Skip to main content

Advertisement

SpringerLink
Log in

Replication and Comparison of the Newly Proposed ADOS-2, Module 4 Algorithm in ASD Without ID: A Multi-site Study

  • S.I. : ASD in Adulthood: Comorbidity and Intervention
  • Published:
Journal of Autism and Developmental Disorders Aims and scope Submit manuscript

Abstract

Recent updates have been proposed to the Autism Diagnostic Observation Schedule-2 Module 4 diagnostic algorithm. This new algorithm, however, has not yet been validated in an independent sample without intellectual disability (ID). This multi-site study compared the original and revised algorithms in individuals with ASD without ID. The revised algorithm demonstrated increased sensitivity, but lower specificity in the overall sample. Estimates were highest for females, individuals with a verbal IQ below 85 or above 115, and ages 16 and older. Best practice diagnostic procedures should include the Module 4 in conjunction with other assessment tools. Balancing needs for sensitivity and specificity depending on the purpose of assessment (e.g., clinical vs. research) and demographic characteristics mentioned above will enhance its utility.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  • American Psychiatric Association. (2000). Diagnostic and statistical manual of mental disorders (4th ed., text rev.). Washington, DC: American Psychiatric Association.

  • American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Washington, DC: American Psychiatric Association.

    Google Scholar 

  • Baio, J. (2014). Prevalence of autism spectrum disorder among children aged 8 years. Autism and Developmental Disabilities Monitoring Network, 14 Sites, United States, 2010. Morbidity and Mortality Weekly Report. Surveillance Summaries. Volume 63, Number 2. Centers for Disease Control and Prevention.

  • Baron-Cohen, S., Wheelwright, S., Skinner, R., Martin, J., & Clubley, E. (2001). The autism-spectrum quotient (AQ): Evidence from Asperger syndrome/high-functioning autism, males and females, scientists and mathematicians. Journal of Autism and Developmental Disorders, 31(1), 5–17.

    Article  PubMed  Google Scholar 

  • Bastiaansen, J. A., Meffert, H., Hein, S., Huizinga, P., Ketelaars, C., Pijnenborg, M., et al. (2011). Diagnosing autism spectrum disorders in adults: The use of autism diagnostic observation schedule (ADOS) Module 4. Journal of Autism and Developmental Disorders, 41(9), 1256–1266. doi:10.1007/s10803-010-1157-x.

    Article  PubMed Central  PubMed  Google Scholar 

  • Bishop, S., & Seltzer, M. (2012). Self-reported autism symptoms in adults with autism spectrum disorders. Journal of Autism and Developmental Disorders, 42(11), 2354–2363.

    Article  PubMed Central  PubMed  Google Scholar 

  • Constantino, J. N., & Gruber, C. P. (2005). Social responsiveness scale (SRS). Los Angeles, CA: Western Psychological Association.

    Google Scholar 

  • Constantino, J. N., & Gruber, C. P. (2012). Social Responsiveness Scale (Second.). Los Angeles, CA: Western Psychological Services.

  • De Bildt, A., Sytema, S., Ketelaars, C., Kraijer, D., Mulder, E., & Volkmar, F. (2004). Interrelationship between autism diagnostic observation schedule-generic (ADOS-G), autism diagnostic interview-revised (ADI-R), and the diagnostic and statistical manual of mental disorders (DSM-IV-TR) classification in children and adolescents with menta. Journal of Autism and Developmental Disorders, 34(2), 129–137.

    Article  PubMed  Google Scholar 

  • Elliot, C. D. (2007). Differential Abilities Scales-II. San Antonio, TX: Harcourt Assessment.

    Google Scholar 

  • Farley, M. A., McMahon, W. M., Fombonne, E., Jenson, W. R., Miller, J., Gardner, M., et al. (2009). Twenty-year outcome for individuals with autism and average or near-average cognitive abilities. Autism Research: Official Journal of the International Society for Autism Research, 2(2), 109–118. doi:10.1002/aur.69.

