NEUROPSYCHOLOGICAL TESTING SPANISH SPEAKERS: THE CHALLENGE OF ACCURATELY ASSESSING LINGUISTICALLY AND CULTURALLY DIVERSE INDIVIDUALS. Carlos A.

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1 NEUROPSYCHOLOGICAL TESTING SPANISH SPEAKERS: THE CHALLENGE OF ACCURATELY ASSESSING LINGUISTICALLY AND CULTURALLY DIVERSE INDIVIDUALS Carlos A. Ojeda A Thesis Submitted to the University of North Carolina Wilmington in Partial Fulfillment of the Requirements for the Degree of Master of Arts Department of Psychology University of North Carolina Wilmington 2010 Approved by Advisory Committee James Jonhnson Nora Noel William Overman Antonio E. Puente Chair Accepted by Dean, Graduate School

2 TABLE OF CONTENTS ACKNOWLEDGMENTS... iii ABSTRACT... iv LIST OF TABLES... v INTRODUCTION... 1 Hispanics Demographics and Characteristics... 2 Clinical Neuropsychology History of Clinical-Neuropsychological Test Usage Standards for Educational and Psychological Testing Standards Chapter 9: Testing Individuals of Diverse Linguistic Backgrounds Clinical Neuropsychology and Hispanics Neuropsychological Testing Spanish Speakers Summary METHOD RESULTS DISCUSSION REFERENCES APPENDIX ii

3 ACKNOWLEDGMENTS Thank you to my family for their strength and love. Special thanks to my mom, dad and sister, they are my inspiration in my life. I also want to thank my mentor, Dr. Antonio E. Puente for his guidance, teachings and support. I would like to thank the members of my committee who have been supportive, understanding and enlightening throughout my graduate education. Many other Psychology professors who are not on the committee as well as the Department of Psychology staff have taught me a great deal and have been of great assistance to me. In addition, I want to thank my friends, especially those who formed Dr. Puente s lab and clinical group, for their encouragement throughout my academic career and life in general. iii

4 ABSTRACT With the increase in population in the United States of Spanish-speakers as well as the growth of clinical neuropsychology in Spanish-speaking countries, a question arises as to what tests are available in Spanish. To address this situation, a three phase study was designed: a) develop a comprehensive and current list of neuropsychological and psychological tests available in Spanish, b) determine which tests are being used by clinical neuropsychologists who speak Spanish and c) determine if the tests uesd meet the criteria from the testing Standards for Educational and Psychological Tests. Findings indicate that there are few tests available in Spanish (555 out a possible of over 3,500), and relatively fewer tests are being used (216). In addition, be approximately tests that are used frequently and a larger number of tests that are used highly infrequently. Finally, most of the tests available in Spanish do not meet the criteria for the testing standards. Overall, findings suggest that the interfacing between neuropsychological testing and Spanish speakers has been gradual and limited. iv

5 LIST OF TABLES Table Page 1. Pew Hispanic Center tabulations of the 2008 American Community Survey Pew Hispanic Center tabulations of the 2000 and the 2008 American Community Survey Criteria from the Standards for assessing Spanish speakers List of Spanish tests developed using the sources previously listed Summary of participants demographic information Frequency and Rank of top 25 Spanish tests found in our list Comparison of top 25 tests in Spanish with the standards criteria v

6 INTRODUCTION Hispanics are a diverse ethnic group with similar characteristics but with significant within group differences. In addition there are different definitions for Hispanics depending on the content and the source. In essence, Hispanics are a heterogeneous group as well as concept. The terms Hispanic/Latino are different but are used interchangeably to refer to individuals from Mexico, and other Central, South American, and Caribbean countries. The Oxford English Dictionary (1989) defines the word Hispanic as an individual pertaining to Spain or with Spanish descent, or an individual from Latin America with Spanish descent living in the U.S who speaks Spanish. Similarly, Merriam-Webster s Collegiate Dictionary in its 10th edition (1998) defines Hispanic as a term related to or being a person from Latin America descent who is living in the U.S from Cuban, Mexican, or Puerto Rican origins. In the U.S., a Hispanic is usually defined as a person who\speaks Spanish as its primary or secondary language and whose heritage background is tied to Spanish origins or Spain (Puente & Ardila, 2000).Thus, defining a Hispanic is extremely difficult because of the diverse and common characteristics within this population; hence, a single uniform definition of Hispanic does not exist. In 2000, the word Latino was added to the Census to describe Hispanic or Spanish individuals (U.S. Census Bureau, 2000). The Oxford English Dictionary (1989) defines the word Latino as a Latin American individual living in the U.S. (2010). Other definitions refer to Latino as an individual residing in Latin America, which includes all countries to the south of the U.S. as well as, but not limited to, Brazil (Puente & Puente, 2009). Thus, defining an individual as Latino is confusing because in the U.S., Latinos are often associated with individuals from Mexican background such as La Raza. Similarly, Latinos from Brazil were not colonized by

