Evaluation of the revised algorithm of Autism Diagnostic Observation Schedule (ADOS) in the diagnostic investigation of high-functioning children and adolescents with autism spectrum disorders.

Kamp-Becker et al. (2013) tested the revised ADOS algorithm on high-functioning kids and teens with autism. They wanted to see if the new rules caught more true cases than the old version. The team compared scores from the original and revised algorithms in a mixed clinical sample.

High-functioning youth often get missed because their symptoms are subtle. The researchers hoped the update would boost sensitivity without flagging too many non-autistic kids.

The revised algorithm picked up more youth with ASD than the old one. Sensitivity went up, meaning fewer kids with autism slipped through. The trade-off was lower specificity for the 'non-autism ASD' group; some kids without true autism now met criteria.

In short, the test became better at finding autism but slightly more likely to over-label mild cases.

Stadnick et al. (2015) moved the same ADOS tool into busy community clinics. They also saw good capture of ASD, but warned that other mental-health problems can inflate social-communication scores. Together the two studies show the revised algorithm works outside the lab if clinicians weigh extra psychiatric symptoms.

Trillingsgaard et al. (2004) sounds like the opposite story: 13 of 16 kids with Angelman syndrome met ADOS-G criteria, yet the authors called the result 'not true autism.' The key difference is developmental level. Inge’s youth were high-functioning; Anegen’s had severe delay. The same test can over-identify ASD when low mental age mimics social deficits.

Lotfizadeh et al. (2020) adds a final layer. They found that billing-code algorithms misclassify many kids. Their poor results remind us why we still need gold-standard tools like the ADOS, even if the algorithm isn’t perfect.

Use the revised ADOS when you evaluate verbally fluent clients who may mask symptoms. Expect it to catch more true cases, but always pair scores with developmental history and observations so you don’t over-diagnose mild social issues. If you work with kids who have intellectual disability or complex genetic conditions, interpret positive scores cautiously; consider the Angelman data and add extra steps before calling it autism.