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

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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 | |

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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

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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.