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Cross-Cultural Considerations in Pediatric Neuropsychology: A Review and Call to Attention a

a

Katie Olson & Kristin Jacobson a

Clinical Psychology, College of Graduate and Professional Studies, John F. Kennedy University, Pleasant Hill, California Published online: 12 Aug 2014.

Click for updates To cite this article: Katie Olson & Kristin Jacobson (2015) Cross-Cultural Considerations in Pediatric Neuropsychology: A Review and Call to Attention, Applied Neuropsychology: Child, 4:3, 166-177, DOI: 10.1080/21622965.2013.830258 To link to this article: http://dx.doi.org/10.1080/21622965.2013.830258

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APPLIED NEUROPSYCHOLOGY: CHILD, 4: 166–177, 2015 Copyright # Taylor & Francis Group, LLC ISSN: 2162-2965 print=2162-2973 online DOI: 10.1080/21622965.2013.830258

Cross-Cultural Considerations in Pediatric Neuropsychology: A Review and Call to Attention Katie Olson and Kristin Jacobson

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Clinical Psychology, College of Graduate and Professional Studies, John F. Kennedy University, Pleasant Hill, California

In the search to understand the basis of performance discrepancies, many clinicians are recognizing that, often, factors with no direct relationship to brain functioning influence performance on neuropsychological measures of cognition among children and adolescents. The emergent research on cross-cultural neuropsychology indicates that while the test performance discrepancies do indeed exist, they can be explained by a number of other factors, some of which are known and others that have yet to be operationalized or even identified. While a review of all such factors is beyond the scope of this article, an examination of those that have received the most attention is presented: factors associated with the examinee, factors associated with the neuropsychological measures, cultural competency of the examiner, and factors at the organizational=political level.

Key words:

culture, diversity, neuropsychology, pediatric

One of the breakthroughs of modern medicine has been the association of symptom clusters with specific pathogens. The same symptoms may be indicative of multiple and varying disorders that require vastly different treatments; therefore, determining the underlying cause is imperative to identifying and executing the most effective intervention. Historically, the job of the pediatric neuropsychologist in the medical setting has been to make sense of a child’s presenting cognitive and behavioral symptoms to arrive at a cause. This search for causation was one of the founding purposes of neuropsychology, until the advent of sophisticated medical technology made locating structural damage both easier and more precise. As a result, the focus of neuropsychology shifted from localizing brain damage to documenting brain function. Unlike in traditional medicine, the cause of injury to the brain does not invariably predict the course of dysfunction. Although the majority of teaching examples seem to be of extreme localized damage, the majority of brain injuries are diffuse Address correspondence to Katie Olson, MPH, MA, College of Graduate and Professional Studies, John F. Kennedy University, 100 Ellinwood Way, Pleasant Hill, CA 94523. E-mail: [email protected]

(Walsh, 1985). Furthermore, while patterns of impairment may be similar and even generalizable, they are not predictable. Thus, it becomes the privilege and task of the neuropsychologist to elucidate brain– behavior relationships to determine changes in functioning after damage occurs, provide a prognosis for functioning in the ‘‘real world,’’ and recommend interventions. Determining such factors through the use of psychological and neuropsychological instruments is, however, not nearly so straightforward. ‘‘There is widespread agreement that many neuropsychological measures do not have acceptable diagnostic accuracy when used among people who are not Caucasian, well-educated, native English-speaking, and middle to upper class’’ (Manly, 2008, p. 179; also see Ardila, Rodriguez-Menendez, & Rosselli, 2002; Boone, Victor, Wen, Razani, & Ponton, 2007; Brickman, Cabo, & Manly, 2006; Loewenstein, Arguelles, Arguelles, & Linn-Fuentes, 1994; Manly, 2005). Although publications addressing ethical, theoretical, and practical issues of cross-cultural neuropsychology have proliferated during the past two decades, they have not kept pace with the population growth of culturally and linguistically

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diverse people. This gap between the very real need for culturally appropriate neuropsychological interventions and the availability of evidence-based tools highlights the vulnerability of neuropsychological practice with diverse people. Furthermore, although the science of pediatric neuropsychology in particular has advanced considerably, publications addressing culturally and linguistically diverse populations are even more limited.African American, Hispanic American, and Native American group members consistently demonstrate lower IQ and achievement test scores when compared with Caucasian Americans (Gasquoine, 1999). Such test score discrepancies reliably persist even when groups are matched on chronological age, years of formal education, sex, and income level (Manly, Jacobs, Touradji, Small, & Stern, 2002; Nabors, Evans, & Strickland, 2000). Debate continues as to whether these discrepancies are due to biological differences among ethnic groups, environmental differences, measure bias and construct definition, the familiarity of administrators with different ethnic groups, other factors of which ethnicity may merely be a proxy, or some combination of any of the aforementioned factors (Brickman et al., 2006; Gasquoine, 1999). In the search to understand the basis of performance discrepancies, many clinicians are recognizing that, often, factors with no direct relationship to brain functioning influence performance on neuropsychological measures of cognition (Brickman et al., 2006). When working with children and adolescents, one can never ignore or underestimate the dynamic nature of cognition and the importance of development. Baron (2010) proposed five maxims of pediatric neuropsychological practice: (a) Maturation is a paramount force; (b) adult brain–behavior relationship rules do not invariably apply to children; (c) a model of normal development provides critical clinical context; (d) pediatric neuropsychological methods are distinctive; and (e) genetic, socioenvironmental, and family factors have primacy. It is with this last maxim that this manuscript is most concerned, although this by no means suggests that the others are of less importance. Another perspective, offered by Super and Harkness (1997), uses the term ‘‘developmental niche’’ to locate a child within a set of social, cultural, and ecological relations known as the ‘‘proximal environment of development.’’ Developmental niches can be examined across three subsystems: (a) the physical and social settings in which the child lives; (b) the culturally regulated child-rearing and socialization practices of the given society; and (c) the psychological characteristics of a child’s caregivers, including their approaches toward child development in general and their specific affective stances toward child-rearing (p. 27). Together, although certainly not exclusively, these three subsystems mediate the child’s experience

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within the broader culture by affecting a brain that is constantly changing. In the case of pediatrics, the developmental stage represents an aspect of the patient’s culture that requires special consideration, while, as with adult patients, additional variables must also be considered. The emergent research on cross-cultural neuropsychology indicates that while the test performance discrepancies do indeed exist between cultural groups, they can be explained by a number of other factors, some of which are known and others that have yet to be operationalized or even identified. While a review of all such factors is beyond the scope of this manuscript, those that have received the most attention may be broadly classified into three distinct groups: factors associated with the examinee, factors associated with the neuropsychological measures, and cultural competency of the examiner.

