The Journal of the International Neuropsychological Society (2004), 10, 566-577 has published an outstanding article entitled African American Acculturation and Neuropsychological Test Performance Following Traumatic Brain Injury (Abstract). As outlined in the abstract, the study reported examined the influence of African American Acculturation on the performance of neuropsychological tests following traumatic brain injury. As defined in the study, “The concept of acculturation emerged as an important and practical concept in the study of cultural factors in pluralistic societies, and occurs when two or more groups come into continuous first-hand contact with each other for an extended period of time” (Berry, 1989). “Level of acculturation has been defined as the degree to which an individual espouses the cultural values, beliefs and practices of a given ethnic group versus that of the dominant ethnic/cultural group (Landrine & Klonoff, 1995).”
The study reviewed past studies that have investigated cultural bias and neuropsychological testing. Summarizing various studies, the article reported that several studies with medically healthy individuals has indicated that minorities in the United States are considered cognitively impaired at a much higher rate than European Americans even when one controlled other variables such as years of education and socioeconomic status. Noting that there has been increased demand for the development of more appropriate normative data for use with African Americans, this study’s goal was to specifically assess the influence of acculturation on neuropsychological test performance in a sample of individuals who had sustained a traumatic brain injury. Id at 568. As noted, it was “generally hypothesized that individuals who espouse more traditional African American cultural values and beliefs (lower level acculturation) would obtain lower scores on many of the neuropsychological tests administered. “Cultural factors were also expected to predict test performance above and beyond what might be anticipated from other demographic factors such as AIDS, sex, education and socioeconomic status.” It was also hypothesized that acculturation effects would be more likely found on test assessing language-related skills and/or complex cognitive abilities such as problem solving and reasoning. Finally, the researchers wanted to ascertain whether examiner ethnicity would effect test performance among participants.
The study consisted of seventy-one participants who were already involved in the southeastern Michigan traumatic brain injury system’s project at the time of their recruitment. Participants were recruited for the current study at approximately one, two, five or ten years post injury. The study involved fifty-eight males and thirteen women. Thirty-two percent of the sample was employed at least part time (only nine were employed at the time of the post-injury assessment.) The vast majority of the sample were in the lowest two social strata.
Thirty-three members sustained traumatic brain injury as a result of an assault while forty-one percent were involved in some type of motor vehicle accident either as an occupant of a motor vehicle or as a pedestrian.
Each participants level of acculturation was assessed using the African American Acculturation Scale-short form. Forty of the participants were tested by a black examiner while the remaining thirty-one by a white examiner.
The study’s finding suggested a significant association between level of African American Acculturation and neuropsychological test performance even after controlling for other potentially confounding variables such as injury severity, time since injury, age, sex, years of formal education, and socioeconomic status. The results appear to “provide additional support for the cultural hypothesis of group differences on cognitive/neuropsychological tests.” Scores on a test assessing receptive language (Tokens test) demonstrated significant and unique acculturation effect, a finding consistent with previous findings linking African American acculturation with language-related measures such as the Boston naming test.
However, the hypothesis that executive functioning measures which specifically be associated with cultural factors was generally not born out by the study. Id at 573.
Some of the results suggested the ethnicity of the examiner might also have an affect on certain test scores when assessing African Americans. It is important to note according to the study, “It is important to note that these findings were limited to specific tests and were not found when evaluating the majority of neuropsychological measures or overall test performance.”
The study concluded by stating that “The findings of this study provide evidence for the importance of cultural factors in the neuropsychological assessment of African Americans following a traumatic brain injury. More generally, the clinician conducting an assessment with an African American client should be aware of the many variables of potential importance (e.g., level of acculturation, year/quality of education, SES, perceived discrimination) in order to conduct a more culturally sensitive neuropsychological evaluation. On the basis of such findings, the use of acculturation scales in a neuropsychological assessment of African Americans would certainly seem advisable. However, it is important to emphasize, given the complexity of the issues involved, that inclusion of an acculturation scale cannot be considered an adequate ‘correction’ for the influence of cultural factors within the context of a clinical neuropsychological assessment.”