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With nearly half of the population under 25 years old, Dublin is a youthful city full of energy and creativity. Experience a Dublin, Ireland cruise to find many young residents getting festive at one of the city's 1,000 pubs, restaurants, and bars. But besides being the life of the party, Dublin is a city steeped in history. Walk the cobblestone streets of the lively Temple Bar neighborhood — dating back to medieval times, today the district is a hub for art institutes, pubs and boutique shops. Cross Ha'Penny Bridge, built in 1816, and head to the National Museum of Ireland, where you can see the famous Book of Kells and artifacts from ancient Celtic history.
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Ireland's No. 1 tourist attraction is the Guinness Storehouse. With seven floors of interactive experiences, the end reward is a perfectly poured pint at the world-famous Gravity Bar. If beer isn't your thing, visit the Jameson Distillery for a 40-minute tasting tour of Ireland's best-selling Irish whiskey.
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Dublin has a long history, beginning with the Viking raids in the 9th and 10th centuries. Explore the city's past at attractions like Malahide Castle, which dates back to the 1100s and houses a complex walled garden. Check out St Patrick's Cathedral, another 12th century built in dramatic Gothic style.
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Dublin has many open green spaces. Phoenix Park, which is the largest enclosed public park in any European capital city. It's home to a herd of fallow deer, Dublin Zoo, gardens and Ashtown Castle. St Stephen's Green is another option, as is the National Botanic Gardens.
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There are almost too many choices for dining in Dublin, from Michelin-starred restaurant to character-filled pubs. To fuel up for you adventure, take down a plate of beans in spiced tomato sauce with toast, topped with a fried egg — the dish is often paired with black pudding, a traditional type of blood sausage.
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Dublin's two main shopping streets are O'Connell and Grafton Streets. For a unique souvenir, visit Avoca for clothes, accessories, wool blankets and home wares. The Ireland-only store still uses the wool mill where it all began in the 1700s. The Irish Design Shop also stocks home wares, jewelry and gifts.
Insider's Tips
1 Dublin is famous for its colorful Georgian doors, which can be found around Fitzwilliam and Merrion Squares.
2 Several companies offer fantastic daily free walking tours around Dublin city center.
3 Don't worry if rain is in the forecast — most of Dublin's biggest attractions are inside.
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Evaluation of the ADOS Revised Algorithm: The Applicability in 558 Dutch Children and Adolescents | mijn-bsl Skip to main content
Open Access 01-09-2009 | Original Paper
Evaluation of the ADOS Revised Algorithm: The Applicability in 558 Dutch Children and Adolescents
Auteurs: Annelies de Bildt, Sjoerd Sytema, Natasja D. J. van Lang, Ruud B. Minderaa, Herman van Engeland, Maretha V. de Jonge
Gepubliceerd in: Journal of Autism and Developmental Disorders | Uitgave 9/2009
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The revised ADOS algorithms, proposed by Gotham et al. (J Autism Dev Disord 37:613–627, 2007) , were investigated in an independent sample of 558 Dutch children (modules 1, 2 and 3). The revised algorithms lead to better balanced sensitivity and specificity for modules 2 and 3, without losing efficiency of the classification. Including the restricted repetitive behaviour domain in the algorithm contributes to a clinical ASD classification in modules 2 and 3. For module 1, the results indicate less improvement, probably due to the low-functioning population. In most groups, the advantages of the revised algorithms are achieved without losing the strength of the original algorithm.
The autism diagnostic observation schedule (ADOS; Lord et al. 1999 ) is a widely used and valuable instrument as a tool for diagnosing autism spectrum disorders (ASDs). The ADOS consists of four modules, each for a separate developmental or language level of functioning. Each module contains different tasks, and all of them are intended to provide the examiner with information on social, communicative, play and stereotyped behavior. Based on the ADOS algorithm a classification can be given of autistic disorder (AD), autism spectrum disorder (not being AD) or non-ASD.
Ongoing research showed that sensitivity and specificity of the original algorithm may be more related to cognitive and verbal level of functioning and chronological age, than seemed to be the case in the initial publications on the ADOS (Lord et al. 2000 ; Bishop and Frazier Norbury 2002 ; Joseph et al. 2002 ; de Bildt et al. 2004 ). Additionally, comparing the different modules based on the algorithm is complicated by the fact that the number and content of items are not totally comparable between the modules.
Recently, Gotham et al. ( 2007 ) published revised algorithms for modules 1 through 3 of the ADOS. The aims were to create more homogeneous algorithms over the various levels of development in order to make a first step towards a 'calibrated metric of severity of autism, as independent as possible from current language levels' and to improve the sensitivity and specificity of the ADOS classifications and their balance and thus to improve the diagnostic validity of the instrument. This more homogeneous algorithm was achieved by organizing the same number of items (i.e., 14 items) in the algorithms of each module, with similar content of the items per module. This increases comparability between the algorithms over the various modules and therefore between the various levels of development the respective modules are meant for. Additionally, the revised algorithm applies to smaller, more specific cells, in developmental level and age. The algorithms are therefore more specific for each subgroup, and this increases the sensitivity and specificity of the algorithm. Another change is the two domains included in the revised algorithm: a domain 'social affect' (SA) and one 'restricted repetitive behaviors (RRB)'. The SA domain is included based on the fact that one factor was found to underlie the social and communication items in previous research with the ADOS (Robertson et al. 1999 ; Lord et al. 1999 , 2000 ). It is a combination of 10 items from the former 'social' and 'communication' domains, yet per module without three items (two communication, one social) and one or two new (social) items. The RRB domain was added based on findings that such items may be important for diagnostic stability, as reported by Lord et al. ( 2006 ). This domain combines three items from the RRB section of the ADOS and one language item for each module. Gotham et al. ( 2007 ) give a clear and complete overview of the items in the new algorithm per module (p. 619).
In their study, the revised algorithm led to an improved specificity for non-autism ASD in lower functioning children, except for children under non-verbal mental ages under 15 months. The sensitivity for non-autism ASD remained relatively low in all groups. Adding the RRB domain did not contribute to distinguishing AD from pervasive developmental disorder-not otherwise specified (PDD-NOS), yet did contribute to the discrimination between PDD-NOS and non-spectrum cases. The authors strongly recommended replication of their revised algorithms in other populations.
Overton et al. ( 2008 ) explored the revised algorithm in 26 Hispanic children, administered with modules 1–3. In module 1 (n = 14), the accuracy of the revised algorithm was slightly increased. Classifications in module 2 (n = 3) and 3 (n = 8) remained unchanged after applying the revised algorithm. As mentioned by the authors, the sample is small and selective.
Gotham et al. ( 2008 ) replicated the revised algorithms in 1,282 children in the US. The results were comparable to the original study of Gotham et al. ( 2007 ). Comparability between the modules was increased. Additionally, predictive value of the ADOS for AD was increased, also increasing the validity of an autism diagnosis beyond the ADI-R. Besides, age and verbal IQ effects on the ADOS total scores were decreased.
Based on the research from Gotham et al. it can be concluded that the revised algorithms increase the comparability between the algorithms of the various modules in the various age or developmental groups. A certain score of a young child on module 2 has the same meaning as the same score for an older child on module 3. It also leads to a classification more independent from age and verbal IQ. Importantly, achieving this comparability and higher independence from developmental level has not been at the expense of the sensitivity and specificity.
In the current paper, the revised algorithms were applied to 558 children administered with modules 1, 2 or 3. The aim of the current paper was to investigate the revised algorithm in these children: how well does the revised algorithm add to a clinical classification of ASD or non-spectrum disorder?
ADOS administrations (modules 1–3) of 558 children were reevaluated with the revised algorithms of Gotham et al. ( 2007 ). All ADOS administrations had taken place as part of two large studies in the Netherlands concerning the genetics of ASDs. These studies included children referred for child-psychiatric problems/ASD and children from an epidemiological study of ASD in mental retardation (population based; De Bildt et al. 2005 ). This means that not all, and especially not all low-functioning participants from the current study were referred for problems in the autism spectrum, yet they were all evaluated by experienced clinicians. The majority of the children completed a diagnostic evaluation based on DSM-IV-TR criteria at the University of Utrecht ASD clinic, or at the University of Groningen Child and Adolescent Psychiatry Clinic/Autism Clinic (ATN). The others completed a standardized classification procedure in the epidemiological study (see for more detail De Bildt et al. 2004 , 2005 ).
In order to enhance comparability with the studies of Gotham et al. the age was 12 years or younger for modules 1 and 2, and up to 16 years for module 3. Gotham et al. their sample into smaller and more homogeneous groups, analyzed separately. Following this division in the current sample, this resulted in n = 99 for module 1, Some Words; n = 124 for module 2, 5 and Older; and n = 335 for module 3. Because very few participants had no words at all at the time of ADOS-administration, a 'no-words' group as described by Gotham et al. could not be included in the current study. Additionally, children younger than 5 could not be included for module 2 due to the small number of administrations in this age range. Thus, the current study only addresses three of the five divisions of the new algorithm.
