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If you are an ADOS-2 user who has not previously been trained in the ADOS, you should do the following to obtain essential competence in the ADOS-2:

1. Make sure you have prior education, training, and experience that includes extensive exposure to autism spectrum disorders.
2. Study the ADOS-2 Manual. You can purchase and complete associated post-test materials for obtaining Independent Study credits (LMS-605MCE) to receive 6 contact hours of professional continuing education credit for learning the ADOS-2 Manual.
3. Attend a WPS ADOS-2 Clinical Workshop (live in-person or live webinar) or complete online self-study using the ADOS-2 Training Video Program (LMS-605). These options offer training in all five ADOS-2 modules.
   1. Upon completion of the ADOS-2 Clinical Workshop (live in-person or live webinar), you will receive a certificate of completion that is equivalent to 12 contact hours of professional continuing education credit. You will also receive materials needed to learn the Toddler Module, and you can purchase and complete associated post-test materials for obtaining Independent Study credits (LMS-606CE) to receive an additional 12 contact hours of professional continuing education credit for learning the toddler-specific materials.
   2. If you opt to complete your training using the ADOS-2 Training Video Program (LMS-605), you can purchase and complete the associated post-test materials for obtaining Independent Study credits (LMS-605CE) to receive 30 contact hours of professional continuing education credit for learning the materials.
4. Practice using the ADOS-2 on cases that are not part of formal evaluations, and become completely confident that you are familiar with the assessment activities and can apply the coding categories accurately. If you have considerable experience in formal behavioral observation and individual test administration, you may reach this level in as few as 10 practice sessions (2 per module). Otherwise, you may need considerably more practice to obtain competence in administering and coding the ADOS-2.
5. If you are involved in formal research that may be published in peer-reviewed journals, you must also take a research training workshop, which is followed by exercises to establish item coding accuracy to a specific criterion. WPS is not involved in the research training workshops. For information on these courses, please visit: http://psychiatry.weill.cornell.edu/education-training/autism

If you are an ADOS-2 user who is already trained in the ADOS, you should do the following to obtain essential competence in the ADOS-2:

1. Study the ADOS-2 Manual. You can purchase and complete associated post-test materials for obtaining Independent Study credits (LMS-605MCE) to receive 6 contact hours of professional continuing education credit for learning the ADOS-2 Manual.
2. Use the ADOS-2 Training Video Program Upgrade (LMS-606) to obtain additional training focused on the new Toddler Module. You can purchase and complete associated post-test materials for obtaining Independent Study credits (LMS-606CE) to receive 12 contact hours of professional continuing education credit for learning the materials.
3. Practice using the ADOS-2 on cases that are not part of formal evaluations, and become completely familiar with the ADOS-2, including the updated administration, coding, and scoring guidelines and the new Toddler Module.
4. If you are involved in formal research that may be published in peer-reviewed journals, you must also take a research training workshop, which is followed by exercises to establish item coding accuracy to a specific criterion. If you have already received research training in the ADOS, you may need to update it for the ADOS-2. WPS is not involved in the research training workshops. For information on these courses, please visit: http://psychiatry.weill.cornell.edu/education-training/autism

An ADOS-2 clinical training workshop is a two-day course that uses a lecture format to introduce people to the basic principles of administering and scoring the ADOS-2. For more information about ADOS-2, please visit the WPS ADOS-2 Clinical Workshop page.

The ADOS-2 Training Video Program (LMS-605) and its associated post-test materials for obtaining Independent Study credits (LMS-605CE) also provide equivalent content. Either of these provides one of the essential steps towards competence in using the ADOS-2 in everyday clinical practice.

Learning to use the ADOS-2 and diagnosing autism spectrum disorders are two different professional activities. The ADOS-2 training is designed to help professionals learn to competently administer and score the ADOS-2. It is the first step toward that end—becoming fully competent on the ADOS-2 itself requires additional practice beyond the initial training. The ADOS-2 training is not a comprehensive curriculum in autism spectrum diagnosis. Autism spectrum diagnosis involves much more than administration of the ADOS-2; it typically involves a multidisciplinary evaluation of multiple areas of a child’s functioning, of which the ADOS-2 is just one piece.

The ADOS-2 is used in several kinds of practice. In each, the test user's credentials must match the purpose of the use. For example, a medical diagnosis requires a license, such as that of a medical doctor or clinical psychologist; a special education qualification requires a locally recognized license or credential, such as that of a school psychologist; and so on. The ADOS-2 can also be used for purposes other than making a diagnosis. For example, occupational therapists and speech and hearing professionals often use the ADOS-2 for treatment planning and program evaluation. Some speech and hearing specialists also use the ADOS-2 for early childhood screening and program qualification, as mandated by the state where they practice. It may be helpful to check with your local mental health licensing agency, and with colleagues who diagnose autism in your area of practice, with additional questions along these lines.

