@dizzlkheinz/ynab-mcpb 0.12.1

package/ADOS-2-Module-1-Complete-Manual.md

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+---
+title: ADOS-2 Module 1 - Complete Coding Manual
+tags: [ados, ados-2, module-1, autism, assessment, diagnostic]
+created: 2025-01-20
+type: reference
+---
+
+# ADOS-2 Module 1: Complete Coding Manual
+
+## Overview
+
+> [!info] Module 1 Target Population
+> **Module 1** is for children **31 months and older** who do **not consistently use phrase speech** (pre-verbal or single-word speakers).
+
+**Administration time:** 40-60 minutes
+**Scoring:** Immediately after administration
+**Scale:** Most items rated 0-3 (some 0-2), with 7, 8, 9 for special circumstances
+
+---
+
+## Module 1 Activities (10 Total)
+
+1. **Free Play**
+2. **Response to Name**
+3. **Response to Joint Attention**
+4. **Bubble Play**
+5. **Anticipation of Routine with Objects**
+6. **Responsive Social Smile**
+7. **Anticipation of Social Routine**
+8. **Functional and Symbolic Imitation**
+9. **Birthday Party**
+10. **Snack**
+
+---
+
+# A Codes: Language and Communication
+
+> [!note] A Codes Overview
+> The **A codes** assess **Language and Communication** behaviors in Module 1. These codes evaluate both verbal and non-verbal communication skills.
+
+## A1: Overall Level of Non-Echoed Language
+
+**What it measures:** Complexity and quality of spontaneous, non-repetitive spoken language.
+
+| Score | Description                                                                                                  |
+| ----- | ------------------------------------------------------------------------------------------------------------ |
+| **0** | Non-echoed phrase speech of **3+ words per utterance**; some grammatical markings (plural, tense)            |
+| **1** | Speech primarily **2-3 word utterances**, minimal/no grammatical markings                                    |
+| **2** | **Occasional phrases only**; mostly single words                                                             |
+| **3** | **Recognizable single words** or word approximations; must use **at least 5 different words** during session |
+| **4** | At least **one word** or approximation, but **fewer than 5 words** used                                      |
+| **5** | **No spontaneous or echoed** use of spoken words                                                             |
+| **7** | **All speech is echoed** (immediate or delayed), with or without communicative intent                        |
+| **8** | No words or word approximations                                                                              |
+| **9** | N/A                                                                                                          |
+
+> [!warning] Critical Code
+> **A1** determines which algorithm is used: **Few-to-No Words** vs. **Some Words**
+
+---
+
+## A2: Frequency of Vocalization Directed to Others ⭐
+
+**What it measures:** How often child directs vocalizations toward examiner/caregiver, and in what contexts.
+
+| Score  | Description                                                                                                                                                        |
+| ------ | ------------------------------------------------------------------------------------------------------------------------------------------------------------------ |
+| **0**  | Directs vocalizations in **variety of pragmatic contexts**. Must include chatting/being friendly OR expressing interest/sharing enjoyment, plus making needs known |
+| **1**  | Directs vocalizations **consistently in ONE context** (e.g., only to request), OR limited vocalizations across variety of contexts                                 |
+| **2**  | **Occasional vocalization** directed to others, inconsistently in limited contexts. May include whining/crying from frustration                                    |
+| **3**  | Vocalizations **never/almost never** directed to others, OR **rarely/never vocalizes**                                                                             |
+| **-1** | Not Collected                                                                                                                                                      |
+| **9**  | Cannot be rated                                                                                                                                                    |
+
+⭐ = **Included in diagnostic algorithm (SA domain)**
+
+---
+
+## A3: Intonation of Vocalizations or Verbalizations
+
+**What it measures:** Quality of pitch, tone, and stress patterns in speech/vocalizations.
+
+| Score  | Description                                                                                                                                           |
+| ------ | ----------------------------------------------------------------------------------------------------------------------------------------------------- |
+| **0**  | **Normal, appropriately varying intonation**, no peculiar or odd intonation                                                                           |
+| **1**  | **Little variation** in pitch/tone; flat or exaggerated, OR **occasional peculiar intonation**                                                        |
+| **2**  | **Odd intonation** or inappropriate pitch/stress, AND/OR **markedly flat/toneless mechanical** vocalizations, OR odd cry with few other vocalizations |
+| **8**  | **N/A** - insufficient vocalizations for assessment (includes normal cry with few other vocalizations)                                                |
+| **-1** | Not Collected                                                                                                                                         |
+| **9**  | Cannot be rated                                                                                                                                       |
+
+> [!tip] Coding Focus
+> **Focus:** Prosody (melody of speech), **NOT** articulation
+
+---
+
+## A4: Immediate Echolalia
+
+**What it measures:** Tendency to repeat others' speech immediately after hearing it.
