Cognitive dissonance on ADOS

I was in an ADOS training this week. I can kind of get at the intended usefulness of this instrument.

But disappointed at a few things that caused a lot of cognitive dissonance for me.

Video of kid who repeated back 2-3 words of one question of the clinician before responding - behavior marked as “echolalia”. But NT folks do this all the time, eg: common tactic in interviews as it buys you time to think. In the NT world this is called "active listening" Yet given as a negative label of echolalia in an autistic child instead of useful social strategy.

"Severe autism has reduced in the last 40 years." Not accurate!! It's just that autism includes many other dx since DSM-V and expanded to accommodate all ages, resulting in a bigger pool, so obviously that %severe looks smaller.

The type of ADOS module used depends on the oral level of the child. Module 1 is the one used for non-verbal/ minimally verbal kids.  Seemed to imply that oral communication mandatory for ADOS, cannot be coded if child uses AAC.

Justification given is that use of AAC means

• "It changes nature of eye contact." 
• "Are they modulating eye contact in some way"
• "It changes the nature of what is happening." 
• They are not making eye contact when they are looking at device.
• They are not doing social engagement with you while looking at device
• There may be some pre-made phrases on device they are making use of

Seems like a fundamental problem if you run the module 1 on a child but say , oh by the way, you can’t communicate unless you can talk with your mouth. 

So my question was whether ADOS then is not applicable to the 20-30% of autistics who have no to little spoken language.

Apparently ‘gestures’ are allowed but how much can you communicate with gestures unless you are fluent with ASL. And it is likely that kids with oral communication issues usually also have motor apraxia so their gesturing ability will not good as well.

Less likely to use AAC. Changes nature of eye contact.  

Changes nature of what is happening.  

Are they modulating eye contact in some way.