Social Psychiatry, Vol. 54 No. 2, 2026.
Meeting abstract
https://doi.org/10.24869/spsih.2026.147
ADOS-2 in a Clinical Dilemma: When the Protocol Sees What Is Not There and Misses What Is
Ivan Zečević
; Centre for Neuropsychology and Sleep Disorders, Vlaška ulica 64, 10000 Zagreb, Croatia
*
* Corresponding author.
Abstract
The ADOS-2 is one of the most commonly used
observational instruments for assessing autism
spectrum symptoms. Although it can be a valuable
part of the diagnostic process, its interpretation
requires caution in patients with a complex
clinical picture in adulthood as well as in
childhood. Caution is especially important when
ADOS-2 is used by professionals who do not have
broader clinical expertise, such as social pedagogues,
speech and language therapists, and educational
rehabilitators, which is why it is necessary
to integrate the findings with psychological
and psychiatric aspects of assessment. A positive
ADOS-2 result is not in itself sufficient for an autism
diagnosis, just as a negative result does not
rule out autism, particularly in individuals with
well-developed compensatory strategies, intact
intellectual functioning, or an atypical clinical
presentation. The aim of this report is to highlight the limitations of the ADOS-2 protocol in
the differential diagnosis of autism in relation to
other conditions. The presentation includes four
clinical cases in which the relationship between
ADOS-2 findings and the clinical picture was diagnostically
inaccurate. The cases presented are
borderline personality disorder, psychoticity, and
avoidant personality disorder that were interpreted
as autism, as well as a case of a patient with
autism, neuropsychological continuity of difficulties,
and findings present since early childhood,
in whom ADOS-2 did not detect autism. The cases
presented emphasize that ADOS-2 must not be
used as a stand-alone diagnostic proof, but rather
as part of a broader multidisciplinary assessment.
It is recommended to carry out a neuropsychological
assessment and a psychiatric examination
and, where necessary, neurological work-up, and,
if ambiguity remains, ADOS-2 may be added —
but ADOS-2 should by no means be the first assessment.
The differential diagnosis of autism
must include a detailed developmental history,
collateral (heteroanamnestic) information,
school and medical documentation, assessment
of personality, psychopathology, intellectual and
neuropsychological profile (attention, verbal and
nonverbal abilities, different types of memory,
executive functions, speech and language abilities,
processing speed, motor speed, perceptual
functions). Such an approach reduces the risk of
false-positive and false-negative conclusions and
enables a more accurate distinction between autism
and conditions that involve problems with
social cognition.
Keywords
adult autism; personality disorders; psychotic disorders; masking; ADOS-2
Hrčak ID:
352266
URI
Publication date:
15.6.2026.
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