MODULE 3

ADOS Verbal expression with sentences

Observation / coding
Child Identification: Construction task
2. Pretend play
Date of birth: ____________________ 3. Joint interaction game
4.Demonstration task
Sex: ____________________ 5. Description of an image
6. Tell the story of a book
evaluation_date ____________________ 7. Cartoons
8. Narrative and conversation
9. Emotions
Examiner: ____________________ 10. Social difficulties
11. Interval
Chronological age: ____________________ 12. Friends and marriage
13. Loneliness
Another piece of information: ____________________ 14. Create a story

NOTES

Observation
1. Construction task

Focus of observation: The focus of observation is to determine whether the

the child indicates the need for more pieces, and the way it does so.
example, reaches over the examiner's arm, vocalizes or
establish eye contact.

Registration of a communication sample:

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2. Pretend play NOTES

Focus of the observation: The focus of the observation is to determine until that
point the child produces sequences of actions that involve the use of
materials beyond their most obvious intention. It should be provided with a
special attention to the way the child assigns a role of being
animated with the dolls and how it pretends that the dolls interact
among them.

3. Joint interaction game

Focus of observation: The focus of observation is on reciprocity.

demonstrated by the child in the interactive game. The objective is for the child to
(not the examiner) develop the interaction and demonstrate a new one
initiative that goes beyond a direct response to the proposals of
examiner.

4. Demonstration task

Focus of observation: The objective of this task is to determine if and how the
child represents family actions through gestures, especially through the use
of your body to represent an object (e.g. a finger to represent
a toothbrush) or pretending to use an imaginary object. To
furthermore, this task provides an opportunity to evaluate the report of
a family event.

5. Description of an image

Focus of observation: The objective of this task is to obtain an example of the

spontaneous speech and communication of the child, as well as perceiving the
what captures your interest.

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NOTES
6. Tell a story from a book

Focus of observation: The objective of this task, like the previous one, is
obtain an example of spontaneous speech and communication of the child, and
to understand what captures your interest. This task also provides a
opportunity to assess the degree to which the child can provide a
sense of continuity to a story.

7.Animated Cartoons

Focus of Observation: The objectives of this task include (a) observation

of the use of gestures and their coordination with speech by the
subject, (b) observation of their response to humor, (c) recording of a
sample of the language, (d) get an idea of its degree of insight
(insight) the flexibility of adapting a narrative to the listening audience, and
(e) note any comments that the subject may make about
affects and relationships.

8. Narrative and Conversation

Observation Focus: The focus of observation centers on the capacity

of the subject in starting from the examiner's sentences and participating completely
in a dialogue, particularly about a topic out of context
immediate. Care should be taken with the way the subject reports
routine and non-routine events, and how it describes relationships and
emotions.

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9. Emotions NOTES

Observation Focus: It has a dual purpose: (a) to identify what

events or objects evoke different emotions in the participant,
especially if they are of a social nature or not, and (b) observe how the
the subject describes their emotions.

Questions:
What do you do to feel happy or content?
What kind of things make you feel this way? How do you feel?
When are you happy? Can you describe (tell me) that?
What scares you?
What makes you feel scared or anxious? How do you feel?
What are you doing?
And when are you angry?
What makes you feel this way? How do you feel 'by
inside" when you are angry?
Everyone gets sad from time to time. What is
what makes you feel this way?
How do you feel when you are sad? What is it that
What happens when you are sad? Can you describe it?

10. Social difficulties

Focus of Observation: The focus of observation is centered on perception.

that the subject has regarding their social difficulties, their insight about the
nature of these problems and whether the subject made any attempt to change the
your behavior in order to better adapt to others. Must
pay attention to the subject's understanding of the appropriateness and
implications of your feelings.

Questions:
Have you ever had problems with people at school (or
at work)?
Is there something that others do that irritates you or
hate? What?
Have you ever been provoked or threatened? Why is that?
do you think that happened?
And you, do you do anything that annoys others?
Have you ever tried to change these things? Ever?
Did you do something to keep others from bothering you?
Did it work?