FACTORS ASSOCIATED WITH THE EXAMINEE Ethnicity In colloquial language, the terms race and ethnicity are often used interchangeably. However, in the interest of promoting culturally competent neuropsychological practice, it is important to clarify that ethnicity is better used to define groups of people with common nationality and=or language, whereas race typically connotes greater genetic involvement (Gasquoine, 1999). One obstacle to cross-cultural neuropsychology is that concepts such as race and ethnicity are complex, multifaceted, and are as often defined by what they exclude as by what they include. To further complicate matters, researchers from fields such as evolutionary biology, anthropology, genetics, and sociology argue that race is a socially constructed term lacking a discrete genetic basis, reliable measurement, and scientific utility (Smedley & Smedley, 2005). If the construct of race does not exist, it becomes less important that there is no agreed upon, consistently employed operational definition. Yet such a consensus within the field of neuropsychology, let alone across disciplines, has not been reached. As a result, many early neuropsychologists either avoided issues of race and ethnicity altogether, or simply reported that, in general, members of Non-Caucasian ethnic groups demonstrated poorer performance on measures of cognitive processes than did Caucasians. Without sufficient explanation, the conclusion was erroneously drawn that Non-Caucasians were less intelligent than their Caucasian counterparts—a conclusion we now know to be thoroughly mistaken. As clinical research has grown more sophisticated, the belief that ethnicity or race must somehow be

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a causative agent in test performance has been replaced by independent variables believed to impact the outcome of interest and to differ among various groups of people. Such variables include acculturation, language proficiency, level of formal education, and socioeconomic status (SES), among others. Brickman et al. (2006) summarized research on ethnicity and neuropsychological performance, concluding that it is incorrect to attribute test performance to ethnicity, as ethnicity does not cause variability in cognitive processes but is rather a marker for other associated and influential factors. The authors stated, ‘‘Simply knowing a patient’s ethnicity or race does not adequately provide the clinician with the necessary information to determine the impact of . . . factors on performance, but it may aid the clinician in understanding the potential unique cultural experiences the patient has had’’ (Brickman et al., 2006, p. 93). It is the likelihood and extent to which other contributing factors are present among certain ethnic groups that makes ethnicity an important consideration in any neuropsychological evaluation. Race=ethnicity served as a proxy for more meaningful variables, such as acculturation, quality of education, socioeconomic class, and racial socialization (Manly, 2006; Puente & Ardila, 2000). Also, measurement of these constructs, reportedly, could result in improved health-related research for both majority and minority ethnic groups. Therefore, considering ethnicity for ethnicity’s sake alone is likely to yield little real understanding of test performance discrepancies. However, considering the ways in which the color of a person’s skin has impacted their education and employment opportunities, how the name of their country of origin affects how they are viewed by those born in the United States, and the quality of their education and SES prior to immigration is likely to provide greater insight into performance on neuropsychological measures. As an example, although the median household income is higher for many Asian groups when compared with Whites, Wong and Fujii (2004) point out that ‘‘this figure is deceiving’’ (p. 27). They explain that although gross household income is greater, the money is often divided among more people, as ‘‘families are generally larger . . . and there are more persons per household in the workforce’’ (p. 27). Language Language proficiency has a tremendous, and often the most obvious, impact on neuropsychological test performance. Among people who immigrated to the United States after 6 years of age, the acquisition of English at grade norm levels of proficiency requires an average of 5 to 7 years (Cummins, 1981). Cummins (1979) differentiated between basic skills necessary for

communication (‘‘surface fluency’’) and the more cognitively taxing and complex levels of language-processing proficiency. In social situations, comprehension is often aided by contextual cues, such as facial expressions or hand gestures. ‘‘The lack of context and the cognitively demanding circumstances of a testing situation require significant language proficiency in excess of that utilized in basic social communication’’ (Candelaria & Llorente, 2009). Thus, simply because an adolescent can check in for their neuropsychological evaluation appointment in English and provide translation for their accompanying non-English-speaking parent does not indicate language proficiency at the level required for valid testing purposes. Yet this scenario, quite unfortunately, is often the only ‘‘screening’’ that occurs prior to the formal neuropsychological evaluation with pediatric, non-native English-speaking patients. The great majority of neuropsychological measures were created and remain available only in English. Although the past few years have seen the development and translation of tests in other languages (practices still replete with problems to be discussed later), the fact remains that clinicians are increasingly being asked to evaluate patients whose primary language is different from their own, with tests written at a sixth- or eighth-grade English-language reading and comprehension level. The ethical standard regarding Standard 9.02 (b) ‘‘Use of Assessments’’ issued by the American Psychological Association requires psychologists to ‘‘. . . use assessment methods that are appropriate to an individual’s language preferences and competency’’ (American Psychological Association, 2010). There are numerous complications associated with attempting to uphold this mandate, only a few of which will be briefly mentioned here. Anyone who has struggled to find a way to convey a concept through use of the English language that does not exist in another language, or who has sat in silent discomfort as an interpreter attempted to do so, likely resonates with the challenges posed by translation. Words in one language may not exist in another language; likewise, two languages may have different meanings for similar words. As such, it is incorrect to assume that only the text of the neuropsychological measures needs to be translated to overcome a language barrier (Echemendia, Harris, Congett, Diaz, & Puente, 1997) or that measures are equivalent across groups so long as they are administered in the patient’s native language (Brickman et al., 2006). Translation of individual test items during evaluation deviates from standardized procedure and is ripe for inconsistencies in word choice, thus confounding the validity of the entire measure. It is likely that the accuracy would vary depending on the experience of the person translating. The use of back translation (translating a test created in English into

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another language and then back to English) has been emphasized (Brislin, 1983); however, with any translation, it is important to recognize that differences in language and culture likely result in changes in the very nature and cognitive equivalency of the test item. The International Test Commission has suggested guidelines for the adaptation of tests (Hambleton, 2005) that comprise four general categories: cultural context, technicalities of developing and adapting instruments, test administration, and documentation and translation. Additional recommendations for translation and adaptation have been proposed by Artiola i Fortuny and Mullaney (1998), Muniz and Hambleton (1996), Van de Vijver and Hambleton (1996), and Loewenstein et al. (1994). The services of an interpreter should only be used if no neuropsychologists are available to perform an evaluation in a patient’s native language, which is unfortunately often the case in many parts of the United States, not only rural areas. This approach is fraught with problems, not the least of which is that unless the translator is a neuropsychologist, they are unlikely to have a thorough knowledge of neuropsychological terms and techniques. The majority of interpreters also lack formal training in interpretation; although they may be fluent in both English and the native language of the patient, there may be misunderstanding of the nature of the task or uncertainty of how to properly interpret the patient’s responses. The use of family members as interpreters should be expressly avoided, particularly in forensic neuropsychology. Regardless, there are likely many more instances than have been discussed in publications in which a family member provided interpretation to avoid forgoing evaluation altogether. The use of a translator should be explicitly noted in the report, along with requisite caveats as to the potential effects this may have on validity. One potential effect of using an interpreter is that it ‘‘may change the comfort level and dynamics during meetings, and the subtleties in communications, such as non-verbal cues and complex language responses, can be lost easily through interpretations’’ (Candelaria & Llorente, 2009, p. 420). As nonverbal communication is important in understanding process observations, rich qualitative data may be lost when using an interpreter. This is especially important when working with patients from Asian, African, Indian, Hispanic=Latin American, and other collectivist cultures, who may use ‘‘silent communication,’’ which ‘‘relies on an implied understanding between people [familiar with] that culture’’ (McLaughlin & Braun, 1998, p. 118). If the neuropsychologist overlooks this valuable information, there is a risk for the patient feeling misunderstood and an incomplete plan of care being developed.

