Few measures are appropriate to assess autism symptoms in minimally verbal adolescents and adults. The Autism Diagnostic Observation Schedule, 2nd Edition (ADOS-2, Lord et al., in Autism diagnostic observation schedule–2nd edition (ADOS-2). Western Psychological Services, Los Angeles, 2012) Modules 1 and 2 were designed and validated with children whose spoken language ranges from few- to- no words to phrase speech. This study describes the development and initial validation of the Adapted-ADOS (A-ADOS), which includes tasks, materials and behavioral codes modified to be suitable for assessing older minimally verbal individuals. A-ADOS algorithms exhibit comparable sensitivity and improved specificity relative to ADOS-2 Modules 1 and 2. Although further validation is needed, the A-ADOS will facilitate research to further understanding of minimally verbal adults and symptom trajectories across the lifespan.
This is a preview of subscription content, access via your institution.
Buy single article
Instant access to the full article PDF.
Tax calculation will be finalised during checkout.
Subscribe to journal
Immediate online access to all issues from 2019. Subscription will auto renew annually.
Tax calculation will be finalised during checkout.
American Psychiatric Association. (2000). Diagnostic and statistical manual of mental disorders: DSM-IV-TR. Washington, DC: American Psychiatric Association.
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Washington, DC: Author.
Bal, V. H., Katz, T., Bishop, S. L., & Krasileva, K. (2016). Understanding definitions of minimally verbal across instruments: Evidence for subgroups within minimally verbal children and adolescents with autism spectrum disorder. Journal of Child Psychology and Psychiatry, 57(12), 1424–1433. https://doi.org/10.1111/jcpp.12609.
Bal, V. H., Kim, S. H., Fok, M., & Lord, C. (2019). Autism spectrum disorder symptoms from ages 2 to 19 years: Implications for diagnosing adolescents and young adults. Autism Research, 12(1), 89–99. https://doi.org/10.1002/aur.2004.
Berument, S. K., Starr, E., Pickles, A., Tomlins, M., Papanikolauou, K., Lord, C., et al. (2005). Pre-linguistic Autism Diagnostic Observation Schedule adapted for older individuals with severe to profound mental retardation: A pilot study. Journal of Autism and Developmental Disorders, 35(6), 821–829. https://doi.org/10.1007/s10803-005-0027-4.
Bishop, S. L., Farmer, C., & Thurm, A. (2015). Measurement of nonverbal IQ in autism spectrum disorder: Scores in young adulthood compared to early childhood. Journal of Autism and Developmental Disorders, 45(4), 966–974. https://doi.org/10.1007/s10803-014-2250-3.
Bishop, S. L., Havdahl, K. A., Huerta, M., & Lord, C. (2016). Subdimensions of social-communication impairment in autism spectrum disorder. Journal of Child Psychology and Psychiatry, 57(8), 909–916. https://doi.org/10.1111/jcpp.12510.
Browne, M. W., & Cudeck, R. (1993). Alternative ways of assessing model fit. In K. A. Bollen & J. S. Long (Eds.), Testing structural equation models (pp. 136–162). Newbury Park, CA: Sage.
Cicchetti, D. V., Showalter, D., & Rosenheck, R. (1997). A new method for assessing interexaminer agreement when multiple ratings are made on a single subject: Applications to the assessment of neuropsychiatric symptomatology. Psychiatry Research, 72(1), 51–63. https://doi.org/10.1016/S0165-1781(97)00095-4.
DiLavore, P. C., Lord, C., & Rutter, M. (1995). The pre-linguistic autism diagnostic observation schedule. Journal of Autism and Developmental Disorders, 25(4), 355–379. https://doi.org/10.1007/BF02179373.
Dunn, L. M., & Dunn, D. M. (2007). Peabody picture vocabulary test (4th ed.). San Antonio: Pearson.
Elliott, C. D. (1990). Differential ability scales. San Antonio, TX: The Psychological Corporation.
Elliott, C. D. (2007). Differential ability scales, 2nd edition: Introductory and technical handbook. San Antonio, TX: The Psychological Corporation.
Fleiss, J. (1986). Reliability of measurements. In J. Fleiss (Ed.), The design and analysis of clinical experiments (pp. 2–31). New York: Wiley.
Gotham, K., Risi, S., Dawson, G., Tager-Flusberg, H., Joseph, R., Carter, A., … Sigman, M. (2008). A replication of the Autism Diagnostic Observation Schedule (ADOS) revised algorithms. Journal of the American Academy of Child & Adolescent Psychiatry, 47(6), 642–651. https://doi.org/10.1097/chi.0b013e31816bffb7.
Gotham, K., Risi, S., Pickles, A., & Lord, C. (2007). The Autism Diagnostic Observation Schedule: Revised algorithms for improved diagnostic validity. Journal of Autism and Developmental Disorders, 37(4), 613. https://doi.org/10.1007/s10803-006-0280-1.
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(8), 1996–2012. https://doi.org/10.1007/s10803-014-2080-3.
Interagency Autism Coordinating Committee. (2017). 2016-2017 Interagency autism coordinating committee strategic plan for autism spectrum disorder. Retrieved from the U.S. Department of Health and Human Services Interagency Autism Coordinating Committee website: Retrieved from https://iacc.hhs.gov/publications/strategic-plan/2017/.
