Measuring Change in Social Communication Behaviors: Reliability, Validity, and Application

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

DSM-5 and autism spectrum disorders (ASDs): an opportunity for identifying ASD subtypes

The heterogeneous clinical presentations of individuals with autism spectrum disorders (ASDs) poses a significant challenge for sample characterization and limits the interpretability and replicability of research studies. The Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-5) diagnostic criteria for ASD, with its dimensional approach, may be a useful framework to increase the homogeneity of research samples. In this review, we summarize the revisions to the diagnostic criteria for ASD, briefly highlight the literature supporting these changes, and illustrate how DSM-5 can improve sample characterization and provide opportunities for researchers to identify possible subtypes within ASD

Quantifying the effects of temperature and noise on attention-level using EDA and EEG sensors

Most people with Autism Spectrum Disorder (ASD) experience atypical sensory modality and need help to self-regulate their sensory responses. Results of a pilot study are presented here where temperature, noise types and noise levels are used as independent variables. Attention-based tests (ABTs), Electrodermal Activity (EDA) and Electroencephalography (EEG) sensors are used as dependent variables to quantify the effects of temperature and noise. Based on the outcome of the analyses, it is feasible to use off-the-shelf sensors to recognize physiological changes, indicating a possibility to develop sensory management recommendation interventions to support people with ASD

Parent-reported and clinician-observed autism spectrum disorder (ASD) symptoms in children with attention deficit/hyperactivity disorder (ADHD): implications for practice under DSM-5

BackgroundChildren with attention deficit/hyperactivity disorder (ADHD) often present with social difficulties, though the extent to which these clearly overlap with symptoms of autism spectrum disorder (ASD) is not well understood.MethodsWe explored parent-reported and directly-observed ASD symptoms on the Autism Diagnostic Interview-Revised (ADI-R) and the Autism Diagnostic Observation Schedule (ADOS) in children referred to ASD-specialty clinics who received diagnoses of either ADHD (n = 48) or ASD (n = 164).ResultsOf the ADHD sample, 21 % met ASD cut-offs on the ADOS and 30 % met ASD cut-offs on all domains of the ADI-R. Four social communication ADOS items (Quality of Social Overtures, Unusual Eye Contact, Facial Expressions Directed to Examiner, and Amount of Reciprocal Social Communication) adequately differentiated the groups while none of the items on the ADI-R met the criteria for adequate discrimination.ConclusionsResults of this work highlight the challenges that clinicians and researchers face when distinguishing ASD from other disorders in verbally fluent, school-age children

Extending the Usefulness of the Brief Observation of Social Communication Change (BOSCC): Validating the Phrase Speech and Young Fluent Version.

The current study investigated the utility of the Brief Observation of Social Communication Change-Phrase Speech Young Fluent (BOSCC-PSYF) as an outcome measure of treatment response by analyzing the measures psychometric properties and initial validity. The BOSCC coding scheme was applied to 345 administrations from 160 participants diagnosed with autism. Participants included individuals of any age with phrase speech, or individuals under the age of 8 years with complex sentences. All were receiving behavioral intervention throughout the study. Test-retest and inter-rater reliability were good for the Early Communication and Social Reciprocity/Language domains, and fair for the Restricted and Repetitive Behavior domain. Significant changes occurred over time in the Early Communication and Social Reciprocity/Language domains, and Core Total scores. The BOSCC-PSYF may provide a low-cost, flexible, and user-friendly outcome measure that reliably measures changes in broad social communicative behaviors in a short period of time