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Special mention must also be made of bilingual children and adolescents, who may have some knowledge that is more easily accessible through English and other knowledge more readily accessed through another language. For example, children who spoke one language before beginning formal education in English may understand some concepts in their native language, which may or may not translate over as they acquire English. Likewise, children who learn English as their first language but live in a home where another language is regularly spoken may have difficulty precisely defining words in either language, while simultaneously reporting comprehension of both languages. There are multiple levels of bilingualism (Cummins, 1991; Mindt et al., 2008), and some children may understand terms better in one language, even if they do not often speak it or are unable to write it. Particularly among young children who are simultaneously learning two languages, it is crucial to assess knowledge in both languages and not assume that test results obtained in English are indicative of cognitive abilities. Acculturation The term acculturation is used to describe how people from one culture adopt, integrate, or conform to the characteristics, traits, and norms valued by another culture (Berry, 1997). Acculturation occurs along a continuum, with different members of the same family adopting, ignoring, or opposing more or fewer facets of the dominant culture. The concept of acculturation assumes that the more familiar an individual becomes with what is prioritized in his or her new culture, the better he or she will understand and perform on measures developed within that new culture (Ponton & Ardila, 1999). Although the process may be related to how long the individual has lived in the United States, the following factors may carry more weight: why the individual left their previous country of origin or residence, the person’s feelings toward their new country, their reception by members of the new country’s dominant group, the degree to which they desire to be perceived as ‘‘part of’’ their new country versus their desire to maintain another cultural identity, and the degree to which acculturation is perceived as being voluntary versus necessary. There is also some evidence that country of origin may play a role in the trajectory of acculturation. For example, immigrants from more Westernized cultures, such as those from Singapore relative to China, may be more likely to adapt to American culture given their established familiarity (Wong & Fujii, 2004). Acculturation may also be associated with language. However, as Echemendia and Julian (2002) pointed out, ‘‘Given the complexity inherent in the acculturation

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process, it is unlikely that unidimensional measures of language use, dominance, or preference will serve as a reliable proxy for acculturation’’ (p. 185). Less is known about measuring acculturation in children than in adults, although it is likely to be further complicated by the developmental process, especially for adolescents who are already in a highly dynamic and often tumultuous state of identity development. Measures of acculturation have not traditionally been part of a standard pediatric neuropsychological battery, perhaps partly because so few measures appropriate for use with children and adolescents exist. Nonetheless, whether viewed as unidimensional or multifaceted, acculturation has been demonstrated to be a powerful factor affecting neuropsychological test performance (Boone et al., 2007; Heaton, Ryan, & Grant, 2009; Manly, Byrd, Touradji, & Stern, 2004; Manly et al., 1998; Touradji, Manly, Jacobs, & Stern, 2001). Cultural Experience Although differences in test performance exist between different groups when they are classified by ethnicity, what is surprising is the amount of difference within groups with the same ethnic label. ‘‘Differences within cultural or ethnic groupings on psychological measures like intelligence are typically more impressive than between-group differences’’ (Gasquoine, 1999, p. 377; see also Brickman et al., 2006). This is because ethnicity is not a reliable or particularly informative proxy of cultural experience, which may be more related to geographic location. Put another way, a person who identifies as Hispanic and lives in Los Angeles is likely to have had very different cultural experiences from a person of the same age and gender who also identifies as Hispanic but lives in Boston. Similarly, the experiences of many African Americans living in the Northern United States may be very different from those of African Americans living in the South. ‘‘Argentineans, Cubans, and Mexicans for instance, will fall under the rubric of Hispanic in the United States, however, they could hardly be considered ethnically, culturally, or linguistically uniform’’ (Ponton & Ardila, 1999, p. 569). In some instances, knowing about the particular neighborhood in which a child lives may be more useful for interpreting test performance than race or ethnicity. Cultural experience is therefore different from ethnicity. It is also different from level of formal education, as a person with the same level of formal education could experience life quite differently depending on where they live (e.g., urban or rural) and the extent to which they accept or avoid both micro and macro cultures within their area of residence. For immigrant patients, country of origin may also play a role. For example, Filipino adolescents who immigrate after the fourth grade

are likely to have a relatively high level of English proficiency, as ‘‘English is the primary language spoken in school from the fourth grade [in the Philippines]’’ (Wong & Fujii, 2004, p. 27). Cultural experience, although likely contingent upon geographic location, is about more than simply where a person was born or currently lives. It is perhaps best understood as their experience resulting from the interaction of locale (defined by large or small geographic boundaries) with other factors such as ethnicity, education, acculturation, gender, and SES. Education Education is one of the most researched and therefore best understood factors affecting neuropsychological test performance. Education is typically measured by the number of years of formal instruction received, but it must be kept in mind that there are differences in educational quality (Byrd, Sanchez, & Manly, 2005). The quality of education may vary by individual school, neighborhood, school district, state, or whether the school is private, public, or parochial (Candelaria & Llorente, 2009). Most neuropsychological measures assess cognitive abilities through procedures and materials also commonly used in schools, so it is no surprise that people with higher levels of education (and more opportunities for exposure to similar methods and items) perform better on such measures (Manly et al., 2002). Indeed, groups with higher levels of educational attainment have demonstrated better performance on intelligence tests (Ostrosky, Ardila, & Rosselli, 1999; Ostrosky-Solis, Ramirez, Lozano, & Velez, 2004), verbal tests (Acevedo et al., 2000; Reis & Castro-Caldas, 1997), and nonverbal tests (Klenberg, Korkman, & LahtiNuuttila, 2001; Rosselli & Ardila, 2003). The purpose of education is to communicate culturespecific information. Cornelious and Caspi (1987) stressed that while educational level is related to performance on some cognitive tests, education is not systematically related to abilities of everyday problem solving. Rosselli and Ardila (2003) concurred, emphasizing that it may not be correct to classify people with lower levels of formal education as ‘‘deprived.’’ Instead, it may be more accurate to emphasize that they have accumulated qualitatively different information. The authors state, ‘‘If tests were based on the knowledge and skills better developed by those with low levels of formal education, then highly educated people would be at a disadvantage’’ (p. 331). Ponton and Ardila (1999) called for the development of measures of functional ability to surpass the boundaries for formal neuropsychological testing, particularly for people with little or no formal education, as well as measures that are corrected for formal education. Given that most neuropsychological

