Autism Diagnostic Interview-Revised ‘Ann Le Covteu MBBS, Catherine Lor, PRD, Micha Rutter 0,685. Comprehensive Algorithm Form Subject Name of Subject/1D: Date of Birth: y / Chronological Age: Gender: Female Male Respondent Name: Relation to Subject: Clinician Name: School/Clinic: Date of Intervie i t Mark the algorithm used. Current Behavior Algorithm Diagnostic Algorithm ) 2 Years, 0 Months to 3 Years, 11 Months () 2 Years, 0 Months to 3 Years, 11 Months: (_} 4 Years, 0 Months to 9 Years, 11 Months (__} 4 Years, 0 Months or Older (-} 10 Years, 0 Months or Older (Verbal Subjects only; Item 30 = 0) Item Codeto G@de 0 1 2 3 7 Algorithm Score Conversion Score. 0 7 . Cre ae Dagrstc u Agucit catots* af jeal je af ‘Cutoff are for Diagnostic Algorithms only. ‘The Current Behavior Algorithms do not have cutofs ‘daiiona copies of this fom (W-382E) may be puchased fom WPS Please contac us at 800-668-8957, Fax 310-478-783, or wirmnpepublish.com we ay 7007 by WSTRNPYHONEIEAL SRT, Ht ood ol‘A: Qualitative Abnormalities in Reciprocal Social Interaction Copy each code into the box for algorithm type and subject age level. Algorithm type Code Use vse Code nes otertte peed Diagnostic Algorithm Al: Failure to use nonverbal behaviors to regulate social interaction Convert ‘0 Scores 50 Direct Gaze OTF 51 Socal Saith9 ocoeoenerenenernee Ju) 57 nang of ria pressions Used Communicate}. J]. C) Co) C 40 HOU QUO Total AL ‘A2: Failure to develop peer relationships 62 Iter in Chen Cc) 6 Response t Approaches of Other Cen nf) 6é Gu lay th ers - eon) OR (score either 64 or 65, depending on age of subj OU 0.000 65 Friendships (score if 10.0 years or older) U Total AZ ‘A3: Lack of shared enjoyment U 0 52 Showing and Directing Attention J U 53 Offering to Share J 54 Seeking to Share Enjoyment With Others Total A3 Ad: Lack of socioemotional reciprocity 4 31 Use of Other's Body to Communicate U 55 Offering Comfort .. 56 Quality of Social Overtures j 58 Inappropriate Facial Expressions QOUU0 QUO QU000 OUD OUOULU UU 0000 ' U 59 Appropriateness of Social Responses Total AG current Behavior Algorithm for 10.0 or older should be scored only for verbal subjects (Item 30 ~0), Total A For this age group, no Current Behavior Algorithm is AL+A2+A3+A4 available for nonverbal subjects (Item 301 oF 2). (cutoff = 10, Giagnostic oly)Qualitative Abnormalities in Communication * Score B1, B4, B2(V), and B3(V) for verbal subjects (Item 30 = 0). ‘#°Score only Bi and B4 for nonverbal subjects (Item 30 = 1 or 2). Copy each code into the box for algorithm type and subject age level. Algorithm type Current WF Algorithm Diagnostic Algorithm a a es at we tec ee Me Nl an amt colder” an older Bi: Lack of, or delay in, spoken language and failure to compensate through gesture Convert to Scores 42 Pointing to Exes Trek CC. —_} C Cc 43 Wot . . : —_= ——! 44 Head Shaking 45 Conventional/Instrumental Gestures 0000 00 000 O00 | B4: Lack of varied spontaneous make-believe or social imitative play (B4 is not scored on Current Behavior Algorithm for 10.0 or older.) 47 Spontaneous Imitation of Actions 48 Imaginative Play 61 Imitative Social Play O00 ane O00 B2(V): Relative failure to initiate or sustain conversational interchange C3 {). 34 Social Verbalization /Chat () (0 00 35. Reciprocal Conversation B3(V): Stereotyped, repetitive, or idi 2 3 atic speech 33 Stereotyped Utterances and Delayed Echoalia 36 Inappropriate Questions or Statements Fs 37 Pronominal Reversal 38 Neologisms/ Idiosyncratic Language boos ont J CO C.- om) UU UOUU ‘Total B3(V) ey Total B(V) SEDESSD 1 + Bs + B2(v) + B3(V) (Gutott 8, diagnostic only) *ourent Behavior Algorithm for 10.0 or older should be scored only for verbal subjects (Item 30 0). by ty ae Total B(NV) For this age goup, no Cutent Behavior Aigoxthn is Bi + B4 available for nonverbal subjects (Item 301 or 2). ( tiagnostic only}Restricted, Repetitive, and Stereotyped Patterns of Behavior Copy each code into the box for algorithm type and subject age level. Algorithm type Current Behavior Algorithm Diagnostic Algorithm i a 2 4 ae 2 iy an older" a ait a he Sid “dl he dhe “dd C1: Encompassing preoccupation or circumscribed pattern of interest 67 Unusual Preoccupations 68 Circumscribed Interests __ (score if 3 years or older) }. { } 39 Verbal Rituals (sore only if tem 30 = 0) rs | } 70 Compulsions/Rituals .. 3: Stereotyped and repetitive motor mannerisms 17 Hand and Finger Namersns ont 3 78 Other Complex Manversns of _ J Stereotyped Body Movements { J Total C3 C4: Preoccupation with parts of objects or nonfunctional elements of material 69 Repetitive Us of Objects o a Interest in Pats of Objects Jonson 171 Unsua Sensory Interests ee Total C4 “Current Behavior Algorithm for 10.0 or older should be scored only for verbal subjects (Item 300) For this age group, no Curent Behavior Algorithm is Total C available for nonverbal subjects (Item 30 1 of 2). C1 +c2 403 +04 (cutoff = 3, diagnostic only) D: Abnormality of Development Evident at or Before 36 Months. Diagnostic Algorithms only. 2 Age Parents First Noticed (if <36 months, score 1) 9 Age of First Single Words (if >24 months, score 1) 10 Age of First Phrases (if >33 months, score 1) 86 Age When Abnormality First Evident (if coded 3 or 4, score 1) 87 Interviewer’ Judgment on Age When Abnormalities First Manifest if <36 months, score) ....{ | J} Total D es (cutoff = 1, diagnostic only)