+
+| Score  | Description                                                                             |
+| ------ | --------------------------------------------------------------------------------------- |
+| **0**  | **Rarely/never repeats** others' speech (requires ≥5 words to code 0 vs. 8)             |
+| **1**  | **Occasional echoing**                                                                  |
+| **2**  | **Echoing words/phrases regularly**, but some spontaneous language (can be stereotyped) |
+| **3**  | **Speech largely consists** of immediate echolalia                                      |
+| **8**  | N/A or **not enough language to judge**                                                 |
+| **-1** | Not Collected                                                                           |
+| **9**  | Cannot be rated                                                                         |
+
+> [!note] Exclusions
+> **Excludes:** Repetitions used as lead-in to response or as memory device
+
+---
+
+## A5: Stereotyped/Idiosyncratic Use of Words or Phrases ⭐
+
+**What it measures:** Unusual, repetitive, or odd word/phrase usage (includes delayed echolalia).
+
+| Score  | Description                                                                                                                                                            |
+| ------ | ---------------------------------------------------------------------------------------------------------------------------------------------------------------------- |
+| **0**  | **Rarely/never** uses stereotyped or idiosyncratic words/phrases (requires ≥5 words)                                                                                   |
+| **1**  | Use **more repetitive than typical**, but not obviously odd, OR **occasional stereotyped utterances** or odd words, OR unusual phrase use with other flexible language |
+| **2**  | **Often uses stereotyped** utterances or odd words/phrases, with some other language                                                                                   |
+| **3**  | **Frequently uses odd/stereotyped** speech, **rarely uses non-stereotyped** spontaneous speech                                                                         |
+| **8**  | **Language too limited to judge**                                                                                                                                      |
+| **-1** | Not Collected                                                                                                                                                          |
+| **9**  | Cannot be rated                                                                                                                                                        |
+
+**Examples:**
+
+- Delayed echolalia (TV/movie scripts)
+- Neologisms
+- Repetitive phrases with consistent intonation
+
+⭐ = **Included in diagnostic algorithm (SA domain)**
+
+---
+
+## A6: Use of Other's Body to Communicate ⭐
+
+**What it measures:** Using another person's body (hand, arm, etc.) as tool to communicate or achieve goals.
+
+| Score | Description                                                                                                                |
+| ----- | -------------------------------------------------------------------------------------------------------------------------- |
+| **0** | **No use** of another's body for specific goals, except when other strategies failed AND with coordinated gaze             |
+| **1** | Takes another's hand and **leads without coordinated gaze**, but no placement of hand on objects, no use as tool           |
+| **2** | **Movement of another's hand** when holding object OR **pushing examiner's hand away** without eye contact                 |
+| **3** | **Placement of another's hand/body on object** OR **use as tool/to gesture "for" child** (e.g., using their hand to point) |
+| **8** | **Little/no spontaneous communication**                                                                                    |
+| **9** | Cannot be rated                                                                                                            |
+
+⭐ = **Included in diagnostic algorithm (SA domain)**
+
+---
+
+## A7: Pointing ⭐
+
+**What it measures:** Use of pointing gestures for communication (referencing or requesting).
+
+| Score  | Description                                                                                                                                                                                                                                                     |
+| ------ | --------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- |
+| **0**  | Points with **index finger** with coordinated gaze/vocalization to reference objects in **≥2 activities**                                                                                                                                                       |
+| **1**  | Points to reference, but **insufficient flexibility/frequency** (only once, or no coordinated gaze with distal pointing), OR **pointing approximation** with coordination, OR only touches nearby objects with gaze/vocalization, OR points only to person/self |
+| **2**  | Points only when **close to/touching object**, **without coordinated gaze or vocalization**                                                                                                                                                                     |
+| **3**  | **Does not point**                                                                                                                                                                                                                                              |
+| **-1** | Not Collected                                                                                                                                                                                                                                                   |
+| **9**  | Cannot be rated                                                                                                                                                                                                                                                 |
+
+> [!important] Key for Score 0
+> Must show **visual referencing** (coordinated gaze to object AND person)
+
+⭐ = **Included in diagnostic algorithm (SA domain)**
+
+---
+
+## A8: Gestures ⭐
+
+**What it measures:** Use of conventional, descriptive, emotional, or instrumental gestures (excluding pointing).
