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I remember being trained on the original ADOS back in grad school, and even though the ADOS-2 has been out for over a decade now, we are still constantly learning about where it shines and where it kind of falls short. In this episode, I’m digging into the actual numbers behind the instrument, from its 90% sensitivity to the much more complicated reality of its specificity, especially when we’re working with clinical populations like ADHD or anxiety. I’m also tackling the “compensation paradox” and the very real data showing how the ADOS-2 might be under-identifying females and people of color. It’s a nuanced look at a tool we use every day, and I think it’s a necessary conversation if we want to move toward more equitable, accurate assessments.

00:35: The history of the ADOS and its evolution into the current “gold standard”
02:21: Breaking down the five modules and how language level dictates administration
05:40: Sensitivity vs. Specificity: What the meta-analyses actually tell us about accuracy
08:25: The false positive problem and the predictive limitations of “Autism Spectrum” classifications
11:11: Why the ADOS-2 should never supersede clinical judgment in a comprehensive battery
12:45: Differential diagnosis challenges with ADHD, social anxiety, and language disorders
15:30: The “Compensation Paradox” in high-functioning and low-support needs individuals
18:49: Data on sex differences and why the algorithm might be biased against female presentations
21:13: Addressing racial bias and the limitations of a tool validated primarily on white samples

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About Dr. Jeremy Sharp

I’m a licensed psychologist and Clinical Director at the Colorado Center for Assessment & Counseling, a private practice that I founded in 2009 and have grown to over 20 clinicians. I earned my undergraduate degree in Experimental Psychology from the University of South Carolina before getting my Master’s and PhD in Counseling Psychology from Colorado State University. These days, I specialize in psychological and neuropsychological evaluation with kids and adolescents.

As the host of the Testing Psychologist Podcast, I provide private practice consulting for psychologists and other mental health professionals who want to start or grow psychological testing services in their practices. I live in Fort Collins, Colorado with my wife (also a therapist) and two young kids.

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566. Autism Mini-Series: A Review of the ADOS-2