The age range for the total sample is 13–198 months. The sample contained 193 (34.6%) children with a clinical classification of AD, 221 (39.6%) with non-autism ASD, and 144 (25.8%) with a non-spectrum classification. Of these 144 the majority had MR (110, 76.4%; most of them from the epidemiological study), 10 ADHD (with or without ODD), 4 a language disorder, 2 selective mutism, 5 anxiety, 2 ODD, 1 motor coordination disorder, 6 were unclear, 3 had no psychiatric disorder, and 1 had another psychiatric disorder. In all modules the majority were boys: 77.8% in module 1, 79% in module 2 and 81.5% in module 3. In Table 1, characteristics of the participants are presented by module and diagnostic group. Of all participants only one administration was included in this study.
Characteristics of the participants
M1 SW
M2 5 and Older
ADI S
ADI C–V
ADI C-NV
ADI RR
ADOS S
ADOS C
ADOS SA
ADOS RR
Non-ASD
M1 SW module 1 some words, M2 module 2, M3 module 3, Age age in months, IQ IQ based on various tests, ADI S ADI-R social total, ADI C–V ADI-R communication total for verbal children, ADI C-NV ADI-R communication total for non-verbal children, ADI RR ADI-R restricted, repetitive behaviors total, ADOS S ADOS social total, ADOS C ADOS communication total, ADOS SA ADOS social affect (revised algorithm), ADOS RR ADOS restricted, repetitive behaviors (revised algorithm)
In general, the current sample is older, contains more clinical non-autism ASD-classifications and lower functioning cases (especially non-spectrum) than the samples of Gotham et al. ( 2007 , 2008 ). For all modules, IQ is significantly lower in the non-spectrum group than in the A(S)D groups. For module 1, Some words and module 3, children in the non-spectrum group are significantly older than in the A(S)D groups.
The ADOS was administered by trained psychologists or psychiatrists who fulfilled requirements of reliability and administration of the ADOS in research (Lord et al. 1999 ). In the current study the original algorithm (Communication and Social Domains; Comm-Soc) was applied in addition to the two revised algorithms: SA (Social Affect, combining items from the Communication and Social Domains) and SARRB (Social Affect combined with Restricted Repetitive Behaviors, combining items from the Communication, Social and Repetitive restricted behaviors domains). IQ's were available for 488 (87.5%) of the children, based on standardized intelligence tests. In module 3 and 2 the majority of cases were tested with WISC-R (Wechsler 1974 ; Vander Steene et al. 1986 ), WPPSI-R (Wechsler 1989 ; Vander Steene and Bos 1997 ) or RAVEN progressive matrices (Raven 1995 , 1996 ). Most cases in module 1 and some cases in module 2 were administered a Dutch nonverbal intelligence test, the Snijders-Oomen Niet-verbale intelligentie test-Revisie (SON-R; Snijders et al. 1996 ), and some in module 1 were administered the Dutch modification of the Bayley scales of Infant Development (Bayley 1969 ; Van der Meulen and Smrkovsky 1983 ).
The Autism Diagnostic Interview-Revised (ADI-R; Rutter et al. 2003 ) was administered to 499 children (89.4%).
The current study aimed to replicate the findings of Gotham et al. and Overton et al. Therefore, Pearson r correlations were computed first, between the revised algorithm domains (SA, RRB and SARRB) and participant characteristics, in order to investigate whether an interrelationship between these variables existed. Second, sensitivity, specificity and efficiency of the ADOS classification were calculated for each of the applied algorithms, compared to clinical classifications of AD versus non-spectrum and non-autism ASD versus non-spectrum.
To also contribute to the further investigation of the revised algorithms, logistic regressions were applied to study the contribution of the ADOS scores on the algorithm domains to the clinical classification of ASD (including AD) versus non-spectrum. All three ADOS algorithm domains were investigated: (1) the original ADOS algorithm total score (Communication and Social; Comm-Soc), analyzed separately; (2) the SA algorithm score; and (3) the RRB algorithm score, combined in one analysis. For all analyses, a p value of <.05 was considered significant.
Correlations between revised algorithm totals and participant characteristics showed no correlation of the revised algorithms with IQ or age. Correlations between the original algorithm domains and IQ and age, showed the same pattern. The correlation between the original and revised algorithm scores is high for all modules, as expected. With respect to the ADI-R, the correlation between SA and SARRB and the Social and Communication domains of the ADI-R is highest in module 1 (see Table 2 for more detail).
Correlations between revised algorithm totals and participant characteristics
ADOS SC
ADOS P
SA total
−.03
RRB total
SA + RRB
M2 O
M1 SW module 1 some words, M2 O module 2 5 and older, M3 module 3, IQ total IQ based on various tests, ADI S ADI-R social total, ADI C–V ADI-R communication total for verbal children, ADI C-NV ADI-R communication total for non-verbal children, ADI RR ADI-R restricted, repetitive behaviors total, ADOS S ADOS social total, ADOS C ADOS communication total, ADOS SC ADOS social-communication total, ADOS P ADOS play total, ADOS RR ADOS restricted, repetitive behaviors total, SA ADOS social affect (revised algorithm), RRB ADOS restricted, repetitive behaviors (revised algorithm), SA+RRB ADOS social affect + restricted, repetitive behaviors (revised algorithm)
Bold values are significant and clinically relevant (>.3)
In Table 3, the sensitivity, specificity and efficiency of the original and revised algorithms are presented, when applicable in relation to formerly reported values (Gotham et al. 2007 , 2008 ; between parentheses). Efficiency represents the percentage of cases classified correctly based on the algorithm used, as compared to the clinical classification mentioned. By including this value, it is possible to see whether improvement of the balance between sensitivity and specificity (as aimed for with the revised algorithms) affects the efficiency. In the current data, efficiency generally remains stable or improves, thus the predictive value of the ADOS does not seem to lose strength with better balanced sensitivity and specificity. The greatest, yet still slight decrease in efficiency exists for module 2, 5 and older, of the SA only algorithm, comparing non-autism ASD versus non-spectrum (and then only .07). The two major differences between the proposed and original algorithms in the current study are: (1) the increased sensitivity for the SA and SARRB algorithm as compared to the original algorithm in classifying AD versus non-spectrum, with a somewhat decreased specificity; and (2) the more balanced sensitivity and specificity in module 2 (AD vs. non-spectrum).
Sensitivity and specificity of the ADOS classifications based on SA, SARRB and Comm-Soc algorithms, compared to the clinical classifications
Meets Comm-Soc for ADOS AUT
Meets SA+RRB for ADOS AUT
Meets SA only for ADOS AUT
AD versus NS
Mod 1 SW AD = 61 NS = 24
.82 (.88a/.73b)
.71 (12; .91a/.91b)
.90 (.91a/81b)
Mod 2 older AD = 40 NS = 50
.63 (.96a)
.76 (9; .90a)
Mod 3 AD = 92 NS = 70
.73 (9; .84a/.92b)
Meets Comm-Soc for ADOS ASD
Meets SA+RRB for ADOS ASD
Meets SA only for ADOS ASD
Non-autism ASD versus NS
Mod 1 SW ASD = 14 NS = 24
.86 (.67a/1.00b)
Mod 2 older ASD = 34 NS = 50
Mod 3 ASD = 172 NS = 70
The absolute numbers between parentheses are the cut-offs of the various algorithms, as described by Gotham et al. ( 2007 )
SE sensitivity, SP specificity, Efficiency cases classified correctly/total cases, AD clinical classification of AD, ASD clinical classification of non-autism ASD, including PDD-NOS and Asperger's disorder, NS clinical classification non-spectrum, SA ADOS social affect (revised algorithm), SA+RRB ADOS social affect + restricted, repetitive behaviors (revised algorithm), Comm-Soc ADOS social-communication total (original algorithm)
aThe percentages between parentheses are the values of the studies by Gotham et al. ( 2007 )
bThe percentages between parentheses are the values of the studies by Gotham et al. ( 2008 )
In module 1, AD versus non-spectrum, the two revised algorithms have a slightly higher sensitivity than the original algorithm, and lower specificities. The balance between sensitivity and specificity did not improve. Comparing the algorithms for non-autism ASD versus non-spectrum, the original and the SARRB algorithms perform equally well, the SA specificity is lower.
In module 2, AD versus non-spectrum, the sensitivity of SA and SARRB is higher than for the original algorithm, with lower specificities. With respect to non-autism ASD versus non-spectrum, the sensitivity of SA is increased compared to the original algorithm, whereas the specificity is decreased, compared to the original and the SARRB algorithms. The balance between sensitivity and specificity was improved for AD versus non-spectrum.
For module 3 the revised algorithms are more sensitive for AD and non-autism ASD than the original one, although there is a slight decrease in specificity for AD and ASD.
With logistic regression the contribution of the algorithms to a clinical classification of ASD (incl. AD) versus non-spectrum was investigated. The odd's ratios (OR, presented in Table 4) express the increase or decrease of the probability of a clinical ASD classification for each additional point on the score of the algorithm domain mentioned. Six analyses were run: two for each module, one for the original algorithm score and one for the SA and RRB algorithm scores, included as separate variables in one analysis. Thus it is possible to investigate the contribution of each, taking the other into account. For all modules, the SA algorithm score and the original algorithm score contribute approximately equally to the clinical classification. The RRB domain contributes to the clinical classification in module 2 and 3, above the SA domain contribution and above the original algorithm contribution, yet does not seem to add to a clinical ASD classification in module 1, when taking SA into account.
Contribution of the ADOS classifications to clinical classifications, controlled for age and IQ
ASD (include AD) versus non-spectrum
Odds ratio (95% CI)
1.43 (1.08–1.906)*
1.61 (.69–3.76)
Comm-Soc
1.56 (1.20–2.03)**
M2 5+
1.25 (1.10–1.41)***
1.57 (1.09–2.26)*
SA ADOS social affect score (revised algorithm),RRB ADOS restricted, repetitive behaviors score (revised algorithm), Comm-Soc ADOS social-communication total score (original algorithm). ASD classification includes AD, PDD-NOS and Asperger's disorder
* p < .05, ** p < .01, *** p ≤ .001
