Neuropsychological Testing Spanish Speakers: the Challenge of Accurately Assessing Linguistically and Culturally Diverse Individuals

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

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.

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

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)

El Salvador (76,500), Dominican Republic (180.900), 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 1980. 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

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 1990. 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

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

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

$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 2006-2008 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

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.

2008 Hispanic Population in the U.S. N %

Mexican 30,746,270 65.7 Puerto Rican 4,150,862 8.9 All Other Spanish/Hispanic/Latino 1,777,278 3.8 Cuban 1,631,001 3.5 Salvadorian 1,560,416 3.3 Dominican 1,334,228 2.8 Guatemalan 985,601 2.1 Colombian 881,609 1.9 Spaniard 629,758 1.3 Honduran 607,970 1.3 Ecuadorean 590,602 1.3 Peruvian 519,349 1.1 Nicaraguan 351,704 0.8 Venezuelan 210,337 0.4 Argentinean 204,707 0.4 Panamanian 153,245 0.3 Chilean 127,747 0.3 Costa Rican 121,655 0.3 Bolivian 93,745 0.2 Uruguayan 60,730 0.1 Other Central American 43,352 0.1

Total 46,822,476 100.00

Table 1. Pew Hispanic Center tabulations of the 2008 American Community Survey

Top 15 States with Most Hispanic Growth 2000-2008

State Hispanics Hispanic Growth 2000- Percent Growth 2008

2000 2008

West Virginia 10,101 21,400 11,299 111.9 South Dakota 10,718 22,420 11,702 109.2 South Carolina 94,652 177,999 83,347 88.1 Minnesota 116,692 217,551 100,859 86.4 Nebraska 80,204 147,968 67,764 84.5 North Dakota 7,429 13,634 6,205 83.5 Arkansas 85,303 155,309 70,006 82.1 New Hampshire 21,536 39,123 17,587 81.7 North Carolina 377,084 678,023 300,939 79.8 Georgia 434,375 780,408 346,033 79.7 Kentucky 56,922 100,366 43,444 76.3 Iowa 72,152 124,030 51,878 71.9 Nevada 393,397 672,393 278,996 70.9 Delaware 37,301 62,506 25,205 67.6 Montana 18,568 31,093 12,525 67.5

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

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).

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 1946. 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

1974.

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-

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 1954. The next version was the Technical Recommendations for Achievement Tests,

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 1955. 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,

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

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

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

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

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.):

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 email 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.

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 1994. 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,

HNS celebrated their first annual conference this 2010. 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

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

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

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.

Consider the following issue about how a bilingual person speaking Spanish can imply a total different meaning for monolingual Spanish speakers, Bilingual Spanish speakers living in the U.S. tend to adapt words and phrases from English into their Spanish vocabulary which are not understandable for a Spanish speaker unfamiliar with the English language or the American culture. For instance, Spanglish expressions like ir al prom (go to prom), pay los billes (pay the bills), dame un ride (give me a ride) or printear (printing) form part of the vocabulary of a

Spanish speaker living in the U.S. because of the strong English influence. However, a monolingual Spanish speaker that is not familiar with the English language or the American culture might not understand such phrases. In sum, English-Spanish dichotomy involving bilingualism makes testing Spanish speakers even more problematic because the test administrator needs to determine not only the dominant language but the context in order to conduct an accurate assessment.

Education level has been strongly related with performance in neuropsychological tests

(Ardila, 1996; Ardila et al. 1994; Pineda et al 2000; Ostrosky-Solis & Lozano, 2006; Rosselli,

Tappen, Williams, & Salvatierra 2006). A particular concern to be addressed by test developers, administrators, scorers, and interpreters is that the educational curriculum of the United States is different from Latin America and Spain. Furthermore, many Spanish speakers might not even complete basic years of schooling in their own language. As a result of the discrepancy among school curriculum, education effect is expected to decrease the accuracy of the testing. For example, Ostrosky-Solis et al. (2000) found that Spanish speaking participants with 1-4 years of schooling had similar MMSE scores than participants with mild dementia. Consistent educational effects have been found in the literature (Ardila et al.; Rosselli et al. 2006; Ostrosky-

Solis et al., 2007).

The strong impact that education level has on neuropsychological testing performance exceeds verbal, arithmetic, or analytical knowledge. Simply, if an individual spends more time in schooling, then the individual is more likely to have more experience in testing situations. The literature indicates that low scores in neuropsychological testing might result from lack of familiarity with testing procedures and conditions (Agranovich & Puente, 2007; Ardila, 1996;

Ardila et al. 1994; Puente & Agranovich, 2004; Puente & Salazar, 1998). As a result, unfamiliarity with testing procedures and conditions can reduce Spanish speakers’ testing scores because their education level might be limited. Recently, Ardila (2005) indicated that unfamiliarity with testing procedures involve the following: a) one to one relationship between a tester and the examiner, b) background authority of the examiner to the test taker, c) best performance, d) isolated environment, e) special type of communication, f) speed, g) internal and subjective issues, and h) use of specific testing elements and strategies. In sum, these factors are common under the Western testing practices, which not only might be foreign to Spanish speakers but also might not be as familiar with such conditions.

According to Olmedo (1981), neuropsychological testing of Spanish speaking groups must address diverse social, political, and economical adversities affecting this group to be accurate. In other words, the social economic status (SES) of Spanish speakers will affect the education opportunities available, access to resources, and other variables which will impact performance in testing. For example, SES has been associated with indirectly affecting the acquisition of testing norms for various Hispanic groups (Llorente, Pontón, Taussig, & Satz;

1999). Also, although Pineda et al (2000) found that socioeconomic status by itself did have a significant effect on Boston Diagnostic Aphasia Examination Battery but strongly correlated with education level, thus a Spanish speaker from low SES might not have access to educational

level, testing skills, acculturation knowledge, or other resources that might impact their performance in neuropsychological tests.

Neuropsychological Testing of Spanish Speakers

Today, the status of neuropsychological testing of Spanish speakers living in the United

States is problematic, perhaps due to the challenge of developing neuropsychological tests in

Spanish (Puente & Puente, 2009). For example, The FAS Fluency Test which is used to determine Verbal Fluency might not provide accurate results when testing individuals in Spanish because the letters F, A, and S are used less often in the Spanish language, thus compromising the scores. Other current issues hindering the development of neuropsychological testing of

Spanish speakers include challenges of developing culturally sensitive tests as well as limited number of Spanish speaking personnel (Puente & Puente, 2009).

As indicated earlier, Camara et al. (2000) surveyed clinical psychologists and neuropsychologists with the objective of determining the tests most commonly used. Results confirmed the daunting situation of testing Spanish speakers given that none of the top 100 (out of 129) tests, none were in Spanish (see Appendix E) In addition, only few tests Depression

Inventory were available in Spanish. Furthermore, although the WAIS has an Argentinean,

Chilean, Mexican, and Spanish versions, these translations include limited norms that do not apply universally to all Spanish speakers. The Beta III contains an over sampling of U.S. Spanish speaking Hispanics (Puente & Puente, 2009). Overall, these findings suggest that further investigations are necessary in order to determine what neuropsychological tests are available to in Spanish and also whether clinical neuropsychologists across the country are using these tests.

A few years later, Salazar, Perez-Garcia, & Puente (2007) addressed the issue of performing clinical neuropsychological assessment of Spanish speakers by comparing testing

practices in the United States and Spain. In sum, it is indicated that assessment patterns of

Spanish speakers in either United States or Spain have been set by American traditions.

Consequently, the following problems arise: a) integrating the influence of culture and acculturation in the assessment, b) lack of instruments in Spanish to perform the testing, c) lack of norms, and d) few adequate comparison samples. Finally, Salazar et al (2007) presented a list of neuropsychological tests used in Spain from two companies: TEA and PSYMTEC. Although the list contains 61 tests, the tests presented in that lists include most if not all of the problems indicated above (see appendix F.).

In 1997 Echemendia et al. conducted the first comprehensive survey among neuropsychologists in the United States to investigate training and practices with Huispanics.

Their objectives were the following: a) gain a better understanding of the training and background of American neuropsychologists regarding cultural issues as well as preparation for working with Spanish speakers, b) the relationship between training experiences to the practices of neuropsychologists with Spanish speaking populations, and c) learn how neuropsychological measures and norms are used when conducting assessment with Spanish speakers. Findings from

Echemendia et al. indicated that 42 (5%) had assessed over 250 Hispanics over their careers.

Still, most neuropsychologists who participated in the survey were unable to read, write, or speak

Spanish. In addition, when participants were asked if they used translators with monolingual

Spanish speakers 53% responded yes while 5% responded yes when asked about the use of translators with bilingual Spanish speakers. Finally, almost 90% of the sample reported not having any kind of graduate training about practicing neuropsychological services for culturally different groups. Overall, these results suggest that neuropsychological training and practices

with Hispanics did not match the criteria of the testing standards (American Educational

Research Association, 1999).

Last year, Lazarus and Puente (2009) compared neuropsychological testing practices and test usage between South Africa and the U.S. They found discrepancies in test usage between both populations, which is attributed to specific demographic factors of each region as well as differences in schooling that affect assessment practices (Lazarus & Puente, 2009). The gap between South Africa and the United States is similar to the challenges of testing Spanish speakers in Latin America. More recently, Renteria (2010) also conducted a survey about the current neuropsychological practices in the U.S. with the objective of answering the following questions: a) who is seeing Spanish speaking clients and in what areas are they located? b) What type of cross-cultural assessment training, if any, have clinicians received? c) Which measures are most commonly used to evaluate adult Spanish speaker Hispanics? Using an online survey,

Renteria (2010) found that 158 participants were distributed as follows: 72% Ph.D., 17% Psy.D.,

10% M.A./M.S., and 0.6% Ed.D./Ed.S. Respondents were mostly located at California (22%),

New York (12%), Illinois (10%), Florida (8%), Texas (5%), and Maryland (4%). Regarding cross-cultural training, Renteria (2010) indicated the following: workshops/seminars/conferences

(49.4%), graduate coursework/ externship (41.8%), case consultations/supervision (40.5%), pre- doctoral internship/ post- doc (37.3%), and self study (9.5%), still 21.5% have not received any relevant training. Finally, Renteria (2010) found that the most common tests used were Raven’s

Standard Progressive Matrices, Test of nonverbal Intelligence- Third Edition (TONI III), Bateria

III, Bateria Neuropsicologica en Español (BNE), Neuropsi: Attention and memory, among others. In sum, results from Renteria (2010) present a gradual improvement since Echemendia et al (1997). However, the following challenges remain; a) validity of many tests is not examined,

b) English to Spanish adapted tests are biased, c) Some tests are not updated and have small sample sizes, d) tests do not meet criteria from the standards (American Educational Research

Association, 1999), and e) accessibility to tests is difficult.

As indicated above, the research literature has indicated that cultural factors have a significant impact in neuropsychological test performance (Agranovich & Puente, 2007; Ardila,

1995; Ardila 1996; Ardila 2005; Ardila et al. 1994; Helms, 1992; Luria 1934; Luria 1979; Perez-

Arce & Puente, 1996; Puente & Agranovich, 2004; Puente & Ardila 2000; Puente, Mora, &

Muñoz-Cespedes, 1997, Puente & Salazar, 1998; Sanchez 1932).A recent study by Matute,

Rosselli, Ardila, and Ostrosky (2010) expanded upon the need to develop neuropsychological tests with relevant items for the Spanish-speaking communities with the objective to develop, standardize, and test the reliability of a neuropsychological test battery for Spanish speaking children called Child Neuropsychological Assessment (ENI) Results from Matute et al (2010) indicated that ENI will be useful to provide comprehensive, reliable, and objective evaluation of diverse cognitive functions in Spanish speaking children, although it suffered from some limitations involving testing Spanish speakers (Echemendia et al 1997, Judd et al. 2009; Puente

& Puente 2009; Renteria, 2010; Salazar et al. 2007) such as limited comparative samples. Thus, in order to overcome the challenges of testing Spanish speakers, there is a need for further research in the relationship between culture and testing.

Last year, HNS and the National Academy of Neuropsychology (NAN) presented professional guidelines to enhance the quality and accessibility of neuropsychological services for Spanish speakers living in the U.S. by focusing on service delivery, training, and organizational policy (Judd et al. 2009). These guidelines cover the following areas of testing: a) professional, cultural, and linguistic competence of neuropsychologists, b) psychometrics, c)

interpreters, d) translators, e) language of evaluation, f) use of interpreters, g) evaluation of acculturation, h) test translation, adaptation, i) application of test norms, j) intervention issues, k) reimbursement and l) organizational issues. Based on the criteria set by the Committee of

Joint Standards for Educational and Psychological Testing, Judd et al. suggested the following steps to improve testing of Spanish speakers: a) careful selection of most appropriate language to conduct the assessment, b) applying caution when performing bilingual evaluation to prevent selected language, c) the heterogeneity of the Spanish speaker population needs to be considered when designing, selecting, administering, scoring and interpreting test scores, and d) it is necessary to incorporate cross-cultural issues in the clinical work and testing to understand their effects on behavior. Although organizations like HNS (Judd, 2010; Puente 2010) proposed helpful guidelines to improve the quality and accessibility of testing Spanish speakers in the

U.S., the challenges addressed in the literature (Ardila et al. 1994; Camara et al. 2000;

Echemendia et al 1997; Ponton & Ardila, 1999; Puente & Ardila; 2000; Puente & Puente, 2009;

Renteria, 2010; Salazar et al. 2007) as well as a lack of awareness and application of the testing

Standards will only be overcome with an active and continuous participation of the field.

Summary

The definition of the term Hispanic is extremely difficult because of the heterogeneous characteristics in this population; hence, a single uniform definition of Hispanic does not exist. In the United States, there are approximately 46.9 million Hispanics which constitute about 15% of the total population. Furthermore, projections indicate that Hispanics are expected to increase to

132.8 million people, who will constitute 30% percent of the U.S. population by the year 2050 and thus, making them the fastest growing minority group and close to the majority group (U.S.

Census Bureau, 2009).The main challenge for clinical neuropsychology is whether or not the psychological specialty is ready to meet the demands of this demographic shift.

A fundamental question of validity: Are current assessment tools in Spanish prepared to provide an accurate measure of neuropsychological constructs of Spanish speakers? To answer this question, a comprehensive and exhaustive review of the Standards for Educational and

Psychological Testing (AERA, 1999) needs to be done to obtain a criteria of the proper procedures involved when designing, developing, administering, scoring and interpreting, neuropsychological tests with individuals from diverse linguistic backgrounds. Particularly, when an educational or psychological test follows the guidelines of the standards, then the results from such assessments will be accurate. If the testing procedure does not follow the Standards, then the validity of the results would be spurious. Hence, when linguistic and cultural variables of Spanish speakers interfere with the measurement of the construct of interest, so that differences among group scores are the result of differences in other skills apart from the construct of interest, then the testing tool is unfair. Since validity means fairness, then not applying the testing standards to neuropsychological testing procedures would represent a threat to the validity of the results and, as a consequence, reduce fairness.

Although Spanish speakers from Latin America, Spain, and the United States speak

Spanish as a common language, important linguistic and cultural variables would affect their performance in neuropsychological tests. Performing neuropsychological testing of Spanish speakers is problematic because there are several variables that interact and affect neuropsychological test performance of Spanish speakers (Ardila et al. 1994; Ardila, 1995;

Pontón & Ardila, 1999; Puente & Ardila, 2000; Puente, A. E. & Perez-Garcia, 2000), These variables are: a) acculturation (Agranovich & Puente, 2007; Ardila, 1996; Ardila et al. 1994;

Ardila, 2005; Puente & Agranovich, 2004; Puente & Salazar, 1998; Sanchez 1932), b) language

(Manuel-Dupont et al. 1992; Rosselli et al. 2002) c) Education (Ardila, 1996; Ardila et al.;

Ostrosky-Solis et al., 2000; Ostrosky-Solis et al., 2007; Ostrosky-Solis & Lozano, 2006; Rosselli et al. 2006) and d) socio-economic status (Llorente et al. 1999; Olmedo 1981; Pineda et al.

2000). Overall, the interaction among these variables has a strong impact on the neuropsychological testing performance of Spanish speakers because of the diverse heterogeneity of this population.

