1. 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.

2. 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

3. 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

4. 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…

5. 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

6. 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?

7. 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

8. 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

9. 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.

10. 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.

11. 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

12. 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

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

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

15. 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.

16. 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

17. 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

18. 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

19. 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

20. 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

21. 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

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

23. 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.

24. 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