By Dr Kristelle Hudry

During 2012, the ADOS-2 – a much anticipated revision to the Autism Diagnostic Observation Schedule – was formally published and became available for international use. The earlier version, the ADOS-G (Generic), published in the year 2000, was considered to be the gold-standard observational assessment for the diagnosis of Autism Spectrum Disorders.

However, with more than a decade passing since the ADOS-G first was published, and with much research conducted in the meantime, a number of important changes were clearly needed to update this tool. The ADOS-2 still provides a rigorous, evidence-based method of coming to an ASD diagnosis, evaluating an individual’s skills for social-communication skills, play/creativity, and restricted/repetitive behaviours and interests. Clinicians and researchers need specialist training before using this tool. Little has changed regarding the administration of the ADOS-2 Modules 1 to 4, compared to the ADOS-G.  However, the ADOS-2 does have two new features which users should be aware of:

First, the ADOS-2 uses a different combination of ‘algorithm items’ for the modules used with children and adolescents (i.e., Modules 1, 2 and 3). That is, the set of codes, which is combined to provide the diagnostic opinion, is slightly different from those used in the ADOS-G. The new algorithm sets have been shown to be a more reliable combination that those used in the ADOS-G, and so will provide a better indication of whether or not an individual is likely to have an ASD. No new training is required to ‘upgrade’ to the ADOS-2, so clinicians who have already been trained can move over to ADOS-2 relatively easily. Newly purchased protocol booklets include the new algorithm combinations as standard. Clinicians should just be sure to read descriptions for the new codes carefully (as there are some subtle changes), and should check that the right items are transferred into the correct algorithm columns. For clinicians who have stocks of old booklets to use up, we can provide a conversion sheet so that the new algorithm sets can be used with the old booklets.

Second, a particularly exciting feature of the ADOS-2 is the new Toddler Module. This is specifically designed for use with very young infants and toddlers – aged 12 to 30 months – who are non-verbal or use single words. Administration is fairly similar to Module 1, but coding requires specialist knowledge of typical infant development. As such, clinicians wishing to use the Toddler Module must first complete a standard ADOS-G or ADOS-2 course, to get confidence with the basic principles of this assessment, and then they can complete a Toddler Module upgrade course, which provides training on this highly-specialised addition. At OTARC and the Early Assessment Clinic (EAC) for Autism Spectrum Disorders our researchers and clinicians have been working to learn the ADOS-2 Toddler Module and to begin to use it within our research studies and clinical practice.

During 2013, we will begin to offer Toddler Module training to community clinicians. Expressions of interest from people, who have already been trained on the standard ADOS-G/2, are currently being taken. From 2013, we are also offering ongoing supervision/professional development sessions for clinicians and researchers who have been trained on the ADOS-G or ADOS-2. These are valuable sessions for maintaining skills for ADOS assessment and scoring.