The current study was undertaken in order to evaluate the revised ADOS algorithms as proposed by Gotham et al. ( 2007 ). The aim was to investigate the sensitivity and specificity of the revised algorithms in an independent sample of 558 children, and to investigate their contributions to a clinical ASD classification. The independent sample consisted of children referred for child-psychiatric problems/ASD and children from an epidemiological study of ASD in mental retardation. Thus, not all participants were referred for problems in the autism spectrum, yet they were all evaluated by experienced clinicians. The sample contained children from three of the five divisions as made by Gotham: administered with module 1 (Some Words group only); module 2 (5 and Older only) and module 3. In general, the current sample was older and contained more clinical non-autism ASD-classifications and lower functioning non-spectrum cases than the sample of Gotham et al. ( 2007 ).
It is promising that the correlation between IQ and the revised algorithms as reported by Gotham et al. in all modules (based on Verbal IQ and Non Verbal IQ; 2007) was not replicated in the current study, comparable to the replication study in the US (Gotham et al. 2008 ). The fact that no correlation was found with IQ or with age in all modules indicates that the revised algorithm domains seem to be independent from these variables in the current sample, which is what Gotham et al. strived for. Nevertheless, this can not be put forward as an enhancement on behalf of the new algorithms, since the same pattern was found for the original algorithm domains, with no correlations with age and IQ in either module. The comparison of data may be complicated by the fact that Gotham et al. ( 2007 ) had measured VIQ and NVIQ, whereas the current IQ measures were based on various tests, resulting in differences between the outcomes. For part of the children TIQ's were available based on verbal and nonverbal subtests, whereas others could only complete non-verbal IQtests. However, both correlations in Gotham's sample between VIQ and NVIQ and the ADOS algorithms were significant whereas the correlations in the current sample were not.
With respect to sensitivity and specificity, our results indicate that applying the revised algorithms improves the balance between these in module 2 and 3, without losing strength with respect to efficiency of the classification. This is comparable to the results as reported by Overton et al. ( 2008 ). The efficiency of the revised algorithms (i.e., the percentage of cases classified correctly) was better for AD than for non-autism ASD. This may be due to the fact that part of the non-spectrum children (the clinical group) were referred for developmental or behavioral problems that gave reason to investigate whether or not ASD was apparent, and therefore may have scored on the ADOS without receiving an ASD diagnosis or may not have sored on the ADOS, while receiving an ASD diagnosis. Amongst children with MR, the distinction between AD and non-autism ASD is even less clear than in a normally intelligent population, as is the discrimination between ASD and non-spectrum in some cases. It is important to keep in mind that the ADOS does not reflect the distinctions made by clinicians between AD and non-autism ASD (see also Lord et al. 2000 ). Additionally, even the combination of ADOS and ADI-R does not lead to a perfect discrimination between ASD and non-spectrum cases, which indicates that the actual criteria for such diagnosis are not clear enough yet (Risi et al. 2006 ).
The balance between sensitivity and specificity is important since a very specific instrument without sufficient sensitivity tends to miss cases, whereas a very sensitive measure without sufficient specificity would be overinclusive. In a former study in a Dutch, low-functioning, population, the ADOS tended to be overinclusive, e.g., to have a high sensitivity without an accordingly high specificity (De Bildt et al. 2004 ). The currently reported balance implies that this is less the case with the revised algorithms in the current (only partially overlapping) sample. However, in module 1, Some Words of the current sample, the balance did not improve, due to a decrease in specificity when sensitivity increased.
The question is whether this balance is reasonable to aim for in this sample. Not only the population as a whole is lower functioning than the previously reported samples, also the clinically classified non-spectrum cases are lower functioning than the A(S)D cases and, in modules 1 and 3, older too. This is due to the fact that the majority of the non-spectrum cases were recruited from a population-based study of ASD in MR, not referred cases for ASD (De Bildt et al. 2005 ).
Based on the specific character of this population, the current sample may increase the difficulty in obtaining a satisfactory specificity, and therefore may affect the balance between sensitivity and specificity: Compared to the findings of Gotham et al. ( 2007 , 2008 ), the current study reports lower values of specificity for all algorithms. As reported by Gotham et al. ( 2007 ), in the nonverbal module 1 participants with very low nonverbal mental ages (≤15 months) specificity was 50 or more % lower as compared to nonverbal children administered with module 1 with mental ages of more than 15 months. Although in the current sample all children were verbal, the same issue may affect the results due to the very low IQ's reported. This may especially be the case in module 1, Some Words, where the non-spectrum cases have a mean IQ of 30.
Another interesting issue with respect to distinguishing ASD from low-functioning children with MR without ASD is the addition of the RRB domain to the SA domain for a classification based on the ADOS. The current study indicates that including the RRB domain additional to SA in the algorithm contributes significantly to the clinical ASD classifications in module 2, 5 and Older and module 3, yet does not increase correct classification of ASD in module 1, Some Words. For modules 2 and 3 these results resemble what Gotham et al. ( 2007 , 2008 ) reported. For module 1, Some words, the outcome is not surprising, since RRB's are important features of low-functioning children with MR as well and may not be specific for or give lead to an ASD diagnosis in such a population.
Due to the restricted behavioural repertoire shown in low functioning children, together with the overlap with behaviours in children with ASD, it may be ambitious to strive for an instrument that is able to distinguish between those two without missing or overincluding cases. However, this should not be judged as a flaw of the algorithms or ADOS, yet is inherent to the nature of the two disorders, because of their behavioural resemblance.
Nevertheless, for (at least part of the) clinicians diagnosing ASD this is daily practice: distinguishing the specific developmental disorder ASD from a more general developmental disorder or MR. Standardized and valid instruments would be of great value in this process.
The currently reported increased balance between sensitivity and specificity in relatively low-functioning children administered with module 2 (5 and older) and module 3 indicates that in these groups, the revised algorithms do not lose any strength compared to the original one, and therefore should be preferred. Adding RRB in the algorithm increases the discriminative power. For module 1, Some Words, an even lower functioning group, the revised algorithms are less clearly preferred. Although the sensitivity increased, the specificity decreased, and the RRB domain did not add to distinguishing between ASD and MR. Further research in very low functioning children is needed in order to obtain the perfect algorithm, or perhaps even a better applicable ADOS-module. After all, the original algorithm of module 1 is not applicable to children with mental ages under 24 months, and although 15 months seems feasible with the revised algorithms, MR and ASD lead to the same behaviours in such low-functioning children.
Whether a high sensitivity (revised algorithms) or a high specificity (original algorithm) is preferred when balance between the two is not feasible (which needs to be further investigated before concluding so) depends on the question behind the administration of the particular ADOS. For research it may be important to only include definite cases of ASD, resulting in the need for a higher specificity. On the contrary, for other uses it may be important not to miss any possible ASD-case, with a need for a higher sensitivity as a result. In any case, this discussion once again emphasizes the fact that the ADOS should never be used as the only indication for whether an ASD is present, also not in low-functioning children.
Unfortunately, we were not able to reliably investigate the children with MR separately, since their number in the current sample was too small, too much distributed amongst the various modules and too little amongst various classifications within these groups. With respect to the further development of the algorithm of the ADOS, investigating it in a large (combined) group with MR will increase the knowledge on the value of the ADOS and its algorithms in this specific group.
Additionally, the number of cases that could be included in the current study may limit interpreting the findings. We could not include module 1, no words or module 2, younger than 5. The current study therefore leaves questions open on the value of the revised algorithms of the ADOS in very young or low functioning children. Additional studies concerning these subpopulations will contribute to investigation of the value of the revised algorithms.
To conclude, our results corroborate the findings as reported by Gotham et al. ( 2008 ) that the advantages of the revised algorithm (i.e., better representation of observed diagnostic features, increased comparability between modules in algorithm content and number, and improved predictive value for autism) have not been at great expense of the sensitivity and specificity, for module 2, 5 and older and module 3. With respect to module 1, in low-functioning children, more research is needed in order to reach good balance between high sensitivity and high specificity.
This research was supported by the Korczak Foundation and ZON-MW.
This article is distributed under the terms of the Creative Commons Attribution Noncommercial License which permits any noncommercial use, distribution, and reproduction in any medium, provided the original author(s) and source are credited.
Open AccessThis is an open access article distributed under the terms of the Creative Commons Attribution Noncommercial License (https://creativecommons.org/licenses/by-nc/2.0), which permits any noncommercial use, distribution, and reproduction in any medium, provided the original author(s) and source are credited.
vorige artikel A Longitudinal Investigation of Psychotropic and Non-Psychotropic Medication Use Among Adolescents and Adults with Autism Spectrum Disorders
volgende artikel Brief Report: Sociometric Status and Behavioral Characteristics of Peer Nominated Buddies for a Child with Autism
go back to reference Bayley, N. (1969). Bayley Scales of Infant Development. New York: Psychological Corporation. Bayley, N. (1969). Bayley Scales of Infant Development. New York: Psychological Corporation.
