Antonio E. Puente, Ph.D. University of North Carolina Wilmington University of Georgia

 Lezak’s Neuropsychological Assessment  English based Clinical neuropsychology has generalized Western culture concepts across different cultures, especially Spanish speakers residing in the US  Today, despite an increasing interest in the effects of culture on cognitive functions, understanding of the cultural impact on neuropsychology is still limited (Ardila,1996).

Examples of Cultural Discrepancy  Time is something primary and crucial in daily routine for Western societies. In contrasts, time is not as important in Hispanic countries.  As a result, individuals not familiarized with the Westernized concept of time might have inaccurate scores in timed testing. (Ardila & Moreno, 2001; Puente & Agranovich, 2004, Puente &Salazar, 1998

Examples of Cultural Inequivalency  Eight is a two syllable word in Spanish (Ocho) but one syllable in English.  The FAS Fluency Test is often used to determine verbal fluency, however, Spanish the letters F, A, S, are not used with similar frequency  Spanish speakers use different names for bus in different countries (bus, micro, microbus, guagua). (Puente & Puente, 2009)

 Hispanics are the largest ethnic minority in the U.S. and the fastest in growth (without including undocumented immigrants)  Hispanics make about 15% of the U.S. population and are expected to become the largest group by  Population: U.S. 304,059,728 Hispanics: 46,822,476 Source: U.S. Census Bureau, 2008 American Community Survey, & PEW Research Center.

6

7

8

9

HISPANIC POPULATION BY STATE: State Hispanic % Hispanic Population Population Within State __________________________________________________________ 1- California 13,434, % 2- Texas 8,815, % 3- Florida 3,846, % 4- New York 3,232, % 5- Arizona 1,964, % ____________________________________________________________ Source: U.S. Census Bureau, 2008 American Community Survey, & PEW Research Center

StateGrowth South Carolina88.1% Minnesota86.4% Nebraska84.5% Arkansas82.1% North Carolina86.4% Georgia79.7% Kentucky76.3% Iowa71.6% Nevada70.9%

Source: U.S. Census Bureau, 2008 American Community Survey, & PEW Research Center

 By Term Chicano/a? Hispanic? Latino/a?  By Race Caucasian? Negroid? Mixed (Mulatto)?  By Behavior Language Family Heritage Behaviors

 Language- Spanish  Religion- Catholic or Christian  Family  Children  Friends  Cooperation  Personalismo  Modesty  Respect & Formality  Hospitality  Enjoyment of Living

 Typical Educational Background Often Limited Usually in Spanish Many are illiterate in Spanish and English  What it Means to be “Educated” The difference between schooling and “education” The value of “educado” The limits of “education”

 College Graduate : 12.9%  Some College: 21.9%  High School Graduate: 26.0%  9 th to 12 th Grade: 15.7%  Less than 9 th grade: 23.5% Source: U.S. Census Bureau, 2008 American Community Survey

 Family Defined  Types of Families Nuclear Extended Divided Double  Types of Family Members Biological Non-biological

 Predominantly Catholic (70%)*  Importance of Religion and Related Social Support  Always Hoping for a “Milagro”  Church and Related Services in Spanish  Religion as a Code of Conduct * Pew Hispanic Center

 Educational  Medical  Legal ◦ Tax ID Numbers ◦ Social Security Numbers ◦ Driver’s Licenses  Aliases  11 million undocumented* *Pew Hispanic Center, 2009

 Variation of Spanish (e.g., Proverbs)  Spanish as a Second Language (i.e., Mayan)  Limits and Perils of Translations  Importance of Non-Verbal Communication  Difficulties With Learning English

 Less than 20, % Foreign born 46.5% Native born 41.9%  20,000 to 40, % Foreign born 42.6% Native born 39.6%  50,000 or more 14.5% Foreign born 10.9% Native born 18.5% Source: U.S. Census Bureau, 2008 American Community Survey

 Why do Spanish Speakers do More Poorly on Most Cognitive & Neuropsychological Measures?  Can You Actually Translate Tests from English into Spanish?  What about Norms? Local? Regional? Universal?  Will There be Test Publishers Interested in These Endeavors?  Will There Be Sufficient Personnel To Pursue These Questions?  What Can Do We Actually Know?

 Total number of articles in PsychInfo on Psychological Testing:  29,186 (only 239 involve Psychological Testing & Hispanics) 23

 There are relatively few tests available in Spanish  There are relatively fewer tests being used by HNS members that responded to this survey  There appears to be approximately tests that are used frequently and a larger number of tests that are used highly infrequently.  Most, if not all, of the tests available in Spanish do not meet the criteria for the Standards for Educational and Psychological Testing (1999).

 The total number of tests available in Spanish is very small and most do not meet current standards for psychological tests according the Standards for Educational and Psychological Testing.  Due to copyright, varieties of economic concerns and cultural variations, this is a very, very difficult task

 Culture affects neuropsychological assessments  Difficult to Define Hispanic  Changing Demographics  Difficult, Slow, Economically Challenging  The Question of Cognitive and Emotional Equivalence and Construct Irrelevance  Where Do We Go From Here?

Antonio E. Puente, Ph.D. Department of Psychology University of North Carolina Wilmington Wilmington, North Carolina