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# ADOS-2 Administration Fidelity Checklist
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| Form ID | FRM-ADOS-001 | Revision | 1.0 |
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|---------|--------------|----------|-----|
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---
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## Section 1: Assessment Information
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| Field | Entry |
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|-------|-------|
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| Child Name | |
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| Date of Birth | |
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| Chronological Age | |
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| Assessment Date | |
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| Examiner Name | |
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| Observer Name (if applicable) | |
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| Medical Record Number | |
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## Section 2: Module Selection
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### Module Selected
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- [ ] Toddler Module (12-30 months)
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- [ ] Module 1 (31+ months, minimal expressive language)
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- [ ] Module 2 (any age, phrase speech)
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- [ ] Module 3 (fluent speech, child/adolescent)
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- [ ] Module 4 (fluent speech, older adolescent/adult)
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### Module Selection Criteria Met
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- [ ] Age appropriate
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- [ ] Expressive language level appropriate
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- [ ] Module selection documented in report
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### Justification for Module Selection
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## Section 3: Pre-Assessment Preparation
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### Materials and Setup
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- [ ] All required materials prepared and available
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- [ ] Testing room appropriate (minimal distractions)
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- [ ] Video recording equipment functional (if recording)
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- [ ] Scoring forms and manual available
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- [ ] Toys/materials in good condition
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- [ ] Backup materials available
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### Examiner Preparation
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- [ ] Reviewed child's background information
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- [ ] Reviewed previous assessments (if available)
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- [ ] Confirmed module selection
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- [ ] Prepared parent/caregiver for observation
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- [ ] Scheduled adequate time (45-60 minutes typical)
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## Section 4: Administration Fidelity
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### General Administration Principles
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| Item | Met | Notes |
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|------|-----|-------|
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| Rapport established with child | ☐ Yes ☐ No ☐ N/A | |
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| Standardized procedures followed | ☐ Yes ☐ No ☐ N/A | |
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| Flexibility applied appropriately | ☐ Yes ☐ No ☐ N/A | |
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| Presses administered correctly | ☐ Yes ☐ No ☐ N/A | |
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| Natural, playful interaction maintained | ☐ Yes ☐ No ☐ N/A | |
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| Appropriate pacing maintained | ☐ Yes ☐ No ☐ N/A | |
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| Child engaged throughout | ☐ Yes ☐ No ☐ N/A | |
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### Activity-Specific Fidelity
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#### Activities Administered (check all that apply)
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**Toddler Module:**
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- [ ] Free Play
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- [ ] Response to Name
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- [ ] Response to Joint Attention
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- [ ] Bubble Play
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- [ ] Anticipation of a Social Routine
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- [ ] Responsive Social Smile
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- [ ] Anticipation of a Social Routine with Objects
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- [ ] Functional Play
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- [ ] Birthday Party
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- [ ] Snack
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**Module 1:**
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- [ ] Free Play
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- [ ] Response to Name
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- [ ] Response to Joint Attention
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- [ ] Bubble Play
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- [ ] Anticipation of a Routine with Objects
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- [ ] Responsive Social Smile
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- [ ] Functional and Symbolic Imitation
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- [ ] Birthday Party
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- [ ] Snack
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**Module 2:**
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- [ ] Free Play
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- [ ] Response to Name Called
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- [ ] Birthday Party
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- [ ] Snack
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- [ ] Bubble Play
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- [ ] Construction Task
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- [ ] Make-Believe Play
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- [ ] Joint Interactive Play
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- [ ] Description of a Picture
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- [ ] Telling a Story from a Book
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- [ ] Conversation and Reporting
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**Module 3:**
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- [ ] Construction Task
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- [ ] Make-Believe Play
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- [ ] Joint Interactive Play
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- [ ] Demonstration Task
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- [ ] Description of a Picture
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- [ ] Telling a Story from a Book
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- [ ] Cartoons
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- [ ] Conversation and Reporting
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- [ ] Break (if needed)
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- [ ] Creating a Story
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- [ ] Social Difficulties and Annoyance
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- [ ] Emotions
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- [ ] Friends and Relationships
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- [ ] Loneliness
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**Module 4:**
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- [ ] Construction Task (if appropriate)
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- [ ] Current Work or School
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- [ ] Description of a Picture
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- [ ] Telling a Story from a Book
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- [ ] Cartoons
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- [ ] Break
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- [ ] Demonstration Task
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- [ ] Creating a Story
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- [ ] Social Difficulties and Annoyance
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- [ ] Emotions
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- [ ] Friends, Relationships, and Marriage
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- [ ] Loneliness
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### Standardization Issues
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**Were there any deviations from standardized administration?**
