Assessment of Autism Spectrum Disorder in Deaf Adults with Intellectual Disability: Feasibility and Psychometric Properties of an Adapted Version of the Autism Diagnostic Observation Schedule (ADOS-2)

D Holzinger,J Hofer,C Weber,S Bölte,J Fellinger

doi:10.1007/s10803-021-05203-5

Abstract

This study describes the adaptation of the autism diagnostic observation schedule (ADOS-2) to assess autism spectrum disorder (ASD) in adults with intellectual disability (ID) and hearing loss who communicate primarily visually. This adapted ADOS-2 was applied to residents of specialized therapeutic living communities (n = 56). The internal consistency of the adapted ADOS-2 was excellent for the Social Affect of modules 2 and 3 and acceptable for Restricted and Repetitive Behaviors subscale of module 2, but poor for module 3. Interrater reliability was comparable to standard ADOS-2 modules 1–3. Results suggest that autism symptoms of deaf adults with ID can be reliably identified by an adapted ADOS-2, provided adequate expertise in deafness, ID, ASD and proficiency in signed language by the administrator.

Highlights

Autism spectrum disorder (ASD) is a neurodevelopmental condition of heterogeneous origin and phenotypic expression of social communication and interaction difficulties along with repetitive, restricted behaviors (American Psychiatric Association, 2013)
The autism diagnostic observation schedule 2nd edition (ADOS-2) is composed of five modules: the Toddler Module for children aged 12–30 months without phrase speech, Module 1 (M1) for children aged > 30 months who do not show phrase speech, Module 2 (M2) for children with phrase speech who are not verbally fluent, Module 3 (M3) for children and young adolescents with fluent language, and Module 4 (M4) for older adolescents and adults with fluent language
The objective of this study was to (a) to describe adaptations of the ADOS-2 for the assessment of deaf or hard of hearing (DHH) adults with intellectual disability (ID) and (b) to investigate the feasibility and reliability of this adapted measure by administering it in a complete sample of deaf adults with ID living in three therapeutic communities

Summary

Introduction

Autism spectrum disorder (ASD) is a neurodevelopmental condition of heterogeneous origin and phenotypic expression of social communication and interaction difficulties along with repetitive, restricted behaviors (American Psychiatric Association, 2013). ASD diagnosis is exclusively behaviorally-defined, making the “best clinical judgment of experienced clinicians” the diagnostic gold standard (Volkmar et al, 2014; National Collaborating Centre for Mental Health (UK), 2012). Even for experienced clinicians a multidisciplinary, consensusbased diagnostic assessment including standardized instruments is recommended and improves the accuracy of ASD diagnosis (Guthrie et al, 2013; Kim & Lord, 2012). In this context the autism diagnostic observation schedule 2nd edition (ADOS-2; Lord et al, 2012) is considered the “goldstandard”, allowing clinician led observation and evaluation. Journal of Autism and Developmental Disorders of ASD defining symptoms in the course of structured playful and interview-based interactions. The ADOS-2 is composed of five modules: the Toddler Module for children aged 12–30 months without phrase speech, Module 1 (M1) for children aged > 30 months who do not show phrase speech, Module 2 (M2) for children with phrase speech who are not verbally fluent, Module 3 (M3) for children and young adolescents with fluent language, and Module 4 (M4) for older adolescents and adults with fluent language

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