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自闭症诊断观察量表第二版（ADOS-2）孤独症诊断观察量表
自闭症诊断观察量表第二版（Autism Diagnostic Observation Schedule, Second Edition, （ADOS-2）是用于诊断和鉴别
诊断自闭症的一种评估工具。由专业的评估者在标准化的活动情境下对儿童的行为进行观察，每次评估需用时40-60分钟，适用于12月以上的儿童或成人。ADOS和ADI-R （自闭症诊断访谈量表修订本）联合,已被欧美许多国家作为诊断自闭症的金标准使用，在世界各地得到了广泛的应用。
自闭症诊断观察量表第二版（ADOS-2）概况：
•开发者：Catherine Lord,博士； Michael Rutter,医学博士；等
•测试年龄：12个月一一成年
•测试时间：40-60分钟
•格式：标准化的行为观察与编码
•计分：幼儿模块提供一系列的关注范围，反映幼儿表现出与自闭症相关的行为程度。模块1至4提供自闭症和自闭症谱系分类的截
止分数。模块1至模块3还提供了一个比较分数，表明与同龄且具有相似语言技能的自闭症儿童相比，自闭症谱系相关症状的水平。
•发布日期：2012年
•资质要求：C
自闭症诊断观察量表第二版（ADOS-2），该修订版改进了已被视为自闭症谱系障碍（ASD）观察评估''黄金标准〃的自闭症诊断观察量表（ADOS）。通过更新的协议，修订的算法，创建新的比较分数和幼儿模块，ADOS-2可以准确地描述当前症状，且不受语言影响。它可用于评估疑似患有自闭症（ASD）的人从没有言语的1岁儿童到口头表达流利的成年人。
自闭症诊断观察量表第二版（ADOS-2）与其前身（ADOS）—样，ADOS-2是通过对交流，社交互动，游戏以及受限和重复行为
的半结构化，标准化评估。通过标准化观察和编码这些行为，您可以获得关于诊断、干预、治疗计划和教育安排的信息。
五个模块：
自闭症诊断观察量表第二版（ADOS-2）.孤独症诊断观察量表，包括五个模块，每个模块只需要40到60分钟即可完成测试。被评估的个人根据语言表达水平和实际年龄来选择一个相应的模块进行测试。
•幼儿模块•适用于12至30个月大的儿童，他们很少使用短语表达
•模块1 •适用于31个月及以上的儿童，他们不经常使用短语表达
•模块2・适用于田可年龄段的儿童，他们使用短语表达，但表达不流畅
•模块3・适用于口头表达流的儿童和青少年
•模块4・适用于口头表达流利的大龄青少年和成年人
每个模块测试是让受试者参与一系列活动，互动测试材料和组件都包含在ADOS-2工具包中。例举模块3中的测试活动包括：构筑任务，装扮游戏，联合互动游戏，示范任务，图片说明，根据书本内容讲故事，卡通图案描述，会话和汇报，情感，社交困难与厌烦，间歇，朋友、关系和婚姻，孤独感，创造一个故事。
标准化管理、编码和评分：
每个ADOS-2模块都具有相应的协议手册”手册构建了测试管理并指导完成编码和评分。当进行测试活动时，观察受试者并做笔
记。之后”立即对观察到的行为进行编码。然后使用算法表单进行评分。
在模块1到4中”将算法分数与截止分数进行比较，得出三种分类之一：自闭症（孤独症），自闭症谱系或非谱系。自闭症和自闭
症谱系分类之间的差异的严重程度，前者表明症状更明显。在幼儿模块中，算法产生的是''关注范围〃而不是分类得分。
改进的方案手册、改进的算法和新的比较分数：
ADOS-2的管理和编码程序在功能上与ADOS相同。模块1至模块4保留了相同的基本测试活动和代码，但一些代码在ADOS・2进行扩展并添加了几个新代码。从而这些模块的协议手册得到了显著的改进，使它们现在提供了更淸晰、更明确的管理和编码说明。
对单元1至单元3的算法进行了修订，以获得更准确和有用的结果，并为比较儿童和青少年使用的三个单元的结果提供更统一的基
础。模块1到模块3的新比较分数允许您查看儿童自闭症谱系相关症状的总体水平与相同年龄且具有相似语言技能的自闭症（ASD）诊断儿童的相关症状。该分数还可以更容易地监测个体的症状。
新的幼儿模块
新的幼儿模块一一学步模块是专门为12到30个月大的孩子设计的，他们不经常使用短语。观察结果在管理之后立即编码，并将代码转换为算法得分。学步儿童模块算法提供的是''关注范围〃，而不是分数线。这些范围可以帮助你形成临床印象，但它们避免了正式的分类__这在这么小的年纪可能不太合适。学步儿童模块量化自闭症（ASD）的风险，并在需要继续监测时提供指导。
目前自闭症（ASD）症状的描述：
通过改进算法，ADOS-2具有较强的预测有效性。它根据实时观察，为您提供当前自闭症（孤独症）相关症状的准确的描述。医
生、临床心理学家、学校心理学家、言语病理学家和职业治疗师可以使用ADOS-2结果来指导诊断、干预、教育安排和治疗计划。
由TADOS-2可以广泛应用于儿童和成人，因此它是为发育障碍患者服务的医院、诊所或学校的配置。
培训方案：
自闭症诊断观察量表第二版（ADOS-2）.孤独症诊断观察量表，管理和编码高度标准化。有三种培训选择:
•ADOS-2临床研讨会
•ADOS-2 DVD培训包（W・605DVD）
•ADOS-2 DVD培训升级包（W-606DVD）
没有接受过ADOS培训临床医生应参加ADOS-2临床研讨会，或者购买ADOS-2 DVD培训包。
接受过使用原始ADOS培训的临床医生应购买ADOS-2 DVD培训升级包。
产品：
•ADOS-2自闭症诊断观察量表第二版•孤独症诊断观察量表”手工评分套件（型号：W-605）
包括ADOS-2使用指南手册；50本测试协议手册（每个模块10本）；测试用材料（100多个刺激物项目）；全部装在一个带把手和轮子的耐用的塑料容器中。
•ADOS-2自闭症诊断观察量表第二版•孤独症诊断观察量表”软件评分套件（型号：W-605S）
