Convergent and discriminant validity of the Minimal Eating Observation Form - version II: a cross-sectional study.

BACKGROUND: The Minimal Eating Observation Form - Version II (MEOF-II) is a brief and easy to use screening tool for eating difficulties, that is psychometrically robust. The aim of this study was to explore convergent (measuring similar constructs) and discriminant (measuring somewhat different constructs) validity of the MEOF-II to other validated dysphagia specific, activity and participation related instruments. METHODS: In this cross-sectional study, participants (n = 100, mean age 72, n = 42 women), diagnosed with either chronic pulmonary disease, Parkinson´s disease, Multiple Sclerosis, or stroke were recruited from rehabilitation centres. Patient-reported outcomes and clinical-rated assessments, capturing eating ability in general and swallowing in specific, included: The Dysphagia Handicap Index (DHI), the 4-question test (4QT), the Minimal Eating Observation Form - II, the Volume - Viscosity Swallow Test (V-VST), Flexible Endoscopic Evaluation of Swallowing (FEES) documented according to the Penetration-Aspiration Scale (PAS). Type of oral intake was documented using the Functional Oral Intake Scale (FOIS). Activities in daily living was assessed with Barthel index (BI). Spearman's correlation coefficient was used to analyze associations. The MEOF-II total score was hypothesised to have moderate correlations (r ≥ 0.3) with the other assessments, besides with PAS and FOIS (weak correlations, r < 0.3). RESULTS: In total 78 participants had any type of eating difficulties (MEOF-II), 69 reported dysphagia (4QT), 62 had dysphagia according to V-VST, 29 showed evidence of penetration/aspiration (PAS), and 31 participants had decreased oral intake ability (FOIS). The MEOF-II total score had moderate correlations with DHI, BI, 4QT, V-VST volume, and weak correlations with V-VST dysphagia and viscosity, PAS, and FOIS. Comparing a prior hypothesised correlation strengths against empirical findings showed that 83% of the hypothesised correlations were correct. CONCLUSIONS: The MEOF-II is a holistic and objective screening tool that can indicate the need for further assessment and corresponds well with the persons' subjective experiences. MEOF-II does not specifically assess the risk for penetration/aspiration.

Enduring the silence: High silence tolerance and other tools for promoting topic initiations of a man with autism.

Persistent deficits in the ability to initiate social interaction is a core criterion for a diagnosis of autism, and quantitative research shows that children with autism initiate fewer bids for interaction than neurotypical children. This conversation-analytic examination of two interactions between a man with autism, Harry, and two familiar carers will provide insights into the scope of his competences in topic initiation. Analyses of the participants' online management of turn-taking and sequence organisation demonstrate that Harry's topic initiations can be facilitated by a high silence tolerance of the interlocutor in initiation-relevant sequential environments. Specifically, Harry initiates more topics, when his conversational partner endures the long silences after possible sequence closure. The analyses underline that Harry does not lack neither competences nor motivation to successfully execute initiations. Instead, it is proposed that Harry's deficits in initiation should be reconceptualised as a difficulty of initiating interaction on neurotypical terms, where the standard maximum silence between turns is approximately one second. Hereby, the study emphasises that communicative competences of individuals with autism are interactionally managed, emerging in interaction with conversational partners.