11. Interval

Observation focus: (a) how the subject occupies themselves during their free time.
(b) how it reacts to the examiner's withdrawal of interaction, and (c) if and how the
the subject initiates and participates in an unstructured conversation or in a
interaction with the examiner.

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NOTES
12.Friends and Marriage

Observation Focus: It centers on how the subject perceives the

concept of friendship and/or marriage and the nature of these relationships, and
how he/she perceives his/her role in these relationships. The questions
related to marriage and long-term relationships also focus on
understanding of the subject regarding why a person would want to do
part of a long-term relationship, and in your perception of its possibility
role in a relationship of this type.

Questions:
Do you have any friends? Can you tell me about them? (Take note
the ages, names, occupation.
What do you like to do together? How do you
Did they meet? Are they often together?
What does it mean to you to be a friend?
What is the difference between a friend and a person with
Who do you work with or who do you hang out with at school?
Do you have a boyfriend/girlfriend? What is their name? How old are they?

what?
When was the last time you were together?
What is he/she like? What do they like to do together?
How do you know he/she is your boyfriend/girlfriend?
Have you ever thought about having a lasting relationship or in
to marry (when you are older)?
Why do you think people get married when they
do they become older?
What do you think of marriage? What does it have to
Good? What do you think could be difficult?

13. Solitude

Observation Focus: These questions refer to perception of the

subject about the concept of loneliness, and how he/she feels
regarding this.

Questions:
Have you ever felt lonely?
Do you think the other boys in your situation also do
feel alone?
Is there anything you do to feel better?

14. Create a story

Observation Focus: Creative use of objects by the subject to

tell a new story or invent the broadcast of a news bulletin
or a preview.

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Coding
The overall ratings given in this section should be determined based on the child's behavior throughout the entire assessment.
If the child's behavior changes qualitatively after a period of adaptation, the classifications should be based on the period.
after the stabilization of the behavior. The ratings should be determined immediately after the assessment. The ratings are
organized according to five main groups: "A. Language and Communication," "B. Reciprocal social interaction," "C. Play," "D.
Stereotyped behaviors and restricted interests," and "E. Other abnormal behaviors.

LANGUAGE AND COMMUNICATION

Unless otherwise specified, the quotation should be made according to chronological age and not in comparison.
with the level of development or the expected expressive language capabilities.

1. Global Level of Non-Ecological Language 3. Immediate Echolalia

The score for this item should reflect the majority of the statements of the This item concerns the immediate repetition that the child makes of the
participant, not merely the best. last sentence or series of sentences said by parents/caregivers or
examiners. When quoting, do not include repetitions that are a
introduction of a response to the examiner or what is used
Use sentences predominantly in form as memorization strategies in specific tasks.
correct (it has to make some eloquent statements)
complex with two or more sentences. 0 = Never or rarely repeats the speech of
1 = A relatively complex speech others.
(occasional speeches with two or more sentences), but with 1 = Occasional repetition.
systematic grammatical errors. 2 = Repetition of words and phrases regularly
but some spontaneous language (it can be
The non-ecolalic speech basically consists of stereotypical
elaborations of at least three words, but simple sentences 3 = Speech consists basically of echolalia
non-elliptical. immediate.
3 = Non-ecological language basically summarizes to sentences
simple.

