ADOS-2 Module 2
Algorithm: Specify Algorithm 1 (younger than 5 years) or Algorithm 2 (5 years or older).
Child Information:
- Child Name:
- Date of Birth:
- Chronological Age:
- Date of Assessment:
- Attendance:
Initial Presentation:
Describe the child’s presentation on arrival and engagement with the clinician on entry.
Behavioural Observations During ADOS-2 Module 2
Language and Communication
- Overall Expressive Language Level: Describe the child’s expressive language level and phrase complexity.
- Overall Level of Non-Echoed Language: Describe the child’s spontaneous, meaningful language use.
- Speech Abnormalities Associated with Autism: Describe any unusual speech qualities.
- Immediate Echolalia: Describe any immediate repetition of words or phrases.
- Stereotyped/Idiosyncratic Use of Words or Phrases: Describe any unusual or context-inappropriate language use.
- Conversation: Describe the child’s ability to engage in reciprocal conversational exchanges.
- Reporting of Events: Describe the child’s ability to describe past events or experiences.
- Asking for Information: Describe the child’s use of questions to seek information.
- Descriptive, Conventional, Instrumental, or Informational Gestures: Describe the range and quality of gesture use.
Reciprocal Social Interaction
- Unusual Eye Contact: Describe the child’s patterns of eye contact.
- Responsive Social Smile: Describe the child’s social smiling in response to others.
- Facial Expressions Directed to Others: Describe the range and social directedness of facial expressions.
- Integration of Gaze and Other Behaviours During Social Overtures: Describe the child’s coordination of gaze, vocalisations, and gestures during social bids.
- Shared Enjoyment in Interaction: Describe the child’s expression and sharing of positive affect.
- Response to Name: Describe the child’s response when their name was called.
- Requesting: Describe how the child made requests.
- Giving: Describe instances of the child giving objects to the clinician or caregiver.
- Showing: Describe instances of the child showing objects to share interest.
- Spontaneous Initiation of Joint Attention: Describe any unprompted attempts to direct others’ attention to objects or events.
- Response to Joint Attention: Describe the child’s ability to follow the clinician’s gaze or point.
- Quality of Social Overtures: Describe the appropriateness and integration of the child’s social bids.
- Amount of Social Overtures/Maintenance of Attention: Describe the frequency and persistence of the child’s social initiations.
- Quality of Social Response: Describe how the child responded to the clinician’s social bids.
- Amount of Reciprocal Social Communication: Describe the overall level of back-and-forth social engagement.
- Overall Quality of Rapport: Describe the rapport established between the child and the clinician.
Play
- Functional Play with Objects: Describe the child’s use of toys in conventional ways.
- Imagination/Creativity: Describe evidence of pretend or symbolic play.
- Quality of Social Overtures (within play context): Describe the social quality of the child’s play interactions.
- Flexibility and Range of Play: Describe the variety and adaptability of play across activities.
Restricted and Repetitive Behaviours
- Unusual Sensory Interest in Play Material/Person: Describe any atypical sensory exploration or avoidance.
- Hand and Finger and Other Complex Mannerisms: Describe any repetitive motor movements.
- Self-Injurious Behaviour: Describe any self-harm behaviours observed.
- Excessive Interest in or References to Unusual or Highly Specific Topics, Objects, or Repetitive Behaviours: Describe any intense interests, repetitive object use, or insistence on sameness.
- Compulsions or Rituals: Describe any ritualistic or compulsive behaviours.
Regulation, Attention, and Behaviour
- Attention and Focus: Describe the quality of the child’s attention across activities.
- Activity Level: Describe the child’s overall energy and movement throughout the session.
- Emotional Regulation: Describe the child’s capacity to manage emotions and recover from distress.
- Transitions Between Activities: Describe the child’s ability to shift between tasks.
- Behavioural Concerns: Note any aggression, tantrums, or safety concerns observed.
Caregiver Interaction and Report
- Caregiver’s Interaction Style: Describe how the caregiver engaged with the child during the session.
- Caregiver Reports During Session: Note relevant information shared by the caregiver about the child’s communication, behaviour, sensory responses, and daily functioning.
Clinical Impressions and Summary
- Summary of Observed Strengths: Describe positive observations and capacities noted during the assessment.
- Summary of Observed Differences and Areas of Support Need: Describe patterns consistent with autism characteristics across domains.
- Overall Clinical Impressions: Provide an integrated observational summary using neurodiversity-affirming language. Select the most appropriate option: (1) ASD characteristics observed, (2) mixed presentation, or (3) below threshold. Do not provide a definitive diagnosis.
