ADOS-2 Training

The introductory training is intended for professionals involved in assessment of autism spectrum disorders (ASD), who are interested in learning more about how the ADOS-2 can be appropriately incorporated into a diagnostic assessment battery. For those who ultimately hope to establish research reliability on the ADOS-2 (see below), the introductory training also serves as a first step in this process.

The ADOS-2 Introductory/Clinical Training for Modules 1-4 takes place over two days and uses a lecture format and live or video demonstrations to introduce the basics of ADOS-2 administration and scoring principles. Introductory/Clinical Trainings are currently offered virtually via Live Webinars, as well as in-person.

Following the workshop, additional practice with administration and scoring will be necessary to ensure competency in using the ADOS-2 for clinical or research purposes.

Prerequisites:

• This workshop presumes that trainees will have prior training in and experience with diagnostic assessment of neurodevelopmental disorders, including ASD.

• People interested in obtaining more training on best practice assessment methods and differential diagnosis of autism spectrum disorders in advance of the specific instrument-focused workshops may find the following workshop series helpful: https://gain.ku.edu/gain-workshops

• Trainees should also have access to an ADOS-2 manual to reference during the training and should review the pre-course materials prior to attending the introductory workshop.

The ADOS-2 Introductory/Clinical training for the Toddler Module is appropriate for clinicians or researchers involved in diagnostic assessment of autism spectrum disorder (ASD) in children 30 months or younger. This 1-day training provides information specific to use of the ADOS-2 Toddler module. Following the workshop, additional practice with administration and scoring will be necessary to ensure competency in using the ADOS-2 Toddler Module for clinical or research purposes.

Prerequisites:

• Trainees must complete the ADOS-2 Introductory/Clinical Training for Modules 1-4 before attending a Toddler Module workshop.

• In addition, this workshop presumes that trainees will have prior training in and experience with diagnostic assessment of neurodevelopmental disorders in very young children.

ADOS-2 Advanced/Research training focuses on bringing attendees’ administration and scoring skills to a higher level of inter-rater agreement with the scoring practices of skilled examiners. This heightened level of accuracy is needed to ensure that administration procedures and item-level coding are comparable across different labs in different parts of the world where research is being conducted. The Advanced/Research training is appropriate for both clinicians and researchers who are regularly using the ADOS-2. Successful completion of an advanced workshop is required for individuals who plan to pursue research reliability on the ADOS-2.

Advanced/Research Trainings are only available in-person.

Prerequisites:

• Professionals with substantial previous experience in assessment of individuals with ASD are most suitable to participate in this training. This could include clinicians who have the qualifications to diagnose ASD individually or as part of a team (e.g., clinical psychologists, psychiatrists, pediatricians), as well as researchers with clinical expertise working with individuals with ASD.

• Trainees must have completed the ADOS-2 Introductory/Clinical Training for Modules 1-4.

• Trainees are also required to submit pre-course videos of themselves administering the ADOS-2 prior to attending the workshop, and will be expected to administer portions of the ADOS-2 with patient volunteers during the workshop.

The Adapted ADOS Advanced Training uses a lecture format to introduce people to the A-ADOS administration and scoring. The A-ADOS training is intended for professionals who are interested in using the A-ADOS in their research studies. Workshops are scheduled on-demand and may be hosted at any individual research site. Following the workshop, additional practice with administration and scoring will be necessary to ensure competency in using the A-ADOS for research purposes.

Prerequisites:

• Trainees must have completed the ADOS-2 Advanced/Research training and have experience with assessment of adolescents or adults who are minimally verbal and/or have intellectual disability.

If you plan to use the ADOS-2 for research purposes, you will need to establish reliability on the instrument before you begin collecting data. Establishing and maintaining reliability is crucial to maintaining consistency and comparability across research studies that employ these instruments. If you plan to use the ADOS-2 for clinical purposes, establishing research reliability is recommended but not required.

To begin the process of obtaining independent research reliability on the ADOS-2, you must first do the following:

1. Attend the Introductory/Clinical training

2. Attend Advanced/Research training.

There are two ways to establish research reliability:

Establishing research reliability on the ADOS-2 with an independent trainer:

Following satisfactory completion of the Advanced/Research Training, you must then fulfill the post-course requirements. The post-course requirements include submitting at least two video recordings (one from each Module set, as described below) of yourself administering the ADOS-2:

• one recording (and corresponding completed protocol) of Module T, 1, or 2 and

• one recording (and corresponding completed protocol) of Module 3 or 4

These recordings will be watched and scored by an independent trainer. The videos must demonstrate that:

• you have learned the standardized administration procedures (i.e., you are administering with fidelity), and

• that your scoring is reliable, as evidenced by at least 80% exact item agreement on both the protocol and the algorithm.

