ADOS-2

Module 4 — Steven
Fluent Speech
Adolescent/Adult

Steven
Participant ID: ____________________________________________________ Observation/Coding

Gender: Female   Male 

X 1. Construction Task*

2. Telling a Story From a Book

Date of Birth: _____________________________________________________

3. Description of a Picture*
Date of Evaluation: ________________________________________________
4. Conversation and Reporting
27 years
Chronological Age: ________________________________________________
5. Current Work or School*

Catherine Lord
Examiner: ________________________________________________________ 6. Social Difficulties and Annoyance

7. Emotions
Consensus Coding
Other Information: ________________________________________________

8. Demonstration Task
__________________________________________________________________
9. Cartoons*
_______________________________________________________
10. Break

_______________________________________________________ 11. Daily Living*

12. Friends, Relationships, and Marriage

13. Loneliness

14. Plans and Hopes

15. Creating a Story

*optional

Copyright © 2012 by Western Psychological Services. Permission is granted to users of the ADOS-2 Training Video Program to reprint this
form from the ADOS-2 Training Protocols CD for the purpose of individual training only. All other uses of this form, in whole or in part, require
the prior written authorization of Western Psychological Services, 625 Alaska Ave., Torrance, CA 90503-5124, USA; rights@wpspublish.com.
W-605CV(CD4) All rights reserved.
ADOS-2 MODULE 4  1
 Observation
Module 4 — Steven

NOTES

1 Construction Task (optional)

Focus of Observation:
 Does the participant indicate the need for more pieces?
– If so, how does he or she attempt to do so?
(For example, does he or she reach over your arm?
Does he or she vocalize, gesture, or make eye contact?)

 Place the extra blocks out of reach, on the other side of your arm, so
that the participant must reach over your arm to take the pieces (or ask
for them).

 Show and tell the participant where the blocks are located,
and initially encourage the participant to ask for more as needed.

Communication Sample:

2 Telling a Story From a Book

Focus of Observation:
 Obtain a sample of the participant’s spontaneous language and
communication, as well as a sense of what captures his or her interest.

 Evaluate the participant’s response to conventional humor, his or her

spontaneous comments about how the characters in the story are feeling,
and the degree to which he or she can convey continuity in a story.

For sole use with ADOS-2 Training Video Program; not for use in actual administration.

2  ADOS-2 MODULE 4
 NOTES
3 Description of a Picture (optional)

Module 4 — Steven
Focus of Observation:
 Obtain a sample of the participant’s spontaneous language and
communication, as well as a sense of what captures his or her interest.

4 Conversation and Reporting

Focus of Observation:
 To what extent does the participant build on your statements,
elaborate on his or her own statements to provide leads for you, and
take a full role in back-and-forth conversation, particularly about a
topic outside of the immediate context?

 How does the participant report routine and nonroutine events, and
how does he or she describe relationships and emotions?

 Observe features of the participant’s communication, including his or her

use of gaze, facial expression, intonation, and gesture.

For sole use with ADOS-2 Training Video Program; not for use in actual administration.

ADOS-2 MODULE 4  3

 NOTES
5 Current Work or School (optional)
Module 4 — Steven

If the participant is in school full time or does not have a job and has never been employed (including working as a volunteer),
omit the employment questions and proceed to the questions about school.

Focus of Observation:
 Is the participant employed and/or in school?
 Has he or she had to leave jobs? If so, for what reasons?
 Does the participant have a realistic understanding of the possibilities
for future employment?
 What has the participant’s school experience been like?
– Does he or she have a realistic understanding of the training or experience
necessary for future employment?

Interview Questions About Work

 Do you have a job?

If so:
 What kind of job is it? How did you find it?

 Have you had other jobs before?

 Are you happy where you are or would you like to move on to
something else eventually? What would it be?

 What about your co-workers? Do they seem to be happy or are they

ready to move on?

If not:
 What do you do during the day?

 Did you have a job before? Why did you leave your old job?
Was it something you had planned?

 Would you like to have a job someday?

If yes:
– What would it be?

– What will you need to do to find this type of job?

If no:
– What would you like to do?

OR

Interview Questions About School

 Are you in school? Where?

 What courses are you taking?

 What year (grade) are you in? How is it going?

If the participant is no longer in school and not employed:

 How far did you go in school? How did it go?

 What do you plan to do next? What experience/training would you

need to do that?

For sole use with ADOS-2 Training Video Program; not for use in actual administration.

4  ADOS-2 MODULE 4
 NOTES
6 Social Difficulties and Annoyance

Module 4 — Steven
Focus of Observation:
 Evaluate the participant’s perception of social difficulties and his or her
insight into the nature of these problems.
– Has the participant made any attempt to change his or her own behavior
in order to fit in with others more smoothly?

 Pay attention to the participant’s understanding of the appropriateness

and implications of his or her feelings and behaviors.

Interview Questions
 Have you ever had problems getting along with people at school or at
work? How about at home? Do you ever get in trouble? Why? What for?

 Are there things that other people do that irritate or annoy you?
What are they?

 What about things you do that annoy others?

– (If no response, ask: What about your family members?)

 Have you ever been teased or bullied? Why, do you think?

 Have you ever tried to change these things? Have you ever done
anything so that others wouldn’t tease you? How has it worked?

 Are there other people you know who get teased or bullied?

For sole use with ADOS-2 Training Video Program; not for use in actual administration.

ADOS-2 MODULE 4  5

 NOTES
7 Emotions
Module 4 — Steven

Focus of Observation:
 Identify the events or objects that elicit different emotions in the
participant, particularly whether they are social in nature or not.

 Observe how the participant describes his or her emotions.

 Does the participant exhibit facial expressions or creative uses of language

in the context of describing his or her emotions and others’ emotions?

 Does the participant display insight into typical social relationships that
may cause some of these emotions?

Interview Questions
 What do you like doing that makes you feel happy and cheerful?

 What kinds of things make you feel this way? How do you feel when
you’re happy? Can you describe it?

 What about things that you’re afraid of?

 What makes you feel frightened or anxious? How does it feel?

What do you do?

 What about feeling angry?

 What kinds of things make you feel that way? How do you feel “inside”
when you’re angry?

