developmental-pediatrics/Forms/Assessment-Tools/FRM-ADOS-001-ADOS-2-Administration-Checklist.md

# ADOS-2 Administration Fidelity Checklist

| Form ID | FRM-ADOS-001 | Revision | 1.0 |
|---------|--------------|----------|-----|

---

## Section 1: Assessment Information

| Field | Entry |
|-------|-------|
| Child Name | |
| Date of Birth | |
| Chronological Age | |
| Assessment Date | |
| Examiner Name | |
| Observer Name (if applicable) | |
| Medical Record Number | |

## Section 2: Module Selection

### Module Selected
- [ ] Toddler Module (12-30 months)
- [ ] Module 1 (31+ months, minimal expressive language)
- [ ] Module 2 (any age, phrase speech)
- [ ] Module 3 (fluent speech, child/adolescent)
- [ ] Module 4 (fluent speech, older adolescent/adult)

### Module Selection Criteria Met
- [ ] Age appropriate
- [ ] Expressive language level appropriate
- [ ] Module selection documented in report

### Justification for Module Selection




## Section 3: Pre-Assessment Preparation

### Materials and Setup
- [ ] All required materials prepared and available
- [ ] Testing room appropriate (minimal distractions)
- [ ] Video recording equipment functional (if recording)
- [ ] Scoring forms and manual available
- [ ] Toys/materials in good condition
- [ ] Backup materials available

### Examiner Preparation
- [ ] Reviewed child's background information
- [ ] Reviewed previous assessments (if available)
- [ ] Confirmed module selection
- [ ] Prepared parent/caregiver for observation
- [ ] Scheduled adequate time (45-60 minutes typical)

## Section 4: Administration Fidelity

### General Administration Principles

| Item | Met | Notes |
|------|-----|-------|
| Rapport established with child | ☐ Yes ☐ No ☐ N/A | |
| Standardized procedures followed | ☐ Yes ☐ No ☐ N/A | |
| Flexibility applied appropriately | ☐ Yes ☐ No ☐ N/A | |
| Presses administered correctly | ☐ Yes ☐ No ☐ N/A | |
| Natural, playful interaction maintained | ☐ Yes ☐ No ☐ N/A | |
| Appropriate pacing maintained | ☐ Yes ☐ No ☐ N/A | |
| Child engaged throughout | ☐ Yes ☐ No ☐ N/A | |

### Activity-Specific Fidelity

#### Activities Administered (check all that apply)

**Toddler Module:**
- [ ] Free Play
- [ ] Response to Name
- [ ] Response to Joint Attention
- [ ] Bubble Play
- [ ] Anticipation of a Social Routine
- [ ] Responsive Social Smile
- [ ] Anticipation of a Social Routine with Objects
- [ ] Functional Play
- [ ] Birthday Party
- [ ] Snack

**Module 1:**
- [ ] Free Play
- [ ] Response to Name
- [ ] Response to Joint Attention
- [ ] Bubble Play
- [ ] Anticipation of a Routine with Objects
- [ ] Responsive Social Smile
- [ ] Functional and Symbolic Imitation
- [ ] Birthday Party
- [ ] Snack

**Module 2:**
- [ ] Free Play
- [ ] Response to Name Called
- [ ] Birthday Party
- [ ] Snack
- [ ] Bubble Play
- [ ] Construction Task
- [ ] Make-Believe Play
- [ ] Joint Interactive Play
- [ ] Description of a Picture
- [ ] Telling a Story from a Book
- [ ] Conversation and Reporting

**Module 3:**
- [ ] Construction Task
- [ ] Make-Believe Play
- [ ] Joint Interactive Play
- [ ] Demonstration Task
- [ ] Description of a Picture
- [ ] Telling a Story from a Book
- [ ] Cartoons
- [ ] Conversation and Reporting
- [ ] Break (if needed)
- [ ] Creating a Story
- [ ] Social Difficulties and Annoyance
- [ ] Emotions
- [ ] Friends and Relationships
- [ ] Loneliness

**Module 4:**
- [ ] Construction Task (if appropriate)
- [ ] Current Work or School
- [ ] Description of a Picture
- [ ] Telling a Story from a Book
- [ ] Cartoons
- [ ] Break
- [ ] Demonstration Task
- [ ] Creating a Story
- [ ] Social Difficulties and Annoyance
- [ ] Emotions
- [ ] Friends, Relationships, and Marriage
- [ ] Loneliness