    Article  Google Scholar 

  • Gotham, K., Pickles, A., & Lord, C. (2009). Standardizing ADOS scores for a measure of severity in autism spectrum disorders. Journal of Autism and Developmental Disorders, 39(5), 693–705.

  • Gotham, K., Risi, S., Pickles, A., & Lord, C. (2007). The Autism diagnostic observation schedule: Revised algorithms for improved diagnostic validity. Journal of Autism and Developmental Disordersmental Disorders, 37(4), 613–627.

    Article  Google Scholar 

  • Gray, K. M., Tonge, B. J., & Sweeney, D. J. (2008). Using the Autism diagnostic interview-revised and the Autism diagnostic observation schedule with young children with developmental delay: Evaluating diagnostic validity. Journal of Autism and Developmental Disorders, 38(4), 657–667.

    Article  PubMed  Google Scholar 

  • Halladay, A. K., Bishop, S., Constantino, J. N., Daniels, A. M., Koenig, K., Palmer, K., et al. (2015). Sex and gender differences in autism spectrum disorder: Summarizing evidence gaps and identifying emerging areas of priority. Molecular autism, 6(1), 36.

    Article  PubMed Central  PubMed  Google Scholar 

  • Harrison, P. L., & Oakland, T. (2003). Adaptive behavior assessment system (2nd ed.). San Antonio, TX: Harcourt Assessment.

    Google Scholar 

  • Howlin, P. (2013). Social disadvantage and exclusion: Adults with autism lag far behind in employment prospects. Journal of the American Academy of Child and Adolescent Psychiatry, 52(9), 897–899. doi:10.1016/j.jaac.2013.06.010.

    Article  PubMed  Google Scholar 

  • Hus, V., Bishop, S., Gotham, K., Huerta, M., & Lord, C. (2013). Factors influencing scores on the social responsiveness scale. Journal of Child Psychology and Psychiatry, 54(2), 216–224.

    Article  PubMed Central  PubMed  Google Scholar 

  • Hus, V., & Lord, C. (2014). The autism diagnostic observation schedule, module 4: Revised algorithm and standardized severity scores. Journal of Autism and Developmental Disorders, 44(8), 1996–2012. doi:10.1007/s10803-014-2080-3.

    Article  PubMed Central  PubMed  Google Scholar 

  • Interagency Autism Coordinating Committee. (2011). The 2011 interagency autism coordinating committee strategic plan for autism spectrum disorder research.

  • Kenworthy, L., Black, D. O., Harrison, B., Della Rosa, A., & Wallace, G. L. (2009). Are executive control functions related to autism symptoms in high-functioning children? Child Neuropsychology, 15, 425–440. doi:10.1080/09297040802646983.

    Article  PubMed  Google Scholar 

  • Le Couteur, A., Rutter, M., Lord, C., Rios, P., Robertson, S., Holdgrafer, M., & McLennan, J. (1989). Autism diagnostic interview: A standardized investigator-based instrument, 19(3), 363–387.

    Google Scholar 

  • Lord, C., Risi, S., Lambrecht, L., Cook, E. H., Leventhal, B. L., Dilavore, P. C. et al. (2000). The autism diagnostic observation schedule–generic: A standard measure of social and communication deficits associated with the spectrum of autism. Journal of autism and developmental disorders, 30(3), 205–223.

    Article  PubMed  Google Scholar 

  • Lord, C., Rutter, M., DiLavore, P. C., & Risi, S. (2002). Autism diagnostic observation schedule. Los Angeles: Western Psychological Services.

    Google Scholar 

  • Lord, C., Rutter, M., DiLavore, P. C., Risi, S., Gotham, K., & Bishop, S. L. (2012). Autism diagnostic observation schedule, 2nd ed. (ADOS-2). Torrance, CA: Western Psychological Services.

  • Lord, C., Rutter, M., & Le Couteur, A. (1994). Autism diagnostic interview-revised: A revised version of a diagnostic interview for caregivers of individuals with possible pervasive developmental disorders. Journal of Autism and Developmental Disorders, 24, 659–685.