 Most people have times when they feel sad. What kinds of things make
you feel that way?

 How do you feel when you’re sad? What is it like when you’re sad?
Can you describe that?

 How about feeling relaxed or content? What kinds of things make you
feel that way?

For sole use with ADOS-2 Training Video Program; not for use in actual administration.

6  ADOS-2 MODULE 4
 NOTES
8 Demonstration Task

Module 4 — Steven
Focus of Observation:
 Does the participant represent familiar actions in gesture?
– If so, how does he or she do this?
– Does the participant use his or her body to represent an object (e.g., a finger
for a toothbrush) or mime the use of a pretend object?

 Evaluate the participant’s report of a routine event and the pragmatics of

teaching a sequence of actions.

9 Cartoons (optional)
Focus of Observation:
 Observe the participant’s use of gesture and its coordination with speech,
as well as his or her response to humor.

 Obtain an additional language sample from the participant and a sense of

his or her degree of flexibility in adapting a narrative to the audience of
the listener.

 Note any comments the participant makes about emotions and relationships.

10 Break
Focus of Observation:
 How does the participant occupy himself or herself during free time?
– How does he or she respond to your withdrawal from and return
to the interaction?

 Does the participant initiate and participate in an unstructured

conversation or interaction with you at the end of the break?
– If so, how does he or she do this?

For sole use with ADOS-2 Training Video Program; not for use in actual administration.

ADOS-2 MODULE 4  7

 NOTES
11 Daily Living (optional)
Module 4 — Steven

Focus of Observation:
 Obtain factual information about the participant’s level of financial
responsibility.
 Where is the participant living, and how was this arrangement made?
 To what extent is the participant realistic about plans for independence
and the complexities of various living arrangements?

Interview Questions About Money

 What about money? Do you take care of your own money?

 Where does it come from? Who pays your bills?

 Have you ever saved your money to buy something or do something

special? What was it?

Interview Questions
About Residential Arrangements
 Where are you living now?

If living at home with parents:

 Have you ever lived away from your parents?

 What would be different about living on your own?

 Would you like it better?

 What would be difficult?

If living on his or her own:

 How did you find the place where you live now?

 Who do you live with?

 Can you tell me a little about it?

Interview Questions About Leisure Activities

 What do you like to do in your spare time at home?

 What about going out?

For sole use with ADOS-2 Training Video Program; not for use in actual administration.

8  ADOS-2 MODULE 4
 NOTES
12 Friends, Relationships, and Marriage

Module 4 — Steven
Focus of Observation:
 Evaluate how the participant understands the concepts of friendship,
marriage, and other social relationships, and the nature of these relationships.
 Evaluate the participant’s understanding of why a person might want to
be involved in a long-term relationship and of his or her own possible role
in such a relationship.

Interview Questions
 Do you have some friends? Can you tell me about them?
(Note the ages of the friends. It can be helpful to ask for names if the participant
is very general about who his or her friends are. Sometimes the names provided
are family members or professionals or a list of an entire class, which is useful
to know in terms of interpreting the answers to the questions below.)

 What do you like doing together? How did you get to know them?
How often do you get together?

 What does being a friend mean to you?

How do you know someone is your friend?

 How is a friend different from someone whom you just work with
or go to school with?

 Do you have a girlfriend or boyfriend? What is her/his name?

How old is she/he?

 When did you see her/him last?

 What is she/he like? What do you like to do together?

 How do you know she/he is your girlfriend/boyfriend?

 Where do you want to live when you get older?

What kind of place (apartment, house, condo)?

 Whom do you think you would like to live with?

Your family, a roommate(s), by yourself?

 Do you ever think about having a long-term relationship or getting

married (when you are older)?

 Why do you think some people get married or live with a girlfriend
or boyfriend when they grow up?

 What would be nice about it? What might be difficult about being married
or living with a girlfriend or boyfriend? Or living with a roommate?

For sole use with ADOS-2 Training Video Program; not for use in actual administration.

ADOS-2 MODULE 4  9

 NOTES
13 Loneliness
Module 4 — Steven

Focus of Observation:
 Does the participant understand the concept of loneliness?
How does he or she feel it pertains to him or her or to other people?

Interview Questions
 Do you ever feel lonely?

 Do you think other people your age ever feel lonely?

 Are there things that you do to help yourself feel better?

What about things other people do to help themselves feel better
when they’re lonely?

14 Plans and Hopes

Focus of Observation:
 What does the participant anticipate in the future?

Interview Questions
 Do you have plans or dreams for the future of things that you would
like to do, or have, or see happen to you? Tell me about them.

15 Creating a Story
Focus of Observation:
 Observe and evaluate the participant’s creative use of objects in telling
a novel story or creating a newscast or commercial.

For sole use with ADOS-2 Training Video Program; not for use in actual administration.

10  ADOS-2 MODULE 4
 Coding

Module 4 — Steven
 The overall ratings that you assign in this section should be made on the basis of the participant’s behavior throughout the entire
ADOS‑2 administration.

 Ratings should include only behavior that is directly observed during the ADOS‑2 administration and should not be based
on behavior reported or observed in other contexts (e.g., parent report).

 If the participant’s behavior changes in quality after a brief, initial adaptation period, ratings should be based on the period after
the behavior stabilizes.

 Ratings should be assigned immediately after the ADOS‑2 assessment.

 The ratings are organized according to five main groupings: “A. Language and Communication,” “B. Reciprocal Social Interaction,”
“C. Imagination,” “D. Stereotyped Behaviors and Restricted Interests,” and “E. Other Abnormal Behaviors.”

A Language and Communication

Unless stated otherwise, code in relation to chronological age expectations, not in comparison to developmental level or estimated
expressive language skills.

A1. Overall Level of Non-Echoed Spoken Language A2. Speech Abnormalities Associated With Autism
The rating for this item should reflect the majority (Intonation/Volume/Rhythm/Rate)
of the participant’s utterances, not merely the best ones. The focus of this item is on speech abnormalities
For the purposes of the ADOS‑2, a complex sentence that are characteristic of autism. Because of the
is defined as an utterance with two or more clauses. variability within the autism spectrum, speech patterns
Examples include “I didn’t go to the zoo because it in intonation, volume, rhythm, or rate (not articulation)
rained” or “I think wasps are really scary.” In contrast, that are unusual, but not obviously characteristic of
“I have two sisters and one brother” would not be autism, should receive a rating of 1. Code this item
considered a complex sentence. relative to the participant’s expressive language level.

