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 StatesBurton, 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 ethnicityThe neuropsychological literature is relatively sparse and almost no information exists (outside of our work) on testing effort of Spanish speakers
3 BackgroundOver the past two decades there has been a growth in the quantity of research regarding culture and psychology , less so in neuropsychologyMuch of what relates to neuropsychology is limited in cross-cultural and linguistic assessments such as test translations
4 Background continuedA 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 ResearchDetection 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 manualsWhat 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 SpainThis 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 SpainIt was determined that the TOMM is an acceptable sensitive toolThe Dot Counting Test was also determined as adequate, however, less sensitive for this population
9 Study Description: Differential prevalence design Community, clinical and forensic populationsResiding 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: ParticipantsParticipants 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= 41.61Mean years of education= 9.50Not involved in litigationN=28Mean age= 29.79Mean years of education= 7.71Involved in criminal cases: capital murder
12 Participants: continued Other Forensic GroupN=25Mean age= 36.56Mean years of education= 6.68Involved 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 SpanishSigned informed consentDemographics collectedTests administered (counterbalanced)
15 Procedure Data collected from the private practice: Demographic information was collectedTwo out of the three SVTs required for inclusionClassified as Capital Murder Group or Other Forensic GroupDescribe why clinical group was not used for the analysis, Approximately 20% of individuals approached declined participation.
16 ResultsDescriptive statistics of the participants regarding nationalityMexicanN=54OtherN= 26t/2pAge; Mean (SD)35.94 (10.67)35.62 (11.43).126.900Education; Mean (SD)7.83 (3.72)8.00 (4.75)-.171.865Gender (males/females)33/2120/61.962.161Rey; Mean (SD)11.57 (3.80)11.81 (3.54)-.249.804Dot Counting; Mean (SD)14.68 (6.91)14.31 (3.79).249TOMM 1; Mean (SD)43.65 (6.36)45.68 (6.61)-1.201.234TOMM 2; Mean (SD)47.28 (5.12)47.68 (5.78)-.287.775
17 ResultsDescriptives for the capital murder, other forensic and clinical control groupsCapital Murder Other ForensicClinical ControlsF/2pAge; Mean(SD)29.79 (7.75)36.56 (10.18)41.61 (11.11)10.315.000Education; Mean (SD)7.71 (4.52)6.68 (3.97)9.50 (3.65)3.285.043Gender (males/females)25/323/27/2237.495
18 ResultsANOVAs for the capital murder, other forensic and control groups on the effort testsNote: 1=Capital murder group; 2=Other forensic group; 3= Control groupCapital MurderOther ForensicControlsFpBonferroniRey; Mean (SD)12.80 (3.30)7.33 (2.69)12.61 (2.87)9.255.0002<(1=3)Dot Counting; Mean (SD)14.03 (4.32)14.44 (4.39)13.81 (5.98).565.571NATOMM 1; Mean (SD)47.47 (5.24)38.11 (6.94)45.04 (22.93)7.202.0022<1TOMM 2; Mean (SD)49.33 (1.59)43.56 (7.84)48.89 (2.22)3.472.037
19 ResultsClassification for the capital murder, other forensic and clinical control groupsaccording to the effort testsCapital MurderOther ForensicControls2pPassFailRey cutoff 6N (%)23 (95.8)1 (4.2)18 (85.7)3 (14.3)28 (96.6)1 (3.4)2.649.266Rey cutoff 922 (91.7)2 (8.3)11 (52.4)10 (47.6)26 (89.7)3 (10.3) 13.603.001Dot Counting combo18 (75)6 (25)12 (60)8 (40)26 (92.9)2 (7.1)7.448.024TOMM 2 cutoff 4518 (90)2 (10)12 (66.7)6 (33.3) 27 (93.1)2 (6.9) 6.658.036
20 DiscussionComparison of countries of origin and sex- no differences were foundAge and education were showed statistical significanceANOVAs were completed with the standardized residuals to determine differences between groups on effort tests
21 DiscussionThe Capital Murder group (CM) performed similarly to the Clinical Control group (CC) on both the Rey 15-Item Test and the Test of Memory MalingeringThe Other Forensic group (OF) tested with the least amount of effort on R-FIT and TOMMThe Dot Counting Test proved to show no significant differences for any of the groups
22 DiscussionMost interesting: the difference between the Capital Murder group and the Other Forensic group
23 Limitations and Future Research Design of the studySample usedLack of comparison of control group for years spent within the United States.Known-groups designExtension of this research with larger samples within the United StatesIncluding other tests of effortInvestigation of the correlation/relationship between the type of litigation individuals are involved in and testing effort1. Did not have clinical group for comparison which could prove to be useful.
24 Summary & QuestionsThese tests appear to be sufficient in addressing effort testing in Spanish speakersImportant 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 unknownFurther studies, with replication and extension are needed for specificity and sensitivity to be determinedAt that point a better understanding of the value and limits of these tests will then be achieved