+
+| Score  | Description                                                                                                                                  |
+| ------ | -------------------------------------------------------------------------------------------------------------------------------------------- |
+| **0**  | Spontaneous use of **≥2 different gestures**; **≥1 used more than once**                                                                     |
+| **1**  | Spontaneous use but **exaggerated or limited** in range/contexts (only one or used only once each). Communicative reaching can be coded here |
+| **2**  | **No spontaneous use**, OR **inappropriate use only** (e.g., signs "more" when wants stop)                                                   |
+| **8**  | **N/A** (limited by severe motor difficulties)                                                                                               |
+| **-1** | Not Collected                                                                                                                                |
+| **9**  | Cannot be rated                                                                                                                              |
+
+**Examples of gestures:**
+
+- Waving
+- Nodding/shaking head
+- Shrugging
+- Opening hands for "all done"
+- Beckoning
+- Conventional signs
+
+⭐ = **Included in diagnostic algorithm (SA domain)**
+
+---
+
+# B Codes: Reciprocal Social Interaction
+
+> [!note] B Codes Overview
+> The **B codes** assess **Reciprocal Social Interaction** behaviors, focusing on how the child engages socially with the examiner and caregiver.
+
+## B1: Unusual Eye Contact ⭐
+
+**What it measures:** Quality and appropriateness of eye contact during social interaction.
+
+| Score  | Description                                                                                                            |
+| ------ | ---------------------------------------------------------------------------------------------------------------------- |
+| **0**  | **Appropriate gaze** with subtle changes meshed with other communication                                               |
+| **2**  | Uses **poorly modulated eye contact** to initiate, terminate, or regulate social interaction                           |
+| **3**  | Poorly modulated eye contact AND **frequently actively avoids** eye contact (turning away, pushing away, closing eyes) |
+| **-1** | Not Collected                                                                                                          |
+| **9**  | Cannot be rated                                                                                                        |
+
+> [!note] Version Difference
+> ADOS-2 removed score 3 for Module 1; Adapted ADOS retained it
+
+⭐ = **Included in diagnostic algorithm (SA domain)**
+
+---
+
+## B2: Responsive Social Smile
+
+**What it measures:** Child's ability to smile in response to others' smiles.
+
+| Score  | Description                                                                                                                                                                               |
+| ------ | ----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- |
+| **0**  | Smiles **immediately** in response to one of **first two smiles** of examiner/caregiver. Must be clear change from nonsmiling to fully responsive smile, not prompted by specific request |
+| **1**  | **Delayed or partial smile** in response to first two smiles, OR smiles fully/partially only after **>2 smiles**, OR smiles only in response to **specific request**                      |
+| **2**  | Smiles fully/partially only after being **tickled or touched**, OR in response to **repeated action with physical component**                                                             |
+| **3**  | **Does not smile** in response to another person                                                                                                                                          |
+| **-1** | Not Collected                                                                                                                                                                             |
+| **9**  | Cannot be rated                                                                                                                                                                           |
+
+---
+
+## B3: Facial Expressions Directed to Others ⭐
+
+**What it measures:** Range and appropriateness of facial expressions directed toward others.
+
+| Score  | Description                                                                                                                                                                       |
+| ------ | --------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- |
+| **0**  | Directs **range of appropriate facial expressions** to examiner/caregiver to communicate affective or cognitive states                                                            |
+| **1**  | **Some direction** of facial expressions (e.g., only emotional extremes, or occasionally directs wider range). Limited range child who directs most expressions may be rated here |
+| **2**  | **Does not direct** appropriate facial expressions to others                                                                                                                      |
+| **-1** | Not Collected                                                                                                                                                                     |
+| **9**  | Cannot be rated                                                                                                                                                                   |
+
+⭐ = **Included in diagnostic algorithm (SA domain)**
+
+---
+
+## B4: Integration of Gaze and Other Behaviors During Social Overtures
+
+**What it measures:** Coordination of eye contact with vocalizations/gestures during social initiations.
+
+| Score  | Description                                                                                                    |
+| ------ | -------------------------------------------------------------------------------------------------------------- |
+| **0**  | Uses **eye contact effectively** with words/vocalizations/gestures to communicate social intention             |
+| **1**  | Uses eye contact and other strategies **independently** (uses both at different times, but doesn't coordinate) |
+| **2**  | Uses **either** eye contact **or** other strategies (vocalization, gestures)                                   |
+| **3**  | Uses **neither** eye contact **nor** other strategies, OR **no social overtures**                              |
+| **-1** | Not Collected                                                                                                  |
+| **9**  | Cannot be rated                                                                                                |
+
+> [!warning] Algorithm Note
+> This item was replaced with "Amount of Reciprocal Social Communication" in ADOS-2 algorithms
+
+---
+
+## B5: Shared Enjoyment in Interaction ⭐
+
+**What it measures:** Child's expression of pleasure during interaction with examiner.
