If you or your child has an upcoming ADOS-2 assessment, it’s completely normal to want a clearer picture of what to expect.
Many people imagine something clinical or formal, but in reality, the ADOS-2 is a relaxed and even enjoyable session, designed to help your clinician get to know you or your child in the most natural way possible.
There’s no studying, no pass or fail, and no pressure to “perform.” The goal is simple: to understand communication, social interaction, and behavior in a supportive, structured way, so your clinician can form the clearest diagnostic picture.
Our previous blog What is ADOS Testing covers all the basics and the most common questions about ADOS. And in this guide, we’ll walk you through exactly what happens during an ADOS-2 assessment, break down the different modules, and hopefully put your mind at ease about what to expect.
What is the ADOS-2 assessment and why is it needed?
The ADOS-2 assessment is one of the most trusted tools used in autism evaluations worldwide.
It stands for “Autism Diagnostic Observation Schedule (Second Edition),” which simply means it focuses on observing a person’s real-time communication, social interactions, and behavior as part of an autism diagnosis.
Although it’s very standardized – which is what makes it so reliable – it doesn’t feel standardized or clinical. It feels like playtime for younger children and a relaxed conversation for teens and adults, using games, stories, and simple tasks – chosen to match the person’s age and communication level.
Even though the assessment feels natural and even personalized, it is in fact carefully structured and designed, with every activity chosen for a reason – because each provides a clear opportunity to identify the presence (or not) of behaviors and traits that are most closely linked to autism. It’s important to understand that the ADOS-2 doesn’t diagnose autism on its own. The results of an autism ADOS assessment are combined with developmental history, interviews, other assessments, and clinical judgment to form a complete diagnostic picture. But it’s by far one of the most common, accurate, and respected parts of an autism evaluation.
What happens during an ADOS-2 assessment?
Although the activities differ depending on age and language level, the overall experience is similar across all ADOS-2 assessments.
You or your child will spend around 40–60 minutes in a quiet room with a trained clinician. Everything is guided – the clinician introduces each activity at a calm pace, explains what will happen next, and ensures that nothing ever feels rushed or overwhelming.
Broadly, every ADOS session looks like this:
- A warm introduction
- A series of simple, structured activities or conversations
- Space to respond naturally – no right or wrong answers
- A gentle, steady rhythm
Depending on the module, the activities might include pretend play, storytelling, picture discussion, answering everyday questions, or talking about interests, friendships, school, work, or feelings.
The entire time, your clinician is observing communication style, social responses, and patterns of behavior – not judging, critiquing, or testing intelligence.
For young children who aren’t yet fluent speakers, a parent is often in the room as a quiet, reassuring presence. For teens and adults, the session is normally one-on-one so the clinician can observe natural communication without distractions or influences.
People are often surprised by how comfortable, engaging, and even enjoyable the session feels.
Understanding the ADOS-2 modules
The ADOS-2 can help diagnose autism in adults as well as children because it includes different modules, each of which is specifically designed to suit different ages and communication levels.
Only one module is ever used per assessment, and it’s chosen based on how the person communicates naturally – not their age alone.Here’s a breakdown of all five ADOS-2 modules, who each is for, and exactly what to expect in each:
ADOS Toddler Module (12–30 months)
This module is for very young children who are beginning to communicate through gestures, sounds, or emerging words.
The session feels like guided play, with activities like:
- blowing bubbles
- exploring simple toys (blocks, cause-and-effect toys, toy food)
- early pretend-play (feeding a doll, pushing a toy car)
- response-to-name activities
- routines that invite shared attention (peek-a-boo, anticipation games)
These activities let the clinician see how the toddler uses eye contact, gestures, vocalizations, and play to connect with others. They’re also an opportunity to observe any early repetitive behaviors, sensory differences, or limited play patterns.
ADOS Module 1 (children with little or no speech)
Module 1 is for children aged 2½ and above, who may use single words but are not yet speaking in phrases.
The session feels like play with a friendly adult, and includes activities like:
- pretend-play scenes (e.g., birthday party, doll play)
- free play with toys
- imitation tasks (copying simple actions)
- bubble play or other sensory toys
- routines that encourage joint attention
- simple requests or opportunities to ask for help
Because the child isn’t expected to use complex language, the focus is on how they communicate nonverbally – how they share enjoyment, respond to their name, imitate actions, join in play, or show what they want. These interactions give insight into early social communication skills as well as any repetitive or sensory-seeking behaviors.
ADOS Module 2 (children who use phrases but are not yet verbally fluent)
Module 2 is for children who use phrase speech (short phrases or simple sentences) but are not yet verbally fluent.
The session feels like a structured but playful interaction, with activities such as:
- describing a picture
- telling a simple story from a book
- make-believe play (e.g., birthday party, toys with roles)
- construction or building tasks
- joint play with the clinician
- snack-time or other routines that invite social interaction
- simple back-and-forth conversation
These activities show how the child uses language to share ideas, respond socially, and stay engaged. They also allow the clinician to observe play skills, flexibility, imaginative thinking, and any repetitive or sensory-related behaviors.