0 = Uses sentences in a largely correct fashion 0 = Appropriately varying intonation, reasonable

(must use some complex speech). volume, and normal rate of speech, with
regular rhythm coordinated with breathing.
1 = Some relatively complex speech (occasional
utterances with two or more clauses), but 1 = Little variation in pitch and tone; rather flat
with recurrent grammatical errors not or exaggerated intonation, but not obviously
associated with use of dialect. peculiar, OR slightly unusual volume,
AND/OR speech that tends to be somewhat
2 = Non-echoed speech is mostly utterances of
unusually slow, fast, or jerky.
at least three words, but without complex
language as described above. 2 = Speech that is clearly abnormal for ANY
of the following reasons: slow and halting;
3 = Non-echoed language is mostly simple
inappropriately rapid; jerky and irregular in
phrases.
rhythm (other than ordinary stutter/stammer),
such that there is some interference with
intelligibility; odd intonation or inappropriate
pitch and stress; markedly flat and toneless
(“mechanical”); consistently abnormal volume.

7 = Stutter or stammer or other fluency disorder

(if odd intonation is also present, code 1 or 2
accordingly).

For sole use with ADOS-2 Training Video Program; not for use in actual administration.

ADOS-2 MODULE 4  11

 A3. Immediate Echolalia A5. Offers Information
Module 4 — Steven

This item pertains to the participant’s immediate The focus of this item is on the participant’s
repetition of the last statement or series of statements spontaneous, appropriate offering of personal
made by the examiner or another person. When information, new to the examiner. It does not have to
coding, do not include repetitions that are a lead-in to a occur in context or be part of a sustained interaction. It
response to the examiner or that are used as a memory can occur as the elaboration of responses to questions,
device in specific tasks. but must include new information, not specified by the
question. It can be related to the participant’s interests,
0 = Does not repeat others’ speech. but should not be related solely to preoccupations.
Comments about facts (e.g., “Did you know that
1 = Occasional echoing.
whales are mammals?”) are not coded here, but can be
2 = Echoing words and phrases regularly, but considered in assigning a rating under “Conversation”
some spontaneous language, which can be later in this section. Comments about relationships or
stereotyped. possessions (e.g., “I have two brothers” or “Our family
has a boat”) can be coded here if they refer to an activity
3 = Speech largely consists of immediate
rather than a list of characteristics or objects. Lists of
echolalia.
multiple characteristics (e.g., “I like to hike, sail, and
fish”) should be counted as one instance of offering
information unless they are part of compulsive listing
A4. Stereotyped/Idiosyncratic Use behavior, which does not receive credit here.
of Words or Phrases
0 = Spontaneously offers information about his
Coding for this item includes delayed echolalia
or her own thoughts, feelings, or experiences
or other highly repetitive utterances with consistent
on several occasions.
intonation patterns. These words or phrases can be
intended meaningfully and can be appropriate to 1 = Occasionally offers information spontaneously
conversation at some level. The focus of the item is on about his or her own thoughts, feelings, or
the stereotyped or idiosyncratic quality of the phrasing, experiences.
unusual use of words or formation of utterances, and/or
2 = Rarely or never offers information
their arbitrary association with a particular meaning.
spontaneously, except about circumscribed
Neologisms and referring to oneself by name should
interests or preoccupations, OR offers
be coded here, as well as clear evidence of a pronoun
information about facts or general knowledge,
error across person (e.g., you or he or she to mean I). Code
including preoccupations or circumscribed
relative to the participant’s expressive language level.
interests.

0 = Rarely or never uses stereotyped or

idiosyncratic words or phrases.

1 = Use of words or phrases tends to be more

repetitive or formal than that of most
individuals at the same level of expressive
language, but not obviously odd, OR
occasional stereotyped utterances or odd
use of words or phrases, with substantial
spontaneous, flexible language as well.

2 = Often uses stereotyped utterances or odd

words or phrases, with some other language.

3 = Frequently uses odd or stereotyped speech,

and rarely uses non-stereotyped spontaneous
speech.

For sole use with ADOS-2 Training Video Program; not for use in actual administration.

12  ADOS-2 MODULE 4
A6. Asks for Information A7. Reporting of Events

Module 4 — Steven
The focus of this item is on the participant’s The focus of this item is on the participant’s ability
spontaneous expression of interest in the examiner’s to select an event spontaneously or in response to the
ideas, experiences, or reactions. This should not be examiner’s general questioning, and to describe it in
part of a preoccupation. When assigning a rating, a comprehensible fashion without requiring specific
exclude asking for information that is not related probes. This should involve a sequential description of
to the examiner, or about the ADOS‑2 materials, or an event outside the immediate environment. Code the
about particular facts not specific to the examiner; “best” example, given the rating constraints described
instead, include these when assigning a rating under below with regard to preoccupations and probes.
“Conversation.” For this item, questions do not
necessarily have to lead to a sustained conversation. 0 = Reports a specific nonroutine event (e.g., a
Questions about relationships or possessions may be holiday, a vacation, a shopping trip) that is
coded here if they refer to the examiner’s experiences not part of any preoccupations or intense
rather than filling in a list. interests and seems likely to be real. Gives a
reasonable account without specific probes,
0 = Asks the examiner about his or her thoughts, but may need to be asked a general question
feelings, or experiences on several occasions. to get started.

1 = Occasionally (at least one clear example) 1 = Gives a reasonable account of a routine event
asks the examiner about his or her thoughts, (e.g., playing a favorite game, usual routine
feelings, or experiences. when he or she arrives home from work or
school) that is not part of a preoccupation
2 = Responds appropriately to examiner’s
or intense interest and seems likely to be
comments about his or her thoughts, feelings,
real. Gives the account without specific
or experiences, but does not spontaneously
probes, but initially may need to be asked to
inquire about them.
describe the event. Include accounts from the
3 = Rarely or never expresses interest in the “Demonstration Task” here.
examiner’s thoughts, feelings, or experiences.
2 = Provides an account of routine or nonroutine
events, but dependent on specific probes, OR
only describes an event that seems unlikely
to have been real.