+
+| Score  | Description                                                                                                                                                      |
+| ------ | ---------------------------------------------------------------------------------------------------------------------------------------------------------------- |
+| **0**  | Shows **definite pleasure** with examiner during **>1 activity**. Must include pleasure in ≥1 activity **not purely physical** (not just tickling)               |
+| **1**  | Shows **some pleasure** appropriate to context during interactions, OR shows definite pleasure during **one interaction** (may be physical)                      |
+| **2**  | Shows **little/no expressed pleasure** during interaction with examiner, but shows pleasure in own actions, with caregiver, or in non-interactive ADOS materials |
+| **3**  | **Little/no expressed pleasure** during ADOS and **little interest in toys**                                                                                     |
+| **-1** | Not Collected                                                                                                                                                    |
+| **9**  | Cannot be rated                                                                                                                                                  |
+
+⭐ = **Included in diagnostic algorithm (SA domain)**
+
+---
+
+## B6: Response to Name ⭐
+
+**What it measures:** Child's response when name is called.
+
+| Score  | Description                                                                                                                                                                                            |
+| ------ | ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ |
+| **0**  | Looks toward examiner and makes **eye contact immediately** on **≥1 of first 2 presses**                                                                                                               |
+| **1**  | Makes eye contact with caregiver after first/second press only, OR with examiner after **third or fourth press** only                                                                                  |
+| **2**  | Does **not immediately make eye contact** in 6 attempts, but **shifts gaze briefly** (no eye contact), shifts gaze after delay, OR looks at least once when **interesting/familiar vocalization** made |
+| **3**  | **Does not look** toward examiner/caregiver after any purely verbal/vocal attempt to get attention                                                                                                     |
+| **-1** | Not Collected                                                                                                                                                                                          |
+| **9**  | Cannot be rated                                                                                                                                                                                        |
+
+⭐ = **Included in diagnostic algorithm (SA domain)**
+
+---
+
+## B7: Requesting
+
+**What it measures:** How child requests objects or actions.
+
+| Score  | Description                                                                                                                                                                                                                                                                                         |
+| ------ | --------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- |
+| **0**  | Exhibits **appropriate integration** of eye contact and ≥1 behavior (vocalization, gesture, handing object) to request. Must include eye contact and definite indication of wanting other person to do/give something (persisting if person pauses). NOT physically pulling/placing examiner's hand |
+| **1**  | Uses ≥1 behavior to request **without integrating eye contact** and other behaviors. Includes handing object without looking, looking without other behavior, brief requests without persistence. NOT pulling examiner's hand                                                                       |
+| **2**  | Does not directly request as above, but uses **some physical means** to request ≥1 action as part of routine (e.g., pulls examiner's hand to object/self)                                                                                                                                           |
+| **3**  | May participate in routines or try to activate object by vocalizing/banging/bouncing **without looking at person** or vocalizing for help, but **does not request**                                                                                                                                 |
+| **-1** | Not Collected                                                                                                                                                                                                                                                                                       |
+| **9**  | Cannot be rated                                                                                                                                                                                                                                                                                     |
+
+---
+
+## B8: Giving
+
+**What it measures:** Spontaneous giving of objects to others.
+
+| Score  | Description                                                                                                                                                                             |
+| ------ | --------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- |
+| **0**  | **Spontaneously gives** toys/objects to others in **variety of contexts** throughout ADOS, including giving toys, food, or pretend food for **sharing**                                 |
+| **1**  | **>1 example** of giving objects for **getting help** (operating toys, opening containers) or as part of routine. May occur in one context but must be repeated without specific prompt |
+| **2**  | **Rarely/never gives** anything to another person                                                                                                                                       |
+| **-1** | Not Collected                                                                                                                                                                           |
+| **9**  | Cannot be rated                                                                                                                                                                         |
+
+---
+
+## B9: Showing ⭐
+
+**What it measures:** Spontaneous showing of objects to others.
+
+| Score  | Description                                                                                                                                                                                         |
+| ------ | --------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- |
+| **0**  | **Spontaneously shows** toys/objects by holding up/placing in front of others and using **eye contact** with/without vocalization                                                                   |
+| **1**  | Shows in **partial or inconsistent manner** (holds up/places without coordinated eye contact, looks from object to person without clearly orienting it, or shows as above on **one occasion only**) |
+| **2**  | **Does not show** objects to another person                                                                                                                                                         |
+| **-1** | Not Collected                                                                                                                                                                                       |
+| **9**  | Cannot be rated                                                                                                                                                                                     |
+
+⭐ = **Included in diagnostic algorithm (SA domain)**
+
+---
+
+## B10: Spontaneous Initiation of Joint Attention ⭐
+
+**What it measures:** Child's ability to direct another's attention to objects of interest (out of reach).
