ADOS Assessment Template

What you document instead

Most family physicians, paediatricians without ADOS training, and nurse practitioners will never administer the instrument. Your job is a developmental history, screening (M-CHAT-R/F, SCQ, or your region's tool), hearing/vision, and a referral that the assessing team can use. After the assessment, your job is to file the report, translate next steps for the family, and keep the medical home moving — school letters, sleep, ADHD comorbidity, GI, safety.

Date / clinician / location:
Patient: [initials, age, sex]  |  Caregivers present:
Language(s) at home / interpreter used:

Reason for query (caregiver words):
Screening tools used (name, date, who completed) — not ADOS scores:
Hearing / vision status:
Prior developmental assessments (year, service, conclusion):

Developmental history relevant to an ADOS referral
Social communication (pointing, showing, joint attention, reciprocal conversation):
Play / interests / sensory:
Language level (words, phrase speech, fluent):
Regression or plateau (what, when):
Adaptive function (feeding, toileting, safety):
School / daycare observations:
Family history of autism, ADHD, intellectual disability, genetic syndromes:
Medical: seizure, genetic testing already done, sleep, GI, diet:

Referral
Service requested (developmental pediatrics / psychology / multidisciplinary team):
Question to the team (autism? language disorder? both? not sure):
Urgency / safety (self-injury, elopement, school exclusion):
Documents attached (screens, school letter, prior reports):

Family prep (what you told them)
ADOS-2 is an observation by a trained examiner, often 40–60 minutes.
Caregiver may be in the room or behind glass depending on module and clinic.
Do not coach the child to 'perform.' Bring usual devices, snacks as instructed.
ADOS is not the whole diagnosis; history and adaptive measures sit beside it.
Wait-time and who calls with the result:

After the official report arrives
Date of ADOS-2 / module used (as stated in the report):
Examiner name and credentials (as stated):
Classification / comparison score — quoted from the report, not rescored:
Team diagnosis (autism / not autism / inconclusive) and other formulations:
Recommendations you are actioning in primary care:
School / funding forms (e.g. provincial autism program) — status:

Referral that a diagnostic team can use

Assessing teams waste visits when the referral is 'please rule out autism' with no language level, no hearing result, and no school observation. Say what you saw, what the caregiver described, what you screened, and what you are unsure about. Name competing explanations: isolated language delay, ADHD, trauma-related social withdrawal, selective mutism, intellectual disability.

• Chronological age and language level — these drive module choice on their side.
• Hearing screen or audiology status. Do not send a child with untreated hearing loss as if the social findings are settled.
• One paragraph of social-communication examples, not a synonym list for 'awkward.'
• What happens at daycare or school, in the teacher's words if you have them.
• Prior genetic or neurology workup, even if normal.
• Family's first language and whether the assessment must be offered in that language.

ADI-R (Autism Diagnostic Interview-Revised) is a companion interview used in some Canadian tertiary clinics. You do not administer it from this template either. If the report mentions ADI-R plus ADOS-2, file both. Your primary-care note should say what the team concluded, not re-interview the algorithm.

Example — pediatric referral (fictional)

Reason: "He doesn't point to show us things, and daycare says he plays beside other kids, not with them."

Screening: M-CHAT-R/F completed by mother last month — failed, follow-up interview still failed. Hearing: newborn screen passed; informal office hearing adequate, formal audiology booked. Vision: ages-and-stages ok. No prior developmental pediatrics.

History: First words ~18 months, now 2-word phrases, echolalia of YouTube. Rarely brings toys to share. Does not consistently respond to name in the office (hearing still pending). Lines cars. Distressed by haircuts. No loss of words. Sleeps 10 h with melatonin 1 mg. No seizures. Daycare letter: parallel play, covers ears at circle time. Older sister typically developing. No family autism history known.

Exam: growth along 40th. No dysmorphism flagged. Plays with cars in waiting room, limited eye contact with examiner, no proto-declarative pointing during visit.

A: Possible autism spectrum — screening positive, language delay, restricted play. Hearing not yet confirmed. Not an ADOS. Not a diagnosis today.

P: Audiology. Referral to [regional developmental assessment program] with daycare letter and M-CHAT attached. Question to team: autism vs language disorder vs both. Prep: explained ADOS-2 is done by their trained clinicians; we will not score anything here; wait-time per program letter. Early intervention / SLP referral in parallel. RTC after audiology.

Filing the report

When the ADOS-2 report arrives, quote the module and the examiner's classification as written. Do not convert their comparison score into a different instrument. Do not write 'ADOS negative so not autism' if the team said the observation was inconclusive because of language, fatigue, or behaviour that stopped the protocol. Inconclusive means inconclusive.

Your problem list should reflect the team's diagnosis plus what you are managing: constipation, insomnia, ADHD traits, school supports. Provincial autism funding and school identification have their own forms. Fill those from the official report and your own function history, not from memory of a comparison score.

Frequently asked questions