2. Irregularities of Speech Associated with Autism 4. Stereotyped/Idiosyncratic Use of Words or

(Intonation/Volume/Rhythm/Speed). Phrases
The focus of this item is on the irregularities of the discourse that areThe quotation for this item includes late echolalia or other utterances.
specifics of autism. Due to the variability within the spectrum of highly repetitive with consistent intonation patterns, well
autism, the patterns of speech that are unusual according to the how the use of words or phrases that are inappropriate
identified characteristics, but not typically autistic, should receive the formal. These words or phrases can be used
rating of 1. Evaluate this item in relation to the level of language significantly and may be appropriate to the conversation to a certain extent
expressive of the participant. To the irregular speech patterns typically point. The focus of the item centers on stereotypical quality or
associates with a general delay in language should be attributed to punctuation.idiosyncratic of phrases, in the unusual use of words or
from 0. formation of elocutions, and/or in their arbitrary association to a
determined meaning. Neologisms should be quoted here,
0 = Varied intonation appropriately, as well as clear evidence of errors in personal pronouns
reasonable volume and normal speed of (e.g., tououele/elapara dizereu). The punctuation is relative to the level
speech, with a coordinated regular rhythm of the participant's expressive language.
with the breath.
1 = Little variation in intensity/height and tone; intonation 0 = Never or rarely uses
fairly low or exaggerated but not obviously peculiar, stereotyped words or phrases
A slightly unusual volume, AND/OR discourse that tends you strange ones.
to be uncommonly slow, fast, or hiccuping. 1 = Use of words or phrases
2 = Clearly unusual speech for any of the tends to be more repetitive or formal than that of
following reasons: slow and hesitant; inadequately majority of individuals with the same level of
quick; stuttering and irregular rhythm (beyond stuttering) complexity, but not explicitly strange,
normal), in such a way that it interferes with its intelligibility; Either occasional stereotyped elocutions or use
strange intonation or inadequate intensity or salience; strange of words or phrases, also with
markedly low and without tone ("mechanical"); volume substantial spontaneous language.
consistently abnormal. Often uses stereotypical clichés
7 = Stuttering or another disruption of fluency. or strange words or phrases with or without another
8 = N/A (inadequate speech of phrases in terms of language.
frequency for to be possible evaluate a 3 = Almost exclusively strange phrases or
intonation/rhythm/speed. stereotypical speeches.

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5. Provides Information 7. Account of Events

The focus of this item is on the spontaneous and appropriate supply of The focus of this item is on the participant's ability to
personal information by the participant, new to the examiner. There is none.
select an event spontaneously or in response to the
to occur in a context of or to be part of a sustained interaction. general questioning of the examiner, and in describing it in a way
It can occur as elaboration or response to questions but must include understandable, without any specific exploration being necessary.
new information, not specified by the question. It may be related to the This should involve a sequential description of an event.
participant's interests but should not be solely related to outside the immediate environment. Point out the 'best' example, given the
concerns. Comments about facts (e.g., "Did you know that the punctuation constraints described below regarding
Are whales mammals? They are not quoted here but can be. concerns and explorations.
considered to assign a score later, in the section
Conversation. The comments about relationships or possessions (e.g., "I 0 = Tell an event
I have two brothers" or "Our family has a boat) specific non-routine (e.g., a
here they refer to an activity more than to a list of holiday, a movie watched once, a
characteristics. shopping trip) that is not part of
of none concern you
0 = Provides information spontaneously about their intense interests and seems to be real. It gives a
thoughts, feelings or experiences reasonable description without any exploitation
on several occasions. specific but it may be necessary to put a
1 = Occasionally provides information general question at the beginning to start the account.
spontaneously about your 1 = Reasonably describes an event of
thoughts, feelings or experiences. routine (e.g., playing a favorite game; normal routine
2 = Never or rarely provides information when you get home from work or school) that
spontaneously, except concerning interests or it is not part of an intense concern or interest
restricted concerns OR provides information about and seems probably real. Gives this description without
facts or general knowledge including interests or no specific exploration is necessary, but
restricted concerns. it may be necessary to question. Include descriptions here
from 'Demonstration Task'.
2 = Provides a description of events
routine or not routine but dependent on
specific explorations, OR just describes a
event that seems unlikely to have been
real.
3 = Inconsistent or insufficient responses anyway
before specific explorations.