+
+| Score  | Description                                                                                                                                                                                                                                                                      |
+| ------ | -------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- |
+| **0**  | Uses **clearly integrated eye contact** to direct another's attention to out-of-reach object by looking at object → examiner/caregiver → back at object (OR starting with examiner). Eye contact may be coordinated with pointing/vocalization. **One clear example sufficient** |
+| **1**  | **Partially references** out-of-reach object. May look at and point to object and/or vocalize, but doesn't coordinate with looking at person, OR looks at object → person but not back at object                                                                                 |
+| **2**  | **No approximation** of spontaneous joint attention to direct another's attention to out-of-reach object                                                                                                                                                                         |
+| **-1** | Not Collected                                                                                                                                                                                                                                                                    |
+| **9**  | Cannot be rated                                                                                                                                                                                                                                                                  |
+
+> [!tip] The "Triangle Gaze"
+> **Key behavior:** object → person → object
+
+⭐ = **Included in diagnostic algorithm (SA domain)**
+
+---
+
+## B11: Response to Joint Attention ⭐
+
+**What it measures:** Child's ability to follow examiner's gaze or pointing to locate objects.
+
+| Score  | Description                                                                                                                                                                                          |
+| ------ | ---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- |
+| **0**  | Uses **examiner's eyes and face alone** as cue to look toward target, without need for pointing. Child must follow gaze and turn face/eyes in direction of target; doesn't have to catch sight of it |
+| **1**  | Responds to **examiner's pointing** by looking at/toward target                                                                                                                                      |
+| **2**  | Does not follow examiner's gaze or pointing, but **looks at target when activated**                                                                                                                  |
+| **3**  | **Does not orient** to object even when activated. If impossible to get child's attention in 5 attempts, assign this rating                                                                          |
+| **-1** | Not Collected                                                                                                                                                                                        |
+| **9**  | Cannot be rated                                                                                                                                                                                      |
+
+⭐ = **Included in diagnostic algorithm (SA domain)**
+
+---
+
+## B12: Quality of Social Overtures ⭐
+
+**What it measures:** Appropriateness and quality of child's social initiations.
+
+| Score  | Description                                                                                                                                     |
+| ------ | ----------------------------------------------------------------------------------------------------------------------------------------------- |
+| **0**  | **Effectively uses** nonverbal and verbal means to make **clear social overtures**. Must be appropriate to immediate contexts                   |
+| **1**  | **Slightly unusual** quality. Overtures restricted to personal demands or strong interests, but with some attempt to involve examiner/caregiver |
+| **2**  | Overtures often **lack integration into context AND/OR social quality**. Some clearly inappropriate overtures, even if other overtures present  |
+| **3**  | **No social overtures** of any kind                                                                                                             |
+| **-1** | Not Collected                                                                                                                                   |
+| **9**  | Cannot be rated                                                                                                                                 |
+
+⭐ = **Included in diagnostic algorithm (SA domain)**
+
+---
+
+# C Codes: Play
+
+> [!note] C Codes Overview
+> The **C codes** assess **Play** behaviors, focusing on functional and imaginative use of toys and materials.
+
+## C1: Functional Play With Objects
+
+**What it measures:** Conventional, appropriate use of toys.
+
+| Score  | Description                                                                                                                                                                                                                                                                  |
+| ------ | ---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- |
+| **0**  | **Spontaneously plays** with variety of toys in **conventional manner**, including appropriate play with **several different miniatures/representational toys** (e.g., telephone, truck, dishes, Birthday Party materials). NOT imitations, prompted actions, or pushing car |
+| **1**  | **Some spontaneous functional play** with ≥1 miniature/representational toy. NOT imitations, responses to direct requests, pushing car, or construction toys                                                                                                                 |
+| **2**  | Plays appropriately with **cause-and-effect toys and/or construction toys only**, AND/OR pushing car. May include imitating demonstration or imitating representational play                                                                                                 |
+| **3**  | **No play with toys** or **only stereotyped play**                                                                                                                                                                                                                           |
+| **-1** | Not Collected                                                                                                                                                                                                                                                                |
+| **9**  | Cannot be rated                                                                                                                                                                                                                                                              |
+
+---
+
+## C2: Imagination/Creativity ⭐
+
+**What it measures:** Spontaneous pretend play.
