Kathryn J. Greenslade

Purpose: Spoken discourse is integral to everyday communication; improving discourse outcomes is a primary goal for individuals with aphasia and their families. Consequently, the application of discourse analysis in aphasia assessment and treatment has gained increasing attention in both research and clinical settings. Despite its recognized value among researchers and clinicians, several barriers—such as limited time, inadequate training, and lack of resources—continue to impede the widespread use of discourse analysis into clinical practice. To facilitate its broader adoption, speech-language pathologists require access to comprehensive resources that include information on discourse tasks, outcome measures, psychometric properties, and practical examples of how to implement spoken discourse assessments effectively. The purpose of this tutorial is to equip clinicians with this knowledge, promoting the consistent and effective application of discourse analysis in clinical settings. Method: This tutorial, developed by members of the FOQUSAphasia Writing Group—comprising both researchers and clinical practitioners—offers an overview of recommended spoken discourse collection and analysis procedures, outcome measures, and their psychometric properties, as well as factors to consider when planning to conduct discourse assessments. It includes a series of case studies (severe aphasia, latent or very mild aphasia, bilingual aphasia, and primary progressive aphasia) that illustrate the utility of discourse analysis for varied clinical contexts and shows how the choice of tasks and measures can reveal meaningful insights tailored to the individual being assessed. In addition, the tutorial provides practical recommendations and considerations for incorporating discourse analysis into clinical aphasia services, along with suggestions for future research. Conclusions: Spoken discourse production can be an important indicator of communication ability in individuals with aphasia. This tutorial is intended to support clinicians by providing evidence-based, practical ways for integrating discourse analysis into aphasia assessment and treatment. Our collation of information and case studies should encourage clinicians to apply spoken discourse-based approaches, ultimately improving outcomes for individuals with aphasia. Supplemental Material: https://doi.org/10.23641/asha.29287505

Purpose: Spoken discourse is integral to everyday communication; improving discourse outcomes is a primary goal for individuals with aphasia and their families. Consequently, the application of discourse analysis in aphasia assessment and treatment has gained increasing attention in both research and clinical settings. Despite its recognized value among researchers and clinicians, several barriers—such as limited time, inadequate training, and lack of resources— continue to impede the widespread use of discourse analysis into clinical practice. To facilitate its broader adoption, speech-language pathologists require access to comprehensive resources that include information on discourse tasks, outcome measures, psychometric properties, and practical examples of how to implement spoken discourse assessments effectively. The purpose of this tutorial is to equip clinicians with this knowledge, promoting the consistent and effective application of discourse analysis in clinical settings.Method: This tutorial, developed by members of the FOQUSAphasia Writing Group—comprising both researchers and clinical practitioners—offers an overview of recommended spoken discourse collection and analysis procedures, outcome measures, and their psychometric properties, as well as factors to consider when planning to conduct discourse assessments. It includes a series of case studies (severe aphasia, latent or very mild aphasia, bilingual aphasia, and primary progressive aphasia) that illustrate the utility of discourse analysis for varied clinical contexts and shows how the choice of tasks and measures can reveal meaningful insights tailored to the individual being assessed. In addition, the tutorial provides practical recommendations and considerations for incorporating discourse analysis into clinical aphasia services, along with suggestions for future research.Conclusions: Spoken discourse production can be an important indicator of communication ability in individuals with aphasia. This tutorial is intended to support clinicians by providing evidence-based, practical ways for integrating discourse anal-ysis into aphasia assessment and treatment. Our collation of information and case studies should encourage clinicians to apply spoken discourse-based approaches, ultimately improving outcomes for individuals with aphasia.

