ADOS-2 Module 4 Assessment Summary

ADOS-2 Module 4

Individual Name: Sam Brown

Date of Birth: 14 March, 2000

Chronological Age: 25 years, 8 months

Date of Assessment: 14 November, 2025

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

Initial Presentation:

Sam arrived on time and entered the assessment room without difficulty. He appeared calm but somewhat guarded on entry, making brief eye contact with the clinician before directing his attention to the materials on the table. He responded politely to introductory conversation and became more at ease as the session progressed.

Behavioural Observations During ADOS-2 Module 4

Language and Communication

• Overall Level of Non-Echoed Language: Sam used fluent, grammatically intact sentences throughout the session, including complex multi-clause constructions; language was spontaneous and varied, with occasional overly formal or verbose phrasing.
• Speech Abnormalities Associated with Autism: Mildly unusual prosody observed; speech was somewhat flat in intonation with limited variation in pitch; rate and rhythm were otherwise unremarkable.
• Immediate Echolalia: No immediate echolalia observed.
• Stereotyped/Idiosyncratic Use of Words or Phrases: Occasional use of formal or technical language that felt slightly incongruous with the conversational context; no neologisms or pronoun errors noted.
• Offering Information: Sam offered personal information spontaneously when topics aligned with his interests; less forthcoming about personal experiences or feelings on clinician-initiated topics.
• Asking for Information: Did not spontaneously ask the clinician about their thoughts, feelings, or experiences; responded appropriately when the clinician offered personal comments but did not follow up with questions.
• Reporting of Events: Provided a clear account of a recent non-routine event when prompted; description was factual and organised but lacking in personal reflection or elaboration.
• Conversation: Conversation flowed on preferred topics with some reciprocal exchange; on clinician-initiated topics, Sam’s responses were often brief and did not provide adequate material for the clinician to continue the dialogue; limited spontaneous elaboration outside areas of personal interest.
• Descriptive, Conventional, Instrumental, or Informational Gestures: Some use of conventional and instrumental gestures observed; descriptive gestures were rare; gesture use was not well integrated with speech.
• Emphatic or Emotional Gestures: Limited emphatic or emotional gestures observed; those present were somewhat understated and not well integrated with verbal expression.

Reciprocal Social Interaction

• Unusual Eye Contact: Eye contact was present but inconsistently modulated; Sam made more sustained eye contact when listening than when speaking; gaze was not reliably used to initiate or regulate social interaction.
• Facial Expressions Directed to the Examiner: Some direction of facial expressions to the clinician observed, primarily in response to humour or moments of engagement on preferred topics; range of expression was limited across the broader session.
• Language Production and Linked Non-Verbal Communication: Vocalisations were accompanied by limited coordinated non-verbal behaviour; changes in facial expression, gesture, and gaze were less frequent and less varied than expected; verbal and non-verbal channels appeared somewhat disconnected.
• Shared Enjoyment in Interaction: Sam showed clear enjoyment during discussions related to his areas of interest; expression of pleasure was less evident across broader interactive tasks; enjoyment was not consistently directed toward the clinician.
• Communication of Own Affect: Described experiencing several emotions across the Emotions task and spontaneous conversation; communication was predominantly verbal and somewhat flat in affective tone; limited use of non-verbal channels to convey emotional states.
• Comments on Others’ Emotions: Demonstrated basic identification of emotions in others during Cartoons and Creating a Story activities; responses were accurate but concrete and focused on observable cues; limited spontaneous perspective-taking or elaboration on others’ internal states.
• Insight into Typical Social Situations and Relationships: Showed some understanding of conventional social relationships; responses to friendship and relationship tasks were brief and formulaic; limited insight into the complexity of interpersonal dynamics or his own role within relationships.
• Responsibility: Described taking responsibility for his own actions across several daily living contexts; some responses suggested difficulty navigating ambiguous social expectations independently; overall presentation was consistent with age-appropriate responsibility in structured situations.
• Quality of Social Overtures: Social overtures were present but predominantly topic-driven; limited integration of gaze and affect when initiating interaction; overtures outside preferred topics were infrequent and less socially engaging.
• Amount of Social Overtures and Attention Attempts: Sam made some attempts to engage the clinician on topics of personal interest; less frequent attempts to direct or maintain the clinician’s attention across broader activities.
• Quality of Social Response: Responsive to most of the clinician’s conversational initiations; responses were appropriate but somewhat limited in range; less responsive to social bids outside preferred topics or more emotionally oriented tasks.
• Amount of Reciprocal Social Communication: Some reciprocal social exchange occurred across the session; sustained back-and-forth communication was more evident on preferred topics and required greater clinician effort on broader or emotionally oriented tasks.
• Overall Quality of Rapport: Rapport developed gradually across the session; interaction was generally comfortable but at times felt somewhat stilted, particularly during socioemotional tasks; Sam appeared more at ease with structured activities than open-ended conversation.

