quite varied, the general principles involving the deliberate variation of the examiner's behavior using a hierarchy of structured and unstructured social behaviors are the same. Because the focus of the ADOS-G is on observation of social behavior and communication, the goal of the activities is to provide interesting, standard contexts in which interactions occur. Standardization lies in the hierarchy of behavior employed by the examiner and the kinds of behaviors taken into account in each activity during the overall ratings. The activities serve to structure the interaction; they are not ends in themselves. The object is not to test specific cognitive abilities or other skills in the activities, but to have tasks that are sufficiently intriguing that the child or adult being assessed will want to participate. What the examiners do not do (such as deliberately waiting to see if the participant will initiate an interaction or try to maintain it) is often as important as what they do. In general, each module should stand on its own in providing a range of tasks and social presses. However, an examiner may need to shift from one module to another if the language level of the individual is different than expected or, if for another reason, the tasks seem generally inappropriate. If in doubt, it is better to err in choosing a module that requires fewer language skills than an individual possesses than to risk confounding language difficulties with the social demands of the instrument. As is discussed later within the four modules, the order of tasks, pacing and materials can be varied, depending on the needs of the individual being assessed. Many of the ratings made at the end of each schedule are similar across modules, with some identical items and some that are relevant only for a subset of modules. Separate algorithms for the different modules have been generated and are presented at the end of each section. Adequate inter-rater reliability for items has been established. However, this work has been carried out in small samples; thus, replication from independent samples will be very important. In the following pages, the manual is organized around the four modules. Within each module, there is a general introduction, a description of tasks, a list of the materials needed and guidelines for overall ratings. Separate coding sheets contain the ratings and provide a recording form for notes made during each activity. These sheets include a summary of the purpose of each activity and the focus of observations targeted during each task. Notes should be taken during administration of each schedule. All modules, even if videotaped, should be rated immediately after they are administered. Earlier research with the PL-ADOS and ADOS showed that ratings of items made after live administration of the scales were equal or greater in reliability (and never less) than ratings from videotapes because the ratings involve social nuances of behavior that are not always observable or interpretable on a screen (such as distinguishing appropriate eye contact from looking over one's shoulder). Within a clinic or research group, examiners should obtain inter-rater reliability with each other before using the instruments for research. Our recommendation has been for 80 percent agreement on individual items and mean kappas greater than .60 (when sample sizes and distributions permit) for raters for three consecutive joint scorings. The examiner needs to be sufficiently familiar with the ratings and the activities that she can focus her attention on observation of the individual being assessed, rather than on administration of the tasks. This requires practice in administering the activities, scoring, and observation. Notes need to be sufficiently detailed to be interpretable but not so lengthy that they interfere with administration. The ADOS-G offers clinicians and researchers the opportunity to observe social behavior and communication in standardized, well-documented contexts. These contexts are defined in terms of the degree to which the examiner's behavior structures the individual participant's response and social initiative. For purposes of diagnosis, use of this instrument should be accompanied by information from other sources, particularly a detailed history from parents whenever possible (see Lord, Rutter & Le Couteur, 1994). Its goal is to provide standardized contexts in which to observe the social-communicative behaviors of individuals across the life span in order to aid in the diagnosis of autism and other pervasive developmental disorders. For this reason, it may not be a good measure of response to treatment or developmental gains especially in the later modules. On the other hand, some items have been deliberately included across several modules, even though they have diagnostic utility only in one (e.g., response to joint attention). It may be that developmental or treatment gains will be measurable using these items. An alternative strategy to measure absolute gains is to re-administer the same modules over time, as well as administering the developmentally appropriate module. They shouldn't just be going by the ADOS to give you a diagnosis - they may use other measures as well. My ds scored way high on the ADOS given at school and our dev ped said that clearly it was either done poorly or he was having a REALLY off day (it was originally done poorly by the