包括ADOS-2使用指南手册；50本测试协议手册（每个模块10本）；测试用材料（100多个刺激物项目）；加上可无限使用电脑评分CD光盘（W-605U）;所有产品均可以放置在一个带把手和轮子的耐用塑料容器中。需要带有Windows 10、8、7、Vista或XP的PC机，需要带有CD-ROM驱动器和USB端口。
•ADOS-2手工评分升级包（型号：W-606）
包括ADOS-2使用指南手册;50本测试协议小册子（每个模块10本）；额外的幼丿濮块刺激物项目（添加到现有的ADOS套件中，允许幼儿模块测试管理的15项）
•ADOS-2软件评分升级包（型号：W-606S）
包括ADOS-2使用指南手册;50本测试协议小册子（每个模块10本）;额外的幼儿模块刺激物项目（添加到现有的ADOS套件中”允许幼儿模块管理的15项）；无限使用的计分CD （W・605U）。需要配备Windows 10,8,7, Vista或XP的PC。需要CDROM驱动器和USB端口。
•ADOS-2自闭症诊断观察量表第二版•孤独症诊断观察量表，DVD培训包（型号：W-605DVD）
完成所有五个ADOS-2模块的培训资源。适用于美国和加拿大。包括培训资源计划DVD;培训资源指南；和CD以及所有培训资
源协议小册子的可打印P D F。
•ADOS-2自闭症诊断观察量表第二版•孤独症诊断观察量表，DVD培训包，PAL格式（型号：W-605DVDP）
完成所有五个ADOS-2模块的培训资源。适用于美国和加拿大以外地区。包括培训资源计划DVD；培训资源指南；以及所有培训
资源协议小册子的可打印pdf格式的CD。
•ADOS-2自闭症诊断观察量表第二版•孤独症诊断观察量表” DVD培训升级包（型号：W-606DVD）
用于ADOS・2 DVD培训资源包和ADOS・2 DVD培训资源升级包。包含所有培训资源协议手册的可打印PDF的CD。ADOS-2
DVD培训资源升级包ADOS-2幼儿模块上的培训资源。适用于美国和加拿大。包括幼儿培训资源DVD;培训资源指南（适用于所
有模块）；和CD以及所有培训资源协议小册子的可打印PDF。
•ADOS-2自闭症诊断观察量表第二版•孤独症诊断观察量表” DVD培训升级包，PAL格式（型号：W-606DVDP）
ADOS-2幼儿模块的培训资源。适用于美国和加拿大以外地区。包括幼儿训练资源计划DVD；培训资源指南（适用于所有模块）;以及所有培训资源协议小册子的可打印pdf格式的CD。
•ADOS-2培训DVD指南和协议CD （型号：W-605CV）
用于ADOS・2 DVD培训资源包和ADOS・2 DVD培训资源升级包。包括CD和所有培训资源协议手册的可打印PDF。
•ADOS-2自闭症诊断观察量表第二版•孤独症诊断观察量表”测试协议手册幼儿模块（-^10份）（型号：W-605A）
•ADOS-2自闭症诊断观察量表第二版•孤独症诊断观察量表”测试协议手册模块1 （—包10份）
•ADOS-2自闭症诊断观察量表第二版•孤独症诊断观察量表”测试协议手册模块2 （—包10份）
•ADOS-2自闭症诊断观察量表第二版•孤独症诊断观察量表”测试协议手册模块3 （—包10份）
•ADOS-2自闭症诊断观察量表第二版•孤独症诊断观察量表”测试协议手册模块4 （—包10份）
•ADOS-2自闭症诊断观察量表第二版•孤独症诊断观察量表”使用指南手册（型号：W-605M）
•ADOS-2自闭症诊断观察量表第二版•孤独症诊断观察量表”无限制使用评分CD （型号：W-605U）
无限使用。需配备Windows 10,8,7, Vista或XP的PC机。适用于所有5个模块。需要CD-ROM驱动器和USB端口。
自闭症诊断观察量表第二版(Autism Diagnostic Observation Schedule, Second Edition, (ADOS-2),文献索引
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Mar 22.
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《Brief Report: Exami ning Test-Retest Reliability of the Autism Diag no Stic Observation Schedule (ADOS ・2)
Calibrated Severity Scores (CSS)》
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《Correction to: ASD symptoms in adults with ADHD: a preliminary study using the ADOS・2》
Mol Autism・ 2022 Mar 7; 13(1):ll.doi: 10.1186/S13229-022-00491-9・
《Phenotypic differences between female and male individuals with suspicion of autism spectrum disorder》
J Pediatr Psychol. 2022 Jan 4;jsabl31.doi: 10.1093/jpepsy/jsabl31 ・ Online ahead of print.
《Pediatric Brain Tumor Survivors' Understanding of Friendships: A Qualitative Analysis of ADOS-2 Interview
Responses》
