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)
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.
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
Control Group (CG)
Capital Murder Group
(CM)
 N=29
 N=28
 Mean age= 41.61
 Mean age= 29.79
 Mean years of education=
 Mean years of education= 7.71
9.50
 Not involved in litigation
 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
Results
Descriptive statistics of the participants regarding nationality
Mexican
Age; Mean (SD)
Education;
Other
t/2
p
N=54
N= 26
35.94 (10.67)
35.62 (11.43)
.126
.900
7.83 (3.72)
8.00 (4.75)
-.171
.865
33/21
20/6
1.962
.161
11.57 (3.80)
11.81 (3.54)
-.249
.804
14.68 (6.91)
14.31 (3.79)
.249
.804
43.65 (6.36)
45.68 (6.61)
-1.201
.234
47.28 (5.12)
47.68 (5.78)
-.287
.775
Mean
(SD)
Gender
(males/females)
Rey; Mean (SD)
Dot Counting; Mean
(SD)
TOMM 1; Mean (SD)
TOMM 2; Mean (SD)
Results
Descriptives for the capital murder, other forensic and clinical control groups
Capital
Other
Clinical
F/2
p
Murder
Forensic
Controls
29.79 (7.75)
36.56 (10.18)
41.61 (11.11)
10.315
.000
7.71 (4.52)
6.68 (3.97)
9.50 (3.65)
3.285
.043
25/3
23/2
7/22
37.495
.000
Age;
Mean(SD)
Education;
Mean (SD)
Gender
(males/females)
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
Rey; Mean (SD)
Capital
Murder
Other
Forensic
Controls
F
p
Bonferroni
12.80 (3.30)
7.33 (2.69)
12.61 (2.87)
9.255
.000
2<(1=3)
14.44 (4.39)
13.81 (5.98)
.565
.571
NA
38.11 (6.94)
45.04 (22.93)
7.202
.002
2<1
43.56 (7.84)
48.89 (2.22)
3.472
.037
2<1
Dot Counting; Mean
14.03 (4.32)
(SD)
TOMM 1; Mean (SD)
47.47 (5.24)
TOMM 2; Mean (SD)
49.33 (1.59)
Results
Classification for the capital murder, other forensic and clinical control groups
according to the effort tests
Rey
cutoff 6
N (%)
Rey
cutoff 9
N (%)
Dot
Countin
g combo
N (%)
TOMM 2
cutoff 45
N (%)
Capital Murder
Pass
Fail
Other Forensic
Pass
Fail
Controls
Pass
23 (95.8) 1 (4.2)
18 (85.7) 3 (14.3)
28
(96.6)
22 (91.7) 2 (8.3)
11 (52.4)
10 (47.6)
18 (75)
6 (25)
12 (60)
8 (40)
18 (90)
2 (10)
12 (66.7) 6 (33.3)
2
p
1 (3.4)
2.649
.266
26
(89.7)
3 (10.3)
13.603
.001
26
(92.9)
2 (7.1)
7.448
.024
27 (93.1) 2 (6.9)
6.658
.036
Fail
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 15Item 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
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
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(2011, August). Tests of effort in normative, clinical