ADOS-2自闭症诊断观察量表第二版（Autism Diagnostic Observation Schedule, Second Edition，（ADOS-2）是自闭症诊断的金标准工具吗？
 
自闭症诊断观察量表第二版（Autism Diagnostic Observation Schedule, Second Edition，（ADOS-2）是用于诊断和鉴别诊断自闭症的一种评估工具。由专业的评估者在标准化的活动情境下对儿童的行为进行观察，每次评估需用时40-60分钟，适用于12月以上的儿童或成人。ADOS-2是由Catherine Lord等人研发的结构化、半结构化观察评估工具，用于评估存在自闭症谱系障碍（Autism Spectrum Disorder, ASD）迹象的儿童、青少年和成人的社交互动、沟通行为、游戏和有限重复行为。ADOS-2是ADOS的更新版，于2012年发布。ADOS和ADI-R（自闭症诊断访谈量表修订本）联合，已被欧美许多国家作为诊断自闭症的金标准使用，在世界各地得到了广泛的应用。美国精神疾病诊断与统计手册（DSM-5）和国际疾病分类（ICD-10/11）均支持其作为诊断依据的重要工具。
 自闭症诊断观察量表第二版（ADOS-2），该修订版改进了已被视为自闭症谱系障碍（ASD）观察评估“黄金标准”的自闭症诊断观察量表（ADOS）。 通过更新的协议，修订的算法，创建新的比较分数和幼儿模块，ADOS-2可以准确地描述当前症状，且不受语言影响。 它可用于评估疑似患有自闭症（ASD）的人 - 从没有言语的1岁儿童到口头表达流利的成年人。自闭症诊断观察量表第二版（ADOS-2）与其前身（ADOS）一样，通过标准化观察和编码行为，可以获得关于诊断、干预、治疗计划和教育安排的信息。
 
五个模块：
自闭症诊断观察量表第二版（ADOS-2）-孤独症诊断观察量表，包括五个模块，每个模块只需要40到60分钟即可完成测试。被评估的个人根据语言表达水平和实际年龄来选择一个相应的模块进行测试。
幼儿模块 - 适用于12至30个月大的儿童，他们很少使用短语表达
模块1 - 适用于31个月及以上的儿童，他们不经常使用短语表达
模块2 - 适用于任何年龄段的儿童，他们使用短语表达，但表达不流利
模块3 - 适用于口头表达流利的儿童和青少年
模块4- 适用于口头表达流利的大龄青少年和成年人
每个模块测试是让受试者参与一系列活动，互动测试材料和组件都包含在ADOS-2工具包中。例举模块3中的测试活动包括：构筑任务，装扮游戏，联合互动游戏，示范任务，图片说明，根据书本内容讲故事，卡通图案描述，会话和汇报，情感，社交困难与厌烦，间歇，朋友、关系和婚姻，孤独感，创造一个故事。
 
标准化管理、编码和评分：
每个ADOS-2模块都具有相应的协议手册，手册构建了测试管理并指导完成编码和评分。当进行测试活动时，观察受试者并做笔记。之后，立即对观察到的行为进行编码。然后使用算法表单进行评分。
在模块1到4中，将算法分数与截止分数进行比较，得出三种分类之一：自闭症（孤独症），自闭症谱系或非谱系。 自闭症和自闭症谱系分类之间的差异的严重程度，前者表明症状更明显。 在幼儿模块中，算法产生的是“关注范围”而不是分类得分。
 
改进的方案手册、改进的算法和新的比较分数：
ADOS-2的管理和编码程序在功能上与ADOS相同。模块1至模块4保留了相同的基本测试活动和代码，但一些代码在ADOS-2进行扩展并添加了几个新代码。从而这些模块的协议手册得到了显著的改进，使它们现在提供了更清晰、更明确的管理和编码说明。
对单元1至单元3的算法进行了修订，以获得更准确和有用的结果，并为比较儿童和青少年使用的三个单元的结果提供更统一的基础。
模块1到模块3的新比较分数允许您查看儿童自闭症谱系相关症状的总体水平与相同年龄且具有相似语言技能的自闭症（ASD）诊断儿童的相关症状。该分数还可以更容易地监测个体的症状。
 