go back to reference Bishop, D. V. M., & Frazier Norbury, C. (2002). Exploring the borderlands of autistic disorder and specific language impairment: A study using standardised diagnostic instruments. Journal of Child Psychology and Psychiatry and Allied Disciplines, 43, 917–929. doi: 10.1111/1469-7610.00114. CrossRef Bishop, D. V. M., & Frazier Norbury, C. (2002). Exploring the borderlands of autistic disorder and specific language impairment: A study using standardised diagnostic instruments. Journal of Child Psychology and Psychiatry and Allied Disciplines, 43, 917–929. doi: 10.1111/1469-7610.00114. CrossRef
go back to reference de Bildt, A., Sytema, S., Ketelaars, C., Kraijer, D., Mulder, E., Volkmar, F., et al. (2004). Interrelationship between Autism Diagnostic Observation Schedule-Generic (ADOS-G), Autism Diagnostic Interview-Revised (ADI-R) and the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR) classification in children and adolescents with mental retardation. Journal of Autism and Developmental Disorders, 34, 129–137. doi: 10.1023/B:JADD.0000022604.22374.5f. PubMedCrossRef de Bildt, A., Sytema, S., Ketelaars, C., Kraijer, D., Mulder, E., Volkmar, F., et al. (2004). Interrelationship between Autism Diagnostic Observation Schedule-Generic (ADOS-G), Autism Diagnostic Interview-Revised (ADI-R) and the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR) classification in children and adolescents with mental retardation. Journal of Autism and Developmental Disorders, 34, 129–137. doi: 10.1023/B:JADD.0000022604.22374.5f. PubMedCrossRef
go back to reference de Bildt, A., Sytema, S., Kraijer, D., & Minderaa, R. (2005). Prevalence of pervasive developmental disorders in children and adolescents with mental retardation. Journal of Child Psychology and Psychiatry and Allied Disciplines, 46, 275–286. doi: 10.1111/j.1469-7610.2004.00346.x. CrossRef de Bildt, A., Sytema, S., Kraijer, D., & Minderaa, R. (2005). Prevalence of pervasive developmental disorders in children and adolescents with mental retardation. Journal of Child Psychology and Psychiatry and Allied Disciplines, 46, 275–286. doi: 10.1111/j.1469-7610.2004.00346.x. CrossRef
go back to reference Gotham, K., Risi, S., Dawson, G., Tager-Flusberg, H., Joseph, R., Carter, A., et al. (2008). A replication of the Autism Diagnostic Observation Schedule (ADOS) revised algorithms. Journal of the American Academy of Child and Adolescent Psychiatry, 47, 642–651. doi: 10.1097/CHI.0b013e31816bffb7. PubMedCrossRef Gotham, K., Risi, S., Dawson, G., Tager-Flusberg, H., Joseph, R., Carter, A., et al. (2008). A replication of the Autism Diagnostic Observation Schedule (ADOS) revised algorithms. Journal of the American Academy of Child and Adolescent Psychiatry, 47, 642–651. doi: 10.1097/CHI.0b013e31816bffb7. PubMedCrossRef
go back to reference Gotham, K., Risi, S., Pickles, A., & Lord, C. (2007). The autism diagnostic observation schedule: Revised algorithms for improved diagnostic validity. Journal of Autism and Developmental Disorders, 37, 613–627. doi: 10.1007/s10803-006-0280-1. PubMedCrossRef Gotham, K., Risi, S., Pickles, A., & Lord, C. (2007). The autism diagnostic observation schedule: Revised algorithms for improved diagnostic validity. Journal of Autism and Developmental Disorders, 37, 613–627. doi: 10.1007/s10803-006-0280-1. PubMedCrossRef
go back to reference Joseph, R. M., Tager-Flusberg, H., & Lord, C. (2002). Cognitive profiles and social-communicative functioning in children with autism spectrum disorder. Journal of Child Psychology and Psychiatry and Allied Disciplines, 43, 807–821. doi: 10.1111/1469-7610.00092. CrossRef Joseph, R. M., Tager-Flusberg, H., & Lord, C. (2002). Cognitive profiles and social-communicative functioning in children with autism spectrum disorder. Journal of Child Psychology and Psychiatry and Allied Disciplines, 43, 807–821. doi: 10.1111/1469-7610.00092. CrossRef
go back to reference Lord, C., Risi, S., DiLavore, P. C., Shulman, C., Thurm, A., & Pickles, A. (2006). Autism from two to nine. Archives of General Psychiatry, 63, 694–701. doi: 10.1001/archpsyc.63.6.694. PubMedCrossRef Lord, C., Risi, S., DiLavore, P. C., Shulman, C., Thurm, A., & Pickles, A. (2006). Autism from two to nine. Archives of General Psychiatry, 63, 694–701. doi: 10.1001/archpsyc.63.6.694. PubMedCrossRef
go back to reference Lord, C., Risi, S., Lambrecht, L., Cook, E. H., Jr, Leventhal, B. L., DiLavore, P. C., et al. (2000). The autism diagnostic observation schedule-generic: A standard measure of social and communicative deficits associated with the spectrum of autism. Journal of Autism and Developmental Disorders, 30, 205–223. doi: 10.1023/A:1005592401947. PubMedCrossRef Lord, C., Risi, S., Lambrecht, L., Cook, E. H., Jr, Leventhal, B. L., DiLavore, P. C., et al. (2000). The autism diagnostic observation schedule-generic: A standard measure of social and communicative deficits associated with the spectrum of autism. Journal of Autism and Developmental Disorders, 30, 205–223. doi: 10.1023/A:1005592401947. PubMedCrossRef
go back to reference Lord, C., Rutter, M., DiLavore, P. C., & Risi, S. (1999). ADOS. Autism diagnostic observation schedule. Manual. Los Angeles: WPS. Lord, C., Rutter, M., DiLavore, P. C., & Risi, S. (1999). ADOS. Autism diagnostic observation schedule. Manual. Los Angeles: WPS.
go back to reference Overton, T., Fielding, C., & Garcia de Alba, R. (2008). Brief report: Exploratory analysis of the ADOS revised algorithm: Specificity and predictive value with hispanic children referred for autism spectrum disorders. Journal of Autism and Developmental Disorders, 38(6), 1166–1169. PubMedCrossRef Overton, T., Fielding, C., & Garcia de Alba, R. (2008). Brief report: Exploratory analysis of the ADOS revised algorithm: Specificity and predictive value with hispanic children referred for autism spectrum disorders. Journal of Autism and Developmental Disorders, 38(6), 1166–1169. PubMedCrossRef
go back to reference Raven, J. C. (1995). Colored progressive matrices sets I and II (1996th ed.). Oxford: Oxford Psychologists Press Ltd. Raven, J. C. (1995). Colored progressive matrices sets I and II (1996th ed.). Oxford: Oxford Psychologists Press Ltd.
go back to reference Raven, J. C. (1996). Progressive matrices: A perceptual test of intelligence. Individual form (1996th ed.). Oxford: Oxford Psychologists Press Ltd. Raven, J. C. (1996). Progressive matrices: A perceptual test of intelligence. Individual form (1996th ed.). Oxford: Oxford Psychologists Press Ltd.
go back to reference Risi, S., Lord, C., Gotham, K., Corsello, C., Chrysler, C., Szatmari, P., et al. (2006). Combining information from multiple sources in the diagnosis of autism spectrum disorders. Journal of the American Academy of Child and Adolescent Psychiatry, 45, 1094–1103. doi: 10.1097/01.chi.0000227880.42780.0e. PubMedCrossRef Risi, S., Lord, C., Gotham, K., Corsello, C., Chrysler, C., Szatmari, P., et al. (2006). Combining information from multiple sources in the diagnosis of autism spectrum disorders. Journal of the American Academy of Child and Adolescent Psychiatry, 45, 1094–1103. doi: 10.1097/01.chi.0000227880.42780.0e. PubMedCrossRef
go back to reference Robertson, J. M., Tanguay, P. E., L'Ecuyer, S., Sims, A., & Waltrip, C. (1999). Domains of social communication handicap in autism spectrum disorder. Journal of the American Academy of Child and Adolescent Psychiatry, 38, 738–745. PubMedCrossRef Robertson, J. M., Tanguay, P. E., L'Ecuyer, S., Sims, A., & Waltrip, C. (1999). Domains of social communication handicap in autism spectrum disorder. Journal of the American Academy of Child and Adolescent Psychiatry, 38, 738–745. PubMedCrossRef
go back to reference Rutter, M., Le Couteur, A., & Lord, C. (2003). ADI-R. Autism diagnostic interview revised. Manual. Los Angeles: Western Psychological Services. Rutter, M., Le Couteur, A., & Lord, C. (2003). ADI-R. Autism diagnostic interview revised. Manual. Los Angeles: Western Psychological Services.
go back to reference Snijders, J. T., Tellegen, P. J., Winkel, M., & Laros, J. A. (1996). SON-R 2, 5–7 Snijders-Oomen Niet-verbale Intelligentietest-Revisie [SON-R 2, 5–7 Snijders-Oomen Non-verbal Intelligence test-Revised]. Lisse, the Netherlands: Swets & Zeitlinger. Snijders, J. T., Tellegen, P. J., Winkel, M., & Laros, J. A. (1996). SON-R 2, 5–7 Snijders-Oomen Niet-verbale Intelligentietest-Revisie [SON-R 2, 5–7 Snijders-Oomen Non-verbal Intelligence test-Revised]. Lisse, the Netherlands: Swets & Zeitlinger.
go back to reference Van der Meulen, B. F., & Smrkovsky, M. (1983). Bayley Ontwikkelingsschalen (BOS 2–30) [Bayley development scales (BOS 2–30)]. Lisse, the Netherlands: Swets & Zeitlinger. Van der Meulen, B. F., & Smrkovsky, M. (1983). Bayley Ontwikkelingsschalen (BOS 2–30) [Bayley development scales (BOS 2–30)]. Lisse, the Netherlands: Swets & Zeitlinger.
go back to reference Vander Steene, G., & Bos, A. (1997). Wechsler Preschool and Primary Scale of Intelligence-Revised. Vlaams-Nederlandse Aanpassing. Lisse, the Netherlands: Swets & Zeitlinger. Vander Steene, G., & Bos, A. (1997). Wechsler Preschool and Primary Scale of Intelligence-Revised. Vlaams-Nederlandse Aanpassing. Lisse, the Netherlands: Swets & Zeitlinger.
go back to reference Vander Steene, G., van Haasen, P. P., De Bruyn, E. E. J., Coetsier, P., Pijl, Y. J., & Poortinga, Y. H. (1986). Wechsler intelligence scale for children-revised. Nederlandstalige Uitgave. Lisse, the Netherlands: Swets & Zeitlinger. Vander Steene, G., van Haasen, P. P., De Bruyn, E. E. J., Coetsier, P., Pijl, Y. J., & Poortinga, Y. H. (1986). Wechsler intelligence scale for children-revised. Nederlandstalige Uitgave. Lisse, the Netherlands: Swets & Zeitlinger.
go back to reference Wechsler, D. (1974). Wechsler intelligence scale for children-revised. New York: Psychological Corporation. Wechsler, D. (1974). Wechsler intelligence scale for children-revised. New York: Psychological Corporation.
go back to reference Wechsler, D. (1989). Wechsler preschool and primary scale of intelligence-revised. New York: Psychological Corporation. Wechsler, D. (1989). Wechsler preschool and primary scale of intelligence-revised. New York: Psychological Corporation.
Annelies de Bildt
Sjoerd Sytema
Natasja D. J. van Lang
Ruud B. Minderaa
Herman van Engeland
Maretha V. de Jonge
Springer US
Journal of Autism and Developmental Disorders / Uitgave 9/2009
Social Competence and Social Skills Training and Intervention for Children with Autism Spectrum Disorders
Attachment and Symbolic Play in Preschoolers with Autism Spectrum Disorders
The Effect of Therapeutic Horseback Riding on Social Functioning in Children with Autism
The Autism Diagnostic Observation Schedule—Toddler Module: A New Module of a Standardized Diagnostic Measure for Autism Spectrum Disorders
Genevieve Edmonds and Luke Beardon (Eds): Asperger Syndrome & Employment: Adults Speak Out about Asperger Syndrome
Increasing Independence in Autism Spectrum Disorders: A Review of Three Focused Interventions

