How does the ADOS-2 fit into a team-based autism assessment?

Conducting team-based autism evaluations is the standard of practice in many school settings, and the ADOS-2 fits right in. In understanding how to use the ADOS-2 in the context of a team autism evaluation, it is important to differentiate a team autism evaluation from a team administration of the ADOS-2.

A team autism evaluation occurs when different professionals come together to provide a multidisciplinary approach to ASD assessment. This is ideal in order to gather information from multiple sources and make use of expertise from different disciplines. The ADOS-2 is only one source of information in a diagnostic assessment. Information must be gathered from multiple other sources, such as through interviewing parents, talking to teachers and medical professionals, conducting other direct testing (e.g., cognitive testing, language testing) with the child, and so on. Because the ADOS-2 is only one of many sources of information gathered during an autism assessment, conducting a team autism evaluation does not require that the ADOS-2 itself be administered as a team.

Nonetheless, it may be useful at times for multiple professionals to observe the ADOS-2 and consensus code the administration. When multiple professionals are present during an ADOS-2 administration, it is important to keep several considerations in mind. As described in the ADOS-2 manual, it is important that the ADOS-2 be administered by one person, as its primary focus is on interactive social behavior between the examiner and examinee. This recommendation does not preclude observers from being present during the administration. When another professional is present in the room during the ADOS-2 administration, however, it is important that the examinee never be confused about which person is the examiner, with whom he or she is expected to interact. Anyone present beyond the examiner should serve solely as an observer.

        The ADOS-2 authors recognize the value of consensus coding a single administration to gain multiple perspectives, as well as to establish and maintain reliability among ADOS-2 examiners. Consensus coding occurs when one person administers and independently scores the ADOS-2 administration based on his or her own notes. Other observers who watched the ADOS-2 administration also independently score the administration based on their own notes. Then the examiner and the observers compare their codes and discuss any disagreements. The group arrives at a consensus code for each item, and the consensus codes are considered the "preferred" codes for that administration. A critical factor here is that each rater completes the codes independently and, after independent coding, the raters discuss and reach consensus. During training, raters may want to discuss codes as they complete them, but this is not appropriate for clinical practice or to be used in student or patient reports. Appropriate consensus coding in clinical practice requires raters to complete codes independently before reaching consensus.

The guidelines described here are intended to help autism evaluation teams make the best use of the ADOS-2 in the context of a team-based autism assessment.