ADOS-2 Module 1 Assessment Summary

ADOS-2 Module 1

Algorithm: Some Words

Child Information:

Child Name: Sam Brown

Date of Birth: 14 March, 2020

Chronological Age: 4 years, 11 months

Date of Assessment: 12 February, 2025

Attendance: Sam attended the session with his mother, Sarah Brown.

Initial Presentation:

Sam arrived appearing calm but immediately oriented away from the clinician toward the toys in the room. He remained physically close to his mother during the initial settling period and did not make eye contact with the clinician on entry. Encouragement and a brief warm-up period were required before Sam tolerated the clinician’s proximity.

Behavioural Observations During ADOS-2 Module 1

Language and Communication

Overall Expressive Language Level:

• Primarily single words and occasional two-word combinations; some jargon vocalisation present; limited spontaneous use of words to communicate wants or comments

Frequency of Spontaneous Vocalisations Directed to Others:

• Occasional vocalisations directed toward others when motivated by preferred objects; most vocalisations were self-directed or undirected

Intonation of Vocalisations or Verbalisations:

• Limited prosodic variation; vocalisations were largely flat or repetitive in quality with minimal communicative modulation

Immediate Echolalia:

• Occasional immediate echolalia observed, including partial repetition of the clinician’s prompts without apparent communicative intent

Stereotyped / Idiosyncratic Use of Words or Phrases:

• Some repetitive use of a phrase (“go go go”) across unrelated contexts; no clearly idiosyncratic language observed beyond this

Use of Another’s Body to Communicate:

• On two occasions, Sam guided the clinician’s hand toward a container he wanted opened, without accompanying eye contact or vocalisation

Pointing:

• Pointing was absent for declarative purposes; one instance of proto-imperative pointing observed toward a preferred toy

Gestures:

• Limited gesture repertoire; reaching observed; no waving, nodding, or showing gestures noted during the session

Reciprocal Social Interaction

Unusual Eye Contact:

• Eye contact was fleeting and not well integrated with other communicative behaviours; brief glances were observed, but gaze was not used to regulate interaction

Response to Name:

• Inconsistent; responded on approximately half of trials; required repeated or louder prompting on other occasions

Facial Expressions Directed to Others:

• Some positive affect observed during preferred activities; expressions were not consistently directed toward the clinician or caregiver to share

Integration of Gaze and Other Behaviours During Social Overtures:

• Limited integration; vocalisations, gestures, and gaze occurred largely in isolation rather than in coordinated social bids

Shared Enjoyment in Interaction:

• Sam showed clear pleasure during preferred activities (e.g., cause-and-effect toys) but did not orient to share this enjoyment with the clinician or his mother

Response to Joint Attention:

• Inconsistent response to joint attention bids; followed distal point on one of three attempts; did not follow gaze shifts alone

Initiating or Maintaining Social Interaction:

• Rarely initiated social interaction independently; engagement was primarily object-focused rather than person-directed

Quality of Social Overtures:

• Social overtures were limited and poorly integrated; approach behaviours were typically instrumental (e.g., to obtain objects) rather than for shared interaction

Amount of Reciprocal Social Communication:

• Minimal reciprocal social communication; brief exchanges occurred when the clinician facilitated them but were not sustained

Overall Quality of Rapport:

• Limited rapport established; Sam tolerated the clinician’s presence but showed minimal social connection or interest in the clinician as a social partner

Showing:

• No spontaneous showing behaviour observed; did not present objects to clinician or caregiver to share interest

Spontaneous Initiation of Joint Attention:

• Absent; Sam did not attempt to direct others’ attention to objects or events of interest during the session

Play

Functional Play:

• Some functional play observed with familiar toys (e.g., rolling a car, stacking blocks); play was brief and not elaborated

Imagination / Creativity:

• No pretend or symbolic play observed; play remained concrete and object-focused throughout the session

Flexibility and Range of Play:

• Limited play repertoire; Sam returned repeatedly to the same two toys and showed some resistance when redirected to new activities

Transitions Between Activities:

• Required support for most transitions; became briefly distressed when a preferred toy was removed, settling within approximately one minute with caregiver support

