Skip to main content

Advertisement

Log in

The Accuracy of the ADOS-2 in Identifying Autism among Adults with Complex Psychiatric Conditions

  • Original Paper
  • Published:
Journal of Autism and Developmental Disorders Aims and scope Submit manuscript

Abstract

The Autism Diagnostic Observation Schedule, Second Edition (ADOS-2), Module 4 is considered a “gold-standard” instrument for diagnosing autism spectrum disorder (ASD) in adults. Although the ADOS-2 shows good sensitivity and specificity in lab-based settings, it is unknown whether these results hold in community clinics that serve a more psychiatrically impaired population. This study is the first to evaluate the diagnostic accuracy of the ADOS-2 among adults in community mental health centers (n = 75). The ADOS-2 accurately identified all adults with ASD; however, it also had a high rate of false positives among adults with psychosis (30%). Findings serve as a reminder that social communication difficulties measured by the ADOS-2 are not specific to ASD, particularly in clinically complex settings.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Similar content being viewed by others

References

  • American Psychiatric Association (2013). Diagnostic and statistical manual of mental disorders (5th edn.). Washington, DC: Author.

    Book  Google Scholar 

  • Bastiaansen, J. A., Meffert, H., Hein, S., Huizinga, P., Ketelaars, C., Pijnenborg, M., … de Bildt, A (2011). Diagnosing autism spectrum disorders in adults: The use of Autism Diagnostic Observation Schedule (ADOS) Module 4. Journal of Autism and Developmental Disorders, 41, 1256–1266. doi:10.1007/s10803-010-1157-x.

    Article  PubMed  Google Scholar 

  • Berument, S. K., Rutter, M., Lord, C., Pickles, A., & Bailey, A. (1999). Autism Screening Questionnaire: Diagnostic validity. British Journal of Psychiatry, 175, 444–451. doi:10.1192/bjp.175.5.444.

    Article  PubMed  Google Scholar 

  • Buck, T. R., Viskochil, J., Farley, M., Coon, H., McMahon, W. M., Morgan, J., & Bilder, D. A. (2014). Psychiatric comorbidity and medication use in adults with autism spectrum disorder. Journal of Autism and Developmental Disorders, 44, 3063–3071. doi:10.1007/s10803-014-2170-2.

    Article  PubMed  PubMed Central  Google Scholar 

  • Chisholm, K., Lin, A., Abu-Akel, A., & Wood, S. J. (2015). The association between autism and schizophrenia spectrum disorders: A review of eight alternate models of co-occurrence. Neuroscience and Biobehavioral Reviews, 55, 173–183. doi:10.1016/j.neubiorev.2015.04.012.

    Article  PubMed  Google Scholar 

  • Constantino, J. N., & Gruber, C. P. (2012). Social Responsiveness Scale, Second Edition (SRS-2). Torrance, CA: Western Psychological Services.

    Google Scholar 

  • Croen, L. A., Zerbo, O., Qian, Y., Massolo, M. L., Rich, S., Sidney, S., & Kripke, C. (2015). The health status of adults on the autism spectrum. Autism, 19, 814–823. doi:10.1177/1362361315577517.

    Article  PubMed  Google Scholar 

  • de Bildt, A., Sytema, S., Meffert, H., & Bastiaansen, J. A. (2016). The Autism Diagnostic Observation Schedule, Module 4: Application of the revised algorithms in an independent, well-defined, Dutch sample (n = 93). Journal of Autism and Developmental Disorders, 46, 21–30. doi:10.1007/s10803-015-2532-4.

    Article  PubMed  Google Scholar 

  • First, M. B., Spitzer, R. L., Gibbon, M., & Williams, J. B. (2002). Structured Clinical Interview for DSM-IV-TR Axis I Disorders, Research Version, Patient Edition. (SCID-I/P) New York: Biometrics Research, New York State Psychiatric Institute (November 2002).

    Google Scholar 

  • Garland, J., O’Rourke, L., & Robertson, D. (2013). Autism spectrum disorder in adults: Clinical features and the role of the psychiatrist. Advances in Psychiatric Treatment, 19, 378–391. doi:10.1192/apt.bp.112.010439.

    Article  Google Scholar 

  • Gerhardt, P. F., & Lainer, I. (2011). Addressing the needs of adolescents and adults with autism: A crisis on the horizon. Journal of Contemporary Psychotherapy, 41, 37–45. doi:10.1007/.s10879-010-9160-2.

    Article  Google Scholar 

  • Hus, V., & Lord, C. (2014). The Autism Diagnostic Observation Schedule, Module 4: Revised algorithm and standardized severity scores. Journal of Autism and Developmental Disorders, 44, 1996–2012. doi:10.1007/s10803-014-2080-3.

