Observation Scale for the Diagnosis of Autlsmo-2

Verbal fluency (children and adolescents)

This section provides an overview of Module 3. It

includes the basic rules for preparing the assessment
room and for guiding the implementation of Module
3, followed by specific instructions for each activity.
Module 3 of the ADOS-2 consists of 14 activities
with 29 items. The activities are tasks and questions
which are applied by the examiner and which allow for
a standardised observation of the examinee. The
items, on the other hand, are the aspects of behaviour
on which the examiner should focus during the
assessment. The examiner codes each item according
to the general coding rules and the specific coding
一 for each item in the Module 3
criteria indicated
protocol.
Before applying or coding module 3, it is important
to be familiar with all its items and the corresponding
codes. During the specific activities, or immediately
after them, the examiner should
take notes on behaviours that may influence coding (e.g. smiling or volunteering information). Item coding
should always be done immediately after the session, based on the live application. As indicated in the coding
instructions for each item, in some cases coding should be based on the respondent's best performance, while
in others it should be based on the consistency of the respondent's responses or the examiner's need to repeat
certain pressures.Several codes refer to the coordination of eye contact with oral or gestural behaviours.This
implies a skilful connection or fit between eye contact and vocalisations or gestures used for communicative
purposes, not just the simultaneous use of the different behaviours.
This module is intended for use with children and adolescents between the ages of 4 and 16 years and who
are 'fluent' in language ('fluent' being defined as the level of functional expressive language that characterises
children of at least 4 years of age). Some 3-year-olds are "very verbal" and have a sufficient level of language for
Module 3, although certain questions or tasks may need to be modified slightly to suit their age. Module 3
should not be applied to 2 year olds, even if they have sufficient language level (2 year olds with fluent speech
should be assessed with Module 2).

Table 2.5. Materials used in module 3

Observation Scale for the Diagnosis of Autlsmo-2

Activities Materials needed

1. Deconstruction task Puzzle pieces and printed model to be reproduced.

Bag 3: 2 male action figures, 1 female action figure, 3
accessories (one for each action figure), a miniature hairbrush, 2
small tools and a toy dinosaur.
Bag 2: miniature spoons, miniature plates, various miniature
2. Symbolic play food items, a small measuring jug, a miniature book, a toy truck,
a toy rocket, a miniature ball, a hologram disc and two worthless
items (a small piece of cloth and a small box of 《jewellery").

3. Joint interactive play Symbolic play" materials (bags 2 and 3).

4. Demonstration task Hand towel and soap (if necessary).
5. Description of an image World map poster and holiday poster.
6. Tell a story from a book Two books of illustrated stories from modules 3 and 4.
Series A: series of the fisherman and the pelican.
7. Bullet points
Series B: monkeys and coconuts series
8. Conversation and narration of events .
9. Emotions -
10. Social difficulties and discomfort 一
Mini-game (pinball), blank sheet of paper, pack of 8 markers,
11. Rest pin art set, marker pen (or spinning top), small radio, a
newspaper and a current affairs magazine.

12. Friendships, relationships and marriage 一

13. Soledad -
6 small objects with a defined function (e.g. an umbrella.a
14. Make up a story car) and 6 small objects without a defined function (e.g. a
string.a wooden stick).

Note: Some of the materials listed are also used in other ADOS-2 modules.

Preparation of the evaluation room for the implementation of Module 3

Pay particular attention to the physical layout of the assessment site, including the available furniture and
space, in order to select the most appropriate arrangement. In order to encourage communication and rather
informal reciprocal interactions, it is usually more appropriate to have an arrangement in which you and the
evaluee are seated diagonally across the corner of a table or side by side at a round table. It is preferable to avoid
any physical arrangement in which you and the evaluee are sitting across the table from each other, as this may
suggest an "examining" or confrontational situation.
Start of implementation of Module 3

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Observation Scale for the Diagnosis of Autlsmo-2

-The structure and approach is such that the majority of people with ASD or with other disorders

have an unstructured conversation.

During the implementation of Module 3

During the implementation of module 3, you should structure the interaction. The following
guidelines may be helpful:
Aim for a standardised application of 40-60 minutes. If the respondent provides information that
may be clinically relevant (e.g., appears distressed while reporting being bullied or describes
depressive symptoms), respond with a sincere but brief show of empathy and support, assuring
the respondent that these issues will be addressed as soon as the activities are completed.
Remember to return to these issues as soon as the ADOS-2 application is completed, but do not
take this additional information into account in the coding.
1Encourage and, to some extent, structure the task-oriented aspects of the assessment without
directly eliciting the specific behaviours. Your ability to conduct the application in this style is
crucial to allow the appraisee to show his or her own level of social behaviour.
1 Avoid providing so much help that there is no opportunity to observe the respondent's
spontaneous behaviour. Conversely, avoid providing so little structure that the evaluee feels
uncomfortable.
Be both active and interactive with the aim of producing appropriate pressures for socio-
communicative exchanges. However, unless otherwise specified, the codes are based
primarily on the initiatives of the examinee in creating, using and developing these
opportunities, rather than on his/her reactions to the examiner's behaviour, creativity or use
of the materials.
Do not constantly strive to maintain the interaction. The respondent should be provided with
some clear opportunities to initiate and maintain interaction. For example, sometimes you
may have to be quiet or allow an "awkward silence" to last for a few moments.
Be careful not to code stereotyped or imitative responses as displays of creativity. ADOS-2 is a
relatively concise set of observations, so do not expect great displays of originality.

