Austism diagnostic observation schedule: A standardized observation of communicative and social behavior

The Autism Diagnostic Observation Schedule (ADOS), a standardized protocol for observation of social and communicative behavior associated with autism, is described. The instrument consists of a series of structured and semistructured presses for interaction, accompanied by coding, of specific target behaviors associated with particular tasks and by general ratings of the quality of behaviors. Interrater reliability for five raters exceeded weighted kappas of .55 for each item and each pair of raters for matched samples of 15 to 40 autistic and nonautistic, mildly mentally handicapped children (M IQ=59) between the ages of 6 and 18 years. Test-retest reliability was adequate. Further analyses compared these groups to two additional samples of autistic and nonautistic subjects with normal intelligence (M IQ=95), matched for sex and chronological age. Analyses yielded clear diagnostic differences in general ratings of social behavior, specific aspects of communication, and restricted or stereotypic behaviors and interests. Clinical guidelines for the diagnosis of autism in the draft version of ICD-10 were operationalized in terms of abnormalities on specific ADOS items. An algorithm based on these items was shown to have high reliability and discriminant validity.

[1]  Jacob Cohen,et al.  Weighted kappa: Nominal scale agreement provision for scaled disagreement or partial credit. , 1968 .

[2]  L. A. Marascuilo,et al.  Nonparametric and Distribution-Free Methods for the Social Sciences , 1977 .

[3]  B. Shaywitz,et al.  Agreement in diagnosis: clinical assessment and behavior rating scales for pervasively disturbed children. , 1978, Journal of the American Academy of Child Psychiatry.

[4]  Lawrence Hubert,et al.  A general formula for the variance of Cohen's weighted kappa. , 1978 .

[5]  B J Freeman,et al.  The Behavior Observation Scale for Autism: initial methodology, data analysis, and preliminary findings on 89 children. , 1978, Journal of the American Academy of Child Psychiatry.

[6]  D. Cicchetti,et al.  A Computer Program for Assessing Specific Category Rater Agreement for Qualitative Data , 1978 .

[7]  M. Rutter.  Diagnosis and definition of childhood autism , 1978, Journal of autism and childhood schizophrenia.

[8]  A. J. Conger,et al.  Self-ratings and judges' ratings of heterosexual social anxiety and skill: a generalizability study. , 1979, Journal of consulting and clinical psychology.

[9]  S. Wolff,et al.  Schizoid personality in childhood: a comparative study of schizoid, autistic and normal children. , 1979, Journal of child psychology and psychiatry, and allied disciplines.

[10]  A. J. Conger.  Integration and generalization of kappas for multiple raters. , 1980 .

[11]  D A Krug,et al.  Behavior checklist for identifying severely handicapped individuals with high levels of autistic behavior. , 1980, Journal of child psychology and psychiatry, and allied disciplines.

[12]  D. Cicchetti,et al.  Developing criteria for establishing interrater reliability of specific items: applications to assessment of adaptive behavior. , 1981, American journal of mental deficiency.

[13]  S. L. Parks.  The assessment of autistic children: a selective review of available instruments , 1983, Journal of autism and developmental disorders.

[14]  B. Freeman,et al.  Behavior assessment of the syndrome of autism: behavior observation system. , 1984, Journal of the American Academy of Child Psychiatry.

[15]  Madalyn Brand Teal,et al.  A validity analysis of selected instruments used to assess autism , 1986, Journal of autism and developmental disorders.

[16]  John P. Rice,et al.  The stability of diagnosis with an application to bipolar II disorder , 1986, Psychiatry Research.

[17]  C. Wenar,et al.  The development of normal and autistic children: A comparative study , 1986, Journal of autism and developmental disorders.

[18]  P. Mundy,et al.  Defining the social deficits of autism: the contribution of non-verbal communication measures. , 1986, Journal of child psychology and psychiatry, and allied disciplines.

[19]  J. Fleiss.  The design and analysis of clinical experiments , 1987 .

[20]  H. Kraemer,et al.  Empirically derived subclassification of the autistic syndrome , 1986, Journal of autism and developmental disorders.

[21]  M. Rutter,et al.  Autism and pervasive developmental disorders: Concepts and diagnostic issues , 1987, Journal of autism and developmental disorders.

[22]  F. Volkmar,et al.  Social deficits in autism: an operational approach using the Vineland Adaptive Behavior Scales. , 1987, Journal of the American Academy of Child and Adolescent Psychiatry.

[23]  M. Drake.  Diagnostic and Statistical Manual of Mental Disorders (3rd ed. rev.) , 1988 .

[24]  F. Volkmar,et al.  An evaluation of the autism behavior checklist , 1988, Journal of autism and developmental disorders.

[25]  S. Folstein,et al.  Diagnosis and Subclassification of Autism , 1988 .

[26]  A. Couteur,et al.  Autism diagnostic interview: A standardized investigator-based instrument , 1989, Journal of autism and developmental disorders.