Neuropsychological Testing Spanish Speakers: the Challenge of Accurately Assessing Linguistically and Culturally Diverse Individuals
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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 TABLE OF CONTENTS ACKNOWLEDGMENTS ............................................................................................................. iii ABSTRACT ................................................................................................................................... iv LIST OF TABLES .......................................................................................................................... v INTRODUCTION .......................................................................................................................... 1 Hispanics Demographics and Characteristics ............................................................................. 2 Clinical Neuropsychology ......................................................................................................... 10 History of Clinical-Neuropsychological Test Usage................................................................. 12 Standards for Educational and Psychological Testing .............................................................. 13 Standards Chapter 9: Testing Individuals of Diverse Linguistic Backgrounds..................... 15 Clinical Neuropsychology and Hispanics ................................................................................. 20 Neuropsychological Testing Spanish Speakers ......................................................................... 28 Summary ................................................................................................................................... 32 METHOD ..................................................................................................................................... 36 RESULTS ..................................................................................................................................... 39 DISCUSSION ............................................................................................................................... 66 REFERENCES ............................................................................................................................. 73 APPENDIX ................................................................................................................................... 79 ii 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 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 25-40 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 LIST OF TABLES Table Page 1. Pew Hispanic Center tabulations of the 2008 American Community Survey .................... 9 2. Pew Hispanic Center tabulations of the 2000 and the 2008 American Community Survey. ......................................................................................... 10 3. Criteria from the Standards for assessing Spanish speakers. ............................................ 20 4. List of Spanish tests developed using the sources previously listed. ............................... 40 5. Summary of participants’ demographic information. ....................................................... 59 6. Frequency and Rank of top 25 Spanish tests found in our list.......................................... 61 7. Comparison of top 25 tests in Spanish with the standards criteria. .................................. 63 v 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 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 El Salvador (76,500), Dominican Republic (180.900), Guatemala (36,600), Honduras