6. Request Information 8. Conversation

The focus of this item is on the expression of spontaneous interest inThe focus of this item centers on the reciprocal use of words and phrases.
participant's part regarding ideas, knowledge, experiences in a social conversation. Rate this item relative to the level of
or reactions of the examiner. This should not be part of aexpressive language of the participant. Provide evidence of (or lack thereof
concern. When assigning a score, exclude request for reciprocal non-verbal communication under 'Quantity of Communication'
information not related to the examiner, or about the materials Reciprocal Social” in section B of this protocol.
from ADOS, or about certain unspecified facts regarding
examiner; subsequently, include these when assigning scores in the The conversation flows from the dialogue
Conversation. For this item, the questions do not necessarily have to of the examiner. This score requires
lead to a sustained conversation. Questions about relationships or that much of the participant's speech
possessions can be quoted here if they refer to an activity more of provide both a response to the speech
that fill in a list. of the examiner as some additional conversation (not
necessarily a question) that starts from what has already been
0 = Questions o examiner about your said and allow an answer from the examiner (i.e., by
thoughts, feelings, or experiences in various fewer sequences of 4 elements: the examiner
occasions. starts, the participant comments, the examiner responds,
1 = Occasionally (at least one clear example) the participant responds to the answer).
questions the examiner about their thoughts, The speech includes some spontaneous elaboration.
feelings or experiences. the participant's own answers in favor of
2 = Respond appropriately to the comments of examiner OR provides clues for the examiner
examiner about your thoughts, feelings continue, but any of these situations is lesser
and experiences, but does not question it spontaneously in quantity of what would be expected for the level of
about this. expressive language, or is it limited in terms of
3 = Never or rarely asks the examiner about flexibility.
your thoughts, feelings, or experiences, nor 2 = Little reciprocal conversation displayed by the
express interest in them. participant; you can follow your own course of
thinking instead of participating in an exchange; it may have
any spontaneous offer of information or
comments but little sense of reciprocity.
3 = Little spontaneous communicative speech (despite
to be able to have a lot of ecological or non-ecological discourse
communicative). This punctuation applies to
participants who give some limited responses,
but very few.
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9. Descriptive, Conventional, Instrumental or Informative Gestures

The focus of this item is on descriptive gestures that establish or represent an object or event. The use of conventional gestures
(e.g., clapping for 'very well!'), informative or instrumental (e.g., pointing, asking, shrugging, waving or shaking the head)
receives partial credit. When quoting, include behaviors that occur during the 'Demonstration Task' and throughout the session. The emphasis,
however, it is in the way the participant uses gestures before being encouraged or asked to do so.

0 = Spontaneous use of various descriptive gestures. These gestures can be typical or idiosyncratic, but they must be
be communicative. You can also use conventional or instrumental gestures.
1 = Some spontaneous use of descriptive gestures, but exaggerated, limited in their variety and/or contexts, OR
frequent use of conventional or instrumental gestures, but not descriptive.
Some spontaneous use of informative, conventional, or instrumental gestures, but not descriptive.
3 = Very limited spontaneous use or absence of conventional, instrumental, informative, or descriptive gestures.
8 = N/A (e.g., limited by physical disability).

B. RECIPROCALSOCIALINTERACTION
To cut in comparison with non-verbal mental age
Unusual Visual Contact 2. Facial Expressions Directed at Others
Cutting this item requires the distinction between a clear gaze, socially. The score for this item should indicate whether the facial expressions of the
regulated and appropriate that is used for a variety of purposes and the participants are directed to another person with the purpose of
view that is limited in flexibility, adequacy or in contexts. If the communicate affection. Facial expressions directed at objects
the participant may appear shy at first and their gaze changes You are not directed are not quoted here. Facial expressions.
marked and consistently as he becomes more comfortable, no Adequate should be quoted even if there are expressions as well.
base the quote on first impressions. However, if the eye contact strange.
do not improve, the quote should be based on what is observed, even if
the participant seems shy. 0 = Directs a variety of facial expressions
suitable for the examiner or another person in
0 Appropriate look with subtle changes mixed in sense of communicating affection.
with another communication. 1 = Some facial expressions directed at
2 Use poorly adjusted eye contact for examiner or another person (e.g., drives only
initiate, terminate or regulate social interaction. expressions indicating emotional extremes
to others, or occasionally drives a
great variety of expressions). A
participant with limited variety
of facial expressions or that only has
slightly unusual facial expressions, but
that directs most of your expressions to
another person can be quoted here.
2 = Never or rarely drives expressions
appropriate faces for others.