 新的幼儿模块
新的幼儿模块——学步模块是专门为12到30个月大的孩子设计的，他们不经常使用短语。观察结果在管理之后立即编码，并将代码转换为算法得分。学步儿童模块算法提供的是“关注范围”，而不是分数线。这些范围可以帮助你形成临床印象，但它们避免了正式的分类——这在这么小的年纪可能不太合适。学步儿童模块量化自闭症（ASD）的风险，并在需要继续监测时提供指导。
 
信度与效度表现优异
内部一致性和重测信度在不同模块中均表现良好，Kappa值和ICC值多数在0.80以上。
判别效度强，能有效区分自闭症谱系障碍与其他发展障碍（如语言发育迟缓、智力障碍等）。
多项研究表明，其诊断灵敏度在0.91左右，特异度在0.87左右，诊断准确性高。
 
临床实用性
直接观察而非依赖家长报告，使得ADOS-2在评估行为表现中更为客观。
模块化设计，覆盖12个月龄儿童到成年非口语者，广泛适应不同受试人群。
 
“金标准”是否绝对？
尽管ADOS-2常被称为自闭症诊断的“金标准”工具，但在科学语境中，这一说法需谨慎使用：
优势：科学验证充分，研究文献广泛，适用性强。常用于科研中的标准化诊断参考。
局限：不能独立诊断ASD，需结合临床访谈、病史（如ADI-R）、DSM-5标准和多学科会诊综合判断。
需要经过专业培训者实施，评估成本较高，对评估者操作熟练度有一定要求。

其他自闭症评估工具：
自闭症儿童心理教育量表第三版（PEP-3）-孤独症儿童心理教育量表第三版

VB-MAPP言语行为里程碑评估和安置程序

异常行为检查表第二版（ABC-2）

Leiter莱特国际操作量表第三版Leiter-3

PEAK关系训练系统- PEAK Relational Training System

ASRS自闭症谱系评定量表

GARS-3吉列姆自闭症评定量表第三版

ADI-R自闭症诊断访谈量表修订本（Autism Diagnostic Interview-Revised)

SCQ社交沟通问卷(Social Communication Questionnaire)

社交反应量表第二版（SRS-2）（Social Responsiveness Scale Second Edition）

CARS2儿童孤独症评定量表第二版（Childhood Autism Rating Scale Second Edition)
 
ADOS-2自闭症诊断观察量表第二版（Autism Diagnostic Observation Schedule, Second Edition，ADOS-2），文献索引（部分）：

• PCN Rep. 2025 May 19;4(2):e70118. doi: 10.1002/pcn5.70118. eCollection 2025 Jun.

Comparison of ADOS-2 scores in adults with attention deficit hyperactivity disorder and autism spectrum disorder

• J Autism Dev Disord. 2025 Mar 9. doi: 10.1007/s10803-025-06778-z. Online ahead of print.

Sensitivity and Specificity Between the Screening Tool for Autism in Toddlers and Young Children (STAT) and Autism Diagnostic Observation Schedule (ADOS-2)

• Child Adolesc Psychiatr Clin N Am. 2025 Apr;34(2):235-255. doi: 10.1016/j.chc.2024.08.007. Epub 2024 Sep 30.

Assessment of Autism in Young Children

• Autism Res. 2025 Jun;18(6):1279-1289. doi: 10.1002/aur.70050. Epub 2025 May 12.

Limited Effect of Masking During COVID-19 Pandemic on ADOS-2 Algorithm Scores in Toddlers With and Without Autism

• J Autism Dev Disord. 2024 Jul 30. doi: 10.1007/s10803-024-06480-6. Online ahead of print.

ADOS-2 Module 4: Psychometric Properties and Diagnostic Performance at an Autism-specialized Clinic

• Autism Res. 2024 Dec;17(12):2487-2502. doi: 10.1002/aur.3245. Epub 2024 Oct 25.

Measuring autism with the ADOS-2 using a bifactor model

• J Autism Dev Disord. 2024 Sep 9. doi: 10.1007/s10803-024-06535-8. Online ahead of print.

