The Autism Diagnostic Observation Schedule—Toddler Module: A New Module of a Standardized Diagnostic Measure for Autism Spectrum Disorders

Abstract

The Autism Diagnostic Observation Schedule (ADOS; Lord et al., 2000) is widely accepted as a "gold standard" diagnostic instrument, but it is of restricted utility with very young children. The purpose of the current project was to modify the ADOS for use in children under 30 months of age. A modified ADOS, the ADOS Toddler Module (or Module T), was used in 360 evaluations. Participants included 182 children with best estimate diagnoses of ASD, non-spectrum developmental delay or typical development. A final set of protocol and algorithm items was selected based on their ability to discriminate the diagnostic groups. The traditional algorithm "cutoffs" approach yielded high sensitivity and specificity, and a new range of concern approach was proposed.Keywords autism spectrum disorders; diagnosis; ADOS; infants; toddlers Almost ten years ago, the standardization of a revised Autism Diagnostic Observation Schedule (ADOS), a semi-structured assessment for the diagnosis of autism spectrum disorders (ASD) (Lord, Rutter, DiLavore & Risi, 1999) was described. The ADOS has gradually become an integral part of many research and clinical protocols of children suspected of having an autism spectrum disorder (ASD). Due to the growing understanding of symptoms in the first two years of life and the desire of researchers and clinicians to have standardized instruments for use with infants and young toddlers, there is a need for diagnostic tools that are appropriate for very young children. This paper presents a new Toddler Module of the ADOS. The Toddler Module retains the original spirit and many of the original tasks of the ADOS, but is intended for use in children under 30 months of age who have nonverbal mental ages of at least 12 months. The scope of this report is to provide a summary of the new measure, the procedures used to develop it, a description of the standardization sample and relevant psychometrics.In introducing this new module, it is valuable to review the structure of the previously published ADOS. The ADOS evaluates social interaction, communication and play through a series of planned "presses" (Lord et al., 1989) in the context of a naturalistic social interaction. Some of the presses are intended to offer a high level of structure for the participant, while others are intended to provide less structure. All presses, however, afford contexts for both initiations and responses, which are then coded in a standardized manner. An algorithm, which sums the scores of particular items from the measure, yields a classification indicative of autism, ASD or nonspectrum conditions. This classification can then be used by a clinician or researcher as one part of a comprehensive diagnostic process.The first ADOS was introduced in the late 1980s and was intended for children who had a spoken language age equivalent of at least 36 months. A revision was published in 2000 that reflected the need for the measure to be applicable to a wider range of chronological and developmental ages. The 2000 version provided f...

Systematic review of tools to measure outcomes for young children with autism spectrum disorder

“…The development paper 76 involved 182 children with best estimate diagnoses of ASD, non-spectrum developmental delay or typical development, aged 12-30 months. Content validity was good; items were revised, rewritten or removed, as necessary, until all remaining items were deemed relevant.…”

“…70 The ADOS-G was able to measure improvement in functioning over time in Ben Itzchak et al 149 and change scores for ADOS-G and ADI-R gave similar findings in Lord et al 65 Autism Diagnostic Observation Schedule-Toddler Module but the paper 76 was judged to be of poor quality for this property, as the measurement was for the agreement of seven raters and 14 videos of assessment. Luyster et al 76 also reported that numerous drafts and pilot analyses for content validity were conducted, and items removed and added as appropriate.…”

“…Luyster et al 76 presented the new Toddler Module of the ADOS (see Autism symptom severity, above). Internal consistency for all groupings was high (younger and non-verbal children: α = 0.88; verbal α = 0.90) for the Social Affect score.…”

Parent-Implemented Social Intervention for Toddlers With Autism: An RCT

“…Experienced diagnosticians administered the Autism Diagnostic Observation Schedule (ADOS), [38][39][40] home observation, parent report measures, standardized measures, and developmental history. Clinical judgment was used to make a best estimate diagnosis, the gold standard 41,42 shown to predict later diagnosis.…”

Observed and Parent-Report Measures of Social Communication in Toddlers With and Without Autism Spectrum Disorder Across Race/Ethnicity

“…Participants received Module 1, 2, 3, or the Toddler Module (Luyster et al, 2009) on the basis of age and expressive language level. Diagnostic classifications of "nonspectrum" or "ASD" were based upon the overall total score.…”