Take opportunities to assess the learner's language skills and communication style
throughout the session. Follow the learner's lead when relevant. Communication style is much
better assessed on the basis of language production during reciprocal conversational exchanges
than through question-answer questioning. This means that
des. Conversational exchanges can (and should) occur also during the other activities, not only
during the activity specified as "Conversation and narration of events".
During the session, encourage and praise the respondent appropriately and clearly compare his/her
enjoyment of the activities.

Observe if the examinee repeatedly exhibits unusual or inappropriate behaviours or social

disinhibition (e.g., touching the examiner's hand, picking his/her nose, etc.). If this happens, ask
the test taker in an obvious way to stop these behaviours or try to avoid them. For example,
interrupt the examinee while he/she is listing a long list of dates. This attempt will allow you to
determine how much the respondent's behaviour interferes with the interaction, as well as how
the respondent responds when interrupted.

Note that several of the tasks are organised in such a way that there are two or more
opportunities for the test taker to display the behaviour to be coded. For example, the activity
Observation Scale for the Diagnosis of Autlsmo-2

'Description of a picture' includes two possible pictures. In general, it is not necessary to provide
additional opportunities if during the first opportunity the assessee has exhibited the
behaviours that constitute the aspects to be observed.

This section includes the specific instructions for each of the activities in module 3: objective of
the activity, materials needed, instructions for implementation and aspects to be observed. In each
set of instructions, verbal instructions addressed to the assessed are written in bold. The plain text in
inverted commas are explicit instructions to be said literally (as written). Sentences in italics
represent examples of what the examiner may say. (A single word or expression written in italics
represents emphasis, a standard usage throughout the ADOS-2 manual; see, for example, "Response
to joint attention").

Construction task

Objective: This task serves as a warm-up activity and as an opportunity to observe the
respondent's interactive behaviour during a structured activity. For this reason, the task
should be easy for the respondent to complete and should have a clear end product (so that
the respondent can see how many pieces are missing). In addition, the task allows to observe
whether and how the respondent asks for help within the context of a structured task.

In this task, the test taker is asked to complete the puzzle with the pieces necessary to
reproduce the design or model printed on the accompanying sheet. The purpose of the task is
solely to create an opportunity for the test taker to ask for help, not to measure motor or
visuospatial skills.

Materials: Puzzle pieces and printed model.

Instructions:

Take all the puzzle pieces out of their packaging and place them on the table so that the
respondent can see them but cannot reach them. It is essential that you sit far enough
away from the respondent so that you can place the pieces out of reach.

Conversation can be introduced before or after what is indicated in the standard sequence of
activities. Conversational exchanges can (and should) also occur during the other activities, not only
during the activity specified as "Conversation and narration of events".
During the session encourage and praise the learner appropriately and clearly share your
enjoyment of the activities.

Observe if the examinee repeatedly displays unusual or inappropriate behaviours or social

disinhibition (e.g., touching the examiner's hand, picking his/her nose, etc.). If this happens, ask the
test taker in an obvious way to stop these behaviours or try to avoid them. For example, interrupt
the examinee while he/she is listing a long list of dates. This attempt will allow you to determine
Observation Scale for the Diagnosis of Autlsmo-2

how much the respondent's behaviour interferes with the interaction, as well as how the
respondent responds when interrupted.

Note that several of the tasks are organised in such a way that there are two or more
opportunities for the test taker to display the behaviour to be coded. For example, the activity
'Description of a picture' includes two possible pictures. In general, it is not necessary to provide
additional opportunities if during the first opportunity the test taker has exhibited the behaviours
that constitute the aspects to be observed.

This section includes the specific instructions for each of the activities in module 3: objective of
the activity, materials needed, instructions for application and aspects to be observed. In each set of
instructions, the verbal indications addressed to the assessed person are written in bold. The plain
text in inverted commas are explicit instructions to be said literally (as written). Sentences in italics
represent examples of what the examiner may say (a single word or expression 《Response to joint
attention').

Construction task

Objective: This task serves as a warm-up activity and as an opportunity to observe the
respondent's interactive behaviour during a structured activity. For this reason, the task
should be easy for the respondent to complete and should have a clear end product (so
that the respondent can see how many pieces are missing). In addition, the task allows to
observe whether and how the test taker asks for help within the context of a structured
task.
In this task, the test taker is asked to complete the puzzle with the pieces necessary to
reproduce the design or model printed on the accompanying sheet. The purpose of the
task is solely to create an opportunity for the test taker to ask for help, not to measure
motor or visuospatial skills.

Materials: Puzzle pieces and printed model.

