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Cognitive dissonance on ADOS

I was in an ADOS training this week. I can kind of get at the intended usefulness of this instrument. Its a screening and diagnostic measure that is widely used for Autism.

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.

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DSM v ADOS

Lexicon [Measures] DSM, ADOS

DSM-5-TR (latest version of DSM) and ADOS-2 (Autism Diagnostic Observation Schedule, Second Edition)  are two distinct tools used in assessment and dx of autism.

DSM-5-TR 

• Diagnostic manual that outlines the criteria for diagnosing ASD, including the presence of social communication deficits and RRB. 
• Serves as a reference for clinicians and researchers in making diagnostic decisions and ensures consistency in the diagnosis of ASD.

ADOS-2 

• Standardized observational assessment tool designed to aid in the diagnosis of ASD. 
• Administered by a trained professional and involves direct interaction with the individual  
• consists of a series of activities and social scenarios that allow the examiner to observe and evaluate the individual's communication skills, social interaction, play, and RRB. 
• It helps in determining whether an individual meets the diagnostic criteria for ASD and provides information to inform intervention and treatment planning.

ADOS-2 can be utilized as part of the diagnostic process, providing information to support the dx under DSM-5. Both tools are commonly used together to aid in the assessment and diagnosis of Autism Spectrum Disorder.

Related Posts: [DSM],[ADOS],[Measures]

ADOS - Autism Diagnostic Observation Schedule

Lexicon [Measures] - ADOS

The Autism Diagnostic Observation Schedule (ADOS) is a semi-structured assessment for diagnosing autism. It consists of various social and play-based activities designed to observe behaviors related to autism. [See posts on other Screening/Diagnostic Measures]

Limitations of ADOS as a dx tool

1. Not a Standalone Diagnostic Tool: It is intended to be part of a comprehensive evaluation, which should also include other assessments and detailed developmental history.
2. Snapshot in Time: ADOS provides a snapshot of an individual's behavior during the time of the assessment, which may not capture the full range of behavior or abilities.
3. Limited Scope: It primarily focuses on two areas: social interaction and communication, and restricted/repetitive behaviors. Other aspects of autism, such as sensory issues or co-occurring conditions, are not part of the primary scoring system.
4. Language and Age Constraints: While ADOS offers different modules for different developmental stages and language abilities, it may not be entirely suitable for all individuals, particularly those with complex profiles or co-occurring conditions.
5. Requires Specialized Training: to ensure accurate administration and interpretation of the results. This requirement can limit its accessibility and use.
6. Culture and Context: The ADOS was developed in English-speaking countries and may not fully account for cultural differences in behavior and communication. Translated versions are available, but they may not capture all nuances.
7. Reliability of Diagnosis over Time: Some studies have questioned the reliability of the ADOS over time, especially in younger children, where symptoms and behaviors can change significantly as the child grows and develops.