Short-term and Long-term Stability of the Autism Diagnostic Observation Schedule (ADOS-2) Calibrated Comparison Scores (CCS) and Classification Scores in Youth with Down Syndrome or Fragile X Syndrome with Intellectual Disability

• J Clin Psychol. 2024 Aug;80(8):1901-1916. doi: 10.1002/jclp.23700. Epub 2024 May 7.

Social communication and restricted, repetitive behavior as assessed with a diagnostic tool for autism (ADOS-2) in women with anorexia nervosa

• Autism Res. 2024 Nov;17(11):2370-2385. doi: 10.1002/aur.3229. Epub 2024 Sep 9.

Profiles of nonverbal skills used by young pre-verbal children with autism on the ADOS-2: Relation to screening disposition and outcomes

• Autism Res. 2024 Nov;17(11):2370-2385. doi: 10.1002/aur.3229. Epub 2024 Sep 9.

Profiles of nonverbal skills used by young pre-verbal children with autism on the ADOS-2: Relation to screening disposition and outcomes

• Front Psychiatry. 2025 May 1:16:1497583. doi: 10.3389/fpsyt.2025.1497583. eCollection 2025.

Identification of smile events using automated facial expression recognition during the Autism Diagnostic Observation Schedule (ADOS-2): a proof-of-principle study

• JAMA Netw Open. 2024 Sep 3;7(9):e2432851. doi: 10.1001/jamanetworkopen.2024.32851.

Automated Analysis of Stereotypical Movements in Videos of Children With Autism Spectrum Disorder

• Eur Arch Psychiatry Clin Neurosci. 2022 Mar;272(2):217-232.doi: 10.1007/s00406-021-01250-2. Epub 2021 Mar 22.

ASD symptoms in adults with ADHD: a preliminary study using the ADOS-2

• J Autism Dev Disord. 2022 Mar;52(3):1388-1394.doi: 10.1007/s10803-021-04952-7. Epub 2021 Apr 7.

Brief Report: Examining Test-Retest Reliability of the Autism Diagnostic Observation Schedule (ADOS-2) Calibrated Severity Scores (CSS)

• Eur Arch Psychiatry Clin Neurosci. 2022 Mar;272(2):233.doi: 10.1007/s00406-021-01317-0.

Correction to: ASD symptoms in adults with ADHD: a preliminary study using the ADOS-2

• Mol Autism. 2022 Mar 7;13(1):11.doi: 10.1186/s13229-022-00491-9.

Phenotypic differences between female and male individuals with suspicion of autism spectrum disorder

• J Pediatr Psychol. 2022 Jan 4;jsab131.doi: 10.1093/jpepsy/jsab131. Online ahead of print.

Pediatric Brain Tumor Survivors' Understanding of Friendships: A Qualitative Analysis of ADOS-2 Interview Responses

• Ann Neurol. 2021 Dec;90(6):874-886.doi: 10.1002/ana.26249. Epub 2021 Oct 29.

Profile of Autism Spectrum Disorder in Tuberous Sclerosis Complex: Results from a Longitudinal, Prospective, Multisite Study

• J Autism Dev Disord. 2021 Nov;51(11):4101-4114.doi: 10.1007/s10803-020-04839-z. Epub 2021 Jan 21.

Systematic Review and Meta-Analysis of the Clinical Utility of the ADOS-2 and the ADI-R in Diagnosing Autism Spectrum Disorders in Children

• J Autism Dev Disord. 2021 Nov;51(11):4033-4042.doi: 10.1007/s10803-020-04867-9. Epub 2021 Jan 13.

Educational and Diagnostic Classification of Autism Spectrum Disorder and Associated Characteristics

• Clin Neuropsychol. 2021 Nov 11;1-21.doi: 10.1080/13854046.2021.1998634. Online ahead of print.

Symptoms of autism spectrum disorder and developmental delay in children with low mental age

• Autism. 2021 Oct 15;13623613211047070.doi: 10.1177/13623613211047070. Online ahead of print.

Sex differences in social communication behaviors in toddlers with suspected autism spectrum disorder as assessed by the ADOS-2 toddler module

• J Autism Dev Disord. 2021 Oct 19.doi: 10.1007/s10803-021-05313-0. Online ahead of print.

