ADOS-2, Observations of Social Affect and Behavior

Asian child and mother playing puzzle together --ar 16:9

The ADOS-2 is one of the most popular observation tools for diagnosing autism spectrum disorder (ASD) in recent research and clinical practice.  As a semi-structured assessment tool, it observes an individual’s behavior and responses through areas significantly influenced by autism, such as communication, social interaction, play, imagination, and atypical movements, to determine if they meet the diagnostic criteria for autism. It is composed of various modules and standardized tools tailored to different age groups and language levels, allowing assessment across a wide range of developmental levels from toddlers to adults. Due to its direct observation and interaction, it is highly evaluated for its reliability and sensitivity in assessing ASD, being considered adequate for ASD assessment and diagnosis.

In Korea, many parents seek ADOS testing, but there are few places where specialized testing can be conducted, resulting in long waits. Even in the United States, there are many places where one must wait over a year to undergo testing. However, ADOS-2 alone does not diagnose autism. While ADOS-2 is a useful tool for overall assessment, it is used only as one information tool based on behaviors collected within a limited time frame to determine the appropriateness of an autism spectrum disorder diagnosis. Therefore, if there are suspicions about a child’s autism or concerns about delayed development, it is more important to begin appropriate intervention quickly rather than waiting in line for testing.

Additionally, ADOS-2 serves as a diagnostic tool and allows for detailed observation of social affect and restrictive and repetitive behaviors, enabling the construction of profiles of the individual’s strengths and weaknesses, leading to more specific intervention plans. Furthermore, ADOS testing follows very conservative coding principles. Therefore, individuals may be included in the autism diagnosis criteria with higher scores than expected. However, the score itself does not determine whether or not one has autism. To make a diagnosis, consideration must be given to various other criteria and coexisting issues. Thus, even if classified as autism with ADOS-2, the diagnosis may not be confirmed. Conversely, if classified as non-spectrum, but high scores are received in either social emotions or repetitive behaviors, it may indicate significant difficulties requiring attention.

If a child is suspected of having autism and there are concerns about development, please pay attention to the child’s social affect and behaviors. Social affect and atypical behaviors are the main observation areas of ADOS-2. Meaningful interactions are essential for the development of social affect, which is also a core area of DIR Floor Time.

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