ADOS mod 4 picture book

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I did the ADOS a few days ago and I'm impatiently waiting for results. I didn't know what it was. I'd never heard of ADOS before I got home that night and started googling "books with frogs flying on lily pads". I know they got a genuine performance out of me since I had no idea what it was all about. I'll get the results of their evaluation in a couple of weeks.

In the meantime, can anyone tell me what the evaluators are looking for as you narrate the wordless picture book, and also what they're looking for with the exercise where you create a story from five objects?

Thanks!

Hello? Is there anybody out there?
Just nod if you can hear me.
Is there anyone home?

Just my speculation here so take it as a grain of salt.

I don't think anyone knows what they are looking for because it's a secret they keep between each other. If they told anyone what they were looking for, then it could screw with the results and people could purposely mess up on the tests because they were trying to get the ASD diagnoses. Sadly there are people who do want a specific label and will keep going until they get it. But I do know that picture sequencing is used to test your TOM because Simon Baron Cohan did a study on it in 1985 and he saw that autistic children didn't do well with them.

Mine asked me whether I thought the book might influence the characters' feelings. So, that. And whether you can describe metaphors in the book (mine was a very surreal book about a boy who went on adventures while dreaming - something I found out from googling it).

I did that one also... I think we'll never know what they are looking for because then people can prepare themselves.
But I feel like I did very good on that one but neurotypicals probably also do well on that one? I don't know.

Yep. It examines an individual's imagination and Theory of Mind.

I agree it's best if the evaluation criteria remain secret. I'm waiting for the official results of the evaluation, but I'm curious what others think based on your experience. Here’s how it went for me:

I went in ten days ago for my initial eval. I spend about 2 hours with one evaluator before a second one joined us for the ADOS. I had to make a story from the picture book "Tuesday". I even asked "you want me to narrate a story?" and they said yes. I tried, but I just couldn't. I described what I saw on each page. "The frogs are flying on lily pads.... what?... ok, the fish are looking up at them. No wait, they're not really looking at them, are they? Um, ok there's a turtle sitting there... what is going on?... [next page]... okay, now the frogs are flying. This one is flying with no hands. [next page] Um, apparently they went blind because they just flew into some sheets that they clearly should have seen coming. [next page] Now they're flying in a town chasing birds. [next page] okay, this guy is eating a midnight snack and the frog is waving at him. he's probably confused like I am why the frogs are flying. [next page] oh great, now they're burglarizing someone's home. They're watching tv, changing the channel with his tongue, this one is looking at artwork. the cat is hiding, maybe he's hunting them? [next page] ok now the frog is flying but then turns around and gets chased by a dog. Why in the world is a dog up at 4:30 in the morning, that makes no sense. [next page] okay now the dog is being chased by a group of frogs... the dog is scared, maybe?... or is he playing with them? hmmm... tough to tell, IDK, his tongue is out, so I'm guessing he's happy. yeah, his tongue is out so he's a happy dog, playing with the frogs. [next page] now they are crashing into some trees? And some are on the roof? what is going on here?... [next page]... okay now the frogs are walking home. [next page]... now the police and an ambulance are there, and the news crew, and the dog and the cat... the police are probably there for the B&E but why is the ambulance there? that makes no sense. And why is the lily pad still wet? They flew all night, there shouldn't be any water left on the lily pad. [next page]... okay, it's next tuesday and the sun is coming up, looks like shadows of pigs ... [next page]... and pigs are flying. the end."

Then they made me tell a story from 5 objects of my choice. They demonstrated. I noticed she gave one of the objects a name, which I thought was really weird, but I told them I was going to mimic what she did. So I studied the objects for a minute or two, then chose a feather, a metal disc from a pizza cutter, a mini basketball, the candlestick from the game Clue, and a card (4 of spades.) I lined them up (didn't realize I did that until afterwards.) My story: "Bird wanted pizza but could only find a pizza cutting wheel, so he decides to play basketball but then the basketball was gone (tossed it aside), so he decides to play Clue and be the candlestick, but has nobody to play with, so he decides to play cards but he is 51 cards short. the end."

Then they interviewed me. I spent most of my time angled towards and addressing the evaluator who I was more familiar with. I make little eye contact typically, but I made a little more with the more familiar one, looking briefly at her maybe 5-10 times in the 45 minutes. The other one I think I made eye contact with like 2 times in 45 minutes, it was really awkward. Then at the end, they said it was time for a lunch break. She started to talk and it sounded like she was going to give me different options for lunch. I didn't know what was coming, I didn't know if they were going to ask me to have lunch with them or go to some new place or what, so I just interrupted her and said "I'll just go to subway, I'm good." And she was like "ok, that works" and that was it.

After lunch was an IQ test. They confirmed it came back in the 98th percentile, but didn’t specify exactly where in that range it was. During that initial meeting, she told me she'd probably be calling my wife to talk to her about my behaviors, etc.

Then on my second visit a week later, I asked when she'd be calling my wife and she said "I don't think I have to." So it sounds to me like they have enough evidence to make a call, but I can't tell what they're gonna say, and I don't find out for 2 more weeks.

