As with all standardized assessments, care should be taken to follow the provided language as closely as possible when administering the ADOS-2. In contrast to many other standardized assessments, however, the standardization of the ADOS-2 does allow for and expect verbal instructions to be adapted when necessary to ensure the participant’s understanding of the task. This includes modifications to account for regional and cultural language variations.

There are various situations in which you may find it necessary to modify the scripted language to ensure the participant can fully understand and engage in the task. For example, when administering Module 3 to very young children, the phrasing of certain interview questions may need to be modified slightly so that the language is more age-appropriate. Similarly, when using an authorized translation of the ADOS-2, you may need to adapt the scripted language to account for regional or cultural variations in language use.

Whenever possible, it is best to plan ahead for the specific administration and determine where, if any, substitutions may be needed in places where the ADOS-2 provides a script. Planning in advance of the administration is helpful in avoiding situations where the participant might inadvertently be provided too many prompts, which in turn can affect coding.

Even with careful advance planning, however, there may be situations in which you first become aware of regional/cultural variations during the administration itself. At these times, you may modify the scripted language and repeat the press, if necessary, to ensure the participant understands the task. You should repeat the press with appropriately modified language only if you believe the specific scripted language has interfered with the participant’s ability to understand the task. You should not repeat the press just because the participant did not respond to the task. Some participants may not respond to a press at all, even after a clarification has been made.

The focus of the ADOS-2 is not on the participant’s understanding of specific words but rather on their social understanding and engagement. In this sense, variations “in the moment” can be made to ensure the participant understands the tasks. Care must be taken, however, to not change the social “press” itself and to not provide too many presses.