7 Spain and speak Portuguese as their first language, yet they are often associated with the Spanish heritage (Puente & Puente, 2009). Despite the growth of the Hispanic/Latino population in the U.S., the interface between Hispanic/Latinos and psychology as well as its specialties, such as neuropsychology, has not been well documented. For example, a review of PsychInfo reveals a total of 1,093,033 citations in the American psychology literature. If one adds, the word Hispanic or Latino, the total number of citations is 10,915, which is a 0.01% of the psychology literature. If one narrows the search further by including neuropsychology and Hispanic or Latino, then that total number of citations is reduced to 6,895. In essence, then, Hispanic-Latino neuropsychology represents approximately 0.006% of the total psychology literature. When this is done for neuropsychology, which includes 91,919 citations, this percentage is approximately 0.08%. The focus of this thesis is to address the serious gap between knowledge within neuropsychology and the issues related to testing Spanish speakers, specifically to develop a list of what neuropsychological tests exists in Spanish. Of particular interest, to gain a better understanding of how tests are used to assess Spanish speakers in neuropsychological assessment. Hispanics Demographics and Characteristics In 1980, the total population in the U.S was 226,505,000, from which 14,506,000 were of Spanish origin (U.S. Census Bureau, 1981). Thus, approximately 6% of the population was of Spanish origin. At that time, the top 5 states with most individuals of Spanish origins were California (4,544,000), Texas (2,986,000), New York (1,659,000), Florida (858,000), and Illinois (636,000) (U.S. Census Bureau, 1981). Furthermore, the U.S. Immigration and Naturalization Service provided information about the immigrants admitted in the U.S. by country of birth between 1981 and 1988 which included Mexico (569,000), Cuba (138,600), Costa Rica (10,700) 2

8 El Salvador (76,500), Dominican Republic ( ), Guatemala (36,600), Honduras (29,000), Nicaragua (23,700), Panama (22,100), Argentina (17,100), Chile (16,400), Colombia (85,000), Ecuador (36,000), Peru (38,500), Venezuela (12,700), and Spain (12,300) (U.S. Census Bureau, 1981); These figures are underestimating the total number of immigrants because they do not include information about undocumented immigrants. Regarding education attainment of individuals with Spanish origin, the U.S. Census Bureau 1981 reported that 30,800 completed less than five years of education, 90,500 completed four years of high school or more, and 15,900 completed four years of college or more (U.S. Census Bureau, 1981). Additionally in the 1980s, 2,538,000 individuals who speak Spanish at home who were younger than 17 years old reported some difficulty with English as well as 6,231,000 individuals at least 18 years old indicated difficulty with English and spoke Spanish at home (U.S. Census Bureau, 1991). Overall, it is necessary to mention that the Census Bureau 1980 defined an individual of Spanish origin at the time included a person from Cuba, Central, South America, and other Spanish origin (U.S. Census Bureau, 1981). A decade later, the population of the United States was 248,710,000 individuals, which included 22,354,000 Hispanics (U.S. Census Bureau, 1991). Approximately 9% of the U.S. population was Hispanic with a 54% population increase since Hence, the U.S. Census Bureau (1990) reported the following percentage distribution of Hispanics in the U.S. in 1990: 61.2% Mexicans, 12.1% Puerto Ricans, 4.8% Cubans, 2.4% Dominicans, 6.0% Central Americans, 4.7% South Americans, 3.9% Other Hispanics, and 4.4% Spaniards. Furthermore, the top five states with most Hispanics were: California (7,688,000), Texas (4,340,000), New York (2,214,000) Florida (1,574,000), and Illinois (904,000) (U.S. Census Bureau, 1991). In addition, the Immigration and Naturalization Service provided an estimate of the Hispanic 3

9 immigrants admitted in the U.S. between 1981 and 1990 by country of birth: Mexico (1,653,300), Cuba (159,200), Dominican Republic (251,800), El Salvador (214,600), Guatemala (87,900), Honduras (49,500), Nicaragua (44,100), Panama (29,000), Argentina (25,700), Chile (23,400), Colombia (124,400), Ecuador (56,000), Peru (64,400), Venezuela (17,900) (U.S. Census Bureau, 2000). However, these do not include undocumented immigrants who did not register with the Immigration and Naturalization Service, thus; they underestimate the total amount of Hispanics. In addition, U.S. Census Bureau (1991) reported the following information regarding the education attainment of Hispanics in 1989, 3,589,000 completed 0-8 years of education, 1,539,000 completed 1-3 years of High School, 2,907,000 completed 4 years of High School, 1,373,000 completed 1-3 years of College, and 1,029,000 completed 4 years or more of College. In 2000, the Bureau Census reported that the total population of the U.S. was 281,422,000, which included 35,306,000 Hispanics (U.S. Census Bureau, 2001). Thus, Hispanics represented 12.5% of the total U.S. population with a 58% increase since Specifically, the distribution of Hispanics were as follows 58.5% Mexicans, 9.6% Puerto Ricans, 3.5% Cubans, 2.2% Dominicans, 0.2% Costa Ricans, 1.1% Guatemalans, 0.6% Hondurans, 0.5% Nicaraguans, 0.3% Panamenians,1.9% Salvadorians, 0.3% Other Central Americans, 0.3% Argentineans, 0.1% Bolivians, 0.2% Chileans, 1.3% Colombians, 0.7% Ecuadoreans, 0.7% Peruvians, 0.1% Uruguayans, 0.3 Venezuelans, 0.2% Other South Americans, and 17.6% Other Hispanic or Latino, which included Spaniards, Spanish, Spanish Americans, or not otherwise classified (U.S. Census Bureau, 2000). Furthermore, the top five states with the highest Hispanic population were: California (10,967,000), Texas (6,670,000), New York (2,868,000), Florida (2,683,000), and Illinois (1,530,000) (U.S. Census Bureau, 2001). In addition, the educational attainment for 4