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measures appear to assess abilities that are not innate or universal but are developed as the result of culturespecific training, the potential for education to impact test performance becomes obvious and especially important to explore. Many neuropsychologists have reported the effects of illiteracy on neuropsychological test performance (Ardila & Moreno, 2001; Manly, Touradji, Tang, & Stern, 2003; Nell, 2000). However, inconsistencies in the definition of literacy complicate attempts to crossreference these additions to the literature. Although literacy has traditionally been associated with the ability to read, other definitions include specific cognitive processes associated with social or even technological knowledge (Kress, 2003). The concept of literacy may also vary depending on whether the language in discussion is the patient’s first, second, or third. For instance, literacy in a native language may be more associated with quality than length of education, and literacy in a second language may be more associated with age, SES, or acculturation than education. As Candelaria and Llorente (2009) mention, the concept of technological literacy is becoming more germane neuropsychology as an increasing number of measures are designed for computer administration. With the proliferation of technology, it becomes especially important to remember that many children experience technological illiteracy, not because of innate deficiencies, but because of reduced exposure to computers and other technological devices at home and=or school. Test-Wiseness It has been noted that members of Non-Caucasian ethnicities are often not as ‘‘test-wise’’ as their Caucasian counterparts (Manly et al., 2002). Nell (2000) posits that the core psychological meaning of Westernization is test-wiseness, to such an extent that test-taking skills are assumed to be innate abilities. Westernized children often experience tests as competitions and opportunities to demonstrate competency as quickly as possible. Hispanic children, on the other hand, may view practicing good manners and seeking to collaborate with the examiner as the ‘‘correct’’ way to approach a neuropsychological evaluation (Puente & Ardila, 2000). Acquisition of test-taking skills occurs predominantly through formal schooling and direct experience with measures of achievement and ability. Education may also contribute indirectly to test-wiseness by teaching and reinforcing behaviors that increase the likelihood of success on neuropsychological measures (e.g., sitting still, following written and oral instructions, attending and concentrating for long periods of time, using writing utensils to draw or copy, and working to complete a task within a time limit; Nell, 2000). However, some schools

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do not utilize tests as often or in the same manner as other schools, so number of years of formal education does not necessarily imply familiarity with tests. Arnold, Montgomery, Castaneda, and Longoria (1994) determined that differential exposure to testing situations accounted for performance differences between Mexican Americans and Anglo-Americans. However, because performance between the two groups did not differ on 7 of the 12 measures from the Halstead-Reitan Neuropsychological Battery, it appears that lack of testwiseness may be reduced or controlled for when cultural equivalence is attained. According to Gasquoine (1999), ‘‘Proof of accuracy in the conceptualization of test bias comes from manipulation of the relevant psychological variables to achieve cultural equivalence. Unless these psychological variables are understood, this process can go astray’’ (p. 378). Through better explication of other influential variables, lack of previous exposure to testing may exert less influence on performance and lead to more valid results. Racial Socialization Racial socialization, also referred to as stereotype threat, has been demonstrated to compromise academic test performance among African Americans. Steele and Aronson (1995) found that African American college students demonstrated poorer performance than Caucasians when a test was introduced as a diagnostic measure of their intelligence. In contrast, no race= ethnicity differences were determined when participants were told that the same test would not be diagnostic of their intelligence. Overall, research on stereotype threat (Aronson et al., 1998; Aronson, Quinn, & Spencer, 1998; Steele, 1997) suggests that the social stigma of inferior intellectual abilities attached to certain ethnic minorities has both short- and long-term implications on both test and school performance. Although more research is needed on the influence of racial socialization with younger children, it is important to recognize that the way an evaluation is perceived by the examinee or the description of the purpose of the tests by the examiner may serve to activate stereotype threat and negatively influence or even invalidate test results. Socioeconomic Status An inverse relationship between SES and neuropsychological and academic performance has repeatedly been demonstrated, especially among young children (The National Research Council Institute of Medicine, 2000). The term SES is used to describe how a person’s cultural experience is influenced by a complex host of interrelated factors such as education, quality of the home environment, employment, health, and nutrition

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(Gasquoine, 1999). Individuals belonging to NonCaucasian ethnic groups are more likely to have lowerSES backgrounds. Ethnic minorities, as compared with Caucasians, are also disproportionately more likely to have incomes below the poverty level. Both length and degree of poverty must be taken into consideration, as persistent or chronic poverty has been shown to be associated with stronger negative effects on children’s achievement test scores compared with transitory or temporary poverty (Duncan, Brooks-Gunn, & Klebanov, 1994; Korenman, Miller, & Sjaastad, 1995). A significant and positive correlation exists between SES and years of education—a relationship especially important to understand when working with children from developing countries. In such countries, severe and prolonged poverty may be associated with impaired cognitive development through malnutrition and infection (Kar, Rao, & Chandramouli, 2008; Watanabe, Flores, Fujiwara, & Tran, 2005). Thus, even if a child moves to the United States and away from such extreme poverty, because of early structural and functional damage, he or she may experience differential benefits from formal education than other children from higher-income families. FACTORS ASSOCIATED WITH NEUROPSYCHOLOGICAL MEASURES Construct Validity The premise of universalism, that cognitive commonalities shared by all humans override the different conditions in which they are born and develop, is seductive for the freedom it promises from concerns of construct validity. Many tests are based upon the assumption of universalism and are touted as being culturally free or fair, usually because they include mostly nonverbal items (Rosselli & Ardila, 2003). Cole (1999) proposed that the entire notion of ‘‘culture-free’’ intelligence is inherently paradoxical, as the abilities that constitute intelligence and the tools used to measure them are inevitably culturally determined. As Ardila (1995) stated, ‘‘Culture prescribes what should be learned and at what age. Consequently, different cultural environments lead to the development of different patterns of abilities’’ (p. 145). This draws into question some of the very constructs chosen for inclusion in cognitiveprocessing measures. Test scores are not only associated with the patient’s history of learning opportunities, but with the very types of information a culture designates as worthy of being learned. The tasks that comprise neuropsychological measures are based on the assumptions that the task actually exists outside of the testing room, and the task is relevant to the life of the person undergoing evaluation.