So given all of the above, and obviously there are a ton of details I haven't shared, I'm curious what others might think the likely outcome is. I have a hard time thinking they would rule out ASD without considering all the evidence (ie talking to my wife), especially considering the ADOS performance. (BTW I'm 41, I've learned to hide a lot over the years, yet I think the ADOS revealed a lot more than I thought it would).

Sorry for being so long-winded. Curious what anyone might think... diagnosis of ASD likely or not?

I definitely think it's likely that the diagnosis will come back ASD based on your description. You did exactly what I did for the Tuesday story; explained exactly what was on the page without much elaboration, and expressed confusion at the story's inconsistencies (e.g why, when the frogs flew down the old woman's chimney, did they come out clean and not covered in soot?) My eval says that I "was very literal in telling the story," so I guess an NT would have provided more characters or a plot or something, but I was too confused by the pictures to think about that at the time.

I was always good with picture sequencing but yet I wasn't aware of how people would feel if I did things and I used to just to things to see how people would react (I think this was because I knew others had different reactions so I was always testing and didn't know when to stop) and I thought other kids were crazy if they didn't like the same things I liked and I thought they were weird and were just joshing me. I was a mystery so no wonder my mom thought I just didn't care. She even had to do things to me to show me how it feels. Then I was shocked that this neighbor boy didn't look in the neighbor's bush where I put his bike as a joke when I was supposed to return it. Then I had learned he didn't know the bike was there when my mom and I talked about it. I figured this had to do with TOM issues but I guess I just had TOM deficits than mind blindness. That just means the kid has TOM but they have parts of it that are impaired and it might not show in the doctor's office when doing the tests which is my guess for why I was this mysterious.

so ToM.... In my made-up story above, I said "bird wants a pizza, bird wants to play basketball, bird wants to play clue, bird wants to play cards."

I told them I was going to copy exactly what the psychologist modeled in her sample story, which started out with "Joe wants to go to the beach... " so I started mine that way and now that I think about it I had a lot of repetition in my story.

But since I talked about what "bird" wanted, does that mean I have ToM, thus I pass the test and I'm NT?

No, theory of mind refers to one's ability to understand that other people think differently from you. Look up the Sally-Anne test, it is an excellent example of how theory of mind works. Your stating that the bird wanted pizza wasn't theory of mind. If however, you were close friends with the bird, and you knew from experience that he liked pizza, and knew that he was currently hungry, then subsequently surmised that he probably wanted pizza, even if you didn't, that would be ToM.

That said, the majority of level 1-2 autistic adults have a decent grasp of theory of mind; it is not entirely absent just because we're on the spectrum. For example, I know that my mother would rather have flowers on her birthday than Star Trek related things, because I know that she has different thoughts and wants than I do, and that she doesn't love the same things as me. My awareness of this doesn't mean I don't have autism.

I think most people on the autistic spectrum develop TOM later than most children. I could pass the Sally Ann test when I was 15. I wonder how I would have answered it at 8 years old or 5. But some NT children haven't developed TOM until age six so that might still be normal if I answered the box at age 5 wherever Sally first put the ball before leaving the room.

I'd wondered about the point of this too.
I thought it was a gauge of intellectual disability. If you can recount what is happening on the pages then your cognitive function is intact. That's what I did, I believe. But I was getting flustered with being asked to do a task while someone sat there and watched me, and didn't recount the amount of detail I observed in the pictures, because when I'm stressed I don't do well with speaking. There really is much too much variation in this for a clinical test.

I think ToM became more concrete for me last night when I was talking about things at work with my wife. I told her how people around me often make these "jokes" that are clearly not funny, and they all laugh and socialize and stuff. I sit there looking at them thinking "what bunch of hypocrites, how can they be so disingenuous?" I realized, I don't consciously decide that that are disingenuous, it's just a given for me, and why is that?... Because I know if I were to laugh at that nonsense, I would be being disingenuous. So automatically, what's going on in my head is going on in there's. Ie, I lack ToM. There are other similar examples also. But it dawned on me for the first time ever last night, "wait a minute, you mean they might ACTUALLY think that stuff is funny? The laughs are genuine?"

You were right. I got an official diagnosis today. Aspergers obviously doesn't exist anymore, and my ADOS score was 12, so I asked if I would have been diagnosed with aspergers under the DSM IV rules rather than autism proper, and they said most likely yes.

My IQ is at the 99.8 percentile while some aspects of my executive functioning are at the 2nd percentile (yes, 2nd). I think about how different my life would have been had I gotten the support I needed in school 30 years ago. I feel very driven right now to make sure kids out there today are getting the services they need so their potential doesn't go unfulfilled. When I was in 7th grade, the school out me on a tracker where I had to bring a form around to each of my teachers every Friday and they would give a mini report card. My grades went through the roof. My mother said "you should be ashamed of yourself, needing the teachers to stay on you like that." After a full quarter, my grades went up and they took me off the plan. And my grades went back down. My mother would always point to that quarter and say "see, you can do it! You just don't want to, you're lazy." I don't want any other kid to experience that.

Congrats on the diagnosis I hope you find it helpful! I too want to help others with autism, though I'm more focused on adults, since we receive even less attention and fewer services than children do. Did they give you a written report?