+
+| Score  | Description                                                                                                                                                    |
+| ------ | -------------------------------------------------------------------------------------------------------------------------------------------------------------- |
+| **0**  | **Spontaneous use** of doll/object as **independent agent**, OR spontaneous use of objects to **represent other objects** (e.g., pretends string is spaghetti) |
+| **1**  | **Spontaneous pretend play** with doll (feeding, hugging, giving drink) or other objects, but **no use as independent agent** or to represent something else   |
+| **2**  | **Imitates** pretend play as above, OR imitation with placeholder; **no spontaneous** pretend play                                                             |
+| **3**  | **No imitated or spontaneous** pretend play                                                                                                                    |
+| **-1** | Not Collected                                                                                                                                                  |
+| **9**  | Cannot be rated                                                                                                                                                |
+
+⭐ = **Included in diagnostic algorithm (RRB domain)**
+
+---
+
+# D Codes: Stereotyped Behaviors and Restricted Interests
+
+> [!note] D Codes Overview
+> The **D codes** assess **Restricted and Repetitive Behaviors**, a core feature of autism spectrum disorder.
+
+## D1: Unusual Sensory Interest in Play Material/Person ⭐
+
+**What it measures:** Unusual sensory examination or sensory-seeking behaviors.
+
+| Score  | Description                                                                                                                                                 |
+| ------ | ----------------------------------------------------------------------------------------------------------------------------------------------------------- |
+| **0**  | **No unusual sensory interests** or sensory-seeking behaviors                                                                                               |
+| **1**  | **Several possible** sensory interests not as clear as below, AND/OR only **one clear occurrence**. One "possible" sensory interest = 0                     |
+| **2**  | **Definite interest** in sensory elements of objects/materials OR sensory examination of self/others; **≥2 clear occurrences**. May be during same activity |
+| **3**  | Definite unusual sensory-seeking behaviors during **≥2 different tasks/activities** and may **interfere with ADOS assessment**                              |
+| **-1** | Not Collected                                                                                                                                               |
+| **9**  | Cannot be rated                                                                                                                                             |
+
+**Examples:**
+
+- Sniffing objects
+- Repetitive touching/feeling texture
+- Licking/biting (not typical mouthing)
+- Unusual reactions to sounds
+- Prolonged visual examination
+
+⭐ = **Included in diagnostic algorithm (RRB domain)**
+
+---
+
+## D2: Hand and Finger and Other Complex Mannerisms ⭐
+
+**What it measures:** Stereotyped hand/finger movements or complex mannerisms.
+
+| Score  | Description                                                                                                                             |
+| ------ | --------------------------------------------------------------------------------------------------------------------------------------- |
+| **0**  | **None**                                                                                                                                |
+| **1**  | Unusual/repetitive hand/finger mannerisms or complex mannerisms **not as clear** as below                                               |
+| **2**  | **Definite** finger flicking or twisting, AND/OR hand/finger/complex mannerisms, stereotypies, or posturing. May be brief/rare if clear |
+| **3**  | Mannerisms occur **frequently**, during **≥2 different tasks/activities**, and/or may **interfere with ADOS assessment**                |
+| **-1** | Not Collected                                                                                                                           |
+| **9**  | Cannot be rated                                                                                                                         |
+
+⭐ = **Included in diagnostic algorithm (RRB domain)**
+
+---
+
+## D3: Self-Injurious Behavior
+
+**What it measures:** Attempts to harm self.
+
+| Score  | Description                                                                                                                                                  |
+| ------ | ------------------------------------------------------------------------------------------------------------------------------------------------------------ |
+| **0**  | **No attempts** to harm self                                                                                                                                 |
+| **1**  | **Dubious or possible** self-injury, and/or **rare but clear** self-injury (one clear example of biting hand/arm, pulling hair, slapping face, banging head) |
+| **2**  | **>1 clear example** of self-injury (head banging, face slapping, hair pulling, self-biting)                                                                 |
+| **-1** | Not Collected                                                                                                                                                |
+| **9**  | Cannot be rated                                                                                                                                              |
+
+---
+
+## D4: Unusually Repetitive Interests or Stereotyped Behaviors ⭐
+
+**What it measures:** Intensity and interference of repetitive interests/behaviors.