Instructions:
Take all the puzzle pieces out of their packaging and place them on the table so that the
respondent can see them but cannot reach them. It is essential that you sit far
enough away from the respondent so that you can place the pieces out of reach.
Place the design or model sheet in front of the test person, pointing to the pieces and
the model, and say: "I want you to put these pieces together to look like this picture.
You have to use all the pieces. You can start with these (bring some of the pieces close
to the test person), and if you need more pieces, let me know.
← Leave the remaining pieces on the table, in view but out of reach of the test taker, and on
the other side of his or her (the examiner's) arm. Make some sort of gesture to show the
pieces that have been put away and make sure that the examinee can see these
additional pieces. When the evaluee has placed the pieces you have provided, wait to
see if he/she asks you for the remaining pieces. If he does, give him more pieces, one at
a time. If the evaluee does not do anything, look at him/her deliberately.
Observe whether the test taker responds to your (the examiner's) direct gaze. If he/she does
not respond to your direct gaze within three to five seconds, point to the test taker's
Observation Scale for the Diagnosis of Autlsmo-2

pieces and say: "Are you doing it right? or "How are you doing? If the test taker does
not respond to this little general help, you can use more specific help by asking: "Do you
need more pieces?
1Continue the task until all the puzzle pieces are in place. When the task is completed, place
the box of puzzle pieces in front of the respondent and open it, then put away some of
the pieces while saying, "Let's do something else. Wait to see if the respondent helps
you put away the remaining pieces.
Special application guidelines: Make sure that the task does not take more than a few
minutes and that it is not frustrating for the evaluee due to the visuospatial or motor demands
it requires. For this reason, two versions of the design are provided, one on each back of the
printed sheet: one with lines delineating the position of each piece and one without. On the
other hand, if the evaluee proves unable to complete the model, you can complete most of the
puzzle for him/her and ask him/her to finish it.

Aspects to observe: Observe and assess whether the examinee indicates that he/she needs
more pieces and, if so, how (e.g., does he/she reach over the examiner's arm to reach the
pieces him/herself? Does he/she verbalise, gesture or make eye contact).

Symbolic play

Aim: The purpose of this activity is to observe the creative or imaginative use of toys and ぶ
111111miniatures in an unstructured task.

Materials: Contents of bag 3: two male action figures, one female action figure, three
accessories (one for each action figure), a miniature hairbrush, two small tools and a toy
dinosaur. Contents of bag 2: two miniature plates and two miniature spoons, several miniature
food items, a small measuring jug, a small book, a toy truck, a toy rocket, a miniature ball, a
hologram disc and two worthless items (a small piece of cloth and a small "jewellery" box). Other
materials from module 2 (i.e. bag 1) can be added if necessary, but because it requires somewhat
less creativity, this difference from the standard presentation should be taken into account in the
coding.

Instructions:
Introduce the action figures with descriptions based on their physical appearance (e.g., "Here is
a princess, a fighter, a soldier and his pet, and a dinosaur").
Take the materials out of bag 2, saying: "Here are some of your things. Could you play
with them for a while?
Observe the child's behaviour. If the child does nothing or seems uncomfortable, after a
while say: "I'll play with these".
Take some objects and use them in a simple but creative way, without including the test
taker in the game. The aim of this is to exemplify a symbolic use of the objects that is
simple enough in scope to give the respondent plenty of freedom to demonstrate his or
her own creativity. Describe the things you do as you act them out. Then say:《 "What are
you going to do with yours?", while pointing to the rest of the objects.
Make comments, show interest and encourage the test taker during the task. However, be
careful not to tell him/her exactly what to do. Sometimes it is useful to ask about what he/she
is doing (e.g. "What is happening now?"). Asking about what has happened before can also
stimulate a response without being directive (e.g., "How did that happen?", "Who is this? or
"Where did you come from? However, it is of utmost importance to distinguish between the
test taker's creative use of objects and mere copied actions of the examiner or answers to the
examiner's questions.
Observation Scale for the Diagnosis of Autlsmo-2

Special application guidelines; If the requirement to play in front of the examiner does not
seem appropriate for the test taker, you can frame the activity within the framework of
creating a video game, music video or television programme. However, please note that the
purpose of this task is to observe a game which has no specific objective, which is interactive
and therefore different from the 'Making up a story' activity presented later in the assessment.
Aspects to observe: Observe the extent to which the examinee produces imaginative
sequences of ininhumnnainntii actions involving the use of materials beyond their most
obvious intention. Pay particular attention to whether and how the evaluee handles dolls and
action figures as animate beings and represents them interacting with each other. In addition,
note any repetitive or sensory interest in the materials. Also note social initiations,
spontaneous language, facial expressions, gestures, and how the evaluee reacts to your
actions.

Joint interactive game

Aim: The aim of this activity is to assess the degree and quality of coordination of the
examinee's behaviour with the examiner and how it is affected by the examiner in a joint
interactive game. To achieve this objective it is crucial that you as the examiner set up the
situation in such a way that it is clear that the game is intended to be collaborative. After you
have played together, there will be an opportunity to observe whether the examinee helps you
to put the materials away.

Materials: "Symbolic play" materials (bags 2 and 3).

Instructions
Start this activity after the evaluee has had enough opportunities to initiate symbolic play on
his/her own (as described in the "Symbolic play" instructions).
Redefine the task by saying: "Can I play too? Who can I be?》 or "Now I would like to play
with you" and immediately proceed to manipulate the objects to produce pressure for
interactive play. For example, you can have your action figure give something to the evaluee
figure.

A
Observe the respondent's reaction. If the respondent responds, respond in turn and then
pause, giving the respondent a chance to start the game. If the respondent does not react,
try some other interactive game.
If the respondent does not react, carry out up to four attempts to evoke interactive play,
using your imagination to think of appropriate ways to achieve interactive play. Add more
complex components as possible (e.g., choosing a third figure to approach or intervene or
commenting on what is happening).
Avoid directing the game too much. However, it can sometimes be useful to say something like
"Who do you want to be? I will be the fighter" and, if necessary, hand the test taker one of the
action figures and say: "Can you be the soldier? It can also be useful to imitate what the test
taker is doing in a positive way. For example, say: "&Can I do that too?" and imitate the actions
of the evaluee. Observe the respondent's reaction and modify your action to see if, in turn, the
respondent modifies it in the same way.