Thus, performing neuropsychological testing in Spanish speakers is very problematic due to the variables previously cited. Consistent with this rationale, recent studies about neuropsychological testing practices with Spanish speakers revealed that there is a gap between current testing procedures and the guidelines from the Standards for Educational and

Psychological Testing (1999) (Camara et al. 2000; Echemendia et al 1997; Puente & Puente;

2009; Renteria, 2010; Salazar et al. 2007). Although, the HNS and NAN have increased efforts to improve the quality and accessibility of neuropsychological testing for Spanish speakers (Judd et al. 2009; Judd, 2010; Puente, 2010), there is still a significant discrepancy between the standards for testing Spanish speaking individuals and current neuropsychological testing practices. For example, during March 4th, 2010, the total number of materials in PsychInfo on neuropsychological testing was 30,929 from which only 251 involved Hispanics, which constitutes only 0.008% of the materials.

In 2000, Camara et al. published a study of commonly used in the U.S. (NAN and

Division 40) neuropsychological tests but not of them were in Spanish. Furthermore, with the increase in population in the U.S. of Spanish speakers as well as the growth of neuropsychology

in Spanish speaking countries, the question remains regarding what neuropsychological tests in

Spanish exist. Additionally, further investigation is needed to determine if the neuropsychological tests in Spanish meet the criteria outlined by the Joint Committee of

Standards for Educational and Psychological Testing (1999).

Given that the population of Spanish speakers has unexpectedly grown throughout the

U.S over the last 30 years, the field of neuropsychology needs to meet the challenge of testing this heterogeneous population. Of particular concern is the predicted continuous increase of

Spanish speakers because neuropsychology is not prepared to solve the problematic task of testing Spanish speakers. As a result, it is abundantly clear that comprehensive research interfacing neuropsychological testing and Spanish speakers is necessary to understand and prepare the field for the browning of America (Puente, 2010). To overcome the challenging task of testing Spanish speakers, this study has the following objectives: a) To develop a comprehensive and current list of neuropsychological and psychological tests available in

Spanish, b) To determine if these tests meet the criteria from the Joint Committee of Standards for Educational and Psychological Testing (1999), and c) Provide suggestions to enhance the testing procedures involving design, development, selection, scoring, and interpretation of results from Spanish speakers.

It is predicted that there will be few tests and that those tests will not meet the Standards criteria.

METHOD

Approval of the UNCW IRB (see Appendix A) and certification of UNCW Human

Research Training (see Appendix B and C) were obtained before initiating this study.

Phase 1

A comprehensive list of Spanish tests was developed by reviewing the following sources: a) prior research about tests in Spanish (e.g., Salazar et al. 2007; Puente & Lazarus, 2009), b)

Buros Mental Measurements Yearbook (Website and Online database), c) Hispanic

Neuropsychological Society List of Spanish Tests, d) The following databases PsychInfo or

WorldCat, and e) Spanish Test publishers such as Manual Moderno Mexico Editorial and TEA

Ediciones (Spain). The review proceeded as follows:

a) If the tests were part of an already existing list of psychological and neuropsychological

tests in Spanish (Buros Book of Mental Measurement 2007, HNS, & Salazar et al. 2007),

the tests were added to the list.

b) If the search took part in PsychInfo or WorldCat, a search using the following keywords

was conducted: Spanish neuropsychological tests, testing and Hispanics, testing and

Latinos, testing and Spanish speakers. The Spanish tests found were added to the list

unless previously repeated.

c) If the search was performed using an already existing list of psychological and

neuropsychological tests in English (Lazarus & Puente, 2009). The English name of the

test was entered in the online Buros Book of Mental Measurement, Psych Info and

WorldCat to search for information of any study regarding translation of the given

material. The Spanish tests found were recorded to the list unless previously repeated.

d) When searching catalogs (TEA & Manual Moderno), the names of the test available were

added to the list unless previously recorded.

After finishing the searches for Spanish tests, the Spanish tests were recorded accordingly and organized in alphabetical order. This alphabetical order was kept even if a test in Spanish had its name in English. In addition, tests were not repeated if found in more than one resource.

The acronym of the Spanish test name was included next to the test name in parenthesis as well as the edition of the test, if available.

Phase II

After the list of Spanish tests was completed, a survey was conducted on their frequency.

The purpose of the survey , “Usage of Neuropsychological and Psychological Spanish Tests Survey” (see

Appendix G.) was to gather the following information: a) demographics and testing practices of neuropsychologists’ that work with Spanish speaking clients U.S. , and b) finding out what

Spanish tests are being used by Spanish speaking neuropsychologists in the U.S. to assess

Spanish speakers. After the approval of the UNCW IRB Board was obtained, pilot testing was conducted to estimate the completion time needed by participants and questions ambiguities by four undergraduate students, a graduate student, a post B.A. student and Post- M.A. student.

Completion time was 10-15 minutes according to these student collaborators.

Before starting data collection, a request (se Appendix J) was sent to the HNS Board of

Directors for approval to conduct data collection using HNS members of the ListServe. As a result, a phone meeting was necessary to discuss the procedures, and rationale of the study with the HNS Board of Directors, the student investigator, and the faculty supervisor. As a result of

the meeting, the student investigator met with HNS Board of Directors during the NAN 2009 conference last November at New Orleans, LA to explain the study. Finally, approval from the

HNS Board of Directors was obtained.

Data collection started on December 15th, 2009 and ended March 4th 2010. The online survey was developed and administered using SurveyMonkey, which is a website that allows users to design, collect, and analyze survey responses. Completion time was 10-15 minutes according to pilot try outs of the survey with student collaborators. This survey asked participants to indicate if they have used any of the indicated Spanish neuropsychological or psychological tests. Also, the survey included 9 demographic questions and an electronic informed consent. For confidentiality purposes, only one response allowed from each e-mail address and all addresses were not registered.

A total of 56 participants from a total of the 83 HNS members (67% participation) were recruited using the HNS Listserve google groups. Members of HNS were surveyed because they have self identified as performing neuropsychological tests with Spanish speaking individuals in the U.S. As part of the HNS Listserve, participants had access to the bulletin board which forwarded the postings to the participants’ emails. To take part in the survey, the participant clicked the link as indicated in the invitation which forwarded him or her to the survey page.

Participation was voluntary and confidential. No record of participants’ contact information was maintained.

The contact information of the student investigator and faculty supervisor were provided at the end of the survey along with an acknowledgement message thanking participants for completing the survey. Finally, participants were given the option to contact the student investigator and faculty supervisor if they want to receive a copy of the results of the study.

During the data collection, participants were contacted 3 times (December 15th 2009, January 8th

2010, and February 9th 2010) (see Appendix H.), to remind them to participate.

Phase III

After the results of the survey were obtained, the tests reported in the survey were matched to the criteria from the Standards for Educational and Psychological Testing Standards

(1999). The criteria were based on chapter 9, which focuses on the criteria for inclusion of non- majority individuals. Each criteria item was awarded either one of the following “Yes” if criteria was met satisfactorily, “No” if criteria was not met satisfactorily. In essence, each test listed was compared the following criteria: a) Test in Spanish, b) Hispanic norms (U.S.), c) Non-U.S.

Hispanic norms, d) Test manual in Spanish

Each test was then rated on each of the preceding domains using a 0 to 4 the criteria with

0 being not all to 4 all. Then, the frequency of usage of Spanish neuropsychological and psychological tests was determined by counting how often a point is repeated in a distribution of data.

RESULTS

Phase I

A total of 555 psychological and neuropsychological tests in Spanish were found after a reviewing the following sources: a) prior research about tests in Spanish (e.g., Salazar et al.

2007; Puente & Lazarus, 2009), b) Buros Mental Measurements Yearbook (Website and Online database), c) Hispanic Neuropsychological Society List of Spanish Tests, d) The following

databases PsychInfo or WorldCat, and e) Spanish Test publishers such as Manual Moderno

Mexico Editorial and TEA Ediciones (Spain) (see Table 4.).

List of Neuropsychological and Psychological Tests in Spanish in Alphabetical Order

1. Academic Intervention Monitoring System 8. ADHD Rating Scale IV. (AIMS). 2. Academic Perception Inventory (API). 9. ADHD Symptoms Rating Scale. 3. Acoso y Violencia Escolar (AVE). 10. Advanced Placement Examination in Spanish Language. 4. Actitudes y Estrategias Cognitivas Sociales 11. Advanced Placement Examination in (AECS). Spanish Literature. 5. Adaptive Behavior Assessment System II 12. The Adjective Checklist. (ABAS II). 6. Adaptive Behavior Inventory for Children 13. Ages and Stages Questionnaires 2nd (ABIC). Edition (ASQ II). 7. AD/HD Comprehensive Rating Teacher’s 14. Ages and Stages Questionnaires: Social Scale 2nd Edition. Emotional (ASQ: SE).

Table 4. List of Spanish tests developed using the sources previously listed.

Table 4 cont. 15. Alcohol Use Disorders Identification Test 32. Athletic Motivation Inventory (AMI). (AUDIT). 16. Alteración del Comportamiento en la 33. Attention Deficit Disorders Evaluation Escuela (ACE). Scale 3rd Edition (ADDES-3). 17. Alzheimer’s Quick Test (AQT). 34. Autoconcepto Forma 5 (AF-5). 18. American Council Alpha Spanish Test. 35. Balanced Assessment in Mathematics. 19. American Council Beta Spanish Test. 36. Baron Emotional Quotient Inventory (Baron EQ-I). 20. American High School Mathematics 37. BASC Monitor For ADHD. Examination (AHSME). 21. Análisis del Retraso del Habla 38. Basic Adlerian Scales for Interpersonal (A-RE-HA). Success Adult Form (BASIS-A). 22. Aprenda (R) 2nd Edition (APRENDA (2)). 39. Bateria para la Actividad Comercial (BAC). 23. Aptitudes Básicas para la Informática 40. Bateria de Aptitudes para el Aprendizaje (ABI). Escolar (BAPAE). 24. Aptitudes en Educación Infantil (AEI). 41. Batería de Conductores (BC). 25. Aptitudes Mentales Primarias (PMA). 42. Batería Escolar Informatizada (BEI). 26. Aptitudes Mentales Primarias Equivalente 43. Batería de Evaluación de Kaufman para (AMPE-F). Niños (K-ABC). 27. Aptitudes Musicales. 44. Batería de Evaluación de los Procesos de Escritura (PROESC). 28. Aptitud de Tipo Superior (CLAVES). 45. Batería de Evaluación de los Procesos Lectores Revisada (PROLEC-R). 29. Aptitud de Tipo Superior (MONEDAS). 46. Batería de Operarios (BO). 30. Assessment of Children’s language 47. Batería de Pruebas de Admisión: Niveles 1 Comprehension (ACLC). & 2 (BPA). 31. Atención Global Local (AGL). 48. Batería de Socialización (BAS).

Table 4. List of Spanish tests developed using the sources previously listed.

Table 4 cont. 49. Batería de Subalternos. 66. Benchmarks (Revised). 50. Batería de tareas Administrativas. 67. Bennett Mechanical Comprehension Test 2nd Edition (BMCT). 51. Batería TEA Inicial (BTI). 68. Bilingual Aphasia Test. 52. Batería Woodcock Muñoz. 69. Bilingual Home Inventory (BHI). 53. Batería III Woodcock Muñoz 70. Bilingual Syntax Measure II (BSM II). (BATERIA III). 54. Batería Neuropsicologica en Español 71. Bilingual Verbal Ability Tests (BVAT). (BNE). 55. Batería- R 72. Binet-Simon Intelligence Scale. 56. Battelle Developmental Inventory 2nd 73. Bloc Screening Revisado (BLOC-S-R). Edition (BDI-2). 57. Beck Anxiety Inventory (BAI). 74. Boehm Test de Conceptos Básicos. 58. Beck Depression Inventory (BDI-II). 75. Boehm Test of Basic Concepts 3rd Edition (BOEHM-3). 59. Beck Hopelessness Scale (BHS). 76. Boehm Tests of Basic Concepts-3 Preeschool. 60. Beck Scale for Suicide Ideation. 77. Boston Diagnostic Aphasia Examination (BDAE). 61. Ber-Sil Spanish Test. 78. Boston, Evaluación de la Afasia y de Trastornos Relacionados 3ra Edición. 62. Behavior Assessment System for Children- 79. Boston Naming Test. 2nd Edition (BASC-2). 63. Behavior Evaluation Scale 3rd Edition 80. Bracken Basic Concept Scale- 3rd Edition (BES-3). Receptive (BBCS-3 R). 64. Behavior Rating Profile 2nd Edition 81. Bracken Basic Concept Scale- Expressive (BRP-2). (BBCS-E). 65. Behavioral Assessment of Pain 82. Bracken School Readiness Assessment Questionnaire. (BSRA).

Table 4. List of Spanish tests developed using the sources previously listed.

Table 4 cont. 83. Brief Battery for Health Improvement 2 100. The Child Neuropsychological (BBHI-2). Questionnaire. 84. Brief Screening and Outcome 101. Children’s PTSD Inventory. Questionnaire (OQ-10.2). 85. Brief Symptom Inventory (BSI). 102. CLEP Examination in College Level Spanish Language: Levels 1 and 2 (CLEP). 86. Brigance Diagnostic Inventory of Basic 103. Clima Laboral (CLA). Skills. 87. BRIGANCE Preeschool Screen II. 104. Cognitive Linguistic Quick Test (CLQT). 88. BRIGANCE (r) Early Preeschool Children 105. College Board Institutional SAT Subject II Test in Spanish. 89. BRIGANCE (r) Infant and Toddler Screen. 106. College Board Institutional SAT Subject in Spanish with Listening. 90. BRIGANCE (r) K and I Screen II. 107. College Board SAT Subject Test in Spanish. 91. Brown Attention Deficit Disorder Scales 108. College Board SAT Subject Test in Spanish with Listening. 92. California Computarized Assessment 109. Color Trails Test (CLT). Package (CalCAP). 93. California Psychological Inventory 3rd 110. Columbia Mental Maturity Scale. Edition (CPI). 94. California Verbal Learning Test (CVLT). 111. Combined Basic Skills. 95. Career Assessment Inventory 2nd Edition. 112. Communications Profile Questionnaire (CPQ). 96. Career Profile System 2nd Edition. 113. COMPE-TEA. 97. Central Ability Measure For Adults. 114. Comprehension of Oral Language. 98. CERAD Assessment Battery (CERAD). 115. Comprehensive Identification Process (Revised). 99. Chicago Early Assessment and 116. Comprehensive Personality Profile (CPP). Remediation Laboratory (Chicago EARLY).

Table 4. List of Spanish tests developed using the sources previously listed. 43

Table 4 cont. 117. Comprensión de Órdenes Escritas (COE). 132. Cuestionario de Ansiedad Estado/Rasgo (STAI). 118. Conner’s Adult ADHD Rating Scales 133. Cuestionario de Ansiedad Estado/Rasgo (CADS). en Niños (STAIC). 119. Conner’s Global Index (CGI). 134. Cuestionario de Auto-Control Infantil y Adolescente (CACIA). 120. Conner’s Rating Scales Revised (CRS-R). 135. Cuestionario de Aserción de la Pareja (ASPA). 121. Consumer Involvement Profile (CIP). 136. Cuestionario “Big Five” (BFQ). 122. Cooperative Spanish Test. 137. Cuestionario “Big Five” de Personalidad para Niños y Adolescentes (BFQ-NA). 123. Coordinación Visomotora. 138. Cuestionario Breve de Calidad de Vida (CUBRECAVI). 124. Coping Inventory for Stressful Situations 139. Cuestionario de Conductas Antisociales 2nd Edition (CISS). Delictivas (A-D). 125. Coping Resources Inventory for Stress 140. Cuestionario Factorial de Personalidad. (CRIS). 126. Cosmetology Student Admision 141. Cuestionario Factorial de Personalidad 5ta Evaluation. Edición. (16 PF-5). 127. Crane Oral Dominance Test (CODT). 142. Cuestionario Educativo Clínico: Ansiedad y Depresión (CECAD). 128. Cuadrado de Letras (CL). 143. Cuestionario de Estrategias de Aprendizaje (CEA). 129. Cuestionario de Afrontamiento al Estrés 144. Cuestionario de Estrategias Cognitivas en para Pacientes Oncológicos (CAEPO). Deportistas (CECD). 130. Cuestionario de análisis Clínico (CAQ). 145. Cuestionario Estructural Tetradimensional para la Depresión (CET-DE). 131. Cuestionario de Ansiedad Infantil (CAS). 146. Cuestionario para la Evaluación de Adoptantes, Cuidadores, Tutores, y Mediadores (CUIDA).