Jack, A., & Pelphrey, K. A. (2017). Annual Research Review: Understudied populations within the autism spectrum–current trends and future directions in neuroimaging research. Journal of Child Psychology and Psychiatry, 58(4), 411–435. https://doi.org/10.1111/jcpp.12687.
Kasari, C., Brady, N., Lord, C., & Tager-Flusberg, H. (2013). Assessing the minimally verbal school-aged child with autism spectrum disorder. Autism Research, 6(6), 479–493. https://doi.org/10.1002/aur.1334.
Lord, C., Risi, S., DiLavore, P. S., Shulman, C., Thurm, A., & Pickles, A. (2006). Autism from 2 to 9 years of age. Archives of General Psychiatry, 63(6), 694–701. https://doi.org/10.1001/archpsyc.63.6.694.
Lord, C., Rutter, M., DiLavore, P., Risi, S., Gotham, K., & Bishop, S. (2012). Autism diagnostic observation schedule–2nd edition (ADOS-2). Los Angeles: Western Psychological Services.
Luyster, R., Gotham, K., Guthrie, W., Coffing, M., Petrak, R., Pierce, K., … Richler, J. (2009). The Autism Diagnostic Observation Schedule—Toddler Module: A new module of a standardized diagnostic measure for autism spectrum disorders. Journal of Autism and Developmental Disorders, 39(9), 1305–1320. https://doi.org/10.1007/s10803-009-0746-z.
McGovern, C. W., & Sigman, M. (2005). Continuity and change from early childhood to adolescence in autism. Journal of Child Psychology and Psychiatry, 46(4), 401–408. https://doi.org/10.1111/j.1469-7610.2004.00361.x.
Mullen, E. M. (1995). Mullen scales of early learning. Circle Pines, MN: American Guidance Service Inc.
Muthen, L. K., & Muthen, B. O. (1998). M-plus user’s guide. Los Angeles: Muthen and Muthen.
Raven, J., Raven, J. C., & Court, J. H. (2003). Manual for Raven’s progressive matrices and vocabulary scales. San Antonio, TX: Harcourt Assessment.
Rutter, M., Bailey, A., & Lord, C. (2003a). The social communication questionnaire: Manual. Los Angeles: Western Psychological Services.
Rutter, M., Le Couteur, A., & Lord, C. (2003b). Autism diagnostic interview-revised. Los Angeles: Western Psychological Services.
Sappok, T., Diefenbacher, A., Budczies, J., Schade, C., Grubich, C., Bergmann, T., … Dziobek, I. (2013). Diagnosing autism in a clinical sample of adults with intellectual disabilities: How useful are the ADOS and the ADI-R?. Research in Developmental Disabilities, 34(5), 1642–1655. https://doi.org/10.1016/j.ridd.2013.01.028.
Shattuck, P. T., Seltzer, M. M., Greenberg, J. S., Orsmond, G. I., Bolt, D., Kring, S., … Lord, C. (2007). Change in autism symptoms and maladaptive behaviors in adolescents and adults with an autism spectrum disorder. Journal of Autism and Developmental Disorders, 37(9), 1735–1747. https://doi.org/10.1007/s10803-006-0307-7.
Siegel, B., Vukicevic, J., Elliott, G., & Kraemer, H. (1989). The use of signal detection theory to assess DSM-III-R criteria for autistic disorder. Journal of the American Academy of Child and Adolescent Psychiatry, 28, 542–548. https://doi.org/10.1097/00004583-198907000-00013.
Skrondal, A., & Rabe-Hesketh, S. (2004). Generalized latent variable modeling: Multilevel, longitudinal, and structural equation models. Chapman and Hall/CRC. https://doi.org/10.1201/9780203489437.
Tager-Flusberg, H., & Kasari, C. (2013). Minimally verbal school-aged children with autism spectrum disorder: The neglected end of the spectrum. Autism Research, 6(6), 468–478. https://doi.org/10.1002/aur.1329.
Wechsler, D. (1999). Manual for the Wechsler abbreviated intelligence scale (WASI). San Antonio, TX: The Psychological Corporation.
We gratefully acknowledge the contributions of the following people who aided in data collection: Gabrielle Gunin, Whitney Guthrie, Lindsay Harvey, Sophie Manevich, Saara Mahjouri, Steven Schwarzbaum.
This work was supported by an Autism Speaks Dennis Weatherstone Predoctoral Fellowship, Naomi E. Lohr Award for Excellence in Clinical Psychology and Bay Area Autism Consortium Collaboration Counts Grant to VHB, and the National Institute of Mental Health (K23MH115166 to VHB and R01MH081873 and R01MH081873-04S1 to CL) and the National Institute of Child Health and Development (R01HD081199 to CL).
Conflict of interest
CL and SR receive royalties for the ADOS-2; however, no royalties are generated from the Adapted ADOS at this time. The AADOS is available to sites meeting training and reliability criteria for the cost of materials and shipping.
All procedures performed in the studies involving human participants 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. This article does not contain any studies with animals performed by any of the authors.
Informed consent was obtained from all individual participants included in this study.
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
About this article
Cite this article
Bal, V.H., Maye, M., Salzman, E. et al. The Adapted ADOS: A New Module Set for the Assessment of Minimally Verbal Adolescents and Adults. J Autism Dev Disord 50, 719–729 (2020). https://doi.org/10.1007/s10803-019-04302-8
- Minimally verbal
- Autism spectrum disorder
- Autism symptoms