10 Hispanics indicated that 9,783,000 graduated High School and 1,821,000 earned a Bachelor s degree or higher (U.S. Census Bureau, 2001). Today, the exponential increase of the Hispanic population is still continuing. According to the American Community Survey (2008), the approximate population of the U.S is 304,059,728 people, from which 46,891,456 are Hispanic. Again, these numbers do not include undocumented Hispanic immigrants who do not participate in the Census. As a result, indicating that at least 15% of the U.S. population is Hispanic is an underestimated amount. Consistent with previous years, Hispanics come from different origins. For instance, the Pew Hispanic Center and the American Community Survey, provide the following distribution of Hispanics in the U.S. according to the origin: 65.7%, Mexicans, 8.9% Puerto Ricans, 3.5% Cubans, 3.3% Salvadorians, 2.8% Dominicans, 2.1% Guatemalans, 1.9% Colombians, 1.3% Spaniards, 1.3% Hondurans, 1.3% Ecuadorians, 1.1% Peruvians, 0.8% Nicaraguans 0.4% Venezuelans 0.4% Argentineans, 0.3% Panamanians, 0.3% Chileans, 0.3% Costa Ricans, 0.2% Bolivians, 0.1% Uruguayans, 3.8% All other Spanish/Hispanic/Latino, and 0.1% other Central Americans (U.S. Census Bureau, 2010). The national growth of the Hispanic population has been consistent within states in different regions across the country. According to the Census Bureau (2010), the top five with the highest Hispanic population are: California (13,434,896), Texas (8,815,582), Florida (3,846,267), New York (3,232,360), and Arizona (1,964,625). Furthermore, the increase of Hispanic population has expanded to states where their presence has not been traditional. In other words, Hispanics are not just present in the bordering regions next to the U.S. boarders such as Florida, Texas, California or New York, but they have begun to migrate to any state in the country. As a result, every state has had an increase in Hispanic population since 2000 to the 5

11 present. For instance, the top ten states with the highest Hispanic population growth between 2000 and 2008 are West Virginia (111.9%), South Dakota (109.2%), South Carolina (88.1%), Minnesota (86.4%), Nebraska (84.5%), Arkansas (82.1%), North Carolina (79.8%), Georgia (79.7%), Kentucky (76.3%), and Iowa (71.9%) (U.S. Census Bureau, 2010).These demographic trends suggest that not only is the Hispanic population growing, but they are spreading across the country rather than concentrating on states with Hispanic populations. Beyond demographics, there are also several aspects of this increasing number of individuals in the U.S. related to such variables as social status and educational attainment. Hispanics represent the largest ethnic minority in the U.S. and the fastest in growth according to the latest Census Bureau reports. However, Hispanics share some common characteristics with other ethnic minorities which include, but are not limited to low socioeconomic status, limited/poor education, poor health care, unskilled jobs, origin from developing or foreign countries, discrimination, English as a second language, distinctive cultural values, rural life background, and acculturation issues (Perez-Arce & Puente, 1996). However, despite the overlap with other ethnic minority groups, Hispanics present unique characteristics that cannot be generalized to either majority or other minority groups. Current trends on education attainment of Hispanics have not followed their demographic growth. This disparity in educational attainment is due to limited opportunities, or language barriers. According to the latest reports, 23.5% completed less than 9th grade, 15.7% attended 9th to 12th grade, 26% graduated High School, 21.9% completed some college, and only 12.9% graduated college (U.S. Census Bureau, 2010).These statistics suggest that the education attainment of Hispanics decrease at higher education levels. As a result of the educational ceiling effect, the total annual earnings of Hispanics are limited with about 44.3% earning less than 6

12 $20,000, 41.2% earning between $20,000-$49,999, and 14.5% earning $50,000 or more (U.S. Census Bureau, 2010). In addition, 19.5% of Hispanics live at poverty levels and nearly half of Hispanics make less than $20,000 per year (U.S. Census Bureau, 2010). However, this estimation does not include undocumented Hispanics who might not participate in Census counts due to fears of deportation. Usually, undocumented Hispanics work under low wages and even inhumane working conditions. North Carolina has also experienced an unusual growth of the Hispanic population. According to the American Community Survey estimates, the total population of North Carolina is 9,036,449, which includes 636,786 Hispanics. Thus, 7% of the population at NC is Hispanic without including undocumented individuals (U.S. Census Bureau, 2008). From the total NC population, 4.6% are Mexican, 0.6% is Puerto Rican, 0.1% is Cubans, and 1.8% Other Hispanic or Latino (U.S. Census Bureau, 2008). The ceiling effect regarding Hispanic educational attainment at a national level is similar within NC, given that Hispanics make up only 9% of all K-12 school enrollments (Pew Hispanic Center, 2007). The persistence of this educational ceiling effect is also attributed to issues regarding language barriers, limited financial and educational resources, and acculturation issues. In addition, the median annual earnings of Hispanics in NC is $18,923, hence 31% of Hispanics 17 and younger are in poverty level in NC (Pew Hispanic Center, 2007). A particular characteristic that distinguishes Hispanic population among other ethnic groups is the Spanish language. Each Latin American country has its own idiosyncrasy with the Spanish language. In other words, each Hispanic has their own particular set of words, phrases, and expressions that vary in meaning depending on the country. However, having Spanish as a first language might represent a barrier for Hispanics in some cases regarding educational 7