3 = Inconsistent or insufficient responses, even to

specific probes.

For sole use with ADOS-2 Training Video Program; not for use in actual administration.

ADOS-2 MODULE 4  13

 A8. Conversation A9. Descriptive, Conventional, Instrumental,
Module 4 — Steven

This is a summary item that focuses on the to-and- or Informational Gestures

fro use of words and phrases in social conversation. Code The focus of this item is on descriptive gestures that
this item relative to the participant’s expressive language enact or represent an object or event (such as acting out
level. Code evidence of (or lack of) nonverbal reciprocity rinsing a toothbrush or showing how a roller coaster
under “Amount of Reciprocal Social Communication” in curves through the air). Gestures that are conventional
section B of this protocol. This rating should consider all (e.g., clapping for “well done”), informational, or
opportunities for conversation, not merely the best. instrumental (e.g., pointing, shrugging, head nodding,
or head shaking) receive partial credit. When coding,
0 = Conversation flows, building on the exclude emphatic gestures (e.g., “beats” accompanying
examiner’s dialogue. This rating requires speech, which are rated in the next item); include
that much of the participant’s speech provide behaviors that occur during the “Demonstration Task”
both a response to the examiner’s speech and and throughout the ADOS‑2 evaluation. The emphasis
some additional talking (not necessarily a is on how the participant uses gestures before he or
question) that builds on what has just been she is prompted or asked to do so, or gestures that the
said and allows a response from the examiner participant adds as he or she responds to a requested
(i.e., sequences of at least four elements: description (e.g., pretending to spit after demonstrating
examiner opens, participant comments, how to use a toothbrush, as requested). Pointing is
examiner responds, participant responds to included here as an instrumental gesture, as it is not
response). coded separately in Module 4. Grabbing and reaching
are not coded here.
1 = Speech includes some spontaneous
elaboration of the participant’s own
0 = Spontaneous use of several descriptive
responses for the examiner’s benefit OR
gestures. These gestures may be typical or
provides leads for the examiner to follow,
idiosyncratic, but must be communicative.
but either this is less in amount than would
May also use conventional or instrumental
be expected for the participant’s expressive
gestures.
language level or it is limited in flexibility.
1 = Some spontaneous use of descriptive
2 = Little reciprocal conversation sustained by
gestures, but exaggerated or limited in range
the participant; may follow his or her own
and/or contexts (e.g., occur only during
train of thought rather than participate in an
“Demonstration Task”), OR frequent use of
interchange; may have some spontaneous
conventional or instrumental gestures, but
offering of information or comments, but
rare or no use of descriptive gestures.
little sense of reciprocity.
2 = Some spontaneous use of informational,
3 = Little spontaneous communicative speech
conventional, or instrumental gestures, but
(although there may be much echoed or
rare or no use of descriptive gestures.
noncommunicative speech). This rating can
be used to describe participants who make 3 = No or very limited spontaneous use of
some limited, but very few, responses to conventional, instrumental, informational,
conversational initiations by the examiner. or descriptive gestures.

8 = N/A (e.g., limited by physical disability).

For sole use with ADOS-2 Training Video Program; not for use in actual administration.

14  ADOS-2 MODULE 4
A10. Emphatic or Emotional Gestures

Module 4 — Steven
The focus of this item is on emphatic (e.g., natural,
rhythmic “beats” that often accompany speech) or
emotional gestures (e.g., hand to mouth or hands up for
“wow”). The rating for this item should be assigned on the
basis of the timing of the gestures as they occur during
speech. Other aspects of coordination of gesture, such as
integration with gaze, should be coded under “Language
Production and Linked Nonverbal Communication” or
“Quality of Social Overtures” in section B.

0 = Variety of appropriate emphatic and/or

emotional gestures that are well integrated
with speech.

1 = Some emphatic or emotional gestures,

but exaggerated, OR limited in frequency,
appropriateness, integration, or style.

2 = Odd, excessive, or definitely awkwardly

integrated emphatic or emotional gestures.

3 = No or very limited emphatic or emotional

gestures.

8 = N/A (e.g., limited by physical disability).

For sole use with ADOS-2 Training Video Program; not for use in actual administration.

ADOS-2 MODULE 4  15

 B Reciprocal Social Interaction
Module 4 — Steven

Code in comparison to nonverbal mental age.

B1. Unusual Eye Contact B3. Language Production and Linked

Coding for this item requires that clear, flexible, Nonverbal Communication
socially modulated, and appropriate gaze that is used for The purpose of this item is to code the degree to
a variety of purposes be distinguished from gaze that is which, when the participant vocalizes, the vocalization is
limited in flexibility, appropriateness, or contexts. If the accompanied by subtle changes in gaze, facial expression,
participant is shy initially, and his or her gaze changes and gesture. This item should be coded on the basis of the
markedly and consistently as he or she becomes more vocalizations used, regardless of their frequency. Code
comfortable, do not base the code on earlier impressions. the most typical occurrences, not merely the best ones.
However, if eye contact never improves, coding must be When assigning a rating, include vocalizations used
based on what is observed, even if the participant seems to maintain interaction or to respond to the examiner,
shy. Do not code eye contact that occurs between the as well as initiations. A rating of 8 (uncodable) should
participant and individuals other than the examiner who be assigned by default if one or more of the following
may be in the ADOS‑2 assessment room. behaviors coded earlier in this protocol received a
rating of 2: “Unusual Eye Contact,” “Facial Expressions
0 = Appropriate gaze with subtle changes meshed Directed to Examiner,” or “Descriptive, Conventional,
with other communication. Instrumental, or Informational Gestures.”

2 = Uses poorly modulated eye contact to initiate,

0 = Vocalization usually accompanied by subtle
terminate, or regulate social interaction.
and socially appropriate changes in gesture,
gaze, and facial expression.

