A Thorough Presentation of Autism Diagnostic Observation Schedule (ADOS-2)

ADOS-2 is considered the gold standard observational instrument for use in the diagnosis and/or classification of autism and ASD. In this chapter, the process of assessment will be described, which involves direct observation and engagement of children and adults for whom an ASD is suspected. Specifically, an emphasis will be put on ADOS structure, namely the five different modules for the assessment. Then, the advantages of ADOS-2 will be elaborated as a diagnostic tool and a brief review of studies concerning its psychometric properties will be reported.

The Brief Observation of Symptoms of Autism (BOSA): Development of a New Adapted Assessment Measure for Remote Telehealth Administration Through COVID-19 and Beyond

Interest in telehealth assessment for autism has increased due to COVID-19 and subsequent expansion of remote psychological services, though options that are easy for clinicians to adopt and available through the lifespan are limited. The Brief Observation of Symptoms of Autism (BOSA) provides a social context with standardized materials and activities that can be coded by clinicians trained in the Autism Diagnostic Observation Schedule. The current project examined psychometric properties to determine optimal use for each BOSA version. Three hundred and seven participants with 453 BOSAs were included to determine best performing items for algorithms, validity, sensitivity, specificity, recommended cut-offs, and proposed ranges of concern. While preliminary, the BOSA provides a promising new option for telehealth-administered assessment for autism.

The Brief Observation of Symptoms of Autism (BOSA): Development of a New Adapted Assessment Measure for Remote Telehealth Administration through COVID-19 and Beyond

Interest in telehealth assessment for autism has increased due to COVID-19 and subsequent expansion of remote psychological services, though options that are easy for clinicians to adopt and available through the lifespan are limited. The Brief Observation of Symptoms of Autism (BOSA) provides a social context with standardized materials and activities that can be coded by clinicians trained in the Autism Diagnostic Observation Schedule (ADOS). The current project examined psychometric properties to determine optimal use for each BOSA version. Three hundred and seven participants with 453 BOSAs were included to determine best performing items for algorithms, validity, sensitivity, specificity, recommended cut-offs, and proposed ranges of concern. While preliminary, the BOSA provides a promising new option for telehealth-administered assessment for autism.

Sex differences in social communication behaviors in toddlers with suspected autism spectrum disorder as assessed by the ADOS-2 toddler module

The Autism Diagnostic Observation Schedule, 2nd-edition (ADOS-2) Toddler Module is the current gold-standard measure of autism spectrum disorder (ASD), a neurodevelopmental condition more frequently diagnosed in toddler boys than girls. Some evidence suggests that behaviors assessed by the Toddler Module may capture an ASD phenotype that is more common among boys than girls. Focus on these behaviors may contribute to sex differences in ASD diagnoses. Particularly, the ADOS-2 may equivalently weight social communication behaviors on which boys and girls are expected to look similar and behaviors that which girls may, due to early socialization, perform differently than boys. As a consequence, the Toddler Module may fail to identify ASD in girls who should qualify for the diagnosis. The current study examined the possibility that some ADOS-2 items may function differently for boys and girls by testing the degree to which eight items equivalently related to a social communication latent factor across sexes in toddlers with suspected ASD. Inconsistent with hypotheses, tests of differential item functioning revealed no evidence of sex differences, suggesting that the Toddler Module assesses these eight items similarly for boys and girls. Examination of factor loadings point to Creativity/Imagination as an area of interest for future research. Lay Abstract When toddlers are suspected of autism spectrum disorder (ASD), the gold-standard assessment technique is with the Autism Diagnostic Observation Schedule, 2nd edition (ADOS-2) Toddler Module, a behavioral observation system. ASD is a neurodevelopmental condition more frequently diagnosed in toddler boys than in toddler girls. There is some evidence that the ADOS-2 assesses behaviors that are more characteristic of boys with ASD than girls. Thus, it is possible that focusing on these behaviors contributes at least in part to why more boys are diagnosed than girls. Specifically, girls may show more social skills than boys during the ADOS-2 assessment due to their socialization histories, which may lead to missed diagnoses of ASD in toddler girls. The current study examined eight social behaviors assessed by the ADOS-2 in a sample of toddlers with suspected ASD to see if they contributed differently to the total score of those items. Examination of those items suggested that those social communication behaviors work the same for boys and girls with suspected ASD, which was inconsistent with hypotheses. However, examination of particular items raises the possibility of examining creative/imaginative play as an area for future research.