13 attainment, employment opportunities, as well as acculturation issues which require a proficient or at least adequate mastery of English. For instance, considering Hispanics who are older than 18, 20.1% speak only English at home, 35.5% speak English very well, and 44.4% speak English less than very well. In contrast, Hispanics who are younger than 18, 33.9% speak only English at home, 49.1% speak English very well, and 17% speak English less than well (U.S. Census Bureau, 2010). Hence, it appears that the older groups of Hispanics have more difficulty learning English and thus keep Spanish as their main language. Similarly, Hispanics language trends are comparable in NC where 1% speaks English at home and 74% speak English less than very well (Pew Hispanic Center, 2007). So, the heterogeneity of the Hispanic population is represented in each country s version of the Spanish language, although this might be a difficulty when attempting to learn English. In sum, Hispanics represent a diverse population group that is continuously increasing in the U.S at a rapid rate (see Table 1.). In fact, the U.S. has the second largest Hispanic population in the world as well as the third largest Spanish speaking population in the world (U.S. Census Bureau, 2009). Also, the demographic trends indicate that the Hispanic population has increased in every state (see Table 2.). However, Hispanics face significant challenges regarding educational attainment and low income. Perhaps, the current negative situation in these challenges is due because issues with acculturation, language barrier, and immigration status difficulties. Given the continuous growth of the Hispanic population in the U.S., future policies need to include a particular focus in this growing population as U.S. gradually becomes more and more Hispanic. 8

14 2008 Hispanic Population in the U.S. N % Mexican Puerto Rican All Other Spanish/Hispanic/Latino Cuban Salvadorian Dominican Guatemalan Colombian Spaniard Honduran Ecuadorean Peruvian Nicaraguan Venezuelan Argentinean Panamanian Chilean Costa Rican Bolivian Uruguayan Other Central American 30,746,270 4,150,862 1,777,278 1,631,001 1,560,416 1,334, , , , , , , , , , , , ,655 93,745 60,730 43, Total 46,822, Table 1. Pew Hispanic Center tabulations of the 2008 American Community Survey 9

15 Top 15 States with Most Hispanic Growth State Hispanics Hispanic Growth Percent Growth West Virginia 10,101 21,400 11, South Dakota 10,718 22,420 11, South Carolina 94, ,999 83, Minnesota 116, , , Nebraska 80, ,968 67, North Dakota 7,429 13,634 6, Arkansas 85, ,309 70, New Hampshire 21,536 39,123 17, North Carolina 377, , , Georgia 434, , , Kentucky 56, ,366 43, Iowa 72, ,030 51, Nevada 393, , , Delaware 37,301 62,506 25, Montana 18,568 31,093 12, Table 2; Pew Hispanic Center tabulations of the 2000 and the 2008 American Community Survey. Clinical Neuropsychology Clinical neuropsychology has become a separate field of specialization within psychology and its main objective is to gain a better understanding of the relationship between 10

16 brain and behavior. Thus, neuropsychology tries to explain how brain activities are expressed through observable behavior (Beaumont, 2008). Recently, Puente (2010) defined neuropsychology as a science based on the processing of information through biological and brain processes as well as how it is affected by culturally based and valued information. So, a current challenge for neuropsychology is to gradually integrate culture as a significant factor affecting the relationship between brain and behavior. Despite the fact that neuropsychology has shown progress in areas such as of assessment of sequelae of brain pathology or the establishment of a relationship between brain and behavior, our understanding about the influences of cultural differences is still very limited (Ardila, 1995).This is due to a cultural and linguistic biases that are still dominating the field even from its origins. For instance, the work of Lezak (1983) cites few references to the effect that variables such as language, culture, age, and education have on the shaping of the brain (Ardila, Rosselli, & Puente, 1994). One of the pioneers to start recognizing the influence between culture and neuropsychology assessment was Alexander Luria (1979) who acknowledged that the impact of language in testing in relation to the education experiences of the individual --specifically different cultures provide diverse sources of education that affect cognitive functioning. During his visits to Central Asia in the 1930s, Luria (1934) investigated the impact of cultural variables on cognition. Consistent with Luria s legacy, cross-cultural research and studies of ethnic groups in the U.S. have supported the essential role that cultural context play in testing performance yet some challenges that have limited our progress in understanding cultural influences in test performances remain: a) controversy over the exact processes that represent mental abilities and b) lack of agreement in defining the concept of culture within testing (Miller-Jones, 1999). 11

