ADOS-2, ADI-R, and neuroinclusive practice: A Q&A with ADI-R trainer Patricia Rios

I was fortunate to be selected to work at the Institute of Psychiatry and the MRC, investigating the genetics of autism under the leadership of Professor Sir Michael Rutter. This involved seven years of collaborative work with Dr Cathy Lord and her team in Canada, Dr Susan Folstein and her team in the USA, alongside our multidisciplinary team in the UK.

These years were both formative and deeply influential in shaping my personal and professional development. During this time, I gained invaluable experience in understanding the diverse presentations of autism through meeting, interviewing, and assessing parents and their children. We were also involved in developing what are now considered gold-standard assessment tools: the Autism Diagnostic Interview-Revised (ADI-R) and the Autism Diagnostic Observation Schedule (ADOS-2).

Our understanding of autism has evolved significantly. We are now more attuned to the wide range of ways in which autistic traits can present and how they impact individuals differently. There has also been an important shift towards more neuroaffirmative language and a commitment to viewing autism through a non-stigmatising, strengths-informed lens.

The most meaningful moments have been the trust placed in me by autistic individuals and their families when engaging in psychological interventions. Supporting people to address fears, phobias, sensory sensitivities, and broader mental health challenges has been both a privilege and a profound source of professional fulfilment.

I value the opportunity to support colleagues in developing a thoughtful, curious approach to assessment – particularly the importance of listening carefully and avoiding assumptions. In the absence of biological markers, asking for rich, detailed behavioural examples is essential.

It is also rewarding to teach a diagnostic tool that has taken many years to develop, while reflecting on how the field has evolved – from viewing autism purely as a disorder to understanding it as a profile of behaviours and experiences. Although we continue to use diagnostic frameworks such as DSM-5 and ICD-11, we are increasingly mindful of using language that is respectful, meaningful, and, where possible, empowering for autistic individuals.

I encourage colleagues to build a strong foundation in developmental psychology and typical developmental milestones. This knowledge is essential for recognising when a child’s developmental trajectory differs, and for making nuanced, clinically informed observations during assessment.