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Burton, V., Puente, A.E., Vilar-López, R.
Hispanics and Neuropsychology: OverviewAccording to the 2010 census, Hispanics are
now the largest minority group within the United States (Census Bureau, 2010)
Hispanic can be defined in many ways, typically including language, culture, and ethnicity
The neuropsychological literature is relatively sparse and almost no information exists (outside of our work) on testing effort of Spanish speakers
BackgroundOver the past two decades there has been a
growth in the quantity of research regarding culture and psychology , less so in neuropsychology
Much of what relates to neuropsychology is limited in cross-cultural and linguistic assessments such as test translations
Background continuedA need for a better understanding of
neuropsychological tests and Hispanics exists and is increasing. (Puente & Ardila, 2000)
Tests of effort are an important tool in neuropsychology (most popularly cited article on the subject is Bush et. al, 2005)
Specifically, no studies have been conducted in the United States with neuropsychological tests of effort and Spanish speakers.
What has been done is limited to Spain (Vilar-Lopez)
Assessments and CultureDue to the use of assessments in
neuropsychology, it is vital to develop assessments that are culturally and linguistically unbiased (Testing Standards, 1999; in revision).
Tests have been developed in the English language with the majority culture as the norm groups
Prior ResearchDetection of malingering in a Spanish (Spain)
population using three specific malingering tests (Vilar-López et al., 2007)
No significant differences were found when compared to the North American samples of the test manuals
What about individual involved in litigation and suspect of malingering?
Prior Research continuedUse of specific malingering measures in a
Spanish sample. (Vilar-López, Gómez-Río, Caracuel-Romero, Llamas-Elvira, & Pérez-García, 2008)
Investigated a battery of assessments including the Rey 15-Item Test for Spanish speakers in Spain
This study concluded that the Rey 15-Item should be used with restrictions, determined as less sensitive
Prior Research continued Malingering detection in a Spanish
population with a known-groups design.(Vilar-López et al., 2008)
Utilized the Dot Counting Test and the TOMM in Spain
It was determined that the TOMM is an acceptable sensitive tool
The Dot Counting Test was also determined as adequate, however, less sensitive for this population
Study Description:Differential prevalence designCommunity, clinical and forensic populationsResiding in the United States.
Method:ParticipantsParticipants were collected from two sources:
1. Tileston Health Clinic (a free multi-disciplinary health clinic for the poor and uninsured) of Wilmington, N.C. 2. Private neuropsychological testing practice in Wilmington, N.C.
Demographics collected: 1. age 2. sex 3. country of origin 4. years of education 5. Years lived in the United States6. years of education in the country of origin 7. years of education in the United States.
ParticipantsControl Group (CG) Capital Murder Group
(CM)N=29Mean age= 41.61Mean years of
education= 9.50Not involved in litigation
N=28Mean age= 29.79Mean years of
education= 7.71Involved in criminal
cases: capital murder
Participants: continuedOther Forensic GroupN=25Mean age= 36.56Mean years of
education= 6.68Involved in civil
litigation cases: workers’ compensation, personal injury, or Social Security disability
Tests of Effort Rey 15-ItemTest of Memory MalingeringDot Counting Test
ProcedureIRB approvalData collected from Tileston Health Clinic:
Participants approached in SpanishSigned informed consentDemographics collectedTests administered (counterbalanced)
ProcedureData collected from the private practice:
Demographic information was collectedTwo out of the three SVTs required for
inclusionClassified as Capital Murder Group or Other
Forensic Group
Results Mexican
N=54
Other
N= 26t/2 p
Age; Mean (SD) 35.94 (10.67) 35.62 (11.43) .126 .900
Education; Mean
(SD)7.83 (3.72) 8.00 (4.75) -.171 .865
Gender
(males/females)33/21 20/6 1.962 .161
Rey; Mean (SD) 11.57 (3.80) 11.81 (3.54) -.249 .804
Dot Counting;
Mean (SD)14.68 (6.91) 14.31 (3.79) .249 .804
TOMM 1; Mean
(SD)43.65 (6.36) 45.68 (6.61) -1.201 .234
TOMM 2; Mean
(SD)47.28 (5.12) 47.68 (5.78) -.287 .775
Descriptive statistics of the participants regarding nationality
Results
Capital
Murder
Other
Forensic
Clinical
ControlsF/2 p
Age;
Mean(SD)29.79 (7.75) 36.56 (10.18) 41.61 (11.11) 10.315 .000
Education;
Mean (SD)7.71 (4.52) 6.68 (3.97) 9.50 (3.65) 3.285 .043
Gender
(males/female
s)
25/3 23/2 7/22 37.495 .000
Descriptives for the capital murder, other forensic and clinical control groups
Results
Capital Murder
Other Forensic
Controls F pBonferroni
Rey; Mean (SD)12.80 (3.30) 7.33 (2.69)
12.61 (2.87)
9.255 .000 2<(1=3)
Dot Counting; Mean (SD)
14.03 (4.32) 14.44 (4.39)13.81 (5.98)
.565 .571 NA
TOMM 1; Mean (SD)
47.47 (5.24) 38.11 (6.94)45.04 (22.93)
7.202 .002 2<1
TOMM 2; Mean (SD)
49.33 (1.59) 43.56 (7.84)48.89 (2.22)
3.472 .037 2<1
ANOVAs for the capital murder, other forensic and control groups on the effort testsNote: 1=Capital murder group; 2=Other forensic group; 3= Control group
Results
Capital Murder Other Forensic Controls2 p
Pass Fail Pass Fail Pass FailRey cutoff 6N (%)
23 (95.8)
1 (4.2)18 (85.7)
3 (14.3)
28 (96.6)
1 (3.4) 2.649 .266
Rey cutoff 9N (%)
22 (91.7)
2 (8.3)11 (52.4)
10 (47.6)
26 (89.7)
3 (10.3)
13.603 .001
Dot Counting comboN (%)
18 (75) 6 (25) 12 (60) 8 (40)26 (92.9)
2 (7.1) 7.448 .024
TOMM 2 cutoff 45N (%)
18 (90) 2 (10)12 (66.7)
6 (33.3)
27 (93.1)
2 (6.9) 6.658 .036
Classification for the capital murder, other forensic and clinical control groups according to the effort tests
DiscussionComparison of countries of origin and sex- no
differences were foundAge and education were showed statistical
significance ANOVAs were completed with the
standardized residuals to determine differences between groups on effort tests
DiscussionThe Capital Murder group (CM) performed
similarly to the Clinical Control group (CC) on both the Rey 15-Item Test and the Test of Memory Malingering
The Other Forensic group (OF) tested with the least amount of effort on R-FIT and TOMM
The Dot Counting Test proved to show no significant differences for any of the groups
DiscussionMost interesting: the difference between the
Capital Murder group and the Other Forensic group
Limitations and Future ResearchDesign of the studySample usedLack of comparison of control group for years
spent within the United States.
Known-groups designExtension of this research with larger samples
within the United StatesIncluding other tests of effortInvestigation of the correlation/relationship
between the type of litigation individuals are involved in and testing effort
Summary & QuestionsThese tests appear to be sufficient in addressing
effort testing in Spanish speakers Important first step in the understanding of the
use of neuropsychological tests with Spanish speakers in the U.S.
The specificity of the tests for sub-populations is unknown
Further studies, with replication and extension are needed for specificity and sensitivity to be determined
At that point a better understanding of the value and limits of these tests will then be achieved