The ADOS-2 is a semi-structured, standardised observational assessment, often used as part of wider formal autism assessments. Practitioners are trained to notice specific information that helps them code items in 5 different areas:
Language and Communication
Reciprocal Social Interaction
Imagination
Stereotyped Behaviours & Restricted Interests
Other Abnormal Behaviours*
*apologies, this is the wording used in ADOS-2 module booklets
If only it was this straightforward……..
The ADOS-2 is a very clever tool that provides a framework that we use to assess across the lifespan, all genders, in all parts of the world, but no two people are the same. This means that the evidence you gather for coding will differ from person to person. The descriptors are concrete and do not change, but the opposite is true for the individuals you assess. This is why the ADOS-2 uses words like “occasional”, “several” and “frequently”- terms that send us all crazy as we just want a number! It can’t give a number because of the infinite range of people we assess.
Furthermore……..
The ADOS-2 trains us to notice everything!
ADOS-2 practitioners have an incredible eye for detail! But this is not always helpful! We can get lost in details and over code.
We notice so much it can be hard to differentiate between what the ADOS descriptors are asking for and what they are not asking for.
AND……………
Although the descriptors specify what they want, it is not always easy to understand exactly what this is. For example, D2. “Rate unusual and/or repetitive movements or posturing of the hands and fingers, arms or boy.” Movements will vary across different people we assess, they will not all be the same. We will see movements that we might think are unusual, but they might not be the type coded in D2. Sometimes we all wish information was more prescriptive, e.g., what exactly counts as repetitive behaviour in D2? The descriptor tells us to include repetitive clapping, but not body rocking, unless it involves more than the torso. We don’t include finger tapping, nail biting, hair twisting or thumb sucking – but what do we include? Doubts like this can make coding stressful and call our judgments into question.
Which means……..
There is a constant stream of questions swirling around our heads.
As soon as we answer one, another instantly appears.
(This is where reliability workshops can help).