    Article  PubMed  PubMed Central  Google Scholar 

  • Kaufman, J., Bismaher, B., Brent, D. A., Rao, U., Flynn, C., Moreci, P., ... Ryan, N (1997). Schedule for Affective Disorders and Schizophrenia for School-Aged Children—Present and Lifetime Version (K-SADS-PL): Initial reliability and validity data. Journal of the American Academy of Child and Adolescent Psychiatry, 36, 980–988. doi:10.1097/00004583-199707000-00021.

    Article  PubMed  Google Scholar 

  • King, B. H., & Lord, C. (2011). Is schizophrenia on the autism spectrum? Brain Research, 1380, 34–41. doi:10.1016/j.brainres.2010.11.031.

    Article  PubMed  Google Scholar 

  • Lopez, M. A., & Basco, M. A. (2015). Effectiveness of cognitive behavioral therapy in public mental health: Comparison to treatment as usual for treatment-resistant depression. Administration and Policy in Mental Health and Mental Health Services Research, 42, 87–98. doi:10.1007/s10488-014-0546-4.

    Article  PubMed  PubMed Central  Google Scholar 

  • Lord, C., Risi, S., Lambrecht, L., Cook, E. H., Leventhal, B. L., DiLavore, P. C., ... Rutter, M (2000). The Autism Diagnostic Observation Schedule–Generic: A standard measure of social and communication deficits associated with the spectrum of autism. Journal of Autism and Developmental Disorders, 30, 205–223. doi:10.1023/A:1005592401947.

    Article  PubMed  Google Scholar 

  • Lord, C., Rutter, M., DiLavore, P. C., Risi, S., Gotham, K., & Bishop, S. L. (2012). Autism Diagnostic Observation Schedule (2nd edn.). Torrance, CA: Western Psychological Services.

    Google Scholar 

  • Lugnegård, T., Hallerbäck, M. U., & Gillberg, C. (2011). Psychiatric comorbidity in young adults with a clinical diagnosis of Asperger syndrome. Research in Developmental Disabilities, 32, 1910–1917. doi:10.1016/j.ridd.2011.03.025.

    Article  PubMed  Google Scholar 

  • Mandell, D. S., Lawer, L. J., Branch, K., Brodkin, E. S., Healey, K., Witalec, R., ... Gur, R (2012). Prevalence and correlates of autism in a state psychiatric hospital. Autism, 16, 557–567. doi:10.1177/1362361311412058.

    Article  PubMed  Google Scholar 

  • Pugliese, C. E., Kenworthy, L., Hus-Bal, V., Wallace, G. L., Yerys, B. E., Maddox, B. B., … Anthony, L. G. (2015). Replication and comparison of the newly proposed ADOS-2, module 4 algorithm in ASD without ID: A multi-site study. Journal of Autism and Developmental Disorders, 45, 3919–3931. doi:10.1007/s10803-015-2586-3.

    Article  PubMed  PubMed Central  Google Scholar 

  • Russell, G., Ford, T., Steer, C., & Golding, J. (2010). Identification of children with the same level of impairment as children on the autistic spectrum, and analysis of their service use. Journal of Child Psychology and Psychiatry, 51, 643–651. doi:10.1111/j.1469-7610.2010.02233.x.

    Article  PubMed  Google Scholar 

  • Rutter, M., Bailey, A., & Lord, C. (2003). The Social Communication Questionnaire. Los Angeles: Western Psychological Services.

    Google Scholar 

  • Wing, L., & Potter, D. (2002). The epidemiology of autistic spectrum disorders: Is the prevalence rising? Mental Retardation and Developmental Disabilities Research Reviews, 8, 151–161. doi:10.1002/mrdd.10029.

    Article  PubMed  Google Scholar 

Download references

Acknowledgement

The authors are grateful to the staff at Hall-Mercer Community Mental Health Center and Horizon House, Inc., without whom this study would not have been possible. Preliminary analyses were presented at the International Meeting for Autism Research.

Author Contributions

DM, JM, and BM conceived of the study and interpreted the data. KS and KM participated in the coordination of the study and data collection. BM, JM, EB, and MC participated in data collection. BM and JM performed the statistical analyses. BM, JM, and JH drafted the manuscript. All authors read and approved the final manuscript.

Funding

This work was funded by a grant from the National Institute of Mental Health (R34MH100356; PI: Mandell).

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Brenna B. Maddox.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical Approval

All procedures performed in this study were in accordance with the ethical standards of the institutional research committee and with the 1964 Helsinki declaration and its later amendments.

Informed Consent

Informed consent was obtained from all individual participants included in the study.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Maddox, B.B., Brodkin, E.S., Calkins, M.E. et al. The Accuracy of the ADOS-2 in Identifying Autism among Adults with Complex Psychiatric Conditions. J Autism Dev Disord 47, 2703–2709 (2017). https://doi.org/10.1007/s10803-017-3188-z

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10803-017-3188-z

Keywords

Navigation