5Be sure to get into the spirit of the game and show clear signs of enjoyment or concern (or
whatever emotion is appropriate) depending on what happens in the game.
Allow the joint play to continue for a few minutes. Then tell the evaluee that it is time to
move on to another activity, and give him/her the opportunity to help you collect the
materials.
Observation Scale for the Diagnosis of Autlsmo-2

Aspects to observe: Observe the reciprocity and shared enjoyment shown by the evaluee in the
interactive game. The aim is for the respondent (and not the examiner) to develop the
interaction and to provide a novel initiative that goes beyond a direct response to the
examiner's proposals or initiations. Take note of whether the evaluee is able to suggest ideas
for the game or is able to follow and participate in your (the examiner's) proposals about what
might happen in the game sequence.

Demonstration task

Objective: The purpose of this activity is to assess the ability of the test taker to convey a series of
everyday actions using gestures or mime accompanied by language and to describe a routine or
habitual event. In this task, the test taker is asked to demonstrate how to brush his/her teeth
and then how to wash his/her hands (if necessary).

Materials: A hand towel and soap (if necessary).

Instructions:
Start the task by saying: "Now we are going to play a different imagination game: are going to
pretend that I don't know how to brush my teeth, so I need you to teach me.
Set up the imaginary scene by making the corresponding gestures (if necessary, indicate to the
client that he/she has to wait and pay attention during this process). Say: "Let's imagine that
this is a bathroom sink, this is the hot water tap and this is the cold water tap". Pretend to
draw a sink and the taps on an area of the table in front of the evaluee. Say: "This is the
toothbrush". Pretend to draw the toothbrush. Say: "This is the toothpaste". Then say, "And
this is a glass". Again, pretend to draw the simulated objects. Gestures should be done slowly
and without adding extraneous movements.
Avoid acting out any aspect of the task (e.g., turning on the tap) unless it is necessary for the test
taker to begin; this is important because the test taker will not be able to receive a score if
he/she makes a gesture that you have already made.

Repeat, "Now I want you to teach me and tell me how you brush your teeth. Start from the
beginning. You have gone into the bathroom to brush your teeth. What are you doing now?
Watch the test taker's performance. If the evaluee performs an isolated action very quickly and
conventionally or mimes (pantomimes) without speaking, say: "That's very good, now tell me and
show me again from the beginning what you are doing, from the moment you entered the
bathroom". Similarly, if the respondent speaks without making any gestures, say: 《 That's very
good. Now you can try again, but this time show me and tell me how you do it at same time》.
- Determine whether the respondent has understood the task. If he/she has not understood the idea
of the task well, describe the scenario again in the same way. If the respondent continues to show
a clear lack of understanding of the task (i.e., the respondent looks lost and does not attempt the
task), you can demonstrate (in very simple terms) an entirely different action before continuing
with the alternative handwashing task (e.g., using words and gestures to act out how to drive a car
by first inserting the key, starting the engine and holding the steering wheel). Note that a different
action should only be acted out if the respondent has not understood the task; you should not
act it out just because the respondent makes a mistake in integrating gestures with language.
Continue with handwashing. Guide this rehearsal in a similar way as with the action of brushing
teeth, this time explicitly setting the scene by pointing out the following simulated objects: a soap,
a hand towel and a sink with taps.
Observation Scale for the Diagnosis of Autlsmo-2

Say: "Now I want you to show me how you wash your hands using soap. If the respondent does
not seem to understand the task, act out the scene again, this time using the real towel and soap
with the fictitious sink. The rationale for including these real materials is so that those learners who
are unable to re-enact or explain the routine act can complete the activity with some perception of
success.
Aspects to observe: Determine whether the test taker can represent everyday actions using gestures
and innhumnminn how he/she does this, in particular whether he/she uses his/her body to represent
an object (e.g. a finger as a toothbrush) or simulates the use of an imaginary object. The task also
provides an opportunity to assess the respondent's narration of a routine action and the pragmatics of
teaching a sequence of actions.

Description of an image

Objective: The purpose of this activity is to generate a sample of language or other mini-
communicative behaviour.

Materials: World map sheet and holiday sheet. Both sheets should be available, but generally only one
will be used for each assessment. The simpler banquet poster from Module 2 can be used as an
alternative if it is more appropriate to the developmental level or interest of the test taker.

