ADOS vs. BOSA: A Mum’s Perspective on Autism Assessments - Mummy Of Four

If you’re navigating the world of autism assessments as a parent, you might have come across terms like “ADOS” and “BOSA.” If they sound confusing, you’re not alone. As a mum of children who have gone through both assessments, I understand how overwhelming the process can be, especially when you’re trying to figure out what’s best for your child.

In this blog post, I want to share what the ADOS and BOSA assessments are, how they differ, and my personal experiences going through both with my 2 youngest children, Bella and Zara. My hope is that by sharing this, other parents can feel a bit more prepared and reassured when facing these assessments themselves.

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Table Of Contents

What is the ADOS?

The Autism Diagnostic Observation Schedule (ADOS) is one of the most commonly used tools to diagnose Autism Spectrum Disorder (ASD). According to the NHS, the ADOS is “a standardised assessment used to diagnose ASD.” It’s a play-based assessment where a trained clinician interacts directly with your child to observe their behaviour and social communication skills. The idea behind ADOS is that it’s highly structured, allowing the clinician to create situations where social responses are observed, giving them a good understanding of the child’s behaviours related to autism.

There are different modules of ADOS, each tailored to different age groups and levels of speech ability:

Module 1: For non-verbal children or those who use few words.
Module 2: For children who speak in phrases but have limited language abilities.
Module 3: For children with fluent speech (this is what Bella had).
Module 4: For adolescents and adults with fluent speech.

The key idea is that no matter where the ADOS is carried out, it follows the same standardised procedures, which means that it should give reliable and consistent results.

What is the BOSA?

The Brief Observation of Symptoms of Autism (BOSA) is a more recent tool that was developed during the pandemic, when traditional face-to-face assessments like the ADOS weren’t feasible due to restrictions. The BOSA involves a parent interacting with the child while the clinician observes from a distance. The NHS describes it as “an adapted version of the ADOS that allows a more flexible assessment while still aiming to identify autism-related behaviours.”

The BOSA is less structured compared to ADOS. Instead of the clinician leading the assessment, the parent does. This can make the child feel more comfortable, as they’re engaging in activities with someone familiar. It also allowed assessments to continue during the pandemic, when social distancing rules made traditional ADOS assessments challenging.

Comparing ADOS and BOSA

Here’s a quick comparison between the ADOS and BOSA assessments:

Structure:
ADOS is clinician-led. The clinician uses specific activities and situations to directly assess the child.
BOSA is parent-led, with a clinician observing. The parent takes the lead, which can create a more relaxed environment for the child.
Observation Environment:
ADOS provides a highly controlled environment, allowing the clinician to see how the child responds without interference from a parent.
BOSA uses a more natural setting, where a parent is present, making it feel less intimidating, especially for younger children.
Use Cases:
The ADOS is generally considered the gold standard for diagnosing autism because of its structured and thorough nature.
The BOSA was developed to help maintain diagnostic continuity during COVID-19, when a full ADOS wasn’t practical.
Strengths and Challenges:
ADOS gives consistent and reliable results but can feel clinical, which might intimidate some children.
BOSA allows the child to be more comfortable, especially in unusual circumstances like a pandemic, but may not provide as comprehensive results.

My Experience with Bella’s ADOS Assessment

Bella’s ADOS assessment was a Module 3, which is used for children with fluent speech. It took place in an NHS children’s clinic, a place we had visited before, which made it slightly less daunting. I was able to watch the assessment through a one-way mirror, while Bella only saw her own reflection. The assessment itself was run by a therapist, with a consultant taking notes.

Specific Activities Bella Took Part In:

Puzzle Task: Bella was given puzzle pieces and a piece of paper with zigzag shapes. The therapist wanted to see if Bella would ask for more pieces or just take them. Bella ended up reaching across the table to take them without asking—something the clinician noted, as children with autism often struggle with the social skill of asking for what they need.
Picture Book Task: Bella was given a picture book and asked to describe what the characters might be thinking or feeling. She focused on what the characters were doing rather than on their emotions, which can be a sign of difficulty with emotional recognition.
Imaginative Play: Bella was given a set of toys and was asked to play. She fixated on making a character hold an object in a very particular way, which indicated a certain rigidity in her thinking—another sign that clinicians look for in assessing autism.
Gesture and Role Play: She was asked to mime activities, like brushing her teeth. Bella didn’t engage much with this task, which was another point noted by the clinician, as it may show challenges with non-verbal communication.

