diff --git a/packages/core/src/repowise/core/analysis/health/engine.py b/packages/core/src/repowise/core/analysis/health/engine.py
index 618982d2c..0f0c3912d 100644
--- a/packages/core/src/repowise/core/analysis/health/engine.py
+++ b/packages/core/src/repowise/core/analysis/health/engine.py
@@ -252,8 +252,9 @@ def _has_paired_test_file(rel_path: str, path_basenames: set[str]) -> bool:
     stem = p.stem
     test_suffix = ".exs" if p.suffix == ".ex" else p.suffix
     candidates = {
-        f"test_{stem}.py",
+        f"test_{stem}{test_suffix}",
         f"{stem}_test{test_suffix}",
+        f"{stem}_spec{test_suffix}",
         f"{stem}.test.ts",
         f"{stem}.test.tsx",
         f"{stem}.test.js",
diff --git a/tests/unit/health/test_paired_test_basenames.py b/tests/unit/health/test_paired_test_basenames.py
index b90685eb6..e659ad428 100644
--- a/tests/unit/health/test_paired_test_basenames.py
+++ b/tests/unit/health/test_paired_test_basenames.py
@@ -25,6 +25,7 @@ def _reference_has_paired_test_file(rel_path: str, all_paths: set[str]) -> bool:
     candidates = {
         f"test_{stem}.py",
         f"{stem}_test.py",
+        f"{stem}_spec.rb",
         f"{stem}.test.ts",
         f"{stem}.test.tsx",
         f"{stem}.test.js",
@@ -104,7 +105,6 @@ def test_empty_paths(self) -> None:
         assert _path_basenames(set()) == set()
         assert not _has_paired_test_file("anything.py", set())
 
-
 class TestPascalPairing:
     """Delphi/FPC's ``u``-prefixed unit pairs with a standalone console test
     program named ``Test<Stem>.dpr`` (the ``u`` dropped) -- confirmed against
@@ -141,3 +141,12 @@ def test_non_pascal_file_is_unaffected_by_pascal_candidate(self) -> None:
         # up the Pascal Test<Stem>.dpr candidate.
         basenames = _path_basenames({"uKeymap.ts", "TestKeymap.dpr"})
         assert not _has_paired_test_file("uKeymap.ts", basenames)
+
+    def test_ruby_and_crystal_underscore_spec_pairing(self) -> None:
+        """Ruby's <stem>_spec.rb (and Crystal's <stem>_spec.cr) is a paired test (#1768)."""
+        ruby = {"spec/user_spec.rb"}
+        assert _has_paired_test_file("lib/user.rb", _path_basenames(ruby))
+        crystal = {"spec/user_spec.cr"}
+        assert _has_paired_test_file("src/user.cr", _path_basenames(crystal))
+        # Same stem, dot form, must NOT count for Ruby's underscore layout.
+        assert not _has_paired_test_file("lib/user.rb", _path_basenames({"spec/user.spec.rb"}))
diff --git a/tests/unit/server/mcp/test_risk.py b/tests/unit/server/mcp/test_risk.py
index 603b59e03..e1faa73f9 100644
--- a/tests/unit/server/mcp/test_risk.py
+++ b/tests/unit/server/mcp/test_risk.py
@@ -351,6 +351,9 @@ def test_classify_bus_factor_unknown_team_size_keeps_behaviour():
         ("lib/user.dart", "test/user_test.dart"),
         ("lib/user.ex", "test/user_test.exs"),
         ("src/user.rs", "tests/user_test.rs"),
+        ("lib/user.rb", "spec/user_spec.rb"),
+        ("src/user.cr", "spec/user_spec.cr"),
+        ("lib/user.rb", "test/test_user.rb"),
     ],
 )
 def test_health_filename_heuristic_supports_suffix_test_conventions(source, test):