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3. Language Production and Non-verbal Communication Shared Pleasure in Interaction

Chained
Score the social response of the participant during any of the
The purpose of this item focuses on quoting the degree to which whentasks or conversations. This quotation should not be used to indicate
participant vocalizes, this vocalization is accompanied by changes the overall emotional state of the participant during the interview. Note
older children and teenagers are expected to demonstrate
subtle in the gaze, facial expression, and gestures. This item must be quoted with
based on the vocalizations used, regardless of their frequency. pleasure in a more controlled and subtle way than the participants
List the most typical occurrences, not just the best. When younger. The score applies to your ability to indicate
assign a score, include the vocalizations used to maintain pleasure in interaction, not just to interact.
interaction or responding to the examiner, as well as initiations. The
a score of 8 (non-scoring) must be assigned by excluding parts, 0 = Demonstrates defined and appropriate pleasure in
If one or more of the following behaviors mentioned earlier participation or interactive conversation for more than
in this protocol received a score of 2: 'Eye Contact' that a task or a topic of conversation.
Uncommon”, “Facial Expressions Directed to Others” or “Gestures 1 = Demonstrates some appropriate pleasure in the acts of
Descriptive, Conventional, Instrumental or Informative.
examiner OR demonstrates defined pleasure in a
interaction.
0 = Vocalization normally accompanied
of subtle and socially appropriate changes 2 = Shows little or no manifest pleasure in
in gestures, gaze, and facial expression. interaction. It can show pleasure in your
own actions or part of the conversation, but not
1 = Vocalization accompanied by gestures,
in the examiner's behavior or in the interaction.
abnormal eye and facial expression, limited or reduced
frequency and/or variety of what is normal, OR use of a 8 = Not applicable due to little or no
mode almost exclusively (e.g., frequent use of interaction, or for other reasons.
look but with very limited use of gestures and facial expressions).

2 = Little or no non-verbal communication associated

the vocalization.
Some avoidance of direct eye contact, especially at the beginning
from the interview, perhaps due to shyness, but shows some 5. Empathy/Comments on the Emotions of Others
modeling e coordination of language with o
The focus of this item is on the communication of understanding and
non-verbal behavior.
empathy on the part of the participant towards the feelings of the
8 = N/A; without vocalization OR without use or minimal use of other people, real or portrayed in stories or other tasks.
gestures, facial expression, or socially directed gaze. This Exclude the shared pleasure with the examiner, which is punctuated in
quotation should be assigned automatically in the absenceprevious item.
association can be taken into account through frequency
limited unusual eye contact, of facial expressions 0 = Clearly communicate understanding and various
and/or gestures. different emotions shared with others.
1 = Communicates some degree of understanding and
shared emotions with others for more than one
emotion, OR communicates a clear understanding and
paraumaemotion experienced by another individual.
2 = Communicates some understanding and/or emotion
shared of at least one experience of another
individual.
3 = Non-existence of or minimum communication of
emotional understanding or shared emotions.

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6. Insight 8. Quality of Social Response

The focus of this item is on the participant's ability to provide This is a summary item that focuses on social responses of
spontaneous examples of insight about the nature of relationships participant throughout the session.
social. These can include lasting relationships, such as friendship or
marriage, or interactive situations, such as getting along with other students in 0 = Displays a range of appropriate responses that
school, which can be discussed in conversation or in response to vary according to social situations and
socio-emotional issues. Two different aspects are quoted of immediate diligences.
relationships: (a) the nature of specific relationships (e.g., what friendship is),
the role of the participant in these relations. 1 = Displays response to most social situations,
more or less socially limited
0 = Demonstrates several examples of insight constraining, inadequate, inconsistent or
about the nature of typical social relations, consistently negative.
including your own role in at least 2 = Strange, stereotyped, or
a. responses that are poorly varied or inadequate to
1 = Demonstrates examples of insight about various context.
typical social relations, but not about one's own role, 3 = No response or minimal response to attempts
Or about just a relationship including your own of the examiner to involve the participant.
paper.
2 = Demonstrates some insight about a social relationship
typical, but not necessarily about its own
paper on it.
3 = Does not demonstrate or demonstrates limited insight about
typical social relations, with or without knowledge of your
paper in them.