1 = Vocalization accompanied by abnormal,

B2. Facial Expressions Directed to Examiner
limited, or less than usual frequency and/or
The rating for this item should indicate whether range of gesture, gaze, and facial expression,
the participant’s facial expressions are directed to the OR use of one modality almost exclusively
examiner for the purpose of communicating affective (e.g., frequent use of gaze, but limited use of
(e.g., enjoyment, frustration) or cognitive (e.g., puzzlement, gesture and facial expression).
skepticism) states. Facial expressions that are directed to
objects or other people in the room, or that are undirected, 2 = Little or no nonverbal communication linked
are not rated here. Appropriate or slightly exaggerated with vocalization.
facial expressions should be coded even if there are also 7 = Some avoidance of direct eye gaze, particularly
odd expressions. at the beginning of the session, perhaps because
of shyness, but shows some modulation and
0 = Directs a range of appropriate facial coordination of language and nonverbal
expressions to the examiner in order to behavior.
communicate affective or cognitive states.
8 = N/A; no vocalization OR no or minimal use
1 = Some direction of facial expressions to the of gesture, facial expression, or socially
examiner (e.g., directs only expressions directed gaze. This code should be assigned
indicating emotional extreme(s), or automatically if the absence of linking can
occasionally directs wider range of be accounted for by the limited frequency
expressions). A participant who has a limited of unusual eye contact, facial expressions,
range of facial expressions, but who directs and/or gestures.
almost all of his or her facial expressions to
the examiner, may be rated here.

2 = Does not direct appropriate facial expressions

to the examiner.

For sole use with ADOS-2 Training Video Program; not for use in actual administration.

16  ADOS-2 MODULE 4
 B4. Shared Enjoyment in Interaction B6. Comments on Others’ Emotions/Empathy

Module 4 — Steven
Rate the participant’s directed pleasure during The focus of this item is on the participant’s
any of the tasks or conversation. This item should not communication of his or her recognition, understanding,
be used to indicate his or her general emotional state and/or response to the feelings of other people or
during the ADOS‑2 evaluation. The rating applies to the characters, real or conveyed in stories or other tasks.
participant’s ability to indicate pleasure to the examiner, Exclude shared enjoyment with the examiner, which is
not just to interact or respond. rated in a preceding item.

0 = Shows definite pleasure appropriate to 0 = Spontaneously communicates clear

context during interactive participation or understanding or labeling of and/or
conversation with the examiner in more than appropriate response to several different
one task or conversational topic. emotions in other people/characters. Labeling
several emotions in others is sufficient but not
1 = Shows some pleasure appropriate to context
necessary if there are other clear indications of
during interactions with the examiner,
understanding and/or appropriate response.
OR shows definite pleasure during one
interaction. 1 = Communicates some understanding, labeling,
or response to an emotion in others (e.g.,
2 = Shows little or no expressed pleasure during
spontaneously and correctly identifies at least
interaction with the examiner, but shows
one emotion in another person/character).
pleasure in his or her own speech or actions
or in noninteractive components of the 2 = No or minimal identification/communication
ADOS‑2 materials or activities. of understanding of emotion in others.

3 = Little or no expressed pleasure during the

ADOS‑2 evaluation.
B7. Insight Into Typical Social Situations
and Relationships
B5. Communication of Own Affect The focus of this item is on the participant’s ability
to provide spontaneous examples of insight into
The focus here is on the participant’s ability to
the nature of social relationships. These can include
convey a range of his or her own emotions using words
ongoing relationships, such as friendships or marriage,
and facial expression, tone of voice, vocalization, and/or
or interactive situations, such as getting along with
gesture. The coding for this item should reflect the range
other students or co-workers, that may be discussed
of emotion and the effectiveness of the communication
in conversation or in response to the socioemotional
(rather than the presence of specific emotions).
questions. Two separate aspects of relationships are
Descriptions elicited during socioemotional questions
coded: (a) the nature of specific relationships (e.g., what
may be rated here, as well as spontaneous comments
is friendship), and (b) the participant’s role in these
and reports.
relationships.

0 = Effective communication of a range of

0 = Shows examples of insight into the nature of
emotions that he or she is feeling or has felt.
several typical social relationships (without
1 = Some description of experiencing several evidence of lack of insight into those same
emotions, but limited effectiveness relationships), including his or her own role
of communication, AND/OR effective in at least one. May show no more than one
communication of at least one emotion. example of inaccurate understanding of other
social relationships.
2 = Some communication about at least one
emotion. 1 = Shows examples of insight into several
typical social relationships, but not into his
3 = Minimal or no communication of his or her
or her own role, OR into only one relationship
own affect.
including his or her own role.

2 = Shows some insight into one typical social

relationship, though not necessarily about his
or her own role in it.

3 = Shows no or limited insight into typical social

relationships.
For sole use with ADOS-2 Training Video Program; not for use in actual administration.

ADOS-2 MODULE 4  17

 B8. Responsibility B10. Amount of Social Overtures/Maintenance
Module 4 — Steven

This item focuses on the participant’s references to of Attention

and descriptions of being responsible for his or her own The focus of this item is on the number of the
actions in typical daily living situations, in responding participant’s attempts to get, maintain, or direct the
to normal social mores and expectations (from getting a examiner’s attention, AND/OR to direct the examiner’s
haircut to finding a job) in an active, independent way. attention to objects, actions, or topics of interest to the
participant. The rating for this item may include verbal
0 = Describes himself or herself as responsible or nonverbal behaviors if they are neither related to
for his or her own actions in several contexts, preoccupations nor aimed at getting objects, but seem to
including dealing with minor problems in function primarily as a method of social contact. Do not
daily living. include requests when rating this item except for a code of 3.

1 = Provides at least one clear indication of being

0 = Frequent attempts to get or maintain the
responsible for his or her own actions, but not
examiner’s attention AND/OR to direct the
consistent across contexts or consistently less
examiner’s attention to objects, actions, or
straightforward than what is described above
topics of interest to the participant.
for a rating of 0. May show no more than one
clear example of a lack of responsibility. 1 = Some attempts at getting, maintaining,
or directing the examiner’s attention as
2 = Shows limited indication of a sense of
described above for a rating of 0, but reduced
responsibility for his or her own actions or
in frequency or the number of different
shows more than one clear example of lack
activities in which they are used.
of responsibility that would be appropriate
for his or her chronological age, taking into 2 = Makes occasional attempts to get, maintain,
account developmental level. or direct the examiner’s attention, including
overtures solely related to preoccupations.

