Rapid Review of the Brief Observation of Social Communication Change (BOSCC) Shows It Can Detect Behavioural Changes...

Reliable measurement of social communication change remains a major challenge in autism research. The Brief Observation of Social Communication Change (BOSCC) was developed to detect subtle changes in communication. This rapid review synthesised current evidence on the BOSCC's responsiveness, validity, and suitability as a clinical trial endpoint. Systematic searches of PubMed, PsycINFO, CINAHL, and Web of Science identified 19 eligible studies (n = 789). Within-group meta-analyses estimated pre-post standardised mean change (Hedges' g) for BOSCC and ADOS (Autism Diagnostic Observation Schedule) outcomes, using random-effect (RE) models. The BOSCC total score for intervention arms showed a moderate, significant change (g = -0.32, 95% confidence interval [CI] = [-0.42, -0.22]), with a smaller, non-significant change in control arms (g = -0.15). The Social Communication subscale yielded consistent effects on the intervention arm (g = -0.34, 95% CI = [-0.49, -0.19]), indicating sensitivity to improvements in reciprocal interaction. The restricted and repetitive behaviour (RRB) subscale also showed a moderate significant effect on the intervention arm but with wide confidence intervals indicating a large degree of heterogeneity in this result (g = -0.40, 95% CI = [-0.74, -0.06]). ADOS scores showed a similar pattern of results for the intervention arms, based on a sub-analysis of four studies that included both BOSCC and ADOS scores. Findings indicate that the BOSCC captures clinically meaningful behavioural change across diverse contexts. Variability in RRB outcomes may arise because they are not routinely targeted by supports for social communication, in line with neuro-affirmative approaches.Lay AbstractAutism research often aims to understand how different supports can help autistic children develop skills that are important to them and their families, such as social communication. However, changes in social communication are very difficult to measure. The Brief Observation of Social Communication Change (BOSCC) was developed to help address this. It focuses on observing natural, everyday interactions to capture subtle shifts in social communication and patterns of behaviour, and restricted and repetitive behaviours. In this review, we gathered and summarised all available studies up to March 2025 that used the BOSCC with autistic children, including both intervention studies and studies examining how well the BOSCC works. Across 19 studies including 789 children, we found that the BOSCC was consistently able to detect changes that occurred during a wide range of supports and programmes. The Social Communication subscale was particularly good at picking up changes, but the scale designed to measure repetitive behaviours was more inconsistent. The lack of changes in repetitive behaviours may reflect the diversity and important self-regulatory roles that repetitive behaviours can have, as well as the fact that many short-term interventions do not focus on changing them. The BOSCC was also found to be better at picking up changes in social communication compared to a diagnostic tool called the Autism Diagnostic Observation Schedule (ADOS). Overall, the evidence suggests that the BOSCC, particularly the Social Communication subscale, may be a useful way to detect changes in autistic communication over time. Future work should acknowledge that repetitive behaviours are not routinely targeted by supports intended to enhance communication and may serve a self-regulatory function, to manage sensory input, or to express emotions. This will help ensure that the BOSCC is used in a way that aligns with neurodiversity-affirming principles and supports ethically grounded research.