The Adapted ADOS: A New Module Set for the Assessment of Minimally Verbal Adolescents and Adults

A Correction to this article was published on 30 January 2021

This article has been updated

Abstract

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.

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  • 30 January 2021

    The original version of the article has contained an error in Table 3 (the organization of Module 2 items into the Basic Social Communication and Interaction Quality factors was incorrect). The updated table is given below and it shows the correct organization (7 Basic and 3 Interaction Quality items).

References

  1. American Psychiatric Association. (2000). Diagnostic and statistical manual of mental disorders: DSM-IV-TR. Washington, DC: American Psychiatric Association.

    Google Scholar 

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

    Book  Google Scholar 

  3. 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.

    Article  PubMed  Google Scholar 

  4. 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.

    Article  PubMed  Google Scholar 

  5. 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.

    Article  PubMed  Google Scholar 

  6. 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.

    Article  PubMed  PubMed Central  Google Scholar 

  7. 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.

    Article  PubMed  Google Scholar 

  8. 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.

    Google Scholar 

  9. 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.

    Article  PubMed  Google Scholar 

  10. 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.

    Article  PubMed  Google Scholar 

  11. Dunn, L. M., & Dunn, D. M. (2007). Peabody picture vocabulary test (4th ed.). San Antonio: Pearson.

    Google Scholar 

  12. Elliott, C. D. (1990). Differential ability scales. San Antonio, TX: The Psychological Corporation.

    Google Scholar 

  13. Elliott, C. D. (2007). Differential ability scales, 2nd edition: Introductory and technical handbook. San Antonio, TX: The Psychological Corporation.

    Google Scholar 

  14. Fleiss, J. (1986). Reliability of measurements. In J. Fleiss (Ed.), The design and analysis of clinical experiments (pp. 2–31). New York: Wiley.

    Google Scholar 

  15. 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.

  16. 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.

    Article  PubMed  Google Scholar 

  17. 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.

    Article  PubMed  PubMed Central  Google Scholar 

  18. 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/.

  19. 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.

    Article  PubMed  Google Scholar 

  20. 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.

    Article  PubMed  PubMed Central  Google Scholar 

  21. 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.

    Article  PubMed  Google Scholar 

  22. 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.

    Google Scholar 

  23. 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.

  24. 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.

    Article  PubMed  Google Scholar 

  25. Mullen, E. M. (1995). Mullen scales of early learning. Circle Pines, MN: American Guidance Service Inc.

    Google Scholar 

  26. Muthen, L. K., & Muthen, B. O. (1998). M-plus user’s guide. Los Angeles: Muthen and Muthen.

    Google Scholar 

  27. Raven, J., Raven, J. C., & Court, J. H. (2003). Manual for Raven’s progressive matrices and vocabulary scales. San Antonio, TX: Harcourt Assessment.

    Google Scholar 

  28. Rutter, M., Bailey, A., & Lord, C. (2003a). The social communication questionnaire: Manual. Los Angeles: Western Psychological Services.

    Google Scholar 

  29. Rutter, M., Le Couteur, A., & Lord, C. (2003b). Autism diagnostic interview-revised. Los Angeles: Western Psychological Services.

    Google Scholar 

  30. 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.

  31. 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.

  32. 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.

    Article  PubMed  Google Scholar 

  33. 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.

    Article  Google Scholar 

  34. 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.

    Article  PubMed  Google Scholar 

  35. Wechsler, D. (1999). Manual for the Wechsler abbreviated intelligence scale (WASI). San Antonio, TX: The Psychological Corporation.

    Google Scholar 

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Acknowledgments

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.

Funding

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).

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Authors

Contributions

All authors contributed to the study conception and design and data collection. VHB conducted the data analysis and drafted the manuscript. All authors commented on previous versions of the manuscript and approved the final manuscript.

Corresponding author

Correspondence to Vanessa H. Bal.

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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.

Ethical Approval

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

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

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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

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Keywords

  • ADOS
  • Minimally verbal
  • Adults
  • Autism spectrum disorder
  • Autism symptoms