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Measuring autism with the ADOS-2 using a bifactor model.

Phebe Albert1, Gal Kaldes1, Erin Tully1

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Summary

The Autism Diagnostic Observation Schedule, Second Edition (ADOS-2) effectively measures autism traits using a bifactor model. However, it may not fully capture restricted and repetitive behaviors (RRBs) in children undergoing autism evaluations.

Keywords:
autism diagnostic observation schedule, second editionautism spectrum disorderbifactor modelnonverbal cognitionverbal cognition

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Area of Science:

  • Psychiatry
  • Developmental Psychology
  • Behavioral Neuroscience

Background:

  • Autism assessment is complex due to variable social impairments and restricted and repetitive behaviors or interests (RRBs).
  • The Autism Diagnostic Observation Schedule, Second Edition (ADOS-2) is a key psychometric tool for autism evaluation.
  • Understanding ADOS-2 item structure and relation to cognition is vital for accurate diagnosis.

Purpose of the Study:

  • To test the dimensionality of the ADOS-2, Module 3 using confirmatory factor analysis (CFA).
  • To examine the relationship between cognitive functioning and ADOS-2 dimensions.
  • To evaluate the utility of a bifactor model for ADOS-2 item analysis.

Main Methods:

  • Confirmatory factor analysis (CFA) was used on data from 188 school-age children referred for autism evaluations.
  • A bifactor model was applied to ADOS-2 algorithm items and algorithm items plus three non-algorithm RRB items.
  • Cognitive functioning was assessed in relation to the identified ADOS-2 factors.

Main Results:

  • A bifactor model with a general autism trait and RRB and Social Affect subfactors demonstrated superior fit for both item sets.
  • Cognitive functioning was not significantly associated with the general or specific factors when using only algorithm items.
  • The ADOS-2, while supportive of validity, may have limitations in fully assessing RRBs.

Conclusions:

  • The bifactor model effectively characterizes ADOS-2 dimensionality, supporting its use for measuring autism traits with minimal cognitive influence.
  • Findings highlight the ADOS-2's utility but also its potential limitations in capturing the full spectrum of RRBs in referred children.
  • Further research can refine autism assessment by considering the nuanced structure of the ADOS-2 and its relationship with cognitive factors.