Do autistic girls have better communication and interaction skills than autistic boys?

There is ongoing debate as to whether autism spectrum disorder (ASD) differentially affects males and females. Several meta-analyses have found little difference between males and females with ASD in terms of social communication and interaction skills. However, such analyses have often relied on diagnostic instruments such as the Autism Diagnostic Observation Schedule, Second Edition 2 that may not be sensitive to how autism presents in females. What’s more, many have been based on global scores, that reflect overall social communication and interaction skills, which could miss subtler differences in specific domains.

Affect and gaze responses during an Emotion-Evoking Task in infants at an increased likelihood for autism spectrum disorder

Background The majority of research examining emotional difficulties in autism spectrum disorder (ASD) prior to age 2 relies on parent report. Methods We examined behavioral responses (affect and gaze) during emotionally salient tasks designed to elicit mildly positive and negative emotional states in infants. At 12 and 18 months, infants at an increased likelihood for an ASD diagnosis (IL; have an older sibling with ASD; n = 60) and low likelihood (LL; no family history of ASD; n = 21) completed the Emotion-Evoking (EE) Task and parents completed the Infant Behavior Questionnaire-Revised (IBQ-R). All children received an Autism Diagnostic Observation Scale—second Edition assessment for ASD symptomatology at 24 months. Results The main findings were (1) the IL group displayed higher rates of negative affect and spent less time looking at the task objects compared to the LL group, and (2) affect and gaze scores at 12 and 18 months, but not scores on the IBQ-R, predicted ASD symptoms at 24 months. Limitations The data were drawn from an IL sample and may not be generalizable to the general ASD population, and the children were not followed to determine a diagnosis of ASD. Conclusion These results suggest that behavioral responses can provide important information that complements parent reports of emotional regulation in IL infants as early as 12 months of age.

Validation of Rapid Interactive Screening Test for Autism in Toddlers Using Autism Diagnostic Observation Schedule™ Second Edition in Children at High-Risk for Autism Spectrum Disorder

The Rapid Interactive screening Test for Autism in Toddlers (RITA-T) is a fast and inexpensive early screening measure for autism spectrum disorder (ASD) that was tested previously in children 18–36 months-old; the current validation study compared the RITA-T with the Autism Diagnostic Observation Schedule™ Second Edition (ADOS-2). The hypothesis is to validate the RITA-T with comparison to the ADOS-2. Thirty-five individuals (18–84 months-old) identified as at risk for ASD received the RITA-T and the ADOS-2 during a single visit. Participants were split into two age groups and both whole-group and sub-group data analysis were conducted. With all participants, RITA-T scores correlated significantly with ADOS-2 total scores (P < 0.001), social affect (SA) sub-scores (P < 0.001), and restrictive and repetitive behavior (RRB) sub-scores (P < 0.05). Similarly, ADOS-2 total and SA scores were significantly correlated in both age groups, while the RRB sub-score was only significant in females (P < 0.05). Lastly, correlations using subgroups based on ethnicity were only significant in the minority (“Other”) group for ADOS-2 total scores and in the Asian group for SA sub-scores (P < 0.05). Our receiver operating characteristic analysis showed that the optimal cut-off score of the RITA-T was consistently at 14, with a sensitivity of 81% and a specificity of 89% in the combined age group with the ADOS-2 and with a sensitivity 74% and specificity 50% with the DSM-5; The area under the curve was 0.84 (95%CI: 0.69–0.99) for ASD classified by ADOS-2 and 0.89 (95%CI: 0.79–0.99) for ASD diagnosed by DSM-5. The RITA-T performed similarly to the ADOS-2 when both were administered in a single visit. Significant correlations between the measures help validate the potential usefulness of the RITA-T as a rapid early screening measure of ASD. This study helps to show that the RITA-T may be used in a larger age range than originally reported and in different ethnic groups. The study involves human participants and was reviewed and approved by the Institutional Review Board (IRB) of Massachusetts General Hospital (MGH, 2017P0000857).

