Why assessors ask about brushing your teeth (and other ADOS-2 activities)

Plenty of adults come out of an autism assessment confused. Why was I asked to explain something I do every day? Why was there a picture book? Why did they ask what a friend is? Searching for those moments afterward is very common. This page explains, in general terms, why observation-based assessments include activities like these. We do not reproduce the actual ADOS-2 materials or instructions, which are protected and are meant to be used only by trained clinicians.

What the ADOS-2 is trying to see

The ADOS-2 is a semi-structured observation. Instead of asking you to rate yourself, it creates a series of small situations that make certain kinds of communication likely to happen naturally. The assessor then notes what they observe: how conversation flows, whether gestures and facial expressions accompany speech, how you describe events and feelings, and whether particular interests or patterns come up.

The brushing teeth question

Many adults who have been through an ADOS-2 describe being asked to explain or act out an ordinary routine. The everyday topic is the point. Almost everyone knows how to do it, so the activity is not about knowledge. It shows how a person organizes a set of steps for a listener, whether they add gestures or mime, how much detail they choose, and whether they check that the other person is following. Different people do this in very different ways, and the assessor is noting the style, not grading the steps.

If you gave an extremely detailed answer, or a very short one, or felt unsure whether to pretend you were holding a toothbrush, none of that is a mistake. The assessor simply records what happened.

The book with no words and storytelling

Adults also often mention telling a story from pictures. Activities like this let the assessor hear how you build a narrative: whether you describe what characters might be thinking or feeling, how you link events, and how you share the story with the listener. It is not a creativity test. Some people tell a vivid story, others describe each picture literally. Both are just information.

Questions about friendship, feelings and relationships

Module 4 includes conversation about everyday life, including work or study, emotions, friendships and relationships. Questions like "what does friendship mean to you?" can feel strangely abstract. They are there because how people think and talk about relationships and emotions is central to autism, and there is no other way to explore it in an observation. Honest, specific answers are more useful than polished ones.

Building tasks and blocks

Some people describe a short construction task with pieces or blocks. These moments create natural chances to ask for help, share attention or comment on what you are doing. Your skill at building is not what the assessor is coding.

Why some activities feel childish

This is one of the most common complaints, and it is acknowledged in professional literature. The same instrument family covers toddlers to adults, and some materials can feel out of place for an adult. Feeling awkward or self-conscious is understandable, and it does not count against you.

There is nothing to pass or fail

This is worth repeating, because anxiety before an assessment is so common. The ADOS-2 is not an exam. It does not score how well you explain, how good your story is, or how well you build. It records patterns of communication and interaction during one session, and the team interprets them together with your history and other information.

Should you prepare for specific tasks?

No. Rehearsing particular activities can make your responses less natural and less useful. A better preparation is practical: know roughly what the day involves, plan rest afterward, and think about examples from your life that you want to make sure the team hears.

• Tell the clinic about sensory needs before the day, such as lighting, noise or seating.
• Ask for breaks or for questions to be repeated whenever you need.
• If you notice yourself masking, you can say so during or after the session.
• Write down any thoughts afterward to share with the team.