17 Almost a century later, the field of neuropsychology is working towards integrating the meaning of culture to gain a better understanding of the cultural and linguistic factors that affect testing (Pedraza & Mungas, 2008). History of Clinical-Neuropsychological Test Usage Historically, trends of psychological assessment have been reported using test usage studies. Hence, various research studies about test usage have been performed. In 1947, Louttit and Browne compared the use of tests from 1935 until They reported a shift to a more frequent use of intelligence and projective personality measures. In a survey with agencies and hospitals, Sundberg (1961) reported a decrease in the use of intelligence tests compared to a more frequent usage of projective tests. Subsequently, Lubin, Wallis, and Praine (1971) also found that this pattern of using projective tests was consistent through the decade. Consequently, Brown and McGuire (1976) expanded on findings from Sundberg (1961) and Lubin et al. (1971). Brown and McGuire found no significant changes in psychological test usage between 1971 and During the following years, test usage surveys began to appear on assessment practices in neuropsychology. Hartlage and Telzrow (1980) examined frequent neuropsychological tests used. The top five most commonly used tests were: 1) Wechsler Adult Intelligence Scales (WAIS), 2) Partial Halstead Reitan Neuropsychological Battery (HRNB), 3) Wide Range Achievement Test (WRAT), 4) Bender Gestalt Test and 5) Full HRNB. A decade later, Butler et al. (1991) investigated neuropsychologists test usage patterns. Findings revealed that the top five most commonly used tests were: 1) WAIS-R, 2) Wisconsin Card Sorting Test (WCST) 3) Minnesota Multiphasic Personality Inventory (MMPI), 4) Boston Naming Test and 5) Rey- 12

18 Osterrieth Complex Figure Task. (ROCFT). Afterwards, Ball, Archer, and Imbof (1994) investigated psychologists perceptions of time required to administer, score and interpret the psychological tests that are used more often. Hence, results from Ball et al. (1994) were consistent with previous studies regarding frequent test usage (Brown and McGuire, 1976; Louttit and Browne; 1947; Lubin et al. 1971; Sundberg, 1961) Ten years ago Camara, Nathan, and Puente (2000) surveyed neuropsychologists and psychologists about their test usage. They reported that the five most frequent tests used were: 1) MMPI (I & II), 2) WAIS-R, 3) Wechsler Memory Scale-Revised (WMS-R), 4) Wechsler Intelligence Scale for Children Revised (WISC-R-III), and 5) Trail Making Tests A & B (TMT). Recently, Rabin, Barr, and Burton (2005) conducted a survey of common testing instruments of clinical neuropsychologists in the United States and Canada, and their results were consistent with findings from Camara et al. (2000). Last year, Lazarus and Puente (2009) conducted a survey comparing test usage of neuropsychologists from South Africa and U.S. They found that the top five most frequent neuropsychological tests used were: a) WAIS, b) ROCFT, c) Trail Making Test, d) WMS, and e) FAS Word Fluency Test. In sum, psychological test usage is constantly changing to meet the needs of the population s demographic shifts. Since the population of Spanish speaking clients is increasing in the U. S., it is necessary that testing practices match of this demographic change. Standards for Educational and Psychological Testing Psychological test and testing standards have been developed by a joint committee over the last 50 years. First there was the Technical Recommendations for Psychological Tests and Diagnostic Techniques prepared and published by the American Psychological Association (APA) in The next version was the Technical Recommendations for Achievement Tests, 13

19 which was developed by the American Educational Research Association (AERA) and the National Council on Measurement Used in Education (NCMUE) and published by the National Education Association in Later in 1966, APA published a third publication called Standards for Educational and Psychological Tests and Manuals to replace the previous two. The publication was developed by a committee including APA, AERA, and the National Council on Measurement in Education (NCME). Then, the Standards for Educational and Psychological Tests and the Standards for Educational and Psychological Testing were developed by APA, AERA, and MCME in 1974 and 1985 respectively. (AERA, 1999). Today, to ensure the procedures and regulations of testing practices measure constructs with validity, the Joint Committee on the Standards for Educational and Psychological Testing (AERA, 1999) were developed to oversee the accuracy in all kinds of standardized testing taking place in the U.S. The two main objectives of the Joint Committee on the Standards for educational and psychological testing are the following: a) to support the accurate and ethical use of tests and b) to provide a basis for evaluating the quality of testing practices. Regarding neuropsychological tests, the question of validity is fundamental. Validity is defined as the degree to which evidence and theory support the interpretations of tests scores entailed by proposes uses of tests (AERA, 1999; p.9). Therefore, if neuropsychological tests have validity, then an accurate representation of the construct of interest has been obtained. However, when the constructs of interest are neuropsychological evaluations of Spanish speakers; such tasks become extremely difficult because the majority of neuropsychological tests lack the validity necessary to measure the neuropsychological performance of Spanish speakers. Moreover, when performing neuropsychological testing on an individual in both languages, 14

20 would it be accurate to expect that both results are equivalent and have validity? Or does language of the test interfere with what the test is supposed to measure? The Joint Committee sets the standards for all educational, psychological, and employment testing in the U.S., which includes standardized tests such as the MCAT, GRE, SAT, or FCAT as well as psychological and neuropsychological tests such as the Stroop Test or the WAIS IV. Furthermore, the standards are divided in three parts: the first part called Test Construction, Evaluation, and Documentation, includes standards for 1) validity, 2) reliability and errors of measurement, 3) test development and revision, 4) scaling, norming, and score comparability, 5) test administration, scoring, and reporting, and 6) supporting documentation for tests. Part two addresses issues on Fairness in Testing, which contains standards on 7) fairness and bias, 8) the rights and responsibilities of test takers, 9) testing individuals of diverse linguistic backgrounds (see Appendix D.) and 10) testing individuals with disabilities. Finally, the third part covers issues regarding Testing Applications, which contains standards about 11) general responsibilities of test users, 12) psychological testing and assessment, 13) educational testing and assessment 14) testing in employment and credentialing, and 15) testing in program evaluation and public policy (AERA, 1999). Standards Chapter 9: Testing Individuals of Diverse Linguistic Backgrounds According to the Standards regarding testing individuals of diverse linguistic backgrounds, it is important to consider language background when developing, selecting, administering, and interpreting test performance because an individual s language deficiency can cause poor test performance (AERA, 1999; p. 91). Consequently, the impact of language skills 15

