Psychological Testing of Hispanics: Clinical, Cultural, and Intellectual Issues [2 ed.] 1433819910, 9781433819919

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Psychological Testing of Hispanics Second Edition

Clinical, Cultural, and Intellectual Issues

Edited by

Kurt F. Geisinger

American Psychological Association • Washington, DC

Copyright © 2015 by the American Psychological Association. All rights reserved. Except as permitted under the United States Copyright Act of 1976, no part of this publication may be reproduced or distributed in any form or by any means, including, but not limited to, the process of scanning and digitization, or stored in a database or retrieval system, without the prior written permission of the publisher. Published by American Psychological Association 750 First Street, NE Washington, DC 20002 www.apa.org

To order APA Order Department P.O. Box 92984 Washington, DC 20090-2984 Tel: (800) 374-2721; Direct: (202) 336-5510 Fax: (202) 336-5502; TDD/TTY: (202) 336-6123 Online: www.apa.org/pubs/books E-mail: [email protected]

In the U.K., Europe, Africa, and the Middle East, copies may be ordered from American Psychological Association 3 Henrietta Street Covent Garden, London WC2E 8LU England Typeset in Goudy by Circle Graphics, Inc., Columbia, MD Printer: Maple Press, York, PA Cover Designer: Mercury Publishing Services, Inc., Rockville, MD The opinions and statements published are the responsibility of the authors, and such opinions and statements do not necessarily represent the policies of the American Psychological Association. Library of Congress Cataloging-in-Publication Data Psychological testing of Hispanics : clinical, cultural, and intellectual issues / edited by Kurt F. Geisinger. — Second edition. pages cm Includes bibliographical references and index. ISBN 978-1-4338-1991-9 — ISBN 1-4338-1991-0 1. Hispanic Americans—Psychological testing. I. Geisinger, Kurt F., 1951-, editor. E184.S75P79 2018 155.8'4680730287—dc23 2014043621 British Library Cataloguing-in-Publication Data A CIP record is available from the British Library. Printed in the United States of America Second Edition http://dx.doi.org/10.1037/14668-000

CONTENTS

Contributors.............................................................................................  ix Foreword.....................................................................................................  xi Melba J. T. Vasquez Acknowledgments.................................................................................   xvii Introduction.................................................................................................. 3 Kurt F. Geisinger Chapter 1. Using Pruebas Publicadas en Español to Enhance Test Selection.............................................. 11 Janet F. Carlson and Sara E. Gonzalez Chapter 2. Evaluating and Measuring Mexican Personality: Etic and Cross-Cultural Perspectives.............................. 29 Fernando A. Ortiz

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Chapter 3. A Brief History of Psychological Testing in Puerto Rico: Highlights, Achievements, Challenges, and the Future............................................ 51 Frances Boulon-Díaz Chapter 4. A Brief Review of Spanish-Language Adaptations of Some English-Language Intelligence Tests................. 67 Kurt F. Geisinger Chapter 5. Issues Related to Intelligence Testing With Spanish-Speaking Clients...................................... 81 Lawrence G. Weiss, Aurelio Prifitera, and Maria R. Munoz Chapter 6. Evaluation of Intelligence and Learning Disability With Hispanics.............................................................. 109 Samuel O. Ortiz and Kristan E. Melo Chapter 7. Neuropsychological Testing of Spanish Speakers...........  135 Antonio E. Puente, Carlos Ojeda, Davor Zink, and Veronica Portillo Reyes Chapter 8. Clinical Assessment of Hispanic Youth Diagnosed With Attention-Deficit/Hyperactivity Disorder and Other Externalizing Disorders................................ 153 José J. Cabiya and Nanet M. López-Córdova Chapter 9. The Clinical Interview With Latina/o Clients...............  171 Miguel E. Gallardo and Douglas I. Gomez Chapter 10. A Personality Approach to Testing Hispanics................. 189 Richard H. Dana Chapter 11. Clinical Approaches to Assessing Cultural Values Among Latinos.............................................................. 215 Lisa M. Edwards and Esteban V. Cardemil Chapter 12.