redpajama_set_name: RedPajamaCommonCrawl


I'm not over being great. I still have plenty of greatness left in me. I'm sure that I do, I just haven't recognized it that well yet.
I do a lot of trying and failing. It's like doing laundry, like a chore that no one wants to do but must be done regardless. The things that we detest doing must be done though, whether we like it or not. I could make a cool list of ideas on how to be productive or do this or that, but it's not a list I myself would even be following so what would be the point? None, no point. So instead, I'll just say that I have made some mistakes and I'm not learning from all of them.
They (they being society and those that think they know what is best for us) tell us to learn from our mistakes, but what happens when we just don't. We read on and on that making mistakes and failing is a part of life and growing up, but if that is true then why are we all still failing? Because try as we might, we still don't have that secret formula to make all our troubles go away. Youth potions might be an idea, but I'll only be on board if they can take me back to my childhood. A time of true and real innocence. For the most part, I didn't have any problems. Not the same kind of problems anyway. Now my problems are of the more convoluted and involved variety that stems from not knowing or not having a real plan. This is our own plan, not one made by anyone else and that's when we realize we might have screwed up somewhere.
Because we need guidance. We need the help to remind us that we're not alone. We need that support network. We don't all have this and it bites us sometimes, but that's ok. Just go online and there's a community for everything and anything that you love or love to hate, so there is no reason to feel alone. No reason to feel excluded in any way. If there is no group then hey! I'll be in your group. 🙂 Make your own light, be your own source of happiness when you let yourself feel good about yourself.
So, maybe you learned something from this. Maybe you learned nothing. Maybe right now you're wondering what the heck you got yourself into and that's ok too. As long as you think you might have it figured out soon(ish) it should hopefully all work out in your favor. I wish you well.
Don't forget to be awesome (I know I forget).
You love your phone, right? You know that feeling of being outside your home and realizing you forgot your phone? It's a terrible feeling that is also rooted in how we view ourselves. Sure, maybe you're busy and really need to answer that email or text. Maybe your boss will be calling you. Saying "I forgot my phone" is as believable as a kid on a tv show saying the dog ate my homework. It didn't happen. Something happened and you don't have the device on your person, but you will thrive regardless of that situation.
Yes you will, don't be negative. Work with me, please.
You're lying to yourself if you believe you will change. Whatever that means. You need to be in the loop, informed. You need to have your phone because it is your anchor. It holds you down and comforts you, whether you choose to admit this or not. Maybe we like to tell people we will do good and be good but are these ideas fact or fiction?
Ok, enough about you then. You're tired of the lies in the media. In the consumer society you have to live in. You take the lies, but then you read the other lies. It's hard to make sense of where the lies stop and the truth begins because in some cases it seems a though the lies are easier to say than the actual truth. You don't follow the news, as you say but there are things you keep up with. Your friends, family, and personal projects all require your attention. You are motivated to keep relationships and connections strong because they, (unlike the restless society), won't let you down. Everyone hates to be let down, but it happens anyway. It's probably in the handbook for life or something. This all doesn't make a lot of sense, but you already know what I'm getting at because you know the whole truth. Your truth is that you don't know what you want but you want so much to know.
You have some idea, but let it float on. Let it meander down the pond. Moving on is a good idea as it allows the mind to refresh. To be able to know is a rare thing these days. We are diverted by so many things on a daily basis, that attention spans are extremely short. Watching a 14-minute youtube video is not something anyone wants to do in their free time, because that is not quick. It is ignored that more time will likely be spent anyway scrolling through social media feeds anyway as the restless mind lives on. The next week will beat on and we will stand, waiting in earnest.
Or maybe just you, because your mind is all over the place today.
I probably get the question "so what are you doing right now?" a lot or at least a fair amount when I do go out and see people. This past weekend was a holiday, so I did have to meet and be merry and of course the question came up without fail. My answer sometimes varies from "doing some journalism work" to "some teaching" or "taking online classes right now but looking for job." People usually relate to the last one there, seeing the initiative to do more as a good sign and knowing that is is quite hard to find a lasting job these days. The people that get that are fine and conversations tend to grow from there.
You might say work with what I do have going for me, work it right? But, I'm awkward and most know it. At the same time, I do my best to sound like I'm not wasting most of my days doing nothing.
I dislike someone speaking on my behalf. I used to be able to be whatever, but I think I might be quieter than some others and maybe more of a creative thinker but I can form my own opinions and thoughts. Regardless, can we just talk about our favorite tv shows? Or no?
It's easier to say that I can't really figure myself out right now. But, I can't always say that. Essentially, I've been in the same place for over a year. Mentally, no job and no chance where I am. Why did I come back is what I think as I write this, but know I needed to regroup before I could start back somewhere big. A bigger place means bigger dreams and larger goals. Maybe less attainable, but that's ok. At least it will be something different and new. Though, maybe in my defense taking online classes is a little different than doing nothing at all, so not totally terrible.
Source: http://giphy.com/gifs/animation-pictures-dibujos-wq3Vb7h1dvDwI Originally from tumblr.
I get that maybe I'm not the only one in such a position. In such a time when things don't really make sense. When you have goals, but you feel like you don't because those around you seem to already have their life figured out. It's a weird place and its not the only weird stop on the ride to normal.
I really liked the gifs I used here and if I could have, I would have used some of the gorgeous illustrations found at 1000drawings.tumblr.com (with credit given of course to artists and blog). Check them out, they're from various artists and really amazing.
Sometimes it's like we're made of plastic and we break so easily. Other times, we refuse to break and steel ourselves hard so it will never be as bad as we think it to be. We try to bend and break, but try as we may our minds are forcing us to shake and cling on to hope even it's an absurd idea.
I'm writing this post with my family in mind. I feel like I just watched a movie this weekend, with all the happy parts in color and the sad parts in black and white. No, this is not another sad post about how writing gets me so down but rather how my family really makes no sense sometimes. I just want out of it all. I hate drama and I hate making everything more intense than it is. Life is already a long journey, don't try to make it more intense than it is. You're only setting yourself up for more tears. Tears which no one wants to see, so go ahead put them away. I'm waiting. You done? This could take awhile you say? Well, that's too bad because that's what you said about finishing that one thing and then that other thing. What is the point of all this anyway?
Since I don't know what I'm doing (and tell people so sometimes) I really just try to be content in the moment. That's what it's all about. I know I'm not about to be half the person that my mother is or even what my father is but I don't know if I would want to. Sure, they're great people. Are they great in their thoughts and ideas? Maybe, but maybe not. But, hey that's all cool. I'm not supposed to hate on them for that anyway. What I'm really doing is trying to lay the foundation for myself. Problem is I don't know what the heck that foundation is or how to get there. So many questions and so many little ways of answering them. Story of me at the moment.