Neither or both of these assumptions are likely to be true when administering measures developed and normed on one group of people to people in other groups. For a long time, it was believed that the effects of culture could be controlled or reduced if verbal items were eliminated from tests in favor of more nonverbal, performance-based items. The study of different cultural groups proved this to be incorrect (Ardila & Moreno, 2001; Mulenga, Ahonen, & Aro, 2001), and some researchers have reported even greater group differences in nonverbal tests (Gasquoine, 1999; Klenberg et al., 2001; Rosselli & Ardila, 2003). As Nell (2000) explained, ‘‘Despite episodes of political misuse, cross-cultural psychology is uniquely able to provide a humane framework within which the best interests of minority and culturally different peoples can be served by recognizing culture-specific differences rather than by an ideological universalism that seeks to obliterate these differences’’ (p. 12). Equivalence It has been proposed that the concept of equivalence in cross-cultural neuropsychology may be as psychometrically important as validity and reliability (Johnson, 2006; Pedraza & Mungas, 2008; Van de Vijver & Leung, 1997). After all, scores are useless if one does not know exactly what is being measured (Puente & Ardila, 2000). For the purposes of this manuscript, definitions put forth by Johnson (2006) are provided. Interpretive equivalence refers to how similarly measures are interpreted across cultural groups, with an emphasis on shared meaning of concepts and constructs. Procedural equivalence refers to technical aspects of the instruments (factorial, metric, etc.), with an emphasis on shared method of cross-cultural measurement. Both forms of equivalence must be achieved to demonstrate cultural fairness (Helms, 1992, 1997; Ramirez, Ford, Stewart, & Teresi, 2005). Norms Although equivalency is the desired result of standard, normalized scores, ‘‘Confounds associated with certain demographic characteristics must continue to be scrutinized during the norms acquisition process when assessments are developed and revised’’ (Candelaria & Llorente, 2009, p. 411). Sufficient normative data for African Americans and Hispanics—the two largest ethnic-minority groups in the United States—are simply not available for the majority of neuropsychological measures (Manly, 2005; Pedraza & Mungas, 2008). While measures are currently normed on different age ranges, failing to include cultural, educational, and linguistic factors in the standardization process creates the risk for pathologizing culturally appropriate

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behavior in groups underrepresented in the normative data. While this is potentially problematic given the aforementioned discussion of race and ethnicity, ‘‘It is evident that whenever a cross-cultural comparison is established, better scores are observed in the cultural group who is responsible for the development of the test’’ (Ardila, 1995, p. 147). The inherent reliance on dominant (and exclusionary) cultural norms, particularly when coupled with low evaluator cultural competence, can prevent a neuropsychologist from recognizing that a particular score would be ‘‘normal’’ if compared with others from the patient’s own cultural group. Thus, in many instances, scores may not be indicative of a deficit as much as they are evident of variable cultural amplification.

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Diagnostic Validity Diagnostic validity refers to the ability of a measure to distinguish persons with a specified disorder from those without the disorder (Smith, Ivnik, & Lucas, 2008). It consists of sensitivity, specificity, and the overall rate of accurate classification. Diagnostic validity is influenced both the scarcity of measures with established equivalence and the lack of normative data representative of cultural groups (Pedraza & Mungas, 2008). The lack of cultural fairness and appropriate normative data results in a substantial proportion of members of ethnic and cultural minorities being misclassified as cognitively impaired (Ardila, 1995; Brickman et al., 2006; Gasquoine, 2001). Pedraza and Mungas (2008) argue that because cutoff values on neuropsychological measures are typically derived through comparison to the normative standard, the choice of normative data and cutoff value directly influence sensitivity and specificity and, ultimately, diagnostic validity. Misdiagnosis is likely to be emotionally distressing and may result in unnecessary treatments and expenses, while also casting doubt on the usefulness of the measure, the ethics of the examiner, and the field of neuropsychology.

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biases and stereotypes, and how these might negatively affect the neuropsychological evaluation process as well as the test outcomes; 2. active efforts by the clinician to understand the worldview of culturally dissimilar clients without criticizing or passing negative judgments; 3. Ongoing and intentional efforts by the clinician to develop and practice relevant and sensitive assessment techniques and communication skills when working with ethnically diverse clients. Sue and Sue (1990) emphasized the process of becoming culturally competent: These three goals stress the fact that becoming culturally skilled is an active process, that it is ongoing, and that it is a process that never reaches an end point. Implicit is recognition of the complexity and diversity of the client and client populations, and acknowledgement of our own personal limitations and the need to always improve. (p. 146)

Cultural competency may be expanded by engaging in some relatively straightforward activities, such as traveling abroad, attending lectures and seminars on the history of other countries and cultural groups, and staying current on scientific literature. Less simplistic, but perhaps more realistic, familiarity with cultures beyond one’s own is often better achieved through multiple interactions with diverse people over time that are increasingly less formal and allow for assumptions to be confronted and questions to be asked. Given the changing demographics of the United States, it is highly likely that every clinician will encounter someone from a different culture or ethnicity than his or her own. Cultural competency should not be encouraged only for those clinicians practicing in urban, metropolitan areas, but should be expected of all clinicians, regardless of location (Judd et al., 2009).

FUTURE DIRECTIONS CULTURAL COMPETENCY OF THE EXAMINER Cultural competence at the individual level is essential for clinical work with cross-cultural populations (Ethical Standard 2.01, Boundaries of Competence, Subsection b; American Psychological Association [APA], 2010). As expounded by Korenman et al. (1995) and Sue and Sue (1990) and later applied to neuropsychology by Mindt, Byrd, Saez, and Manly (2010), cultural competence entails: 1. continuous awareness by the clinician of his or her assumptions about human behavior, values,

Taking into account factors associated with the examinee (ethnicity, language proficiency, acculturation, cultural experience, education, test-wiseness, racial socialization, and SES), aspects of the neuropsychological measures used (constructs, norms, and diagnostic utility), and the cultural competence of the examiner, an appropriate neuropsychological evaluation appears daunting, if not outright impossible. However, as the sheer length of this manuscript serves to indicate, research continues to add to the empirical basis of crosscultural neuropsychology. The following are suggestions intended to answer the question, ‘‘Where do we go from here?’’ The interested reader is also referred to Judd

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et al. (2009) and the Standards for Educational and Psychological Testing (American Educational Research Association, 1999). 1. Develop new norms. a. Develop new norms for existing instruments, taking into account ethnicity, culture, and language (Ardila, 1995). Large-scale normative projects have recently been undertaken for Spanish-speaking populations (Artiola i Fortuny, Romo, Heaton, & Pardee, 1999) and for African Americans (Heaton, Miller, Taylor, & Grant, 2004; Lucas et al., 2005). Use of race-based norms is not universally accepted, and using ethnicity or race as an independent variable has been proposed to be of limited merit because ethnicity and=or race are socially constructed means of differentiating and categorizing, not genetically or physiologically determinable characteristics. Also, the terms ethnicity and race even as used consist of attributes that are complex and multifarious and have heretofore defied operationalization. Using separate norms obscures the primary factors contributing to betweengroup discrepancies. 2. Develop new instruments. a. Group differences in performance on current instruments are more likely to be artifacts of the tests themselves and not indicative of any real group differences in ability or knowledge (Reynolds, 2000). Teng (1996) has argued that translation and back translation of measures are insufficient and unnecessary processes— insufficient, in that translated tests may demonstrate equivalency in content while failing to do so in meaning, and unnecessary, in that it is the cultural context that provides validation and shapes the expression of cognitive abilities, meaning that a word could be correctly translated while being devoid of any cultural meaning. As Ponton and Ardila (1999) point out, ‘‘. . . brain–behavior relationships do not transcend the cognition–context paradigm’’ (p. 569). Researchers with expertise both in psychometric construction and in understanding the cultural factors that impact cognitive performance are best suited to develop tests for ethnic-minority groups (American Psychological Association, 2010). Guidelines for test development have been proposed (Artiola i Fortuny & Mullaney, 1997). 3. Continue efforts to train and educate current and future pediatric neuropsychologists.