Assessment of Anxiety in Latinos................................. 237 Denise A. Chavira and Andrea Letamendi

Chapter 13. Latinos and Depression: Measurement Issues and Assessment............................................................. 255 Azara L. Santiago-Rivera, Gregory Benson-Flórez, Maria Magdalena Santos, and Marisela Lopez vi       contents

Chapter 14. Culturally Informed Psychosocial Stress Assessment for Hispanics.................................................................. 273 Richard Cervantes and Thuy Bui Chapter 15. Assessing Sexual Orientation and Gender Identity Among Latinos.............................................................. 291 Francisco J. Sánchez Chapter 16. Some Conclusions Regarding the Testing of Hispanics: A Look at the Past, the Present, and the Future.............................................. 309 Kurt F. Geisinger Index ......................................................................................................... 317 About the Editor....................................................................................... 335

contents     

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CONTRIBUTORS

Gregory Benson-Flórez, PhD, The Chicago School of Professional Psychology, Chicago, IL Frances Boulon-Díaz, PhD, University of Puerto Rico, Rio Piedras Campus, San Juan, Puerto Rico Thuy Bui, PhD, Behavioral Assessment, Inc., Los Angeles, CA José J. Cabiya, PhD, PhD Program in Clinical Psychology, Carlos Albizu University, San Jan, Puerto Rico Esteban V. Cardemil, PhD, Frances L. Hiatt School of Psychology, Clark University, Worcester, MA Janet F. Carlson, PhD, Buros Center for Testing, University of Nebraska– Lincoln Richard Cervantes, PhD, Behavioral Assessment, Inc., Los Angeles, CA Denise A. Chavira, PhD, Department of Psychology, University of California, Los Angeles Richard H. Dana, PhD, Regional Research Institute, Portland State University, Portland, OR Lisa M. Edwards, PhD, Counselor Education and Counseling Psychology, Marquette University, Milwaukee, WI

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Miguel E. Gallardo, PsyD, Pepperdine University, Irvine, CA Kurt F. Geisinger, PhD, Buros Center for Testing, University of Nebraska– Lincoln Douglas I. Gomez, MA, Pepperdine University, Irvine, CA Sara E. Gonzalez, Buros Center for Testing, University of Nebraska–Lincoln Andrea Letamendi, PhD, Department of Psychology, University of California, Los Angeles Marisela Lopez, MA, University of Wisconsin–Milwaukee Nanet M. López-Córdova, PsyD, PsyD Program in Clinical Psychology, Carlos Albizu University, San Jan, Puerto Rico Kristan E. Melo, St. John’s University, Queens, NY Maria R. Munoz, MA, Pearson Clinical Assessment, San Antonio, TX Carlos Ojeda, MA, University of Arkansas, Fayetteville Fernando A. Ortiz, PhD, ABPP, Gonzaga University, Spokane, WA Samuel O. Ortiz, PhD, St. John’s University, Queens, NY Veronica Portillo Reyes, Universidad Autónoma Ciudad de Juárez, Mexico Aurelio Prifitera, PhD, Pearson Clinical Assessment, Upper Saddle River, NJ Antonio E. Puente, PhD, University of North Carolina Wilmington Francisco J. Sánchez, PhD, The University of Wisconsin–Madison Azara L. Santiago-Rivera, PhD, The Chicago School of Professional Psychology, Chicago, IL Maria Magdalena Santos, MA, University of Wisconsin–Milwaukee Melba J. T. Vasquez, PhD, Vasquez and Associates Mental Health Services, Austin, TX Lawrence G. Weiss, PhD, Pearson Clinical Assessment, San Antonio, TX Davor Zink, MA, University of Nevada, Las Vegas

