Title: Measuring Change in Social Communication Behaviors
Description: Purpose: The field of Autism Spectrum Disorder (ASD) intervention research is in need of treatment response measures that are sensitive to change and flexible enough to be used across studies. The Brief Observation of Social Communication Change (BOSCC) was developed to address this need. The purpose of this work is to examine the initial reliability and validity of the BOSCC in two samples of children with ASD. Method: In a sample of 56 children participating in ongoing early intervention, the primary objectives of Study 1 were to 1) determine items for inclusion in the BOSCC coding scheme, 2) explore the relationships among items using factor analysis, 3) assess inter-rater and test-retest reliability, and 4) explore change over time. Using a sample of school-age, minimally-verbal children, the primary objectives of Study 2 were to extend the results of Study 1 to a new sample to 1) assess BOSCC changes over time, 2) compare changes in BOSCC to clinician determinations of improvement, 3) examine the relationship between change in BOSCC scores with changes in baseline cognitive skills, adaptive functioning, and ASD severity, and 4) compare changes in BOSCC scores in children who did and did not change on other standard measures.

Results: Study 1 revealed that the BOSCC has high to excellent inter-rater and test-retest reliability and shows convergent validity with measures of language and communication skills. The BOSCC Core total demonstrated statistically significant amounts of change over time while the ADOS Calibrated Severity Score over the same period did not. Results of Study 2 confirmed excellent inter-rater reliability but the BOSCC did not change significantly over time. Most children were identified by clinicians as improving in response to treatment. However, only 15% of children changed significantly on the BOSCC over 16 weeks of intervention. Limitations: Both studies had small samples of predominantly male, Caucasian children. When interpreting the results of these studies, it is important to consider the differences between samples, including the shorter time of treatment and more cognitively and language impaired children in Study 2. Conclusions: These studies are a first step in the development of a novel outcome measure for social-communication behaviors with applications to clinical trials and longitudinal studies.

Future work should continue to explore the benefits and limitations of the BOSCC in larger independent samples.