A Comment on Test Validation: The Importance of the Clinical Perspective.

Purpose The misuse of standardized assessments has been a long-standing concern in speech-language pathology and traditionally viewed as an issue of clinician competency and training. The purpose of this article is to consider the contribution of communication breakdowns between test developers and the end users to this issue. Method We considered the misuse of standardized assessments through the lens of the 2-communities theory, in which standardized tests are viewed as a product developed in 1 community (researchers/test developers) to be used by another community (frontline clinicians). Under this view, optimal test development involves a conversation to which both parties bring unique expertise and perspectives. Results Consideration of the interpretations that standardized tests are typically validated to support revealed a mismatch between these and the interpretations and decisions that speech-language pathologists typically need to make. Test development using classical test theory, which underpins many of the tests in our field, contributes to this mismatch. Application of item response theory could better equip clinicians with the psychometric evidence to support the interpretations they desire but is not commonly found in the standardized tests used by speech-language pathologists. Conclusions Advocacy and insistence on the consideration of clinical perspectives and decision making in the test validation process is a necessary part of our role. In improving the nature of the statistical evidence reported in standardized assessments, we can ensure these tools are appropriate to fulfill our professional obligations in a clinically feasible way.

Using the Delphi Technique to Explore Complex Concepts in Speech-Language Pathology: An Illustrative Example From Children's Social Communication.

PURPOSE: In recent years, there has been an increasing interest in expanding the research approaches that speech-language pathologists utilize, particularly for addressing complex questions. Consensus-building techniques can be useful for addressing such questions. The Delphi technique is a consensus-building process involving structured communication among members of an expert panel via independent responses to iterative rounds of questionnaires. The purpose of this research note is to describe and demonstrate the Delphi technique using an application to a complex problem in speech-language pathology, that is, the bases of social communication and pragmatics. METHOD: The Delphi technique was described and illustrated via the following study: 10 expert speech-language pathologists participated in a 3-round Delphi study. Participants were asked to list the key features of social communication and pragmatics in Round 1. Questions for Rounds 2 and 3 were developed on the basis of the participants' responses to previous rounds. RESULTS: The Delphi technique was useful in bringing participants to consensus on the key features of social communication and pragmatics and offered a starting point for the continued exploration of this complex problem. CONCLUSION: A discussion of the benefits and limitations of the technique is included, highlighting the utility of the technique to the field of speech-language pathology.

Exploring use of the ICF in health education.

PURPOSE: Currently, little is known regarding use of the International Classification of Functioning, Disability and Health (ICF) in health education applications. Therefore, this review sought to examine the scope of work that has been conducted regarding the application of the ICF in health education. METHODS: A review of the current literature related to use of the ICF in health education programs was conducted. Twelve electronic databases were searched in accordance with a search protocol developed by a health sciences librarian. In total, 17,878 records were reviewed, and 18 articles met the criteria for inclusion in this review. RESULTS: Current evidence regarding use of the ICF in healthcare education revealed that program and participant properties can be essential facilitators or barriers to successful education programs. In addition, gaps in comprehensive outcome measurement were revealed as areas for future attention. Educational applications of the ICF are very much a work in progress as might be expected given the ICF's existence for only a little over a decade. CONCLUSIONS: To advance use of the ICF in education, it is important to incorporate the measurement of both knowledge acquisition and behavior change related to ICF-based programs. Ultimately, widespread implementation of the ICF represents not only a substantial opportunity but also poses a significant challenge.

A comprehensive description of functioning and disability in children with velopharyngeal insufficiency.

UNLABELLED: Children with velopharyngeal insufficiency (VPI) experience functional impairments in a variety of areas that extend beyond the primary physical impairment associated with this disorder. At present, the physical deficits associated with VPI have been studied extensively; however, a comprehensive description of social and communicative participation in this population is needed. Therefore, a biopsychosocial framework such as the International Classification of Functioning, Disability and Health for Children and Youth (ICF-CY), may offer an enhanced understanding of the daily experiences of children with VPI. Specifically, the ICF-CY framework is intended to model complex nonlinear systems, and as such, to describe functioning as the interaction of multiple components from which a limitation in communicative participation may emerge. This paper describes how the ICF-CY framework can be utilized to comprehensively describe functioning and disability in children with VPI by describing the interaction of components of this framework. LEARNING OUTCOMES: As a result of this activity, the reader will be able to: (1) discuss the utility of the ICF-CY in describing the multi-dimensional nature of velopharyngeal insufficiency (VPI); (2) describe interrelationships between functioning and disability in children with VPI; and (3) identify how limitations in communicative participation may emerge from the interaction of components of the ICF-CY in children with VPI.

A critical exploration of the International Classification of Functioning, Disability, and Health (ICF) framework from the perspective of oncology: recommendations for revision.

