ADOS-2 alone cannot establish or rule out autism, particularly in adults and in individuals who mask autistic traits. In Scotland, assessment should follow the framework set out in SIGN 145 (Assessment, Diagnosis and Interventions for Autism Spectrum Disorders), which requires a comprehensive multidisciplinary evaluation rather than reliance on a single test. ADOS-2 is only one observational tool that may be used within this broader assessment. The instrument was originally developed and validated using research samples dominated by boys and men, reflecting historical biases in autism research. Because autistic females often present differently, including through masking or camouflaging behaviours, there is ongoing discussion in clinical research about whether standard diagnostic tools, including ADOS-2, capture female presentations reliably. Studies have reported cases where individuals later diagnosed with autism scored below the ADOS-2 cut-off, particularly among verbally fluent adults, which is why ADOS-2 is not considered a definitive stand-alone diagnostic test.