ADOS-2: AUTISM DIAGNOSTIC OBSERVATION SCHEDULE –
SECOND EDITION
1. Introduction
The ADOS-2 is a semi-structured, standardized assessment of
communication, social interaction, play, and restricted and repetitive
behaviors (RRBs). It is considered the gold standard observational tool for
diagnosing Autism Spectrum Disorder (ASD) across age, developmental,
and language levels.
• Purpose: To observe and rate behaviors directly related to the diagnostic
criteria for ASD.
• Type of tool: Observational, developmental, diagnostic.
• Developer: Dr. Catherine Lord and colleagues.
• Publisher: Western Psychological Services (WPS).
2. Historical Background
ADOS-1 (2000): First structured direct observational tool for ASD across
modules.
ADOS-2 (2012): Added Toddler Module, revised algorithms, aligned with
DSM-5, and introduced Calibrated Severity Scores (CSS).
Why ADOS-2?
- ADOS-1 was limited in early age groups and scoring interpretation.
- ADOS-2 added:
• Toddler Module (12–30 months)
• Updated algorithms for Modules 1–3
• Calibrated Severity Scores
• Enhanced clinical utility and diagnostic accuracy.
3. Structure of ADOS-2
Age and Language-Based Modular Design:
• Toddler Module: 12–30 months, no phrase speech
• Module 1: 31+ months, no phrase speech
• Module 2: Any age, phrase speech but not fluent
• Module 3: Children (typically 4–10), fluent speech
• Module 4: Adolescents and Adults, fluent speech
4. Activities by Module
• Toddler Module: Free play, response to name, peekaboo, bubbles,
imitation, snack
• Module 1: Free play, bubble play, doll play, snack, name call, imitation
• Module 2: Construction task, make-believe, picture description,
storytelling, conversation
• Module 3: Emotions, storytelling, social relationships, hypothetical
situations
• Module 4: Personal insights, abstract reasoning, friendship, social norms
5. Domains Assessed
1. Social Affect (SA): Eye contact, facial expressions, gestures, joint
attention, social overtures
2. Restricted and Repetitive Behaviors (RRB): Stereotyped speech/behavior,
sensory interests, routines
6. Scoring System
• Item Scores: 0 = Typical, 1 = Slightly abnormal, 2 = Clearly abnormal, 3 =
Markedly abnormal
• Algorithm Scores: SA + RRB = Total Score, compared to cutoffs
• Calibrated Severity Score (CSS): Scale 1 to 10, indicates ASD symptom
severity across modules
7. Interpretation
• Below Cutoff: Not consistent with ASD
• At/Above Cutoff: Consistent with Autism or Autism Spectrum
• Higher CSS = Greater symptom severity
Note: Results must be interpreted with other tools (e.g., ADI-R, CARS-2).
8. Merits
• Gold standard in research and clinical settings
• Modular structure for all age/language levels
• Standardized administration
• Observational and flexible
• Captures nonverbal communication
• Aligned with DSM-5
• Allows tracking over time
9. Demerits
• Time-consuming (40–60 mins)
• Requires trained professionals
• Costly materials/training
• Should not be used in isolation
• May have cultural bias
• May under-identify girls
• Language-heavy for higher modules
10. Clinical and Research Significance
• Used in diagnosis, intervention planning, special education, research
• Often combined with ADI-R, CARS-2, ISAA
• Helps determine eligibility for developmental disability services
11. Summary
• Tool: ADOS-2 (2012, WPS)
• Developer: Catherine Lord et al.
• Type: Observational Diagnostic
• Modules: Toddler, 1, 2, 3, 4
• Domains: Social Affect, RRB
• Use: Diagnosis, tracking, research