+
+| Score | Description                                                                                                                                                                                                                                                                                                                    |
+| ----- | ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ |
+| **0** | **No repetitive or stereotyped** behaviors during ADOS                                                                                                                                                                                                                                                                         |
+| **1** | Interest/behavior **repetitive or stereotyped to unusual degree**, including intense interest in particular toy/object, definite interest in unusual object/activity, unusually routinized activity, or clear interest in **part of object**. Occurs with several other activities, doesn't prevent completing ADOS activities |
+| **2** | **Clearly repetitive or stereotyped** interests/behaviors. May form **substantial minority** of child's interests and spontaneous behaviors and may **interfere** with completing activities, but possible to direct attention to other objects/activities, at least momentarily                                               |
+| **3** | Repetitive/stereotyped interests/behaviors form **majority of child's interests**, AND/OR attempts to direct attention to other objects/activities met with **significant resistance and/or distress**                                                                                                                         |
+| **9** | Cannot be rated                                                                                                                                                                                                                                                                                                                |
+
+⭐ = **Included in diagnostic algorithm (RRB domain)**
+
+---
+
+# E Codes: Other Abnormal Behaviors
+
+> [!note] E Codes Overview
+> The **E codes** capture **Other Abnormal Behaviors** that may be present but are not core diagnostic features of ASD.
+
+## E1: Overactivity
+
+**What it measures:** Activity level relative to developmental expectations.
+
+| Score  | Description                                                                                                                                                     |
+| ------ | --------------------------------------------------------------------------------------------------------------------------------------------------------------- |
+| **0**  | Sits/stands still appropriately when expected during ADOS. May explore room as expected for developmental level but **not obviously overactive**                |
+| **1**  | Sits/stands still when clearly expected (e.g., symbolic imitation, birthday party) for activities besides snack, but often **fidgets, moves about, or gets up** |
+| **2**  | **Fidgety; more active** than other children of same developmental level                                                                                        |
+| **3**  | **Incessantly and energetically** moves around room in way difficult to interrupt; level of activity **disrupts ADOS assessment**                               |
+| **7**  | **Underactive**                                                                                                                                                 |
+| **-1** | Not Collected                                                                                                                                                   |
+| **9**  | Cannot be rated                                                                                                                                                 |
+
+---
+
+## E2: Tantrums, Aggression, Negative or Disruptive Behavior
+
+**What it measures:** Frequency and intensity of negative/disruptive behaviors.
+
+| Score  | Description                                                                                                               |
+| ------ | ------------------------------------------------------------------------------------------------------------------------- |
+| **0**  | **Not upset, disruptive, negative, destructive, or aggressive** during ADOS                                               |
+| **1**  | Displays **one example** of mild upset, anger, aggression, negativism, or intentionally disruptive behavior               |
+| **2**  | **>1 intentionally disruptive** (e.g., swiping toys off table) or mildly aggressive act. Loud screaming can be coded here |
+| **3**  | Shows **marked or repeated negativism, temper tantrums**, or **more significant aggression** (hitting, biting others)     |
+| **-1** | Not Collected                                                                                                             |
+| **9**  | Cannot be rated                                                                                                           |
+
+---
+
+## E3: Anxiety
+
+**What it measures:** Level of anxiety during assessment.
+
+| Score  | Description                                                                                                                               |
+| ------ | ----------------------------------------------------------------------------------------------------------------------------------------- |
+| **0**  | **No obvious anxiety** (trembling, jumpiness)                                                                                             |
+| **1**  | **Mild signs** of anxiety, especially at beginning, OR marked anxiety only in response to **specific request or one particular toy/task** |
+| **2**  | **Marked anxiety** in response to **>1 toy/task** or **several times** during ADOS                                                        |
+| **-1** | Not Collected                                                                                                                             |
+| **9**  | Cannot be rated                                                                                                                           |
+
+---
+
+# Scoring and Algorithms
+
+## Diagnostic Domains
+
+> [!info] Two Main Domains
+> Module 1 uses a two-domain structure introduced in ADOS-2
+
+### Social Affect (SA) Domain
+
+Combines communication and social interaction items
+
+**Algorithm items (12 total):**
+
+- A2, A5, A6, A7, A8 (Communication)
+- B1, B3, B5, B9, B10, B11, B12 (Social Interaction)
+
+### Restricted and Repetitive Behaviors (RRB) Domain
+
+**Algorithm items (4 total):**
+
+- C2 (Imagination/Creativity)
+- D1, D2, D4 (Stereotyped Behaviors)
+
+---
+
+## Module 1 Algorithms
+
+> [!warning] Algorithm Selection
+> Two different algorithms based on **A1 (Overall Level of Non-Echoed Language)**
+
+### Algorithm 1: Few to No Words
+
+**Used when:** Child has minimal verbal language (A1 = 4, 5, 7, or 8)
+
+**Calculation:**
+
+- SA Total + RRB Total = **Overall Total**
+
+**Diagnostic Cutoffs:**
+
+| Classification      | Overall Total |
+| ------------------- | ------------- |
+| **Autism**          | ≥ 16          |
+| **Autism Spectrum** | 11-15         |
+| **Non-Spectrum**    | ≤ 10          |
+
+---
+
+### Algorithm 2: Some Words
+
+**Used when:** Child uses some single words or phrases (A1 = 0, 1, 2, or 3)
+
+**Calculation:**
+
+- SA Total + RRB Total = **Overall Total**
+
+**Diagnostic Cutoffs:**
+
+| Classification      | Overall Total |
+| ------------------- | ------------- |
+| **Autism**          | ≥ 12          |
+| **Autism Spectrum** | 8-11          |
+| **Non-Spectrum**    | ≤ 7           |
+
+---
+
+## Score Conversion
+
+> [!tip] Algorithm Conversion
+> Algorithm items are converted from original scale (often 0-3) to **0-2 scale** before summing
+
+**Typical conversion:**
+
+- Original 0 → Algorithm 0
+- Original 1 → Algorithm 1
+- Original 2 → Algorithm 2
+- Original 3 → Algorithm 2
+
+Some items are already on 0-2 scale and don't require conversion.
