A Pilot Study Examining the Use of the Autism Diagnostic Observation Schedule in Community-Based Mental Health Clinics.
ADOS works in real-world clinics, yet high social-communication scores can be fooled by other mental-health issues, so always cross-check before diagnosing.
01Research in Context
What this study did
Stadnick et al. (2015) asked: Can community mental-health clinicians give the ADOS and get the right answer?
They ran a small pilot in two regular clinics. Staff watched a short ADOS training, then tested youth sent for behavior concerns.
Final ASD diagnosis was made later by a full team. The team compared that answer to the ADOS score.
What they found
Most of the time the ADOS matched the final diagnosis. About six in ten kids turned out to have ASD.
When the ADOS was wrong, it usually said ASD when the child really had another mental-health issue. Social-communication scores looked like autism but were driven by anxiety or trauma.
How this fits with other research
Salley et al. (2015) extends this work. They showed ADOS scores line up on a clear ladder: ASD on top, then ASD-plus-ADHD, then ADHD alone, then typical kids. That gives you a road map for tough mixed cases.
Taylor et al. (2017) seems to contradict the pilot. Only one-third of their clinicians agreed on the same ADOS video. The difference is method: Nicole looked at final team diagnosis, while J looked at how often raters agree. Both can be true—ADOS helps, but only if you train well and use a second opinion.
Lancioni et al. (2009) is the earlier warning. They saw less than half agreement in community clinics long before ADOS was common. Nicole’s pilot shows ADOS can raise that agreement, but only if you watch for comorbid problems.
Why it matters
You can trust the ADOS in busy clinics, but it is not a stand-alone ticket. Score social-communication items alongside the child’s full picture—anxiety, trauma, ADHD. If scores are high but history is muddy, bring in a second clinician or add a structured parent interview before you say “yes” to ASD.
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02At a glance
03Original abstract
Community-based mental health (CMH) services play an important, but relatively understudied role in the identification and treatment of youth with autism spectrum disorder (ASD) who may be receiving care for other psychiatric conditions. Little is known about the role of standardized ASD assessment measures administered by providers working in generalist community-based mental health (CMH) settings. This pilot study extracted data from three CMH clinics to examine the use of the Autism Diagnostic Observation Schedule (ADOS) by 17 CMH providers who received ASD assessment training with 62 youth (Mean = 10.69 years) referred for an ASD diagnostic evaluation. Results indicated that 57% of youths assessed ultimately received an ASD diagnosis. All cases given a final ASD diagnosis were classified as "Autism" or "ASD" on the ADOS. Seventy percent of youth who did not receive a final ASD diagnosis were classified as "Non-Spectrum" on the ADOS. In these false positive cases, report narratives indicated that social communication difficulties identified on the ADOS were explained by symptoms of other mental health conditions (e.g., ADHD, anxiety). Future research is needed to examine the utility of the ADOS when used by CMH providers to facilitate CMH capacity to identify ASD.
Research in autism spectrum disorders, 2015 · doi:10.1016/j.rasd.2015.08.007