How well does the ADOS assess for autism in adults? How might Obama perform on an ADOS?

One ADOS task is engaging in interactive play that involves joint attention and ability to change based on what the other person does. President Obama seems to engage in a lot of “my way or no way” behavior which is not interactive. When President Obama got the stimulus bill signed he immediately turned it over to Speaker of the House Nancy Pelosi to figure out how to distribute the “pork”. President Obama did not wield his mighty pen and interactively “cut” out pork. Overall global assessment: As Obama’s abilities to interactively “play” appear low, he gets a score of 2 for the joint interactive task.

A second task on the ADOS: The person must demonstrate both verbally and non-verbally how to do something in daily life. Getting bills such as ObamaCare passed has been part of President Obama’s daily life. Can you imagine President Obama — without a teleprompter — explaining with use of gesture and words how he got ObamaCare passed? On the demonstrate a Daily Activity task Obama scores another 2. The total score is now 4 points.

A third task on the ADOS: The person assessed must tell a story based on a picture book that has no words. So, imagine a picture book showing the Tea Party movement at various rallies. How might Obama tell that story? Can Obama see a series of pictures and make a coherent story about a major political event, i.e. the Tea Party movement? Doubtful. Hence, on the Tell a Story task President Obama gets another score of 2.

On just three ADOS tasks Obama is already up to a total score of 6. There are about 12 or so tasks on the ADOS.

Let’s hypothetically assume that President Obama can meet the ADOS cutoff score for a possible diagnosis of an autistic spectrum disorder. More information is necessary to assign a diagnosis of autism or some variation.

The foregoing gives you an idea of the kind of tasks persons must perform during an ADOS assessment.

For each ADOS task a rater gives one global overall rating. O = no impairment. Various numbers can be assigned.

How subjective is ADOS? Relatively, the ADOS test is substantially more subjective compared to a Wechsler IQ test. Assigning one overall value to how well a task has been performed is a subjective act. How accurate are subjective ratings? In California the Board of Psychology finally stopped requiring Oral Exams for licensure because the subjective ratings over time varied so much.

What does the ADOS Manual say? The ADOS manual (i.e., the manual that comes with tapes) states that persons using the ADOS should regularly videotape. That way the videotape can be examined by others.

When litigation arises are videotapes of the ADOS routinely provided as evidence? Per what I hear and in my experience, taping is not typically done. .Should videotapes be routinely done of the ADOS when litigation may be involved? Yes.

The ADOS manual states that it is important to routinely get supervision. Videotaping, comparing to test tapes and regular outside supervision are important to prevent “drift” as to how global ratings are assigned.

Of importance, in contrast to the ADOS, Manuals for I.Q tests do not suggest or recommend that videotaping and on-going supervision are necessary for accuracy in scoring an intelligence test.

To get a diagnosis of 299.0 Autistic Disorder an adult — such as President Obama — must be substantially impaired in a number of areas.

How might President Obama do given the above hypothetical performance on the ADOS combined with additional background information and interview data?

Diagnostic criteria for 299.00 Autistic Disorder: A total of six with at least two from Category 1 and at least one from Categories 2 and 3.

Category 1: Qualitative impairment in social interaction, as manifested by at least two of the following.
a. Marked impairment in multiple nonverbal behaviors such as eye to eye gaze, facial expression, body postures and gestures.

Might the teleprompter which Obama routinely uses show marked impairment in eye to eye gaze with the general public? Notice that Obama typically has his chin tilted to the left or right when speaking? Notice that on television Obama rarely makes direct eye contact? Of importance, Obama does not readily “read” non-verbal clues directed to him from the American public. Thus, Obama gets an X in this category.

b. Failure to develop peer relationships appropriate to age.
Obama has peer relations appropriate to his age and development.

c. A lack of spontaneous seeking to share enjoyment, interests or achievements with other people.
Both before and after the 2010 election, did President Obama share his enjoyment and achievements with the American public? No. He did not talk about his achievements (ObamaCare, the stimulus bill, the bailouts) and he immediately left the county for ten days. On his most recent birthday, President Obama went by himself to Chicago. His wife and child went to Spain for a separate holiday. Obama scores an X in this category.