Brief Report: Emotional and Behavioral Problems Among Young Children with ASD: An Exploratory Study of ADOS E-Codes and Child Characteristics

• J Autism Dev Disord. 2021 Dec;51(12):4520-4533.doi: 10.1007/s10803-021-04892-2. Epub 2021 Feb 6.

Rethinking Measurement Standards of Autism Symptomology in Adolescents with Fragile X Syndrome

• Autism Res. 2021 Dec;14(12):2524-2532.doi: 10.1002/aur.2625. Epub 2021 Oct 15.

Autism severity aggregates with family psychiatric history in a community-based autism sample

• J Clin Med. 2021 Sep 24;10(19):4374.doi: 10.3390/jcm10194374.

Diagnosing Autism Spectrum Disorders in Deaf Children Using Two Standardised Assessment Instruments: The ADIR-Deaf Adaptation and the ADOS-2 Deaf Adaptation

• Front Nutr. 2021 Sep 30;8:748513.doi: 10.3389/fnut.2021.748513. eCollection 2021.

Correlation Between Serum Concentrations of Menaquinone-4 and Developmental Quotients in Children With Autism Spectrum Disorder

• Brain Sci. 2021 Sep 26;11(10):1278.doi: 10.3390/brainsci11101278.

Symptoms of Autism Spectrum Disorder in Individuals with Down Syndrome

• J Autism Dev Disord. 2021 Aug 17.doi: 10.1007/s10803-021-05245-9. Online ahead of print.

Correction to: Assessment of Autism Spectrum Disorder in Deaf Adults with Intellectual Disability: Feasibility and Psychometric Properties of an Adapted Version of the Autism Diagnostic Observation Schedule (ADOS-2)

• J Clin Med. 2021 Aug 16;10(16):3605.doi: 10.3390/jcm10163605.

Association among Autistic Traits, Treatment Intensity and Outcomes in Adolescents with Anorexia Nervosa: Preliminary Results

• Clin Neuropsychol. 2021 Jul 22;1-17.doi: 10.1080/13854046.2021.1942220. Online ahead of print.

Autism Diagnostic Observation Schedule (ADOS-2) elevations in a clinical sample of children and adolescents who do not have autism: Phenotypic profiles of false positives

• Neuropsychiatr Dis Treat. 2021 Jul 5;17:2163-2172.doi: 10.2147/NDT.S300452. eCollection 2021.

Differential Diagnosis in Children with Autistic Symptoms and Subthreshold ADOS Total Score: An Observational Study

• J Autism Dev Disord. 2021 Jul 28.doi: 10.1007/s10803-021-05203-5. Online ahead of print.

Assessment of Autism Spectrum Disorder in Deaf Adults with Intellectual Disability: Feasibility and Psychometric Properties of an Adapted Version of the Autism Diagnostic Observation Schedule (ADOS-2)

• J Neurodev Disord. 2021 Jul 10;13(1):26.doi: 10.1186/s11689-021-09370-5.

Characterisation of the clinical phenotype in Phelan-McDermid syndrome

• Mol Autism. 2021 Jun 30;12(1):47.doi: 10.1186/s13229-021-00455-5.

Autism symptoms in anorexia nervosa: a comparative study with females with autism spectrum disorder

• Autism Res. 2021 Jun;14(6):1284-1295.doi: 10.1002/aur.2496. Epub 2021 Mar 8.

Replication study of ADOS-2 Toddler Module cut-off scores for autism spectrum disorder classification

• Medicine (Baltimore). 2021 Jun 18;100(24):e26391.doi: 10.1097/MD.0000000000026391.

Correlation analysis of expression of CC and CXC chemokines in children with autism spectrum disorder

• Am J Intellect Dev Disabil. 2021 May 1;126(3):260-265.doi: 10.1352/1944-7558-126.3.260.

Examination of the ADOS-2 Expressive Language Score in Fragile X Syndrome

• J Autism Dev Disord. 2021 May;51(5):1508-1527.doi: 10.1007/s10803-020-04573-6.

Diagnosing Autism Spectrum Disorder in Toddlers Born Very Preterm: Estimated Prevalence and Usefulness of Screeners and the Autism Diagnostic Observation Schedule (ADOS)