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《Profile of Autism Spectrum Disorder in Tuberous Sclerosis Complex: Results from a Longitudinal, Prospective,
Multisite Study》
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^Systematic Review and Meta-Analysis of the Clinical Utility of the ADOS-2 and the ADI-R in Diagnosing Autism
Spectrum Disorders in Children》
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《Educational and Diagnostic Classification of Autism Spectrum Disorder and Associated Characteristics》
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《Symptoms of autism spectrum disorder and developme ntal delay in children with low men tai age》
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assessed by the ADOS-2 toddler module》
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《Brief Report: Emotional and Behavioral Problems Among Young Children with ASD: An Exploratory Study of
ADOS E-Codes and Child Characteristics》
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《Rethinking Measurement Standards of Autism Symptomology in Adolescents with Fragile X Syndrome》
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《Diag no sing Autism Spectrum Disorder in Toddlers Born Very Preterm: Estimated Prevale nee and Usefulness of
Screeners and the Autism Diagnostic Observation Schedule (ADOS)》
The ADOS-2 contains five modules, each requiring just 40–60 minutes to administer. The individual being evaluated is given only one module, selected based on their expressive language level and chronological age.
Each module engages the examinee in a series of activities involving interactive stimulus materials, all of which are included in the ADOS-2 Kit. To illustrate, these are the activities in Module 3:
Each ADOS-2 module has its own Protocol Booklet, which structures the administration and guides clinicians through coding and scoring. As the clinician administers activities, they observe the examinee and take notes. Immediately afterward, the clinician codes the behaviors observed. Then the clinician uses the Algorithm Form for scoring.
In Modules 1–4, algorithm scores are compared with cutoff scores to yield one of three classifications: autism, autism spectrum, or non-spectrum. The difference between autism and autism spectrum classifications is one of severity, with the former indicating more pronounced symptoms. In the Toddler Module, algorithms yield “ranges of concern” rather than classification scores.
