What to expect in a Module 3 ADOS Assessment in the UK

So you have a child that is showing signs of autism? Maybe they are in the process of going through an autism assessment?

My 5-year-old daughter is currently going through the autism assessment process. She recently had her ADOS assessment and was tested using “Module 3”. Today I am sharing exactly what happened in her assessment so that you can know what t expect from an ADOS assessment in the UK, so keep reading or check out the video below.

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Table Of Contents

What is an ADOS?

ADOS stands for The Autism Diagnostic Observation Schedule and is a widely used form of assessing autism in the UK. The assessment is standardised and very structured and codes responses and behaviours to give a final score that will determine whether autism is present and whether the diagnosis is “mild, moderate or severe” autism.

What is module 3? Which ADOS module will my child have?

There are several modules of ADOS assessment and the module chosen to test with is determined by the individual’s level of language and development rather than age.

Module 1

Used for children who are pre-verbal or only have single word language.

Module 2

This module is used for children with phrased speech abilities who are not fully fluent. When my now 8 year old son was nearly 4 and had his ADOS, he was tested with module 2.

Module 3

For children and teenagers who are verbally fluent. Although my daughter is only just 5, during her social communication clinic, her spoken language age was assessed at age 7. While children of age 5 usually undertake module 2, the team decided that it was best to use module 3, as she is so fluent.

Module 4

This is used for adults who are verbally fluent.

What happens before the ADOS?

As I discussed in my post explaining Our Autism Journey So Far, there are a number of steps before the ADOS assessment. These steps include;

Referral to be assessed
An initial meeting where an autism specialist confirms whether assessment is necessary
Questionnaires filled out by other people that care for the child, such as teachers
A social communication clinic where both an in-depth interview with parents and speech and language assessment with the child are carried out

Where does the ADOS take place?

I cannot speak for every area (as in my experience, different areas have different systems), but in our case, the assessment was carried out in the same building where we’d had the other appointments. It was a special facility for children with all sorts of diagnostic and treatment needs, not just ASD.

Can I be present for the ADOS?

In my experience and from what I have heard from others, parents cannot remain in the same room for the assessment. This is largely because, as parents, we prompt and aid our children, especially those with additional needs. For the reason, allowing parents to remain can mean that the results may be skewed.

We were, however, allowed to watch from an adjoining room through one way glass.

Will I be able to easily follow along what is going on in the assessment?

Yes, and no.

For my son’s module 2 assessment I was given a schedule of what they would be doing with him and I was able to follow it quite easily. As I had read extensively about Autism traits before the assessment, I was able to understand what they were looking for and guess how he was scoring for each task.

For my daughter’s module 3 assessment, they were not planning to give me a copy of the sheet they use for marking, although they were more than happy to provide one when I asked.

Her module 3 assessment didn’t seem as obvious or linear as I remember the module 2 being, although module 2 was a number of years ago so is remembered through my Mummy fogged brain. For my daughter’s assessment, they seemed to skip back and forth a little more, perhaps responding to her and adjusting the sequence accordingly.

Will the assessment be stressful or upsetting for my child?

Although I cannot guarantee that your child will not be upset in any way, as I do not know which difficulties your particular child faces, I hope that you find some comfort in the fact that both of my children breezed theirs, emotionally speaking. The room was bright and airy, and the adults assessing them were really lovely with them. The whole things is set up like a series of tasks and games rather than tests and the props and toys that were used they found interesting.

So no, your child will probably not find the experience stressful or upsetting.

What exactly happens in the actual module 3 ADOS assessment?

Like I said, the memory of my son’s module 2 assessment is a little hazy. Keen to remember my daughter’s module 3 assessment in detail so that I could share it with you so that you may know what to expect, I made a lot of notes.

Here is what happened in her assessment in the order in which it happened.

Let me just say at this point

I am not a doctor, nor am I a trained autism specialist. I am just a Mum of children on the spectrum who is pretty well-read on the subject. While I will do my best to explain what happened during this assessment, any conclusions that I draw about what exactly they were looking for in each task and how my daughter scored, are purely conjecture and my best-educated guess.

As always, know that these things can vary from area to area, so if you have any concerns about your own child or questions about their assessment or case, please speak to your own doctor.

With that out of the way, let me get on to explaining, to the best of my ability, what happened in the assessment.

Puzzle pieces

They began with a piece of paper with the outlines of zigzag shapes on it. The speech and language therapist leading the assessment (who I shall refer to as “the therapist” from here on in) chatted to her and explained that they were going to fit the pieces onto the page. She gave my daughter a handful of pieces and kept the rest in her hand where she sat across the table from my daughter.

