Antonio E. Puente, Ph.D.
(with assistance of Carlos Ojeda)
University of North Carolina Wilmington
American Psychological Association
08.06.11, Washington, DC

60,000,000
50,000,000
40,000,000
30,000,000
20,000,000
10,000,000
0
Source: U.S. Census Bureau, 2008
2009
2050
2

3

4

5

6

Source: US Census, 2008


A total of 1,199,239 citations for
PSYCHOLOGY

A total of 11,019 citations using either the word HISPANIC OR SPANISH

Approximately .01%
(source: PsycBooks & PsycInfo, 07.11)

CATEGORY TOTAL #
PSYCHOLOGICAL
ASSESSMENT
13,674
PSYCHOLOGICAL
TESTING
34,221
TOTALS 47,895
SPANISH
203
862
1065
HISPANIC
87
242
329
(combined=.03%)

CATEGORY TOTAL #
PSYCHOLOGICAL
ASSESSMENT
14,566
PSYCHOLOGICAL
TESTING
1,992
TOTALS 16,558
SPANISH
227
12
238
HISPANIC
106
12
118
(combined=.02%)


Camara, Nathan, and Puente (2000) surveyed test usage.

Five most frequently used tests were: MMPI
(I&II), WAIS R, WMS-R, WISC-R-III, TMT.

None of them were in Spanish.

Consistent in other studies like Rabin et al
(2005).


Validity = Fairness.

Validity is defined: “the degree to which evidence and theory support the interpretations of tests scores entailed by proposed uses of tests” (AERA, 1999; p.9).

Fundamental question of validity:
Are psychological tests available unfair?


Testing standards have been developed by a joint committee for the last 50 years.

The Joint Committee was formed to oversee the accuracy with Standardized testing in the
U.S.


It is important to consider language background when developing, selecting, administering, and interpreting test performances
(AERA, 1999; p. 91).

According to the Standards, tests for Spanish speakers individuals should meet the following criteria:




Test in Spanish
Hispanic norms (US)
Non-US Hispanic norms
Instructions and manuals in Spanish


Approximately 83% of neuropsychologists felt inadequately prepared to work with Hispanic individuals
(Echemendia et al., 1997).

Salazar, Perez-Garcia, Puente (2007) listed 60 Spanish test.

Hispanic Neuropsychological Society includes over 170 tests (in progress).

Judd et al (2009) published recommendations when evaluating Hispanics. (NAN)


What tests are available in Spanish to assess
Spanish speakers? (Phase 1)

What tests in Spanish are neuropsychologists who are members of the HNS using to evaluate Spanish speakers? (Phase 2)

Do these tests meet the testing standards criteria ? (Phase 3)

◦ Obtained UNCW IRB Approval.
◦ Developed comprehensive list of Spanish tests by reviewing the following:
 Prior literature ( Camara et al., 2000; Salazar et al.
2007; etc.)
 Buros Mental Measurement Yearbook (Website &
Online Database).
 Hispanic Neuropsychological Society Test Database
 Psych Info & World Cat.
 Spanish Test Publishers (TEA & Manual Moderno)


After searches, tests in the list were recorded and organized in alphabetical order.

Acronym and test edition was included next to Spanish test if available.


After completing the list of tests, an online survey was conducted to assess usage.

Created using Survey Monkey

IRB approval and HNS BoD approval were obtained.


Pilot testing was conducted.

Data collection started December 15 th 2009 and ended on March 4 th 2010.

A total of three reminders were sent.


Included electronic informed consent & nine demographic questions.

Participants endorsed whether they did or did not use the test listed.

Survey was sent to participants’ e-mails and only one response was allowed for each e-mail address registered.


56 participants out of 83 HNS members (67%) participated in the study.

Participants received contact emails for faculty supervisor and student investigator if they had questions and concerns.

Participation was voluntary and their responses were confidential.


Survey were results were matched to the criteria of the Standards. One point was given if the following criteria were met.
◦ Test in Spanish?
◦ Hispanic Norms (U.S.)?
◦ Non U.S. Hispanic Norms?
◦ Test Manual in Spanish (including instructions)?

Each test was rated using a rating scale of:
0(not at all) to 4(all)


Found 555 tests in Spanish out of a total of approximately 3,500 tests .

These are both psychological and neuropsychological tests.

Gender
Male 22 40.7%
Female 32 59.3%
Race/Ethnicity
Caucasian/White 14 25.0%
Hispanic/Latino 42 75.0%
Degree
Ph.D. 34 61.8%
Psy.D. 14 25.5%
Other 7 12.7%
Board Certified
No 46 82.1%
Yes 10 17.9%
Use Technicians/Translators
Certified Translators 6 10.9%
Uncertified Technicians 6 10.9%
Uncertified Translators 1 1.8%
None of the Above 44 80.0%


Primary Work Setting
Hospital 15 27.3%
Outpatient Clinic 9 16.4%
Private Practice 23 41.8%
University 8 14.5%
Level Spanish Proficiency
No Proficiency 2 3.6%
Limited Proficiency 1 1.8%
Some Proficiency 4 7.1%
Extensive Proficiency 49 87.5%
Cultural Context Knowledge
Limited Knowledge 1 1.8%
Some Knowledge 8 14.3%
Extensive Knowledge 47 83.9%
Spanish Speaking Clients
Less than 25% 15 26.8%
More than 25% 15 26.8%
More than 50% 10 17.9%
More than 75% 8 14.3%
100% 8 14.3%


A total of 56 (67%) HNS members participated.