way, by a person who was six months out of grad school and she had NO clue what she was doing). The second time it was given, he still scored higher than he should have (you can see why in my above post). I'd be interested in seeing what he scored now. I believe on the module my ds took the first time, the autism cutoff was 11 and my ds got a 12. The ASD cutoff was a 7, I believe. So he scored in the full autism range and our dev ped (after doing other evaluations since he didn't believe the school's) was still hesitant to give ds a diagnosis at all. He did, but even though the ADOS is considered a gold standard, it still is only as good as the person giving it (and observing) as well as it depends on how the child is doing that day. It is a good test, don't get me wrong - but it isn't always accurate. BTW, I'm not in denial here. The observer for the first ADOS took me aside and told me that my ds was going to score high on the ADOS - but that it wasn't an accurate reflection of him. She had worked with him several times previously and knew his abilities and areas he needed work on. But she had to go on HOW HE DID THAT DAY - not what she previously knew. Basically, this was code for the school psych didn't know what she was doing. I have seen the ADOS done (in grad school - I have my MSW) and she was not doing a lot of things accurately. Like she repeatedly asked my ds yes/no questions when she was supposed to be asking open-ended questions. So, he scored really high on not interacting much. He didn't like her either (neither did I for that matter) so he really didn't interact much with her. That being said, interaction was definitely one of his weak points at that time - but not to the extent they had to score him. They also asked him to do things he hadn't ever seen before. For instance, to mime how to brush your teeth at the sink. Well, us being over-protective had always done it for him and not at the sink. We hadn't ever had him spit out toothpaste either because we were still using non-fluoride toothpaste. And, he really had never observed us brushing our teeth either. So, he just wasn't able to do that task at all. The test was a good wake-up to the fact that I needed to stop being so protective and teach him to do a lot more stuff than he was doing. He's now really pretty independent about doing most self-care tasks - except combing his hair. We just can't get that one down yet! During ADOS for my son, the Dr played with him with several toys and carefully watched his reaction. For example he blew bauble and when my son was watching him, stopped blowing and watch if he requested for more bubbles or not...Or he put a (toy) cake, a candle, a match on the table and watched if he put the candle on the cake and ... ETA I looked at my son's ADOS report. He was 27 month when ADOS was done. Module one was done and it is written: "On the module 1, he obtained scores of 6 in communications, 14 in social inetractions giving a total of 20 where the autism cut-off is 12". We were told he had "mild to moderate autism closer to moderate". Does anybody have any idea how are the scores related with this "mild/moderate" lable? Daddy
with the ADOS, I would appreciate it. Specifically, I am concerned with my
son "shutting down" and not performing to his full ability level.My son is scheduled to have the ADOS next month, he is already dx'd , but our doctor wants to use it as a tool to see where his biggest deficits are. I am pretty anxious about it also, because I have been so encouraged lately by his progress, and I'd hate to get a big slap in the face if he does worse than we expect, but I can't think about my feelings here, it will help him in the long run! I am going to try and look at it as a benchmark for future progress. My son is 25 months so I imagine they will just do the first module with him.
Good luck!
My dd scored an 8 at age 5 and my youngest scored a 7 at age 2. It does sound right since she is more affected than he is IMO. I'm sure she would have had a higher score at his age based on things he is doing now that she wasn't at that age. Both kids have a PDD-NOS dx. My son's areas affected on the DSM-IV are more mild while dd has some areas on the DSM that are considered significantly impaired.
On my dd's ADOS there are only scores for social and communication. I have noticed some people have an imagination score, but I don't see that on our paperwork. I assume it is the module used? Not sure.
HTH
I agree. My dd would definitely have scored higher at age 2 now that I see what they are looking for.
More important than the ADOS score, I found it helpful to see how they rated each area on the DSM since it is more specific.
Wow. What a response. It is so nice reading what everyone
else has been through. I was scared about having the ADOS
done. The prelim eval was horrid. The MD (we were told she
was a resident by our ped, but I was firmly corrected by the eval
center lady that the person doing our eval was not a resident, just an
MD seeking further training - GREAT
)
was horrible. It really was a comedy of errors. The
person doing the ADOS is a full Ph. D in Psych and has been there for
years, so I feel a bit more confident.
Question: Should I write the guy who is doing the eval and
describe what behaviors we are seeing? They mailed us a
questionnaire to fill out, and I did, but it is very "clinical."
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