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J Autism Dev Disord. 2014 Aug;44(8):1996-2012. doi: 10.1007/s10803-014-2080-3.

The autism diagnostic observation schedule, module 4: revised algorithm and standardized severity scores.

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Department of Psychology, University of Michigan, 530 Church Street, Ann Arbor, MI, 48109, USA,


The recently published Autism Diagnostic Observation Schedule, 2nd edition (ADOS-2) includes revised diagnostic algorithms and standardized severity scores for modules used to assess younger children. A revised algorithm and severity scores are not yet available for Module 4, used with verbally fluent adults. The current study revises the Module 4 algorithm and calibrates raw overall and domain totals to provide metrics of autism spectrum disorder (ASD) symptom severity. Sensitivity and specificity of the revised Module 4 algorithm exceeded 80 % in the overall sample. Module 4 calibrated severity scores provide quantitative estimates of ASD symptom severity that are relatively independent of participant characteristics. These efforts increase comparability of ADOS scores across modules and should facilitate efforts to examine symptom trajectories from toddler to adulthood.

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