Burton, V., Puente, A.E., Vilar-López, R. Tests of Effort in Normative, Clinical and Forensic Populations of Spanish Speaking Individuals Residing in the United States Burton, V., Puente, A.E., Vilar-López, R.

Hispanics and Neuropsychology: Overview According 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

Background Over 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 continued A 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) Talk about importance and use of these tests and those who talk about it …buch castano, vilar, puente…

Assessments and Culture Due 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 Research Detection 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 continued Use 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 design Community, clinical and forensic populations Residing in the United States. Need to clearly define what I am referring to as “normal” in this context. Maybe create a new label for this term.

Method: Participants Participants 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 States 6. years of education in the country of origin 7. years of education in the United States.

Participants Capital Murder Group (CM) Control Group (CG) N=29 Mean age= 41.61 Mean years of education= 9.50 Not involved in litigation N=28 Mean age= 29.79 Mean years of education= 7.71 Involved in criminal cases: capital murder

Participants: continued Other Forensic Group N=25 Mean age= 36.56 Mean years of education= 6.68 Involved in civil litigation cases: workers’ compensation, personal injury, or Social Security disability

Tests of Effort Rey 15-Item Test of Memory Malingering Dot Counting Test

Procedure IRB approval Data collected from Tileston Health Clinic: Participants approached in Spanish Signed informed consent Demographics collected Tests administered (counterbalanced)

Procedure Data collected from the private practice: Demographic information was collected Two out of the three SVTs required for inclusion Classified as Capital Murder Group or Other Forensic Group Describe why clinical group was not used for the analysis, Approximately 20% of individuals approached declined participation.

Results Descriptive statistics of the participants regarding nationality   Mexican N=54 Other N= 26 t/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 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

Results Descriptives for the capital murder, other forensic and clinical control groups   Capital Murder  Other Forensic Clinical Controls F/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/females) 25/3 23/2 7/22 37.495

Results ANOVAs for the capital murder, other forensic and control groups on the effort tests Note: 1=Capital murder group; 2=Other forensic group; 3= Control group   Capital Murder Other Forensic Controls F p Bonferroni 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

Results Classification for the capital murder, other forensic and clinical control groups according to the effort tests   Capital Murder Other Forensic Controls 2 p Pass Fail Rey cutoff 6 N (%) 23 (95.8) 1 (4.2) 18 (85.7) 3 (14.3) 28 (96.6) 1 (3.4) 2.649 .266 Rey cutoff 9 22 (91.7) 2 (8.3) 11 (52.4) 10 (47.6) 26 (89.7) 3 (10.3)  13.603 .001 Dot Counting combo 18 (75) 6 (25) 12 (60) 8 (40) 26 (92.9) 2 (7.1) 7.448 .024 TOMM 2 cutoff 45 18 (90) 2 (10) 12 (66.7) 6 (33.3)  27 (93.1) 2 (6.9)  6.658 .036

Discussion Comparison of countries of origin and sex- no differences were found Age and education were showed statistical significance ANOVAs were completed with the standardized residuals to determine differences between groups on effort tests

Discussion The 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

Discussion Most interesting: the difference between the Capital Murder group and the Other Forensic group

Limitations and Future Research Design of the study Sample used Lack of comparison of control group for years spent within the United States. Known-groups design Extension of this research with larger samples within the United States Including other tests of effort Investigation of the correlation/relationship between the type of litigation individuals are involved in and testing effort 1. Did not have clinical group for comparison which could prove to be useful.

Summary & Questions These 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