    Article  PubMed  Google Scholar 

  • Papanikolaou, K., Paliokosta, E., Houliaras, G., Vgenopoulou, S., Giouroukou, E., & Pehlivanidis, A. (2009). Using the Autism diagnostic interview-revised and the Autism diagnostic observation schedule-generic for the diagnosis of Autism spectrum disorders in a Greek sample with a wide range of intellectual abilities. Journal of Autism and Developmental Disorders, 39(3), 414–420.

    Article  PubMed  Google Scholar 

  • Pugliese, C. E., Anthony, L., Strang, J. F., Dudley, K., Wallace, G. L., & Kenworthy, L. (2015). Increasing adaptive behavior skill deficits from childhood to adolescence in autism spectrum disorder: Role of executive function. Journal of Autism and Developmental Disorders, 45, 1579–1587.

    Article  PubMed  Google Scholar 

  • Rutter, M., Bailey, A., Berument, S. K., Le Couteur, A., & Lord, C. (2003). Social communication questionnaire (SCQ) manual. Los Angeles, CA: Western Psychological Services.

    Google Scholar 

  • Seltzer, M. M., Krauss, M. W., Shattuck, P. T., Orsmond, G., Swe, A., & Lord, C. (2003). The symptoms of autism spectrum disorders in adolescence and adulthood. Journal of Autism and Developmental Disorders, 33(6), 565–581.

    Article  PubMed  Google Scholar 

  • Shattuck, P. T., Seltzer, M. M., Greenberg, J. S., Orsmond, G. I., Bolt, D., Kring, S., et al. (2007). Change in autism symptoms and maladaptive behaviors in adolescents and adults with an autism spectrum disorder. Journal of Autism and Developmental Disorders, 37(9), 1735–1747. doi:10.1007/s10803-006-0307-7.

    Article  PubMed Central  PubMed  Google Scholar 

  • Sparrow, S., Balla, D. A., & Cicchetti, D. (1984). Vineland Adaptive Behavior Scales (expanded form). Circle Pine, MN: American Guidance Service.

    Google Scholar 

  • Sparrow, S., Cicchetti, D., & Balla, D. A. (2005). Vineland adaptive behavior scales second edition: Survey forms manual. Minneapolis, MN: Pearson.

    Google Scholar 

  • Taylor, J. L., & Seltzer, M. M. (2010). Changes in the autism behavioral phenotype during the transition to adulthood. Journal of Autism and Developmental Disorders, 40(12), 1431–1446.

    Article  PubMed Central  PubMed  Google Scholar 

  • Volkmar, F. R., Langford Booth, L., McPartland, J. C., & Wiesner, L. A. (2014). Clinical evaluation in multidisciplinary settings. In Handbook of autism and pervasive developmental disorders, 4th edition (pp. 661–672).

  • Wechsler, D. (1991). Manual for the Wechsler Intelligence Scale for children (3rd ed.). San Antonio, TX: The Psychological Corporation.

    Google Scholar 

  • Wechsler, D. (1997). Wechsler adult intelligence scale (3rd ed.). San Antonio, TX: The Psychological Corporation.

    Google Scholar 

  • Wechsler, D. (1999). The Wechsler Abbreviated Scale of intelligence. San Antonio, TX: The Psychological Corporation.

    Google Scholar 

  • Wechsler, D. (2003). Wechsler Intelligence Scale for children-fourth edition, administration and scoring manual. San Antonio, TX: Harcourt Assessment Inc.

    Google Scholar 

  • Wechsler, D. (2008). Wechsler adult intelligence scale: Technical and interpretive manual (4th ed.). San Antonio, TX: Pearson.