21 on test performance is significantly related to issues including test validity, test reliability, test development, and test administration. Although, test modifications such as translation of a test from English to Spanish are often needed to ensure the validity of the test scores, there are several hazards that need to be avoided when doing such translation. The standards for testing individuals of diverse linguistic backgrounds indicate the following recommendations when translating a test: a) it should not be assumed that translation produces an equivalent version of the test in content, difficulty level, validity, and reliability, b) test takers acculturation experiences should not be assumed to be transferable between translations, c) different words have different frequency rates or difficulty levels depending of the language, which needs to be considered when translating, d) words in two different languages that might appear similar in meaning may differ significantly thus affecting the translated test for intended use, and e) content of a translated test may not be equivalent to the original test version (American Educational Research Association, 1999; p. 92). These recommendations are applicable when translating neuropsychological tests from English to Spanish, thus further investigations are necessary to determine if current neuropsychological tests that were translated from English to Spanish follow these guidelines. As mentioned earlier, although Spanish is a common language in Latin America and Spain, there are important linguistic differences among the different countries. Regarding language proficiency in testing individuals from diverse linguistic backgrounds, the standards recognize the relevance of linguistic group differences in establishing accurate design, development, selection, administration, and interpretation of tests (AERA, 1999; p. 93). Furthermore, when testing individuals familiar with two or more languages, language dominance and proficiency need to be considered when conducting standardized tests. The standards 16

22 recommend that the test administrator needs to determine which language is dominant at first. If both languages are equally dominant, then the test should be administered in the most proficient language if possible. However, if both languages are specialized in a particular context such as English at work and school, but Spanish at home, then testing in both languages is necessary in such cases (AERA, 1999; p. 94). When testing bilinguals the standards identify some special challenges; specifically, when an individual who knows two languages may not test well in either language. Also, some individuals who are bilingual use their first language in most social situations while using English in academic or work related activities. Since the use of a particular language depends on the situation, understanding the type and degree of bilingualism in an individual is necessary for accurate test use (AERA, 1999; p. 95). So, when testing a bilingual individual (English and Spanish), special consideration should be addressed towards which context a particular language is dominant. Does the individual speak Spanish mainly at home and English at work? Or does he or she speak Spanish mainly with parents and older members of a native community, while speaking English with younger cohorts and siblings? The context of the language of a bilingual person has strong implications for the accuracy of neuropsychological tests. When testing, it cannot be assumed that a test taker belongs to the cultural or linguistic population from which a test is standardized because standardized administration procedures and norms might not apply to establish an accurate comparison of the test taker s results (AERA, 1999; p. 95). The standards for testing individuals from different linguistic backgrounds recommend that a test taker should be given an adequate opportunity to complete the test and demonstrate their level of competence in the construct that the test measures regardless of the language. However, the standards recognize that the following factors may affect test taker s 17

23 performance in testing: a) cultural and linguistic background of the test taker and test administrator, b) gender as well as testing style of the test administrator, c) level of acculturation of the test taker and the test administrator, d) the language in which the test is administrated in its original language, d) whether or not the test is administered in the primary language of the test taker or in both languages (if so in what order), e) the testing time limits, and f) the use of a bilingual interpreter (AERA, 1999; p. 95). In the context of testing Spanish speakers, these factors are extremely relevant regarding their test performance because of the linguistic and cultural variability, gender beliefs, and time perception of this population. For example, standardized test administration procedures and norms would be different when testing a Spanish speaker raised in Ecuador compared to a Spanish speaker living in Spain despite that they both speak Spanish. When testing individuals from diverse linguistic backgrounds, there might be the case when adequately translated version of a test is not available or does not exist. According to the testing standards, the assessment should be conducted by a professionally trained bilingual test administrator who should be proficient in the test taker s language at a professional level. If a bilingual test administrator is not available, an interpreter should be used to administer the test with the test examiner in the test taker s primary language (AERA, 1999; p. 95). Although, the standards suggest the use of interpreters as a last option, they indicate some inherent challenges and difficulties involving this practice: a) lack of linguistic and cultural equivalence between translation and test, b) the translator/interpreter might be properly trained on neither testing procedures nor testing standards, and c) norms might not be available to score and interpret results accurately. These challenges represent a significantly reduced validity when testing 18