Both videos must be submitted at the same time. 

If you are not successful on your initial tape submissions, you must submit additional videos until you achieve fidelity in administration and reliability in coding on one tape from each Module set (i.e., one from Module T, 1, or 2 and one from Module 3 or 4)

Once you have achieved independent reliability on the ADOS-2 with an independent trainer, you will be able to use the ADOS-2 for research purposes. The independent trainer will then be responsible for tracking and vouching for you in case you need to provide documentation that you have achieved research reliability. You are also permitted to train others at your same physical site (i.e., in your same lab or clinic) with whom you have frequent contact, in order to help them achieve on-site reliability (see below).

Establishing on-site reliability on the ADOS-2:

If you work directly with someone who has previously established reliability on the ADOS-2 with an independent trainer, you may choose to establish on-site reliability with that person. To do so, you must be working at the same physical site and have frequent (i.e., at least weekly) contact to talk about administration and coding issues.

To establish ADOS-2 reliability with an independently reliable person at your site, you must achieve:

• 80% exact item agreement in coding on both the protocol and the algorithm across three consecutive administrations from each Module set (i.e., 3 in a row for Modules T/1/2 AND 3 in a row for Modules 3/4).

  • *you must also independently conduct at least one of the administrations from each Module set to show fidelity of your administration

If you obtain on-site reliability, you are not permitted to then train other people in your lab or clinic. Thus, if you need to be able to train other people in your lab or clinic, you must complete the research reliability process with an independent trainer.

If an individual who has established on-site reliability leaves the site where they first established reliability, they will need to re-establish on-site reliability with another independently reliable individual at their new site OR establish reliability with an independent trainer before collecting data at the new site.

Even after a person has achieved research reliability on the ADOS-2, it is essential that they take steps to maintain their reliability as long as they continue to use the ADOS-2. Regardless of their level of experience, it is possible for clinicians and researchers to “drift” in administration and scoring practices if there is not frequent discussion and a chance to compare scores with other people who have established reliability. We recommend the following activities to maintain research reliability:

• For research projects using the ADOS-2, we recommend that you double-score and reassess reliability with other reliable coders for approximately 10% of administrations.

• Attendance at “refresher” or booster” trainings is highly recommended for researchers and clinicians. These are offered periodically at designated training sites (see below).

• The Global Autism Interactive Network (GAIN) is another way to maintain reliability in scoring procedures using video recordings. GAIN is a virtual, live training webinar hosted by independent trainers.

No. The Introductory/Clinical Training is designed to provide training to individual users only. Completion does not provide the additional training or materials required to train others.

After you are reliable with an independent trainer, you can then train other members of your research or clinical team who are in the same physical location as you are and with whom you have at least weekly contact.

If you need to be able to train others outside of your lab or clinic, you must complete the requirements for becoming an independent trainer. Only independent trainers are permitted to train people outside of their own lab/clinic or conduct introductory/clinical or advanced/research workshops.

You can apply to become a Trainer-in-Training. The Trainer-in-Training program involves several steps, including:

1. achieving research reliability,

2. submitting additional reliability tapes and

3. attending another Advanced/Research Training at a designated ADOS-2/ADI-R training site

In general, a person must hold a doctorate degree to be eligible to become a trainer. However, exceptions have been made in certain cases, such as when someone who otherwise has all of the relevant expertise is the only person in a country or region who has achieved research reliability, and there are no other trainers in that country or region. In all cases, we give priority to people who have extensive experience in assessment and differential diagnosis of ASD, and who are experienced users of the ADOS-2. Please note that there are very few slots for Trainers-in-Training each year, and we cannot guarantee acceptance into the Trainer-in-Training program.

These sites have been designated by the authors of the instruments to host advanced/research trainings, as well as Booster trainings. They also serve as approved sites for the Trainer-in-Training program.

In the United States, the designated ADOS-2/ADI-R training sites include University of California San Francisco (UCSF), University of Minnesota, Rutgers University, and University of California Los Angeles (UCLA). SpectrumKU at Korea University is an international designated training site that works closely with our US designated training sites.

The designated ADOS-2/ADI-R training sites maintain a list of independent trainers from the US and certain international locations. These trainers have graduated from our Trainer-in-Training program and are authorized to conduct independent trainings.

It is possible that some international trainers are not included on this list because they have been trained as trainers at designated training sites in Europe. However, other individuals may be providing trainings without having completed any formal training on the instruments. Before enrolling in a course, trainees should ensure that the course will be led by an independent trainer or someone who has been formally trained as a trainer through a designated international program.