Administration and coding procedures for the ADOS-2 are functionally identical to those for the ADOS. Modules 1–4 retain the same basic activities and codes, though some have been expanded and several new codes have been added. Protocol Booklets for these modules have been significantly improved and now provide clearer, more explicit administration and coding instructions.
Algorithms for Modules 1–3 have been revised to achieve more accurate and useful results and to provide a more uniform basis for comparing results across the three modules used with children and young adolescents.
A new Comparison Score for Modules 1–3 allows clinicians to compare a child’s overall level of autism spectrum–related symptoms with the symptoms of children diagnosed with ASD who are the same age and have similar language skills. This score also makes it easier to monitor an individual’s symptoms over time.
The Toddler Module is designed specifically for children between 12 and 30 months of age who do not consistently use phrase speech. Observations are coded immediately following administration, and the codes are converted to algorithm scores. Toddler Module algorithms provide “ranges of concern” rather than classification scores. These ranges help clinicians form clinical impressions, but the ranges avoid formal classification—which may not be appropriate at such a young age. The Toddler Module quantifies risk for ASD and guides further monitoring.
With improved algorithms, the ADOS-2 demonstrates strong predictive validity. It gives clinicians a highly accurate picture of current ASD-related symptoms based on real-time observations. Physicians, clinical psychologists, school psychologists, speech–language pathologists, and occupational therapists can use ADOS-2 results to inform diagnosis, intervention, educational placement, and treatment planning. Because the ADOS-2 can be used with a wide range of children and adults, it is an essential addition to any hospital, clinic, or school that serves individuals with developmental disorders.
ADOS-2 administration and coding are highly standardized. Therefore, valid assessment requires training. A variety of training options are available (all offer opportunities to earn continuing education credits):
The ADOS-2 Training Video Program (LMS-605) and the ADOS-2 Training Video Program Upgrade (LMS-606) are available online on the WPS Learning Management System (WPS LMS).
Chapters 3 and 7 of the ADOS-2 Manual present case examples for using Modules 1–4 and the Toddler Module. The case examples include a variety of completed ADOS-2 protocols/algorithms and examples of how to include ADOS-2 results in written reports. Cases range from a toddler exhibiting delays in physical development and social communication to an adult experiencing academic and social difficulties in college. Below is an excerpt from the case example for Module 2.
Harry is a 6-year-old boy who received a diagnosis of ASD from a statewide early intervention project when he was 2 years old. Harry and his family were recruited to participate in a genetics study of ASD. As part of the study protocol, Harry’s family participated in a research evaluation to confirm Harry’s diagnosis of ASD. Harry’s parents completed a parent interview and several questionnaires. Harry was administered a cognitive test (Differential Ability Scales, Second Edition [DAS-2; Elliot, C. D. (2007). Differential Ability Scales (2nd ed.). San Antonio, TX: Psychological Corporation]) and the ADOS-2.
On the DAS-2, Harry received a Verbal Cluster score of 70 and a Nonverbal Cluster score of 90, indicating Borderline verbal abilities and Average nonverbal abilities. He was observed to use primarily phrase speech. Although Harry often used sentences that included several words, such as “Where are you going, Daddy?” or “I don’t want to go to school,” he did not use complex sentences that included multiple clauses (e.g., “I don’t want to go to school tomorrow because I am too tired”). Module 2 was selected as the appropriate module based on Harry’s expressive language level.
Harry’s mother was present for the administration of Module 2 while Harry’s father met separately with another clinician to complete the parent interview portion of the research evaluation. A description of Harry’s social and communicative behavior during the ADOS-2 is provided in the excerpt from his evaluation report, presented next.
The Autism Diagnostic Observation Schedule, Second Edition (ADOS-2), Module 2 was administered to Harry for diagnostic purposes as part of a research protocol for a study of the genetics of autism. The ADOS-2 is a semi-structured, standardized assessment instrument that includes many play-based activities designed to obtain information in the areas of communication, reciprocal social interactions, and restricted and repetitive behaviors associated with a diagnosis of ASD. Module 2 of the ADOS-2 is designed for children with phrase speech whose speech is not yet “fluent” (that is, who are not yet consistently combining two relatively complex ideas in sentences to talk about objects or events that are not present). Module 2 includes activities such as a construction task, interactive play with a family of dolls, a demonstration task, looking at a book and pictures, a pretend birthday party, bubbles, and a snack.