For Category 1, Obama meets the criteria of two different areas. He must get one in Category 2 and one in Category 3 and a total of six. Can he meet criteria for a diagnosis of 299.0 Autistic Disorder? Let’s see….

d. Lack of social or emotional reciprocity
Obama is frequently described as aloof, cold, distant. First visiting the gulf after the oil disaster he chastised the governor as soon as he got off the plane. That Obama was largely interested in how he was viewed and perceived rather than how were the people in the gulf doing says a lot. In various situations, Obama’s social and emotional reciprocity is low — but not lacking entirely. So, no X here.

Category 2: Quantitative impairments in communication as manifested by at least one of the following:

a. Delay in or total lack of development of spoken language .in individuals with adequate speech not accompanied by alternative modes, e.g., gesture, mime.

There is no information in President Obama’s two autobiographies about his early development. Insufficient information known. No rating given.

b. In individuals with adequate speech, marked impairment in the ability to initiate or sustain a conversation with others

President Obama says that most Americans do support his policies but that there has been a “communication problem”. Obama says it is a PR problem and that he must do a better job explaining his policies to the public. Does Obama’s comments on the election results show an inability to “sustain a conversation” with the American public? Is Obama merely tone deaf? A conversation entails the ability to “hear” what others are saying and understand what is said from their perspective. Obama is not hearing what the public said per the 2010 elections. Hence, Obama gets an X rating for Category 2 b.
c. Stereotyped and repetitive use of language or idiosyncratic language.
Obama engages considerable repetitive use of language. How many hundreds of times has Obama said, “you can keep your health care… you can keep your health care….health care costs will not rise…. taxes on the middle class will not rise… Hence, Obama gets an X in this category.

d. Lack of varied spontaneous make believe play or social imitative play appropriate to developmental level.
President Obama engages in considerable make believe play and there is a knee jerk reaction rather than spontaneity in how he does it. For example, it is make believe play to print billions of funny money and say to the public that this will “grow the economy”. But there is no “lack…” Thus, no rating of an X.
Category 3: Restricted repetitive and stereotyped patterns of behavior, interests, and activities as manifested by at least one of the following:
a. Encompassing preoccupation with one or more stereotyped and restricted patterns of interest that is abnormal either in intensity or focus

President Obama clearly was preoccupied in pushing his agenda through congress. ObamaCare will pass whether the public likes it or not. The intensity of focus to achieve his goals was apparent to the American public. Was his preoccupation abnormal either in intensity or focus? That is hard to estimate. The American public said no more and voted Democrats out of office who were pro-Obama policies. It was not only what he did but how President Obama went about it. There was no listening to l the Republicans. No inclusion of others. Overall, an X here.

b. Apparently inflexible adherence to specific, nonfunctional routines or rituals.
No information. No rating made.

c. Stereotyped and repetitive motor mannerisms.
None observed or reported. Head bobbing because of teleprompter has been coded already.

d. Persistent preoccupation with parts of objects.
Not observed or reported. No rating made.

Overall, using the above scoring — an adult such as President Obama does not meet criteria for a diagnosis of 299.0 Autistic Disorder. However, he may meet a criteria for PDD-NOS or Asperger’s Disorder. More information is necessary….

Yes this is done tongue in cheek. This is an imaginary exercise.

Conclusions: The ADOS is a test that is subjective and “drift” in scoring can readily occur. When used in litigation the entire ADOS tape should be provided in evidence for others to examine.

In actuality I do not think President Obama suffers from an autistic disorder. But he is “tone-deaf”. And he seems convinced that he knows best for America. Probably, narcissistic is a better description of many of his behaviors.

So what say you? Is President Obama “out of it”? Tone deaf? Narcissistic? Sort of autistic?

written by Cameron Jackson DrCameronJackson@gmail.com