24 Spanish speakers, specifically in psychology where the amount of bilingual professionals and properly standardized tests in Spanish is limited. According to the standards for testing individuals of diverse linguistic backgrounds, cultural differences need to be considered in the testing process because they affect linguistic behavior. This will impact how an individual s responses are scored or interpreted when testing (AERA, 1999; p. 96). Thus, this particular recommendation has a significant relevance when testing Spanish speakers because of their intense and heterogeneous cultural variables. For example, older Spanish speakers might be hesitant to speak or collaborate with younger test administrators who might be seen as inexperienced as well as detached from the Latin culture. As a result of the cultural disparity, the test taker might provide responses which would provide an inaccurate assessment of the skill being measured. Thus, it is necessary to be aware of the impact of language in the testing process to preserve the validity of the measurements. Given that the population of Hispanics with diverse origins has increased in recent years, the Joint Committee sets great importance in testing Spanish speakers; the ninth chapter of the standards is focused on testing individuals of diverse linguistic backgrounds. Hence, all testing results from Spanish speaking individuals who need to meet the following criteria of the standards in order to have validity: a) Test name in Spanish, b) Hispanic norms (U.S.), c) Non- U.S. Hispanic norms, and d) Test manual in Spanish. If tests do not meet the criteria of the standards, then these tests validities would be spurious (AERA, 1999) (see Table 3.): 19

25 Criteria for Testing Spanish speakers according to the Standards for Educational and Psychological Testing (1999). Test in Spanish Hispanic norms (U.S.) Non-U.S. Hispanic norms Test manual in Spanish Table 3. Criteria from the Standards for assessing Spanish speakers. Clinical Neuropsychology and Hispanics Performing neuropsychological testing on Spanish speakers has been a challenging task given the linguistic and cultural diversity within this population. To make matters worse, the development of neuropsychology has not been significantly slower in Latin America than in the U.S. Pontón and Ardila (1999) proposed the following explanations for the gap in neuropsychology between Latin America and the U.S.: a) access to academic and professional resources is problematic because scientific and economical challenges within Latin America, b) communication among Latin American nations has been slow, insufficient, and unreliable through history. Although has ameliorated the situation, not everyone has access to internet connections, c) low earnings from neuropsychologists in Latin America as well as limited institutional resources to purchase peer- reviewed scholarly journals, and d) the amount of neuropsychology literature in Spanish has been different because of the reasons above. Considering all these limitations, it is not surprising that neuropsychology in Latin America is not developed as in the United States. 20

26 Despite the exponential increase of the Hispanic population in the U.S., the psychology field has been unable to keep up with the demographic shift. For instance, only about 1 percent of all U.S. psychologist practitioners identify themselves as Latino regardless of the continuous growth of the Hispanic population (Dingfelder, 2005). Another example of the grim situation of psychology and Hispanics is that most translated tests sold in the U.S. only include English language manuals (Fernandez, Boccaccini, & Noland, 2007). Thus, an upcoming challenge for the psychology field is to provide an accurate service for the growing Hispanic population, which will require training psychology professionals to be able to communicate with Spanish speaking clients as well as developing more neuropsychological tests in Spanish. In neuropsychology the situation is daunting; the prevailing assumption that brain function is immune to cultural and linguistic variables is the major cause of why the paucity of neuropsychology towards the understanding about the effects of cultural differences in neuropsychological performance is still limited (Ardila, 1995). Similarly, aside from the work of a few such as Ardila, Puente, and others (Ardila, Rosselli, & Puente, 1994) and the founding of the Hispanic Neuropsychological Society (HNS) in According to their website, HNS is a group formed by clinical and research neuropsychologists interested in developing and promoting competent neuropsychology practices with Spanish speaking populations in the U.S. and Latin America. Furthermore, since 1994, members of the HNS have worked to solve issues regarding testing Spanish speakers in the U.S., such as test development from test publishers (Ponton & Ardila, 1999). Despite these efforts, the field of neuropsychology has not matched the impact of the demographic shift occurring in the U.S. Today, HNS members continue their collaborative efforts to improve testing of Spanish speakers in this country. For example, the HNS Listserve functions as a discussion board for research or practice of neuropsychology. Also, 21

27 HNS celebrated their first annual conference this Unfortunately, there is a potentially greater problem with the typical neuropsychologists regarding the gap between neuropsychology and Spanish speakers. In fact, the disparity between neuropsychology and demographic shifts is represented in findings from Echemendia, Harris, Congrett, Diaz, & Puente (1997) which indicated that approximately 83% of neuropsychologists felt less than adequately prepared to work with Hispanic individuals. Even from the beginnings of neuropsychological testing back in 1930, the validity of the testing results of minority children was considered spurious. For instance, Sanchez (1932) addressed that neuropsychological measures obtained from Spanish speaking children are not accurate given that environmental and linguistic difficulties hamper their performances when compared to majority group children. Historically, the dominant foundations in neuropsychology are directing us to an inaccurate understanding of how culture, race, ethnicity, and related demographic variables affect human behavior. Thus, this erroneous approach is evident in our current practices when testing Spanish speakers (Puente, 1990). Almost a century later, the status of testing minorities is still as daunting as Sanchez (1932) predicted mainly because understanding of how racial, ethnic, linguistic, and cultural variables affect brain function and neuropsychological testing is still scarce (Ardila, 1996: Helm, 1992). In neuropsychology, an existing concern involves the cultural discrepancy current neuropsychological instruments, procedures, and norms result in conceptual errors in assessment when testing non Western individuals (Ardila, 1995). As a result, the focus on the effects of culture in cognitive functions has gained a lot momentum in recent years (Agranovich & Puente, 2007; Ardila, 1995; Ardila, 1996; Perez-Arce & Puente, 1996; Puente & Agranovich, 2004; Puente & Salazar, 1998). For instance, it has been shown that neuropsychological test 22