3 = Shows relatively little concern as to whether

B9. Quality of Social Overtures the examiner is paying attention to him or
This is a summary item that focuses on the quality her unless he or she needs help (e.g., initiates
of the participant’s attempts to initiate social interaction social contact only when requesting).
with the examiner, not on the frequency of such 7 = Unusually frequent, intense, or excessive
attempts. Special attention should be given to the form demands for attention.
of the overture and its appropriateness to the social
context. The rating should reflect the majority of social
overtures to the examiner, not merely the best ones.
B11. Quality of Social Response
0 = Effectively uses nonverbal and verbal/vocal This is a summary item that focuses on the
means to make clear social overtures to the participant’s social responses throughout the ADOS‑2
examiner. The overtures must be appropriate evaluation.
to immediate contexts.
0 = Shows a range of appropriate responses that
1 = Slightly unusual quality of some social
are varied according to immediate social
overtures. Overtures may be restricted
situations and presses.
to personal demands or related to the
participant’s own interests, but with some 1 = Shows responsiveness to most social contexts,
attempt to involve the examiner in those but somewhat limited, socially awkward,
interests. inappropriate, inconsistent, or consistently
negative.
2 = Inappropriate overtures; many overtures
lack integration into context AND/OR social 2 = Odd, stereotyped responses, or responses that
quality. This includes the participant’s are restricted in range or inappropriate to the
bringing up preoccupations with little context.
attempt to involve the examiner in them.
3 = Minimal or no response to the examiner’s
3 = No social overtures of any kind. attempts to engage the participant.

For sole use with ADOS-2 Training Video Program; not for use in actual administration.

18  ADOS-2 MODULE 4
 B12. Amount of Reciprocal Social Communication B13. Overall Quality of Rapport

Module 4 — Steven
The focus of this item is on the frequency with which The code for this item is a summary rating
reciprocal interchanges occur during the course of the that reflects the examiner’s overall judgment of the
ADOS‑2 evaluation, using any mode of communication. rapport established with the participant during the
Frequency here is defined both by absolute number of ADOS‑2 evaluation. The rating should particularly
occurrences and distribution across a range of contexts. take into account the degree to which the examiner
The rating for this summary item should describe aspects had to modify his or her own behavior to maintain the
of nonverbal and verbal/vocal behavior that need not be interaction successfully.
coordinated but must result in at least brief reciprocal
interchanges with the examiner (not others who may be 0 = Comfortable interaction between the
present in the ADOS‑2 assessment room). participant and examiner that is appropriate
to the context of the ADOS‑2 assessment.
0 = Extensive use of verbal or nonverbal
1 = Interaction sometimes comfortable, but not
behaviors (at whatever level attained) for
sustained (e.g., sometimes feels awkward or
social interchange (i.e., chat, comments,
stilted, or the participant’s behavior seems
remarks, or nonverbal behaviors that appear
mechanical or slightly inappropriate).
to have reciprocal intent).
2 = One-sided or unusual interaction resulting
1 = Some reciprocal social communication (as
in a consistently mildly uncomfortable session
described above for a rating of 0), but reduced
or a session that would have been difficult if the
in frequency or amount, or in the number
examiner had not continuously modified the
of contexts in which such behaviors occur
structure of the situation beyond the standard
(regardless of the amount of nonsocial talk).
activities in the ADOS‑2 evaluation.
2 = Most communication is either object-oriented
3 = The participant shows minimal regard for
(i.e., to ask for things), OR response to
the examiner, OR the session is markedly
questions, OR echolalic, OR concerned with
uncomfortable for a significant proportion
particular preoccupations; little or no social
of the time.
chat or give-and-take.

3 = Little or no communication with the examiner.

C Imagination
Code this item in comparison to expressive language skills.

C1. Imagination/Creativity
This item should be assigned a rating that reflects
the degree to which any of several forms of creativity/
inventiveness are exhibited by the participant
throughout the ADOS‑2 evaluation, either in his or her
use of objects or through verbal descriptions.

0 = Several different spontaneous, inventive,

creative activities or comments in conversation.

1 = Some creative or make-believe actions, but

limited in range or occurring only in response
to one structured situation (e.g., creating a
story).

2 = Little spontaneous creative or make-believe

actions, OR only actions that are repetitive
OR stereotyped in quality.

3 = No creative or inventive actions (not even

stereotyped or repetitive).

For sole use with ADOS-2 Training Video Program; not for use in actual administration.

ADOS-2 MODULE 4  19

 D Stereotyped Behaviors and Restricted Interests
Module 4 — Steven

Code in relation to chronological age expectations.

D1. Unusual Sensory Interest in Play Material/Person D2. Hand and Finger and Other Complex Mannerisms
Rate the participant’s interest in or unusual behaviors Rate unusual and/or repetitive movements or
associated with sensory aspects of toys or surroundings posturing of the hands and fingers, arms, or body.
(e.g., sniffing, repetitive feeling of texture, licking, Repetitive clapping may be coded here. Do not include
mouthing, or biting, unusually strong interest in the body rocking unless it involves more than the torso.
repetition of certain sounds, unusual or prolonged visual Finger tapping, nail biting, hair twisting, and thumb
examination). sucking are also not coded here. The participant does
If the participant has a preoccupation that is based on not have to watch the movements of his or her fingers or
a sensory interest, this may be coded here as one unusual hands for the movements to be coded here.
sensory interest. For example, if he or she shows an
interest in radiators or plumbing, that is coded later in this 0 = None.
section of the protocol under “D4. Excessive Interest in or
1 = Unusual and/or repetitive hand and finger
References to Unusual or Highly Specific Topics or Objects
mannerisms or complex mannerisms not as
or Repetitive Behaviors.” If the participant is interested in
clear as specified below for a rating of 2.
the radiator in the room because he or she likes to look at
it, as shown by peering at it while tilting his or her head, 2 = Definite finger flicking or twisting, AND/OR
rocking from side to side, and jiggling his or her hands, hand or finger or complex mannerisms,
this should be coded under “D2. Hand and Finger and stereotypies, or posturing. May be brief and/or
Other Complex Mannerisms,” but it may also be coded rare if clear.
here because of the sensory component involved. If the
3 = Mannerisms, as described above, occur
participant likes to look out of the corner of his or her eye
frequently, during at least two different tasks
at the radiator, the corners of the room, the doors on the
or activities, and/or may interfere with the
cabinets, and the slats of the window blinds, but does not
ADOS‑2 assessment.
become overly preoccupied with any of these objects and
does not move in unusual ways as he or she does so, he Specify:
or she should be coded here for unusual sensory interests
but not under “Hand and Finger and Other Complex
Mannerisms” or under item “D4. Excessive Interest…”
If the ADOS‑2 assessment occurs in a room with a
one-way mirror, looking into the mirror is not coded as an
D3. Self-Injurious Behavior
unusual sensory interest. Do not code here for touching the
Rate behaviors that involve any kind of aggressive
pin art. Sensory aversions are also not coded here.
act to self, even if not clearly harmful.

