Brief observational tools produced comparable results in clinic and home-based play sessions, potentially giving researchers a more flexible way to track change in young autistic children and caregiver strategies.
A new study suggests that two brief observational tools could make autism intervention research more practical and more accurate by allowing scientists to track progress in both clinics and homes. Published in the Journal of Autism and Developmental Disorders, the research found that the Brief Observation of Social Communication Change, or BOSCC, and the Measure of NDBI Strategy Implementation-Caregiver Change, or MONSI-CC, performed reliably in both settings, raising the prospect of more flexible outcome measurement for young autistic children and the caregivers who support them.
The work comes at a moment when Naturalistic Developmental Behavioural Interventions, or NDBIs, are increasingly delivered in everyday routines rather than in formal therapy rooms. These approaches, which include models such as the Early Start Denver Model, JASPER and Project ImPACT, rely heavily on caregivers using structured strategies during play and daily interaction. Until now, researchers have had limited tools for capturing whether those strategies, and the child’s response to them, are changing in the same way across different environments.
The study, led by Ji Eun Han, Yeseul Shin and So Hyun Kim of Korea University with Catherine Lord of the University of California, Los Angeles, involved 60 caregiver-child pairs. Each dyad completed the same 12-minute caregiver-led play task twice: once in a clinic and once at home. In the home setting, researchers provided remote support to mirror the procedures used in clinic, creating a telehealth-style design that reflects how many family-focused autism programmes are now delivered.
The BOSCC was developed to detect subtle shifts in social communication, rather than to establish a diagnosis. It focuses on changes such as eye contact, gestures, verbal initiation and shared engagement during a short play interaction. The MONSI-CC, by contrast, measures whether caregivers are using NDBI strategies consistently, including following the child’s lead, structuring the environment to prompt communication and responding in a way that builds on the child’s actions. Earlier research on both measures had already suggested that they were sensitive to change and could be used in intervention studies.
According to the new paper, home administration proved feasible and acceptable, with caregivers willing to take part and the sessions carried out with high fidelity. That matters because assessment systems are often designed around clinic visits that can be difficult for families to manage, particularly when transportation, work schedules or other pressures make repeated travel impractical. The study suggests that the measurement process itself may now be able to move closer to the place where intervention actually happens.
Reliability findings were also encouraging. The researchers reported similar patterns of internal consistency, inter-rater reliability and test-retest reliability in both clinic and home settings. In practical terms, that means the tools appeared to behave in a stable and predictable way regardless of where the observation took place. For researchers, that is an important requirement if progress is to be compared across families, sites or delivery models.
Perhaps most importantly, the scores recorded in clinics and homes were broadly comparable. The study found that most BOSCC and MONSI-CC results did not differ significantly between the two environments, and several cross-setting correlations were significant. That points to a useful conclusion: a child or caregiver who performs one way in clinic is likely to show a similar pattern at home. For trial designers, that could mean less need to insist on one fixed location for every assessment.
The findings also reinforce a wider developmental point. Links between caregiver strategy use and child social communication were strongest within the same setting, but they were also visible across settings, fitting with the view that development is shaped through ongoing back-and-forth between children and the adults around them. Research on the MONSI-CC published previously found that stronger caregiver use of NDBI strategies was associated with improvements in child symptoms, while reviews of the BOSCC have shown that the tool can detect changes across a range of interventions. Taken together, those studies strengthen the case for using these measures not only in research clinics but also in family homes.
The authors are careful not to claim that the study proves treatment works better at home or in clinic. Instead, it shows that short standardised observations can be carried out reliably in either place, which may help reduce barriers for families and give researchers a more realistic way to monitor change. As autism intervention increasingly shifts into homes, schools and telehealth-supported programmes, the ability to measure progress in the setting where it naturally unfolds may prove just as important as the intervention itself.
Disclaimer: This content is for informational purposes only and is not intended to be a substitute for professional medical judgment, advice, diagnosis, or treatment.