Harry was excited to transition into the more play-based tasks of the ADOS-2 from the cognitive tests that were administered first. He immediately began exploring the various toys that were set out for him. Harry’s language during the ADOS-2 consisted primarily of short phrases. He said things like, “It’s a cat,” as he was pointing to a picture of a cat on the music box, and “I like more,” and “I like two,” when he was requesting things. Harry sometimes echoed things that other people said, such as “Ooh, nice!” or “Alright.” At times, it was quite easy to understand what Harry was saying, but at other times his articulation made it difficult to understand him. He also occasionally mixed up his pronouns, such as saying, “You do it,” to mean that he wanted to do it. Harry had difficulty participating in conversational exchanges with the examiner. Although he was able to answer simple questions about familiar topics (e.g., How old are you? Do you have any pets?), he did not elaborate on his brief answers or ask questions of the examiner when provided opportunities to do so. This made it difficult to build a conversation with Harry.
Harry sometimes integrated his verbal communication with other modes of nonverbal communication, such as looking at the examiner, smiling, and saying, “Wow,” when he saw something he liked. At other times, he did not use eye contact when talking to people or interacting with them. Harry used a few gestures, such as pretending to brush his teeth when asked to teach this activity to the examiner and blowing a kiss to a baby doll when his mother prompted him to do so. He did not spontaneously use gestures at other times when communicating with the examiner or his mother.
In terms of Harry’s social reciprocity during the ADOS-2, he was sometimes quite interested in interacting with the examiner or his mother. He made a variety of overtures to ask for things and occasionally to express interest or draw attention to something that he was enjoying. Harry had a tendency to be repetitive when initiating interactions with other people, however, such as by saying the same phrase in the same way (e.g., saying “You do it, mommy?” with an exaggerated sing-song intonation to ask for permission). Harry also exhibited a strong interest in University of Michigan football, and he insisted on bringing up things about the football team, even when it was clear that the examiner was trying to change the subject.
While Harry was often responsive to the examiner’s attempts to talk to him or play with him, he showed less interest in social interaction when he was involved in repetitive play activities. At one point, Harry became very interested in putting small objects into a teapot, then dumping them out and starting over again. When the examiner tried to join Harry and put something into the teapot, he stomped and yelled, “No!” and took it out. On another occasion, Harry spent several minutes putting blocks into a box repetitively. He became quite distressed and frustrated when the examiner tried to interrupt him; he flapped his hands while protesting loudly.
Harry exhibited some imaginative play during the ADOS-2. He enjoyed the “Birthday Party” and spontaneously pretended to feed cake to the baby doll. He also rocked the baby doll in a blanket and hugged her as he pretended to put her to bed. Harry had more difficulty playing creatively with the family of dolls. He became so engrossed in playing repetitively with the teapot and the small objects that the repetitive play may have prevented him from using the objects in a more imaginative way.
Harry’s Overall Total score on the ADOS-2 Module 2 algorithm for children aged 5 years or older was consistent with an ADOS-2 Classification of autism. His ADOS-2 Comparison Score further indicated that, on the ADOS-2, he displayed a high level of autism spectrum–related symptoms as compared with children who have ASD and are of the same chronological age and language level. For the genetics research project protocol, the diagnostic classification of the participants was based on the results of the ADI-R, the ADOS-2, and the clinical impression of the principal investigator (a developmental pediatrician experienced in ASD assessment and diagnosis). Harry’s scores on the ADI-R met cutoffs for autism as well. The senior research clinician reviewed Harry’s charts (including the results of cognitive testing), read the results of the ADI-R, watched a video of the ADOS-2 Module 2 administration, and met with the clinicians who conducted the parent interview and child assessment. On the basis of the available information, the clinician gave Harry an overall diagnosis of autism and assigned him to the ASD (as opposed to the non-ASD) diagnostic group in the genetics research project. Behavioral observations from the ADOS-2 were used to identify specific intervention targets for Harry’s speech therapy program, such as responding to others’ comments to improve conversational skills. The ADOS-2 was also important in highlighting that Harry’s interests were quite restricted, leading to the goal of increasing his variety of play behaviors.
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