Background: Pragmatic communication difficulties encompass many distinct behaviours, including the use of vague and/or insufficient language, a common characteristic following traumatic brain injury (TBI) that negatively impacts psychosocial outcomes. Existing assessments evaluate pragmatic communication broadly, often with only one or two items capturing each behaviour, thus limiting sensitivity and precision to variations within each behaviour. Given that greater nuance is needed to detect subtle pragmatic communication differences and investigate underlying cognitive mechanisms, a more refined measure is critical to improve psychosocial outcomes. The Vague scale was developed to address those needs.Aim: To provide preliminary evidence supporting the novel Vague language use (Vague) scale's reliability, validity and clinical utility.Methods and Procedures: The Vague scale rates each discourse sample utterance for vague language use on a 3‐point scale; the measure's Vague score represents the mean of utterance‐level ratings. Using the Vague scale, two raters naïve to diagnosis evaluated Cinderella narratives of 46 adults with severe TBI and 46 controls with no brain injury, providing reliability, construct validity and classification accuracy evidence. Vague scores were also compared to other clinical measures to gather criterion‐related validity evidence.Outcomes and Results: Interrater agreement across all transcripts was moderate. Construct validity was supported by expected group differences and criterion validation, including significant relationships with increased violations of Grice's maxim of quantity and measures of lexical variation; significant relationships with psychosocial outcomes, supporting clinical utility; and nonsignificant relationships with measures of syntax and overall pragmatic communication. Classification accuracy expectedly did not support using Vague scores in isolation for diagnosis, due to unacceptable sensitivity (0.696).Conclusions and Implications: Evidence supported the Vague scores’ psychometric properties. Thus, the Vague scale shows promise as a measure of one distinct pragmatic communication behaviour: vague language use. Future research should apply the Vague scale to determine its sensitivity in individuals with subtle social communication challenges (e.g., mild TBI), explore its utility with more naturalistic discourse samples as part of a pragmatic communication battery, longitudinally examine changes in Vague scores, and investigate cognitive mechanisms underlying this specific pragmatic communication behaviour.WHAT THIS PAPER ADDS: What is already known on this subject: Use of vague language is common following traumatic brain injury (TBI) and may contribute to negative psychosocial outcomes related to employment and relationships. However, existing measures of vague language lack sensitivity and precision, limiting their utility for identifying subtle performance variations or determining the cognitive mechanisms underlying this specific pragmatic communication behaviour. What this study adds to existing knowledge: The current study gathered promising reliability, validity and clinical utility evidence to support using the novel Vague language use (Vague) scale, which was developed to address these limitations. Based on complex (Cinderella) stories of adults with and without TBI, Vague scores demonstrated moderate interrater agreement and promising construct validity based on expected group differences and criterion validation, including moderate associations with related constructs and weak associations with unrelated constructs. Because pragmatic communication profiles post‐TBI can vary, classification accuracy expectedly indicated that Vague scores should not be used alone to identify communication differences post‐TBI. What are the clinical implications of this work?: Vague scores show promise for documenting clients’ use of vague language and planning intervention to address associated discourse‐level challenges. Future research should investigate applying the Vague scale to naturalistic discourse samples (1) as part of a battery that sensitively and precisely identifies pragmatic communication differences and (2) as a tool for investigating cognitive mechanisms underlying vague language use, with the goal of improving interventions that support pragmatic communication and enhance psychosocial outcomes.

Introduction: Traumatic brain injury (TBI) negatively impacts social communication in part due to social cognitive difficulties, which may include reduced mental state term (MST) use in some discourse genres. As social cognitive difficulties can negatively impact relationships, employment, and meaningful everyday activities, assessing and treating these difficulties post-TBI is crucial. To address knowledge gaps, the present study examined MST use in the narrative retells of adults with and without severe TBI to compare between-group performance, evaluate changes over the first two years post-TBI, and investigate the impact of participant and injury-related variables.Methods: The total number of MSTs, ratio of MSTs to total utterances, and diversity of MSTs were identified in the Cinderella narratives of 57 participants with no brain injury and 57 with TBI at 3, 6, 9, 12, and 24-months post-TBI.Results: Reduced MST use in participants with TBI was found at 3, 6, 9, and 12-months post-TBI, but these reductions disappeared when story length (total utterances) was accounted for. Further, MST diversity did not differ between groups. Similarly, although the total number of MSTs increased over time post-TBI, no changes were observed in the ratio of MSTs to total utterances or MST diversity over time. Injury severity (post-traumatic amnesia duration), years of education, and verbal reasoning abilities were all related to MST use.Discussion: Overall, although individuals used fewer MSTs in complex story retells across the first year following severe TBI, this reduction reflected impoverished story content, rather than the use of a lower ratio of MSTs. Further, key prognostic factors related to MST use included injury severity, educational attainment, and verbal reasoning ability. These findings have important implications for social communication assessment and treatment targeting social cognition post-TBI.

Purpose: Narration within a story grammar framework requires speakers to organize characters and events logically. Despite abundant research characterizing narrative deficits following a traumatic brain injury (TBI), the evolution of narrative story grammar over the first 2 years post-TBI has rarely been explored. This study analyzed story grammar in complex narratives of adults with and without severe TBI to (a) examine between-group differences and (b) investigate longitudinal changes over the first 2 years post-TBI. Method: Story grammar analyses of Cinderella narratives from 57 participants with TBI and 57 participants with no brain injury yielded measures of productivity (total number of episodes, total number of story grammar elements), elaboration (total number of elaborated–complete episodes, mean number of episodic elements per episode), and completeness (total number of incomplete episodes). Mann–Whitney U tests compared measures across groups; generalized estimating equation (GEE) models identified predictors of change, including recovery time (3, 6, 9, 12, and 24 months post-TBI) and demographic/injury-related characteristics. Results: Between-group differences were statistically significant for all productivity and elaboration measures at 3, 6, and 9 months post-TBI; one productivity measure and one elaboration measure at 12 months; and none of the measures at 24 months. GEE models showed significant improvements in all productivity and elaboration measures over the first 24 months post-TBI, with educational attainment and duration of posttraumatic amnesia affecting recovery. Incomplete episodes only showed between-group differences at 12 months and did not capture recovery. Conclusion: Productivity and elaboration are key story grammar variables that (a) differentiate complex narration in individuals with and without severe TBI and (b) capture narrative improvements over the first 2 years post-TBI. Supplemental Material: https://doi.org/10.23641/asha.25148999