+
+---
+
+# Special Score Codes
+
+| Code    | Meaning                   | Usage                                                           |
+| ------- | ------------------------- | --------------------------------------------------------------- |
+| **0-3** | Standard severity ratings | Most items use this scale                                       |
+| **7**   | Alternative presentation  | e.g., underactive (E1) instead of overactive                    |
+| **8**   | N/A - Not applicable      | Insufficient behavior to rate this item                         |
+| **9**   | Cannot be rated           | Other reason (e.g., examiner error, didn't administer activity) |
+| **-1**  | Not Collected             | Item was not assessed (Adapted ADOS)                            |
+
+---
+
+# Quick Reference Tables
+
+## Algorithm Items by Domain
+
+### Social Affect (SA) - 12 Items
+
+| Code | Item Name                                    | Type          |
+| ---- | -------------------------------------------- | ------------- |
+| A2   | Frequency of Vocalization Directed to Others | Communication |
+| A5   | Stereotyped/Idiosyncratic Use of Words       | Communication |
+| A6   | Use of Other's Body to Communicate           | Communication |
+| A7   | Pointing                                     | Communication |
+| A8   | Gestures                                     | Communication |
+| B1   | Unusual Eye Contact                          | Social        |
+| B3   | Facial Expressions Directed to Others        | Social        |
+| B5   | Shared Enjoyment in Interaction              | Social        |
+| B9   | Showing                                      | Social        |
+| B10  | Spontaneous Initiation of Joint Attention    | Social        |
+| B11  | Response to Joint Attention                  | Social        |
+| B12  | Quality of Social Overtures                  | Social        |
+
+### Restricted and Repetitive Behaviors (RRB) - 4 Items
+
+| Code | Item Name                      |
+| ---- | ------------------------------ |
+| C2   | Imagination/Creativity         |
+| D1   | Unusual Sensory Interest       |
+| D2   | Hand and Finger Mannerisms     |
+| D4   | Unusually Repetitive Interests |
+
+---
+
+## Non-Algorithm Items (Observation Only)
+
+### Communication Items
+
+- **A1** - Overall Level of Non-Echoed Language _(determines algorithm)_
+- **A3** - Intonation
+- **A4** - Immediate Echolalia
+
+### Social Interaction Items
+
+- **B2** - Responsive Social Smile
+- **B4** - Integration of Gaze and Other Behaviors
+- **B6** - Response to Name
+- **B7** - Requesting
+- **B8** - Giving
+
+### Play Items
+
+- **C1** - Functional Play
+
+### Restricted/Repetitive Behavior Items
+
+- **D3** - Self-Injurious Behavior
+
+### Other Behavior Items
+
+- **E1** - Overactivity
+- **E2** - Tantrums/Aggression
+- **E3** - Anxiety
+
+---
+
+# Summary Statistics
+
+> [!info] Module 1 Code Summary
+>
+> - **Total behavioral codes:** 29
+> - **Algorithm items:** 16 (12 SA + 4 RRB)
+> - **Observation/clinical items:** 13
+> - **Two algorithms:** Few-to-No Words vs. Some Words
+
+---
+
+## Tags for Quick Navigation
+
+#ados/module1 #assessment #autism-diagnosis #communication #social-interaction #restricted-repetitive-behaviors #play #diagnostic-algorithm
+
+---
+
+## Related Notes
+
+- [[ADOS-2 Overview]]
+- [[Module 2 Coding]]
+- [[Autism Diagnostic Criteria]]
+- [[DSM-5 Autism Criteria]]
+- [[Early Intervention Planning]]
+
+---
+
+_Last updated: 2025-01-20_