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7. Quality of Social Approaches 9. Amount of Reciprocal Social Communication

This is a summary item that focuses on the quality of the attempts The focus of this item is on the frequency with which exchanges occur.
participant in initiating social interaction with the examiner, and not in the reciprocal during the session, using any mode of
frequency of these attempts. Special attention should be paid to the communication.Frequency is defined here both in terms of
the way of approaches and their suitability to the social context. The punctuation absolute number of occurrences as distribution over a
it should reflect the majority of social approaches to the examiner, shouldn't it variety of immediate contexts. The punctuation for this has to
only the best. the summary should describe aspects of nonverbal behavior and
verbal/vocal that do not need to be coordinated but have to
result in reciprocal exchanges.
0 = Use verbal/vocal means positively and
non-verbal cues for making social approaches
clear to the examiner. The approaches must be 0 = Extensive use of verbal and non-verbal behaviors
to be suitable for immediate contexts. verbals for social exchanges (i.e., conversation,
comments, observations or behavior not
Slightly unusual quality of some approaches verbal expressions that seem to have a reciprocal intention.
social. The approaches can be restricted to requirements
personal or related to one's own interests 1 = Some reciprocal social communications (such as
participant, but with some attempt to involve the was described above for the score of 0) but
examiner in this interest. lower in frequency or quantity, or in number
the contexts in which such behaviors occur
2 = Inadequate approaches; many approaches without (regardless of the amount of non-conversation)
integration in the context of AND/OR social quality. This includes the
social).
mention of concerns by the participant without much
attempts to engage the examiner. 2 = Most communication is oriented towards
objects (i.e., to ask for things) OR is response to
3 = Insignificant or non-existent social approaches. issues, OR it is ecolalic, OR it is related to certain
worries; little or no social conversation or
of giving and receiving.

3 = Little to no social communication

reciprocal.

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10. Overall Quality of the Report

The rating for this item is a summary score that reflects the examiner's overall assessment of the report established with the participant.
during the session. The scoring should specifically take into account the extent to which the examiner had to modify their own behavior.
to maintain a successful interaction.

0 = Comfortable interaction with the examiner appropriate to the context.

1 = Interaction sometimes comfortable but not sustained (e.g., sometimes it can be awkward or artificial, or the
the participant's behavior seems mechanical or slightly inappropriate.
2 = Unilateral or unusual interaction resulting in a consistent and slightly uncomfortable interview or an interview that
It would have been difficult if the examiner had not continually modified the structure of the situation beyond the activities.
standardized of the ADOS.
3 = The participant demonstrates minimal attention to the examiner, OR the interview is markedly uncomfortable for a period.
of significant time.

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C. IMAGINATION
To cut this item in comparison with the capabilities of expressive language
Imagination/Creativity
This item should be assigned a score that reflects the degree to which some forms of creativity/inventiveness are displayed by the
participant throughout the session, either through the use of objects or through verbal descriptions.

0 = Various spontaneous, inventive, creative activities or comments during the conversation.

Some creative or 'pretend' actions, but limited in variety or occurring only in
response to an artificial situation (e.g., inventing a story).
2 = Few creative or spontaneous 'pretend' actions, OR only actions that are repetitive, OR stereotyped in
quality.
3 = Without creative or inventive actions (not even stereotypical or repetitive).

D. STEREOTYPED BEHAVIORS AND RESTRICTED INTERESTS

Cut in relation to expectations for chronological age.

