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ADOS-2 Administration 1,2 and T

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Marie Velasco

on 22 July 2015

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Transcript of ADOS-2 Administration 1,2 and T

Special Administration notes (Modules 1-2, T)
Previous testing experience with very young children is crucial for Modules T-2:

-Young children are supposed to be wary of new situations and people (e.g., excessive animation may overwhelm a young child)

-For toddler Module to be valid, the examiner must have skills necessary to respond to relevant behaviors

Module 1 Administration
Module 2 Administration
Viewing and Independent Coding of ADOS-2 Administration
Module 1 or 2
Response to Name
Module 2 Activities
Viewing and Independent Coding
of ADOS-2 Administration
ADOS-2 Administration Modules 1, 2, and T
Guidelines for selecting an ADOS-2 module
Module 1 activities (Pre-verbal/Single Words)
31 months and older
1. Free Play

2. Response to Name

3. Response to Joint Attention

4. Bubble Play

5. Anticipation of a Routine
with Objects
6. Responsive Social Smile

7. Anticipation of a Social Routine

8. Functional and Symbolic Imitation

9. Birthday Party

10. Snack
Free Play
Observation - spontaneous engagement of child alone or with parent--what does s/he play with? Symbolic or functional use of objects. Time spent with any activity? Repetitive use

Relaxed atmosphere - can play with parent

If shy - base ratings on behavior after child has relaxed

Get into from parent - how typical is this of child

Might include - Response to Name/Responsive Social Smile
Response to Joint Attention
Observation - Response of child to hierarchical auditory stimuli

Examiner x 2 - pause - repeat x 2

Parent calling name only

Parent making familiar vocal approach

Parent making physical approach

Bubble Play
Anticipation of a Routine with Objects
Observation - child's anticipation and initiation of the repetition of an action routine, initiation of joint attention, enjoyment, verbalizations and motor behavior
Blow up balloon slowly and hold it directly in front of the child
Alert child "Ready, Steady, Go" and let go of balloon
Repeat the action and wait of the child to return it and request repetition - this can be repeated with deliberately slow steps twice more
If the child is afraid of the balloon, use another cause and effect toy with suitable enthusiasm
Again, wait for the child to signal interest or excitement
Responsive Social Smile
Observation - consistency of child's smile in response to a purely social overture from an adult
Get child's attention - call name
Make a positive statement "That's a lovely car" - silly face or noise
If no response repeat
If no clear positive response ask parent - without having to touch child
Coding based on clear change in facial expression resulting in a smile towards person who initiates the interaction

Anticipation of a Social Routine
Observation - child's affect and attempts to anticipate, request and participate in a social routine
Based on prior observation of the child - peek-a-boo, tickling or swinging can be used
Initiate the game, pause and repeat the action
Wait for the child to make any move to request repetition
Functional and Symbolic Imitation
Functional and Symbolic Play
Birthday Party
Observation- the child's interest and ability to join in the "script" of a doll's birthday party - symbolic and functional play, use of the doll as an animate being, spontaneous contribution to the enactment of the party or imitation of the examiner's actions
Carry out at a slow pace to give the child the opportunity to join in
Put the doll on the table and say "look, here's the baby" - the child can tough, hug or play with the doll if s/he wants to
Say "It's the baby's birthday! Let's have a birthday party for the baby" - make a cake out of the play-doh and put a candle in "Here are the candles" - give the second candle to the child and leave the other two nearby
Light the candles and indicate "Hot" then say "What should we do now" if the child does not spontaneously blow out the candles or use the doll to do so, say "Let's blow out the candles"
Blow out the candles leaving pauses between steps and look at the child each time - clap and cheer

Birthday Party (cont.)
Give the child a fork and say "The baby is hungry", if there is no response, say "The baby wants some birthday cake" - if the child does not feed the doll, demonstrate "Let's feed the baby"

The cup should be near the child to see if s/he gives the doll a drink, if not suggest it as before, if no response, do it yourself

"OK, the party is over, what will baby do?" out the doll on the table and place the blanket nearby without indicating it. If there is no response say "The baby is tired. Time for baby to sleep?"

