Brief Outcomes in Autism Tool (BOAT): Use of a Novel Outcomes Tool to Improve Medication Management in Persons with Autism Spectrum Disorders

Background:  Many persons with autism spectrum disorders (ASD) suffer from behavioral problems that lead caregivers to seek treatment. The use of medication as an intervention has been climbing rapidly, with recent estimates reporting that the majority of persons, including children, with ASD are treated with at least one psychotropic medication. There is a pressing need to have robust measures that assess not only the impact of medications on symptoms, but also concurrently measure key aspects of pharmacotherapy itself.

Objectives:  We sought to develop an instrument to quantify behavioral changes and assess the quality of pharmacotherapy that could be easily and quickly be completed by caregivers in an outpatient setting, both at an initial encounter and for repeated measures. The goal of this scale is to provide valid and reliable caregiver reported measures to guide clinical decision making, especially of the use of pharmacotherapy in ASD.

Methods: We report on a novel ASD-specific 16-item care-giver assessed outcome measure, the Brief Outcomes in Autism Tool for Medications (BOAT-M) that measures clinically relevant dimensions related to pharmacotherapy in youth with ASD including acute symptom burden, overall caregiver perception of medication benefit, medication compliance, effect of medication changes, and non-specific and ASD-specific chronic symptom burden. We describe the design and creation of this measure, including the analysis of a preliminary data set to support the validity and responsiveness of the BOAT-M. The Clinical Global Severity (CGI-S) and Improvement (CGI-I) scale served as a standard to assess the clinical utility of the BOAT-M.

Results:   A retrospective chart review of the BOAT form of 253 persons treated over a 3 month period at an outpatient academic child psychiatry practice specializing in developmental disabilities. Two-hundred and fifty three subjects were included in this analysis with basic demographic characteristics and chronic symptom burden presented in Table 1. The summation BOAT-M score (Figure 1) was significantly correlated with the CGI-S for all subjects (n=233; r=0.403; p < 0.01) and ASD subjects (n=143; r=0.374; p<0.01). Normality was confirmed with examination of a Q-Q plot. A higher chronic symptom severity subscale score (SS) was present between ASD and typically developing persons (TDC) (t=3.5740; p < 0.001). Subscales and clinical measures are reported in Table 2.

Conclusions: The BOAT-M is a 16 item, rapid, self-administered behavioral measure directed toward caregivers with children with developmental disabilities that is divided into 5 scored subscales and 1 summation score. The subscales are Behavioral Severity (BS), Mediation Compliance (CC), Medication Benefit (MB), Medication Change (MC), and Symptom Severity (SS). Initial psychometric properties indicate the summation score is highly correlated to a standardized clinical measure. In addition, chronic symptom burden can be delineated from acute behavioral symptoms. Future directions will investigate changes between multiple visits and sensitivity to treatment response.