Investigating the Autism Diagnostic Observation Schedule 'Gold Standard' Origin Myth

The Autism Diagnostic Observation Schedule (ADOS) is regularly cited as the standalone 'gold standard' or an essential inclusion for diagnosis of Autism Spectrum Disorder. This research considers whether the evidence is consistent with the strength of such beliefs.

A random sample of 100 published articles referring to the ADOS as having 'gold standard' status was reviewed. Analysis of cited evidence for this proposition was performed over three iterations, exploring the source of each 'gold standard' statement.

The first iteration found 62% of 'gold standard' statements were either unreferenced or only cited test materials. From the remaining 38%, a total of 47 discrete sources were referenced. In the second iteration, about 60% of papers did not include any supporting reference, with another five citing references inconsistent with 'gold standard' statements. Only one paper from the third iteration cited source material that had not been reviewed in the first and second iterations. Two of the three associated references cited in that one paper contained no mention of the ADOS as a 'gold standard'.

The majority of papers reviewed failed to cite support for a 'gold standard' statement. Failure to identify these issues at peer-review suggests a pervasive, but erroneous, assumption that there is a broad consensus about the status of the ADOS. In reviewing this sample, 'gold standard' consensus appears based more on hearsay and marketing than clinical support, suggesting a need for greater vigilance during the review process by requiring authors to establish evidence for significant assertions.