If the child does not respond by putting the doll on the bed or any other action towards the doll, cover the doll with the blanket and say "Night night, baby" - give the doll to the child

Put the party items back into the bag, giving the child the opportunity to help
Observation - how the child indicates a preference and requests food in a familiar context - use of gaze, gesture, reaching, facial expression and vocalization to communicate a request to examiner
With the child at the table say "It's time for a snack" - put the plate within easy reach of the child. "We have X and Y" - give a small piece of each food onto the child's plate and wait until s/he has eaten them
Lift the containers in each hand out of reach of the child and say "What do you want?"
Repeat what is in the containers with one word and wait for the child to indicate a preference by, any means - if s/he does, give what is asked for
Repeat the activity again, but more quickly to avoid frustration
If the child shows no interest in food, use a drink in consultation with the parent
Response to Name
Observation - child's response to examiner's use of eye contact coordinated with facial orientation, verbalization & pointing to distant object
Place toy to the right of child
Gain eye contact "Look X"
Repeat "Look X - look at that"
Repeat five times and then point with verbal instruction
If no response - activate the toy
Turn off and wait for 5 seconds to see if child requests
If no response, put toy in front of child and see if s/he requests activation
If no response activate again for 5 seconds and turn off

Observation - spontaneous initiation of eye contact & vocalization, enjoyment, pointing, reaching to initiate joint attention. Unusual sensory behaviors/movements may be elicited. Opportunity for requesting behavior is given.

Move a distance of 5 feet away from the child and activate bubble gun away from your body

Continued for 5 seconds after the child has noticed

Note any gestures, vocalizations or looks to parent or examiner within first 5 seconds

Give child opportunity to request more bubbles

Gun, but not liquid can be placed for the child to access

Show child how the gun works, if necessary
Observation - child's imitation of simple actions with real objects and a non-meaningful placeholder for the same objects
Begin with an example - frog or car
"Look at the car" - move the car across the table with the sound effect "Vroom vroom" - give the car to the child and say "You do it"
If the child does not imitate the action - s/he can be physically helped to do so up to 3 times
If the child imitates - clap and cheer
Proceed with the other trials - using the appropriate sound effects
For trials with the cylindrical block, it is used as a placeholder for the other common objects
Now,this is a ..." - demonstrate the action previously carried out with the real miniature
If child imitates with the real objects and with placeholder - the activity is finished
If the child imitates with real objects and not with the placeholder - repeat the action with a real object and repeat the sequence
*If child fails the first model of frog or car, provide hand-over modeling on the 2nd model. Examiner then models the action a third time and asks child to imitate independently. Hand-over-hand can e used ONLY during the Teaching trial.
1. Construction Task

