Formulating instructions in testing for linguistic and cognitive abilities

People with linguistic or cognitive disorders are often administered clinical tests, either to assess their linguistic abilities and cognitive status, or for therapeutic intervention. These tests, that take place in interaction between patients and doctors or therapists, have received special attention from Conversation Analysis: previous studies have shown that testing activity is a socially organized phenomenon and that the results of testing are collaborative productions (Marlaire & Maynard, 1990; Schegloff, 2003; Wilkinson, 2013). Pursuing this line of investigation, our research focuses on how instructions from standardized tests are introduced and formulated in clinical practice. The analyses are based on a 12-hours corpus of video-recordings of doctor-patient and speech-language therapist-patient interactions. The data were collected in Brazil and France as part of two projects investigating the dynamics of clinical and therapeutic interactions. The languages involved are Brazilian Portuguese and French. The interactions were transcribed following the multimodal transcription conventions developed by Mondada (2018). In our data, patients are administered standardized neuropsychological tests such as MMS (Mini-Mental State, Folstein & Folstein, 1975) or naming tests (Kaplan et al., 2001). Even if the instructions and questions come from a standardized protocol, the way health professionals introduce them at the beginning of the test have implications for the patients' understanding of the task and how they might respond to it (for variation in standardized test, see Jones et al., 2020). A detailed analysis of the sequential organization of these interactions allowed us to identify moments when the initial instructions and test questions are: a) repeated; b) reformulated; c) modified by the therapist; or d) checked and assessed by the patient. Moreover, a multimodal analysis of the data allowed us to take into account not only the verbal dimension of testing, but also their ecology, that is the contextual configuration of the scene, the material environment (documents, objects) and the embodied resources (postures, gestures, gazes). The results provide us with evidence to distinguish difficulties of the patients in responding to the test contents from difficulties related to how test instructions are designed. Implications for how health professionals interpret patients' performances are finally discussed. Folstein, M.F.; Folstein, S.E.; McHugh, P.R. (1975). Mini-mental status. A practical method for grading the cognitive state of patients for the clinician. Journal of Psychiatric Research,12 (3), 189–98. Jones, D., Wilkinson, R., Jackson, C., & Drew, P. (2019). Variation and Interactional Non-Standardization in Neuropsychological Tests: The Case of the Addenbrooke’s Cognitive Examination. Qualitative Health Research, 30(3), 458-470. Kaplan, E., Goodglass, H., & Weintraub, S. (2001). Boston Naming Test. Baltimore, MD: Lippincott Williams & Wilkins. Marlaire, C. L., & Maynard, D. W. (1990). Standardized testing as an interactional phenomenon. Sociology of Education, 83-101. Mondada, L. (2018). Multiple Temporalities of Language and Body in Interaction: Challenges for Transcribing Multimodality. ROLSI, 51(1), 85-106. Wilkinson, R. (2013). The interactional organization of aphasia naming testing. Clinical Linguistics & Phonetics, 27(10-11), 805-822. Schegloff, E. A. (2003). Conversation Analysis and 'Communication Disorders. In Goodwin C. (eds), Conversation and Brain Damage. Oxford University Press, p. 21–55.