Participants reported using 216 (39%) tests.

Approximately 25 tests that were used for most of the participants.

There were 69 tests used by only one participant .

Rank Order
1
2
3
4
5
6
6
7
8
9
Test Name
Trail Making Test
Beck Depression Inventory (BDI-II)
Boston Naming Test
Test of Memory Malingering (TOMM)
Beck Anxiety Inventory (BAI)
Inventario Multifásico de Personalidad de
Minnesota-2 (MMPI 2)
Stroop Test de Colores y Palabras
Bateria III Woodcock Muñoz (BATERIA III)
Vineland Adaptive Behavior Scales
Color Trails Test (CLT)
28
27
26
35 n
33
29
26
24
23
22
%
76.1%
71.7%
63.0%
60.9%
58.7%
56.5%
56.5%
52.2%
50.0%
47.8%

Rank Order
9
9
10
10
11
12
13
Test Name
Escala de Inteligencia de Wechsler para
Adultos III (EIWA III)
Raven Matrices Progresivas (RAVEN) n
22
%
47.8%
Escala Wechsler de Inteligencia para Niños IV
(WISC IV).
Evaluación Neuropsicológica Breve en
Español (NEUROPSI)
22 47.8%
21
21
45.7%
45.7%
Wechsler Adult Intelligence Scale Third
Edition (WAIS III)
20 43.5%
Wechsler Memory Scale 3rd Edition (WMS III) 19 41.3%
California Verbal Learning Test (CVLT) 18 39.1%

Rank Order
13
13
14
15
15
16
17
17
Test Name
Examen Cognoscitivo Mini-Mental
(MMSE)
Test de Copia de una Figura Compleja de
Rey
Escala de Inteligencia Wechsler para
Adultos (EIWA)
Test de Vocabulario en Imagenes
Peabody
Test de Clasificación de Tarjetas de
Wisconsin (WCST)
Bateria Woodcock Muñoz
Adaptive Behavior Assessment System
(ABAS-II)
Prueba Beery Buktenica del Desarrollo de la Integración Visomotriz (VMI) n
18
18
17
16
16
15
14
14
%
39.1%
39.1%
37.0%
34.8%
34.8%
32.6%
30.4%
30.4%


Of the top 25 most frequently used tests, almost none meet the criteria of the
Standards for testing Spanish speakers.

Test Name
1) Trail MakingTest
Number of
Times Test
Selected
Test in Spanish
35 0 (No)
2) Beck Depression
Inventory II (BDI-II)
33 1 (Yes)
Hispanic
Norms
(U.S.)
0 (No)
0 (No)
Hispanic Norms
(Non-U.S.)
Test Manual
Spanish
0 (No)
1 (Yes) (MX)
(SP)
0 (No)
1(Yes)
29 1 (Yes) 0 (No) 1 (Yes) 0 (No) 3) Boston Naming
Test
4) Test of Memory
Malingering
(TOMM)
28 1 (Yes) 0 (No) 1 (Yes) 0 )No)
5) Beck Anxiety
Inventory (BAI)
27 1 (Yes) 0 (No) 0 (No) 1 (Yes)
Total
0
3
2
2
2

Test Name Number of
Times Test
Selected
26
Test Name in
Spanish
Hispanic
Norms
(U.S.)
1 (Yes) 6) Inventario
Multifásico de
Personalid. de
Minnesota-2
(MMPI 2)
1 (Yes)
7 ) Stroop Test de Colores y
Palabras
8)Bateria III
Woodcock
Muñoz (Bateria
III)
26
24
1 (Yes)
1 (Yes)
0 (No)
1 ( Yes)
9) Vineland
Adaptive
Behavior Scales
23 0 (No) 0 (No)
Color Trails Test 22 1 (Yes)
(CLT)
1 (Yes)
Hispanic Norms
(Non-U.S.)
Test Manual
Spanish
1 (Yes) 1 (Yes)
1 (Yes)
1 (Yes)
0 (No)
1 (Yes)
1 (Yes)
1 (Yes)
0 (No)
1 (Yes)
TOTAL
4
3
4
0
4