So if nothing goes according to the always changing plan (that plan being get a job, get out, travel, or go to grad school and teach far away) then I'll just write my head away into the clouds. Like I might have said in another post, I don't know anything else. I really don't. Who knows who the heck reads these, because they do get posted on my twitter and tumblr (sometimes) but if you are reading then know this: It doesn't get better. You might as well know that now. It gets worse before it gets better is a better thing to say, if you ask me (this is not referring to LGBT issues or anything, it's just life in general). I'm going to keep writing this blog. I'm going to help people and I'm going to ignore the negativity around me because it does nothing. I don't have time to be sad, when life is already so overdramatic sometimes.
As a precaution also that nothing works out, I'm still going to read books. I'm still hoping to be on someone's awesome list for something. I'm watching people I went to high school with get married and have kids and settle in life. And I'm just…here. I don't want to travel to be an impact, not necessarily. No, I want to do things for my own personal happiness too. Because that is important too, is it not. I thought so. Well, just in case anyone wanted to know I am still searching. For myself. For what I want. For who I want. For a best friend, because really I've never had one and hey, life is lonely sometimes when everyone else is gone off but you.
I don't think I've found my direction yet. It's going to take some more time, I'm grateful for my mother. She seems to understand my pains, since she has been there. I'm not very good at expressing myself, however (something I'm working on). I don't really write in here anymore, but I haven't forgotten about it. So, here's to hopefully more posting.
I'm still hoping someone will hire me, but I've realized I need to keep writing online. In the next few days, I'm going to just crank out some articles on different sites. I haven't been sharing new articles with family, but I will since there will be more to read. My parents love to read whatever I write. I'm working on getting healthy (not that I'm not), but I guess more active. It can make you incredibly happy, too.
So, writing. It's what I do. But, I what to teach too. To inspire people. Do I do that already? I don't really know. I want to travel abroad and maybe teach abroad. I want to one day mentor someone and impact their lives positively. I want to live in a house or apartment with girls and we will all become good friends. Mostly because I don't have any. But that's ok, because I have my mother, right? No, sometimes it really is not enough.
I think I should stop now. I'm confused with life. I don't want to end up alone. I want to be happy, but that is not someplace that is easy to reach out and grab.


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text:
HomeCelebrity SizesKat Dennings Bra Size
Katherine Litwack popularly known as Kat Dennings is a popular actress in Hollywood as well as a television personality. She was born in a small town near Philadelphia and at first her parents were against her pursuing an acting career but they supported her by moving to L.A. Now they never regretted their decision. She is one of the most famous celebrities in the Hollywood and was an important character in HBO well-known series Sex in the City. Kat got her break for her role in the rom-com movie, Nick & Norah in 2008's Infinite Playlist. Her career has blossomed due to her talent, glamorous look and sexy attractive body. 2 Broke Girls, Thor Movie Series, The House Bunny are some movies she appeared.
Kat Dennings is famous for her physical appearance and she got many fans because of her enticing looks. Through exercise and intense diet, she has been able to maintain her attractive body physique. Kat started to become more of a household name, people began realizing her boobs sized 34DD. Kat Dennings claimed her boobs are natural and you would believe her as there is no sign of any surgery. Because if she had a boob job done, the difference in size and shape of her boobs could have been noticed but Kat Dennings breasts look incredibly normal.
Kat Dennings Bra Size: 34DD
Kat Dennings Measurements
Body Measurements: 38-27-34 in or 96.5-68.5-87 cm
Height: 5 ft 3½ in or 161 cm
Weight: 128 pounds or 58 kg
Bra Size: 34DD
Cup Size: DD
Shoe Size: 7 (US)
Dress Size: 10 (US) Not Sure
Christina Hendricks Bra Size
Katy Perry Bra Size


A tough challenge for many executives is convincing top talent to join their company. A second challenge is training newcomers to understand the company's core values.
To become better at hiring and training, it pays to know how humans are hardwired for stories. If you want the prospective employees to think it over, give them lots of facts and figures. If you want them to decide to join your company for the right reasons, then tell them the right story.
Now any executive can easily use proven techniques of telling a great story employed by Hollywood, Madison Avenue, and Wall Street by employing six simple steps to storytelling to attract the right candidates and properly train them on your company culture.
These stories must be true case studies but told in a certain way. The process starts with understanding your core values.
Top candidates don't want to work just anywhere. They want an organization where they align with the core values.
Start with a main character. Every story starts with the name of a character who wants something. This is your client. Make your main characters likable so the listeners will root for them. To make them likable, describe some of their good qualities or attributes. Generally, three attributes work best: "Marie was smart, tough, and fair" or "Johan was hardworking, caring and passionate." For privacy reasons you do not need to use their real names ("this is a true story, but the names have been changed to protect confidentiality").
Have a nemesis character. Stories need conflict to be interesting. What person, institution, or condition stands in the character's way? The villain in the story might be a challenge in the business environment, such as the recession of 2008 or the Affordable Care Act (the government is always a classic nemesis character).
Bring in a mentor character. Heroes need help on their journey. They need to work with a wise person. This is where you come in. Be the voice of wisdom and experience. The hero does not succeed alone; they succeed because of the help you provided.
Know what story you are telling. Human brains are programmed to relate to one of eight great meta-stories. These are: monster, underdog, comedy, tragedy, mystery, quest, rebirth, and escape. If the story is about overcoming a huge problem, that is a monster problem story. If the company was like a David that overcame an industry Goliath, that is an underdog story.
Have the hero succeed. Typically, the main character needs to succeed, with one exception: tragedy. The tragic story is told as a cautionary tale. Great for teaching lessons, but not great for attracting clients. Have the hero go from mess to success (it was a struggle, and they couldn't have done it without you).
Give the listeners the moral of the story, which is the core value. Take a cue from Aesop, the man who gave us fables like The Tortoise and the Hare (the moral: slow and steady wins the race). Don't count on the listeners to get the message. The storyteller's final job is to tell them what the story means.
After you build an inventory of stories that demonstrate your core values in action, you are then ready to deploy the stories. In storytelling, context is everything. You should never randomly tell stories, but instead use stories at the right strategic times.
During a job interview. No, don't start the interview telling stories. However, once the candidate has shared about themselves, then the interviewer can share stories about the core values of the organization.
During a training class. Core values should be taught during training. First, state the core value and then explain what that means. For them to really get the point, tell a story about that core value in action.
At weekly staff meetings. One executive boasted that his organization had 22 core values, and they were on posters throughout the office. Asked if he had any stories to illustrate, a little red faced he said "No." Now every week at staff meeting they tell a story to illustrate one of the twenty-two core values.
At company-wide meetings. Is it time to assemble all the troops? Maybe for a change in direction or for recognition? This is a perfect time for core value selling.
On the company website. Promote core value stories on your website to detail for clients and potential clients the power of story.
In company brochures and collateral material. Since stories connect on an emotional level, doesn't it make sense to put them down in writing?
Storytelling helps persuade on an emotional level. Maybe that is why so many Fortune 500 companies are honing in on storytelling techniques and imparting that wisdom on their sales and business development professionals to tell relatable stories that will convince prospects.
Henry DeVries, CEO of Indie Books International, works with consultants to attract high-paying clients by marketing with a book and speech. As a professional speaker, he teaches sales and business development professionals how to build an inventory of persuasive stories. He is the author of "Marketing with a Book" and "Persuade with a Story!" For more information, visit www.indiebooksintl.com.