a. While more culturally informed measures are in development, it is imperative to foster the development of culturally competent neuropsychologists at all levels of practice, from early graduate student to experienced clinician. As sensitivity to the inherent, if unintentional, biases of instruments increases, along with recognition of the limitations of outcome data, practitioners can directly address such challenges in report summaries and can recommend caution in interpreting cognitive abilities based on test performance. b. Practitioners can also increase their understanding of how different groups perceive psychology in general, authority figures, and the role of the neuropsychologist. For example, neuropsychologists working with Asian cultures may need to assume the role of an expert who gives direct advice (Wong & Fujii, 2004), while Western European patients may wish to have a larger role in making treatment-related decisions. c. A deeper understanding of family roles and dynamics across cultural groups is essential in pediatric neuropsychology, given the level of communication with a child’s caregivers (Prathikanti, 2000). Among Caucasian patients, it may be perceived as completely normal to leave a child alone in a room with a stranger to ask (often personal) questions without a caregiver present; in other cultures, such a practice may be unacceptable to caregivers. It is also important to recognize that the definition of ‘‘family’’ may include more people than merely the traditional one or two primary caregivers; grandparents, aunts, uncles, and even cousins may arrive expecting to accompany the child to the evaluation. The reader is also referred to Judd et al. (2009) for additional recommendations about culturally informed training.

ADDITIONAL RESEARCH: ORGANIZATIONAL=POLITICAL LEVEL Additional research is needed with regards to effecting change at the organizational=political level, the ‘‘[d]evelopment of core cultural competencies, at the organizational level, based on new theories, practices, policies, and organizational structures that are more responsive to all groups’’ (Mindt et al., 2010, p. 430). Nell (1997) noted that although psychologists and neuropsychologists have tended to regard their fields

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as being above or removed from politics, this can never be the case, as cultural differences cannot be examined without eventually confronting the values, attitudes, and beliefs that underlie the study of differing abilities. Psychology has an unfortunate history of using group differences in abilities to justify racism, and Western social systems are based on the erroneous belief that ‘‘different’’ equals ‘‘inferior.’’ Consider H. H. Goddard, American student of Binet, and his quest to determine if Binet’s newly developed instrument might prevent the feebleminded from disembarking at Ellis Island (Gould, 1981). The First World War provided the largest opportunity in history to study the utility of intelligence testing through the U.S. Army Alpha and Beta tests, intended to shed light on the ability of military personnel and assist in assigning civilian recruits to ‘‘appropriate’’ positions. This early purpose of determining ability in order to assign position or allocate resources was later paralleled through the misuse of psychological tests in the process of recommending ethnic-minority children to special education classes (U.S. Commission on Civil Rights, 2007). Although attempts to change such policies have been and continue to be successful, much clearly remains to be done with affecting both the real and perceived impact of cognitive testing.

CONCLUSION Increasing multicultural awareness and competency at the individual level, increasing multicultural training and education at the organizational level, and increasing research at the national level are all necessary steps toward altering systematic forms of organizational and political biases and discrimination. This can be accomplished through advocating for and recognizing, rather than suppressing, crosscultural differences, as well as basing interpretations of differences on empirical data rather than speculation or biases. It is hoped that as trainees and clinicians become more culturally astute, they will share their research and observations with others at all levels of educational and organizational systems. With the proliferation of culturally inclusive data, changes can be made in discriminatory practices at both the aforementioned levels and at the level of national and international politics. Cross-cultural neuropsychology has the unique opportunity to contribute to the fundamental understanding of cognitive processes among people with perhaps little else in common except some form of brain injury or dysfunction. Acknowledging and appreciating the influence of factors associated with the examinee, the test instruments, the examiner, and the sociopolitical milieu will contribute to greater awareness of

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brain–behavior relationships, better diagnostic accuracy, and more effective and appropriate interventions. REFERENCES Acevedo, A., Loewenstein, D. A., Barker, W. W., Harwood, D. G., Luis, C., Bravo, M., . . . Duara, R. (2000). Category fluency test: Normative data for English and Spanish. Journal of the International Neuropsychological Society, 6, 760–769. American Educational Research Association. (1999). Standards for educational and psychological testing. Washington, DC: American Educational Research Association Publications. American Psychological Association. (2010). Ethical principles of psychologists and code of conduct. Retrieved from http://www. apa.org/ethics/code/index.aspx Ardila, A. (1995). Directions of research in cross-cultural neuropsychology. Journal of Clinical and Experimental Neuropsychology, 17, 143–150. Ardila, A., & Moreno, S. (2001). Neuropsychological test performance in Aruaco Indians: An exploratory study. Journal of the International Neuropsychological Society, 7, 510–515. Ardila, A., Rodriguez-Menendez, G., & Rosselli, M. (2002). Current issues in neuropsychological assessment with Hispanic=Latinos. Lisse, The Netherlands: Swets & Zeitlinger. Arnold, B. R., Montgomery, G. T., Castaneda, I., & Longoria, R. (1994). Acculturation and performance of Hispanics on selected Halstead-Reitan neuropsychological tests. Assessment, 1, 239–248. Aronson, J., Lustina, M. J., Good, C., Keough, K., Steele, C., & Brown, J. (1999). When White men can’t do math: Necessary and sufficient factors in stereotype threat. Journal of Experimental Social Psychology, 35, 29–46. Aronson, J., Quinn, D., & Spencer, S. (1998). Stereotype threat and the academic underperformance of minorities and women. In J. Swim & C. Stangor (Eds.), Prejudice: The target’s perspective (pp. 83–103). San Diego, CA: Academic. Artiola i Fortuny, L., & Mullaney, H. (1997). Neuropsychology with Spanish speakers: Language use and proficiency issues for test development. Journal of Clinical and Experimental Neuropsychology, 19, 615–622. Artiola i Fortuny, L., & Mullaney, H. (1998). Assessing patients whose language you do not know: Can the absurd be ethical? The Clinical Neuropsychologist, 12, 113–126. Artiola i Fortuny, L., Romo, D. H., Heaton, R. K., & Pardee, R. E. (1999). Manual de normas y procedimientos para la bateria neuropsicologica en Espanol [Manual of rules and procedures for neuropsychological batteries in Spanish]. Tucson, AZ: m Press. Baron, I. S. (2010). Maxims and a model for the practice of pediatric neuropsychology. In K. O. Yeates, M. D. Ris, H. G. Taylor, & B. F. Pennington (Eds.), Pediatric neuropsychology: Research, theory, and practice (2nd ed., pp. 473–498). New York, NY: Guilford. Berry, J. W. (1997). Immigration, acculturation, and adaptation. Applied Psychology, 48, 5–34. Boone, K. B., Victor, T. L., Wen, J., Razani, J., & Ponton, M. (2007). The association between neuropsychological scores and ethnicity, language, and acculturation variables in a large patient population. Archives of Clinical Neuropsychology, 22, 355–365. Brickman, A. M., Cabo, R., & Manly, J. J. (2006). Ethical issues in cross-cultural neuropsychology. Applied Neuropsychology: Child, 13, 91–100. Brislin, R. W. (1983). Cross-cultural research in psychology. Annual Review of Psychology, 34, 363–400. Byrd, D. A., Sanchez, D., & Manly, J. J. (2005). Neuropsychological test performance among Caribbean-born and U.S.-born