Instructions:

Say to the evaluee: "Now let's look at this picture. Can you tell me something about it? What's
going on? The aim is to generate a language sample, so encourage the respondent to comment on
the picture and respond positively to what the respondent says.
Show enthusiasm and interest in what the respondent is saying, but do not provide the most important
information about the image being described. For example, if the respondent says "This looks like
a boat, you might say: "I've never been on one, have you?" If the respondent points to the camel
and says "Look, it's close to the lion", you should say "You're right" or "That's true. Have you
seen a lion or a camel?" Notice if the evaluee relates the picture to his or her own experiences
(family, friends, activities, etc.). If so, encourage this opportunity for conversation. This
conversation can be assessed when coding at the end of the assessment.
- Make comments and use a variety of general questions and answers during the activity. Instead,
refrain from modelling or asking specific questions about particular parts of the image.
Allow time for the respondent to comment on the picture spontaneously and to respond to the
pre-questions or general notes as described above. If the respondent still does not respond to the
general notes or questions, cannot name more than isolated objects or people, or mentions only one
sentence containing an agent, object or action, you should model the use of more complex language.
For example, you might say: "Look at this. This man must be a snake charmer because he is playing the
flute and here is the snake". If the test taker has not made any such statement or has not identified
any object in the picture, you should ask specific questions, such as "What is this?", "Who is this?",
"What are you doing?" or "What is happening here?". Continue to encourage and develop the
respondent's answers.
Present the second slide only if a sufficient language sample has not been obtained with the first
slide or if the test taker is not interested in the first image.
Aspects to observe: Get a sample of the respondent's spontaneous language and communication and
get a sense of what captures their interest.

Telling a story from a book

Observation Scale for the Diagnosis of Autlsmo-2

Objective: The purpose of this activity is to assess the test taker's ability to narrate a sequential picture
book story and to provide a context for discussion about social relationships and emotions.

Materials: Either of the two picture books from modules 3 and 4 can be used. Two books are provided
in case one of them is not suitable for the test taker (e.g. because he/she has seen one of the books
recently).

Instructions:
Introduce one of the books and say: "Let's look at this book. It tells a story with pictures... It starts
with... (describe the first picture in the book). Can you tell me the story as we go along? You go first
and then I will. This instruction is provided to help the test taker focus on the story of the book and to
warn him/her that you will interrupt him/her.
Hand the book to the respondent, providing as much help as necessary to encourage the
respondent to begin describing the story and then turn the page. If the test taker seems hesitant or
reluctant, you should give no more than two specific aids to get him or her started. For example, you
could describe the action of an illustration and say, "I wonder what will happen now", and then give
the respondent a chance to comment on it. If the respondent focuses on the specific details of
particular illustrations, you can say: "You are right. Can you tell me the story?" or "What are the
pictures about?" (do not provide more than two general aids of this type).
Do not model the identification of emoclones. For example, do not make comments such as
"Look, this frog is very surprised". One of the aspects to observe in this task is whether the
assessee names or comments on the emotions of the characters in the book. Therefore, the
test taker should be given the opportunity to do this spontaneously.
Give the respondent a few minutes to describe the book. Then say: "Fantastic! Now its my
turn, and quickly finish the story in place of the respondent or with the respondent's help.
There may be more turns if you need to speed up or slow down the respondent's pace in
telling the story to avoid both the task taking too long and the respondent rushing through
the task without providing sufficient opportunity to observe the behaviours. This will also
allow you to observe whether the respondent allows another person to take a turn telling
the story. If the evaluee insists on finishing the story himself/herself, make a note of this and
let him/her finish.
Special application guidelines: If the respondent says that the book seems "childish", you can
highlight the most creative aspects of the story (e.g., rhetorical figures) and finally initiate a
conversation about what kind of books the respondent likes to read.
Aspects to observe: Get a sample of the respondent's spontaneous language and communication
and get a sense of what captures his or her interest. In addition, assess their reaction to
conventional humour, their spontaneous comments about how the characters in the story feel,
and the degree to which they can express the continuity of a story.

Bullet points

Aim: The purpose of this activity is to observe how the assessee narrates a story, uses gestures to
represent events and integrates gestures with eye gaze and language. It also provides an
opportunity to comment on the emotions of the characters in the stories.
H Materials: Set A of vignettes (a story with a fisherman, a cat and a pelican) and set B
(a story about two monkeys and some coconuts). Each set of cards represents a short story in
vignette form, with one picture per card, with no dialogue or narrative text written on the cards.

Instructions:
Observation Scale for the Diagnosis of Autlsmo-2

Tell the evaluee that you are going to show him/her some vignettes now and then ask him/her
to retell the story depicted in the vignettes without looking at them.
Select either series A or series B and give a brief description of the vignettes in very general
terms (e.g. "This is a story about a fisherman and a cat" or "This is a story about two
monkeys").
1 Go through the cards one by one with the respondent, encouraging them to comment on what
is happening on each card. Try not to give too much information about the cards. However, if
the respondent is in doubt about what is happening in the story, you can help by clarifying
the situations depicted.
Do not model the identification of emotions. As in "Telling a story from a book", the test
taker should be given the opportunity to do this spontaneously.
Ask the evaluee to move his or her chair away from the table (so that the table is out of reach),
stand up and tell the story. It is usually helpful if you stand up as well. It is important that the
respondent has nothing in his or her hands or is not touching the table, chair or wall, and that
his or her chair is away from the table so that he or she can gesture freely with his or her
hands and feet.
arms. If an observer is present in the room, it may be useful to ask the respondent to tell the
story to the observer.
Note whether the evaluee seems reluctant or uncomfortable:
If the respondent seems reluctant to stand up and retell the story, it may be helpful to
place two sheets of paper on the floor in the appropriate places, telling the respondent to
stand on one of the sheets of paper as if it were "the stage" while you stand on the other sheet
to represent "the audience".
If the respondent is noticeably uncomfortable standing up to retell the story, he or she
may remain seated in his or her chair; even so, you should make a determined effort to get the
respondent to remain standing. If the evaluee insists on remaining seated, try to get him or her
to move the chair away from the table, since most people tell stories much more effusively if
they cannot rest their hands and arms on the table.
Try to prevent the respondent from looking at the vignettes while retelling the story. Although
often test takers will ask you to let them look at the vignettes, it is important to prevent them
from doing so whenever possible, as people are less likely to gesture when they are looking at the
vignettes. If the respondent seems particularly distressed by this, you can say: "Try it first, and if
you really need it, I will show you a vignette to help you remember".Remember that the
"Vignettes" activity is not an assessment of how the respondent memorises the story but of how
the respondent uses various forms of communication to retell a story.
Continue with the second set of vignettes only if the first set has "broken down" in some way (e.g.,
the respondent put his hands in his pockets while retelling the story but seemed too nervous to
be interrupted or insisted on looking at the cards). In this case, ask the respondent to retell the
story of the second set of vignettes following the same procedure as described for the first set.
Aspects to observe: Observe the 1111111evaluee's use of gestures and their coordination with
speech, as well as his or her response to humour. Use this task also to get an additional sample of
the test taker's language and to form an opinion about how flexible the test taker can be in
adapting a narrative to the audience. In addition, take note of any comments the evaluee makes
about emotions and personal relationships.

