, Volume 19, Issue 2, pp 185-212

Austism diagnostic observation schedule: A standardized observation of communicative and social behavior

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Abstract

The Autism Diagnostic Observation Schedule (ADOS), a standardized protocol for observation of social and communicative behavior associated with autism, is described. The instrument consists of a series of structured and semistructured presses for interaction, accompanied by coding, of specific target behaviors associated with particular tasks and by general ratings of the quality of behaviors. Interrater reliability for five raters exceeded weighted kappas of .55 for each item and each pair of raters for matched samples of 15 to 40 autistic and nonautistic, mildly mentally handicapped children (M IQ=59) between the ages of 6 and 18 years. Test-retest reliability was adequate. Further analyses compared these groups to two additional samples of autistic and nonautistic subjects with normal intelligence (M IQ=95), matched for sex and chronological age. Analyses yielded clear diagnostic differences in general ratings of social behavior, specific aspects of communication, and restricted or stereotypic behaviors and interests. Clinical guidelines for the diagnosis of autism in the draft version of ICD-10 were operationalized in terms of abnormalities on specific ADOS items. An algorithm based on these items was shown to have high reliability and discriminant validity.

This research was funded in part by grants from the Social Sciences and Humanities Research Council of Canada, the Alberta Heritage Foundation for Medical Research, and the Medical Sciences Institute to the first author. Susan Goode was supported by a grant from the Bethlem-Maudsley Research Fund. Lynn Mawhood was supported by a postgraduate studentship funded by the John D. and Catherine T. MacArthur Foundation. We acknowledge the work of Joyce Magill, Deborah Dewey, and numerous members of the Department of Child and Adolescent Psychiatry at the Institute of Psychiatry, Division TEACCH, and Glenrose Rehabilitation Hospital for their help in the development of this scale.