Downloaded by [New York University] at 08:07 29 June 2015

176

OLSON & JACOBSON

African American elderly: The role of age, education and reading level. Journal of Clinical and Experimental Neuropsychology, 27, 1056–1069. Candelaria, M. A., & Llorente, A. M. (2009). The assessment of the Hispanic child. In C. R. Reynolds & E. Fletcher-Janzen (Eds.), Handbook of clinical child neuropsychology (3rd ed., pp. 401–424). New York, NY: Springer. Cole, M. (1999). Culture-free versus culture-based measures of cognition. In R. J. Sternberg (Ed.), The nature of cognition (pp. 645–664). Cambridge, MA: MIT Press. Cornelious, S. W., & Caspi, A. (1987). Everyday problem solving in adulthood and old age. Psychology of Aging, 2, 144–153. Cummins, J. (1979). Cognitive=academic language proficiency, linguistic interdependence, the optimum age question and some other matters. Working Papers on Bilingualism, 19, 121–129. Cummins, J. (1981). The role of primary language development in promoting educational success for language minority students. In California State Department of Education (Ed.), Schooling and language minority students: A theoretical framework (pp. 3–49). Los Angeles, CA: National Dissemination and Assessment Center. Cummins, J. (1991). Interdependence of first- and second-language proficiency in bilingual children. In E. Bialystok (Ed.), Language processing in bilingual children (pp. 70–89). Cambridge, UK: Cambridge University Press. Duncan, G., Brooks-Gunn, J., & Klebanov, P. (1994). Economic deprivation and early childhood development. Child Development, 65, 296–318. Echemendia, R. J., Harris, J. G., Congett, S. M., Diaz, M. L., & Puente, A. E. (1997). Neuropsychological training and practices with Hispanics: A national survey. The Clinical Neuropsychologist, 11, 229–243. Echemendia, R. J., & Julian, L. J. (2002). Neuropsychological assessment of Latino children. In F. R. Ferraro (Ed.), Minority and cross-cultural aspects of neuropsychological assessment (pp. 181–204). Lisse, The Netherlands: Swets & Zeitlinger. Gasquoine, P. G. (1999). Variables moderating cultural and ethnic differences in neuropsychological assessment: The case of Hispanic Americans. The Clinical Neuropsychologist, 13, 376–383. Gasquoine, P. G. (2001). Research in clinical neuropsychology with Hispanic American participants: A review. The Clinical Neuropsychologist, 15, 2–12. Gould, S. J. (1981). The mismeasure of man. New York, NY: W. W. Norton. Hambleton, R. K. (2005). Issues, designs and technical guidelines for adapting tests into multiple languages and cultures. In R. K. Hambleton, P. F. Merenda, & C. D. Spielberger (Eds.), Adapting psychological and educational tests for cross-cultural assessment (pp. 3–38). Mahwah, NJ: Lawrence Erlbaum. Heaton, R. K., Miller, S. W., Taylor, M. J., & Grant, I. (2004). Revised comprehensive norms for an expanded Halstead-Reitan battery: Demographically adjusted neuropsychological norms for African American and Caucasian adults. Lutz, FL: Psychological Assessment Resources. Heaton, R. K., Ryan, L., & Grant, I. (2009). Demographic influences and use of demographically corrected norms in neuropsychological assessment. In I. Grant & K. M. Adams (Eds.), Neuropsychological assessment of neuropsychiatric and neuromedical disorders (3rd ed., pp. 127–158). Oxford, UK: Oxford University Press. Helms, J. E. (1992). Why is there no study of cultural equivalence in standardized cognitive testing? American Psychologist, 47, 1083–1101. Helms, J. E. (1997). The triple quandary of race, culture, and social class in standardized cognitive testing. In D. P. Flanagan, J. L. Genshaft, & P. L. Harrison (Eds.), Contemporary intellectual assessment (pp. 517–532). New York, NY: Guilford.

Johnson, T. P. (2006). Methods and frameworks for crosscultural measurement. Medical Care, 44(Suppl. 3), S17–S20. Judd, T., Capetillo, D., Carrion-Baralt, J., Marmol, L. M., San Miguel-Montes, L., Navarette, M. G., . . . Valdes, J. (2009). Professional considerations for improving the neuropsychological evaluation of Hispanics: A National Academy of Neuropsychology education paper. Archives of Clinical Neuropsychology, 24, 127–135. Kar, B. R., Rao, S. L., & Chandramouli, B. A. (2008). Cognitive development in children with chronic protein energy malnutrition. Behavioral and Brain Functions, 4, 31. Retrieved from http://www. behavioralandbrainfunctions.com/content/pdf/1744-9081-4-31.pdf Klenberg, L., Korkman, M., & Lahti-Nuuttila, P. (2001). Differential development of attention and executive functions in 3- to 12year-old Finnish children. Developmental Neuropsychology, 20, 407–428. Korenman, S., Miller, J., & Sjaastad, J. (1995). Long-term poverty and child development in the United States: Results from the NLSY. Children and Youth Services Review, 17, 127–155. Kress, G. (2003). Literacy in the media age. London, England: Routledge. Loewenstein, D. A., Arguelles, T., Arguelles, S., & Linn-Fuentes, P. (1994). Potential cultural bias in the neuropsychological assessment of the older adult. Journal of Clinical and Experimental Neuropsychology, 16, 623–629. Lucas, J. A., Ivnik, R. J., Willis, F. B., Ferman, T. J., Smith, G. E., Parfitt, F. C., . . . Graff-Radford, N. R. (2005). Mayo’s older African Americans normative studies: Normative data for commonly used clinical neuropsychological measures. The Clinical Neuropsychologist, 19, 162–183. Manly, J. J. (2005). Advantages and disadvantages of separate norms for African Americans. The Clinical Neuropsychologist, 19, 270–275. Manly, J. J. (2006). Deconstructing race and ethnicity: Implications for measurement of health outcomes. Medical Care, 11(Suppl. 3), S10–S16. Manly, J. J. (2008). Critical issues in cultural neuropsychology: Profit from diversity. Neuropsychology Review, 18, 179–183. Manly, J. J., Byrd, D. A., Touradji, P., & Stern, Y. (2004). Acculturation, reading level, and neuropsychological test performance among African American elders. Applied Neuropsychology, 11, 37–46. Manly, J. J., Jacobs, D. M., Touradji, P., Small, S. A., & Stern, Y. (2002). Reading level attenuates differences in neuropsychological test performance between African American and White elders. Journal of the International Neuropsychological Society, 8, 341–348. Manly, J. J., Miller, S. W., Heaton, R. K., Byrd, D., Reilly, J., Velasquez, R. J., . . . Grant, I. (1998). The effect of AfricanAmerican acculturation on neuropsychological test performance in normal and HIV-positive individuals. Journal of the International Neuropsychological Society, 4, 291–302. Manly, J. J., Touradji, P., Tang, M. X., & Stern, Y. (2003). Literacy and memory decline among ethnically diverse elders. Journal of Clinical and Experimental Neuropsychology, 25, 680–690. McLaughlin, L. A., & Braun, K. L. (1998). Asian and Pacific Islander cultural values: Considerations for health care decision making. Health Social Work, 23, 116–126. Mindt, M. R., Arentoft, A., Germano, K. K., D’Aquila, E., Scheiner, D., Pizzirusso, M., . . . Gollan, T. H. (2008). Neuropsychological, cognitive, and theoretical considerations for evaluation of bilingual individuals. Neuropsychological Review, 18, 255–268. Mindt, M. R., Byrd, D., Saez, P., & Manly, J. J. (2010). Increasing culturally competent neuropsychological services for ethnic minority populations: A call to action. The Clinical Neuropsychologist, 24, 429–453. Mulenga, K., Ahonen, T., & Aro, M. (2001). Performance of Zambian children on the NEPSY: A pilot study. Developmental Neuropsychology, 20, 375–384.

