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PURPOSE: Our goal was to develop brief pragmatic assessments of Behavioral Activation (BA) fidelity to support its dissemination in low-resource settings. METHODS: We used qualitative and quantitative methods across three investigations to develop pragmatic assessments rated from the perspective of therapists, patients, and observers: (1) we developed an initial comprehensive pool of 119 items and adapted/refined the item pool to 32 items through stakeholder focus groups and cognitive interviews; (2) independent blind judges rated each of items in the refined item pool on an early session of BA for 64 patients to support the selection of items based on predictive validity; and (3) we conducted a preliminary evaluation of the acceptability and feasibility of the assessments of BA fidelity from the perspective of therapists and patients. RESULTS: The internal consistency reliability for the 10-item total score was .83 rated from the perspective of independent observers. The assessment was completed by patients following 90% of sessions and by clinicians following 93% of sessions. Items were rated high on overall satisfaction by both therapists (M = 4.6, SD = 0.89) and patients (M = 4.8, SD = 0.41). CONCLUSION: Our findings suggest that these brief assessments of BA fidelity are reliable, feasible, and acceptable to community stakeholders.

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Linguistic phenotypes of individuals with Fragile X (FXS) and Williams (WS) syndromes exhibit various degrees of pragmatic impairment, involving difficulties in social communication and in adapting to conversational principles. The goal of the present study was to explore syndrome-specific pragmatic profiles of adults with FXS and WS based on the assessment of the observance of Gricean maxims of conversation. The participants were 12 Spanish-speaking adults (6 FXS/6 WS), without a diagnosis of ASD, whose extensive naturalistic conversations (71,859 words) were transcribed and coded with the CHILDES/TALKBANK tools and the PREP-CORP pragmatic protocol. Violations of the maxims of conversation were analyzed, and indexes of cooperation and conversational response were obtained. Both groups showed reduced verbal production and repetitive dysfluencies; prominent features in the FXS profile were higher proportion of non-contingent language, perseverations of topic and form, and impulsive conversational responses; in the WS profile, salient characteristics were higher proportion of tangential utterances, reformulations, and conversational responses reflecting overly literal interpretation. Pragmatic profiles of violation of conversational maxims reflect specific communication skills impaired in adults with FXS and WS and raise the need for assessment and intervention methods that specifically address their social communication abilities.

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Sensitivity and specificity are key aspects in evaluating the performance of diagnostic tests. Accuracy and AUC are commonly used composite measures that incorporate sensitivity and specificity. Average Weighted Accuracy (AWA) is motivated by the need for a statistical measure of diagnostic yield that can be used to compare diagnostic tests from the medical costs and clinical impact point of view, while incorporating the relevant prevalence range of the disease as well as the relative importance of false positive versus false negative cases. We derive the variance/covariance estimators and testing procedures in four different scenarios comparing diagnostic tests: (i) one diagnostic test vs. the best random test, (ii) two diagnostic tests from two independent samples, (iii) two diagnostic tests from the same sample, and (iv) more than two diagnostic tests from different or the same samples. The impacts of sample size, prevalence, and relative importance on power and average medical costs/clinical loss are examined through simulation studies. Accuracy has the highest power while AWA provides a consistent criterion in selecting the optimal threshold and better diagnostic tests with direct clinical interpretations. The use of AWA is illustrated on a three-arm clinical trial evaluating three different assays in detecting Neisseria gonorrhoeae (NG) and Chlamydia trachomatis (CT) in the rectum and pharynx.

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The vast individual differences in the developmental origins of risk and resilience pathways combined with sophisticated capabilities of big data science increasingly point to the imperative of large, neurodevelopmental consortia to capture population heterogeneity and key variations in developmental trajectories. At the same time, such large-scale population-based designs involving multiple independent sites also must weigh competing demands. For example, the need for efficient, scalable assessment strategies must be balanced with the need for nuanced, developmentally sensitive phenotyping optimized for linkage to neural mechanisms and specification of common and distinct exposure pathways. Standardized epidemiologic batteries designed for this purpose such as PhenX (consensus measures for Phenotypes and eXposures) and the National Institutes of Health (NIH) Toolbox provide excellent "off the shelf" assessment tools that are well-validated and enable cross-study comparability. However, these standardized toolkits can also constrain ability to leverage advances in neurodevelopmental measurement over time, at times disproportionately advantaging established measures. In addition, individual consortia often expend exhaustive effort "reinventing the wheel," which is inefficient and fails to fully maximize potential synergies with other like initiatives. To address these issues, this paper lays forth an early childhood neurodevelopmental assessment strategy, guided by a set of principles synthesizing developmental and pragmatic considerations generated by the Neurodevelopmental Workgroup of the HEALthy Brain and Child Development (HBCD) Planning Consortium. These principles emphasize characterization of both risk- and resilience-promoting processes. Specific measurement recommendations to HBCD are provided to illustrate application. However, principles are intended as a guiding framework to transcend any particular initiative as a broad neurodevelopmentally informed, early childhood assessment strategy for large-scale consortia science.

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BACKGROUND: Social communication assessment after traumatic brain injury (TBI) remains a challenging area within speech-language pathology (SLP) clinical practice. Difficulties include the lack of TBI-specific standardized assessment instruments and limited knowledge and uptake of discourse assessment methods clinically. The aim of this paper was to review recent research literature reporting on innovative social communication and discourse assessment measures and methods, to guide evidence-based SLP practice and inform future research. MAIN CONTRIBUTION: This review describes novel standardized and non-standardized assessment tools for SLP use reported in TBI research literature from the past 15 years. Measures include published assessment batteries and pragmatic rating scales designed for use with adults with TBI, and novel discourse tasks and protocols. CONCLUSION: This paper delineates social communication assessment measures and discourse analyses described in research literature that may be practical for SLPs to use with adults with TBI. The clinical implications and utility of these measures are discussed. This should assist SLPs in decision-making on social communication assessment for adults with TBI. Further research is needed to investigate translation of research knowledge on discourse assessment methods to SLP practice.

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OBJECTIVE: The aim of this study was to standardize an Egyptian Arabic Pragmatic Language Test (EAPLT) using linguistically and socially suitable questions and pictures in order to be able to address specific deficits in this language domain. PARTICIPANTS AND METHODS: Questions and pictures were designed for the EAPLT to assess 3 pragmatic language subsets: pragmatic skills, functions, and factors. Ten expert phoniatricians were asked to review the EAPLT and complete a questionnaire to assess the validity of the test items. The EAPLT was applied in 120 typically developing Arabic-speaking Egyptian children (64 females and 56 males) randomly selected by inclusion and exclusion criteria in the age range between 2 years, 1 month, 1 day and 9 years, 12 months, 31 days. Children's scores were used to calculate the means and standard deviations and the 5th and 95th percentiles to determine the age of the pragmatic skills acquisition. RESULTS: All experts have mostly agreed that the EAPLT gives a general idea about children's pragmatic language development. Test-retest reliability analysis proved the high reliability and internal consistency of the EAPLT subsets. A statistically significant correlation was found between the test subsets and age. CONCLUSION: The EAPLT is a valid and reliable Egyptian Arabic test that can be applied in order to detect a pragmatic language delay.

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