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PURPOSE: Psychometric properties and diagnostic performance of the ADOS-2 module 4 were evaluated with participants from an autism-specialized clinic. METHODS: The sample had 331 participants with 226 males and 70 females receiving an ASD diagnosis. The evaluation consisted of the following: (1) A replication of the Exploratory Factor Analysis (EFA) reported by Hus, V., & Lord, C. (2014). The Autism Diagnostic Observation Schedule, Module 4: Revised Algorithm and Standardized Severity Scores. Journal of Autism and Developmental Disorders, 44(8), 1996-2012. https://doi.org/10.1007/s10803014-2080-3 .). (2) Identification of ADOS-2 items best predicting clinical diagnosis using Recursive Feature Elimination (RFE) and comparison of these items to previous findings. (3) Receiver Operating Characteristic (ROC) curve analyses of the effects of age and IQ on diagnostic performance. (4) Comparisons of ADOS-2 revised algorithm scores between females and males and their association with ADI-R scores. RESULTS: The EFA item-to-factor allocation of the ADOS-2 revised algorithm was largely reproduced. When comparing the present RFE to previous RFE findings, the item Quality of Social Responses stood out. ROC curve analysis showed outstanding diagnostic performance for adults with IQ above 70 but for females, ADOS-2 revised algorithm scores were lowered, and, contrary to males, did not correlate with ADI-R scores. CONCLUSION: Reproducing the item-to-factor allocation and finding outstanding agreement with the diagnostic decision for adults with IQ > 70 showcase the strength of the ADOS-2 revised algorithm. Furthermore, by incorporating, into future revisions, the finding of inter-clinic importance of the item Quality of Social Responses, performance might be further enhanced. Lastly, though, that female scores were lowered and did not correlate with ADI-R indicate a weakness in the ADOS-2 when applied to the adult female population.
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On the surface, fear and humor seem like polar opposite states of mind, yet throughout our lives they continually interact. In this paper, we synthesize neurobiological, psychological, and evolutionary research on fear and humor, arguing that the two are deeply connected. The evolutionary origins of humor reside in play, a medium through which animals benignly explore situations and practice strategies, such as fight or flight, which would normally be accompanied by fear. Cognitively, humor retains the structure of play. Adopting a view of humor as requiring two appraisals, a violation appraisal and a benign appraisal, we describe how fear-inducing stimuli can be rendered benignly humorous through contextual cues, psychological distance, reframing, and cognitive reappraisal. The antagonistic relationship between humor and fear in terms of their neurochemistry and physiological effects in turn makes humor ideal for managing fear in many circumstances. We review five real-world examples of humor and fear intersecting, presenting new data in support of our account along the way. Finally, we discuss the possible therapeutic relevance of the deep connection between humor and fear.