Diagnosing ASD in Adults Without ID: Accuracy of the ADOS-2 and the ADI-R.
ADOS-2 Module 4 is only partly accurate and ADI-R is weaker for diagnosing autism in adults without intellectual disability.
01Research in Context
What this study did
Fusar-Poli et al. (2017) checked how well two gold-standard autism tools work for adults who do not have intellectual disability.
They looked at ADOS-2 Module 4 and the ADI-R.
The goal was to see if the scores give a correct yes-or-no autism answer in this specific group.
What they found
ADOS-2 Module 4 was only partly accurate.
ADI-R was even less reliable for these adults.
The authors say to use ADOS-2 cautiously and to question ADI-R results.
How this fits with other research
Papanikolaou et al. (2009) found good accuracy for both tools in a mixed-IQ Greek sample.
The 2017 adult-only, no-ID sample shows lower accuracy, so the tools work better when some participants have intellectual disability.
Sturm et al. (2024) extend this work by showing a short self-report, the RAADS-14, can screen adults well.
Whaling et al. (2025) add that social-emotional reciprocity items carry the most weight, so you can focus on those during ADOS-2 Module 4.
Why it matters
If you assess bright, verbal adults, do not trust ADI-R alone.
Use ADOS-2 Module 4 but stay cautious and add tools like RAADS-14 or check DSM-5 social reciprocity items.
This guards against both missed diagnoses and false positives.
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02At a glance
03Original abstract
Diagnosing autism spectrum disorder (ASD) in adulthood often represents a challenge in clinical practice. The aim of the present study was to evaluate the sensitivity and specificity of the ADOS and ADI-R in diagnosing ASD in adults. 113 subjects with an IQ of 70 or above were assessed through an extensive clinical evaluation. The ADOS-2 Module 4 and the ADI-R were separately administered by staff members blind to clinical judgment. Our results cautiously confirm the accuracy of ADOS-2 Module 4, while suggest that ADI-R might not be reliable in adults without intellectual disability. Clinicians' training and experience remains of primary importance while assessing adults who could potentially belong to the autism spectrum.
Journal of autism and developmental disorders, 2017 · doi:10.1007/s10803-017-3258-2