BACKGROUND: In 2001, the World Health Organization developed the International Classification of Functioning, Disability, and Health (ICF) framework in an effort to attend to the multidimensional health-related concerns of individuals. Historically, although the ICF has frequently been used in a rehabilitation-based context, the World Health Organization has positioned it as a universal framework of health and its related states. Consequently, the ICF has been utilized for a diverse array of purposes in the field of oncology, including: evaluating functioning in individuals with cancer, guiding assessment in oncology rehabilitation, assessing the comprehensiveness of outcome measures utilized in oncology research, assisting in health-related quality of life instrument selection, and comparing the primary concerns of health professionals with those of their patients. DISCUSSION: Examination of the ICF through the lens of cancer care highlights the fact that this framework can be a valuable tool to facilitate comprehensive care in oncology, but it currently possesses some areas of limitation that require conceptual revision; to this end, several recommendations have been proposed. Specifically, these proposed recommendations center on the following three areas of the ICF framework: (1) the replacement of the term "health condition" with the more inclusive and dynamic term "health state;" (2) the continuing development and refinement of the personal factors component to ensure issues such as comorbidities can be accounted for appropriately; and (3) the inclusion of a mechanism to account for the subjective dimension of health and functioning (eg, quality of life). SUMMARY: It is through the expansion of these conceptual parameters that the ICF may become more relevant and applicable to the field of oncology. With these important revisions, the ICF has the potential to provide a broader biopsychosocial perspective of care that captures the diverse range of concerns that arise throughout the continuum of care in oncology.

The relationship between peer conflict resolution knowledge and peer victimization in school-age children across the language continuum.

UNLABELLED: Peer victimization, or bullying, has been identified as a significant child health priority and children with language impairment (LI) are among those who are vulnerable. Given the mandate of educators to provide support for all students who are bullied regardless of language status, research is needed that integrates the study of risk factors for peer victimization among children who are developing typically and children who have LI. Accordingly, this preliminary study explored the degree to which one potential risk factor, peer conflict resolution knowledge, was related to peer victimization in children across the language continuum, and considered whether or not individual differences in language ability influenced that relationship. Participants included 17 girls and 15 boys aged 9-12 years with a wide range of language abilities, six meeting criteria for LI. Participants completed a hypothetical peer conflict resolution task and a measure of peer victimization. Correlational analyses revealed very different patterns of relationships for boys and girls. Whereas boys' reports of peer victimization were meaningfully related to how they responded to hypothetical peer conflicts, girls' reports were most strongly associated with language ability. These preliminary findings suggest that it is important to consider gender when conceptualizing how factors such as peer conflict resolution knowledge might influence children's risk of being bullied. LEARNING OUTCOMES: Readers will be able to: (1) provide a definition of peer victimization and give examples of different forms of peer victimization; (2) recognize that inadequate peer conflict resolution knowledge may be a risk factor for peer victimization; (3) describe the relationships between peer conflict resolution knowledge, language ability, and peer victimization in this study, and explain how these relationships differed for boys and girls; and (4) identify at least three opportunities for future research that would help to clarify risk factors for peer victimization in boys and girls.

Innovations in measuring peer conflict resolution knowledge in children with LI: exploring the accessibility of a visual analogue rating scale.

UNLABELLED: This preliminary study explored peer conflict resolution knowledge in children with and without language impairment (LI). Specifically, it evaluated the utility of a visual analogue scale (VAS) for measuring nuances in such knowledge. Children aged 9-12 years, 26 with typically developing language (TLD) and 6 with LI, completed a training protocol and hypothetical task in which they rated goals and strategies that could be pursued following peer conflict. Whereas participants with TLD provided graded judgments using the entire VAS, most children with LI relied solely on the scale anchors. These results suggest at least two possibilities. The less differentiated manner in which participants with LI utilized the VAS may have been influenced by how they viewed the peer conflict situations. Alternatively, additional training may be required to enable them to consistently use the whole scale. Further research is needed to establish whether ratings made by children with LI reflect differences in social perceptions or a need for further experience with the VAS. In either case, distinguishing between these alternatives will likely provide a better understanding of factors that impact the peer relationships of children with LI. LEARNING OUTCOMES: Readers will be able to: (1) identify challenges associated with assessing peer conflict resolution knowledge in children with language impairments; (2) describe current methods for measuring children's peer conflict resolution knowledge; (3) describe a visual analogue rating (VAS) scale and explain the potential advantages of this scale format; and (4) describe similarities and differences in how children with and without LI used a VAS in a hypothetical peer conflict resolution task.

Developmental language impairment through the lens of the ICF: an integrated account of children's functioning.

