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.