No. The WPS materials are designed to provide training to individual users only. Completion does not provide the additional materials and experiences required for the skills needed to train others. The ADOS-2 Training Video Program (LMS-605) can be used to train multiple clinical users at a single site.

Further training through the specialized research training course offered by the research community is required before others may be trained. (Please also see FAQs "What is an ADOS-2 research training workshop?" and "Once I have completed an ADOS-2 research training workshop, can I train someone else?")

An ADOS-2 research training workshop is only available to those who have completed the in-person clinical training workshop. Research training focuses on bringing attendees' scoring skills to a high level of inter-rater agreement with the scoring practices of skilled examiners. The heightened level of accuracy is needed to ensure that item-level coding is comparable at different labs in different parts of the world where research is being conducted. Research training workshops are offered by the ADOS-2 authors and their colleagues; WPS is not involved in these courses.

For information about research training workshops, including current dates and locations, please visit the websites for CADB and for UCSF ASD training.

Yes! WPS provides a research discount on all of its test publications for graduate students and for researchers involved in formal, funded research directed at publication in peer review journals. WPS also offers scholarly discounts for educational use of its test materials. You may apply if you are using a WPS-proprietary product (identified by a “W-“ product number) in a research study or if you are planning to use WPS-proprietary products to train students.For information about how to apply for research and educational discounts, click here.

Research suggests that there are not overall practice effects on the ADOS-2. Although children who are given the ADOS-2 repeatedly (such as every month or so) may become more familiar with particular tasks (e.g., they may get better at following a birthday party routine), their scores are generally not affected, and the diagnosis as a whole does not seem to be impacted. The scoring of the ADOS-2 emphasizes the child’s spontaneous initiations and responses to the examiner’s behavior, as opposed to scoring of the tasks themselves. Therefore, it makes sense that becoming more familiar with an activity should not change the child’s scores. Similar observations have been made when the ADOS-2 is used repeatedly with adults with ASD; they may become more familiar with the tasks, but they are consistently classified on the algorithm as having ASD.

Although ADOS-2 scores do not change much on repeated administration, ideally it is better if examinees do not learn the tasks. There should always be good clinical reasons for repeating the ADOS-2, especially if it is administered more than twice within a brief interval. If it is known that the ADOS-2 is going to be repeated during a short period of time, the examiner may want to decide in advance to use different materials from the kit each time when possible (e.g., use one book one time and another the next).

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.

Access to translations is managed by WPS Rights & Permissions (rights@wpspublish.com). Several ADOS-2 translations have been licensed to our international publishing partners and will become available for all research and clinical applications when they are released. The full process of translation, back-translation, author-review, and production generally takes 18 to 24 months. WPS Rights & Permissions can also arrange authorization for academically qualified groups to make research-only translations for the ADOS-2 in languages where no commercial versions are underway. In addition, there are some 15 fully reviewed and authorized translations of the original ADOS, which remain valid and will be useful for users who cannot wait for or undertake the creation of ADOS-2 translations.

For information about formally published ADOS translations and in-development ADOS-2 translations,click here.

To obtain permission to make a translation or to inquire further about translations, please contact WPS Rights & Permissions (rights@wpspublish.com)

It is the firm policy of WPS and the ADOS-2 authors that all ADOS-2 administrations must make use of a written translation that has undergone a formal review and approval process through WPS or one of our licensed international publishing partners. The authors take this position because of their concerns about proper standards of patient care. Experience indicates that translation can significantly affect ADOS-2 scores, and thus the reliability and validity of test results. Only properly reviewed translations can provide results that correspond with those published in the manual and research literature. WPS echoes these concerns, not only in exercising our responsibilities and obligations under international copyright law, but also in protecting the integrity of our proprietary materials across cultures. To help you meet professional standards when conducting assessments with the ADOS-2, WPS will continually work to broaden the availability of the ADOS-2 across language groups and cultures. All uses in translation must have the prior, written consent of WPS.

To obtain permission to make a research translation, or to inquire about available translations, please contact WPS Rights & Permissions (rights@wpspublish.com)

The Comparison Score for the Spanish language translation of the ADOS-2 can be calculated using a procedure identical to that used for the English version. However, the algorithm form for the Spanish language translation does not include the scoring information for the Comparison Score on the form itself.

To calculate this score after completing the algorithm form, there are four options:

1. Refer to Appendix C of the English language ADOS-2 Manual, which includes full scoring information for the Comparison Score for all ADOS-2 Modules for which the score is available (i.e., Modules 1, 2, and 3).