Table 4. List of Spanish tests developed using the sources previously listed.

Table 4 cont. 147. Cuestionario de Evaluación de Riesgos 162. Cuestionario de Valores Interpersonales Psicosociales (DECORE). (SIV). 148. Cuestionario de Desajuste Emocional y 163. Cuestionario de Valores Personales Recursos Adaptivos en Infertilidad (DERA). (SPV). 149. Cuestionario de Hábitos y Técnicas de 164. Cuestionario de 90 Síntomas (SCL-90-R). Estudio (CHTE). 150. Cuestionario de Intereses Profesionales 165. Culture Fair Series Scales 1,2,3. (CIPSA). 151. Cuestionario de Madurez 166. Das Naglieri Cognitive Assessment Neuropsicológica Infantil (CUMANIN). System. 152. Cuestionario de Personalidad (CEP). 167. Davidson Trauma Scale (DTS). 153. Cuestionario de Personalidad para 168. Dean-Woodcock Neuropsychological Adolescentes (16 PF-APQ). Bettery (DWNB). 154. Cuestionario de Personalidad para 169. Derogatis Interview for Sexual Adolescentes (HSPQ). Functioning (DISF). 155. Cuestionario de Personalidad: Formas A y 170. Desarrollo de las Habilidades Cognitivas B (EPI). (DHAC). 156. Cuestionario de Personalidad: Formas A y 171. Desarrollo de la Percepción Visual J (EPQ). FROSTIG. 157. Cuestionario de Personalidad de Eysenck- 172. Detección de Riesgo en la Escuela Revisado (EPQ-R). Primaria. 158. Cuestionario de Personalidad para Niños 173. Developing Skills Checklist (DSC). (CPQ). 159. Cuestionario de Personalidad Situacional 174. Developmental Indicators for the (CPS). Assessment of Learning (DIAL-3). 160. Cuestionario PNP. 175. Devereux Early Childhood Assessment (DECA). 161. Cuestionario de Sobreingesta Alimentaria 176. Diagnostico Integral del Estudio (OQ). (DIE 1,2,3).

Table 4. List of Spanish tests developed using the sources previously listed.

Table 4 cont. 177. Diagnostico Neuropsicológico de Adultos 193. Entrevista para Síndromas Psiquiátricos (LURIA-DNA). en Niños y Adolescentes (chiPS). 178. Differential Aptitude Tests. 194. Escala de Alexander. 179. Dissociative Experience Scale (DES). 195. Escala de Ansiedad Manifesta en Adultos (AMAS). 180. The Divine Inventory (Revised) (DI). 196. Escala de Ansiedad Manifesta en Niños Revisada (CMAS-R). 181. Domestic Violence Inventory (DVI). 197. Escala de Bienestar Psicológico (EBP). 182. Dos Amigos Verbal Language Scales. 198. Escala de Depresión para Niños (CDS). 183. Drug Use Screening Inventory Revised 199. Escala de Dificultades de Socialización de (DUSI-R). Cantoblanco (SOC). 184. Early Childhood Environment Rating 200. Escala Europea de Aptitudes Intelectuales Scale Revised Edition (ECERS-R). (EAS). 185. Early Intervention Developmental Profile. 201. Escala de Evaluación de la Psicomotricidad en Preescolar (EPP). 186. Early Literacy Skills Assessment (ELSA). 202. Escala de Habilidades Sociales (EHS). 187. Early Reading Diagnostic Assessment 203. Escala de Inteligencia Revisada para el Second Edition (ERDA-II). Nivel Escolar (WISC-RM). 188. Early Screening Inventory-Revised 204. Escala de Inteligencia para los Niveles (ESI-R). Preescolar y Primario Infantil (WPPSI). 189. Eje V. de Kennedy (EJE K). 205. Escala de Intensidad de Apoyos (SIS). 190. Ejercicios para la Adquisición de 206. Escala de Madurez Mental de Columbia Conceptos Boehm. (CMMS). 191. Ejercicios de Sensoriormotricidad y 207. Escala de Motivaciones Psicosociales Percepción. (MPS). 192. Entrevista para el Diagnóstico del 208. Escala Multidimensional de Asertividad Autismo (ADI-R). (EMA).

Table 4. List of Spanish tests developed using the sources previously listed.

Table 4 cont. 209. Escala de Observación para el 224. Escalas McCarthy de Aptitudes y Diagnóstico del Autismo (ADOS). Psicomotrocidad para Niños (MSCA). 210. Escala Observacional del Desarrollo 225. Estrategias de Aprendizaje ACRA. (EOD). 211. Escala de Preferencias 226. Estudio de Valores. 212. Escala de Satisfacción Familiar por 227. Evaluación de la Afasia y de Trastornos Adjetivos (ESPA). Relacionados. 213. Escala de Socialización Parental en la 228. Evaluación de la Autoestima en Adolescencia (ESPA29). Educación Primaria. 214. Escala de Inteligencia Wechsler para 229. Evaluación de la Comprensión Lectora Adultos (WAIS). (ECL 1 y 2). 215. Escala de Inteligencia Wechsler para 230. Evaluación de la Convivencia Escolar Adultos (EIWA). (CONVES). 216. Escala de Inteligencia de Wechsler para 231. Evaluación de la Discriminación Auditiva Adultos III (EIWA III). y Fonólogica (EDAF). 217. Escala de Inteligencia de Wechsler para 232. Evaluación Factorial de las Aptitudes Niños Revisada (WISC-R). Intelectuales (EFAI). 218. Escala de Inteligencia de Wechsler para 233. Evaluación de Grado Medio & Alto Niños Revisada de Puerto Rico (WISC-R-PR). (GMA). 219. Escala Wechsler de Inteligencia para 234. Evaluación Inicial para Estudiantes con Niños IV (WISC IV). Aptitudes Sobresalientes (SAGES 2). 220. Escalas de Afrontamiento para 235. Evaluación Neuropsicológica Breve en Adolescentes. Español (NEUROPSI). 221. Escalas de Apreciación del Estrés (EAE). 236. Evaluación Neuropsicológica en la Edad Preescolar Luria Inicial. 222. Escalas Bayley de Desarrollo Infantil 237. Evaluiación Neurológica de las Funciones (BSID). Ejecutivas en Niños (ENFEN). 223. Escalas de Inteligencia de Reynolds 238. Evaluación Neuropsicológica Infantil (RIAS). (ENI).

Table 4. List of Spanish tests developed using the sources previously listed.

Table 4 cont. 239. Evaluación Neuropsicológica de Memoria 253. Formas Idénticas (FI). y Aprendizaje Visual (DCS). 240. Evaluación del Potencial de Aprendizaje 254. Fuld Object Memory Evaluation (FOME). (EPA-2). 241. Evaluación de Precurrentes 255. General Ability Measure for Adults Instrumentales para la Adquisición de la (GAMA). Lectura. 242. Evaluación de los Procesos Lectores en 256. Gestión por Competencias (SOSIA). Alumnos de 3er Ciclo de Primaria y Secundaria. 243. Evaluación del Trastorno por Déficit de 257. Grandparent Strengths and Needs Atención con Hiperactividad (EDAH). Inventory (GSNI). 244. Evaluación y Ejercicios para Bebes y 258. Group Inventory for Finding Creative Niños con Necesidades Especiales Currículo Talent (GIFT). Carolina 245. Examen Cognoscitivo Mini-Mental 259. Group Inventory for Finding Interests (MMSE). (GIFI). 246. Exploratory Battery of Sexuality 260. Guía de Preguntas del Manual de Psicoterapia Breve, Intensiva, y de Urgencia. 247. Expressive One Word Picture Vocabulary 261. Halstead-Reitan Neuropsychological Test Test: Spanish Bilingual Edition Battery (HRNB). (EOWPVT-SBE). 248. Fábulas de Duss. 262. The Harrington O’Shea Career Decision Making System- Revised (CDM-R). 249. Factores de Riesgo Interpersonales para el 263. Hawaii Early Learning Learning Profile consumo de Drogas en Adolescentes (PRIDA). (HELP). 250. Family Assessment Measure 3rd Edition 264. Hay Aptitude Test Battery Revised. (FAM III). 251. FB 360. 265. Health Assessment Questionnaire (HAQ). 252. The Five Ps. 266. HIV/University of Miami Annotated Neuropsychological Test Battery in Spanish (HUMANS).

Table 4. List of Spanish tests developed using the sources previously listed.

Table 4 cont. 267. IDEA Oral Language Proficiency Test 281. Inventario Clínico de Millón para (IPT). Adolescentes (MACI). 268. IDEA Reading and Writing Proficiency 282. Inventario Clínico Multiaxial de Test (IPT R & W). Millón III (MCMI III). 269. Infant/ Toddler and Brief Infant Toddler 283. Inventario de Depresión Infantil (CDI). Social and Emotional Assessment (ITSEA/BITSEA). 270. Informant Questionnaire on Cognitive 284. Inventario de Depresión Estado/Rasgo Decline in the Early (IQCODE). (IDER). 271. Instrucciones Complejas (IC). 285. Inventario de Desarrollo Battelle. 272. Instrumento No Verbal de Inteligencia 286. Inventario de Desarrollo Comunicativo (BETA II-R). McArthur. 273. Instrumento No Verbal de Inteligencia 287. Inventario Estructurado de Simulación de (BETA III). Síntomas. 274. Integrated Visual and Auditory 288. Inventario de Expresión de Ira Continuous Performance Test (IVA + Plus). Estado/Rasgo en Niños y Adolescentes (STAXI-2). 275. Inteligencia Creativa (CREA). 289. Inventario de Expresión de Ira Estado/Rasgo en Niños y Adolescentes (STAXI-NA). 276. Inteligencia General Nivel 2 (IG-2). 290. Inventario de Hábitos de Estudio (IHE). 277. Inventario de Adaptación de Conducta 291. Inventario de Intereses y Preferencias (IAC). Profesionales Revisado (IPP-R). 278. Inventario de Adjetivos para la 292. Inventario Millón de Estilos de Evaluación de los Trastornos de la Personalidad (MIPS). Personalidad (IA-TP). 279. Inventario de Ansiedad: Rasgo-Estado 293. Inventario MacArthur Bates del (IDARE). Desarrollo de Habilidades Comunicativas (CDI). 280. Inventario Bochum de Personalidad y 294. Inventario Multifásico de Personalidad de Competencias (BIP). Minnessota-2 (MMPI 2).

Table 4. List of Spanish tests developed using the sources previously listed.

Table 4 cont. 295. Inventario Multifásico de Personalidad de 311. Luria Nebraska Neuropsychological Minnesota para Adolescentes (MMPI-A). Battery (LNNB). 296. Inventario de Pensamiento Constructivo 312. Jackson Vocational Interest Survey (CTI). (JVIS). 297. Inventario de Personalidad NEO Revisado 313. JOB-O. (NEO-PI-R). 298. Inventario de Personalidad para 314. Jugando en Serio con tu Diabetes. Vendedores (IPV). 299. Inventario de Rasgos Temperamentales 315. Juvenile Automated Substance Abuse (IRT). Evaluation (JASAE). 300. Inventario de Situaciones y Respuestas de 316. Katz Adjustment Scales- Relative Report Ansiedad (ISRA). Form (KAS-R). 301. Inventario de Trastornos de la Conducta 317. Kaufman Adolescent and Adult Alimentaria (EDI-2). Inteligence Test. 302. Inventario de Trastornos de la Conducta 318. Keirsey Temperament Sorter II (KTS-II). Alimentaria (EDI-3). 303. Inventory of Depresion for Children. 319. Language Assessment Battery (LAB). 304. Inventory of Interests. 320. Learning Style Inventory, Version 3 (LSI 3). 305. Inventory of Suicide Orientation-30 321. The Level of Service Inventory Revised (ISO 30). (LSI-R). 306. Iowa Placement Examinations. 322. Maferr Inventory of Feminine Values (MIFV). 307. IPI Job Tests Program. 323. Maferr Inventory of Masculine Values (MIMV). 308. IPT Early Literacy Test. 324. Management and Leadership System (MLS). 309. I SPEAK Your Language. 325. Manejo del Estrés en el Trabajo. Plan de Acción Detallado para Profesionales. 310. Laminated Bell Curve Card. 326. Manual del Entrevistadoe.

Table 4. List of Spanish tests developed using the sources previously listed.

Table 4 cont. 327. Manual de Estimulación Cognitiva para 342. The Multidimensional Addictions and Enfermos de Alzeihmer en Ambiente Familiar, Personality Profile (MAPP). Baúl de los Recuerdos. 328. Manual para la Evaluación de las 343. Multifactor Leadership Questionnaire 3rd Funciones del Yo (EFY). Edition (MLQ). 329. Marital Satisfaction Inventory Revised 344. Multilingual Aphasia Examination (MSI-R). (MAE). 330. Materiales de Prevención y de 345. Multilingual Aphasia Examination 3rd Intervención Conves. Edition. 331. Memoria Auditiva Inmediata (MAI). 346. Muliphasic Sex Inventory II (MSI II). 332. Memoria Visual de Rostros. 347. The Multiple Inteligences Development Assessment Scales (MIDAS). 333. Mental Satisfaction Inventory. 348. Myers Briggs Type Indicator Form M (MBTI). 334. Merrill Palmer Revised Scales of 349. Naglieri Non Verbal Ability Tests Development (M-P-R). (NNAT). 335. Método & Orden (MO- 1 & 2). 350. National Spanish Examinations (NSE). 336. Michigan Alcoholism Screening Test 351. NEEDS Survey (NEEDS). (MAST). 337. Millon Adolescent Personality Inventory 352. Neurobehavioral Cognitive Status (MAPI). Examination (COGNISTAT). 338. Millon Behavioral Health Inventory 353. NEO Personality Inventory. (MBHI). 339. Millon Behavioral Medicine Diagnostic 354. NEO Five Factor Inventory (NEO-FFI). (MBMD). 340. Millon Clinical Multiaxial Inventory II 355. Neuropsychological Screening Battery for (MCMI-II). Hispanics. 341. Minnesota Importance Questionnaire 356. Niveles Elemental, Medio y Superior (MIQ). (NAIPES II).

Table 4. List of Spanish tests developed using the sources previously listed.

Table 4 cont. 357. Non Verbal Reasoning Test Series. 373. Perfil e Inventario de Personalidad (PPG- IPG). 358. Occupational Personality Questionnaire 374. Perri Test de Aprendizaje Verbal y de (OPQ). Memoria. 359. Online Computarized Adaptive Placement 375. Personal Characteristics Inventory (PCI). Exam (Web-CAPE). 360. Oral English/Spanish Proficiency 376. Personal Style Indicator (PSI). Placement Test (OE/SPPT). 361. OTIS Sencillo: Test de Inteligencia 377. Personality Assessment Inventory (PAI). General (OS). 362. Outcome Questionnaire for Adults 378. Personality Inventory for Children 2nd (OQ-30.1). Edition (PIC-2). 363. Outcome Questionnaire (OQ-45.2). 379. Personality Research Form 3rd Edition (PRF). 364. Pain Patient Profile (P-3). 380. Pervasive Developmental Disorders Screening Test II (PDDST-II). 365. P.A.R. Admissions Test. 381. Phase II Profile Integrity Status Inventory and Addendum. 366. Parent as a Teacher Inventory Revised 382. Poker de la Personalidad. (PAAT). 367. The Parenthood Questionnaire. 383. PRE-LAS English (PRE-LAS). 368. Parent Success Indicator (PSI). 384. Preschool and Kindergarten Behavior Scales 2nd Edition (PKNS-2). 369. Parents’ Evaluation of Developmental 385. Preschool Child Observation Record 2nd Status (PEDS). Edition (COR). 370. Parents’ Observations of Infants and 386. Preschool Language Scale 4th Edition Toddlers (POINT). (PLS-4). 371. Percepción de Diferencias (CARAS). 387. Prison Inmate Inventory (PII). 372. Perfil de Estrés. 388. Procedimientos de Evaluación.

Table 4. List of Spanish tests developed using the sources previously listed.