0 = No unusual sensory interests or sensory‑seeking

0 = No attempts to harm self.
behaviors.
1 = Dubious or possible self-injury, and/or rare
1 = Several possible sensory interests not as clear as
but clear self-injury (e.g., one clear example of
specified below for a rating of 2 AND/OR only
biting at own hand or arm, pulling own hair,
one clear occurrence of an unusual sensory
slapping own face, or banging own head).
interest or a sensory‑seeking behavior. One
“possible” sensory interest should be coded 0. 2 = More than one clear example of self-injury,
such as head banging, face slapping, hair
2 = Definite interest in sensory elements of objects
pulling, or self-biting.
or of play materials, OR sensory examination of
himself or herself or others; two or more clear
occurrences must be observed. May be observed
during the same activity.

3 = Definite unusual sensory-seeking behaviors

occur frequently, during at least two different
tasks or activities, and may interfere with the
ADOS‑2 assessment.

Specify:

For sole use with ADOS-2 Training Video Program; not for use in actual administration.

20  ADOS-2 MODULE 4
D4. Excessive Interest in or References to Unusual D5. Compulsions or Rituals

Module 4 — Steven
or Highly Specific Topics or Objects or The emphasis for compulsions or rituals in this
Repetitive Behaviors context is on the participant’s determination to carry
Because circumscribed interests, preoccupations, or out an activity that involves a predictable sequence,
unusual behaviors are often difficult to judge during a brief endpoint, or manner that is not required as part
observation, the focus of this item is on any references that of an ADOS‑2 task (e.g., checking if a wallet is in a
(a) are unexpectedly high in frequency, (b) pertain to an purse; insistence on completing the book used for the
unusual or odd topic, (c) are not well integrated into the storytelling task; careful placement of materials as they
conversation, or any behaviors that (d) pertain to use of were initially presented; reciting a list of classmates as
an object in a manner highly specific to the participant, or friends). Provision of lists should be rated here.
(e) pertain to use of the participant’s own body in a highly
specific manner not clearly associated with behaviors 0 = No obvious activities or verbal routines that
coded under items D1 (Sensory Interests) or D2 (Hand/ must be completed in full or according to a
Finger Mannerisms); for example, putting his or her hands sequence that is not part of the task.
over and/or fingers in his or her ears should be considered
1 = Unusually routinized in speech or activities
here. Persistent aversive reactions that are unusual in form
(includes insistence on finishing the book
and/or intensity to sensory stimuli (e.g., the feel of the
or providing a list that is not relevant to the
laminated picture, the sound of the examiner clearing his
conversation), but no behavior that appears
or her throat) can be coded here as 1, 2, or 3, as appropriate.
clearly compulsive in quality.
Topics that are developmentally or age appropriate should
not be coded here (e.g., a participant with a mental age 2 = One or more activities or verbal routines
of 8 years who repeatedly talks about a recent vacation that the participant has to perform or say
in general terms would not be coded here; if he or she in a special way. The participant appears
repeatedly talks about staying in hotel room 465, that under pressure or becomes anxious if an
behavior would be considered here). activity is disrupted (i.e., compulsive quality
The focus of this item is on the topic of references is present). Include the recitation of lists that
and/or unusual forms of behavior. Use of unusual terms must be completed or that the examiner is
(e.g., stereotyped phrases) and/or lack of conversational asked to record (e.g., friends, favorite foods)
flexibility are coded elsewhere. Behaviors may be coded or insistence that the examiner respond in a
in two ways if they represent separate instances of each specific way.
domain. For instance, if the participant repeatedly says
Specify:
“Do they need room service in room 465?”, uses the same
phrase in several other contexts (“No more room service!”,
“Room service now!”), and makes other statements about
hotel room numbers, this would be coded both here and
under “A4. Stereotyped/Idiosyncratic Use of Words or
Phrases” earlier in this protocol. Repetitive behaviors
involving objects that have a clear sequence (e.g., touching
objects in a particular order) should be coded under the
following item, “Compulsions or Rituals.”

0 = No excessive interest in or references to

unusual or highly specific or restricted topics
or objects or repetitive behaviors.

1 = Occasional references to unusual or highly

specific topics or patterns of interest,
occurring to an unusual degree, or occasional
repetitive behaviors.

2 = Definite, stereotyped, or unusual patterns of

interest that may or may not intrude and/or
interfere with social communication and/or
definite repetitive behaviors.

3 = Definite preoccupation(s) and/or repetitive

behaviors to a degree that interferes with the
ADOS‑2 assessment.
For sole use with ADOS-2 Training Video Program; not for use in actual administration.

ADOS-2 MODULE 4  21

 E Other Abnormal Behaviors
Module 4 — Steven

Unless stated otherwise, code these items without reference to developmental level or estimated expressive language skills.

E1. Overactivity/Agitation E3. Anxiety

This item describes excessive movement or physical Anxiety includes initial wariness or self-consciousness,
agitation. as well as more obvious signs of worry, upset, or concern.