Test Name
11) Escala de
Inteligencia Wechsler para Adultos III (EIWA
III)
Number of
Times Test
Selected
22
Test Name in
Spanish
1 (Yes)
22 1 (Yes) 12) Raven Matrices
Progresivas (RAVEN)
13) Escala Wechsler de
Inteligencia para Niños
IV (WISC IV)
14) Evaluación Breve
Neuropsicologica
(NEUROPSI)
15) Wechsler Adult
Inteligence Scale Third
Edition (WAIS III)
21
21
20
1 (Yes)
1 (Yes)
1 (Yes)
Hispanic
Norms
(U.S.)
1 (Yes)
Hispanic Norms
(Non-U.S.)
1 (Yes)
Test Manual
Spanish
1 (Yes)
TOTAL
4
0 (No)
1 (Yes)
0 (No)
0 (No)
1 (Yes)
1 (Yes)
1 (Yes)
1 (Yes)
1 (Yes)
1 (Yes)
1 (Yes)
1 (Yes)
3
4
3
3

Test Name
16) Wechsler Memory
Scale 3rd Edition
(WMS III).
Number of
Times Test
Selected
19
Test Name in
Spanish
1 (Yes)
Hispanic
Norms
(U.S.)
1 (No)
Hispanic Norms
(Non-U.S.)
1 (Yes)
Test Manual
Spanish
1 (Yes)
TOTAL
3
17) California Verbal
Learning Test (CVLT)
18) Examen
Cognoscitivo Mini-
Mental (MMSE)
19) Test de Copia de una Figura Compleja de Rey
20) Escala de
Inteligencia Wechsler para Adultos (EIWA)
18
18
18
17
0 (No)
1 (Yes)
1 (Yes)
1 (Yes)
0 (No)
1 (Yes)
0 (No)
0 (No)
1 (Yes)
1 (Yes)
1 (Yes)
1 (Yes)
0 (No)
1 (Yes)
1 (Yes)
1 (Yes)
1
4
3
3

Test Name
21) Test de Vocabulario en Imagenes Peabody
Number of Times
Test
Selected
16
Test Name in
Spanish
1 (Yes)
Hispanic
Norms
(U.S.)
1 (Yes)
Hispanic Norms
(Non-U.S.)
Test Manual
Spanish
TOTAL
1 (Yes) 1 (Yes) 4
22) Test de Clasificacion de Tarjetas de Wisconsin
(WCST)
23)Bateria Woodcock
Muñoz
16
15
24) Adaptive Behavior
Assessment System
(ABAS-II)
25)Prueba Beery
Buktenica del Desarrollo de la Integracion
Visomotriz (VMI)
14
14
1(Yes)
1 (Yes)
1 (Yes)
1 (Yes)
0 (No)
1 (Yes)
0 (No)
1 (Yes)
0(No)
0 (No)
0 (No)
0 (No)
0 (No)
1 (Yes)
0 (No)
1 (Yes)
1
3
1
3


Few tests available in Spanish (555 out of
3,500)

Fewer tests being used (216).

Approximately 25-40 tests that are used frequently, a few are infrequently used and most tests are never used.

Most of the tests available do not meet the criteria of the testing Standards.


The number of Spanish tests found in our list exceeds previous reports from Camera et al.
(2000); Salazar et al. (2007); Lazarus and
Puente (2009); HNS (in press); & Renteria
(2010).

However, the number of tests represent only
16% of the 3,500 tests in Buros.


Participants use 216 (39%) of 555 tests.

Only TMT is consistent with the top five most frequently used tests. (Camara et al., 2000;
Rabin et al. 2005; Lazarus & Puente, 2009).

Differences in tests usage might be due to differences in availability of tests (ENG >SPA).


Most, if not all, of the tests met criteria of the Standards.

Lack of norms were common.

Test manual in Spanish for 17 out of 25 tests….etc.

If the Standards are not followed, such assessments are considered potentially invalid and their use potentially unethical (Vilar-Lopez & Puente, 2010).





Translators
Translations
Norms
Expertise




Typical
◦ Family
◦ Non-psychological staff member
“Qualified”
◦ Certified translators and psychological knowledge
Problems
◦ Significant error (both false positives and negatives)




Problems
◦ Linguistic equivalence
◦ Cultural equivalence
Customized Translations
◦ Translate as you go
Official Translations
◦ Approaches
 Back translation
 Translation check by experts
◦ The case of the Spanish WAIS III




Sample
◦ Samples of convenience
◦ Rural Vs. City dwellers (community?)
◦ Country of Origin
◦ Parental Origin & Educational Attainment
◦ Language spoken at home/school
◦ Socio-economic status
Statistical Manipulation
◦ Community Vs. Statistical Goals
Case of the Spanish WAIS III





Personnel
◦ Using neuropsychology as an example, 01%
Linguistic
◦ Literal Vs. Cognitive Equivalence
Cultural
◦ Bi-cultural?
Country of Origin
◦ Bure, et al (unpublished)






There are increasing and large number of
Spanish speakers
There are relatively few tests.
Of those few tests, very few are being regularly used.
Those being used do not appear to meet the
Standards criteria.
Serious ethical challenges face as demographics, science and practice do not match