Table 4 cont. 389. Program for the Child Behavior Checklist. 404. Prueba de Inmaginación Creativa (PIC). 390. Programa de Desarrollo de Aptitudes para 405. Prueba de Inmaginación Creativa Jóvenes el Aprendizaje Escolar Revisado (PDA-R). (PIC-J). 391. Programa para el Desarrollo de la 406. Pruebas de Benton para el Diagnostico Percepción Visual FROSTIG. Neuropsicologico. 392. Programa de Desarrollo Socio-Afectivo 407. Pruebas de Lectura: Niveles 1 y 2. (DSA). 393. Programa de Educación Psicomotriz 408. Pruebas Psicológicas. (PEP). 394. Programa Insruccional para la Evaluación 409. Psicodiagnóstico de Rorschach. y Liberación Emocional (PIELE). 395. Programa de Intervención para Aumentar 410. Quality of Life Inventory. la Atención y Reflexibilidad: Niveles 1 y 2: (PIAAR-R). 396. Programa Preventivo sobre Imagen 411. Quality of Life Questionnaire (QOL-Q). Corporal y Trastornos de la Alimentación (PICTA). 397. Progress Assessment Chart of Social 412. Quick Language Assessment Inventory. Development (PAC). 398. Prueba Beery Buktenica del Desarrollo de 413. Quick Test (QT). la Integración Visomotriz (VMI). 399. Prueba de Comprensión Lectora. 414. Rapidez Motora (RM). 400. Prueba de Destreza Stromberg (PDS). 415. Raven Matrices Progresivas (RAVEN). 401. Prueba de Exploración Cambridge 416. Receptive One Word Picture Vocabulary Revisada para la Valoración de los Trastornos Test Spanish-Bilingual Edition Mentales en la Vejez (CAMDEX-R). (ROWPVT-SBE). 402. Prueba de Frases Incompletas con 417. Receptive One Word Picture Vocabulary Aplicación a la Industria (FiGS). Test (ROWPVT). 403. Prueba de Lenguaje Oral Navarra 418. Registro de Preferencias Vocacionales Revisada (PLON-R). (KUDER-C).

Table 4. List of Spanish tests developed using the sources previously listed.

Table 4 cont. 419. Resolución de Problemas (RP 30). 434. Sentence Completion Test (SCT). 420. Reynolds Adolescent Depression Scale 435. Sequenced Inventory of Communication (RADS). Development Revised Edition (SICD-R). 421. Reynolds Bully Victimization Scales For 436. Severity of Dependence Scale (SDS). Schools (RBVSS). 422. The Rivermead Behavioral Memory Test 437. Sistema de Evaluación de la Conducta de (RBMT). Niños y Adolescentes (BASC). 423. Rorschach Inkblot Test. 438. Sistema de Evaluación, Valoración, y Planeamiento de Programas para Infantes. 424. Rotter Sentence Completion Test. 439. Social Adjustment Scale-Self Report (SAS-SR). 425. Rust Inventory of Schizotypal Cognitions 440. Social Problem Solving Inventory (RISC). Revised (SPSI-R). 426. Scale for the Assessment of Negative 441. Spanish Assessment of Basic Education Symptoms (SANS). (SABE). 427. Scales for Identifying Gifted Students 442. Spanish and English Neuropsychological (SIGS). Assessment Scales (SENAS). 428. School Attitude Measure 2nd Edition 443. Spanish Language Assessment Procedure. (SAM). 429. SDS Búsqueda Autodirigida Forma R y J 444. Spanish Reading Inventory. (SDS). 430. Self Directed Search (SDS). 445. Spanish Structured Photographic Expressive Language Test (SPELT). 431. Self Directed Search Form R-4th Edition 446. Spanish/English Reading Comprehension Spanish (SDS Form R IV). Test Revised. 432. Self Perceptions Inventory (SPI). 447. Stanford Binet Intelligence Scale. 433. Sensory Profile Suite of Products- 448. Strength Deployment Inventory (SDI). Sensory Profile, Infant/Toddler Sensory Profile & Adolescent/Adult Sensory Profile.

Table 4. List of Spanish tests developed using the sources previously listed.

Table 4 cont. 449. Stroop Test de Colores y Palabras. 466. Test de Aptitudes Burocraticas y Administrativas (TABA). 450. Survey of Organizations (SOO-2000). 467. Test de Aptitudes Cognoscitivas I (PRIMARIA I). 451. System of Multicultural Pluralistic 468. Test de Aptitudes Cognoscitivas II Assessment (SOMPA). (PRIMARIA II). 452. Szondi Test. 469. Test de Aptitudes Diferenciales (DAT-5). 453. Taller de Memoria: Niveles 1 y 2. 470. Test de Aptitudes Escolares (TEA). 454. Tarea de Atención Sostenida en la 471. Test de Aptitudes Mecánicas. Infancia (CSAT). 455. Taylor Johnson Temperament Analysis 472. Test de Árbol. (T-JTA). 456. Técnica Proyectiva de Dibujo (H-T-P). 473. Test de Atención. 457. TEDI-MATH. 474. Test Autoevaluativo Multifactorial de Adaptación. 458. Temperament Inventory (TI). 475. Test Barcelona Revisada. 459. TerraNova 2nd Edition. 476. Test Breve de Inteligencia de Kaufman (K-BIT). 460. Test de Analisis de la Lecto-Escritura 477. Test de la Casa. (TALE). 461. Test Anxiety Inventory (TAI). 478. Test de Cinco Cifras. 462. Test de Apercepción. 479. Test de los Cinco Dígitos (FDT). 463. Test de Aprendizaje Verbal España 480. Test de Clasificación de Tarjetas de Complutense (TAVEC). Wisconsin (WCST). 464. Test de Aprendizaje Verbal España 481. Test de Competencia Matemática Complutense Infantil (TAVECI). Básica 3 (TEMA 3). 465. Test de Aptitud Verbal (BAIRES). 482. Test de Comprensión de Estructuras Gramaticales (CEG).

Table 4. List of Spanish tests developed using the sources previously listed.

Table 4 cont. 483. Test de Copia de una Figura Compleja 498. Test de Estrategias Cognitivoemocionales Rey. Moldes. 484. Test de Creatividad Infantil (TCI). 499. Test para el Examen de la Afasia. 485. Test de los Cuentos de Hadas (FTT). 500. Test de Flexibilidad Cognitiva (CAMBIOS). 486. Test de Destreza en el Manejo de 501. Test of General Educational Development Herramientas. (GED). 487. Test de Destreza con Pequeños Objetos. 502. Test Gestáltico Visomotor Bender. 488. Test de Destreza de Stromberg. 503. Test de Habilidades Mentales Primarias (HMP). 489. Test del Dibujo de la Familia. 504. Test de Habilidades en la Negociación (NEGO). 490. Test de Dibujo de la Figura Humana. 505. Test de Homogeneidad y Preferencia Lateral (HPL). 491. Test de Dibujo de la Figura Humana 506. Test de Identificación de Daltonismos Goddenough. (TIDA). 492. Test del Dibujo de dos Figuras Humanas 507. Test Illinois de Aptitudes (T2F). Psicolinguísticas (ITPA). 493. Test de Dominancia Lateral Harris. 508. Test de Inteligencia Breve de Reynolds (RIST). 494. Test de Dominos (D-48). 509. Test de Inteligencia General: Nivel 1 & 2 (TIG). 495. Test de Dominos (D-70). 510. Test de Inteligencia No Verbal (TONI-2). 496. Test de Emparejamiento de Figuras 511. Test de Interpretación Selectiva de Datos Conocidas (MFF-20). (TISD). 497. Test de Empatía Cognitiva y Afectiva 512. Test de Laberintos Porteus. (TECA).

Table 4. List of Spanish tests developed using the sources previously listed.

Table 4 cont. 513. Test de Memoria (MY). 531. Tolouse Pieon (TP). 514. Test de Memoria y Aprendizaje 532. Tower of London Test. (TOMAL). 515. Test of Memory Malingering (TOMM). 533. Trail Making Test. 516. Test de Motivaciones en Adolescentes 534. Tratamiento de Disfunciones Sexuales. (SMAT). 517. Test de Observación (TO-1). 535. Uso y Prevención de Dísfonias la Voz. 518. Test Pata Negra. 536. Versant Spanish Test. 519. Test de Personalidad (TPT). 537. Vineland Adaptive Behavior Scales. 520. Test of Phonological Awareness in 538. Vineland Social Emotional Early Spanish (TPAS). Childhood Series (SEEC). 521. Test de Pronóstico Académico (APT). 539. Vocational Research Interest Inventory (VRII). 522. Test Tápido Barranquilla (BARSIT). 540. Ward Atmosphere Scale 3rd Edition (WAS). 523. Test de Retención Visual de Benton 541. Wonderic Personnel Test (WPT). (TRVB). 524. Test de Siluetas para Adolescentes (TSA). 542. Scholastic Level Exam (SLE). 525. Test de Símbolos y Dígitos (SDMT). 543. Wechsler Adult Intelligence Scale Third Edition (WAIS III). 526. Test de Vocabulario en Imagenes 544. Wechsler Adult Intelligence Scale 3rd Peabody. Edition (Mexican Adaptation) (WAIS III). 527. Tests de Escala 1 (FACTOR G). 545. Wechsler Memory Scale 3rd Edition (WMS III). 528. Tests de Escala 2 y 3 (FACTOR G). 546. Western Aphasia Battery (WAB). 529. Tests de Rendimiento Escolar (TR35). 547. Woodcock Johnson III. 530. Token Test. 548. Woodcock Johnson Psychoeducational Battery.

Table 4. List of Spanish tests developed using the sources previously listed.

Table 4 cont. 549. Woodcock Language Proficiency Battery 553. Youth Outcome Questionnaire-Omni (WLPB). Version (Y-OQ-SR 2.0). 550. Word Accentuation Test (WAT). 554. Youth Outcome Questionnaire-Self Report (Y-OQ-SR 2.0). 551. Word Memory Test (WMT). 555. Z Test. 552. Worley’s ID Profile (WIDP).

Table 4. List of Spanish tests developed using the sources previously listed.

Phase II

A total of 56 (67%) HNS members participated in the study (see Table 5.). Participants were primarily females (59%) and mainly Hispanic/Latino (75%). In addition, 34 (61.8%) of the participants reported a Ph.D. and 14 (25.5%) of the participants reported a Psy.D. as their degree.

Also, 46 (82.1%) of the participants reported not being Board Certified. Furthermore, 44 participants (80.0%) indicated that did not use Certified Technicains, Certified Translators,

Uncertified Technicians, or Uncertified Technicians when assessingSpanish speaking clients. In fact, only six (10.9%) participants reported using Certified Translators and none of them indicated using Certified Technicians. In contrast, six participants (10.9%) reported using

Uncertified Technicians and there was only one participant (1.8%) using Uncertified Translators.

Regarding participants’ primary work setting, 23 (41.8%) participants indicated Private Practice,

15 (27.3%) participants indicated Hospital, nine (16.4%) participants indicated an Outpatient

Clinic and eight (14.5%) participants indicated a University. Additionally, 49 (87.5%) participants reported extensive Spanish language proficiency, four (7.1%) reported some Spanish language proficiency, only a participant (1.6%) reported limited Spanish proficiency while two participants reported no Spanish language proficiency. Similarly, findings from participants’

knowledge of the cultural context of Spanish speaking clients showed that 47 (83.9%) participants reported extensive knowledge, 8 (14.3%) reported some knowledge, and only one participant (1.8%) reported limited knowledge. Finally, at least 14% of the participants’ clients were Spanish speakers.

Summary of Demographic Data

n % n %

Gender Primary Work Setting Male 22 40.7% Hospital 15 27.3% Female 32 59.3% Outpatient Clinic 9 16.4% Race/Ethnicity Private Practice 23 41.8% Caucasian/White 14 25.0% University 8 14.5% Hispanic/Latino 42 75.0% Level Spanish Proficiency Degree No Proficiency 2 3.6% Ph.D. 34 61.8% Limited Proficiency 1 1.8% Psy.D. 14 25.5% Some Proficiency 4 7.1% Other 7 12.7% Extensive Proficiency 49 87.5% Board Certified Cultural Context Knowledge No 46 82.1% Limited Knowledge 1 1.8% Yes 10 17.9% Some Knowledge 8 14.3% Use Technicians/Translators Extensive Knowledge 47 83.9% Certified Translators 6 10.9% Uncertified Technicians 6 10.9% Uncertified Translators 1 1.8% None of the Above 44 80.0%

Table 5. Summary of participants’ demographic information.

Table 5 cont. Spanish Speaking Clients Less than 25% 15 26.8% More than 25% 15 26.8% More than 50% 10 17.9% More than 75% 8 14.3% 100% 8 14.3%

Table 5. Summary of participants’ demographic information

In addition, the HNS respondents reported using 216 (39%).of the Spanish tests included in our list (see Table 6.). Furthermore, findings showed approximately 25 tests that were used for most of the participants, and there were 69 tests used by only one participant (12%).

Frequency and Rank Order of Spanish Tests n %

1-Trail Making Test 35 76.1% 2- Beck Depression Inventory (BDI-II) 33 71.7% 3- Boston Naming Test 29 63.0% 4- Test of Memory Malingering 28 60.9% 5- Beck Anxiety Inventory (BAI) 27 58.7% 6- Inventario Multifásico de Personalidad de Minnesota-2 (MMPI 2) 26 56.5% 6- Stroop Test de Colores y Palabras 26 56.5% 7- Bateria III Woodcock Muñoz (BATERIA III) 24 52.2% 8- Vineland Adaptive Behavior Scales 23 50.0% 9- Color Trails Test (CLT) 22 47.8% 9- Escala de Inteligencia de Wechsler para Adultos III (EIWA III) 22 47.8% 9- Raven Matrices Progresivas (RAVEN) 22 47.8% 10- Escala Wechsler de Inteligencia para Niños IV (WISC IV) 21 45.7% 10- Evaluación Neuropsicológica Breve en Español (NEUROPSI) 21 45.7% 11- Wechsler Adult Intelligence Scale Third Edition (WAIS III) 20 43.5% 12- Wechsler Memory Scale 3rd Edition (WMS III) 19 41.3% 13- California Verbal Learning Test (CVLT) 18 39.1% 13- Examen Cognoscitivo Mini-Mental (MMSE) 18 39.1% 13- Test de Copia de una Figura Compleja de Rey 18 39.1% 14- Escala de Inteligencia Wechsler para Adultos (EIWA) 17 37.0%

Table 6.Frequency and Rank of top 25 Spanish tests found in our list.

Table 6 cont. 15- Test de Vocabulario en Imagenes Peabody 16 34.8% 15- Test de Clasificacionde Tarjetas de Wisconsin (WCST) 16 34.8% 16- Bateria Woodcock Muñoz 15 32.6% 17- Adaptive Behavior Assessment System (ABAS-II) 14 30.4% 17- Prueba Beery Buktenica del Desarrollo de la Integración 14 30.4% Visomotriz (VMI)

Table 6.Frequency and Rank of top 25 Spanish tests found in our list.

Phase III

The top 25 tests most frequently used in Spanish were compared to the Standards for

Educational and Psychological Testing. Results from the comparison showed that almost none of the tests meet the criteria of the Standards for testing Spanish speakers (see Table 5.)

Comparison of Top 25 Tests with Standards Criteria when Testing Spanish Speakers

Test Name # Times Test in Hispanic Hispanic Test Total Spanish Norms Norms Manual Selected (U.S.) (Non in Spanish U.S.)

Trail Making Test 35 0 (No) 0 (No) 0 (No) 0 (No) 0 Beck Depression Inventory II (BDI-II) 33 1 (Yes) 0 (No) 1 (Yes) 1 (Yes) 3 Boston Naming Test 29 1 (Yes) 0 (No) 1(Yes) 0 (No) 2 Test of Memory Malingering (TOMM) 28 1 (Yes) 0 (No) 1 (Yes) 0 (No) 2 Beck Amxiety Inventory (BAI) 27 1(Yes) 0 (No) 0 (No) 1 (Yes) 2 Inventario Multifásico de Personalidad de 26 1(Yes) 1 (Yes) 1(Yes) 1 (Yes) 4 Minnesota- 2 (MMPI-2) Stroop Test de Colores y Palabras 26 1 (Yes) 0 (No) 1 (Yes) 1 (Yes) 3 Bateria III Woodcock Muñoz (BATERIA 24 1 (Yes) 1 (Yes) 1 (Yes) 1 (Yes) 4 III) Vineland Adaptive Behavior Scales 23 0 (No) 0 (No) 0 (No) 0 (No) 0 Color Trails Test 22 1 (Yes) 1(Yes) 0(No) 0(No) 2 Escala de Inteligencia Wechsler para 22 1 (Yes) 1 (Yes) 1 (Yes) 1 (Yes) 4 Adultos III (EIWA III)

Table 7. Comparison of top 25 tests in Spanish with the standards criteria.