Unusual Sensory Interest in Materials/People 2. Manners with Hands and Fingers or

Other Complex Manners
Rate the participant's interest in the sensory aspects of the toys.
or what surrounds him. If he has a concern based on an interest Point out unusual and/or repetitive movements or postures of
sensory, this can be quoted here as unusual sensory interest. hands and fingers, arms or the whole body. Clapping repetitively
For example, if he shows an interest in radiators or can be quoted here. Do not include body sway unless
pipelines, that is quoted later in the section of 'Interests' wrap more than just the torso. Drumming with the fingers, gnawing the
Excessive in or References to Highly Topics or Objects nails, curling hair or sucking on a finger are also not
Specific or Unusual or Repetitive Behaviors of the protocol. quoted here. The participant does not have to observe the movements
If the participant is interested in the radiator because they like to look at of your fingers or hands to be quoted here.
he, as can be seen by the fact of peering and tilting it
head, shaking from side to side and waving hands, this
should be quoted in the section 'Mannerisms of Hands and Fingers and Others' 0 = Nonexistent
Complex Maneirisms, but it can also be quoted here with the 1 = Hand or finger or other mannerisms
a score of 1 due to the sensory component involved. If the more complex mannerisms very brief or
participant likes to peek out of the corner of the eye at the radiator, the strange, or mannerisms not as clear as it is
corners of the room, the cabinet doors, the slats of the frames of specified below for a score of 2.
windows, but don't worry too much about any of them
he does not move unusually, he must receive here a 2 = Clearly bend or roll the fingers AND/OR
score of 2 for unusual sensory interests and a rating of 0 hand mannerisms or other mannerisms and
in the section "Mannerisms of Hands and Fingers and Other Mannerisms" stereotypes.
Complexes. Do not quote here to touch on the (pin-art). Specify:

0 = Doesn't smell, touches repetitively,

feel the texture, lick, put in your mouth
you bite, you are not interested in
repetition of certain sounds, or examines
visually in an unusual way or 3. Self-Aggressive Behavior
prolonged.
Point out any behavior that involves any type of act.
1 = Occasional unusual sensory interests OR not aggressive towards oneself, even if it is not clearly
as clear as specified in punctuation 2. prejudicial.
2 = Interest defined in non-functional elements of
playful materials, OR self-observation or of the 0 = Without attempts to hurt oneself.
others.
1 = Rare and/or dubious auto-aggression (e.g., bites)
Specify: at least once on one's own hand or arm
when contradicted, he pulls out his own hair,
hit on the own face or hit with the head)
2 = Clear presence of self-aggression (e.g., more of
what an example of hitting with the head, hitting on the
way, pulling hair or self-biting).

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4. Excessive Interest in or References to Topics 5. Compulsions and Rituals

Vulgar or Highly Specific or Objects or The emphasis given to compulsions or rituals in this context and in the
Repetitive Behaviors determination of the participant to carry out an activity that
Once the interests, concerns, or behaviors involves a sequence, an ending, or a predictable form that
circumscribed vulgarities are often difficult to judge during a is not required as part of the ADOS task (e.g., to check if a
brief observation, the focus of this item centers on any reference that the wallet is in the bag, insistence on completing the used book for the
(a) is unexpectedly high in its frequency, (b) is relevant to task of telling a story; careful placement of the materials such
an unusual or strange topic or the use of an object in a highly unusual way how they were initially presented; recite a list of
specific to the individual, and (c) is not well integrated into the conversation.classmates as friends). The provision of lists must
Topics that are developmentally appropriate or age-appropriate. to be quoted here.
should be quoted here (e.g., an 8-year-old child who speaks
repeatedly about some recent holidays in general terms would not be 0 = There is no obvious activity or verbal routines
quoted here, while a participant who speaks repeatedly about that must be fully completed or
staying in hotel room no. 465 may be). The focus of this quotation centers on according to a sequence that does not make
it notes references or unusual forms of behavior. The part of the task.
use of unusual terms (e.g., stereotyped phrases) and/or lack of 1 = Unusually speech or activities
flexible conversations are quoted elsewhere. Behaviors can be routed.
quoted in two ways to represent different examples of each
domain. For example, if the participant repeatedly says 'They One or more verbal activities or routines
they need room service now, immediately, at this very moment, what the participant has to perform or say
next minute, in room 465?” is using the same phrases in several in a special way. The participant appears under
other contexts and makes other statements about the room numbers pressure or becomes anxious if an activity
from the hotel, this would be quoted both here and in 'Use' is disturbed.
Stereotyped/Idiosyncratic of Words or Phrases,” further back in
protocol. The repetitive behaviors involving objects that
they should have a clear sequence (e.g., align things) and must be quoted in
Next item 'Compulsions or Rituals'.