Prosocial helping is a fundamental communication behaviour that supports successful social relationships. This study investigated the clinical utility of the Analog Task of Prosocial Helping (AToP-H): a tool for assessing how helping is influenced by the communicative function it serves and the cues used to elicit helping in young children with and without a social communication disorder. To present evidence of the AToP-H's reliability, validity and clinical utility. The AToP-H examines three communicative functions expressed through helping-instrumental (request-based), informative (information-based) and empathic (emotion-based) helping-within a naturalistic context. Prosocial helping is elicited using semi-structured interactions in which increasingly explicit cues are provided to scaffold child responses. To gather reliability and validity evidence, the AToP-H was administered to 20 children with autism spectrum disorder (ASD) (49-79 months) and 20 with typical development (37-77 months). Procedural reliability and inter-observer agreement for the AToP-H were high. Item-level codes were consistent with overall task performance, showing strong internal consistency. Supporting construct validity, higher scores were observed in older children with ASD, consistent with an expectedly protracted developmental period for prosocial helping. Children with ASD required more cues to elicit helping overall and informative and empathic helping in particular. Furthermore, more children with ASD did not respond or required explicit cues to respond with informative and empathic helping. Supporting criterion-related validity, total helping cue scores were significantly correlated with measures of social cognition, social abilities and receptive language, but were only weakly correlated with general language. The AToP-H shows promise in measuring helping performance as an indicator of young children's social communication strengths and weaknesses as well as scaffolding cues to facilitate intervention planning. What is already known on the subject Prosocial helping is critical for successful relationships, which can be difficult for children with social communication disorders such as ASD. Two factors that influence helping are the communicative function of the helping behaviour and the cues used to elicit helping. Existing helping tasks have been developed for research purposes, focusing on internal validity with little attention to applying or generalizing results to clinical settings or groups. Thus, assessing factors that influence helping behaviours in naturalistic, ecologically valid contexts could provide clinicians with critical information to improve prosocial helping in children with social communication disorders. What this paper adds to existing knowledge This paper presents preliminary psychometric evidence for a naturalistic clinical task: the AToP-H, which assesses instrumental (request-based), informative (information-based) and empathic (emotion-based) helping elicited with increasingly explicit cues. What are the potential or actual clinical implications of this work? Evidence from samples of young children with and without ASD supports the reliability and validity of AToP-H scores. The AToP-H shows promise as a clinical tool to effectively assess and plan interventions targeting social communication, prosocial helping and associated interactions.

Purpose: This tutorial addresses the use of analog tasks to assess social communication abilities in toddlers through adolescents. In analog tasks, clinicians manufacture situations that give rise to naturalistic social dilemmas (or dilemmas “analogous” to ones encountered in everyday interactions); the result is a sample of children's spontaneous, real-time, social communication performance, targeting specific behaviors of interest. Method/Results: Potential social communication behaviors to be assessed and the critical impact of contextual factors on those behaviors are discussed. Next, analog tasks are defined, and their clinical benefits relative to other types of informal assessments are described. Several research-developed analog tasks, along with their key characteristics, are presented to illustrate these benefits and provide a starting place for clinicians to add analog tasks to their clinical toolbox. Finally, the process of developing analog tasks is described and applied in an example and associated case study, which together highlight the utility of analog tasks in identifying social communication deficits and potential strategies to facilitate intervention. Conclusions: Improving clinicians' understanding, access to, and use of analog tasks will offer new ecologically valid assessment tools that efficiently capture representative and generalizable social communication performance and highlight specific strengths and weaknesses in context. Such results can provide a strong foundation for clinical decision making and improve the services provided to children with social communication disorders.

Recently, a multilevel analytic approach called Main Concept, Sequencing, and Story Grammar (MSSG) was presented along with preliminary normative information. MSSG analyses leverage the strong psychometrics and rich procedural knowledge of both main concept analysis and story grammar component coding, complementing it with easy-to-obtain sequencing information for a rich understanding of discourse informativeness and macrostructure. This study is the next critical step for demonstrating the clinical usefulness of MSSG’s six variables (main concept composite, sequencing, main concept+sequencing, essential story grammar components, total episodic components, and episodic complexity) for persons with aphasia (PWAs). We present descriptive statistical information for MSSG variables for a large sample of PWAs and compare their performance to a large sample of persons not brain injured (PNBIs). We observed significant differences between PWAs and PNBIs for all MSSG variables. These differences occurred at the omnibus group level and for each aphasia subtype, even for PWAs with very mild impairment that is not detected with standardized aphasia assessment. Differences between PWAs and PNBIs were also practically significant, with medium to large effect sizes observed for nearly all aphasia subtypes and MSSG variables. This work deepens our understanding of discourse informativeness and macrostructure in PWAs and further develops an efficient tool for research and clinical use. Future research should investigate ways to expand MSSG analyses and to improve sensitivity and specificity.