Downloaded by [New York University] at 08:07 29 June 2015

CROSS-CULTURAL CONSIDERATIONS Muniz, J., & Hambleton, R. K. (1996, August). Directions for the translation and adaptations of tests. Papeles del Psicologo, 63–70. Nabors, N. A., Evans, J. D., & Strickland, T. L. (2000). Neuropsychological assessment and intervention with African Americans. In E. Fletcher-Janzen, T. L. Strickland, & C. R. Reynolds (Eds.), Handbook of cross-cultural neuropsychology (pp. 31–42). New York, NY: Kluwer Academics=Plenum. The National Research Council Institute of Medicine. (2000). From neurons to neighborhoods: The science of early childhood development. Washington, DC: National Academy Press. Nell, V. (1997). Science and politics meet at last: The South African insurance industry and neuropsychological test norms. South African Journal of Psychology, 27, 43–49. Nell, V. (2000). Cross-cultural neuropsychological assessment: Theory and practice. Mahwah, NJ: Lawrence Erlbaum. Ostrosky, F., Ardila, A., & Rosselli, M. (1999). Neuropsi: A brief neuropsychological test battery in Spanish with norms by age and educational level. Journal of the International Neuropsychological Society, 5, 413–433. Ostrosky-Solis, F., Ramirez, M., Lozano, A., & Velez, A. (2004). Culture or education? Neuropsychological test performance of a Maya indigenous population. International Journal of Psychology, 39, 36–46. Pedraza, O., & Mungas, D. (2008). Measurement in cross-cultural neuropsychology. Neuropsychology Review, 18, 184–193. Ponton, M. O., & Ardila, A. (1999). The future of neuropsychology with Hispanic populationsin the United States. Archives of Clinical Neuropsychology, 14, 565–580. Prathikanti, S. (2000). East Indian American families. In E. Lee (Ed.), Working with Asian Americans: A guide for clinicians (pp. 79–100). New York, NY: Guilford. Puente, A. E., & Ardila, A. (2000). Neuropsychological assessment of Hispanics. In E. Fletcher-Janzen, T. Strickland, & C. R. Reynolds (Eds.), Handbook of cross-cultural neuropsychology (pp. 87–104). New York, NY: Kluwer Academic=Plenum. Ramirez, M., Ford, M. E., Stewart, A. L., & Teresi, J. A. (2005). Measurement issues in health disparities research. Health Services Research, 40, 1640–1657. Reis, A., & Castro-Caldas, A. (1997). Illiteracy: A cause for biased cognitive development. Journal of the International Neuropsychological Society, 5, 444–450. Reynolds, C. R. (2000). Methods for detecting and evaluating cultural bias in neuropsychological tests. In E. Fletcher-Janzen, T. Strickland, & C. R. Reynolds (Eds.), Handbook of cross-cultural neuropsychology (pp. 249–286). New York, NY: Kluwer Academic=Plenum.

177

Rosselli, A., & Ardila, A. (2003). The impact of culture and education on non-verbal neuropsychological measurements: A critical review. Brain and Cognition, 52, 326–333. Smedley, A., & Smedley, B. D. (2005). Race as biology is fiction, racism as a social problem is real. American Psychologist, 60, 16–26. Smith, G. E., Ivnik, R. J., & Lucas, J. A. (2008). Assessment techniques: Test, test batteries, norms, and methodological approaches. In J. Morgan & J. Ricker (Eds.), Textbook of clinical neuropsychology (pp. 38–57). New York, NY: Taylor & Francis. Steele, C. M. (1997). A threat in the air: How stereotypes shape intellectual identity and performance. American Psychologist, 52, 613–629. Steele, C. M., & Aronson, J. (1995). Stereotype threat and the intellectual test performance of African Americans. Journal of Personality & Social Psychology, 69, 797–811. Sue, D. W., & Sue, D. (1990). Counseling the culturally different: Theory and practice. New York, NY: Wiley. Super, C. M., & Harkness, S. (1997). The cultural structuring of child development. In J. W. Berry, P. S. Dasen, & T. S. Saraswathi (Eds.), Handbook of cross-cultural psychology: Vol. 2. Basic processes and human development (2nd ed., pp. 1–40). Needham Heights, MA: Allyn & Bacon. Teng, E. L. (1996). Cross-cultural testing and the Cognitive Abilities Screening Instrument. In G. Yeo & D. Gallagher-Thompson (Eds.), Ethnicity and the dementias (pp. 77–85). Washington, DC: Taylor & Francis. Touradji, P., Manly, J. J., Jacobs, D. M., & Stern, Y. (2001). Neuropsychological test performance: A study of Non-Hispanic White elderly. Journal of Clinical and Experimental Neuropsychology, 23, 643–649. U.S. Commission on Civil Rights. (2009). Minorities in special education (Briefing report). Retrieved from http://www.usccr.gov/ pubs/MinoritiesinSpecialEducation.pdf Van de Vijver, F., & Hambleton, R. K. (1996). Translating tests: Some practical guidelines. European Psychologist, 1, 89–99. Van de Vijver, F. J. R., & Leung, K. (1997). Methods and data analysis for cross-cultural research. Newbury Park, CA: Sage. Walsh, K. W. (1985). Understanding brain damage: A primer of neuropsychology evaluation. Edinburg: Churchill Livingstone. Watanabe, K., Flores, F., Fujiwara, J., & Tran, L. T. H. (2005). Early childhood development interventions and cognitive development of young children in rural Vietnam. Journal of Nutrition, 135, 1918–1925. Wong, T. M., & Fujii, D. E. (2004). Neuropsychological assessment of Asian Americans: Demographic factors, cultural diversity, and practical guidelines. Applied Neuropsychology, 11, 23–36.