UNLABELLED: The conceptual framework of the World Health Organization's International Classification of Functioning, Disability and Health (ICF) has the potential to advance understanding of developmental language impairment (LI) and enhance clinical practice. The framework provides a systematic way of unifying numerous lines of research, which have linked a wide array of factors to the functioning of children with LI. The result is an integrated account of LI where children's functioning emerges from the complex interaction of core linguistic processes, the ability to use them in social interactions, and a variety of environmental and personal factors. This account is well-suited to the clinical context because it focuses clinical attention on how such factors may be interacting to maintain a child's functional limitations, and on how they might work together to facilitate optimal everyday functioning, the ultimate goal of intervention. In this paper, the ICF's conceptual framework is described, and the nature of the relationships among its components explained. We explore how the integrated view of LI inspired by this conceptual framework differs from the prevailing impairment-driven account, provide examples from the literature that are consistent with the former view, and discuss its implications for clinical decision-making. LEARNING OUTCOMES: As a result of this activity, the reader will be able to: (1) describe the nature of the relationships that exist among components of the ICF; (2) describe how interactions among components may shape the functioning of children with LI; (3) identify ways in which the integrated account of LI engendered by the ICF may improve clinical service.

Personal perception and personal factors: incorporating health-related quality of life into the International Classification of Functioning, Disability and Health.

PURPOSE: The International Classification of Functioning, Disability and Health (ICF), introduced by the World Health Organisation in 2001, offers a unique perspective from which to view the role of rehabilitation in one's lived experience of a health condition. However, the ICF does not capture the individual's perception of that experience that is key to understanding functioning, disability and quality of life (QOL) and more specifically health-related quality of life (HRQOL). The purpose is to explore expansion of the ICF framework to incorporate personal perception to offer a more complete expression of functioning and disability. METHOD: We examine the concepts of HRQOL and personal perception, as well as how they have been linked to the ICF in the literature. Through a review of the foundations of the biopsychosocial model, we propose an enhanced version of the ICF that integrates HRQOL within the framework by expanding the personal factors component. RESULTS: Through operationalising aspects of personal perception and situating them among the personal factors, we demonstrate how HRQOL may be integrated within the ICF framework. CONCLUSION: Using several case examples, we illustrate that if personal perception is housed within the personal factors component all other components may be influenced through mechanisms of the ICFs reciprocal interactions. In doing so, HRQOL becomes part of the experience of a health condition and functioning and disability are completely described.

Identification of children with language impairment: investigating the classification accuracy of the MacArthur-Bates Communicative Development Inventories, Level III.

PURPOSE: This study tested the accuracy with which the MacArthur-Bates Communicative Development Inventories, Level III (CDI-III), a parent report measure of language ability, discriminated children with language impairment from those developing language typically. METHOD: Parents of 58 children, 49 with typically developing language (age 30 to 42 months) and 9 with language impairment (age 31 to 45 months) completed the CDI-III, a 2-page questionnaire that includes 100 vocabulary items, 12 sentence pairs, and 12 questions regarding linguistic concepts. RESULTS: A discriminant analysis indicated that the CDI-III total score together with age classified children into language status groups with 96.6% accuracy overall. The corresponding likelihood ratios supported this strong level of accuracy, although precision may not be as high as indicated by broad confidence intervals. CONCLUSIONS: Results of this study contribute to the accumulating evidence on the types of valid inferences that may be made from the CDI-III, specifically its classification accuracy. Further research should continue to investigate classification accuracy in larger samples with broader maternal education levels and with different types of language impairments. Additional research should also investigate the classification accuracy when the CDI-III is used in combination with other tests.

The detection and monitoring of comprehension errors by preschool children with and without language impairment.

PURPOSE: In this study, the authors examined emerging comprehension monitoring, including error detection, evaluation, and correction within the context of story understanding in preschool children with and without language impairment. METHOD: Thirty-seven children between the ages of 30 and 61 months completed an online comprehension monitoring task. There were 3 groups: 10 children with language impairment, 13 typically developing children who were matched for age, and 14 typically developing children who were matched for receptive vocabulary. RESULTS: Analyses of variance revealed that children with language impairment attained significantly lower scores on the comprehension monitoring task than both age-matched and language-matched groups. CONCLUSION: The skills underlying successful comprehension monitoring that may be affected in young children with language impairment are discussed.

Identifying language comprehension impairment in preschool children.

PURPOSE: This study examined the validity of 3 discourse comprehension measures for preschool children and the ability of a combination of them to classify children with and without language impairment. METHOD: Thirty-seven children with typical language and 12 children with language impairment completed 3 measures of oral story comprehension: the Joint Story Retell task, the Expectancy Violation Detection task, and comprehension questions. RESULTS: Discriminant analyses revealed that each measure successfully classified pre-identified groups. The clinical combination of all 3 measures resulted in 96% accurate identification of the language status of this cohort. CONCLUSION: Results support these procedures as valid measures of discourse comprehension and monitoring and provide preliminary evidence that their combination can be validly employed for identifying young children with language comprehension impairment.