ADOS Module 3 (verbally fluent children and young teens)
Module 3 is for children and younger adolescents who can speak fluently and engage in everyday conversation.
The session feels like a relaxed conversation mixed with simple tasks, such as:
- open-ended conversation (about school, friendships, interests)
- simple storytelling from pictures or books
- discussing emotions or everyday social situations
- talking through simple problem-solving or imaginative scenarios
- questions about friendships, feeling left out, and other emotions or experiences
Through these conversations, the clinician can see how the young person manages back-and-forth communication, uses eye contact and facial expressions, understands emotions, and picks up on social cues. The session also makes it easier to notice any very strong interests, rigid thinking patterns, repetitive topics, or language that sounds different from peers – all of which can help clarify an autism profile.
ADOS Module 4 (verbally fluent older teens and adults)
This module is for older teenagers and adults with fluent, everyday speech.
The session feels like a structured but natural conversation, and usually includes:
- conversations about daily life, relationships, work, or interests
- discussing more abstract topics or hypothetical scenarios
- exploring emotional or social problem-solving situations
- conversational tasks that require flexibility or perspective-taking
- storytelling or describing a picture
This module helps the clinician observe higher-level social communication – how the person interprets social nuances, understands other people’s perspectives, stays engaged in reciprocal conversation, and uses (or struggles with) nonverbal cues. It also makes it easier to identify any repetitive themes, rigid thinking patterns, or strong, focused interests.
An adult autism diagnosis can sometimes be harder as adults have often learned how to mask traits, but the ADOS is designed to address this – and draw out the traits in the most natural way possible.
How an ADOS-2 assessment is scored
Although each ADOS module uses different activities depending on age and language level, all of the activities are designed to highlight behaviors across four main categories that reflect the main autistic traits:
- Communication: both verbal and nonverbal, including use of gestures, eye contact, and sharing enjoyment.
- Social Interaction: how they connect with others, and initiate and respond to social cues, facial expressions, and body language.
- Play/Imaginative Activity: the ability to use objects creatively or engage in pretend scenarios.
- Repetitive Behaviors/Restricted Interests: behaviors like hand-flapping, repetitive actions, or an unusual focus on specific topics or objects.
Each behavior is rated (from 0 to 3) based on how typical or atypical it is for someone of the same age and language level.
Throughout the assessment, the clinician will make notes and assign scores for all the behaviors observed during each activity. And using a specific and standardized algorithm, those individual observations are then combined into a final score, which indicates how closely the person’s behaviors align with common autism patterns.
A few important things to remember:
- There is no pass or fail. Scores simply help show whether autism is likely, possible, or unlikely.
- ADOS-2 is not used alone to diagnose autism. ADOS scores are always interpreted alongside other information, including developmental history, interviews, questionnaires, and clinical judgment. It’s one part of a full evaluation, not the diagnosis on its own.
Ultimately, the goal of scoring isn’t to label behaviors, but to guide the clinician toward the most accurate and supportive diagnosis.
How ADOS-2 results are used – and what happens next
Soon after the ADOS assessment, you’ll meet with your clinician to go over the results.
This will typically include:
- An explanation of what was observed during the ADOS assessment
- What those results mean
- How the scores fit into the bigger diagnostic picture
- Whether an autism diagnosis has been made, and if so what level of autism
- What next steps and supports would be most helpful
If autism is diagnosed, recommendations may include:
- ABA therapy
- Speech or occupational therapy
- Counseling or psychiatric support
- School or workplace accommodations
- Referral to specialist services, such as EA Schools autism program
- Referral to other community resources
If autism is not diagnosed, don’t worry – you won’t be left without answers. Your clinician will still explain what they did observe, make referrals or recommendations for other assessments or evaluations that may be helpful, and provide you with guidance on other available support.
How to prepare for an ADOS-2 assessment
There’s no preparation needed for the ADOS assessment. You don’t need to study or practice anything, or bring anything specific with you.
In fact, the best preparation is simply being as rested and relaxed as possible, as the assessment works best when all interactions are completely natural.
For children, you might want to explain that they will be playing and talking with a friendly adult. And some parents find it helpful to bring items they find comforting (e.g. a toy or blanket), to ensure they’re at ease.
For teens or adults, knowing it’s not a test or something you can “fail” often helps reduce anxiety.
But beyond this, there’s nothing you need to do before the assessment. Your clinician will guide the entire session, explain everything clearly, and ensure the experience is as relaxing and comfortable as possible.
ADOS-2 assessments at REACH Ohio
At REACH Behavioral Health, we know that seeking an autism evaluation – for yourself or your child – can often feel emotional, confusing, or overwhelming.
That’s why our goal is to make the process as clear, compassionate, and supportive as possible.
Whether you already have an ADOS-2 scheduled or you’re just beginning to explore autism testing, we’re here to help answer any questions or concerns – before, during, and after your autism ADOS assessment.
If you’re ready to schedule an ADOS-2 assessment or want to learn more, contact us today.
No referrals needed. No long waitlists. Just clear, compassionate support at every step.