The Brief Observation of Symptoms of Autism (BOSA): Development of a New Adapted Assessment Measure for Remote Telehealth Administration Through COVID-19 and Beyond.
Deanna Dow, Alison Holbrook, Christina Toolan and 5 others
PMID 34914016WHAT IT FOUND
The BOSA is a 12 to 14 minute autism observation that works remotely or in person.
It shows good agreement with the gold standard ADOS-2 for toddlers and older children, but it is less precise than the full test and should not be used alone for diagnosis.
Key findings
01The BOSA showed strong correlation with the ADOS-2 for the Toddler Module and Module 3, but data was too limited to interpret convergence for other modules.
02Sensitivity was high across modules, ranging from 86% to 96%, but specificity varied widely from 70% to 100% depending on the module and sample size.
03The authors state the BOSA is less precise than the ADOS-2 and should be used as a screener or in conjunction with other methods, not as a standalone diagnostic tool.
STILL TO COME
How it was doneWhat they foundWhat it means for SLPs
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What it does not show
The study was conducted during the pandemic, so the samples were not representative and had very few non-autistic control participants, especially for some modules. Convergent validity with the ADOS-2 could only be assessed for the Toddler Module and Module 3 due to a lack of paired data for other groups. The BOSA is less precise than the ADOS-2 and may miss subtle symptoms or fail to elicit certain behaviors, such as restricted interests, because it lacks the full range of standardized activities. When caregivers administer the test, their natural tendency to support their child can mask the child's independent difficulties, making it harder to assess true ability.
Declared interests
The study was funded by the Simons Foundation Autism Research Initiative. The authors state that training and materials for the BOSA are available free of charge.
The easy way to misread this
Do not treat the BOSA as a standalone diagnostic tool. The authors explicitly state it is less precise than the ADOS-2 and that reliance on its scores alone should not be used to make a conclusive diagnosis.