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The Autism Diagnostic Observation Schedule, 2nd-edition (ADOS-2) Toddler Module is the current gold-standard measure of autism spectrum disorder (ASD), a neurodevelopmental condition more frequently diagnosed in toddler boys than girls. Some evidence suggests that behaviors assessed by the Toddler Module may capture an ASD phenotype that is more common among boys than girls. Focus on these behaviors may contribute to sex differences in ASD diagnoses. Particularly, the ADOS-2 may equivalently weight social communication behaviors on which boys and girls are expected to look similar and behaviors that which girls may, due to early socialization, perform differently than boys. As a consequence, the Toddler Module may fail to identify ASD in girls who should qualify for the diagnosis. The current study examined the possibility that some ADOS-2 items may function differently for boys and girls by testing the degree to which eight items equivalently related to a social communication latent factor across sexes in toddlers with suspected ASD. Inconsistent with hypotheses, tests of differential item functioning revealed no evidence of sex differences, suggesting that the Toddler Module assesses these eight items similarly for boys and girls. Examination of factor loadings point to Creativity/Imagination as an area of interest for future research.

The intersection of children identified with autism spectrum disorders (ASD) and children within the foster care system who have experienced trauma can complicate timely assessment and eligibility for special education services, creating health disparities for this group of students. As students with ASD are over three times more likely to be involved in the foster care system than typically developing peers, school psychologists must be equipped to assess for ASD in this population. The complex clinical presentation of students with ASD within foster care contributes to delays in identification and access to special education services. In particular, schools may struggle to disentangle the symptoms of ASD from the consequences of trauma exposure that often accompanies foster care placement. This paper reviews the relation between students in foster care and those with ASD, outlines the similarities and differences in developmental profiles of these students, and provides recommendations for school practitioners associated with assessment practices, prevention strategies to reduce the risk of trauma subsequent foster care placement for students with ASD, as well as needed advocacy efforts and future research.

The measurement of autism characteristics can be challenging due to variability of social impairments and restricted and repetitive behaviors or interests (RRBs). Psychometrically strong measures such as the Autism Diagnostic Observation Schedule, Second Edition (ADOS‐2) can improve our capacity for thorough autism assessment. The conceptualization of the ADOS‐2 has been shaped by research exploring the structure of its items, which evaluate autism traits associated with social affect and RRBs. Continuously refining our understanding of these items and their relations to other characteristics, such as cognition, is crucial for more accurate autism assessment and diagnosis. This study used data from a sample of 188 school‐age children with mostly average cognitive functioning referred for clinical autism evaluations to (1) test the dimensionality of the ADOS‐2, Module 3 (appropriate for children with relatively higher verbal ability), across two sets of items (i.e., algorithm only, algorithm with three non‐algorithm RRB items) using confirmatory factor analysis (CFA) and (2) examine the relations of cognition to the dimensions tested in the ADOS‐2. A bifactor model, featuring a general autism trait and two subfactors (RRB and Social Affect), provided superior fit for algorithm‐only and algorithm with three non‐algorithm items. Cognitive functioning was not significantly related to the general or specific factors in the model with only algorithm items. While the findings support the validity of the ADOS‐2, it may not fully capture RRBs among children referred for autism. This study enhances our understanding of the ADOS‐2, highlighting the utility of a bifactor model for characterizing its dimensionality, measuring autism traits with minimal cognitive influence, and identifying its limitations in assessing RRBs. Lay summary: Improving our understanding of autism assessment tools like the ADOS‐2 is crucial for accurate diagnosis and effective treatment planning. This study found that the individual items in the ADOS‐2 accurately reflected children's overall performance and were not substantially influenced by cognitive functioning. Future improvements to the assessment may include additional items to better capture restricted and repetitive behaviors or interests (RRBs). [ABSTRACT FROM AUTHOR]

This Viewpoint describes efforts to provide timely, comprehensive, and high-quality mental health care to a large population-representative subset of children within a single health system and demonstrate its potential impact and true cost. [ABSTRACT FROM AUTHOR]

The measurement of autism characteristics can be challenging due to variability of social impairments and restricted and repetitive behaviors or interests (RRBs). Psychometrically strong measures such as the Autism Diagnostic Observation Schedule, Second Edition (ADOS-2) can improve our capacity for thorough autism assessment. The conceptualization of the ADOS-2 has been shaped by research exploring the structure of its items, which evaluate autism traits associated with social affect and RRBs. Continuously refining our understanding of these items and their relations to other characteristics, such as cognition, is crucial for more accurate autism assessment and diagnosis. This study used data from a sample of 188 school-age children with mostly average cognitive functioning referred for clinical autism evaluations to (1) test the dimensionality of the ADOS-2, Module 3 (appropriate for children with relatively higher verbal ability), across two sets of items (i.e., algorithm only, algorithm with three non-algorithm RRB items) using confirmatory factor analysis (CFA) and (2) examine the relations of cognition to the dimensions tested in the ADOS-2. A bifactor model, featuring a general autism trait and two subfactors (RRB and Social Affect), provided superior fit for algorithm-only and algorithm with three non-algorithm items. Cognitive functioning was not significantly related to the general or specific factors in the model with only algorithm items. While the findings support the validity of the ADOS-2, it may not fully capture RRBs among children referred for autism. This study enhances our understanding of the ADOS-2, highlighting the utility of a bifactor model for characterizing its dimensionality, measuring autism traits with minimal cognitive influence, and identifying its limitations in assessing RRBs., (© 2024 International Society for Autism Research and Wiley Periodicals LLC.)