Journal of Autism and Developmental Disorders

, Volume 47, Issue 9, pp 2703–2709 | Cite as

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

  • Brenna B. MaddoxEmail author
  • Edward S. Brodkin
  • Monica E. Calkins
  • Kathleen Shea
  • Katherine Mullan
  • Jack Hostager
  • David S. Mandell
  • Judith S. Miller
Original Paper


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.


Autism spectrum disorder Autism Diagnostic Observation Schedule Adults Psychosis Community mental health 



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.


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

Compliance with Ethical Standards

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.


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Copyright information

© Springer Science+Business Media New York 2017

Authors and Affiliations

  • Brenna B. Maddox
    • 1
    • 2
    Email author
  • Edward S. Brodkin
    • 3
  • Monica E. Calkins
    • 4
  • Kathleen Shea
    • 1
    • 5
  • Katherine Mullan
    • 1
  • Jack Hostager
    • 1
  • David S. Mandell
    • 1
  • Judith S. Miller
    • 2
  1. 1.Center for Mental Health Policy and Services Research, Department of PsychiatryPerelman School of Medicine at the University of PennsylvaniaPhiladelphiaUSA
  2. 2.Center for Autism ResearchThe Children’s Hospital of PhiladelphiaPhiladelphiaUSA
  3. 3.Center for Neurobiology and Behavior, Department of PsychiatryPerelman School of Medicine at the University of PennsylvaniaPhiladelphiaUSA
  4. 4.Neuropsychiatry Section, Department of PsychiatryPerelman School of Medicine at the University of PennsylvaniaPhiladelphiaUSA
  5. 5.Collaborative on Community Inclusion of Individuals with Psychiatric Disabilities, Department of Rehabilitation SciencesTemple UniversityPhiladelphiaUSA

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