On Monday last a bazaar was held in the Girls' Board Schoolroom, at Bozeat, in aid of the fund for the restoration of this church. In 1876 the spire of the church fell, and in consequence of the ruinous condition of the tower it was deemed necessary to remove the bells. An attempt has now been set on foot to re-build the tower and re-hang the bells; and, if possible, to rebuild the spire also, and do other necessary repairs to the church. The parish, however, is far from being a wealthy one, and it is hoped that Churchmen in neighbouring parishes will be disposed to assist in so praiseworthy an undertaking. The weather on Monday last was everything that could be desired, and the day being now kept as a general holiday there was a good attendance of visitors at the opening of the bazaar. The ceremonial was of the simplest kind, and occupied only a few minutes. The Vicar, the Rev. A. E. Kinch, explained the object of the bazaar, and then called upon the Ven. Archdeacon of Oakham to formally open it. Archdeacon Lightfoot expressed the pleasure it gave him to be present on that occasion, and his hearty sympathy with the object which had brought them together. They could not have a better or nobler work than restoring the house of God. He could remember seeing the spire of Bozeat Church several years ago, but now it was impossible for a visitor not to notice the absence of the spire, and the silence of the bells. He hoped the bazaar would prove very successful, and that at no distant day they might be enabled to carry out the proposed restoration. The rev. gentleman then formally declared the bazaar open, and active operations at once commenced, a brisk trade being done throughout the day. Amongst the visitors present were Archdeacon Lightfoot and party; Canon Barker and party; Rev. F. W. Willis and party; Hon. and Rev. L. C. R. Irby and Mrs. Irby (Whiston), Rev. G. P. Irby (Doddington), Rev. J. Geldart and Mrs. Geldart (Podington), Rev. F. Ball (Wollaston), Rev. J. C. Fold (East Haddon), Mr. T. Revis (Clifton Reynes), Mr. and Mrs. Maxwell, Mr. and Mrs. Drage and family, Mrs Gibbard and family, Mr. and Mrs. Everett and family of Doddington, Mr. and Mrs. Walker and family (Strixton), Miss Keep (Wollaston), Miss White (Podington), Mrs. Brown and Misses Brown, Mrs. Orr (Wollaston), Mrs. Gillitt and family (Wollaston), Mr. Ashwell (Stowe, Bucks.), Mr. and Mrs. Monk and family, Mr. T. H. Wykes and Mrs. Wykes and family (Strixton), Mr. N. T. Hewens, Mr. E. Blott, Miss Sharman and Miss Woolston (Wellingborough), &c., &c. The hall was prettily decorated, and the well-stocked stalls were admirably arranged and presented a very pleasing appearance. The refreshment stall—always a prominent feature upon these occasions—was under the management of Mrs. Walker (Strixton) and Mrs. Gibbard (Strixton), and the stalls for the sale useful and fancy articles, including some good specimens of Dunmore pottery, were presided over by Mrs. Kinch, Miss Kinch, Mrs. Wm. Kinch, Mrs. Orr, Miss Hill, Miss Wykes, Mrs. Kirby, Mrs. Bass (Leicester); Mrs. W. Drage and Mrs. Monk. In addition to the ordinary stalls, there were also the usual accessories to a bazaar, via., a weighing machine in charge of Mr. J. Monk; a doll's house, Miss Lily Tyler and Miss Maud Bass; flowering plants, Miss Malin and Miss Humphries; bran pie, Misses Ethel Monk, Nellie Monk, and Polly Drage; post office, Miss Kate Bass; and fish pond, Mr. W. Kinch. We must not omit to mention that there were also numerous young ladies who offered "button-holes" to gentlemen visitors with considerable success. The museum, without which no bazaar would be complete, was arranged in one of the class-rooms, and found an efficient curator in Mr. Kirby, the parochial schoolmaster. Amongst the curiosities exhibited were Fiji dresses and clubs, from Mr. Warwick, Brington; Indian butterflies, &c., from Rev. L. H. Loyd, Northampton; Zulu assegais, from the battle field of Gingilhovo, lent by Mr. Kinch; a fine old Bible printed in 1619, and belonging to Mr. Cooke, the Bozeat postman; New Zealand village and household idols, &c., lent by the Rev. Fredk. Ball, of Wollaston; Egyptian curiosities, including a very ancient brick, supposed to have been made by the Israelities, from Mr. W. Blott, Wellingborough; and various other equal interesting exhibits from Mr. Rice, Harleston; Mr. Reed, Kibworth, &c.; amongst them being a Nubian tear bottle, Zulu and Fiji head scratchers, African and Egyptian photographs, &c. The bazaar remained open during the remainder of the day, and also on Tuesday, and on each occasion there was a brisk trade. In the evening there was a selection of vocal and instrumental music. Previous to the bazaar, we understand that £200 had been subscribed towards the restoration fund, the list being headed with a donation of £50 from the lord of the manor, Mr. T. Revis, Clifton Reynes. This amount was, no doubt, largely augmented by the proceeds of the bazaar.
The church bells which, as stated above, have been removed from the tower, are now placed in the churchyard. The largest was cast in 1633, and bears the following inscription:— "I. H.S., Nazarenus, Rex Judeorum. Fili Dei Miserere Mei." The next in size is dated 1635, and is similarly inscribed, whilst the third simply states, "Newcome, of Leicester, made me." On the smallest is the following: "Tho. Drake, vic.; Will. Jakes, Tho. Wright, church-wardens. Henry Penn, Founder, 1723. This is ingeniously fixed in the churchyard, and does temporary duty for the whole.
Bozeat Ambulance Parade—At the annual church parade at Bozeat on Sunday of the local ambulance corps, First Officer Swindall and Sergeant Knight, of Rushden, were among those present, representatives from Higham Ferrers, Irchester, Wollaston, and Wellingborough also attending. After the service, which was conducted by the Rev. Frank Jones, of Wellingborough, the men were entertained to supper by the Rev. W. D. Sargeaunt (vicar). At the close, First Officer Swindall heartily thanked the rev. Gentleman for his kindness.


After some long hours of editing in front of the computer screen, I present my newest experiment into film making. Please enjoy a true glimpse into paradise. The video was filmed while sailing across the extremely remote Tuamotus atolls. Exploring French Polynesia has certainly been an all-time favorite destination for me so far!
For nearly four weeks I was able to join the voyage of Tua-Lisa. Maria and Modris welcomed me warmly aboard their cozy boat. Since departing from Stockholm about 2,5 years ago they have sailed their vessel through northern Europe, across the Atlantic to Brazil and then all the way around the southern end of the continent before crossing the Pacific from Chile to the Marquesas. Together with their Chilean stray dog Preta, we got to explore the beautiful island of Tahuata.
© 2014 - 2016. Doran Hannes. All rights reserved.


This Crock Pot Orange Chicken is super fast to put together and you can cook it on low or high depending on how long you plan to cook it for. All you need to do is combine all of the ingredients together in the crock pot and let it cook! Serve it with your favorite rice or fried rice.
Stir together all ingredients aside from the chicken together, then pour the sauce in on top of the chicken and stir to coat. Next, cover and cook on high for 3-4 hours or low for 6-8 hours!
The chicken is ready once the internal temperature reaches 165 degrees. You can also shred the chicken at this point, which I do sometimes but today left it in pieces. Serve and enjoy!
Put chicken in crock pot.
In a separate bowl, combine remaining ingredients for sauce. Then, pour on top of chicken and stir to coat.