ADOS-2 Module 2 Algorithm Scores (if available)
- Algorithm Used
- Social Affect (SA) Total
- Restricted and Repetitive Behavior (RRB) Total
- Overall Total (SA + RRB)
- ADOS-2 Classification
- Comparison Score
Risk, Safety, and Consent
- Risk and Safety: Note any safety concerns identified, or confirm none were present.
- Child’s Engagement: Describe the child’s willingness to participate and tolerance of the assessment.
Plan and Next Steps
- Further Assessment: Describe any additional assessment components planned.
- Feedback Session: Note the plan for sharing results with the family.
- Additional Clinical Notes: Note any factors that may have influenced the child’s performance.
ADOS-2 Module 2
Algorithm: Algorithm 1 (younger than 5 years)
Child Name: Sam Brown
Date of Birth: 3 September, 2021
Chronological Age: 4 years, 2 months
Date of Assessment: 14 November, 2025
Attendance: Sam attended the session with his mother, Sarah Brown.
Initial Presentation:
Sam entered the assessment room cautiously, staying close to his mother initially and requiring gentle encouragement before engaging with the materials. He warmed gradually over the first few minutes and began approaching toys independently. No significant distress was observed on entry.
Behavioural Observations During ADOS-2 Module 2
Language and Communication
- Overall Expressive Language Level: Used short phrases of 2–4 words throughout the session; sentence structure was emerging but not yet consistently formed.
- Overall Level of Non-Echoed Language: Language was primarily spontaneous and meaningful, with occasional echoed repetition of clinician phrases; flexible phrase use observed across multiple contexts.
- Speech Abnormalities Associated with Autism: Mildly atypical prosody noted; some utterances had a flat or monotone quality; no unusual intonation or scripted speech patterns otherwise observed.
- Immediate Echolalia: Occasional immediate repetition observed, not persistent.
- Stereotyped/Idiosyncratic Use of Words or Phrases: No clearly idiosyncratic language noted; repeated use of “uh-oh” across several unrelated contexts.
- Conversation: Responded to direct questions with brief relevant answers; did not elaborate or sustain conversational exchange without significant scaffolding; rarely initiated a topic or maintained a conversational thread across turns.
- Reporting of Events: Provided brief, concrete responses when prompted; limited elaboration without repeated prompting; responses did not extend to narrative.
- Asking for Information: Did not spontaneously ask questions of the clinician; made requests for objects but not for information.
- Descriptive, Conventional, Instrumental, or Informational Gestures: Limited gesture repertoire observed; used reaching and some pointing to request; descriptive or conventional gestures were largely absent; gestures were not consistently integrated with language or gaze.
Reciprocal Social Interaction
- Unusual Eye Contact: Eye contact was intermittent; brief glances observed during requests and transitions; eye contact was not consistently used to regulate social interaction.
- Responsive Social Smile: Social smiling was present but inconsistent; some responses to clinician warmth, though not reliably directed.
- Facial Expressions Directed to Others: Limited range of expressions observed; affect appeared somewhat flat across activities; expressions were not consistently directed toward the clinician or mother.
- Integration of Gaze and Other Behaviours During Social Overtures: Limited integration of gaze, vocalisation, and gesture during social bids; communicative behaviours tended to occur in isolation rather than coordinated.
- Shared Enjoyment in Interaction: Sam showed enjoyment during preferred activities but did not consistently share this with others through gaze or vocalisation; pleasure was generally self-contained.
- Response to Name: Required repeated prompts across multiple trials; response was inconsistent and often delayed.
- Requesting: Used reaching, vocalisation, and occasional single-word requests to obtain objects; did not use a consistent combined verbal-gestural requesting pattern.
- Giving: Gave objects to clinician on one occasion when directly prompted; no spontaneous giving observed.
- Showing: No spontaneous showing observed; did not hold up or orient objects toward others to share interest.
- Spontaneous Initiation of Joint Attention: Absent; Sam did not spontaneously direct the clinician’s attention to objects or events using gaze shift, pointing, or vocalisation.
- Response to Joint Attention: Inconsistent; followed the clinician’s point on some trials with additional cueing but did not reliably shift gaze to the target.
- Quality of Social Overtures: Social overtures, when present, were primarily instrumental rather than declarative or socially oriented; limited integration and reduced variety in the quality of social bids.
- Amount of Social Overtures/Maintenance of Attention: Infrequent social initiations; Sam did not sustain attention to social interaction without significant support.
- Quality of Social Response: Responses to the clinician’s bids were inconsistent; Sam engaged with some social overtures but did not respond reliably.
- Amount of Reciprocal Social Communication: Brief exchanges occurred with considerable scaffolding; sustained reciprocal communication was not observed.