Imagination and Creativity

• Imagination and Creativity: Sam engaged with the Creating a Story and Telling a Story From a Book activities; narrative contributions were competent but tended toward factual or plot-driven descriptions; spontaneous creative elaboration was limited; no creative or inventive contributions were observed outside structured tasks.

Stereotyped Behaviours and Restricted Interests

• Unusual Sensory Interest in Play, Materials, or People: No unusual sensory interests or sensory-seeking behaviours observed.
• Hand and Finger and Other Complex Mannerisms: No repetitive motor movements or unusual posturing observed.
• Self-Injurious Behaviour: No self-injurious behaviour observed.
• Excessive Interest in or References to Unusual or Highly Specific Topics, Objects, or Repetitive Behaviours: Repeated references to a specific technical domain across multiple activities including Conversation, Creating a Story, and Plans and Hopes; references were extensive and at times difficult to redirect; Sarah confirmed this represents a longstanding and pervasive interest that significantly dominates Sam’s daily life and conversation.
• Compulsions or Rituals: No clearly compulsive behaviours or rituals observed; some tendency toward providing detailed lists when describing experiences, though this did not significantly disrupt the assessment.

Other Abnormal Behaviours

• Overactivity and Agitation: Sat appropriately throughout the assessment; no significant restlessness or agitation observed.
• Tantrums, Aggression, Negative or Disruptive Behaviour: No significant behavioural concerns noted during assessment.
• Anxiety: Mild anxiety observed at the start of the session, particularly during open-ended socioemotional tasks; this settled as the session progressed and Sam became more familiar with the assessment format.

Support Person Interaction and Report

• Support Person’s Interaction Style: Sarah was warm and supportive; remained largely observant during the session and allowed Sam to engage independently; offered contextual clarifications when asked by the clinician.
• Support Person Reports During Session: Sarah reported that Sam has significant difficulty initiating and maintaining peer relationships and tends to socialise primarily through shared interest groups; noted longstanding challenges with unstructured social situations and unexpected changes to routine; reported that his circumscribed interest in his technical domain occupies a substantial portion of his daily life.

Clinical Impressions and Summary

• Summary of Observed Strengths: Demonstrated fluent, grammatically intact language with broad vocabulary; engaged in reciprocal conversation on topics of personal interest; showed capacity for basic emotional identification; presented as responsible and cooperative throughout the assessment; rapport improved across the session; willingness to engage with all assessment activities.
• Summary of Observed Differences and Areas of Support Need: Inconsistent modulation of eye contact; limited integration of verbal and non-verbal communication; reduced spontaneous social initiation outside preferred topics; restricted conversational reciprocity on clinician-initiated topics; limited spontaneous expression of interest in the clinician’s perspective; concrete and limited perspective-taking; repeated and pervasive references to a specific area of interest across activities; limited creative elaboration in storytelling tasks.

Overall Clinical Impressions:

Based on today’s structured observational assessment using ADOS-2 Module 4, Sam demonstrated a pattern of differences in social communication and reciprocal social interaction, along with restricted and repetitive behaviours and interests, that are consistent with an autistic neurotype / autism spectrum presentation. Specifically, he showed inconsistent modulation of eye contact, limited integration of verbal and non-verbal communication, reduced spontaneous social initiation outside areas of personal interest, restricted conversational reciprocity, limited perspective-taking, and pervasive references to a specific topic across multiple assessment activities. These observations should be integrated with developmental history, support person report, and other assessment data to inform the clinician’s diagnostic formulation.

ADOS-2 Module 4 Algorithm Scores:

Communication (A) Total: 5 (items A4, A8, A9, A10)

Social Interaction (B) Total: 8 (items B1, B2, B6, B8, B9, B11, B12)

Communication + Social Interaction Total: 13

Stereotyped Behaviours and Restricted Interests Total: 3 (items C1, D1, D2, D4, D5)

ADOS-2 Classification: Autism

Risk, Safety, and Consent

• Risk and Safety: No immediate safety concerns were identified during today’s assessment.
• Individual’s Engagement: Sam tolerated the assessment well overall; engaged with all activities; some hesitancy noted during open-ended socioemotional tasks; performance is considered a representative indication of current functioning.

Plan and Next Steps

• Further Assessment: Developmental history interview to be completed with Sarah; review of previous assessment and educational records.
• Feedback Session: Feedback session scheduled for 28 November, 2025 at 10:00 AM to discuss assessment findings with Sam and Sarah and outline next steps.
• Additional Clinical Notes: Sarah noted that Sam had been anxious about the assessment in the days prior; presentation on the day was reported to be broadly typical; co-occurring anxiety may have contributed to some guardedness at the start of the session.