Replication and Comparison of the Newly Proposed ADOS-2, Module 4 Algorithm in ASD Without ID: A Multi-site Study

Cara E. Pugliese, Lauren Kenworthy, Vanessa Hus Bal, Gregory L. Wallace, Benjamin E. Yerys, Brenna B. Maddox, Susan W. White, Haroon Popal, Anna Chelsea Armour, Judith Miller, John D. Herrington, Robert T. Schultz, Alex Martin, Laura Gutermuth Anthony

Research output: Contribution to journalArticlepeer-review

44 Scopus citations


Recent updates have been proposed to the Autism Diagnostic Observation Schedule-2 Module 4 diagnostic algorithm. This new algorithm, however, has not yet been validated in an independent sample without intellectual disability (ID). This multi-site study compared the original and revised algorithms in individuals with ASD without ID. The revised algorithm demonstrated increased sensitivity, but lower specificity in the overall sample. Estimates were highest for females, individuals with a verbal IQ below 85 or above 115, and ages 16 and older. Best practice diagnostic procedures should include the Module 4 in conjunction with other assessment tools. Balancing needs for sensitivity and specificity depending on the purpose of assessment (e.g., clinical vs. research) and demographic characteristics mentioned above will enhance its utility.

Original languageEnglish (US)
Pages (from-to)3919-3931
Number of pages13
JournalJournal of Autism and Developmental Disorders
Issue number12
StatePublished - Dec 1 2015
Externally publishedYes

All Science Journal Classification (ASJC) codes

  • Developmental and Educational Psychology


  • Adolescents
  • Adults
  • Autism diagnostic observation schedule
  • Autism spectrum disorder
  • Diagnosis
  • Sensitivity
  • Specificity


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