week two

Color Trails Test: Normative Data and Criterion Validity for the Greek Adult Population

The authors developed normative data for the Greek adult population on the Color Trails Test (CTT) and examined the criterion validity of the CTT in discriminating between healthy controls and two clinical groups (Parkinson's disease and acute stroke patients).

- Increased age and lower educational level are strongly associated with slower completion times on both parts of the Color Trails Test. - Patients with Parkinson's disease and recent stroke patients performed significantly worse on the Color Trails Test compared to healthy controls. - The Greek Trail Making Test and the Color Trails Test showed strong positive correlations, indicating they measure corresponding cognitive abilities.

Lecture

Australia ius the argest cultrally diverse population in the world that is mostlty english speeking,

Mandarin is the biggest non-english langauge

Acculturation: assimilation to a different culture, typically the dominant one. • the process of acculturation may impact both social and psychological well-being • Traditional (adheres completely to beliefs, values, and behaviours of his/her country of origin); • Bicultural (has a mix of new and old beliefs, values, and behaviours); • Acculturated (has modified his/her old beliefs, values, and behaviours in an attempt to adjust) • Assimilated (has completely given up old beliefs, values and behaviours and adopted those of the new country)

Culture Shapes The Way We Think • Societal values sculpt one’s point of view and guide behaviours • Cultural activities, such as the use of language, influence our learning processes, affecting our ability to collect different kinds of data, make connections between them, and infer a desirable mode of behaviour • Over time, thinking and behaviours change to accommodate learning required by cultural norms • The effect of culture on cognitive evolution is expressed through modifications of learning through experience and support learning new processes • Our ‘cultural norms’ are dictated by what we normalise and are exposed to by way of: • Political influences & social policy • Media & pop culture • Significant events (war)

Language & Communication (Verbal & Non-Verbal) • Verbal Communication • Language is used daily in order to communicate, negotiate, learn, and argue • Differs between cultures significantly (tone, expression) • Words maybe not exist in some cultures that are commonly found in others • Non-Verbal Communication • Touch (hand shake, kiss on cheeks vs bowing) • Gestures (non-verbal OK differs across cultures) • Physical space (keeping distance vs being close) • Gender norms

Politics • Political Influence on Cultural & Societal Views (internal & external) • Provide us with a sense of belonging and help us define cultural fabric • Democratic, Communist, Dictatorship • Paint views of other nations (culture, religion, ethnicity) • USA & Iraq / Afghanistan • US and other media outlets paint America as liberators, while Iraq and other Middle Eastern nations painted as oppressive • North Korea (DPRK) vs South Korea • NK very unique example of communist dictatorship ‘frozen in time’: • Citizens have limited (no) access to material from other cultures (TV, clothing, cars, news) • Travel restrictions (no contact with SK or other parts of the world) • Subjected to propaganda from very early age limits critical thinking

Education • Style & Quality of Education • Western focus on critical thinking, problem-solving skills, and generating new ideas • Eastern focus on reading, memorising, describing and explaining • Education and experience with testing environments reinforces the way that we learn, how we perform on tests, and think about the world around us

Clinical Psychology & Clinical Neuropsychology Clinical Psychology • Understanding the broad expanse of mental health issues • Knowledge of mental illness and how to diagnose and treat • Psychological tests in order to assess your problem and be more effective in understanding and treating patients • Talk based therapy Clinical Neuropsychology • Assess and treat people with brain disorders that affect memory, learning, attention, language, reading, problem-solving and decision-making • Understand brain structure, function and dysfunction, and the effects on cognitive and behavioural • Use of psychometric tests to determine abnormal brain function • Dementia, Traumatic Brain Injury

Psychological & Psychometric Assessment Psychologists working in clinical setting use a range of methods and sources of information to arrive at a diagnosis, include: Clinical Interviewing • Developmental History • Psychological History • Medical History • Substance Use Psychometric Testing • General Intelligence (IQ) • Memory Assessment • Achievement Scale (reading, spelling) • Personality Scale

Clinical Psychological Diagnoses & CALD Groups • Care must be taken when applying diagnostic labels to CALD groups • DSM constructed for use within Western populations • Some diagnoses may not translate across cultures • Leading to misdiagnosis • Research in Australian CALD groups is not sufficient • DMS criteria to be used with caution, or not at all • Labels Stick

Psychological Diagnoses & CALD Groups • Keep what you know about mental illness in mind but ensure that you try to understand cultural understanding of problems. • People from different cultures often have different views on what constitutes mental illness. • The DSM-5 makes it clear that diagnoses can only be made if the person’s behaviour is abnormal within culture. While there are similarities in the forms of illnesses across different cultures, the specific symptoms and signs vary for different societies. • For example, a individual in Australia with psychosis may talk of aliens controlling his thoughts, while an individual from Fiji might blame magics. • It is also not uncommon for people from some cultures (particularly South- East Asian countries) to express psychological distress purely through somatic (physical) symptoms.