SRINAGAR, Apr 14: National Conference (NC) president Farooq Abdullah Saturday said this parliamentary elections will decide whether Jammu and Kashmir will be "able to remain a part of the Union with dignity".
Addressing election meetings in at Babademb in Khanyar and Kangan in Ganderbal, Abdullah, who is contesting from Srinagar LokSabha seat, said people have to vote for preserving the country's secular disposition, integrity and unity.
"This election shall decide if the state of Jammu and Kashmir is able to remain a part of the Union with dignity.
The people of state are directly fighting the BJP and their cronies here through ballot for the protection of their identity," he said.
He alleged that Prime Minister NarendraModi has failed on all fronts. "He is a failed prime minister of a failed government. He has failed on every conceivable matrix. Not to talk of his promises which he made in the run up to the 2014 elections. He has put into abyss what good was achieved by the previous government.
"Why is he (Modi) shying away from answering what he was able to achieve during his stint in power? The other day, Congress leader KapilSibal revealed aRs three lakh crore currency racket involving the BJP. Not just that, people are seeking answers from him (prime minister) on Rafael deal," Abdullah said.
"I earnestly insist a thorough inquiry into the incident that killed 40 CRPF men on the Jammu Srinagar highway. Unfortunately, PM Modi is milking the post-Pulwama situation and Balakote (anti-terror airstrikes) to extreme levels to hide his misrule and misgovernance.


text:
HomeAssociationsA4E calls on EU to defend travellers as Europe faces another air traffic control strike in France
A4E calls on EU to defend travellers as Europe faces another air traffic control strike in France
The negative impact of ATC strikes on European Aviation is a key issue for A4E airlines and their customers.
Last two‐day strike caused over 1,000 flight cancellations and 500,000 minutes of delay. A4E urges the EU and key stakeholders to support an immediate action plan to minimise strike impact.
Just after ten days of extensive disruptions in European aviation another French air traffic controller (ATC) strike will cause further chaos to the travel plans of millions of European travellers for at least 36 hours from tomorrow evening. This will be the 43rd strike day in France since 2009 and it will see hundreds of flights being cancelled creating disruption and extensive delays across the continent.
"Repeated and disproportionate industrial action by French ATC unions is seriously impacting the travel plans of thousands of passengers during Easter. It is unacceptable that airlines and their customers can be repeatedly punished by these unjustified strikes. We call on the European Commission to act immediately to defend consumers", said Thomas Reynaert, Managing Director of A4E.
"We are currently working on an immediate action plan to minimise strike effects on both local traffic and overflights. But we also need the European Commission to remain at the helm of implementing a European Aviation Strategy without disruptions and to the benefit of travellers. This must be a priority," he added.
The French ATC strike from 20th till 22nd of March caused over 1,000 cancellations among the A4E members and was the source of 500,000 delay minutes (8,333 hours or 347 days) across all airlines operating in European airspace during the strike period. "Needless to say A4E accepts that the right to strike is a fundamental right, but one million or more passengers cannot have their travel plans spoiled again by this dispute," confirmed Reynaert.
Last year, more than 10,000 flights operated by A4E members were affected by 28 days of ATC strikes in Europe causing unjustified disruptions to millions of passengers.
At its launch in January this year, A4E highlighted its position on improving European Air Traffic Management. The key aims are: delivering reliable and efficient airspace by reducing the cost of ATC provision through completion of the Single European Sky and better economic regulation at EU level; ensuring that the disruption caused to passengers across Europe by ATC strikes is minimised; using new technology to make efficiency savings; and using SESAR funding to drive compliance with the Single Sky framework.
Airports and airlines call for halt to unnecessary and ineffective travel restrictions
Airports and airlines issue plea to Europe's Heads of State
A4Eair travelstrike
The Government of Canada announces new investment in Parks Canada's historic canals in Quebec
EgyptAir flight MS181 hijack ended with all passengers freed


text:
The Call of Courage is a 1925 American silent Western film directed by Clifford Smith and written by Harold Shumate. The film stars Art Acord, Olive Hasbrouck, Duke R. Lee, Frank Rice, John T. Prince, and Turner Savage. The film was released on December 22, 1925, by Universal Pictures.

Cast

References

External links

1925 films
1925 Western (genre) films
Universal Pictures films
Films directed by Clifford Smith
American black-and-white films
Silent American Western (genre) films
1920s English-language films
1920s American films

redpajama_set_name: RedPajamaWikipedia


text:
<?php

namespace Fenchy\NoticeBundle\Entity;

use Doctrine\ORM\Mapping as ORM,
    Fenchy\NoticeBundle\Entity\Notice,
    Doctrine\Common\Collections\ArrayCollection;

use Symfony\Component\Validator\Constraints as Assert;

/**
 * @ORM\Table(name="notice__dictionary")
 * @ORM\Entity(repositoryClass="Fenchy\NoticeBundle\Entity\DictionaryRepository")
 */
class Dictionary
{
    /**
     * @ORM\Id
     * @ORM\Column(type="integer")
     * @ORM\GeneratedValue(strategy="IDENTITY")
     */
    private $id;

    /**
     * @var string $text
     *
     * @ORM\Column(type="string", length=255, nullable=false, unique=true)
     * @Assert\NotBlank
     */
    private $text;

    /**
     * @var integer
     * @ORM\Column(type="boolean", nullable=false)
     */
    private $tag;

    /**
     * @var integer $quantitySearch
     *
     * @ORM\Column(name="quantity_search", type="integer", length=255, nullable=false)
     */
    private $quantitySearch;

    /**
     * @var integer $quantityTag
     *
     * @ORM\Column(name="quantity_tag", type="integer", length=255, nullable=false)
     */
    private $quantityTag;

    /**
     * @var integer
     * @ORM\Column(name="search_activated", type="boolean", nullable=false)
     */
    private $searchActivated;

    /**
     * @var integer
     * @ORM\Column(name="tag_activated", type="boolean", nullable=false)
     */
    private $tagActivated;

    /**
     * @var bool $disabled
     * @ORM\Column(type="boolean", nullable=false)
     */
    private $disabled;

    /**
     * @var ArrayCollection $notices
     *
     * @ORM\ManyToMany(targetEntity="Fenchy\NoticeBundle\Entity\Notice", inversedBy="dictionaries")
     * @ORM\JoinTable(name="notice__notices__dictionaries")
     */
    protected $notices;

    public function __construct() {

        $this->quantitySearch = 0;
        $this->quantityTag = 0;
        $this->searchActivated = FALSE;
        $this->tagActivated = FALSE;
        $this->disabled = FALSE;
        $this->tag = FALSE;
        $this->notices = new ArrayCollection();
    }

    public function __toString() {
        return $this->text;
    }

    /**
     * @return integer
     */
    public function getId() {

        return $this->id;
    }

    /**
     * @param integer $id
     * @return Notice
     */
    public function setId($id) {

        $this->id = $id;

        return $this;
    }

    /**
     * @return string
     */
    public function getText() {

        return $this->text;
    }

    /**
     * @param string $text
     * @return Dictionary
     */
    public function setText($text) {

        $this->text = $text;

        return $this;
    }

    public function setSearchActivated($activated) {

        $this->searchActivated = $activated;

        return $this;
    }

    public function getSearchActivated() {

        return $this->searchActivated;
    }

    public function setTagActivated($activated) {

        $this->tagActivated = $activated;

        return $this;
    }

    public function getTagActivated() {

        return $this->tagActivated;
    }

    public function setDisabled($disabled) {

        $this->disabled = $disabled;

        return $this;
    }

    public function getDisabled() {

        return $this->disabled;
    }

    public function setQuantitySearch($quantity) {

        $this->quantitySearch = $quantity;

        return $this;
    }

    public function getQuantitySearch() {

        return $this->quantitySearch;
    }

    public function incQuantitySearch($amount = 1) {

        $this->quantitySearch += $amount;

        return $this;
    }

    public function setQuantityTag($quantity) {

        $this->quantityTag = $quantity;

        return $this;
    }

    public function getQuantityTag() {

        return $this->quantityTag;
    }

    public function incQuantityTag($amount = 1) {

        $this->quantityTag += $amount;

        return $this;
    }

    public function setTag($bool) {

        $this->tag = (bool) $bool;

        return $this;
    }

    public function getTag() {

        return $this->tag;
    }

    public function getNotices11() {

        return $this->notices;
    }

    public function setNotices($notices) {

        $this->notices = $notices;

        return $this;
    }

    public function addNotice($notice) {

        $this->notices->add($notice);

        return $this;
    }

    public function removeNotice($notice) {

        $this->notices->removeElement($notice);

        return $this;
    }
}

redpajama_set_name: RedPajamaGithub


"The Continuation of the Scheme"
The founder of a non-profit group that promotes teaching of the U.S. Constitution stumbled on an early draft of it in Philadelphia this week, penned by James Wilson and entitled, "The Continuation of the Scheme."
She was exploring in the Historical Society of Pennsylvania, when she connected a short passage on the back of one draft of the Constitution, in Wilson's hand, to the rest of the document, buried in the archives among Wilson's papers.
"This was national scripture, a piece of our Constitution's history," she said of her find in November. "It was difficult to keep my hands from trembling."
As other researchers "realized what was happening, there was a sort of hushed awe that settled over the reading room," Toler said. "One of them said the hair on her arms stood on end."
Two drafts of the Constitution in Wilson's hand had been separated from his papers long ago. One of them included the beginning of still another draft and was apparently seen as part of a single working version, instead of a separate draft.
Toler said "The Continuation of the Scheme," including its provisions about the executive and judiciary branches, completes that draft, making it a third.
I guess there are worse pitches to make to possible donors for a Constitution non-profit than, "Remember that time I found a new draft of the Constitution?"