Integrating Culturally Informed Qualitative Data in Neuropsychological Evaluations of Non-Native English Speakers

Objective: As the U.S. public challenges leaders to confront the racial injustices and ethnic disparities deeply rooted within American culture, neuropsychology as a field must engage in thoughtful self-reflection. Although progress has been made in reducing the impact of neuropsychology's White- and Euro-centric origins, vestiges of this bias remain, especially in evaluations of those who speak English as a second language (ESL). Of particular concern are the lack of a broad consensus for collecting datapoints relevant to ESL individuals through the use of existing acculturation measures, and insufficient acknowledgment that culture impacts performance on verbal and non-verbal measures. Method: This review provides: (a) a timely re-visit of the historical context of evaluating cultural and linguistic minorities, including a re-examination of the ethnocentric rationale underlying the origins of commonly used instruments; (b) a summary of potential confounds in evaluating non-native English speakers, many of which are not artifacts of language per se; and (c) a discussion about reaching a consensus for using acculturation measures to improve the quality of evaluations and future research. Results: Neuropsychological evaluations for non-native English speakers could be improved by developing an agreed-upon set of questions capturing the most pertinent acculturation information and using that information judiciously to inform test-related decision making. Conclusions: Accumulating more standardized data from acculturation measures can inform policy and best practices, improving the overall quality of neuropsychological evaluations. This review also underscores the need to take a critical eye to stimuli across instruments in order to reduce bias and promote cultural inclusivity.