Skip to main content

Brief Report: The ADOS Calibrated Severity Score Best Measures Autism Diagnostic Symptom Severity in Pre-School Children


The severity of autism spectrum disorder (ASD) is often measured by co-occurring conditions, such as intellectual disability or language delay, rather than deficits in social interaction, and restricted interests and repetitive behaviors. The Autism Diagnostic Observation Schedule calibrated severity score (ADOS CSS) was created to facilitate comparison of the diagnostic features of ASD independent of related conditions over time. We examined the relationship between the ADOS CSS, ADOS total score, and clinician rated degree of impairment (DOI) in the Study to Explore Early Development. Like others, we confirmed that, among the measures we evaluated, the ADOS CSS was least influenced by developmental functioning and demographic factors and is therefore the best measure of core features of ASD in pre-school children.

This is a preview of subscription content, access via your institution.


  1. Achenbach, T. (1992). Child Behavior Checklist. Burlington: Achenbach System of Empirically based Assessment.

    Google Scholar 

  2. American Psychiatric Association (2013). Diagnostic and Statistical Manual of Mental Disorders (5th edn.). Arlington: American Psychiatric Publishing.

    Book  Google Scholar 

  3. Cohen, J. (1988). Statistical power analysis for the behavioral sciences (2nd edn.). Hillsdale: Lawrence Earlbaum Associates.

    Google Scholar 

  4. Flanagan, J.E., et al. (2012). Head lag in infants at risk for autism: A preliminary study. Journal of Occupational Therapy, 66, 577–585.

    Article  Google Scholar 

  5. Gotham, K., Pickles, A., & Lord, C. (2009). Standardizing ADOS scores for a measure of severity inautism spectrum disorders. Journal of Autism and Developmental Disorders, 39(5), 693–705.

    Article  PubMed  Google Scholar 

  6. Gotham, K., Pickles, A., & Lord, C. (2012). Trajectories of autism severity in children using standardized ADOS scores. Pediatrics, 130, e1278–e1284.

    Article  PubMed  PubMed Central  Google Scholar 

  7. Jang, J., Dixon, D. R., Tarbox, J., & Granpeesheh, D. (2011). Symptom severity and challenging behavior in children with ASD. Research in Autism Spectrum Disorders, 5(3), 1028–1032.

    Article  Google Scholar 

  8. Jang, J., & Matson, J. L. (2015). Autism severity as a predictor of comorbid conditions. Journal of Developmental and Physical Disabilities, 27, 405–415.

    Article  Google Scholar 

  9. Johnson, C. P., Myers, S. M., & The Council on Children with Disabilities (2007). Identification and evaluation of children with autism spectrum disorders. Pediatrics, 120, 1183–1215.

    Article  Google Scholar 

  10. Kanne, S. M., Gerber, A. J., Quirmbach, L. M., Sparrow, S. S., Cicchetti, D. V., & Saulnier, C. A. (2011). The role of adaptive behavior in autism spectrum disorders: Implications for functional outcome. Journal of Autism and Developmental Disorders, 41(8), 1007–1018.

    Article  PubMed  Google Scholar 

  11. Kozlowski, A. M., Matson, J. L., Horovitz, M., Worley, J. A., & Neal, D. (2011). Parents’ first concerns of their child’s development in toddlers with autism spectrum disorder. Developmental Neurorehabilitation, 14(2), 72–78.

    Article  PubMed  Google Scholar 

  12. Lee, L., David, A. B., Rusyniak, J., Landa, R., & Newschaffer, C. J. (2007). Performance of the Social Communication Questionnaire in children receiving preschool special education services. Research in Autism Spectrum Disorders, 1, 126–138.

    Article  Google Scholar 

  13. Levy, S. E., Giarelli, E., Lee, L. C., Schieve, L., Kirby, R., Cunniff, C., et al. (2010). Autism spectrum disorder and co-occurring developmental, psychiatric, and medical conditions among children in multiple populations of the United States. Journal of Developmental and Behavioral Pediatrics, 31(4), 267–275.

    Article  PubMed  Google Scholar 

  14. Lord, C., Rutter, M., DiLavore, P. C., & Risi, S. (1999). Autism Diagnostic Observation Schedule. Los Angeles: Western Psychological Services.

