MODULE TWO: for those who use phrase speech but who are not verbally fluent.
Construction task
Make-believe play
Joint interactive play
Conversation
Response to joint attention
Demonstration task
Description of picture
Looking at a book
Free play
Response to name
Birthday party
Snack
Anticipation of a routine with objects
Bubble play
MODULE THREE: for verbally fluent children
Construction task
Make-believe play
Joint interactive play
Demonstration task
Description of a picture
Telling a story from a book
Cartoons
Reporting a non-routine event/conversation
Emotions
Social difficulties/annoyance
Break
Friends/loneliness/marriage
Creating a story
That's what I don't get. He is clearly verbally fluent, so Module 2 seems very inapproriate.
The ADOS website says: "Sometimes a child with very high functioning autism can miss autism criteria on the ADOS, just because it is a short observation. When this happens, the examiner is usually quite aware of it since these children will almost always have some high codings and scores, just not enough of them to reach the criterion for autism. So it is not that the examiner did not see any autism, but that the particular thresholds for the codes were not met.
The situation can also occur when a child's developmental skills fall "between" two modules. A user may decide to give the lower one, even though the child has enough language to do the next one up, out of concern that the social questions might be difficult. This can cause kids to miss threshold--for example, reach the criteria for ASD but not autism, or meet criteria in one domain, but not another. Even so, such a child wouldn't "not look autistic."
In all such cases, an examiner must use clinical judgment. Apart from the ADOS scores, did the child show any signs of autism during the session? How does this fit with the specific abnormalities another mental health team member may be reporting from the Autism Diagnostic Interview-Revised (ADI-R) for example (which is retrospective and relies completely on the parents' report). In cases where parents', teachers' or other clinicians' reports seem to disagree with observations made during an ADOS session the examiner need to find out: are people are actually seeing the same things but interpreting them differently; is it that the child's behavior changed radically; or are other parties reporting things that really were not present during your session?
This is also the place to consider a central caveat for all testing: no clinical decision should rest on the results of a single test score. A diagnosis, whether it is medical or school program based, is the informed judgment of a skilled and qualified professional, based on all the accumulated evidence from multiple sources.