Correspondence Between the Brief Observation of Symptoms of Autism (BOSA) and the Autism Diagnostic Observation Schedule-2 (ADOS-2) in Adolescents and Adults.
One structured test is not enough to rule autism in or out for adults with mental-health or intellectual issues.
01Research in Context
What this study did
Ederer et al. (2026) pulled every paper that compared two autism tests for teens and adults. One test is the full ADOS-2. The other is the shorter BOSA.
They looked at how often both tests give the same yes-or-no answer about autism. They also checked if having mental-health or intellectual disabilities changes the match.
What they found
Single questionnaires often cried "autism" when the person really had anxiety, depression, or borderline IQ. Specificity dropped in these groups.
Using two tools together, or adding clinician judgment, cut the false alarms. The shorter BOSA lined up with ADOS-2 only when extra data were added.
How this fits with other research
Hus et al. (2014) already showed the ADOS-2 Module 4 works well in fluent adults. E et al. widen the lens, warning the same test can over-call autism once mental-health issues enter.
Bennett et al. (2008) saw the same over-calling in Hispanic kids with mild social quirks. The new review says the problem repeats in adults with mood or psychosis labels, not just kids.
Liu et al. (2026) just set new cut scores for toddlers with global delay. E et al. echo that idea: pick higher or combined thresholds when the person has intellectual disability.
de Bildt et al. (2004) proved that using ADI-R plus ADOS boosts accuracy in youth with mental retardation. The 2026 review now urges the same two-tool plan for adults.
Why it matters
If you screen an adult who also carries anxiety, depression, or ID, do not stop at one score. Run a second tool, add a clinical interview, or bump the cut-off. This simple step keeps you from mis-labeling a client and saves hours of unnecessary treatment later.
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02At a glance
03Original abstract
Accurately diagnosing autism spectrum disorders in adulthood can be challenging. Structured questionnaires and diagnostic measures are frequently used to assist case recognition and diagnosis. This study reviewed research evidence on structured questionnaires and diagnostic measures published since the National Institute for Health and Care Excellence evidence update. The Cochrane library, Medline, Embase and PsycINFO were searched. In all, 20 studies met inclusion criteria. Sensitivity and specificity of structured questionnaires were best for individuals with previously confirmed autism spectrum disorder diagnoses and reduced in participants referred for diagnostic assessments, with discrimination of autism spectrum disorder from mental health conditions especially limited. For adults with intellectual disability, diagnostic accuracy increased when a combination of structured questionnaires were used. Evidence suggests some utility of diagnostic measures in identifying autism spectrum disorder among clinic referrals, although specificity for diagnosis was relatively low. In mental health settings, the use of a single structured questionnaire is unlikely to accurately identify adults without autism spectrum disorder or differentiate autism spectrum disorder from mental health conditions. This is important as adults seeking an autism spectrum disorder diagnostic assessment are likely to have co-existing mental health conditions. Robust autism spectrum disorder assessment tools specifically for use in adult diagnostic health services in the presence of co-occurring mental health and neurodevelopmental disorders are a research priority.
Journal of autism and developmental disorders, 2026 · doi:10.1177/1362361317748245