Table 7 cont. Raven Matrices Progresivas (RAVEN) 22 1 (Yes) 0 (No) 1 (Yes) 1 (Yes) 3 Escala Wechsler de Inteligencia para 21 1 (Yes) 1 (Yes) 1 (Yes) 1 (Yes) 4 Niños IV (WISC IV) Evaluación Breve Neuropsicológica en 21 1 (Yes) 0 (No) 1 (Yes) 1 (Yes) 3 Español (NEUROPSI) Wechsler Adult Inteligence Scale Third 20 1 (Yes) 0 (No) 1 (Yes) 1 (Yes) 3 Edition (WAIS III) Wechsler Memory Scale 3rd Edition 19 1(Yes) 0 (No) 1 (Yes) 1 (Yes) 3 (WMS III) California Verbal Learning Test (CVLT) 18 0 (No) 0 (No) 1 (Yes) 0 (No) 1 Examen Cognoscitivo Mini-Mental 18 1 (Yes) 1 (Yes) 1 (Yes) 1 (Yes) 4 (MMSE) Test de Copia de una Figura Compleja 18 1 (Yes) 0 (No) 1 (Yes) 1(Yes) 3 Rey Escala de Inteligencia Wechsler para 17 1 (Yes) 0 (No) 1 (Yes) 1 (Yes) 3 adultos (EIWA) Test de Vocabulario en Imagenes Peabody 16 1 (Yes) 1 (Yes) 1(Yes) 1 (Yes) 4 Test de Clasificacion de Tarjetas de 16 1 (Yes) 0 (No) 0 (No) 0(No) 1 Wisconsin (WCST)

Table 7. Comparison of top 25 tests in Spanish with the standards criteria.

Table 7 cont. Bateria Woodcock Muñoz 15 1 (Yes) 1 (Yes) 0 (No) 1 (Yes) 3 Adaptive Behavior Assessment System 14 (1) Yes 0 (No) 0 (No) 0 (No) 1 (ABAS-II) Prueba Beery Buktenica del Desarrollo de 14 (1) Yes (1) Yes 0 No 1 Yes 3 la Integración Visomotriz (VMI)

Table 7. Comparison of top 25 tests in Spanish with the standards criteria.

DISCUSSION

In the last 30 years, the population of Spanish speakers has unexpectedly grown in the

U.S., which sets a challenge for the specialty of clinical neuropsychology regarding how to accurately assess this diverse and continuously growing population. To improve the current challenging task of testing Spanish speakers, this study had the following objectives: a) to develop a comprehensive and current list of neuropsychological and psychological tests available in Spanish, b) to determine what tests are used and c) address the issue as to whether these tests meet the criteria from the Joint Committee of Standards for Educational and Psychological

Testing (1999), Overall, findings suggest that the interfacing between neuropsychological testing and Spanish speakers has been gradual and limited.

Phase 1

The findings from reviewing previous literature, catalogs, and Spanish tests databases revealed 555 Spanish tests. The 555 tests found in our list exceed the number of Spanish tests previously reported by Camara et al. (2000), Salazar et al. (2007), Lazarus and Puente (2009),

Hispanic Neuropsychological Society (in press) and Renteria (2010). However, the 555 tests represent a small percentage of the 3,500. For instance, the Buros Mental Measurement

Yearbook online database indicates that there are over 3,500 tests found in print in the U.S.

When comparing the 3,500 tests from Buros to the 555 Spanish tests in our list, the list of

Spanish tests represents just 16% of the total tests in the U.S. Since the population of Spanish speakers is expected to continuously increase in the U.S., it is clear that the 555 Spanish tests need to increase substantially in order to meet the challenge of the demographic shift.

The small number of tests available in Spanish found in this study is consistent with previous literature. Recent test usage surveys in the U.S. did not include any neuropsychological or psychological test in Spanish (Camara el al. 2000; Rabin et al. 2005; Lazarus & Puente, 2009).

Furthermore, although results from this study indicate there are 555 tests available in Spanish, this number exceeds previous tests usage surveys focused on Spanish speakers. For instance, the list published by Salazar et al. (2007) included 60 neuropsychological tests in Spanish, which is only 0.02% (61 out of over 3,500) of the total test available. Similarly, Renteria (2010) included

97 tests (0.03% out of total tests) in her study regarding current practices in Hispanic neuropsychology in the U.S. In sum, there are two reasons that explain the length of this list: a)

Psychological tests were included, and b) this list includes a more comprehensive through approach to finding the tests, the most comprehensive approach to date. Although the 555 tests found are an increase from previous reported accounts of tests available in Spanish, there is still a marked discrepancy between the large number of tests available in English and the small number of tests available in Spanish.

Phase II

Regarding test usage, findings indicate that HNS members use 216 (39%).of the 555

Spanish tests included in our list. Furthermore, findings indicate approximately 25 (4%) are used for most of the participants, and there are 69 tests used by only one participant (12%). A very large percentage of tests, 339 (61%) were reported as not being used. Overall, these suggest that there not only relatively smaller number of tests available in Spanish when compared to English

(555 to 3,500), but also there is a relatively smaller number of Spanish tests being used.

Participants are using only 6% of total test available. In addition, only 25-50 tests are used frequently, while a larger number of tests are used infrequently or not at all. 67

In this study, the top five most commonly used tests in Spanish were the following: a)

Trail Making Test, b) Beck Depression Inventory II (BDI-II), c) Boston Naming Test, d) Test of

Memory Malingering (TOMM), and e) Beck Anxiety Inventory (BAI). These results are not consistent with previous test usage reports. For instance, only the Trail Making Test is consistent with the top 5 tests previously reported (Camara el al. 2000; Rabin et al. 2005; Lazarus &

Puente, 2009). Although the TMT, in both English and Spanish, tests individuals using letters and numbers, which might not suggest that test scores would be affected by language. There are crucial language differences regarding the letters of the alphabet and frequency of usage in letters that will differentiate the test performances between English and Spanish speakers. For instance, there are some letters in Spanish (ll, ñ, LL, Ñ) that do not exist in English. Also, letters A, F and

S are used at a fewer rate in Spanish than in English.

In addition, when comparing the results with the top 5 tests from Renteria (2010), only the Trail Making Test and the Beck Depression Inventory are present. These differences in test usage might exist because of the gap between tests available in Spanish and English. It is important to note that only the Camera et al. study included both psychological and neuropsychological tests whereas the other studies included only neuropsychological tests. Since, there is more test available in English than Spanish, differences in test usage are to be expected.

Phase III

The question of whether the tests used match the criteria outlined by the Standards remain to be answered. Most if not all of the 25 most frequently used tests do not meet the criteria for the Standards for Educational and Psychological Testing (1999). First the issue of norms will be addressed. For instance, two out of the top 25 most frequently used tests in

Spanish (Trail Making Test, Vineland Adaptive Behavior Scale) do not have any Hispanic U.S. norms and Non-U.S. Hispanic norms, and the testing manual is not in Spanish. In addition, these tests did not have any norms for Hispanics in the U.S: BAI II, BNT, TOMM, BAI, Stroop Test,

RAVEN, NEUROPSI, WAIS III, CVLT, and WCST. Also, although most of the top 25 tests have norms for Hispanics outside of the U.S., particularly Puerto Rico, Mexico, and Spain, these norms represent only a small section of the diverse Hispanic population. For example, WAIS IV presents norms for Spanish speakers from Puerto Rico, Mexico, and Spain, which are relatively fewer numbers of norms compared to other tests. Even then, there are varied versions of the

WAIS. For example, there is one from Mexico and another from Puerto Rico finally another from Spain. The norms are not cross referenced. The tests are different in terms of specifics items. There is no clear cultural equivalence and they cannot be purchased in the U.S.

Furthermore, the norms do not fit most of the Spanish speaking population, which is South

America. As a result, there would not be a respective norm group to determine how the individual is performing in comparison with his/her group. Finally, although 6 of the 25 most frequently used tests meet all the Standards criteria, results from these tests might be inaccurate since the norms for non U.S. Hispanics are limited to certain countries.

Regarding test instructions, 17 out of the top 25 most frequently used tests had testing manuals in Spanish. Testing manuals are the basis that dictates not just instructions regarding test administration, but also procedures related to scoring and interpretation of results. Hence, it is essential that the test manuals to be in the same language as the test user because language discrepancy (English manual- Monolingual test user) can produce error.

The findings indicating that most tests in Spanish do not meet the criteria from the

Standards for Educational and Psychological Testing (1999) are consistent with previous literature. In essence, translating a test from English to Spanish is a challenging task that threatens the validity of the assessments if done inaccurately. For instance, Puente and Ardila

(2000) indicate that differences in language and culture are main difficulties when translating a test from English to Spanish. Similarly, Puente and Puente (2009) specify issues in the following areas and represent major challenges in assessing Spanish Speakers: a) problematic translation, b) copyright barriers, and c) lack of normative samples. In addition, Renteria (2010) indicates that many tests used to evaluate Spanish speakers do not satisfy the criteria from the testing

Standards. Finally, Vilar-López and Puente (2010) hightlight that the usage of Spanish tests based on idiosyncratic practices produces erroneous and invalid results, which are also unethical since such practices do not meet the standards criteria.

Overall Summary

Based on the findings, there is a gap between the number of Spanish tests available (555) and the number tests in English (3,500) and even more alarming is the fact that only six of the top 25 most frequently used tests meets the criteria of the Standards for Educational and

Psychological Testing when assessing Spanish speakers. Overall, findings put in doubt how accurate are the tests that are used to assess Spanish speakers. An additional concern is the small number of Spanish tests used (216) compared to what is available for evaluating Spanish speakers (555). In other words, HNS members are using 39% of what is available to assess

Spanish speakers. Furthermore, HNS members are using 0.06% relative to the tests available in

English.

Recommendations

The following recommendations are suggested to improve the accuracy of testing in the assessment of Spanish speakers: a) develop and conduct research regarding the validity of the tests available, b) develop norms for respective groups c) revise current English-Spanish translations, d) increase Spanish language and cultural knowledge training so that test users will be able to select, administer, score, and interpret Spanish tests with accuracy, e) interface the needs and challenges of testing Spanish speakers with future editions of the Standards for

Educational and Psychological Testing, f) increase the training of and personnel in clinical neuropsychology with expertise in Spanish and g) develop an institute similar to Buros, which focuses on the needs and challenges of testing Spanish speakers.

If a replication of this study was conducted, the following questions should be addressed: a) How many members of HNS are also members of NAN and INS? b) What percentage of

NAN/Division 40 members are Spanish speakers? c) Which states are HNS members located in? d) Are the primary positions of HNS members academic? Overall, addressing these questions will help to differentiate the organizational membership of HNS as compared to other organizations such as NAN or INS. In addition, by knowing where HNS members are located, it might provide a good estimate of the background of their clients (e.g. Cubans mainly located in

Florida compared to Mexicans who are mainly located in California). Finally, determining if the primary position of an HNS member is academic will allow us to gain a better estimate of the percentage of HNS members conducting the research related to the issues in testing Spanish speakers.

Limitations and Future Study Suggestions

Even though 56 out of 83 HNS members participated in the study, it was expected to include all the members of the population of interest. Also, response rate was slow, thus participants had to be sent 2 reminders in addition to the first message contacting them. Finally,

10 participants skipped question(s) regarding the list of tests, so some of the test usage reports might be underreported. Future studies regarding testing Spanish speakers should sample data from multiple groups like NAN, APA, HNS, etc to compare their respective use of Spanish tests.

In addition, gathering data comparing Spanish tests among Latin America, Spain, and the United

States is an ambitious but yet necessary step in order to assemble a more comprehensive and unitary Spanish tests database.

Conclusion

In conclusion, this study contributed to the literature regarding neuropsychological and psychological testing of Spanish speakers in the U.S. It has been the first study to compare

Standards for Educational and Psychological Testing (1999) with a comprehensive list of

Spanish tests. Furthermore, findings from the list indicated that there are 555 Spanish tests available, from which 216 are being used, yet of the top 25 most frequently used tests, only 6 complete the criteria of the Standards when assessing Spanish speakers. Overall, this study highlighted some of the main issues and challenges of conducting neuropsychological and psychological testing with Spanish speakers.

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Matuté, E., Rosselli, M., Ardila, A., & Ostrosky, F. (2010). ENI: A neuropsychological battery for Spanish speaking children. First conference of the Hispanic Neuropsychological Society. Acapulco, Mexico. Merriam-Webster’s Collegiate Dictionary (1998). (10th ed.) Springfield, MA: Merriam-Webster. Miller-Jones, D. (1989). Culture and testing. American Psychologist, 44, 360-366. Ostrosky-Solis, F., Ardila, A., & Rosselli, M. (1999). Neuropsi: A brief neuropsychological test battery in Spanish with norms by age and educational level Journal of International Neuropsychological Society, 5, 413-433. Ostrosky-Solis, F., Gómez-Perez, M., Matute, E., Rosselli, M., Ardila, A., & Pineda, D. (2007). NEUROPSI ATTENTION AND MEMORY: A neuropsychological test battery in Spanish with norms by age and educational level. Applied Neuropsychology, 14, 156-170. Ostrosky-Solis, F., Lopez Arango, G., & Ardila, A. (2000). Sensitivity and specificity of the Mini-Mental State Examination in a Spanish speaking population. Applied Neuropsychology, 7, 25-31. Ostrosky-Solis, F. & Lozano, A. (2006). Digit Spam: effect of education and culture. International Journal of Psychology, 41, 333-341. Ostrosky-Solis, F., Ramirez, M., & Ardila, A. (2004). Effect of culture and education on neuropsychological testing: A preliminary study with indigenous and non-indigenous population. Applied Neuropsychology, 11, 186-193. Ostrosky-Solis, F., Ramirez, M., Lozano, A., Picasso, H., & Velez, A. (2004). Culture or education? Neuropsychological test performance of a Maya indigenous population. International Journal of Psychology, 39, 36-46. Ostrosky-Solis, F., Ramirez, M., & Ardila, A. (2007). Same or different? Semantic verbal fluency across Spanish speakers from different countries. Archives of Clinical Neuropsychology, 22, 367-377. The Oxford English Dictionary (1989). OED Online (2nd ed.). Oxford University Press. Retrieved March, 23 2010 from http://oed.com/ Pedraza, O. & Mungas, D. (2008). Measurement in cross-cultural neuropsychology. Neuropsychology Review, 18, 184-193. Perez-Arce, P. & Puente, A.E. (1996). Neuropsychological evaluation of ethnic minorities. In R.J. Sbordone & C.J. Long (Eds.) Ecological validity of neuropsychological testing (283-300). Delray Beach, FL: St. Lucie Press. Pew Hispanic Center (2007). Demographic profile of Hispanics in North Carolina, 2007. Retrieved on March 24, 2010 from http://pewhispanic.org/states/?stateid=NC

Pineda, D. A., Rosselli, M., Ardila, A., Mejia, S. E., Romero, M. G., & Perez, C. (2000). The Boston diagnostic aphasia examination-Spanish version: The influence of demographic variables. Journal of International Neuropsychological Society, 6, 802-814. Pontón, M. O. & Ardila, A. (1999). The future of neuropsychology with Hispanic populations in the United States. Archives of Clinical Neuropsychology, 14, 565-580. Puente, A. E. (1990). Psychological assessment of minority group members. In G. Goldstein & M. Hersen (Eds.) Handbook of psychological assessment. New York: Pergamon. Puente, A. E. (2010). State of the art of Spanish neuropsychological tests. First conference of the Hispanic Neuropsychological Society. Acapulco, Mexico. Puente, A. E., & Agranovich, A. (2004). The cultural in cross-cultural neuropsychology. In M. Hersen, G. Goldstein, & S. R. Beers (Eds.). Comprehensive handbook of psychological assessment. Vol. 1: Intellectual and neuropsychological assessment. (pp. 321-332) Hoboken, NJ: Willey. Puente, A.E. & Ardila, A. (2000). Neuropsychological assessment of Hispanics. In E. Fletcher- Janzen, T. Strickland, and C.R. Reynolds (Eds.) Handbook of cross-cultural neuropsychology. New York: Plenum Press. Puente, A.E., Mora, M.S., & Muñoz-Cespedes, J.M. (1997). Neuropsychological assessment of Spanish- speaking children and youth. In C.R. Reynolds and E. Fletcher Janzen (Eds.) Handbook of clinical child neuropsychology (2nd ed.). New York: Plenum.