Stereotyped Behaviours and Restricted Interests

Unusual Sensory Interest in Play Material / Person:

• Pronounced visual inspection of spinning components on toys; spent extended periods watching a spinning top to the exclusion of social engagement

Hand, Finger and Other Complex Mannerisms:

• Occasional hand flapping observed during moments of excitement; no finger posturing or other complex mannerisms noted

Self-Injurious Behaviour:

• No self-injurious behaviour observed during the assessment

Unusually Repetitive Interests or Stereotyped Behaviours:

• Repetitive spinning of toy wheels; lining up of small blocks noted on two occasions; behaviours were prominent and recurred across the session

Frequency and Impact of Repetitive Behaviours:

• Frequent; repetitive behaviours periodically interrupted engagement with structured activities and required redirection

Regulation, Attention, and Behaviour

Attention and Focus:

• Over-focused on preferred sensory items to the exclusion of social interaction; required significant support to redirect attention to assessment activities

Activity Level:

• Slightly elevated; Sam moved frequently between areas of the room and was difficult to settle at the table for structured tasks

Emotional Regulation:

• Generally manageable; brief frustration observed during transitions and when preferred items were unavailable, resolving with caregiver proximity and verbal reassurance

Behavioural Concerns:

• No significant behavioural concerns noted during the assessment

Caregiver Interaction and Report

Caregiver’s Interaction Style:

• Sarah was warm and responsive throughout the session; she required some guidance to step back during structured activities to allow independent observation of Sam’s behaviour

Caregiver Reports During Session:

• Sarah reported that Sam has approximately 20 words at home, though these are used inconsistently; she noted significant difficulties with transitions and strong preference for sameness in daily routines; she described sensory sensitivities to certain textures and sounds; she reported he rarely engages in pretend play and shows limited interest in other children

Clinical Impressions and Summary

Summary of Observed Strengths:

• Showed clear enjoyment during preferred play activities; demonstrated some functional play with familiar toys; used reaching and hand-leading to communicate wants; responded to name on some occasions; settled with caregiver support following brief distress

Summary of Observed Differences and Areas of Support Need:

• Differences noted across social communication and reciprocal social interaction domains, including reduced and poorly integrated eye contact, absent declarative pointing, limited gesture use, absent showing and spontaneous joint attention, and minimal reciprocal social communication; restricted play repertoire with no pretend play observed; repetitive behaviours including spinning and lining up objects were prominent and frequent; sensory interests in spinning objects were notable

Overall Clinical Impressions:

Based on today’s structured observational assessment using ADOS-2 Module 1, Sam demonstrated a pattern of differences in social communication and reciprocal social interaction, along with restricted/repetitive behaviours and interests, that are consistent with an autistic presentation. Specifically, he showed absent declarative pointing and showing, limited integration of gaze with other communicative behaviours, minimal spontaneous joint attention, absent pretend play, and prominent repetitive behaviours including spinning and object-lining. These observations should be integrated with developmental history, caregiver report, and other assessment data to inform the clinician’s diagnostic formulation.

ADOS-2 Module 1 Algorithm Scores:

Social Affect (SA) Total: 14

Restricted and Repetitive Behaviour (RRB) Total: 4

Overall Total (SA + RRB): 18

ADOS-2 Classification: Autism

Comparison Score: 8 (High level of autism spectrum-related symptoms)

Risk, Safety, and Consent

Risk and Safety:

• No immediate safety concerns were identified during today’s assessment

Child’s Engagement:

• Sam tolerated the assessment overall; brief distress was observed during transitions but resolved with caregiver support; a small number of activities were abbreviated due to limited engagement

Plan and Next Steps

Further Assessment:

• Comprehensive developmental history interview to be completed with Sarah; MIGDAS-2 Parent/Caregiver Questionnaire to be administered prior to the feedback session

Feedback Session:

• Feedback session scheduled for 26 February, 2025 at 10:00 AM to discuss assessment findings with Sarah and outline next steps

Additional Clinical Notes:

• Sarah reported that Sam had a disrupted sleep the night prior to the assessment; this may have contributed to slightly elevated activity levels and reduced tolerance for transitions observed during the session