### Standardization Issues

**Were there any deviations from standardized administration?**
- [ ] No deviations
- [ ] Minor deviations (describe):
- [ ] Major deviations affecting validity (describe):

**Deviations Description:**




### Child Factors Affecting Administration
- [ ] Attention difficulties
- [ ] Behavioral challenges
- [ ] Fatigue
- [ ] Illness
- [ ] Anxiety/shyness
- [ ] Language barriers
- [ ] Sensory sensitivities
- [ ] Other: _______________

**Impact on Assessment:**




## Section 5: Scoring Fidelity

### Real-Time Scoring
- [ ] Codes recorded during administration
- [ ] Behavioral notes documented
- [ ] Unclear items flagged for review

### Post-Administration Scoring
- [ ] All items scored within 24 hours
- [ ] Video review conducted (if recorded)
- [ ] Scoring manual consulted for unclear items
- [ ] All required items completed

### Algorithm and Classification
- [ ] Algorithm scores calculated correctly
- [ ] Social Affect (SA) total calculated
- [ ] Restricted/Repetitive Behavior (RRB) total calculated
- [ ] Overall Total calculated
- [ ] Comparison score determined (if applicable)
- [ ] Classification range determined

### Classification Result
- [ ] Autism
- [ ] Autism Spectrum
- [ ] Non-Spectrum

**Overall Total:** _____
**Comparison Score (if applicable):** _____

## Section 6: Integration with Other Data

### ADOS-2 Results Considered Alongside
- [ ] ADI-R (Autism Diagnostic Interview-Revised)
- [ ] Developmental history
- [ ] Cognitive assessment
- [ ] Adaptive behavior assessment
- [ ] Language evaluation
- [ ] Parent/caregiver report measures
- [ ] Teacher/school observations
- [ ] DSM-5-TR diagnostic criteria

### Clinical Judgment Applied
- [ ] ADOS-2 results interpreted in context
- [ ] Limitations of ADOS-2 acknowledged
- [ ] Best estimate clinical diagnosis made

## Section 7: Quality Assurance

### Examiner Qualifications
- [ ] Research-reliable training completed (or equivalent)
- [ ] Module-specific training completed
- [ ] Adequate supervised experience
- [ ] Annual competency check completed

### Inter-Rater Reliability (if applicable)
- [ ] Second scorer reviewed video
- [ ] Agreement calculated
- [ ] Agreement ≥80% achieved

**Agreement Percentage:** _____%

### Supervision/Consultation
- [ ] Case reviewed with supervisor (if trainee)
- [ ] Consultation obtained for complex case
- [ ] Scoring reviewed with experienced colleague

## Section 8: Documentation

### Required Documentation Complete
- [ ] ADOS-2 protocol form completed
- [ ] Algorithm and classification documented
- [ ] Behavioral observations recorded
- [ ] Integration with other data documented
- [ ] Diagnostic impression documented
- [ ] Recommendations documented

### Video Recording (if applicable)
- [ ] Consent for recording obtained
- [ ] Video quality adequate for review
- [ ] Video stored securely per HIPAA
- [ ] Video retention per policy

## Section 9: Issues and Concerns

### Administration Issues Encountered




### Validity Concerns
- [ ] No concerns - results considered valid
- [ ] Minor concerns (specify):
- [ ] Major concerns affecting validity (specify):

### Follow-Up Needed
- [ ] No follow-up needed
- [ ] Repeat assessment recommended
- [ ] Additional assessment needed
- [ ] Consultation recommended

## Section 10: Competency Verification

*(To be completed by supervisor or reviewer)*

### Fidelity Rating
- [ ] Excellent - All procedures followed correctly
- [ ] Adequate - Minor deviations, results valid
- [ ] Inadequate - Significant issues, retraining needed

### Reviewer Comments




### Reviewer Signature | | Date | |

---

## Section 11: Examiner Self-Reflection

### Self-Assessment of Administration




### Areas for Improvement




### Training Needs Identified




## Section 12: Signatures

| Examiner Signature | | Date | |
|-------------------|---|------|---|
| Supervisor Review (if applicable) | | Date | |

---

*Form FRM-ADOS-001 Rev 1.0*

**Note:** This checklist is intended to support standardized ADOS-2 administration and quality assurance. It does not replace the official ADOS-2 manual or required training. Examiners must complete research-reliable training or equivalent before administering the ADOS-2 independently.