Brief observation of symptoms of autism (BOSA): an alternative or replacement to autism diagnostic observation schedule (ADOS)

Abstract

The COVID-19 pandemic has led to significant changes in many areas of healthcare, such as a shift to telehealth models. This has created challenges for families with children awaiting autistic spectrum disorder evaluations. The Brief Observation of Symptoms of Autism (BOSA) was developed as a novel method to ensure that service users referred to services could still take part in structured observations during autism assessments in the pandemic. A service user was offered a BOSA when a clinician could not administer the Autism Diagnostic Observation Schedule–Second Edition (ADOS-2) due to COVID-19 precautions. The designers of the ADOS-2 felt that it was not designed to be used for video assessments and that its sensitivity would be significantly affected in face-to-face assessments with face covers. This paper aims to highlight some advantages and disadvantages of BOSA. Four cases were studied in a BOSA clinic, half of whom met the threshold of autism spectrum disorder based on scoring of ADOS-2 after BOSA assessment. It was found that BOSA, just like ADOS-2, allows health professionals to observe indicators of autism reliably while maintaining social distance. It is a time-efficient measure, as unlike ADOS-2, which takes about 45 minutes to be administered, it takes much less time (around 15 minutes). While the sample size is low, the issues identified may be taken forward in future studies.