The Autism Diagnostic Observation Schedule (ADOS), a standardized protocol for observation of social and communicative behavior associated with autism, is described. The instrument consists of a series of structured and semistructured presses for interaction, accompanied by coding of specific target behaviors associated with particular tasks and by general ratings of the quality of behaviors. Interrater reliability for five raters exceeded weighted kappas of .55 for each item and each pair of raters for matched samples of 15 to 40 autistic and nonautistic, mildly mentally handicapped children (M IQ = 59) between the ages of 6 and 18 years. Test-retest reliability was adequate. Further analyses compared these groups to two additional samples of autistic and nonautistic subjects with normal intelligence (M IQ = 95), matched for sex and chronological age. Analyses yielded clear diagnostic differences in general ratings of social behavior, specific aspects of communication, and restricted or stereotypic behaviors and interests. Clinical guidelines for the diagnosis of autism in the draft version of ICD-10 were operationalized in terms of abnormalities on specific ADOS items. An algorithm based on these items was shown to have high reliability and discriminant validity.

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Fifty-eight high-functioning autistic children were assessed during preschool and early school years and followed over a period of 8 years. Early and current psychometric and language tests, parent interviews concerning autistic symptomatology, and direct observations were examined as predictors of the Vineland Adaptive Behavior Scales and scores on standardized achievement tests. Verbal skills emerged as the strongest predictor of social-adaptive functioning. Clear, positive relationships also emerged between intellectual functioning, and academic attainment. Early non-verbal IQ also showed a positive relationship with outcome. Academic performance appeared considerably stronger than in earlier studies.