INS NYC 2024 Program

Poster	Poster Session 11 Program Schedule 02/17/2024 10:45 am - 12:00 pm Room: Shubert Complex (Posters 1-60) Poster Session 11: Cultural Neuropsychology \| Education/Training \| Professional Practice Issues Final Abstract #12 Neuropsychological Evaluations of Bilingual (Spanish/English) Pediatric Patients with Case Study Demy Alfonso, Children's Healthcare of Atlanta, Atlanta, United States Eva del Valle Martinez, Children's Healthcare of Atlanta, Atlanta, United States Adriana Mendez, Children's Healthcare of Atlanta, Atlanta, United States Vindia Fernandez, University of California, Los Angeles, Los Angeles, United States Donald Bearden, Children's Healthcare of Atlanta, Atlanta, United States Category: Cross Cultural Neuropsychology/ Clinical Cultural Neuroscience Keyword 1: bilingualism/multilingualism Keyword 2: cross-cultural issues Keyword 3: assessment Objective: In 2020 the U.S. public school system had ~5 million English-language learners (ELLs)¹. Over 75% of ELLs were native Spanish speakers. Recently, the neuropsychology field began considering bilingual language development in patient conceptualization based on research showing bilingual children are at increased risk of being misdiagnosed with a language disorder^2,3. To do this, it is important to use proper testing protocols for bilingual children that minimize perception-based diagnostic determinations of language and communication. Clinicians have developed practical recommendations for the assessment of Spanish/English bilingual children that include obtaining history of acculturation, language exposure and use, standardized language proficiency testing, analysis of raw and normed scores, and informal conversations with the patients⁴. Additionally, clinical limit testing of language skills allows patients to answer in both languages, even if it is outside the normed tests’ language. We present a neuropsychological case study of a bilingual (Spanish/English) pediatric patient. Participants and Methods: The patient was a 14-year-old, left-handed female with a history of juvenile myoclonic epilepsy (JME), headaches, anxiety, and depression. Her history was otherwise noncontributory. Patient is a first-generation American raised in a Spanish-speaking household and is proficient in Spanish and English. Initial information was obtained during an interview with patient and parent; they reported both languages were strong. Then, standardized language testing was conducted revealing patient’s expressive language skills were stronger in Spanish. As such, most testing and questionnaires were completed in Spanish. Academic achievement testing was completed in English consistent with academic instruction. Clinical limit testing revealed improved performance on verbal tasks when the patient was provided the opportunity to respond using both Spanish and English. Results: The patient’s evaluation performance was highly variable. Language skills were stronger in Spanish for expressive naming (7%ile vs. 1%ile) and language comprehension (27%ile vs. 16%ile). Attention, working memory, and learning/memory were average. Visuospatial skills were low average, while visuoconstructional skills and bilateral fine-motor dexterity were exceptionally low. Academic skills were within grade expectation except for weak math calculation skills. Concerns with adaptive skills and mood were endorsed. Based on this information, Response-to-Intervention programming and English to Speakers of Other Language services were recommended at school. There was also a language barrier between the family and school team, and the family was unaware of the patient’s rights as a student. As such, the examiners provided family with psychoeducation and met with the school team to advocate for services that addressed the patient’s medical needs as well as interventions with primary language support. Conclusions: Establishing structured, formalized testing for bilingual patients is essential for valid neuropsychological evaluations. While clinicians are encouraged to interpret findings in this context and make diagnostic determinations in a multidimensional manner, there is no consensus on best-practices in the field. Spanish is the second most spoken language in the U.S making it imperative that bilingual neuropsychologists be trained on proper assessment of language proficiency before conducting bilingual evaluations. This is especially important in pediatric populations where language proficiency changes rapidly across development.

Poster

02/17/2024
10:45 am - 12:00 pm
Room: Shubert Complex (Posters 1-60)

Poster Session 11: Cultural Neuropsychology | Education/Training | Professional Practice Issues

Final Abstract #12

Neuropsychological Evaluations of Bilingual (Spanish/English) Pediatric Patients with Case Study

Demy Alfonso, Children's Healthcare of Atlanta, Atlanta, United States
Eva del Valle Martinez, Children's Healthcare of Atlanta, Atlanta, United States
Adriana Mendez, Children's Healthcare of Atlanta, Atlanta, United States
Vindia Fernandez, University of California, Los Angeles, Los Angeles, United States
Donald Bearden, Children's Healthcare of Atlanta, Atlanta, United States

Category: Cross Cultural Neuropsychology/ Clinical Cultural Neuroscience

Keyword 1: bilingualism/multilingualism
Keyword 2: cross-cultural issues
Keyword 3: assessment

Objective:

In 2020 the U.S. public school system had ~5 million English-language learners (ELLs)¹. Over 75% of ELLs were native Spanish speakers. Recently, the neuropsychology field began considering bilingual language development in patient conceptualization based on research showing bilingual children are at increased risk of being misdiagnosed with a language disorder^2,3. To do this, it is important to use proper testing protocols for bilingual children that minimize perception-based diagnostic determinations of language and communication. Clinicians have developed practical recommendations for the assessment of Spanish/English bilingual children that include obtaining history of acculturation, language exposure and use, standardized language proficiency testing, analysis of raw and normed scores, and informal conversations with the patients⁴. Additionally, clinical limit testing of language skills allows patients to answer in both languages, even if it is outside the normed tests’ language. We present a neuropsychological case study of a bilingual (Spanish/English) pediatric patient.

Participants and Methods:

The patient was a 14-year-old, left-handed female with a history of juvenile myoclonic epilepsy (JME), headaches, anxiety, and depression. Her history was otherwise noncontributory. Patient is a first-generation American raised in a Spanish-speaking household and is proficient in Spanish and English. Initial information was obtained during an interview with patient and parent; they reported both languages were strong. Then, standardized language testing was conducted revealing patient’s expressive language skills were stronger in Spanish. As such, most testing and questionnaires were completed in Spanish. Academic achievement testing was completed in English consistent with academic instruction. Clinical limit testing revealed improved performance on verbal tasks when the patient was provided the opportunity to respond using both Spanish and English.

Results:

The patient’s evaluation performance was highly variable. Language skills were stronger in Spanish for expressive naming (7%ile vs. 1%ile) and language comprehension (27%ile vs. 16%ile). Attention, working memory, and learning/memory were average. Visuospatial skills were low average, while visuoconstructional skills and bilateral fine-motor dexterity were exceptionally low. Academic skills were within grade expectation except for weak math calculation skills. Concerns with adaptive skills and mood were endorsed.

Based on this information, Response-to-Intervention programming and English to Speakers of Other Language services were recommended at school. There was also a language barrier between the family and school team, and the family was unaware of the patient’s rights as a student. As such, the examiners provided family with psychoeducation and met with the school team to advocate for services that addressed the patient’s medical needs as well as interventions with primary language support.

Conclusions:

Establishing structured, formalized testing for bilingual patients is essential for valid neuropsychological evaluations. While clinicians are encouraged to interpret findings in this context and make diagnostic determinations in a multidimensional manner, there is no consensus on best-practices in the field. Spanish is the second most spoken language in the U.S making it imperative that bilingual neuropsychologists be trained on proper assessment of language proficiency before conducting bilingual evaluations. This is especially important in pediatric populations where language proficiency changes rapidly across development.