Brief Observation of Symptoms of Autism (BOSA)

What is a BOSA?

We understand that you will want to prepare for the assessment and your child or young person may have questions too. Below are some videos we created together with parents and their children who have had a BOSA assessment to help explain what a BOSA is and what to expect at the assessment.  You will also find more information in the sections below. 

Information for parents and carers

BOSA - Parent Carer Image

Information for young people 

BOSA - Children YP Image

There is also an animation designed for young people about BOSA assessments.

Animation for children

Covid-19 has imposed changes on the way health care is delivered across the country and worldwide with greater use of technology, which has brought both challenges and benefits. As part of adaptations made to our services, we have changed the way we are carrying out assessments for children suspected of showing symptoms of Autism Spectrum Disorder (ASD).

Before Covid, these assessments were carried out using the Autism Diagnostic Observation Schedule (ADOS) delivered by a clinician working one-to-one with the child on a schedule of assessments in order to provide a diagnosis. These assessments are designed to investigate the key indicators of ASD including communication, social interaction and restricted and repetitive behaviours. The pandemic made it difficult to deliver ADOS because it did not allow for social distancing and put the young person and clinician at risk of infection. Crucially, however, the main reason that ADOS was not able to be used was because the wearing of face masks and personal protective equipment (PPE) can impact on how the young person behaves so the results may not be reliable.

Therefore, a new clinical approach was adopted called the Brief Observation of Symptoms of Autism (BOSA). The BOSA is just one component of a multi-disciplinary diagnostic assessment and allows the young person’s behaviour to be observed. But unlike ADOS, the BOSA involves the young person interacting with their parent (or an adult they are comfortable with) rather than directly with the clinician. This is not an alternative assessment to the ADOS.  It is an assessment we can use during the pandemic to gather more information about your child’s needs.

What happens during a BOSA assessment?

Child playing game with parent BOSA assessment

During the BOSA assessment the parent will use a set of standardised tasks designed to achieve responses from their child. The activities in the BOSA are designed to give opportunities for you and your child to join in together and have fun, to interact, to communicate, to play and chat. You and your child will be asked to remove your face masks only for the duration of these play activities. This will allow us too observe your child’s own facial expressions and reactions to you. 

There are four different modules and the clinician will select the one which is most appropriate for your child’s age and level of language. During the session the clinician may need to step up or step down the assessment activities depending on your child’s strengths and needs.ur facial expressions. In order to run the assessment effectively the clinician will give parents clear instructions so that they can be well prepared for the assessment. If the parent is unsure during the assessment, the clinician is there to provide support and can coach the parent. The BOSA has been designed to be fun and interactive for all ages and the games are quick and fun to make them easy to engage with.

Your appointment letter will explain which of the four assessments has been selected for your child or young person (MV, PSYF, F1 or F2), please find below videos showing you what to expect at each of the assessment.  Please select the correct link for the assessment as mentioned in your appointment letter and do not watch this video with your child, there is an information video for young people and an animation for children.

The BOSA will be observed by an experienced clinician (for example, a Highly Specialist Speech and Language Therapist, Clinical Nurse Specialist, Paediatrician or a Clinical Psychologist) in the room, possibly with observers, wearing PPE (face mask, gloves and apron) and socially distanced. The clinicians involved in observing the BOSA are ADOS trained and have experience in administration of the ADOS.

The clinicians will be looking out for interaction and communication behaviours like, the sounds your child makes, their talking, what they talk about and how they use their body language. They will also be looking at how your child engages with the items provided, how they play and pretend and what your child is really interested in. They will be looking to see if there are any repetitive or unusual movements your child makes. They will look for any sensory behaviours they show such as sniffing items, looking very closely at the items or licking them.

How long is the BOSA assessment appointment?

The assessment takes around 45 to 60 minutes and it will be video recorded.  We will request your consent to be video recorded and written consent will be requested at the appointment. The video recording will be used only by our clinicians to review the assessment and will be held in secure storage.

What happens after the BOSA assessment?

As the BOSA is only part of your child’s assessment, the clinician will be unable to give you any feedback during the BOSA assessment appointment. The clinician observing the BOSA will write a detailed report and share this with your child’s paediatrician. A feedback appointment will then be arranged for you, with the paediatrician. They will contact you directly to arrange this.

During the feedback appointment, the paediatrician will go through the BOSA report and all of the information gathered so far. You will have an opportunity to ask questions and share any concerns regarding your child’s difficulties. The paediatrician will let you know the outcome of the diagnostic assessment and will explain why they have reached this conclusion. They will also talk about different support services available locally, that might be useful for you and your family. Please be aware there maybe the need for further assessment or ADOS if it is not possible to conclude your child’s assessment. 

After the feedback appointment, you will receive a report from the paediatrician, containing the findings and the conclusion. A copy of the BOSA report will be attached with the Paediatrician’s report.

It’s important to remember that the BOSA assessment is just one part of a wider assessment by our highly-trained staff, which will include a detailed case history of your child. Once we have the results of the BOSA, we will send you a full report and we will be able to decide on the right support that your child will need

You can find out more about the BOSA assessment here: 

We worked with families to improve the BOSA experience

We spoke to families who had experienced a BOSA assessment to find out what we could do to improve the experience for parents, carers, children and young people. 

Below are two story maps for Eva and Rebecca, both parents from two different families, you will see that they both had positive feedback but also shared how they felt the experience could be improved by having a leaflet, video and clearer information.  We listened to their feedback and that of other parents and invited Rebecca and Eva to work together with us and parent carer forums to co-produce (create together) a leaflet, a video for parents and carers and one for young people, an animation for younger children and instruction videos for parents and carers. 

BOSA Feedback - Eva
BOSA Feedback - Rebecca

A Glossary to support the BOSA report

We have included on this page a document giving an explanation of some of the words, terms or abbreviations used.  Click on the link to download the glossary

You can also find a quick guide to the glossary online, by clicking here

If you are interested in working with us to help improve the quality of the service that we deliver, then please complete this form and our co-production lead will be in touch.

And finally...

Here is a video of our journey co-producing (creating together) all the wonderful resources you can see on this page.   We worked hard but had fun along the way too.

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