Puente, A. E. & Puente, N. (2009). The challenges of measuring abilities and competencies in Hispanics/Latinos. In E. L. Grigorenoko (Ed.). Multicultural psychoeducational assessment (pp.417-441). New York: Springer. Puente, A. E. & Salazar, G. (1998). Assessment of minority and culturally diverse children. In A. Prifitera & D. H. Saklofske (Eds.). WISC III Clinical use and interpretation: scientist practitioner perspectives (pp. 227-248). San Diego: Academic Press. Rabin, L. A., Barr, W. B. & Burton, L. A. (2005). Assessment practices of clinical neuropsychologists in the United States and Canada: A survey of INS, NAN, and APA Division 40 Members. Archives of Clinical Neuropsychology, 20, 33-65.

Renteria, L. (2010). Current practices survey in the neuropsychological assessment of Hispanics in the U.S. . First conference of the Hispanic Neuropsychological Society. Acapulco, Mexico. Rosselli, M., Ardila, A., Santisi, M., Arecco, M., Salvatierra, J., Conde, A. et al. (2002). Stroop effect in Spanish-English bilinguals. Journal of the International Neuropsychological Society, 8, 819-827.

Rosselli, M., Tappen, R., Williams, C., & Salvatierra, J. (2006). The relation between education and gender on the attention items of the Mini-Mental State Examination in Spanish speaking orders. Archives of Clinical Neuropsychology, 21, 677-686. Salazar, G. D., Perez-Garcia, M., & Puente, A. E. (2007). Clinical neuropsychology of Spanish speakers. The challenge and pitfalls of a neuropsychology of heterogeneous population. In. B. Uzzel (Ed.) International Handbook of Cross-Cultural Neuropsychology. New Jersey: LEA Publishers Sanchez, G. (1932). Group differences and Spanish speaking children. A critical review. Journal of Applied Psychology, 16, 549-558.

Sundberg, N. D. (1961). The practice of psychological testing in clinical services in the United States. American Psychologist, 16, 79-83.

SurveyMonkey Website. Retrieved on January 21, 2010 from http://www.surveymonkey.com/

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U.S. Census Bureau (2008). American Community Survey: Demographic and Housing Estimates 2006-2008. Retrieved on March 24, 2010 from http://factfinder.census.gov/servlet/ADPTable?_bm=y&-geo_id=04000US37&- qr_name=ACS_2008_3YR_G00_DP3YR5&-context=adp&-ds_name=&-tree_id=3308&- _lang=en&-redoLog=false&-format=

U.S. Census Bureau (2009). Retrieved on March 4, 2010 from http://www.census.gov/Press- Release/www/releases/archives/facts_for_features_special_editions/013984.html U.S. Census Bureau (2010) 2008 American Community Survey: Statistical portrait of Hispanics in the United States, 2008. Retrieved February, 11 2010 from U.S. Census Bureau online database: http://pewhispanic.org/factsheets/factsheet.php?FactsheetID=58

Villár López, R. & Puente, A. (2010). Forensic neuropsychological assessment of members of minority groups. The case for assessing Hispanics. In A. M. Horton, and L. C. Hartlage (Eds.). Handbook of Forensic Neuropsychology (2nd ed.) (pp. 309-332). New York : Springer.

APPENDIX Appendix A. Institutional Review Board Approval

Appendix B. Human Research Curriculum Completion Report

CITI Collaborative Institutional Training Initiative

Human Research Curriculum Completion Report

Printed on

Learner: Carlos Ojeda (username: cao4348)

Institution: University of North Carolina Wilmington

Contact Information Department: Psychology Phone: 305 725 3200 Email: [email protected]

Social/Behavioral Research Course:

Stage . Basic SBR Passed on 06/21/09 (Ref # 2916264)

Date Required Modules Completed Score

Belmont Report and CITI Course Introduction 06/18/09 3/3 (100%)

Students in Research - SBR 06/18/09 9/10 (90%)

History and Ethical Principles - SBR 06/18/09 3/4 (75%)

Defining Research with Human Subjects - SBR 06/18/09 4/5 (80%)

The Regulations and The Social and Behavioral Sciences - SBR 06/21/09 5/5 (100%)

Assessing Risk in Social and Behavioral Sciences - SBR 06/18/09 4/5 (80%)

Informed Consent - SBR 06/18/09 3/4 (75%)

Privacy and Confidentiality - SBR 06/21/09 4/4 (100%)

Research with Prisoners - SBR 06/21/09 3/4 (75%)

Research with Children - SBR 06/21/09 4/4 (100%)

Research in Public Elementary and Secondary Schools - SBR 06/21/09 4/4 (100%)

International Research - SBR 06/21/09 3/3 (100%)

Internet Research - SBR 06/21/09 4/5 (80%)

Conflicts of Interest in Research Involving Human Subjects 06/21/09 1/2 (50%)

University of North Carolina Wilmington 06/18/09 no quiz

For this Completion Report to be valid, the learner listed above must be affiliated with a CITI participating institution. Falsified information and unauthorized use of the CITI course site is unethical, and may be considered scientific misconduct by your institution.

Paul Braunschweiger Ph.D. Professor, University of Miami Director Office of Research Education CITI Course Coordinator

Appendix C. Responsible Conduct of Research Curriculum Completion Report

CITI Collaborative Institutional Training Initiative (CITI)

Responsible Conduct of Research Curriculum Completion Report

Printed on

Learner: Carlos Ojeda (username: cao4348)

Institution: University of North Carolina Wilmington

Contact Information Department: Psychology Phone: 305 725 3200 Email: [email protected]

Social and Behavioral Responsible Conduct of Research Course 1.:

Stage . RCR SBR Passed on 06/24/09 (Ref # 2916265)

Date Required Modules Completed Score

The CITI Course in the Responsible Conduct of Research 06/21/09 no quiz

Introduction to the Responsible Conduct of Research 06/21/09 no quiz

Introduction to Research Misconduct 06/21/09 no quiz

Social & Behavioral Research Misconduct 06/21/09 6/6 (100%)

Case Study - In the Field, No One Will Know SBR. 06/21/09 2/3 (67%)

Data Acquisition and Management Module - Social & Behavioral 06/21/09 3/5 (60%)

Case Study - Data Management "Who Owns Research Data?" sbr 06/21/09 3/3 (100%)

Responsible Authorship and Publication in SBR 06/22/09 4/5 (80%)

Authorship and Publications -The Grateful Author (SBR) 06/22/09 5/5 (100%)

Responsible Peer Review Module in SBR 06/21/09 3/5 (60%)

What is Responsible Peer Review (SBR) 06/22/09 4/5 (80%)

Responsible Mentoring Basic Module * 06/23/09 6/6 (100%)

Mentoring Case Study: The Graduate Student Laborer. 06/22/09 4/4 (100%)

Social & Behavioral Science Conflicts of Interest and Commitment 06/23/09 4/6 (67%) Module

CoI Case Study -The Case of the Entrepreneurial Psychologist - 06/23/09 3/3 (100%) SBR

Responsible Conduct of Collaborative Science Module - Social & 06/24/09 3/6 (50%) Behavioral Research

When Collaborators Disagree (SBR)* 06/23/09 3/3 (100%)

The CITI RCR Course Completion Page. 06/23/09 no quiz

Paul Braunschweiger Ph.D. Professor, University of Miami Director Office of Research Education CITI Course Coordinator

Appendix D. Testing Individuals of Diverse Linguistic Backgrounds

Appendix E. Frequency and Rank Order of Tests Used by Clinical Psychologists and Neuropsychologists (Camara, el al. 2000).

Clinical Neuropsychologists Psychologists

Test Rank n Rank n Total n

Aphasia Screening Test 23 27 17 156 186

Beck Depression Inventory 10 53 11 200 253

Bender Visual Motor Gestalt Test 5 112 25 96 208

Boston Naming Test 42 13 8 209 222

California Verbal Learning Test 36 18 14 189 207

Category Test 31 20 9 203 223

Children’s Apperception Test (CAT-A) 16 38 60 29 67

Conners’ Parent and Teacher Rating Scales 18 37 39 57 94

FAS Word Fluency Test 37 17 5 241 258

Finger Tapping Test 29 22 6 228 250

Grooved Pegboard Test 44 12 15 180 192

Halstead- Reitan Neuropsychological Test 23 27 7 214 241 Battery

Hand Dynamometer (Dynamic Hand Grip 44 12 20 136 148 Strength Test)

Hooper Visual organization Test 59 8 19 145 153

House-Tree- Person (H-T-P) Projective 8 60 31 78 138 Technique

Human Figures Drawing Test 13 49 41 55 104

Millon Adolescent Clinical Inventory 16 38 56 35 73

Millon Clinical Multiaxial Inventory 10 53 24 100 153

Minnesota Multiphasic Personality 2 138 1 359 497 Inventory (MMPI) I and II

Peabody Picture Vocabulary Test-Revised 20 34 28 89 123

Rey Complex Figure Test 25 25 12 196 221

Rorschach Inkblot Test 4 124 18 153 177

Rotter Incomplete Sentences Blank 14 45 51 41 86

Sentence Completion Test 15 40 42 54 94

Thematic Apperception Test (TAT) 6 107 26 91 198

Trail Making Test A&B 12 52 4 246 298

Vineland Adaptive Behavior Scales 18 37 44 51 88

Wechsler Adult Intelligence Scale Revised 1 151 2 331 482 (WAIS-R)

Wechsler intelligence Scale for Children- 3 135 16 178 313 Revised (WISC-R-III)

Wechsler Memory Scale- Revised 9 58 3 257 315

Wide Range Achievement test- Revised and 7 86 9 203 289 III

Wisconsin Card Sorting Test 33 19 12 196 215

Note. Only tests ranked in the top 20 by either the clinical or neuropsychology sample are listed in the table *A subtest of the Halstead- Reitan and the Reitan Indiana Neuropsychological Batteries. b A subtest of the Halstead neuropsychological Evaluation System. cA substest of the Hailstead-Reitan Neuropsychological Battery.

Appendix F. List of Neuropsychological Tests Commonly Used in Spain (Salazar, et al. 2007)

Appendix G. Usage of Neuropsychological and Psychological Spanish Tests Survey

1. Informed Consent

Dear Participant:

Thank you for taking the time to complete this survey. This process should take you approximately 10 minutes.

By proceeding to complete this survey, you are consenting to participate in this study. Your participation is voluntary and all your information will be kept anonymous. Please click the “Done” button and close the browser after you are done.

Thank you for your time.

100

2. Demographics

Please provide some basic information about yourself.

1- Please indicate your gender and age?

Male Female Indicate age in the box below (in years).

2- What is your race/ethnicity background?

a) African American/ Black b) Asian c) Caucasian/White d) Hispanic/Latino e) Multi-racial f) Native American g) Other (please specify)

3- What is your degree?

a) Ph.D. b) Psy.D. c) Other (please specify)

101

4- Are you Board certified?

a) No b) Yes

5- Do you use any of the following when assessing Spanish speaking clients? (Click all

that apply)

a) Certified Technicians b) Certified Translators c) Uncertified Technicians d) Uncertified Translators e) None of the above

6- What is your primary work setting?

a) Hospital b) Outpatient Clinic c) Private Practice d) University

7- How would you describe your Spanish language proficiency?

a) No knowledge b) Limited Knowledge c) Some Knowledge d) Extensive Knowledge

8- How would you describe your knowledge of the cultural context of Spanish speaking clients?

e) No knowledge f) Limited Knowledge g) Some Knowledge h) Extensive Knowledge

102

9- What percentage of your clients are Spanish speaking clients?

a) Less than 25% b) More than 25% c) More than 50% d) More than 75% e) 100%

103

3. Tests Usage

Please indicate if you have used any of the following psychological or neuropsychological tests for assessing Spanish speaking clients. Note: This is the only list you will need to read. These tests were initially developed in Spanish or were translated into Spanish (Please check all that apply). 1. Academic Intervention Monitoring 279. Inventario de Ansiedad: Rasgo-Estado System (AIMS). (IDARE)

2. Academic Perception Inventory 280. Inventario Bochum de Personalidad y (API) Competencias (BIP)

3. Acoso y Violencia 281. Inventario Clínico de Millón para Adolescentes (MACI)

4. Actitudes y Estrategias Cognitivas 282. Inventario Clínico Multiaxial de Millón Sociales (AECS) III (MCMI III)

5. Adapive Behavior Assessment 283. Inventario de Depresión Infantil (CDI) System II (ABAS II). 6. Adaptive Behavior Inventory for 284.Inventario de Depresión Estado Children (ABIC). Estado/Rasgo (IDER)

7. AD/HD Comprehensive Rating 285. Inventario de Desarrollo Battelle Teacher’s Scale 2nd Edition 8. ADHD Rating Scale IV 286. Inventario de Desarrollo Comunicativo

9. ADHD Symptoms Rating Scale 287. Inventario Estructurado de Simulación de Síntomas

10. Advanced Placement Examination 288. Inventario de Expresión de Ira in Spanish Language Estado/Rasgo (STAXI-2)

11. Advanced Placement Examination 289. Inventario de Expresión de Ira in Spanish Literature Estado/Rasgo en Niños y Adolescentes (STAXI-NA)

12. The Adjective Checklist 290. Inventario de Hábitos de Estudio (IHE)

13. Ages and Stages Questionnaires 2nd 291. Inventario de Intereses y Preferencias Edition (ASQ II) Profesionales Revisado (IPP-R)

14. Ages and Stages Questionnaires: 292. Inventario Millón de Estilos de

104

Social Emotional (ASQ: SE) Personalidad (MIPS)

15. Alcohol Use Disorders 293. Inventario MacArthur Bates del Identification Test (AUDIT) Desarrollo de Habilidades Comunicativas (CDI)

16. Alteración del Comportamiento en 294. Inventario Multifásico de Personalidad la Escuela (ACE) de Minnesota-2 (MMPI-2)

17. Alzheimer Quick Test (AQT) 295. Inventario Multifásico de Personalidad de Minnesota para Adolescentes (MMPI-A)

18. American Council Alpha Spanish 296. Inventario de Pensamiento Constructivo Test (CTI)

19. American Council Beta Spanish 297. Inventario de Personalidad NEO Test Revisado

20. American High School Mathematics 298. Inventario de Personalidad para Examination (AHSME) Vendedores (IPV)

21. Análisis del Retraso del Habla (A- 299. Inventario de Rasgos Temperamentales RE-HA) (IRT)

22. Aprenda (R) 2nd Edition 300. Inventario de Situaciones y Respuestas de (APRENDA (2)) Ansiedad (ISRA)

23. Aptitudes Básicas para la 301. Inventario de Trastornos de la Conducta Informática (ABI) Alimentaria (EDI-2)

24. Aptitudes en Educación Infantil 302. Inventario de Trastornos de la Conducta (AEI). Alimentaria (EDI-3)

25. Aptitudes Mentales Primarias 303. Inventory of Depression for Children (PMA) 26. Aptitudes Mentales Primarias 304. Inventory of Interests Equivalente (AMPE-P) 27. Aptitudes Musicales 305. Inventory of Suicide Orientation – 30 (ISO-30)

28. Aptitud de Tipo Superior 306. Iowa Placement Examination (CLAVES)

105

29. Aptitud de Tipo Superior 307. IPI Job Tests Program (MONEDAS) 30. Assessment of Children’s Language 308. IPT Early Literacy Test Comprehension (ACLC) 31. Atención Global Local (AGL) 309. I SPEAK Your Language

32. Athletic Motivation Inventory 310. Laminated Bell Curve Card

33. Attention Deficit Disorders 311. Luria Nebraska Neuropsychological Evaluation Scale 3rd Edition Battery (LNNB) (ADDES-3) 34. Autoconcepto Forma 5 (AF-5) 312. Jackson Vocational Interest Survey (JVIS)

35. Balanced Assessment 313. JOB-O

36. Baron Emotional Quotient 314. Jugando en Serio con tu Diabetes Inventory (Baron EQ-I) 37. BASC Monitor for ADHD 315. Juvenile Automated Substance Abuse Evaluation (JASAE)