0 = There is no excessive interest in

or references a topics or
unusual or highly unusual objects
specific or restricted.
1 = Occasional references to topics or patterns of
unusual or highly specific interests,
occurring to an unusual degree.
2 = Clear, stereotyped patterns of interest, or
vulgarizers that may or may not invade and/or interfere
with the media.
3 = Clear concerns to an extent that interferes with the
evaluation.

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 ADOS module 3

E. OTHER ABNORMAL BEHAVIORS

Unless stated otherwise, compare these items without referencing the developmental level or the capabilities.
estimates of language.
Hyperactivity/Agitation
This item describes excessive movement or physical agitation. Rate this item in relation to the participant's non-verbal mental age.

0 = Remains seated properly throughout the assessment.

1 = Remains seated but frequently fidgets or moves in the chair. The difficulties in assessment do not
are mostly due to hyperactivity or agitation.
Difficulty remaining seated; gets up and returns to the chair or handles objects in a difficult manner.
interrupt. The level of activity disrupts the assessment.
7 = Sub/Hypoactive.

2. Beer, Aggression, Negative or Disruptive Behavior.

This item includes any form of anger or disturbance beyond communicating mild frustration or whining.

0 = Does not show disruptive, destructive, negative, or aggressive behavior during the evaluation with the ADOS.

1 = Occasionally displays slight disturbance, anger or aggression or negative behavior towards the
examiner (includes verbal threats or deliberate loud voice).
2 = Demonstrates marked or repeated temper tantrums or significant aggression (e.g., throwing things, hitting or biting the
screaming or shouting is included here.

3. Anxiety
Anxiety includes initial caution or self-awareness, as well as more obvious signs of worry, annoyance, or restlessness.

0 = Without obvious anxiety (e.g., trembling or alertness).

1 = Slight signs of anxiety or self-awareness, especially at the beginning of the interview or in response to items.
specific.
2 = Anxiety marked throughout the evaluation (it can be intermittent or continuous).

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 ADOS module 3

ADOS ____________
Sex
MODULE 3 ______________________

ADOS Algorithm Communication

for the
diagnosis Number of social proposals/Maintaining attention (A-2) __________
of autism
no DSM- Stereotypical/idiosyncratic use of words or phrases (A-5) __________
IV/ICD10
(current scores) Conversation (A-6) __________
of 3 in the protocol
we go to 2, and To point (A-7)
treat all the
other scores that Descriptive, conventional, instrumental or informative gestures (A-8) __________
do not be 0-3
as 0) Total communication __________
(ponto de corte para oautismo=5; para oespectro autista= 3)

Reciprocal social interaction

Unusual eye contact (B-1) __________

Facial expression directed at others (B-2) __________

Spontaneous onset of joint attention (B-6) __________

Quality of social initiatives (B-8)

Quality of social response (B-9) __________

Amount of reciprocal social communication (B-10) __________

Overall quality of the observation (B-11) __________

Total reciprocal social interaction __________

(ponto de corte para oautismo=6;para oespectro autista= 4)

Total communication + reciprocal social interaction __________

(ponto de corte para oautismo=12;para oespectro autista=8)

Imagination/Creativity (C-2)

Stereotyped behaviors and restricted interests

Unusual sensory interest in the game material or person (D-1) __________

Mannerisms of hands and fingers and other complexes (D-2) __________

Unusual repetitive interests or stereotyped behaviors (D-4) __________

Total stereotyped behaviors and restricted interests __________

Diagnosis:
ADOS Classification ____________________________________________________________________

General diagnosis _____________________________________________________________________

____________________________________________________________________________________

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ADOS module 3

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