2. Refer to the algorithm page of the English language ADOS-2 protocol form that corresponds to the Spanish language module that was administered. The front and back sides of the English language form can be referenced alongside the scores from the Spanish language administration in order to calculate the Comparison Score.

3. Use the English language ADOS-2 scoring CD in conjunction with the protocol form from the Spanish language administration in order to calculate the Comparison Score.

4. Create an account on www.teacorrige.com for a complimentary web-based calculation of the Comparison Score. Each purchased set of Spanish language protocol forms includes a PIN number and instructions for accessing this web-based calculation. Further information about this system can be found in the Spanish language translation of the ADOS-2 Manual.

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.

As with any clinical assessment, the ADOS-2 should be administered in the language with which the examinee has the most familiarity and comfort. When determining the language of administration of the ADOS-2 for a bilingual examinee, it is important to remember that the goal of the evaluation is to maximize the examinee’s ability to participate in the assessment by minimizing the influence from the language of administration. In this sense, establishing the examinee’s comfort and familiarity with the language of administration is more important than determining which language is “dominant” per se.

Toddler Module and Module 1

The standardization for these modules includes samples of young children with limited receptive and expressive language skills (in any language), and the diagnostic algorithms give greater weight to nonverbal behavior. In order to validly administer the English version of these modules, the examiner should confirm that the examinee has begun to respond to or is comfortable with simple commands and statements in English (e.g., “Look!”). This may be confirmed by gathering information from the caregiver that suggests that the examinee is currently exposed to some English in the context of a therapeutic or educational program or in the home setting.

Modules 2, 3, and 4

These modules have a greater emphasis on spoken language and should be administered in the examinee’s dominant language by a native speaker whenever possible (authorized ADOS-2 translations are available in many languages). For Module 2, if this is not possible, care should be taken to ensure that the examinee understands the examiner at the level of simple phrases and familiar everyday expressions. For Modules 3 and 4, examinees should demonstrate basic proficiency in their comprehension of the examiner’s conversational language and have the ability to verbally express themselves using phrases and simple sentences in the same language. The examiner should have basic familiarity with the examinee’s dialect (inclusive of the examinee’s accent) and subculture-specific uses of language.

During the administration

Once testing is under way, it is acceptable to “code-switch” during the administration of any module, based on the needs of the examinee during the assessment. For example, it is acceptable for the examiner to ask questions in one language, if that is what the examinee understands better, but allow the examinee to answer in the other language. If the bilingual examinee does not respond to the examiner’s presses in one language, it may be necessary to present the press again in the other language.

Testing the limits

At times, the examiner may wish to test the limits and involve the caregiver, asking them to present a few activities using the language they use at home. This observation can help the examiner understand whether the examinee demonstrates different behaviors in different language contexts. When caregivers are asked to assist with administration of an activity, the examiner must help them understand the importance of saying or doing exactly what the examiner asks them to do, without any elaborations or embellishments. Testing the limits in this way provides clinically useful information; however, depending on the extent of change in the examinee’s behavior in different language contexts, it may be necessary to use caution when interpreting the results of the ADOS-2.

Considering the effects of the language of administration

After completion of the testing session, as is true of all assessments, examiners should question whether the examinee’s behavior during testing differed from behavior in other contexts (e.g., by asking the caregiver for their observations). If it is determined that the examinee’s behavior was markedly different and/or the examiner suspects that the language of administration affected the examinee’s social responses or the examiner’s ability to understand the child’s behavior, the data should not be interpreted or it should be interpreted with caution, and such qualifiers should be clearly stated in the summary report and/or relevant database.

Using an interpreter

Regardless of the language of administration, the examiner should have adequate familiarity with both languages of the bilingual examinee whenever possible. There may be clinical situations in which the only possible way to administer the ADOS-2 is with the presence of an interpreter. These situations may range from an examiner who needs minor assistance from an interpreter to comprehend the examinee’s words to an examiner who is mostly reliant on an interpreter to administer activities. When an interpreter is present, it is important to remember that administration through use of an interpreter is nonstandard and may not produce accurate results consistent with those published in the test manual or the research literature. This is particularly true when an interpreter must be relied upon for the majority of the administration. While administering the ADOS-2 with the assistance of an interpreter may provide useful qualitative information as a structured observation, the algorithms generally should not be used or should be interpreted with caution, as they have not been validated for use with an interpreter.

Authorized ADOS-2 translations

When administering the ADOS-2 (or portions of it) in a language other than English, the examiner must use the published translation for that language to be sure that the language used during the administration is standardized. Spanish materials ar­e available through WPS, and materials in other languages are available from our international publishing partners (a list of available translations can be found on the WPS website). When an authorized translation is not available for a given language, it is not possible to provide a standard administration of the ADOS-2 in that language, even if the examiner is a fluent speaker of the language.