Overall, the ADOS assessment was quite an intense experience—for both Bella and me. It was hard not being able to be in the room and having to watch from behind a mirror. Bella did her best, but there were moments where I just wanted to be there to comfort her. In the end, it took about two weeks for us to get the results, and that waiting period was emotionally exhausting.

My Experience with Zara’s BOSA Assessment

Zara’s assessment took place during the pandemic, which meant it was quite different from Bella’s. Instead of doing an ADOS, Zara went through a BOSA assessment. I was in the room with Zara, leading her through the activities, while the clinician observed. This made for a more natural setting for Zara, but it also meant I had to be really careful not to influence her responses too much.

Activities Zara Took Part In:

Puzzle Task: Zara was given puzzle pieces and told to do whatever she liked with them. She ended up creatively using the pieces to form words like her siblings’ names, which the clinician noted as impressive, but also pointed to her fixation on details.
Gestures: Zara used some basic gestures, like nodding and indicating numbers with her fingers, but she didn’t “talk with her hands” as I do. The clinician pointed out that this could be a subtle indicator of autism.
Interaction with Toys: Zara, like Bella, showed some fixation. She became very focused on arranging puzzle pieces into words, and while this was creative, it also showed a pattern of detail-oriented behaviour that they consider during an autism assessment.

I found Zara’s BOSA assessment both comforting and challenging. It was comforting because I was right there with her, but it was challenging because I worried about how my presence might affect her responses. When we received the diagnosis that Zara met the criteria for autism, I felt a wave of emotions—relief that we had some answers, but also shock and sadness. Even though I knew it was a possibility, hearing the confirmation was still overwhelming.

Reflections on the Pros and Cons

Benefits of Each Assessment:

ADOS is incredibly thorough, offering a structured approach that allows clinicians to really get a complete picture. It’s still considered the gold standard for autism diagnosis.
BOSA is much more relaxed, which can make a world of difference for children who find clinical environments intimidating. Having me in the room meant Zara felt more at ease, which was a big positive.

Challenges:

With ADOS, it’s incredibly difficult as a parent to watch from a distance and not be able to jump in to support your child. The structured environment can also be intimidating for some children.
BOSA is easier for the child in many ways, but being involved in the assessment as a parent can be tough. I worried a lot about influencing Zara’s behaviour and affecting the outcome.

What I Want Other Parents to Know

If you’re facing an autism assessment for your child, I want you to know that both ADOS and BOSA can provide really valuable insights. Each has its place, and the choice between the two might depend on circumstances—like it did for us with the pandemic.

The most important thing you can do is trust your instincts. Advocate for your child. Ask questions about the process, and if you feel something isn’t right, speak up. These assessments are not about defining your child—they’re about understanding them better so that you can support them as best as possible.

Final Thoughts

The journey through autism assessments isn’t easy, but it’s a step towards getting the support your child needs. Whether your child has an ADOS or a BOSA, remember that these are just tools. Bella and Zara are still the same wonderful children they’ve always been. The assessments simply helped us understand how we can help them thrive.

If you’re in the middle of this process, I hope this post has given you a little insight and some reassurance. It’s okay to feel overwhelmed, but it’s also okay to feel empowered by the knowledge these assessments provide.

If you wantto hear more about my experiences and reflections, I’ve also recorded a podcast episode that dives deeper into both assessments. You can find it linked below or in your favourite podcast app.

Remember, you’re not alone on this journey. The more we share, the more we can support each other.

Related Podcast Episode: [Listen to the Podcast Here]

Thank you for reading, and I’d love to hear about your own experiences. Feel free to share in the comments if your child has gone through an autism assessment, and how it went for you. Together, we can help each other navigate this journey.

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