Utredning av autismespekterforstyrrelser i BUP – hvor godt samsvar er det mellom instrumenter og endelig klinisk diagnose?

Background: The Developmental, Dimensional and Diagnostic Interview (3Di) and the Autism Diagnostic Observation Schedule (ADOS-2) may be useful when assessing autism spectrum disorder (ASD), but the accuracy of the Norwegian 3Di is not known. Method: We investigated the classification accuracy of the 3Di and the ADOS-2 in identifying clinically diagnosed ASD in 130 participants (mean age 11 years). Results: We found acceptable accuracy in identifying ASD with both the 3Di and ADOS-2 (sensitivities/specificities > 70 %), and highest accuracy (positive likelihood ratio = 17.12) when combining the two instruments, but this gave lower sensitivity (54 %). Conclusions: The 3Di is useful when assessing ASD, and most accurate when combined with information from the ADOS-2. Clinicians should be aware that some children with ASD may be missed by requiring endorsement from both instruments. Keywords: Autism Diagnostic Observation Schedule, inter-rater reliability, sensitivity, specificity, Developmental, Dimensional and Diagnostic Interview

Symptoms of Autism Spectrum Disorder in Individuals with Down Syndrome

There is a growing body of evidence to suggest that individuals with Down syndrome (DS) are diagnosed with autism spectrum disorders (ASD) at a higher rate than individuals in the general population. Nonetheless, little is known regarding the unique presentation of ASD symptoms in DS. The current study aims to explore the prevalence and profiles of ASD symptoms in a sample of individuals with DS (n = 83), aged between 6 and 23 years. Analysis of this sample (MAge = 15.13) revealed that approximately 37% of the sample met the classification cut-off for ASD using the Autism Diagnostic Observation Schedule 2 (ADOS-2) Calibrated Severity Score (CSS), an indicator of the participants’ severity of ASD-related symptoms. Item-level analyses revealed that multiple items on Module 2 and Module 3 of the ADOS-2, mostly in the Social Affect (SA) subdomain, differentiated the children with DS who did not meet ASD classification (DS-only) from those who did (DS + ASD). Lastly, comparisons of individuals with DS-only and those with DS + ASD differed significantly on the syntactic complexity of their expressive language. These findings shed light on the unique presentation of ASD symptoms in a sample of individuals with DS and suggest that expressive language abilities may play a pivotal role in the presentation of ASD symptoms in DS.

Predictors in ASD: The Importance of Parents' Perception

Several predictors may influence children's developmental trajectories with Autism Spectrum Disorder (ASD), and parents' concerns may play an important role. This study aimed to investigate developmental trajectories of two groups of children with ASD to understand predictive factors, including parental perception. We examined the clinical features of a sample of 55 children with ASD at 3 and 6 years of age in two moments of evaluation to understand this process. We used the Autism Diagnostic Observation Schedule, (ADOS) in both moments. We selected two groups based on ADOS results at moment two: one group with a worse outcome (ADOS results above 8) and one group with a better outcome (ADOS results below 8 in the second moment). We also selected questions from a questionnaire (elaborated by the authors and used in clinical practice) applied to parents to understand if early parents' concerns may help to predict ASD prognosis. We found a significant association between imitation and playability and the child's prognostic. Also, Interactive Gestures, Beginning of Joint Attention, Reciprocity, and Pleasure in Interaction might help identify positive case evolution. Our findings are significant in early intervention program development, not only with direct intervention with the child but also including the parents' involvement in the intervention.