Conversation and narration of events

Aim: This activity assesses the ability of the test taker to engage in a conversation with reciprocal
exchanges and to describe an issue or situation that has occurred outside the immediate context.
Observation Scale for the Diagnosis of Autlsmo-2

In addition, this activity assesses the test taker's ability to relate a non-routine event (e.g. a
birthday party, a holiday, a specific interaction with a person at school...). This task also provides
an opportunity to generate a sample of language in less structured circumstances than the tasks in
the films.

Materials: None.

Instructions:
During the evaluation use your judgement to determine what is best to make the evaluee feel
comfortable and to invite a conversational exchange. Generally, the conversational phase works
best if you start by talking about what has happened during the session or what the evaluee has
said. At the appropriate time, develop the conversation to discuss

topics that are not part of the immediate situation (e.g. school or work, siblings, leisure
activities...) in order to assess the ability of the respondent to report on situations or
activities that have occurred in the past.
Use previous opportunities that have arisen during the session to start the conversation if
relevant. For example, the activity "Telling a story from a book" could be followed by a
conversation about the evaluee's interests in reading books or watching films.

Avoid a question-answer type of interaction, making a deliberate effort to employ a more

conversational style by responding to the respondent, commenting on what he/she says and
developing the conversation further.
Show interest and involvement in the conversation and respond to the respondent's
conversation with relevant co-commentaries that in some way invite a reciprocal exchange,
acting as "pressures". To emphasise the reciprocal nature of the task, you can prompt or
develop the conversation.
Give the respondent the opportunity to describe a non-routine event (e.g. a holiday or a
family celebration). This event should be something that actually happened and not simply the
retelling of a film or story. For example, 'Description of a picture' may be followed by an account
of a holiday or a family celebration. Sometimes it may be necessary to ask specific questions to
introduce a topic. At some point, however, you should stop the conversation and remain quiet
for a few seconds while being interested to see if the respondent can take the initiative to tell
about an event without being given any specific prompting.

Special application guidelines: In order to be able to observe whether the person being assessed can
carry out a mii exchange in the form of a conversation, you should provide sufficient clues, guidance
and indications on a certain topic. Many people with ASD may be very inhibited in an unstructured
situation that is too open and in which they have to take the initiative with an adult they do not know,
so it is important that you make appropriate use of the evaluee's own interests during this exchange,
incorporating phrases, comments or questions that the child has previously asked, whenever possible.
Conversations can begin around the evaluee's strongest interests but should not be exclusively focused
on specific concerns or favourite topics (e.g., power tools). The conversation should include some
comments on topics of interest relevant to the evaluee's age (e.g., music, pets, birthdays, field trips,
sports, etc.) that are not stereotyped or restricted.
Observation Scale for the Diagnosis of Autlsmo-2

Aspects to observe: Assess the extent to which the evaluee builds his/her conversation on the
examiner's imimhmmmonunnmi comments, elaborates his/her own sentences to prompt your
participation, and takes an active role in reciprocal conversation, especially in relation to a topic outside
the immediate context.Pay particular attention to how the evaluee reports routine and non-routine
events and how he/she describes relationships and emotions. Also note the characteristics of the
respondent's communication, including the use of gaze, facial expression, intonation and gestures.

Emotions

Aim: This task provides a context for the respondent to talk about his or her emotions and
personal experiences. The aim is to observe both the content of what the respondent says and the
extent to which the child or adolescent can use language to talk about more abstract topics,
during different emotions intended to be a pressure to talk about a topic that is very difficult for
the respondent, make a note of this and continue with the next activity.

Materials: None.

Instructions:

as a task about 《emotions'.

Ask the interview questions "Emotions" in the order of your choice. It is usually more
appropriate to start or end with "happy" or another positive emotion.
Continue asking the interview questions "Emotions" until the respondent has given detailed
descriptions of at least two emotions, including the contexts in which they arise and the
nature of the particular experience of these emotions. You do not need to ask about all
emotions if the respondent gives vivid and clear descriptions of the emotions.
> Don't dwell too long on one emotion. Don't "insist" on getting a good answer before moving on;
many test takers will not be able to provide detailed descriptions of emotions.
End the task when the respondent has provided enough details (as just stated) or once all
interview questions have been asked. If you do not feel comfortable ending this part with
questions about negative emotions, you can continue with questions about things that are
pleasant or about feeling relaxed and calm.

