ADOS-2 Module 3 Assessment Summary

ADOS-2 Module 3

Child Name: Sam Brown

Date of Birth: 14 March, 2016

Chronological Age: 9 years, 8 months

Date of Assessment: 14 November, 2025

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

Initial Presentation:

Sam entered the assessment room willingly and separated from his mother without difficulty. He engaged readily with the materials and appeared curious about the activities. Some initial reticence was noted in conversational exchanges, which eased as the session progressed.

Behavioural Observations During ADOS-2 Module 3

Language and Communication

• Overall Level of Non-Echoed Language: Language was generally spontaneous and flexible; Sam used varied vocabulary and generated novel utterances across most contexts; occasional formulaic phrasing noted when transitioning between topics.
• Speech Abnormalities Associated with Autism: Mildly unusual prosody observed; some utterances had a slightly elevated pitch and flat intonation; no markedly atypical rhythm or rate otherwise noted.
• Immediate Echolalia: No immediate echolalia observed.
• Stereotyped/Idiosyncratic Use of Words or Phrases: Occasional use of overly formal or adult-like phrasing that felt scripted; no idiosyncratic vocabulary or neologisms noted.
• Offers Information: Sam offered information spontaneously on topics of personal interest; less inclined to volunteer information on clinician-led topics without prompting.
• Asks for Information: Asked occasional questions, primarily related to preferred topics; limited use of questions to maintain broader conversational exchange.
• Reporting of Events: Provided coherent accounts of recent events when prompted; responses were organised but lacked elaboration; did not extend narratives spontaneously.
• Conversation: Engaged in reciprocal exchanges on preferred topics; difficulty maintaining conversational flow on clinician-initiated topics; limited responsiveness to conversational leads outside areas of interest.
• Descriptive, Conventional, Instrumental, or Informational Gestures: Limited gesture use observed; gestures were not consistently integrated with verbal communication; pointing and nodding present but infrequent.

Reciprocal Social Interaction

• Unusual Eye Contact: Eye contact was present but variable; more consistent during preferred topic discussions; reduced during less preferred or more demanding activities.
• Facial Expressions Directed to Others: Some variation in facial expression observed; expressions were not consistently directed toward the clinician; affect appeared somewhat flat during non-preferred activities.
• Language Production and Linked Non-Verbal Communication: Partial integration of verbal and non-verbal communication; gaze and gesture were not reliably coordinated with speech, particularly during extended conversational exchanges.
• Shared Enjoyment in Interaction: Sam showed clear enjoyment when discussing areas of interest; sharing of positive affect with the clinician was limited outside these contexts.
• Comments on Others’ Emotions/Empathy: Demonstrated basic identification of emotions in the Cartoons and Emotions tasks; responses were concrete and focused on observable cues; limited spontaneous reference to others’ internal states or perspective-taking.
• Insight into Typical Social Situations and Relationships: Showed some understanding of social conventions; responses to friendship and relationship tasks were brief and formulaic; limited insight into the complexity of social relationships or the perspectives of others.
• Quality of Social Overtures: Social overtures were present but tended to be topic-driven rather than relationally motivated; limited integration of gaze and affect during bids.
• Amount of Social Overtures/Maintenance of Attention: Social initiations were infrequent outside preferred topics; Sam did not consistently sustain engagement with the clinician across activities.
• Quality of Social Response: Responses to clinician’s social bids were inconsistent; engaged more readily when topics aligned with personal interests; less responsive to broader social overtures.
• Amount of Reciprocal Social Communication: Brief reciprocal exchanges occurred across the session; sustained back-and-forth communication required considerable clinician scaffolding.
• Overall Quality of Rapport: Moderate rapport established over the course of the session; Sam was more engaged during preferred activities; connection with the clinician remained somewhat limited in breadth.

Play and Imagination

• Imagination/Creativity: Sam engaged in Make-Believe Play with some imaginative elements when given a structured prompt; spontaneous creativity was limited; storytelling tended toward concrete descriptions rather than elaborated narratives; preferred to reference familiar characters or scenarios rather than generating novel content.

Stereotyped Behaviours and Restricted Interests

• Unusual Sensory Interest in Play Material/Person: No unusual sensory exploration observed.
• Hand and Finger and Other Complex Mannerisms: No repetitive motor mannerisms 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 video game franchise across multiple activities including Make-Believe Play, Telling a Story From a Book, and Creating a Story; Sarah confirmed this represents an intense and longstanding interest that dominates much of Sam’s leisure time and conversation at home.
• Compulsions or Rituals: No compulsions or rituals observed.

Regulation, Attention, and Behaviour

• Overactivity/Agitation: Age-appropriate activity level throughout; no significant restlessness or agitation noted.
• Tantrums, Aggression, or Disruptive Behaviour: No significant behavioural concerns noted during assessment.
• Anxiety: Mild anxiety observed at the start of the session, particularly during open-ended conversational tasks; settled as the session progressed and structure became more familiar.

Caregiver Interaction and Report

• Caregiver’s Interaction Style: Sarah was warm and supportive; remained largely observant during the session and allowed Sam to engage independently; offered brief clarifications when asked.
• Caregiver Reports During Session: Sarah reported that Sam has significant difficulty with peer relationships at school and tends to gravitate toward adults or solitary activities; noted that he becomes distressed when routines are changed unexpectedly; reported strong interest in video games that can interfere with daily functioning and transitions.

Clinical Impressions and Summary

• Summary of Observed Strengths: Demonstrated fluent verbal language with varied vocabulary; engaged in reciprocal conversation on preferred topics; showed enjoyment during activities of interest; demonstrated basic emotional identification; rapport developed over the course of the session; willingness to engage with all assessment activities.
• Summary of Observed Differences and Areas of Support Need: Reduced integration of non-verbal and verbal communication; limited spontaneous social initiation outside preferred topics; restricted range of imaginative content; repeated references to a specific topic across activities; reduced perspective-taking and insight into social relationships; inconsistent responsiveness to clinician’s social bids; limited sharing of positive affect.

Overall Clinical Impressions:

Based on today’s structured observational assessment using ADOS-2 Module 3, 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 limited integration of non-verbal and verbal communication, reduced spontaneous social initiation, restricted imaginative content, repeated references to a specific area of interest across activities, and limited perspective-taking. These observations should be integrated with developmental history, caregiver report, and other assessment data to inform the clinician’s diagnostic formulation.

ADOS-2 Module 3 Algorithm Scores:

Social Affect (SA) Total: 11

Restricted and Repetitive Behaviour (RRB) Total: 2

Overall Total (SA + RRB): 13

ADOS-2 Classification: Autism Spectrum

Comparison Score: 6 (Moderate 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 well overall; engaged with all activities; some initial reticence during open-ended 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 school reports and teacher 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 anxious about the assessment in the days prior; presentation on the day was reported to be broadly typical.