Commonly Used Psychometric Tests • The most commonly used psychometric tests in English speaking counties and Europe: • Weschler Scale of Adult Intelligence (WAIS) • Pre-school, Child, Adult • Weschler Memory Scale (WMS) • California Verbal Learning Test • Minnesota Multiphasic Personality Inventory (MMPI) • Millon Clinical Multiaxial Inventory (MCMI) • Test have excellent psychometric properties and wide range of norms for specific groups • Very reliable estimates of cognitive function and personality assessment in Western groups

Tests and Normative Data • Normative data is data from a reference population that establishes a baseline distribution for a score or measurement, and against which the score or measurement can be compared. • Normative data is typically obtained from a large, randomly selected representative sample from the wider population. Calculations of scores include: • Age, Gender, Level of Education, Race, Ethnicity • Tests of intelligence/memory are broken up according to age groups (gender, education, and race also considered in this scored) for reference groups • At present, norms do not exist for a range of commonly used psychometric tests for Australian CALD groups, which limits their clinical use • Average level of education is high in most test norms

Characteristic of Australian CALD Groups • Non-English speaking groups that may perform poorly on Western psychometric tests: • Varying levels and quality of education • Generally, older female CLAD tend to have lower levels of formal education and literacy • Gender norms were different 50-60 years prior • Need to examine cultural landscape of country of origin & opportunity for education (particularly elderly CALD): • European Civil Wars • WW-II (1939–1945) • Chinese Cultural Revolution • Middle Eastern refugees (wars) • African refugees (war)

Wechsler Adult Intelligence Scale • WAIS-IV, which was released in 2008, is composed of 10 core subtests and five supplemental subtests, with the 10 core subtests yielding scaled scores that sum to derive the Full Scale IQ. • WAIS-IV was standardized on a sample of 2,200 people in the United States ranging in age from 16 to 90

Impact of Culture on Testing • Are current measures appropriate for use within Australia’s CALD community? • While research in limited in Australia, studies from the US have indicated that when assessing minority groups using existing measures and norms: • Groups with low levels of education are 2-3 times more likely to be misclassified/misdiagnosed using the WAIS & WMS (Manley et al., 1998) • Greek Australians (GA) vs. Greek Nationals (GN) (Pliats et al., 2009) • GA performed significantly lower compared to GN counterparts on both the CAMCOG and the MMSE (screening measures) • If the original cut-off score were applied to GA participants, 66–72% of GA would be classified as demented

Impact of Culture on Testing Across English Speaking Nations • CVLT: measure of verbal learning and memory, which demonstrates sensitivity to a range of clinical conditions • encoding, recall and recognition • four semantic categories: tools, fruits, clothing, spices and herbs • 16 words, in fixed order, over five learning trials • Barker-Collo and colleagues (2002): US CVLT vs. New Zealand content • 90 healthy individuals aged 17 to 81 years of age • New Zealanders performed significantly poorer on US version compared to culturally relevant NZ version, despite both versions of the task were in English • Within-subject comparisons revealed significantly better performances on the NZ version for short-delay recall, long-delay recall, and recognition trials

Attempts to Establish Data in CALD Australians • Wallace and colleagues (2018) set out to establish norms for a brief neuropsychological test battery in a sample of 145 Chinese Australian older migrants aged 55 to 87 years • Seven commonly used tests (memory, speed of processing, abstract reasoning) • Only two tests held up and were thought be clinically reliable • Methodological Issues • Chinese culture defined poorly within group (China, Hong Kong, Macau, Taiwan, Vietnam) • Quality of education plays big part in tests development and sample selection • Psychometric testing is a Western concept and many psychometric tests are academically focussed. Educated people have a significant advantage • Tests may not be tapping into what they have learned while at school • Develop new culturally appropriate tests, instead of re-norming Western tests

Naming Tests & Item Bias • Items in a test perform differently in different groups • Whilst the overall construct might be measured by the test, the specific items do not perform the same between cultures • Particularly relevant to picture naming tests (e.g. Boston Naming Test), but also with verbal items in word lists, story recall.

Ecological Validity & Cross-cultural Assessment

Exposure to ecological factors (e.g., natural environment, mass media, technology) shape cognitive process and impacts upon test-taking behaviours • Kimberley Indigenous Cognitive Assessment (KICA; LoGiudice et al., 2006) • Items contained reflect ecological material commonly observed within this Indigenous community (i.e., boomerang, emu). • Dementia previously difficult to assess and monitor within Indigenous Australians due to the lack of a validated cognitive instrument. • 45 years and older living in rural and remote areas • Kimberley Indigenous Cognitive Assessment (KICA) Regional Urban • modification of the original KICA for regional and urban Indigenous communities • cognitive questionnaire and picture component of the screening tool have been adapted

Implications • Copying of both two- and three-dimensional geometric designs among healthy low educated samples can be normal. • Many of the errors committed were related to poor planning and execution of fine motor skills. • Consequently, the interpretation of visuoconstructional test performances in individuals with low levels of education warrants caution, as they can easily be misinterpreted as signs of cognitive impairment. • Low scores on neuropsychological tests in low educated samples can be due to differences in learning opportunities of those abilities tested, in this particular case drawing skills.

Implications • Individuals who are inexperienced with using a pen or pencil tend to hold the instrument in an cumbersome manner and have trouble drawing straight lines towards intended directions. • Many participants were unable to interpret figures represented on a piece of paper in three dimensions, such as the Necker cube. • For individuals without knowledge of geometry, these figures may appear to be a meaningless juxtaposition of line segments of two-dimensional shapes (Teng, 2002). • Low scores may be due to the fact that the sample are not test-wise and may not know how to behave in a test situation (Ardila et al., 2010).