Interview questions:

← What do you like to do to feel happy and content?

What kinds of things make you feel this way? How do you feel when you are
happy? Can you describe it?
What things scare you?
- What makes you feel scared or anxious? What does that feeling look like? What do
you do in those moments?

- &And angry (annoyed, annoyed)?

-What kinds of things make you feel that way? How do you feel 'inside 》 when you are
angry?
Observation Scale for the Diagnosis of Autlsmo-2

- Most people go through times when they feel sad. What kinds of things make you feel
this way?
How do you feel when you are sad? What is it like for you to be sad? &Can you describe it?

What about when you feel relaxed or calm? What things make you feel that way?

Aspects to observe: Identify which events n objects evoke different emotions in the
evaluee.Especially whether they are of a secial nature or not. Observe how the respondent
describes his/her emotions. Also observe whether the respondent shows facial expressions or
creative uses of language in the context of describing his/her emotions and those of others, and
whether he/she demonstrates understanding of the usual social relationships that cause some
of these emotions.

Social difficulties and discomfort

Aim: These questions allow the assessment of the respondent's perception of personal social
difficulties and sense of responsibility for his or her own actions.
Materials:None.

Instructions:

Pose all the interview questions "Social difficulties and discomfort" in the order in which they
are presented.
Note that it is possible to ask about work in addition to or instead of school in the case of older
adolescents who may work while attending school (or who only work and do not go to school).

Interview questions:

Have you ever had difficulty getting along with people at school (or at work)? And at
home with your family? Have you ever got into trouble? Why? What for?
Do other people do things that irritate or annoy you? What kind of things?
What things do you do that bother others? (If no answer, ask: "2Do you do things
that bother your brothers, your sisters, your mother or your father?)
Have you ever been teased or bullied in any way? Why do you think did it?
Have you ever tried to change these things? Have you ever done anything to stop
people making fun of you? LFuncloned?
- Do you know other children/people who are being teased or bullied by ?

Aspects to observe; Assess the respondent's perception of social difficulties, his/her understanding
of the nature of these problems and whether he/she has made any attempts to change his/her own
behaviour to better fit in with those around him/her. Pay attention to the respondent's understanding
of the appropriateness and implications of his/her feelings and behaviours.

Rest
Observation Scale for the Diagnosis of Autlsmo-2

11Objective: The primary objective of this activity is to observe the evaluee's behaviour in less
structured circumstances. The secondary objective is to give the evaluee a break from the social
demands of evaluation.
Materials: A mini-game (pin ball), a blank sheet of paper for drawing, markers, a pin art set, a marker pen
(a spinning top with a marker on the end), a small radio, a recent newspaper and a current affairs
magazine. If requested by the evaluee, the "Symbolic play" materials can be used during the "Break". If
necessary, a snack can also be prepared.

Instructions:
Decide on the appropriate time to do the "Break" activity. The break can be taken at any time during
the assessment and it is possible to take several breaks if necessary. The break materials can be presented
at the end of the assessment if the examiner feels that the test taker will feel more comfortable doing all
of the more structured tasks first.
Say: "Let's take a break", and indicate that you need a moment to take notes.
Point to the "Break" materials and tell the respondent that you hope he/she can find something that
interests him/her among them. If the respondent is not familiar with any of the materials, you can
show him/her how they work (e.g., take the cap off the marker pen or put his/her hand on the relief
set).
1Say:《I need a few minutes to write some notes', and move your chair away from the table so that you
are sitting in view but away from the table where the evaluee is sitting.
Look for the respondent's interest in the "Break" materials. If he/she is not interested in any of them, ask
him/her if he/she would like to do something else or if he/she would like something to eat or drink.
Once the test taker is settled and you have made a reasonable attempt to interest him/her in the
materials (even if there are none that interest him/her), he/she should work on his/her notes for at
least 2 minutes (this time can be slightly extended if this is helpful to the test taker or the examiner).
Observe whether the respondent initiates an interaction. If he or she does, respond briefly and positively,
but indicate that you must finish the paperwork before you can speak. After a few seconds, look up, make
eye contact with the respondent and smile briefly to encourage the respondent. The goal is to create an
opportunity for the respondent to initiate an interaction. If this does not happen, you can go back to your
notes or say, "I'll just be another minute.
After several minutes, return to the table. Make it obvious that you have finished taking notes (e.g. by
bringing your chair back to the table or leaving your pen and protocol on the table). Wait to see if the
respondent invites you back to interact by making a social initiation. If necessary, you can glance at the
objects on the table, showing interest in them, but leaving it to the respondent to take the initiative.
Special application guidelines: This task should be carried out with the "Break" materials,11111 as
described. If the respondent mentions that he/she prefers to leave the room during the activity, you
should make it clear to him/her that it will be a very short break and that it will be done inside the room.
If necessary, you can indicate that a longer break can be taken a little later. If there is a real break
outside the room (e.g. to go to the toilet or to take medication), be sure to apply the task "Break" as
described here when the respondent returns.

