Examining the Relationship Between Social Communication on the ADOS and Real-World Reciprocal Social Communication in Children with ASD

Background:  Autism Spectrum Disorder (ASD) is characterized by two sets of symptoms: deficits in social communication and restricted and repetitive interests. One measure used to aid in the diagnosis of ASD is the Autism Diagnostic Observation Schedule (ADOS). The ADOS uses structured and unstructured activities to elicit specific behaviors, which are then coded on several different dimensions with two subdomains (Social Communication, Restricted Interests and Repetitive Behaviors) that together achieve a total score. Although naturalistic play can be difficult to observe and measure, remote observation equipment and detailed behavioral coding paradigms can record and quantify the social behavior of ASD children in a realistic play setting.

Objectives: We aimed to look at how well the two subscales of the ADOS predicted actual reciprocal social behavior in children with ASD during play with same-age peers using the Peer Interaction Playground paradigm. We predicted that higher scores on the Social Communication subscale of the ADOS (more severe autism symptomology) would be associated with less reciprocal communication with peers on the playground.

Methods: The participants included 30 children with ASD. Each child was given the ADOS by a trained, research-reliable clinician as a part of a neuropsychological assessment. The children with ASD were paired with a typically developing participant and a typically developing confederate for a 20-minute session on a playground. The participants were remotely audio and video recorded so as not to interfere with natural play. Reliable coders conduced a comprehensive, in-depth analysis of playground behavior of the child with ASD, including variables such as Reciprocal Communication with peers and Self-play. Separate linear regressions models were performed with Reciprocal Communication with peers or Self-play as the dependent variables and diagnostic and demographic variables (verbal IQ, age, the ADOS Social Communication and the Restricted Interests and Repetitive Behaviors subscales) as predictors.

Results: Linear regression for Reciprocal Communication was found to be significant [F(4, 29)=3.68, p=0.018], with ADOS Social Communication as the primary significant predictor of reciprocal communication with peers during play [t(4, 29)=-3.317, p=.003]. The other variables, including the Restricted Interests and Repetitive Behaviors subscale, were not found to be significant. The diagnostic and demographics variables did not predict Self-play behavior on the playground [t(4, 29)= 1.158, p=.258]. 

Conclusions:  We found that higher scores on the ADOS Social Communication subscale were predictive of the amount of communication with peers on the playground. Higher ADOS scores were associated with less time talking during play. The specificity of the relationship between Social Communication on the ADOS and Reciprocal Communication with peers in a real world setting provides support for the reliability and validity of the diagnostic instrument for predicting day-to-day functioning.