Applied Evidence

Expressive Language Sample Concordance With ADOS-2 Scores: Autism, Down Syndrome, Fragile X Syndrome.

American journal on intellectual and developmental disabilities · 2026 · Other · SLP

Hannah Barton, Sara Kover, Angela John Thurman and 7 others

PMID 42584862

The ADOS-2 EL score (1–8) reflects a person's spoken syntax and vocabulary, but it did not change over a year while traditional language-sample measures did.

Use it as a snapshot, not a progress tracker.

Key findings

1The EL score was significantly predicted by syntactic complexity (MLUm) in both the narration and ADOS-2 contexts, and by lexical diversity (NDW) in the conversation context, confirming it captures spoken language mastery.

2Total utterances during conversation was a negative predictor of EL score, and neither diagnostic group (DS, FXS vs. autism) nor autism severity (ADOS-2 comparison score) predicted the EL score in any model.

3Over one year, MLUm increased significantly in all three sampling contexts, but the EL score did not change significantly (p = 0.128), indicating it is not sensitive to language growth.

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What it does not show

The Down syndrome (n = 20) and Fragile X (n = 21) groups are small, so findings for those populations carry less weight than for the autism group. Inclusion required phrase-level speech (at least occasional three-word utterances), so the results do not apply to non-speaking or single-word users. Only 70 of the 76 autistic participants completed the one-year follow-up; six were lost to incomplete transcripts or non-return. Transcriber training agreement was 70%, which is modest for a study whose entire analysis depends on transcript accuracy. Single-site study; the interaction was with an unfamiliar, neurotypical examiner, which may not reflect a patient's communication in familiar settings.

Declared interests

No funding source or conflict-of-interest statement appears in the provided text.

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