28 performance of indigenous population with contemporary neuropsychological tests does not represent a valid measure of cognitive performance because the assigned tasks are not relevant to them (Ardila & Moreno, 2001; Ostrosky-Solis, Ramirez, & Ardila, 2004; Ostrosky-Solis, Ramirez, Lozano, Picasso, & Velez, 2004). Since most neuropsychological tests are mostly oriented towards a dominant Western idiosyncrasy, then minority groups, such as Spanish speakers, might not perform according to their abilities, thus threatening the validity of these results. In order to further investigate the issues related to performing neuropsychological testing of minority group individuals, such as Spanish speakers, cross-cultural neuropsychology has emerged to allow us to gain a better understanding of the cultural variables that affect neuropsychological testing in Spanish speakers (Ardila et al. 1994; Ardila, 1995; Pontón & Ardila, 1999; Puente, A. E. & Perez-Garcia, 2000). According to the literature cited above, the main variables within the Spanish speakers culture that affect neuropsychological testing are a) acculturation (familiarity with the Western culture), b) language (bilingualism, Spanish proficiency), c) Education (reading, writing, vocabulary, mathematical and analytical skills), and d) socio-economic status (income, accessibility to resources, poverty). In sum, the interactions of these variables among each other have a strong impact on the neuropsychological testing performance of Spanish speakers because of the diverse heterogeneity of this population. Culture, which is defined as values, beliefs, and styles of behaviors, can affect neuropsychological testing (Ardila, 2005). However, a major concern is how generalization of Western-culture oriented tests and norms can hinder the performance in neuropsychological tests for individuals of non-western backgrounds (Puente & Agranovich, 2004). For example, Western culture places a high value in time to the point that time is extremely valued in Western 23

29 society where time efficiency is encouraged. On the other hand, non-western groups closer to the Equator consider time as something that just occurs, or sometimes secondary to a particular task. In other words, non-western societies do not consider time efficiency as relevant or important as Western societies. Consequently, since Spanish speakers might not have such time efficiency idiosyncrasy when performing a task, then it might be expected that Spanish speakers will receive lower scores in neuropsychological testing conditions where time (speed) is determinant (Puente & Salazar, 1998). Similarly, such cultural differences regarding the concept of time and time efficiency norms have also been found when comparing the performance of Russian and American samples in neuropsychological tests (Agranovich & Puente, 2007). Thus, depending of the value a culture places son time, an instruction such as as fast as you can, might suggest different meanings for a non-western and a Western individual. When conducting neuropsychological tests, Spanish speakers might score lower because they are not acculturated with the time efficiency idiosyncrasy from Western norms. Another variable within the cultural context of Spanish speakers that has an impact on their performance in neuropsychological tests is language. Although, it might seem accurate to test an Argentinean, a Puerto Rican, and a Mexican with the same version of tests translated and standardized with norms from Spain because they all have Spanish as a common language, this assumption is misleading and incorrect. Although Spanish speakers share Spanish as a universal language, crucial difference exist in words, phrases, and expressions depending of the country of origin (North America, Central America, South America, or Spain). These linguistic differences have an impact on testing Spanish speakers because they might interpret different meanings for the same word. For instance, the word bus (bus) has the same meaning in Spanish and Latin America. However, each Spanish speaking country has their own word besides bus to refer to the 24

30 object, for example, Uruguay and Chile, a bus also known as autobus, microbus, or micro. In contrast, a bus is also known as guagua (Puente & Puente, 1999). Also, not only each Spanish speaking country has its own word to describe something but some words can deviate in meaning depending of the country the Spanish speaker is from. For example, guagua does not mean bus in South American countries like Peru, Ecuador, or Bolivia which adopted the word guagua from Quechua, an indigenous language in the Andes region, into their Spanish vocabulary. In these South American countries, guagua means child. Thus, when working with neuropsychological tests in Spanish, a particular attention must be placed at the country of origin of an individual due to the linguistic differences within the same language. Besides difficulties testing Spanish speakers within the context of linguistic difference in Spanish, the situation is not ameliorated if the Spanish speaker also knows English. In fact, testing a bilingual client could be even more challenging because the degree of expertise of either language varies according the context. In other words, a person can use Spanish at home to communicate with family and English in school or job settings, thus each language is dominant in a particular setting. So, bilingualism adds variability to the complex task of testing Spanish speakers. For example, Rosselli et al. (2002) found that bilingual Spanish speakers had a performed lower in the Stroop Test compared to monolingual Spanish speakers. According to Manuel-Dupont, Ardila, Rosselli, & Puente (1992), bilinguals form a very heterogeneous group that vary in the following dimensions: a) sociolinguistic background, b)types of bilingualism, c) degree of proficiency/communicative competence, d) age and sequence of language acquisition, e) method of acquisition, f) language-specific factors, and g) anatomical variations. Because of the variability in of these dimensions, the context of the language in which a bilingual individual is being tested is just as important as the language of the test itself. 25