- Overall Quality of Rapport: Limited rapport established; Sam engaged more with objects than with the clinician across the session; some comfort with caregiver proximity but limited social connection with unfamiliar adult.
Play
- Functional Play with Objects: Demonstrated appropriate functional play with familiar items; play was competent but narrow in scope.
- Imagination/Creativity: No spontaneous pretend play observed; play remained concrete and object-focused throughout; did not respond to clinician’s modelled pretend scenarios.
- Quality of Social Overtures (within play context): Play was largely solitary; Sam did not use play as a context for social engagement with the clinician or caregiver.
- Flexibility and Range of Play: Limited play repertoire; returned repeatedly to the same two or three activities; showed some resistance when redirected from preferred items.
Restricted and Repetitive Behaviours
- Unusual Sensory Interest in Play Material/Person: Visual inspection of spinning tops and wheels noted; watched spinning motion for extended periods; no mouthing or olfactory exploration observed.
- Hand and Finger and Other Complex Mannerisms: Brief hand-flapping observed on two occasions during heightened excitement.
- Self-Injurious Behaviour: No self-injurious behaviour observed.
- Excessive Interest in or References to Unusual or Highly Specific Topics, Objects, or Repetitive Behaviours: Strong preference for wheel-spinning and repetitive pushing of vehicles; persisted with these behaviours across transitions; Sarah reported intense interest in fans and spinning objects at home.
- Compulsions or Rituals: Lined up vehicles in a specific order on one occasion; became briefly distressed when the arrangement was disrupted.
Regulation, Attention, and Behaviour
- Attention and Focus: Sustained attention to preferred objects; disengaged quickly from non-preferred activities; difficulty shifting attention away from preferred items.
- Activity Level: Broadly age-appropriate activity level; some increased motor activity during transitions.
- Emotional Regulation: Generally calm; brief distress observed when preferred items were removed, settling within approximately one minute with caregiver reassurance.
- Transitions Between Activities: Required support for transitions; some resistance and vocalisation observed when moving between activities; settled more readily when given brief advance notice.
- Behavioural Concerns: No significant safety concerns noted; brief protest behaviours during transitions were managed effectively with caregiver support.
Caregiver Interaction and Report
- Caregiver’s Interaction Style: Sarah was warm and responsive; allowed Sam independence while remaining available; required minimal guidance during the session.
- Caregiver Reports During Session: Sarah reported that Sam has limited peer interaction at childcare and tends to play alongside rather than with other children; noted strong sensory preferences for spinning objects and distress in response to unexpected loud noises; reported some rigid routines around mealtimes and bedtime transitions.
Clinical Impressions and Summary
- Summary of Observed Strengths: Demonstrated functional play with objects and emerging phrase speech; responded to familiar routines and adult direction with support; showed enjoyment in preferred activities; some capacity for brief social exchange when scaffolded; settled effectively with caregiver reassurance following distress.
- Summary of Observed Differences and Areas of Support Need: Reduced spontaneous eye contact and limited integration of gaze with other communicative behaviours; absent declarative joint attention (initiating and responding); limited social use of gestures; no showing behaviour observed; restricted and repetitive play patterns; absent pretend play; sensory seeking behaviours and strong preference for sameness; difficulty with transitions and flexibility.
Overall Clinical Impressions:
Based on today’s structured observational assessment using ADOS-2 Module 2, 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 neurotype / autism spectrum presentation. Specifically, he showed limited integration of gaze and communicative behaviours, absent declarative joint attention, restricted gesture use, no pretend play, prominent repetitive object use, and sensory-seeking behaviours. These observations should be integrated with developmental history, caregiver report, and other assessment data to inform the clinician’s diagnostic formulation.
ADOS-2 Module 2 Algorithm Scores:
Algorithm Used: Algorithm 1 (younger than 5 years)
Social Affect (SA) Total: 13
Restricted and Repetitive Behaviour (RRB) Total: 4
Overall Total (SA + RRB): 17
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; some resistance during transitions and non-preferred tasks; a small number of activities were abbreviated due to limited engagement; overall performance is considered a reasonable representation of current functioning.
Plan and Next Steps
- Further Assessment: Developmental history interview to be completed with Sarah; ADOS-2 Module 2 Algorithm scoring to be finalised; review of caregiver questionnaire data.
- Feedback Session: Feedback session scheduled for 28 November, 2025 at 10:00 AM to discuss assessment findings with Sarah and outline next steps.
- Additional Clinical Notes: Sarah noted that Sam had been unwell with a mild cold earlier in the week; presentation was reported to be broadly typical; no significant performance concerns identified.