2. Response to Name

3. Make-Believe Play

4. Joint Interactive Play

5. Conversation

6. Response to Joint Attention

7. Demonstration Task
8. Description of a Picture

9. Telling a Story from a Story Book

10. Free Play

11. Birthday Party

12. Snack

13. Anticipation of a Routine With Objects

14. Bubble Play
Construction Task
Observation - how child indicates a need for more pieces, how s/he does so - eye contact, gesture, vocalization, reaching over examiner's arm
Place some of the block pieces out of reach of the child "Show me how you would put these blocks together - when you need more let me know"
Ensure the remaining blocks are within the child's view but at the other side of the examiner's arm
When the child has assembled the blocks, s/he has the examiner should move slightly away and wait for the child to ask for the remaining blocks
If the child does nothing, the examiner should look deliberately at her/him
If there is no response in 3 seconds, the examiner should say "Are you doing okay?" or "How are you doing?" Only then should the examiner ask "Do you need more blocks?"
At the end of the task, the examiner begins to clear away the blocks while saying "Time to clear up" - Watch to see if the child helps put away the remaining blocks
Make-Believe Play
Observation - extent to which the child produces imaginative or creative use of miniature objects, in particular how s/he uses the dills as animate beings interacting with each other
Present the figures "This is a family, with a mother and father, a little boy/girl and a baby. Here are some of their things. Could you play with these now for a while?"
If the child does nothing, examiner can pick-up some if the toys ans make limited but creative use of them to demonstrate some make-believe use of the objects "What are you gong to do with your?"
Examiner should show interest without telling the child what to do, it can be helpful to talk about what s/he is doing "Who is this?"
Important to distinguish the child's own creative actions from merely copying the examiner's prompts
Joint Interactive Play
Observation - reciprocity shown by the child in joint play with examiner - how the child, not the examiner develops the interaction and provides novel initiatives that go beyond responses to the examiner's overtures
When the child has had sufficient time to initiate make-believe play the examiner asks "Can I play too?"
Examiner may pick up a doll and have it give something to the child's doll
If the child responds, the examiner responds in turn
It can be helpful to say "Who do you want to be? I'll be the daddy"
Imitate what the child does "Oh, can I do that too?"
Enter into the spirit of the play and show appropriate enthusiasm and pleasure
Observation - extent to which the child builds on examiner's statements and makes leading statements to facilitate back and forth conversation
Can be administered at any time during the schedule
Goal is to have a conversation-like exchange, regardless of complexity level
Examiner makes comments about any of the materials and give the child time to respond
Comments out of the immediate context can be made to see if the child can maintain the conversation without visual support
At some point the examiner should stop maintaining the conversation to see if the child can take the initiative
Examiner should incorporate the child's interests and earlier comments into the exchange - avoid topics known to be particularly strong interests
Open questions, comments or interpretations should be used where possible
Demonstration Task
Observation - how the children represents familiar action n gesture and/or words
"I want you to pretend game with me" and set and set the imaginary scene with gestures
"This is the pretend washbasin and this is the pretend toothpaste" - gestures should be slow and without extraneous movement
"Now I want you to teach me how you brush your teeth, can you show me and tell me, start right at the beginning. You've come into the bathroom. What do you do now?"
If the child does not understand, repeat the instructions
A demonstration of another scene can be given of a different event - driving a car
If the child gestures without words, say "That's good, now tell me, it's OK to talk as well as show me"
If this proves impossible for the child, real items (soap, flannel and towel can be used) in another scene
Module 2 - Description of a Picture
Observation - generation of a spontaneous language sample and what captures the child's interest
Present the picture to the child "Let's look at this picture now. Can you tell me about it? What's happening in the picture?"
Prompt can be repeated in different words
Encourage the child to talk at any level and respond enthusiastically, no further information about the picture is given
If the child does not respond after general prompts and questions or procedures only labels - the exam should model a complex sentence and repeat as necessary
Specific questions may be used "What/who/where"
If the child is not interested in the first picture, another one may be used, if there is still no response, the examiner ask a question which requires a pointing response "Do you see the kite in the picture?"
Telling a Story from a Book
Observation - spontaneous language sample and how the child conveys continuity in a story
Present the story book "Have a look at this book. It tells a story. See it starts out with..." and describe the first picture
Give the book to the child and prompt as necessary
Give no more than two specific prompts to get started "I wonder what happens next?"
When the child has described for a few minutes, say "That was great, now I'll take a turn" and quickly finish the story. If the child is determined to finish the story. If the child is determined to finish the story, note this and allow her/him to finish

ADOS-2 : Toddler Module
General Introduction
Challenges in assessing autism symptoms in very young children
Diagnoses are less stable
Manifestations of core autism are different depending on age and language level
Early "red flags" can be very subtle
-Assessing your children requires different strategies
Accurate diagnosis is dependent on comprehensive assessment by trained, experienced clinicians with knowledge of development in infancy and early development
The Toddler Module
Same basic structure as the other ADOS-2 modules

Appealing toys and simple routines

Examiner provides more structure than in other modules

Less focus on initiations by the child and greater focus on responses
Toddler Module is standardized by:
Behavior of the Examiner
Behaviors to be Observed
How the Child's behavior is Quantified
Algorithm Section
Risk Ranges
Trainings of the Examiner
Standards achieving and Maintaining Reliability

When to use ADOS-2: Toddler Module?
Children between 12 and 30 months
If 31 months or older (no speech to phrase speech)
--> Module 1
Nonverbal to primary single words and occasional phrases
If flexible 3-unit phrases --> Module 2 (regardless of age)
MUST have nonverbal mental age at least 12 months and be walking - If not, validity of the Toddler Module is weakened; risk of overclassification
of this Training
Overview the ADOS-2, Toddler Module
Demonstration of Toddler Module to illustrate administration and coding
Understanding algorithms and resulting risk ranges
Description of Toddler Module development and psychometrics
Information necessary for further use
Prerequisite Experience for the Toddler Module
Clinical use of the Toddler Module presumes previous training and experience with Modules 1-4 of the ADOS-2
To establish research reliability on the Toddler Module, one must first establish research reliability on Modules 1-4

