Associations between emotion and behavior codes and ADOS-2 scores in a sample of children referred for autism evaluation.

Researchers studied how a child's behavior during autism testing (hyperactivity, disruptive behavior, anxiety) affects their test scores. They found that autistic children who were hyperactive or disruptive scored higher on autism measures, while anxious autistic children scored lower. For non-autistic children, only anxiety affected scores. This suggests that a child's emotional state during testing might influence results and should be considered when interpreting autism assessments.

This study examined how emotion and behavior codes (E codes) on the ADOS-2 assessment influence autism diagnostic scores in 3,364 children. E codes measure overactivity, disruptive behavior, and anxiety during testing but aren't included in final scores. Results showed that for children with autism, overactivity and disruptive behavior were associated with higher autism severity scores, while anxiety was linked to lower scores. For children without autism, anxiety was associated with increased social affect scores.

These findings suggest E codes may provide important contextual information for interpreting ADOS-2 results, though effect sizes were small.

Clinicians should consider a child's emotional and behavioral state during ADOS-2 administration when interpreting results. Anxiety may mask autism symptoms in diagnosed children or create misleading social affect scores in non-autistic children. These E codes provide valuable contextual information for diagnostic decision-making.

The abstract does not specify study design, control variables beyond age/sex/language, or generalizability beyond the single clinic setting. Effect sizes were small, limiting clinical significance. The mechanism underlying these associations remains unclear.

While the Autism Diagnostic Observation Schedule, Second Edition (ADOS-2) is considered a "reference standard" measure to observe symptoms of autism spectrum disorder (ASD), little is known about the utility of its Other Abnormal Behaviors or "E codes." This study investigated the unique influence of each E code (overactivity, disruptive behavior, anxiety) on ADOS-2 scoring. Data from ADOS-2 administrations (Modules 1, 2, 3) were collected from 3364 children (mean age = 6.73 years) at an outpatient ASD clinic. For those with ASD, ADOS-2 Calibrated Severity Scores (CSS) were descriptively higher for those with overactivity and disruptive behavior, but lower for those with anxiety. For those without ASD, no patterns emerged when comparing means.

After controlling for age, sex, and language level, multivariable linear models indicated the presence of overactivity was significantly associated with increased CSS for children with ASD compared to those without. No significant interaction was present for disruptive behavior. The presence of anxiety was significantly associated with increased Social Affect CSS only for those without ASD. All effect sizes were small.

This is one of the first studies to evaluate the effect of each individual E code on ADOS-2 CSS. Unique differences emerged across diagnostic groups, suggesting implications for ADOS-2 interpretation.Lay SummaryThe Autism Diagnostic Observation Schedule, Second Edition (ADOS-2) is a common assessment tool used during an autism evaluation. As part of the ADOS-2, the examiner rates "E codes," which are levels of hyperactivity, disruptive behavior, and anxiety during testing. These codes are not part of the final ADOS-2 score.

While there is a lot of research on the ADOS-2, less is known about these E codes. This study looked at how the E codes might affect the final ADOS-2 scoring. Information came from 3364 in-person autism assessments (average age = 6.73 years) who were evaluated at an autism specialty clinic. For autistic children, ADOS-2 scores were higher (i.e. more autism-related behaviors) for those with overactivity and disruptive behavior, but lower for those with anxiety.

For those without autism, there was no pattern. After accounting for the child's age, sex, and language level, there were unique results for each E code, depending on whether the child received an autism diagnosis. This study is important as it is one of the first to evaluate the effects of each E code on ADOS-2 scores and could impact how scores are interpreted when considering an autism diagnosis.