38. Basic Adlerian Scales for 316. Katz Adjustment Scales- Relative Report Interpersonal Success Adult Form Form (KAS-R) (BASIS-A) 39. Batería para la Actividad Comercial 317. Kaufman Adolescent and Adult (BAC) Intelligence Test

40. Batería de Aptitudes para el 318. Keirsey Temperament Sorter II (KTS-II) Aprendizaje Escolar (BAPAE) 41. Batería de Conductores (BC) 319. Language Assessment Battery (LAB)

42. Batería Escolar Informatizada (BEI) 320. Learning Style Inventory Revised (LSI- R)

43. Batería de Evaluación de Kaufman 321. The Level of Service Inventory Revised para Niños (K-ABC) (LSI-R)

44. Batería de Evaluación de los 322. Maferr Inventory of Feminine Values Procesos de Escritura (PROESC) (MIFV)

45. Batería de Evaluación de los 323. Maferr Inventory of Masculine Values Procesos Lectores Revisada (MIMV) (PROLEC-R)

106

46. Batería de Operarios (BO) 324. Management and Leadership Systems (MLS)

47. Batería de Pruebas de Admisión: 325. Manejo del Estrés en el Trabajo. Plan de Niveles 1 & 2 (BPA) Acción Detallado para Profesionales

48. Batería de Socialización (BAS) 326. Manual del Entrevistador

49. Batería de Subalternos 327. Manual de Estimulación Cognitiva para Enfermos de Alzheimer en Ambiente Familiar, Baúl de los Recuerdos

50. Batería de Tareas Administrativas- 328. Manual para la Evaluación de las Revisada (BTA-R) Funciones del Yo (EFY)

51. Batería TEA Inicial (BTI) 329. Marital Satisfaction Inventory Revised (MSI-R)

52. Batería Woodcock Muñoz 330. Materiales de Prevención y de Intervención Conves

53. Bateria III Woodcock Muñoz 331. Memoria Auditiva Inmediata (MAI) (BATERIA III) 54. Batería Neuropsicológica en 332. Memoria Visual de Rostros Español (BNE) 55. Batería-R 333. Mental Satisfaction Inventory

56. Battelle Developmental Inventory 334. Merrill Palmer Revised Scales of 2nd Edition (BDI-2) Development (M-P-R)

57. Beck Anxiety Inventory (BAI) 335. Método & Orden (MO- 1 & 2)

58. Beck Depression Inventory (BDI-II) 336. Michigan Alcoholism Screening Test (MAST)

59. Beck Hopelessness Scale (BHS) 337. Millon Adolescent Personality Inventory (MAPI)

60. Beck Scale for Suicide Ideation 338. Millon Behavioral Health Inventory (MBHI)

61. Ber-Sil Spanish Test 339. Millon Behavioral Medicine Diagnostic

107

(MBMD)

62. Behavior Assessment System for 340. Millon Clinical Multiaxial Inventory II Children- 2nd Edition (MCMI-II)

63. Behavior Evaluation Scale 3rd 341. Minnesota Importance Questionnaire Edition (BES-3) (MIQ)

64. Behavior Rating Profile 2nd Edition 342. The Multidimensional Addictions and (BRP-2) Personality Profile (MAPP)

65. Behavioral Assessment of Pain 343. Multifactor Leadership Questionnaire 3rd Questionnaire Edition (MLQ)

66. Benchmarks (Revised) 344. Multilingual Aphasia Examination (MAE)

67. Bennet Mechanical Comprehension 345. Multilingual Aphasia Examination 3rd Test 2nd Edition (BMCT) Edition

68. Bilingual Aphasia Test 346. Multiphasic Sex Inventory II (MSI II)

69. Bilingual Home Inventory (BHI) 347. The Multiple Intelligences Development Assessment Scale (MIDAS)

70. Bilingual Syntax Measure II (BSM 348. Myers Briggs Type Indicator Form M II) (MBTI)

71. Bilingual Verbal Ability Tests 349. Naglieri Non Verbal Ability Tests (BVAT) (NNAT)

72. Binet-Simon Intelligence Scale 350. National Spanish Examinations (NSE)

73. Bloc Screening Revisado (BLOC-S- 351. NEEDS Survey (NEEDS) R) 74. Boehm Test de Conceptos Básicos 352. Neurobehavioral Cognitive Status Examination (COGNISTAT)

75. Boehm Test of Basic Concepts 3rd 353. NEO Personality Inventory Edition (BOEHM-3) 76. Boehm Tests of Basic Concepts-3 354. NEO Five Factor Inventory (NEO-FFI) Preschool 77. Boston Diagnostic Aphasia 355. Neuropsychological Screening Battery

108

Examination (BDAE) for Hispanics

78. Boston, Evaluación de la Afasia y 356. Niveles Elemental, Medio y Superior de Trastornos Relacionados 3ra (NAIPES G) Edición 79. Boston Naming Test 357. Non Verbal Reasoning Test Series

80. Bracken Basic Concept Scale- 3rd 358. Occupational Personality Questionnaire Edition Receptive (BBCS- 3-R) (OPQ)

81. Bracken Basic Concept Scale- 359. Online Computerized Adaptive Expressive (BBCS-E) Placement Exam (Web-CAPE)

82. Bracken School Readiness 360. Oral English/Spanish Proficiency Assessment (BSRA) Placement Test (OE/SPPT)

83. Brief Inventory for Health 361. OTIS Sencillo: Test de Inteligencia Improvement 2 (BBHI-2) General (OS)

84. Brief Screening and Outcome 362. Outcome Questionnaire for Adults (OQ- Questionnaire (OQ-10.2) 30.1)

85. Brief Symptom Inventory (BSI) 363. Outcome Questionnaire (OQ-45.2)

86. Brigance Diagnostic Inventory of 364. Pain Patient Profile (P-3) Basic Skills 87. BRIGANCE Preschool Screen II 365. P.A.R. Admissions Test

88. BRIGANCE (r) Early Preschool 366. Parent as a Teacher Inventory Revised Children II (PAAT)

89. BRIGANCE (r) Infant and Toddler 367. The Parenthood Questionnaire Screen 90. BRIGANCE (r) K and I Screen II 368. Parent Success Indicator (PSI)

91. Brown Attention Deficit Disorder 369. Parents’ Evaluation of Developmental Scales Status (PEDS)

92. California Computerized 370. Parents’ Observations of Infants and Assessment Package (CalCAP) Toddlers (POINT)

93. California Psychological Inventory 371. Percepción de Diferencias (CARAS) 3rd Edition

109

94. California Verbal Learning Test 372. Perfil de Estrés (CVLT) 95. Career Assessment Inventory 2nd 373. Perfil e Inventario de Personalidad (PPG- Edition IPG)

96. Career Profile System 2nd Edition 374. Perri Test de Aprendizaje Verbal y de Memoria

97. Central Ability Measure For Adults 375. Personal Characteristics Inventory (PCI)

98. CERAD Assessment Battery 376. Personal Style Indicator (PSI) (CERAD) 99. Chicago Early Assessment and 377. Personality Assessment Inventory (PAI) Remediation Laboratory (Chicago EARLY) 100. The Child Neuropsychological 378. Personality Inventory for Children 2nd Questionnaire Edition (PIC-2)

101. Children’s PTSD Inventory 379. Personality Research Form 3rd Edition (PRF)

102. CLEP Examination in College 380. Pervasive Developmental Disorders Level Spanish Language: Levels 1 Screening Test II (PDDST-II) and 2 (CLEP) 103. Clima Laboral (CLA) 381. Phase II Profile Integrity Status Inventory and Addendum

104. Cognitive Linguistic Quick 382. Poker de la Personalidad Test (CLQT) 105. College Board Institutional 383. PRE-LAS English (PRE-LAS) SAT Subject Test in Spanish 106. College Board Institutional 384. Preschool and Kindergarten Behavior SAT Subject in Spanish with Scales 2nd Edition (PKNS-2) Listening 107. College Board SAT Subject 385. Preschool Child Observation Record 2nd Test in Spanish Edition (COR)

108. College Board SAT Subject 386. Preschool Language Scale 4th Edition Test in Spanish with Listening (PLS-4)

109. Color Trails Test (CLT) 387. Prison Inmate Inventory (PII)

110

110. Columbia Mental Maturity 388. Procedimientos de Evaluación de Scale Ancianos de Clifton

111. Combined Basic Skills 389. Program for the Child Behavior Checklist

112. Communications Profile 390. Programa de Desarrollo de Aptitudes para Questionnaire (CPQ) el Aprendizaje Escolar Revisado (PDA-R)

113. COMPE-TEA 391. Programa para el Desarrollo de la Percepción Visual FROSTIG

114. Comprehension of Oral 392. Programa de Desarrollo Socio-Afectivo Language (DSA)

115. Comprehensive Identification 393. Programa de Educación Psicomotriz Process(Revised) (PEP)

116. Comprehensive Personality 394. Programa Instruccional para la Scale (CPP) Evaluación y Liberación Emocional (PIELE)

117. Comprensión de Órdenes 395. Programa de Intervención para Aumentar Escritas (COE) la Atención y Reflexibilidad: Niveles 1 y 2 (PIAAR-R)

118. Conner’s Adult ADHD Rating 396. Programa Preventivo sobre Imagen Scales (CADS) Corporal y Trastornos de la Alimentación (PICTA)

119. Conner’s Global Index (CGI) 397. Progress Assessment Chart of Social Development (PAC)

120. Conner’s Rating Scales 398. Prueba Beery Buktenica del Desarrollo de Revised (CRS-R) laIntegración Visomotriz (VMI)

121. Consumer Involvement Profile 399. Prueba de Comprension Lectora (CIP) 122. Cooperative Spanish Test 400. Prueba de Destreza Stromberg (PDS)

123. Coordinación Visomotora 401. Prueba de Exploración Cambridge Revisada para la Valoración de los Trastornos Mentales en la Vejez (CAMDEX-R)

124. Coping Inventory for Stressful 402. Prueba de Frases Incompletas con

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Situations 2nd Edition (CISS) Aplicación a la Industria (FIGS)

125. Coping Resources Inventory 403. Prueba de Lenguaje Oral Navarra for Stress (CRIS) Revisada (PLON-R)

126. Cosmetology Student 404. Prueba de Inmaginación Creativa (PIC) Admission Evaluation 127. Crane Oral Dominance Test 405. Prueba de Inmaginación Creativa Jóvenes (CODT) (PIC-J)

128. Cuadrado de Letras (CL) 406. Pruebas de Benton para el Diagnostico Neuropsicológico

129. Cuestionario de Afrontamiento 407. Pruebas de Lectora: Niveles 1 y 2 al Estrés para Pacientes Oncológicos (CAEPO) 130. Cuestionario de Análisis 408. Pruebas Psicológicas Clínico (CAQ) 131. Cuestionario de Ansiedad 409. Psicodiagnóstico de Rorschach Infantil (CAS) 132. Cuestionario de Ansiedad 410. Quality of Life Inventory Estado/Rasgo (STAI) 133. Cuestionario de Ansiedad 411. Quality of Life Questionnaire (QOL-Q) Estado/Riesgo en Niños (STAIC) 134. Cuestionario de Auto-Control 412. Quick Language Assessment Inventory Infantil y Adolescente (CACIA) 135. Cuestionario de Aserción de la 413. Quick Test (QT) Pareja (ASPA) 136. Cuestionario “Big Five” (BFQ) 414. Rapidez Motora (RM)

137. Cuestionario “Big Five” de 415. Raven Matrices Progresivas (RAVEN) Personalidad para Niños y Adolescentes (BFQ-NA) 138. Cuestionario Breve de Calidad 416. Receptive One Word Picture Vocabulary de Vida (CUBRECAVI) Test Spanish- Bilingual Edition (ROWPVT- SBE)

139. Cuestionario de Conductas 417. Receptive One Word Picture Vocabulary Antisociales Delictivas (A-D) Test (ROWPVT)

140. Cuestionario Factorial de 418.Registro de Preferencias Vocacionales Personalidad (ESPQ)

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(KUDER-C)

141. Cuestionario Factorial de 419. Resolución de Problemas (RP 30) Personalidad 5ta Edición (16 PF-5) 142. Cuestionario Educativo 420. Reynolds Adolescent Depression Scale Clínico: Ansiedad y Depresión (RADS) (CECAD) 143. Cuestionario de Estrategias de 421. Reynolds Bully Victimization Scales for Aprendizaje (CEA) Schools (RBVSS)

144. Cuestionario de Estrategias 422. The Rivermead Behavioral Memory Test Cognitivas en Deportistas (CECD) (RBMT)

145. Cuestionario Estructural 423. Rorschach Inkblot Test Tetradimensional para la Depresión (CET-DE) 146. Cuestionario para la 424. Rotter Sentence Completion Test Evaluación de Adoptantes, Cuidadores, Tutores, y Mediadores (CUIDA) 147. Cuestionario de Evaluación de 425. Rust Inventory of Schizotypal Cognitions Riesgos Psicosociales (DECORE) (RISC)

148. Cuestionario de Desajuste 426. Scale for the Assessment of Negative Emocional y Recursos Adaptivos en Symptoms (SANS) Infertilidad (DERA) 149. Cuestionario de Hábitos y 427. Scales for Indentifying Gifted Students Técnicas de Estudio (CHTE) (SIGS)

150. Cuestionario de Intereses 428. School Attitude Measure 2nd Edition Profesionales (CIPSA) (SAM)

151. Cuestionario de Madurez 429. SDS Búsqueda Autodirigida Forma R y J Neuropsicológica Infantil (CUMANIN) 152. Cuestionario de Personalidad 430. Self Directed Search (SDS) (CEP) 153. Cuestionario de Personalidad 431. Self Directed Search Form R-4th Edition para Adolescentes (16-PF-APQ) Spanish (SDS Form R IV)

154. Cuestionario de Personalidad 432. Self Perceptions Inventory (SPI) para Adolescentes (HSPQ)

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155. Cuestionario de Personalidad: 433. Sensory Profile Suite of Products- Formas A y B (EPI) Sensory Profile, Infant/ Toddler Sensory Profile & Adolescent/Adult Sensory Profile

156. Cuestionario de Personalidad: 434. Sentence Completion Test (SCT) Formas A y J (EPQ) 157. Cuestionario de Personalidad 435. Sequenced Inventory of Communication de Eysenck- Revisado (EPQ-R) Developmental Revised Edition (SICD-R)

158. Cuestionario de Personalidad 436. Severity of Dependence Scale (SDS) para Niños (CPQ) 159. Cuestionario de Personalidad 437. Sistema de Evaluación de la Conducta de Situacional (CPS) Niños y Adolescentes (BASC)

160. Cuestionario PNP 438. Sistema de Evaluación, Valoración, y Planeamiento de Programas para Infantes

161. Cuestionario de Sobreingesta 439. Social Adjustment Scale- Self Report Alimentaria (OQ) (SAS-SR)

162. Cuestionario de Valores 440. Social Problem Solving Inventory Interpersonales (SIV) Revised (SPSI-R)

163. Cuestionario de Valores 441. Spanish Assessment of Basic Education Personales (SPV) (SABE)

164. Cuestionario de 90 Síntomas 442. Spanish and English Neuropsychological (SCL-90-R) Assessment Scales (SENAS)

165. Culture Fair Series Scales 1,2,3 443. Spanish Language Assessment Procedure

166. Das Naglieri Cognitive 444. Spanish Reading Inventory Assessment System 167. Davidson Trauma Scale (DTS) 445. Spanish Structured Photographic Expressive Language Test (SPELT)

168. Dean-Woodcock 446. Spanish/English Reading Comprehension Neuropsychological Battery Test Revised

169. Derogatis Interview for Sexual 447. Stanford Binet Intelligence Scale Functioning (DISF) 170. Desarrollo de las Habilidades 448. Strength Deployment Inventory (SDI) Cognitivas (DHAC)

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171. Desarrollo de la Percepción 449. Stroop Test de Colores y Palabras Visual FROSTIG 172. Detección de Riesgo en la 450. Survey of Organizations (SOO-2000) Escuela Primaria 173. Developing Skills Checklist 451. System of Multicultural Pluralistic (DSC) Assessment (SOMPA)

174. Developmental Indicators for 452. Szondi Test the Assessment of Learning (DIAL- 3) 175. Devereux Early Childhood 453. Trailer de Memoria: Niveles 1 y 2 Assessment (DECA) 176. Diagnostico Integral del 454. Tarea de Atención Sostenida en la Estudio (DIE 1,2,3) Infancia (CSAT)