0 = Sits still appropriately throughout the 0 = No obvious anxiety (e.g., trembling or

ADOS‑2 assessment. jumpiness).

1 = Sits, but often fidgets or moves about in the 1 = Mild signs of anxiety or self-consciousness,
chair. Difficulties in the ADOS‑2 assessment especially at the beginning of the ADOS‑2
are not principally due to overactivity or session or in response to specific activities.
agitation.
2 = Marked anxiety throughout the ADOS‑2
2 = Difficulty sitting; moves either in or out of the assessment (may be intermittent or
chair or handles or manipulates objects in a continuous).
way that is mildly disruptive.

3 = Overactive behaviors are difficult to interrupt.

The level of activity disrupts the ADOS‑2
assessment.

7 = Underactive.

E2. Tantrums, Aggression, Negative

or Disruptive Behavior
This item includes any form of anger or disruption
beyond communication of mild frustration or whining.

0 = Not disruptive, destructive, negative, or

aggressive during the ADOS‑2 assessment.

1 = Displays an example of mild disruption,

anger, or aggression or negative behavior
to the examiner (includes verbal threats,
swearing, or a deliberately loud voice).

2 = More than one intentionally disruptive or

negative incident. Loud talking or repeated
swearing is coded here.

3 = Shows marked or repeated temper tantrums

or significant aggression (e.g., throwing
things, hitting or biting others). Screaming or
yelling is included here.

For sole use with ADOS-2 Training Video Program; not for use in actual administration.

22  ADOS-2 MODULE 4
ADOS-2 Module 4 Algorithm

Module 4 — Steven
Participant ID: Steven Examiner: Catherine Lord
Gender: Female Male X Date of Birth: Date of Evaluation: Chronological Age: 27 years

CONVERTING ITEM CODES TO ALGORITHM SCORES

쐍 Convert assigned ratings of 3 to algorithm scores of 2.
쐍 Convert assigned ratings other than 0, 1, 2, or 3 (i.e., 7, 8, and 9) to algorithm scores of 0.
쐍 Transfer assigned ratings of 0, 1, and 2 directly to the algorithm form (do not convert).

Communication
Stereotyped/Idiosyncratic Use of Words or Phrases ......................................................................... (A-4)

Conversation ........................................................................................................................................... (A-8)

Descriptive, Conventional, Instrumental, or Informational Gestures ............................................... (A-9)

Emphatic or Emotional Gestures .......................................................................................................... (A-10)

COMMUNICATION TOTAL

Reciprocal Social Interaction

Unusual Eye Contact ............................................................................................................................... (B-1)

Facial Expressions Directed to Examiner ............................................................................................. (B-2)

Comments on Others’ Emotions/Empathy ......................................................................................... (B-6)

Responsibility .......................................................................................................................................... (B-8)

Quality of Social Overtures .................................................................................................................... (B-9)

Quality of Social Response .................................................................................................................... (B-11)

Amount of Reciprocal Social Communication ..................................................................................... (B-12)

SOCIAL INTERACTION TOTAL

COMMUNICATION + SOCIAL INTERACTION TOTAL

See the back of this form for guidance on how to convert the Communication Total, Social Interaction Total,
and Communication + Social Interaction Total to the ADOS-2 Classification.

Imagination/Creativity (C-1)

Stereotyped Behaviors and Restricted Interests

Unusual Sensory Interest in Play Material/Person ............................................................................. (D-1)

Hand and Finger and Other Complex Mannerisms ............................................................................. (D-2)

Excessive Interest in Unusual or Highly Specific Topics/Objects or Repetitive Behaviors ............ (D-4)

Compulsions or Rituals .......................................................................................................................... (D-5)

STEREOTYPED BEHAVIORS AND RESTRICTED INTERESTS TOTAL

CLASSIFICATION/DIAGNOSIS

ADOS-2 Classification:

Overall Diagnosis:

Copyright © 2012 by Western Psychological Services. Permission is granted to users of the ADOS-2 Training Video Program to reprint this
form from the ADOS-2 Training Protocols CD for the purpose of individual training only. All other uses of this form, in whole or in part, require
the prior written authorization of Western Psychological Services, 625 Alaska Ave., Torrance, CA 90503-5124, USA; rights@wpspublish.com.
W-605CV(CD4) All rights reserved.
ADOS-2 MODULE 4 23
 Converting the Communication Total, Social Interaction Total,
and Communication + Social Interaction Total to the
ADOS-2 Classification
Compare the Communication Total, Social Interaction Total, and Communication + Social Interaction Total to the cutoff scores below for Module 4:

For sole use with ADOS-2 Training Video Program; not for use in actual administration.
COMMUNICATION SOCIAL INTERACTION COMMUNICATION + SOCIAL INTERACTION
autism 3 6 10
autism spectrum 2 4 7
Assign the ADOS-2 Classification:
autism All three totals (Communication Total, Social Interaction Total, combined Communication + Social Interaction Total) are equal to
or greater than the three separate corresponding autism cutoffs:
쐍 All of the following are true: Communication Total is 3 or higher AND Social Interaction Total is 6 or higher AND
Communication + Social Interaction Total is 10 or higher
autism spectrum All three totals (Communication Total, Social Interaction Total, combined Communication + Social Interaction Total) are equal to
or greater than the three separate corresponding autism spectrum cutoffs, but at least one is less than its corresponding autism cutoff:
쐍 All of the following are true: Communication Total is 2 or higher AND Social Interaction Total is 4 or higher AND
Communication + Social Interaction Total is 7 or higher
AND
쐍 At least one of the following is also true: Communication Total is 2; Social Interaction Total is 4 or 5;
Communication + Social Interaction Total is 7 to 9
non-spectrum Any one of the three totals (Communication Total, Social Interaction Total, combined Communication + Social Interaction Total)
is less than the autism spectrum cutoff:
쐍 At least one of the following is true: Communication Total is 1 or lower; Social Interaction Total is 3 or lower;

24 ADOS-2 MODULE 4
Communication + Social Interaction Total is 6 or lower
Record the ADOS-2 Classification on the front of this form in the space marked ADOS-2 Classification.
Module 4 — Steven