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- [ ] No deviations
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- [ ] Minor deviations (describe):
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- [ ] Major deviations affecting validity (describe):
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**Deviations Description:**
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### Child Factors Affecting Administration
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- [ ] Attention difficulties
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- [ ] Behavioral challenges
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- [ ] Fatigue
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- [ ] Illness
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- [ ] Anxiety/shyness
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- [ ] Language barriers
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- [ ] Sensory sensitivities
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- [ ] Other: _______________
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**Impact on Assessment:**
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## Section 5: Scoring Fidelity
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### Real-Time Scoring
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- [ ] Codes recorded during administration
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- [ ] Behavioral notes documented
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- [ ] Unclear items flagged for review
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### Post-Administration Scoring
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- [ ] All items scored within 24 hours
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- [ ] Video review conducted (if recorded)
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- [ ] Scoring manual consulted for unclear items
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- [ ] All required items completed
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### Algorithm and Classification
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- [ ] Algorithm scores calculated correctly
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- [ ] Social Affect (SA) total calculated
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- [ ] Restricted/Repetitive Behavior (RRB) total calculated
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- [ ] Overall Total calculated
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- [ ] Comparison score determined (if applicable)
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- [ ] Classification range determined
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### Classification Result
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- [ ] Autism
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- [ ] Autism Spectrum
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- [ ] Non-Spectrum
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**Overall Total:** _____
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**Comparison Score (if applicable):** _____
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## Section 6: Integration with Other Data
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### ADOS-2 Results Considered Alongside
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- [ ] ADI-R (Autism Diagnostic Interview-Revised)
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- [ ] Developmental history
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- [ ] Cognitive assessment
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- [ ] Adaptive behavior assessment
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- [ ] Language evaluation
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- [ ] Parent/caregiver report measures
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- [ ] Teacher/school observations
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- [ ] DSM-5-TR diagnostic criteria
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### Clinical Judgment Applied
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- [ ] ADOS-2 results interpreted in context
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- [ ] Limitations of ADOS-2 acknowledged
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- [ ] Best estimate clinical diagnosis made
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## Section 7: Quality Assurance
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### Examiner Qualifications
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- [ ] Research-reliable training completed (or equivalent)
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- [ ] Module-specific training completed
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- [ ] Adequate supervised experience
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- [ ] Annual competency check completed
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### Inter-Rater Reliability (if applicable)
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- [ ] Second scorer reviewed video
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- [ ] Agreement calculated
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- [ ] Agreement ≥80% achieved
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**Agreement Percentage:** _____%
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### Supervision/Consultation
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- [ ] Case reviewed with supervisor (if trainee)
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- [ ] Consultation obtained for complex case
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- [ ] Scoring reviewed with experienced colleague
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## Section 8: Documentation
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### Required Documentation Complete
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- [ ] ADOS-2 protocol form completed
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- [ ] Algorithm and classification documented
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- [ ] Behavioral observations recorded
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- [ ] Integration with other data documented
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- [ ] Diagnostic impression documented
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- [ ] Recommendations documented
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### Video Recording (if applicable)
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- [ ] Consent for recording obtained
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- [ ] Video quality adequate for review
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- [ ] Video stored securely per HIPAA
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- [ ] Video retention per policy
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## Section 9: Issues and Concerns
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### Administration Issues Encountered
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### Validity Concerns
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- [ ] No concerns - results considered valid
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- [ ] Minor concerns (specify):
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- [ ] Major concerns affecting validity (specify):
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### Follow-Up Needed
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- [ ] No follow-up needed
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- [ ] Repeat assessment recommended
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- [ ] Additional assessment needed
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- [ ] Consultation recommended
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## Section 10: Competency Verification
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*(To be completed by supervisor or reviewer)*
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### Fidelity Rating
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- [ ] Excellent - All procedures followed correctly
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- [ ] Adequate - Minor deviations, results valid
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- [ ] Inadequate - Significant issues, retraining needed
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### Reviewer Comments
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### Reviewer Signature | | Date | |
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---
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## Section 11: Examiner Self-Reflection
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### Self-Assessment of Administration
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### Areas for Improvement
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### Training Needs Identified
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## Section 12: Signatures
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| Examiner Signature | | Date | |
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|-------------------|---|------|---|
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| Supervisor Review (if applicable) | | Date | |
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---
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*Form FRM-ADOS-001 Rev 1.0*
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**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.
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