The Accuracy of the ADOS-2 in Identifying Autism among Adults with Complex Psychiatric Conditions
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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.
KeywordsAutism 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.
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.
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 was obtained from all individual participants included in the study.
- 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.CrossRefPubMedGoogle 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.CrossRefPubMedPubMedCentralGoogle Scholar
- Constantino, J. N., & Gruber, C. P. (2012). Social Responsiveness Scale, Second Edition (SRS-2). Torrance, CA: Western Psychological Services.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.CrossRefPubMedGoogle 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
- 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.CrossRefPubMedGoogle 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.CrossRefPubMedPubMedCentralGoogle 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.CrossRefPubMedGoogle 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
- 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.CrossRefPubMedPubMedCentralGoogle 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.CrossRefPubMedGoogle Scholar
- Rutter, M., Bailey, A., & Lord, C. (2003). The Social Communication Questionnaire. Los Angeles: Western Psychological Services.Google Scholar