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.