Aspects to observe: Observe how the evaluee keeps busy during free time and how mni / mm responds
to the examiner's withdrawal and return to the interaction. Also observe whether and how he/she
initiates and engages with you in a conversation or unstructured interaction.

Friendships, relationships and marriage

Observation Scale for the Diagnosis of Autlsmo-2

Objective: These questions provide an opportunity to obtain a detailed description of one or

more relationships that the test taker would consider to be friendships and also to obtain a
general description of the test taker's understanding of the concept of friendship and the idea of
marriage or long-term partnership. Note that the purpose of this activity is not to determine
whether the test taker has friends, but to assess the test taker's understanding of the concepts of
friendship, marriage or long-term partnership.
m111Material
s: None.

Instructions:

Ask all the interview questions "Friendships, relationships and marriage" regardless of the
chronological age of the respondent. It is not necessary to read the questions verbatim.
Make appropriate modifications to the language used in the questions, depending on the
developmental level of the test taker. For example, for 4-year-olds in Module 3, you should use
simpler sentences or shorten the questions, for example by saying:《iDo you know anyone who
is married? Similarly, if the respondent has no experience or is reluctant to talk about his or
her boyfriend or girlfriend, you could ask: "Do you know anyone who has a girlfriend or
boyfriend?" and "How do you know it is his or her girlfriend or boyfriend? Note that
respondents of both sexes will be asked the question as it is phrased: "Do you have a girlfriend
or boyfriend?
Be sure to keep the "spirit" of the questions and proceed through them in order to ensure
that the information needed for coding is obtained.
Note that it is possible to ask about work in addition to, or instead of, school in the case of
older adolescents who may work while going to school (or who only work and do not go to
school).

Interview questions:

Do you have any friends? (It may be useful to ask the respondent to specify their names
if the respondent talks in a very general way about who their friends are. Sometimes
they give names belonging to family members or professionals or provide the list of
names of the whole class, and it is useful to know this in interpreting the answers to
the friendship questions).
What do you like to do together? How did you get to know them? How often do you meet?
What does it mean to you to be a friend? How do you know someone is your friend?
1 What is the difference between a friend and someone you only see at school?
- Do you have a girlfriend or boyfriend? What is his or her name? How old is he or she?

- When was the last time you saw him?

- What is it like? What do you like to do together?
1 How do you know he/she is your boyfriend/girlfriend?
a Where do you want to live when you grow up? What kind of place (flat, house ....?
Who do you think you would like to live with? With your family, with a flatmate,
alone...?
Have you ever thought about having a long-term relationship or getting married (when
you are older)?
- Why do you think some people marry or live with a girlfriend or boyfriend when they
are older?
What would be good about it? What could be difficult about getting married or
living with a girlfriend or boyfriend? Or living with a flatmate?
Observation Scale for the Diagnosis of Autlsmo-2

Aspects to observe: Assess how the evaluee understands the concepts of friendship, marriage and
mm other social relationships and the nature of these relationships. Also assess the respondent's
understanding of why a person wants to be part of a long-term relationship and what his/her
possible role in such a relationship might be.

Soledad

Aim: These questions provide another opportunity to assess the respondent's understanding of
their social situation as well as their ability to describe their emotional reaction to it.

、 Materials:N
one.

Instructions:

> Pose the interview questions "Loneliness" in the order in which they are presented.

Interview questions:
m111
-Do you ever feel lonely?

> Do you think that other children/people of the same age as you ever feel lonely?
- Do you do anything to make yourself feel better? What things do other people do to
try to feel better when they are lonely?

Aspects to observe: Assess whether the evaluee understands the concept of loneliness and how
he/she feels it referred to him/herself or to other people.

Making up a story

Aim: This task provides an opportunity to observe the test taker's creativity in a 'play situation that
is appropriate for older children, adolescents and verbally fluent adults. The test taker has to use
five objects to make up a story, a newscast or an advertisement.

Materials: 6 objects with a defined function (e.g. umbrella, car...) and 6 objects without a defined
function (e.g. string, wooden stick...).

Instruction
s:mimmin
niimin
Say to the evaluee: "Now you and I are going to make up stories using some of these
objects, first I will choose five things and use them to create a story, and then you will
create another story using five different objects.
▶Exemplify by selecting five objects and making up a simple story. Use three objects in a creative
or novel way (e.g., using a piece of sponge as a bed or using an umbrella as a basket) and use
two objects in the way they were intended to be used (e.g., using a paper clip to hold papers).
Observation Scale for the Diagnosis of Autlsmo-2

Use one object to represent the "actor" in the story (e.g., "Mrs. Llama woke up this morning",
using a candlestick). After having exemplified the creation of a story, set aside the five objects.
Tailor your story to the developmental level of the evaluee. Keep it simple enough so that the
evaluee does not feel intimidated or overwhelmed by the task.

Encourage the test taker to choose five new objects from the bag to use in a story that he/she
has invented. It is generally advisable for the test taker to be able to use the car, as it is a
relatively simple object to incorporate into a story. Make sure that the evaluee does not select
only "real" objects to create their story, so that they have to use at least some of the more
abstract objects (i.e. those that have no defined function). A simple way to do this is to familiarise
yourself with the objects in the "Make up a story" bag for the evaluee.

Aspects to observe: Observe and evaluate the evaluee's creative use of objects in mnhinminйmimii
telling an original story or creating a news programme or commercial.