    Google Scholar 

  15. Lord, C., Rutter, M., & Le Couteur, A. L. (1994). Autism diagnostic interview-revised: A revised version of a diagnostic interview for caregivers of individuals with possible pervasive developmental disorders. Journal of Autism and Developmental Disorders, 24(5), 659–685.

    Article  PubMed  Google Scholar 

  16. MacDonald, M., Lord, C., & Ulrich, D. A. (2014). Motor skills and calibrated autism severity in young children with autism spectrum disorder. Adapted Physical Activity Quarterly, 31(2), 95–105.

    Article  PubMed  Google Scholar 

  17. Mullen, E. (1995). Mullen Scales of Early Learning. San Antonio: Pearson.

    Google Scholar 

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

    Google Scholar 

  19. Schendel, D., DiGuiseppi, C., Croen, L., Fallin, D., Reed, P., Schieve, L., et al. (2012). The Study to Explore Early Development (SEED): A multi-site epidemiologic study of autism by the Centers for Autism and Developmental Disabilities Research and Epidemiology (CADDRE) Network. Journal of Autism and Developmental Disorders, 42, 2121–2140.

    Article  PubMed  PubMed Central  Google Scholar 

  20. Schreck, K. A., Mulick, J. A., & Smith, A. F. (2004). Sleep problems as possible predictors of intensified symptoms of autism. Research in Developmental Disabilities, 25, 57–66.

    Article  PubMed  Google Scholar 

  21. Shumway, S., Farmer, C., Thurm, A., Joseph, L., Black, D., & Golden, C. (2012). The ADOS calibrated severity score: Relationship to phenotypic variables and stability over time. Autism Research, 5(4), 267–276.

    Article  PubMed  PubMed Central  Google Scholar 

  22. Sparrow, S., Balla, D., & Cicchetti, D. (2005). Vineland Adaptive Behavior Scales, (2nd edn). San Antonio: Pearson.

    Google Scholar 

  23. Wiggins, L. D., Bakeman, R., Adamson, L. B., & Robins, D. L. (2007). The utility of the Social Communication Questionnaire in screening for autism in children referred for early intervention. Focus on Autism and Other Developmental Disabilities, 22, 33–38.

    Article  Google Scholar 

  24. Wiggins, L. D., Reynolds, A., Rice, C., Moody, E. J., Bernal, P., Blaskey, L., Rosenberg, S. A., Lee, L.-C., & Levy, S. (2015). Using standardized diagnostic instruments to classify children with autism in the Study to Explore Early Development. Journal of Autism and Developmental Disorders, 45, 1271–1280.

    Article  PubMed  PubMed Central  Google Scholar 

Download references


This publication was supported by six cooperative agreements from the Centers for Disease Control and Prevention: Cooperative Agreement Number U10DD000180, Colorado Department of Public Health; Cooperative Agreement Number U10DD000181, Kaiser Foundation Research Institute (CA); Cooperative Agreement Number U10DD000182, University of Pennsylvania; Cooperative Agreement Number U10DD000183, Johns Hopkins University; Cooperative Agreement Number U10DD000184, University of North Carolina at Chapel Hill; and Cooperative Agreement Number U10DD000498, Michigan State University. The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the CDC or HRSA.

Author Contributions

Study concept (Lisa Wiggins), study design and methods (all authors), statistical analysis (Brian Barger), statistical review and interpretation (all authors), manuscript preparation and/or review (all authors).

Author information



Corresponding author

Correspondence to Lisa D. Wiggins.

Ethics declarations

Conflict of interest

The authors do not have any conflicts of interest to report.

Ethical Standard

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

Informed Consent

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

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Wiggins, L.D., Barger, B., Moody, E. et al. Brief Report: The ADOS Calibrated Severity Score Best Measures Autism Diagnostic Symptom Severity in Pre-School Children. J Autism Dev Disord 49, 2999–3006 (2019).

Download citation


  • Autism Diagnostic Observation Schedule
  • Autism spectrum disorder
  • Calibrated severity score
  • Symptom severity