Burton, V., Puente, A.E., Vilar-López, R.. Hispanics and Neuropsychology: Overview According to the 2010 census, Hispanics are now the largest minority.

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