What this training is not:
Equivalent to full preparation for clinical use
A replacement for reading the manual

Further practice and experience will be needed before you can use the ADOS-2, Toddler Module reliably for clinical or research purposes.
BEFORE the Toddler Module Administration
BEFORE the Toddler Module Administration
Tell the parent/caregiver what to expect and how to behave
Observe child's comfort level and respond accordingly
Provide time to warm up
Kneel or sit at child's level
Avoid starting with child in caregiver's lap
Avoid introducing personal objects (e.g. pacifier, blanket, favorite toy, etc.)
DURING the Toddler Module Administration
Aim for standardized administration of 40-60n minutes, completed in one setting
There should only be one examiner
An observer may help with materials, but codes should only be assigned with regard to the examiner (and/or parent/caregiver as specified)
Be flexible! Match your style to the child
Observe and promote interactions between child and caregiver as necessary, BUT
Encourage parent/caregiver to allow child to participate independently
End the session on a positive note
AFTER the Toddler Module Administration
Assign codes immediately following the assessment
-Codes should ALWAYS be assigned based on live (not taped) administration and only on behaviors that occurred during the ADOS-2
-Importantly, psychometric data are based on information from live coding
-Video recording can be used for detailed study, assessment of reliability, etc.
Use information from the Toddler Module in combination with all other information from the diagnostic assessment
Prepare room and materials before participants arrives
Arrange the environment
-Prepare a toddler-friendly room with toddler-size table and chairs
-Do not use a child-size with restraints; child must be able to move in and out of the chair independently
-Arrange task materials accessibly, but out of child's reach -- provide comfortable chair for parent/caregiver
Toddler Module
Age range 12-30 months
Expressive language level - no speech, single words or simple phrases (not yet used consistently)
Based on Module 1, with some additional tasks
Consists of 11 activities
Parent/caregiver must be present
Initial wariness in new situations with unfamiliar people expected at this age
Observe child's comfort level - waiting few minutes before beginning administration may be necessary
Allow interactions to occur between the child and parent/caregiver
Be more affective present
More structure provided than in other modules
More focus on child's responses than initiations
Toddler Module activities (Pre-verbal/Single Words)
(12-30 months old; NV age of at least 12 months, must be walking
Toddler Module Administration
Note: additional toys are included in the Toddler module free play:
Toddler Module Administration
Free Play
metal lid, plastic ring and cylindrical tube
at any point during Free Play
Hand each object (one by one) to the child, allowing 15-30 seconds
Each object should be attempted (regardless of observed behaviour)
Should be administered at the table
Observation: child's exploration of objects, particularly whether it is receptive.

1. Free Play
1a. Ball

2. Blocking Toy Play

3. Response to Name

4. Bubble Play
4a. Teasing Toy Play

5. Anticipation of a Routine with Objects
5a. Unable Toy Play
6. Anticipation of a Social Routine

7. Response to Joint Attention

8. Response to Social Smile*

9. Bath Time
9a. Ignore

10. Functional and Symbolic Imitation

11. Snack
*Administration of Responsive Social Smile differs from Module 1
Free Play
1. Handbag with keys, phone, lipstick etc

2. Tool Kit

3. Shape sorter

4. Lid, plastic ring, cylinder
Approximately 3 minutes (should not last longer than 10 min)
Discreetly remove cause and effect toys to probe for functional & representation play
Examiner may model simple pretend play
FREE PLAY - probe for repetitive behaviour
Free Play - Ball
Materials: using any of the balls from free play
Administration: Gently bounce or roll the ball towards the child
May invite parent into the game
Purpose: observe how does the child respond to introduction of a new toy, and how they respond to common games
Blocking Toy Play
shape sorter, or pop-up toy or jack-n-the-box
Administration: at any point during Free Play
Hand each object (one by one) to the child, allowing 15-30 seconds
Each object should be attempted (regardless of observed behaviour)
Should be administered at the table
Observation: child's exploration of objects, particularly whether it is receptive

Administer when child is involved with a toy or activity
BUT, not so overly engaged he is unlikely to respond
Position yourself at a distance
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