Although it did not specifically state this in the sheet I was given, it is my belief that what they were looking for here was whether the child being tested would verbally ask for more pieces to complete the puzzle (as a neurotypical person would be expected to do) or simply reach for them.

To my surprise, my very verbally fluent, and usually very polite daughter, did not verbally ask for more pieces. Even when the therapist pulled the puzzle pieces even closer into her body, making them harder to reach, she still did not use her words and reached for the pieces. It is my opinion that she will have scored this task as showing a sign of ASD.

Next, they chatted

The therapist talked to my daughter about a “pretend birthday” that she was having in school that they had discussed during our last meeting. My daughter changed the subject and offered information about an entirely unrelated subject. This would likely have scored as showing a sign of autism.

The Picture Book

Then a picture book was brought out. The therapist asked my daughter to look at various facial expressions of character in the book. She was asked to imagine what they were saying, thinking and feeling. My best guess is that children who talked bout how the characters were feeling would be scored as neurotypical and those who did not would be scored towards the autism end of the spectrum. My daughter talked a lot about what they might think but not what they felt. The also took the topic of conversation off on a tangent a lot, which I assume would also be scored as an autism trait.

I noted at this point that the whole thing seemed far left structured than my son’s module 2 which was a little more one task, then another. I felt that module 3 had much more of a “natural conversation” feel. I could be wrong, but perhaps they skip about and are a little more led by the test subject when the child is more fluent.

Questions about the future

The therapist asked if she would like her own house when she was older and what she might like to do for a job. My daughter replied that it would be ages until then as she is only 5. They then went back to the book and discussing the thoughts and feelings of the people in the pictures. Again, my daughter didn’t really mention how they felt much.

Imaginary & Role Play

For the next activity, a selection of random toys and objects were taken out of a bag and placed on the table. Items included a jug, some tools, some people, dinosaurs and other bits too.

The therapist picked up one of the toy people and said “I’ll be this one, which one would you like to be?” My daughter became quite fixated on the toy person that she chose being able to old one of the other objects. This fixation I would imagine was scored as an ASD sign.

“Hello, I’ve lost my friend,” said the therapist, pretending to be the character that she had chosen talking to my daughter’s character, “have you seen him anywhere? He’s got a blue top and red trousers and brown hair.”

In spite of the fact that this described one of the other toys on the table, my daughter did not respond.

When the therapist further promoted my daughter by pretending to be the other “lost” character in the blue top, she offered information as to where the friend was, but it did not flow naturally.

Questions About Siblings

When the therapist talked to my daughter about her siblings, I noticed that she addressed her reflection in the one-way glass, rather than making eye contact with the therapist. She seemed to do this a lot, which I assume they will count as a sign of ASD.

“How does your brother react when you play with his toys?” the therapist asked. I think they were looking for her understanding of the feelings of others here. “I don’t know” she replied.

Looking At A Map Like Picture Of An Island

My daughter was shown a picture of an island and asked to point things out that she could see in the picture. At a guess, what they were looking for here, was whether she would respond with a general and more neurotypical response, such as sea, sky, land, or noticing very small details as those with ASD often do. I mean, I could be way off here, but that’s where my money is.

Either way, she didn’t really respond much either way to this.

Mime & Gesture

For this talk, she was shown a variety of black and white pictures and asked to act out what was happening in the picture. As a sign of ASD is limited use of gesture, I assume that was what they were looking at here.

First, she was shown a picture of fishing. She verbalised what was going on, pointed to the pictures, but did not act anything out.

The pictures were then put away and the therapist said “pretend I am an alien and I know nothing about the earth. Show me how to brush your teeth”. Now this, she managed to do incorporating more mime.

Making Up Stories

For this task, another random bag was brought out and not the therapist and my daughter choose 5 things each to make up a story. The therapist went first, modelling what she expected, then my daughter had her turn. While her daughter’s story was not as elaborate, she had a good go at hers.

The Results

Now all that is left to do is to wait for the results. With a high functioning child, by all accounts the only way to know whether a diagnosis is necessary is by carefully adding up the scores.

This Much I Know

Diagnosis or no diagnosis, she’s still my beautiful, clever, funny and wonderful baby girl. If she doesn’t need a diagnosis, great! No harm done, I’ll be glad I checked. If she does, then all it means it that I’ll be better able to access the help she needs when she needs it. She’ll still be her.

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