The Brief Observation of Social Communication Change (BOSCC) Using Naturalistic Social Interactions for Minimally Verbal Children with ASD

Background: The Brief Observation of Social Communication Change (BOSCC), a new treatment outcome measure, is designed to provide a standardized and efficient method of measuring changes in social and communicative behaviors in children with ASD over a relatively brief period of time (minimum of 8 – 12 weeks), observed in a naturalistic, play-based, semi-structured environment. The BOSCC offers the possibility of truly “blinded” scoring of videos by non-expert human coders. Much progress has been made in recent work on the BOSCC including the initial evidence of its strong reliability and validity (Grzadzinski et al., 2016; Kim, Grzadzinski, Martinez, & Lord, 2018).

Objectives: 1) We aim to synthesize the results from our recent work to demonstrate the initial validity and reliability of the BOSCC based on parent-child interactions (Grzadzinski et al., 2016)as well as examiner-child interactions using the standardized segments from the Autism Diagnostic Observation Schedule (ADOS; referred to as the ADOS-BOSCC hereafter) in minimally verbal children (Kim, Grzadzinski, Martinez, & Lord, 2018)as well as the work by other groups (Divan et al., 2018; Fletcher-Watson et al., 2016; Kitzerow, Teufel, Wilker, & Freitag, 2016; Nordahl-Hansen, Fletcher-Watson, McConachie, & Kaale, 2016). 2) We will also propose future directions to extend the usefulness of the BOSCC based on interactions across different adult social partners (e.g., parents vs. blind examiners) as well as varying contexts (e.g., lab vs. home).

Methods: Initial psychometric studies of the BOSCC and ADOS-BOSCC included 56 children with ASD ranging from 1-5 years of age. Inter-rater and test-retest reliability as well as convergent validity were examined. The feasibility of the BOSCC application across different social partners and settings were examined based on past and on-going studies of 72 young children with ASD.

Results: Initial studies of the BOSCC and the ADOS-BOSCC demonstrated high inter-rater and test-retest reliability (intra-class correlations ranging from 0.79-0.98) as well as strong convergent validity with measures of language and adaptive communication skills. Changes in social communication skills were observed in minimally verbal children using the BOSCC with parent-child and examiner-child interactions with medium effect sizes (Cohen’s d= 0.3-0.6). A preliminary analysis based on 72 toddlers showed that the BOSCC scores obtained from the lab versus home environment did not differ significantly (t=.474, p=.492). Using a subset of children (n=49), the BOSCC scores based on examiner-child interactions were highly correlated with the BOSCC scores based on parent-child interactions (r=0.8, p<0.01).

Conclusions: The BOSCC could provide blinded observations of social communication changes in minimally verbal children with ASD under 5 years of age across different social partners and contexts with high reliability and validity. We hope to extend the usefulness of the BOSCC in future studies to further examine its strengths and limitations as well as the additive effects of the information gathered through different contexts on measuring treatment outcome.