    Google Scholar 

Download references

Acknowledgments

This work was supported in part by an award from the Isadore and Bertha Gudelsky Family Foundation and the Fredrick and Elizabeth Singer Foundation, and grants by the Organization for Autism Research, Autism Speaks (Dennis Weatherstone Predoctoral Fellowship), the Philadelphia Foundation, Pfizer, Shire Pharmaceuticals, Robert Wood Johnson Foundation (#6672), the Pennsylvania Department of Health (SAP #4100042728, SAP # 4100047863), and the National Institutes of Health and the Intramural Research Program at NIMH (1-ZIA-MH002920-05, P30HD040677, T32 HD046388-01A2, 1K01MH079945-01, K23MH086111, R21MH092615, RC1MH088791, and P30HD026979). We gratefully acknowledge Catherine Lord, PhD for contributing data for comparative analyses; those data were funded by R01MH081873 to CL.

Author Contributions

Dr. Pugliese designed the study, conducted the statistical analyses, wrote the initial draft of the paper, and participated in revising the manuscript and addressing the reviewers’ comments. Dr. Anthony assisted in designing the study, guiding analyses, assisting with manuscript development, participated in revising the manuscript and addressing the reviewers’ comments. Drs. Kenworthy, Hus-Bal, Wallace, Yerys, Maddox, White, Miller, Herrington, Schultz, and Martin assisted with manuscript development, provided guidance on statistical analysis, and participated in revising the manuscript and addressing the reviewers’ comments. Ms Armour and Mr. Popal collected data, built the databases, and reviewed the manuscript.

Author information

Authors and Affiliations

  1. Center for Autism Spectrum Disorders & Children’s National Research Institute, Children’s National Health System, Washington, DC, USA

    Cara E. Pugliese, Lauren Kenworthy, Anna Chelsea Armour & Laura Gutermuth Anthony

  2. Department of Psychiatry, University of California San Francisco School of Medicine, San Francisco, CA, USA

    Vanessa Hus Bal

  3. Department of Speech and Hearing Sciences, George Washington University, Washington, DC, USA

    Gregory L. Wallace

  4. Center for Autism Research, Children’s Hospital of Philadelphia, Philadelphia, PA, USA

    Benjamin E. Yerys, Brenna B. Maddox, Judith Miller, John D. Herrington & Robert T. Schultz

  5. Department of Psychiatry, Perelman School of Medicine - University of Pennsylvania, Philadelphia, PA, USA

    Benjamin E. Yerys, Judith Miller & John D. Herrington

  6. Department of Psychology, Virginia Tech, Blacksburg, VA, USA

    Brenna B. Maddox & Susan W. White

  7. Laboratory of Brain and Cognition, National Institute of Mental Health, Bethesda, MD, USA

    Gregory L. Wallace, Haroon Popal & Alex Martin

  8. Department of Pediatrics, University of Pennsylvania, Philadelphia, PA, USA

    Robert T. Schultz

Authors
  1. Cara E. Pugliese
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Lauren Kenworthy
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Vanessa Hus Bal
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Gregory L. Wallace
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Benjamin E. Yerys
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Brenna B. Maddox
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Susan W. White
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Haroon Popal
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Anna Chelsea Armour
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Judith Miller
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. John D. Herrington
    View author publications

    You can also search for this author in PubMed Google Scholar

  12. Robert T. Schultz
    View author publications

    You can also search for this author in PubMed Google Scholar

  13. Alex Martin
    View author publications

    You can also search for this author in PubMed Google Scholar

  14. Laura Gutermuth Anthony
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Cara E. Pugliese.

Ethics declarations

This project involved human subjects and was conducted in compliance with standards established by all institution’s IRB including procedures for informed consent. This research did not involve the use of animals.

Conflict of interest

There are no financial or non-financial conflicts of interest to declare.

Electronic supplementary material

Below is the link to the electronic supplementary material.

Supplementary material 1 (DOC 61 kb)

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Pugliese, C.E., Kenworthy, L., Bal, V.H. et al. Replication and Comparison of the Newly Proposed ADOS-2, Module 4 Algorithm in ASD Without ID: A Multi-site Study. J Autism Dev Disord 45, 3919–3931 (2015). https://doi.org/10.1007/s10803-015-2586-3

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10803-015-2586-3

Keywords

Search

Navigation