177. Diagnostico Neuropsicológico 455. Taylor Johnson Temperament Analysis de Adultos (LURIA-DNA) (T-JTA)

178. Differential Aptitude Tests 456. Técnica Proyectiva de Dibujo (H-T-P)

179. Dissociative Experiences Scale 457. TEDI-MATH (DES) 180. The Divine Inventory 458. Temperament Inventory (TI) (Revised) (DI) 181. Domestic Violence Inventory 459. TerraNova 2nd Edition (DVI) 182. Dos Amigos Verbal Language 460. Test de Analisis de la Lecto-Escritura Scales (TALE)

183. Drug Use Screening Inventory 461. Test Anxiety Inventory (TAI) Revised (DUSI-R) 184. Early Childhood Environment 462. Test de Apercepción Temática (TAT) Rating Scale Revised Edition (ECERS-R) 185. Early Intervention 463. Test de Aprendizaje Verbal España Developmental Profile Complutense (TAVEC)

186. Early Literacy Skills 464. Test de Aprendizaje Verbal España Assessment (ELSA) Complutense Infantil (TAVECI)

187. Early Reading Diagnostic 465. Test de Aptitud Verbal (BAIRES) Assessment Second Edition (ERDA-

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II) 188. Early Screening Inventory- 466. Test de Aptitudes Burocraticas y Revised (ESI-R) Administrativas (TABA)

189. Eje V de Kennedy (EJE K) 467. Test de Aptitudes Cognoscitivas I (PRIMARIA I)

190. Ejercicios para la Adquisición 468. Test de Aptitudes Cognoscitivas II de Conceptos Boehm (PRIMARIA II)

191. Ejercicios de 469. Test de Aptitudes Diferenciales (DAT-5) Sensoriormotricidad y Percepción 192. Entrevista para el Diagnóstico 470. Test de Aptitudes Escolares (TEA) del Autismo (ADI-R) 193. Entrevista para Síndromes 471. Test de Aptitudes Mecánicas Psiquiatricos en Niños y Adolescentes (chIPS) 194. Escala de Alexander 472. Test del Árbol

195. Escala de Ansiedad Manifesta 473. Test de Atención en Adultos (AMAS) 196. Escala de Ansiedad Manifesta 474. Test Autoevaluativo Multifactorial de en Niños Revisada (CMAS-R) Adaptación

197. Escala de Bienestar 475. Test Barcelona Revisada Psicológico (EBP) 198. Escala de Depresión para 476. Test Breve de Inteligencia de Kaufman Niños (CDS) (K-BIT)

199. Escala de Dificultades de 477. Test de la Casa Socialización de Cantoblanco (SOC) 200. Escala Europea de Aptitudes 478. Test de Cinco Cifras Intelectuales (EAS) 201. Escala de Evaluación de la 479. Test de los Cinco Digitos (FDT) Psicomotricidad en Preescolar (EPP) 202. Escala de Habilidades Sociales 480. Test de Clasificación de Tarjetas de (EHS) Wisconsin (WCST)

203. Escala de Inteligencia 481. Test de Competencia Matemática Básica Revisada para el Nivel Escolar 3 (TEMA 3) (WISC-RM) 204. Escala de Inteligencia para los 482. Test de Comprensión de Estructuras

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Niveles Preescolar y Primario Gramaticales (CEG) Infantil (WPPSI) 205. Escala de Intensidad de 483. Test de Copia de una Figura Compleja Apoyos (SIS) Rey

206. Escala de Madurez Mental de 484. Test de Creatividad Infantil (TCI) Columbia (CMMS) 207. Escala de Motivaciones 485. Test de los Cuentos de Hadas (FTT) Psicosociales (MPS) 208. Escala Multidimensional de 486. Test de Destreza en el Manejo de Asertividad (EMA) Herramientas

209. Escala de Observación para el 487. Test de Destreza con Pequeños Objetos Diagnóstico del Autismo (ADOS) 210. Escala Obervacional del 488. Test de Destreza de Stromberg Desarrollo (EOD) 211. Escala de Preferencias 489. Test del Dibujo de la Familia

212. Escala de Satisfacción Familiar 490. Test del Dibujo de la Figura Humana por Adjetivos (ESPA) 213. Escala de Socialización 491. Test de Dibujo de la Figura Humana Parental en la Adolescencia Goddenough (ESPA29) 214. Escala de Inteligencia 492. Test del Dibujo de dos Figuras Humanas Wechsler para Adultos (WAIS) (T2F)

215. Escala de Inteligencia 493. Test de Dominancia Lateral Harris Wechsler para Adultos (EIWA) 216. Escala de Inteligencia de 494. Test de Dominios (D-48) Wechsler para Adultos III (EIWA III) 217. Escala de Inteligencia de 495. Test de Dominios (D-70) Wechsler para Niños Revisada (WISC-R) 218. Escala de Inteligencia de 496. Test de Emparejamiento de Figuras Wechsler para Niños Revisada de Conocidas (MFF-20) Puerto Rico (WISC-R-PR) 219. Escala de Wechsler de 497. Test de Empatia Cognitiva y Afectiva Inteligencia para Niños IV (WISC (TECA) IV) 220. Escalas de Afrontamiento para 498. Test de Estrategias Cognitivoemocionales Adolescentes

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Moldes

221. Escalas de Apreciación del 499. Test para el Examen de la Afasia Estrés (EAE) 222. Escalas Bayley de Desarrollo 500. Test de Flexibilidad Cognitiva Infantil (BSID) (CAMBIOS)

223. Escalas de Inteligencia de 501. Test of General Educational Reynolds (RIAS) Development (GED)

224. Escalas McCarthy de Aptitudes 502. Test Gestáltico Visomotor Bender y Psicomotricidad para Niños (MSCA) 225. Estrategias de Aprendizaje 503. Test de Habilidades Mentales Primarias ACRA (HMP)

226. Estudio de Valores 504. Test de Habilidades en la Negociación (NEGO)

227. Evaluación de la Afasia y de 505. Test de Homogeneidad y Preferencia Trastornos Relacionados Lateral (HPL)

228. Evaluación de la Autoestima 506. Test de Identificación de Daltonismos en Educación Primaria (TIDA)

229. Evaluación de la Comprensión 507. Test Illinois de Aptitudes Lectora (ECL 1 Y 2) Psicolinguísticas (ITPA)

230. Evaluación de la Convivencia 508. Test de Inteligencia Breve de Reynolds Escolar (RIST)

231. Evaluación de la Convivencia 509. Test de Inteligencia General: Nivel 1 y 2 Escolar (CONVES) (TIG)

232. Evaluación Factorial de las 510. Test de Inteligencia No Verbal (TONI-2) Aptitudes Intelectuales (EFAI) 233. Evaluación de Grado Medio & 511. Test de Interpretación Selectiva de Datos Alto (GMA) (TISD)

234. Evaluación Inicial para 512. Test de Laberintos Porteus Estudiantes con Aptitudes Sobresalientes (SAGES 2)

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235. Evaluación Neuropsicológica 513. Test de Memoria (MY) Breve en Español (NEUROPSI) 236. Evaluación Neuropsicológica 514. Test de Memoria y Aprendizaje en la Edad Preescolar Luria Inicial (TOMAL)

237. Evaluación Neuropsicológica 515. Test of Memory of Malingering (TOMM) de las Funciones Ejecutivas en Niños (ENFEN) 238. Evaluación Neuropsicológica 516. Test de Motivaciones en Adolescentes Infantil (ENI) (SMAT)

239. Evaluación Neuropsicológica 517. Test de Observación (TO-1) de Memoria y Aprendizaje Visual (DCS) 240. Evaluación del Potencial de 518. Test Pata Negra Aprendizaje (EPA-2) 241. Evaluación de Precurrentes 519. Test de Personalidad de TEA (TPT) Instrumentales para la Adquisición de la Lectura 242. Evaluación de los Procesos 520. Test de Phonological Awareness in Lectores en Alumnos de 3er Ciclo Spanish (TPAS) de Primaria y Secundaria 243. Evaluación del Trastorno por 521. Test de Pronóstico Académico (APT) Déficit de Atención con Hiperactividad 244. Evaluación y Ejercicios para 522. Test Rápido Barranquilla (BARSIT) Bebes y Niños con Necesidades Especiales Currículo Carolina 245. Examen Cognoscitivo Mini- 523. Test de Retención Visual de Benton Mental (MMSE) (TRVB)

246. Exploratory Battery of 524. Test de Siluetas para Adolescentes (TSA) Sexuality 247. Expressive One Word Picture 525. Test de Símbolos y Dígitos (SDMT) Vocabulary Test: Spanish Bilingual Edition (EOWPVT- SBE) 248. Fábulas de Duss 526. Test de Vocabulario en Imagenes Peabody

249. Factores de Riesgo 527. Tests de Escala 1 (FACTOR G) Interpersonales para el consume de Drogas en Adolescentes (FRIDA)

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250. Family Assessment Measure 528. Tests de Escala 2 y 3 (FACTOR G) 3rd Edition (FAM-III) 251. FB 360 529. Tests de Rendimiento Escolar (TR35)

252. The Five Ps 530. Token Test

253. Formas Idénticas 531. Toulouse Pieon (TP)

254. Fuld Object Memory 532. Tower of London Test Evaluación (FOME) 255. General Ability Measure for 533. Trail Making Test Adults (GAMA) 256. Gestión por Competencias 534. Tratamiento de Disfunciones Sexuales (SOSIA) 257. Grandparent Strengths and 535. Uso y Prevención de Disfonías la Voz Needs Inventory (OSNI) 258. Group Inventory for Finding 536. Versant Spanish Test Creative Talent (GIFT) 259. Group Inventory for Finding 537. Vineland Adaptive Behavior Scales Interests (GIFI) 260. Guía de Preguntas del Manual 538. Vineland Social Emotional Early de Psicoterapia Breve, Intensiva, y Childhood Series (SEEC) de Urgencia 261. Halstead-Reitan 539. Vocational Research Interest Inventory Neuropsychological Test Battery (VRII) (HRNB) 262. The Harington-O’Shea Career 540. Ward Atmosphere Scale 3rd Edition Decision Making System- Revised (WAS) (CDM-R) 263. Hawaii Early Learning Profile 541. Wonderlic Personnel Test (WPT) (HELP) 264. Hay Aptitude Test Battery 542. Scholastic Level Exam (SLE) Revised 265. Health Assessment 543. Wechsler Adult Intelligence Scale Third Questionnaire (HAQ) Edition (WAIS III)

266. HIV/University of Miami 544. Wechsler Adult Intelligence Scale 3rd Annotated Neuropsychological Test Edition (Mexican Adaptation) (WAIS III) Battery in Spanish (HUMANS) 267. IDEA Oral Language 545. Wechsler Memory Scale 3rd Edition Proficiency Test (IPT) (WMS III)

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268. IDEA Reading and Writing 546. Western Aphasia Battery (WAB) Proficiency Test IPT 269. Infant Toddler and Brief Infant 547. Woodcock Johnson III Toddler Social and Emotional Assessment (ITSEA/BITSEA) 270. Informant Questionnaire on 548. Woodcock-Johnson Psychoeducational Cognitive Decline in the Elderly Battery (IQCODE) 271. Instrucciones Complejas (IC) 549. Woodcock Language Proficiency Battery (WLPB)

272. Instrumento No Verbal de 550. Word Accentuation Test (WAT) Inteligencia (BETA II-R) 273. Instrumento No Verbal de 551. Word Memory Test (WMT) Inteligencia (BETA III) 274. Integrated Visual and Auditory 552. Worley’s ID Profile (WIDP) Continuous Performance Test (IVA + Plus) 275. Inteligencia Creativa (CREA) 553. Youth Outcome Questionnaire-Omni Version (Y-OQ-30.1)

276. Inteligencia General Nivel 2 554. Youth Outcome Questionnaire Self Report (Y-OQ-SR 2.0)

277. Inventario de Adaptación de 555. Z Test Conducta (IAC) 278. Inventario de Adjetivos para la Evaluación de los Trastornos de la Personalidad (IA-TP)

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Appendix H. Request Letter to HNS Board Members 10.14.09 Department of Psychology University of North Carolina Wilmington Wilmington, NC, 28403 Dear Dr. Peery, My name is Carlos Ojeda and I am a graduate student from the University of North Carolina Wilmington as well as a student member of the Hispanic Neuropsychological Society. Dr. Antonio E. Puente and I are working on a study that we would greatly appreciate support from HNS.

The reason of the present letter is to request permission to contact HNS members using the HNS List Serve to complete an online survey about the usage of neuropsychological and psychological tests for Spanish speaking clients.

HNS members would receive a communication posting from Dr. Antonio Puente indicating: a) the rationale of the study and b) the approximate time it takes to participate. To participate, HNS members will follow the survey monkey link as indicated in the posting.

This study was reviewed and approved by IRB at UNCW. If participants were to have any questions or concerns, my contact information and that of my supervisor will be available. Results of the study will help us gain a better understanding of neuropsychological and psychological test usage of Spanish tests as well as determining what neuropsychological and psychological tests meet the guidelines of the Standards for Educational and Psychological Testing (1999).

We anticipate that the results of this study will be the foundation for a presentation at the HNS meeting in Acapulco.

Thank you for your assistance,

Carlos A. Ojeda Graduate Student University of North Carolina Wilmington Department of Psychology Graduate Student [email protected] (305) 725 3200

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Appendix J. Postings to Participants 12.15.09 Department of Psychology University of North Carolina Wilmington Wilmington, NC, 28403 Survey: Assessment of Psychological and Neuropsychological Test Usage Dear Colleagues:

We are completing a study that is an extension of a previously published study on test usage (Camara, Nathan, & Puente, 2000).Whereas that study focused on psychological and neuropsychological tests used with English speaking individuals, we are focusing this study on tests used for Spanish-speaking persons. We are asking that you take 10-15 minutes of your time to complete the attached survey. The survey was approved by the UNCW IRB as well as the Board of Directors of the Hispanic Neuropsychological Society. The tests found in this list are based on a comprehensive review of the psychological literature a) Buros MentalMeasurements Yearbook Website Database, b) prior research about testing (Salazar, Perez, & Puente, 2007; Lazarus, 2009), c) Hispanic Neuropsychological Society List of Spanish Tests, d) Databases such as Psychinfo or WorldCat, and e) Spanish Test Publishers such as Manual Moderno Mexico Editorial and TEA. Please go to the following link to complete the survey. http://www.surveymonkey.com/s/J9Y2J8M

Antonio E. Puente Carlos Ojeda Professor of Psychology Psychology Graduate Student

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01.08.10

Department of Psychology University of North Carolina Wilmington Wilmington, North Carolina 28403

Survey: Assessment of Psychological and Neuropsychological Test Usage

Estimados Colegas:

On 12.15.09, we sent you an e-mail asking for your assistance in completing a short survey on test usage for Spanish speakers. To date, we have received 24 completed surveys. This is approximately 25% of the HNS membership.

To those that were able to complete the survey, muchas gracias. For those that took the holidays seriously (as any good Latin citizen would) and did not have time to complete the survey, we are asking your assistance in helping us complete a study that will be useful not only to us but to others such as insurance companies and test publishers. Your assistance is not only much appreciate but also much needed.

Our goal is to present the outcome of the study at the HNS meeting in Acapulco next month.

Un codial saludo,

Antonio E. Puente and Carlos Ojeda

Please go the following link to complete the survey: http://www.surveymonkey.com/s/J9Y2J8M

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02.09.10 Department of Psychology University of North Carolina Wilmington Wilmington, North Carolina 28403

RE: Assessment of Psychological and Neuropsychological Test Usage Estimados Colegas:

Last week in Acapulco, we presented results from our survey at HNS (talk) and INS (poster). It came to our attention that some individuals and students did complete the survey. In the case of students, for example, some felt that they did not know which category of education they should check (i.e., “other). We are aiming to get over 50% response rate and we are very close to that mark. Our goal is to finish collecting data this week and continue with our analyses. If you have not completed the survey yet, please complete it by following this link. http://www.surveymonkey.com/s/J9Y2J8M

If you completed the survey and/or heard our talk or saw our poster and have specific suggestions for analyses or questions to be pursued,please contact us via e-mail either through [email protected] or [email protected].

Gracias!

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