Towards a biopsychosocial framework of osteoarthritis of the knee.

Research into the causes of osteoarthritis (OA) of the knee has traditionally followed a biomedical approach whereby the disease development and progression is regarded as an internal physiological process. As a result, treatment has focused on symptom reduction with limited modification of psychosocial variables. In fact, psychosocial factors such as environment and employment play a substantial role in the disease process and are important determinants of the overall level of disability of affected individuals. Thus, by placing greater importance on the biomedical aspects of knee OA, a complete representation of the health condition cannot be achieved thereby limiting treatment effectiveness. The purpose of this clinical commentary is to provide a rationale for the implementation of a biopsychosocial model of knee OA that can aid in more effective research and treatment for the disorder.

School-aged children with SLI: the ICF as a framework for collaborative service delivery.

UNLABELLED: Reports of associated disabilities among children with specific language impairment (SLI) and children with other developmental disabilities are widespread. Clinicians require a broader definition of SLI that recognizes associated disabilities because it is their goal to impact children's everyday functioning. In this paper, we explore SLI from a broader perspective in which consideration is given to features known to be common across different developmental disabilities. The World Health Organization's (2001) International Classification of Functioning, Disability and Health (ICF) is utilized as an organizational and conceptual framework for considering how knowledge of commonalities across developmental disabilities may be used to promote collaborative service delivery in an educational setting. This framework can potentially provide a coherent and comprehensive approach to treating SLI and its associated disabilities without overburdening clinical services. LEARNING OUTCOMES: As a result of this activity, the reader will be able to: (1) describe the potential role of the ICF in facilitating collaborative service delivery in the school setting; (2) identify and describe the commonalities among SLI and its associated disabilities; and (3) describe how knowledge of commonalities may inform approaches to service delivery.

A meeting of minds: interdisciplinary research in the health sciences in Canada.

Brought together by the newly formed Canadian Academy of Health Sciences (CAHS), recognized national leaders in the 6 health sciences disciplines consider the environment for conducting interdisciplinary health research (IDHR) in Canada. Based on first-hand knowledge and thoughtful reflection, the authors argue that although much progress has been made in support of IDHR in Canada, the practical experience of researchers does not always bear this out. This article examines government, industry and academia to identify the cultural and structural characteristics that demand, promote or prevent IDHR in each sector. At its heart is the question, How can universities best support and enhance IDHR, not only for the benefit of science, but also to meet the growing needs of industry and government for intellectual capital? Focusing on the predominant health sciences disciplines, the authors define IDHR as a team of researchers, solidly grounded in their respective disciplines, who come together around an important and challenging health issue, the research question for which is determined by a shared understanding in an interactive and iterative process. In addition, they suggest that IDHR is directly linked to translational research, which is the application of basic science to clinical practice and the generation of scientific questions through clinical observation. This analysis of academic, industry and government sectors is not intended to offer rigorous data on the current state of IDHR in Canada. Rather, the goal is to stimulate research-policy dialogue by suggesting a number of immediate measures that can help promote IDHR in Canada. Recommended measures to support IDHR are aimed at better resourcing and recognition (by universities and granting agencies), along with novel approaches to training, such as government-and industry-based studentships. In addition, we recommend that professional organizations reconsider their policies on publication and governance. Although intended to maintain professional scopes of practice, these policies also serve to entrench disciplinary boundaries in research. We conclude by suggesting a number of research questions for a more rigorous assessment of the climate for IDHR in Canada. We call for an inventory and comparative analysis of academic centres, institutes and consortiums in Canada that strive to facilitate IDHR; an examination of the impact of professional organizations on health research, and on IDHR in particular; and a systematic review of research training opportunities that promote IDHR, with a view to identifying and replicating proven models.

Computer-Based Language Assessment Software: The Effects of Presentation and Response Format.

Nonstandard presentation and response formats are often employed by speech-language pathologists when clients are unable to perform the pointing response required of many standardized tests. However, any adaptation to test administration potentially compromises the norming standards of that test. The present study investigated the effects of computerized presentation of the Peabody Picture Vocabulary Test-Revised (PPVT-R, Dunn & Dunn, 1981) Form M, using two computer-based response formats. Seventy-two normally developing children between the ages of 4:0 (years:months) and 8:11 participated in this study. Subjects were randomly assigned to one of three response conditions: (1) standard presentation -direct pointing, (2) computer presentation-trackball, and (3) computer presentation-automated scanning. Statistical analyses revealed that there were no differences in performance across the response conditions, which is consistent with the hypothesis that computerized testforms are equivalent to standard forms. Age was strongly related to increased accuracy regardless of condition. Thus, the adapted response formats of the computerized version constitute statistically equivalent forms of the PPVT-R and can be used with the published norms for this test.