x       contributors

FOREWORD MELBA J. T. VASQUEZ

The need for a comprehensive volume about psychological tests for the Hispanic population has never been greater. The growth of the Latina/o population has led to an increased need to provide resources for service providers, educators, and researchers. There is critical need for the ethical and competent development, evaluation, research, and use of psychological tests with Latina/o populations. Culturally competent practitioners are encouraged to be knowledgeable of the limitations of assessment practices, from intakes to the use of standardized assessment instruments (American Psychological Association [APA], 2010). The “Ethical Principles of Psychologists and Code of Conduct” (APA, 2010) urges psychologists to “use assessment instruments whose validity and reliability have been established for use with members of the population test. When such validity or reliability has not been established, psychologists describe the strengths and limitations of test results and interpretation” (p. 12). The ethical, competent provision of mental health services in general, and assessment in particular, includes the consideration of clients’ cultural context. Cultural competence in the provision of services has become part of the mainstream fundamental knowledge and skill set required for effective, ethical practice. The fast-moving demographic changes in the xi

U.S. population have significant implications for psychology and the mental health profession. Culture is significantly involved in the development of individuals within their identity group. The social construction of race and ethnicity, gender, social class, and other variables affects the various strands of identi­ ties, including how individuals experience and respond to life’s challenges and distress, as well as the unique forms of adjustment, resilience, and strengths. A national culture derives from the heritage, language, economic system, customs, and values shared by those who share the same geography (Vontress, 2008), but the national culture may consist of a number of subsystems, result­ ing in variation of cultures. Individuals adjust to and are most comfortable in the way of life in which they were born and socialized. In some cases, various exposures to aspects of those subsystems influence continuing development for individuals, resulting in acculturation and/or the development of bicul­ tural or multicultural identities. Culturally competent assessment implies the importance of the consideration of the realities of these aspects of human difference. Assessment and measurement using more sophisticated methods and instruments is thus required. Cultural competence also includes knowledge of the challenges involved in appropriate development, selection, and use of tests, especially given the incredible diversity among Hispanics. Language and acculturative learning, for example, are two of the most critical variables related to test performance in evaluation of intelligence and learning disability (Chapter 6, this volume). Puente, Ojeda, Zink, and Portillo Reyes (Chapter 7) concur in regard to the importance of language and acculturation as key variables that affect neuro­ psychological testing of Spanish speakers, and adds education and socio­ economic status as salient variables. Others include gender roles, experience and perception of discrimination, and related identity issues such as sexual orientation, disability, gender identity, and so forth (La Roche, 2013). Psychologists are urged to attend to the issue of an individual’s language preference. Ongoing areas of research related to language focus on the trans­ lation and adaptation of instruments, the appropriate or inappropriate use of instruments, identifying different scores that may be more accurate for vari­ ous groups, and so on. Cultural competency involves the provision of services in a client’s or patient’s preferred language, and this includes with formal and informal assessments. It is immensely gratifying to know that a wide array of clinical, intel­ lectual, and other tests have been translated, normed, and validated with a variety of subgroups of Latina/o populations. The development of the chap­ ters in this volume is a significant contribution to this area of endeavor. The contributing authors provide reviews of various assessment instruments and methods in terms of cultural equivalence of measures, their validity and xii       foreword

reliability, psychometric support of the instruments to use with Latinas/os, and so forth. The Buros Center for Testing has continued to provide resources for those who develop, evaluate, study, purchase, and/or use tests. In Chapter 1 of this volume, Carlson and Gonzalez describe the development of a new resource, Pruebas Publicadas en Espanol (PPE; Tests Published in Spanish; Schlueter, Carlson, Geisinger, & Murphy, 2013). Buros developed PPE to develop and compile available Spanish measures to support good testing practices, particularly in terms of appropriate test selection. PPE is designed for practitioners who work with those who (a) speak Spanish exclusively, (b) are bilingual in Spanish and English, or (c) speak English primarily and have limited proficiency in Spanish. The importance of distinguishing among Hispanic groups is critical (see Chapter 10, this volume). Culturally competent conceptualization and reports require a systematic review and knowledge of the evidence-based literature about the subgroup with which the providers work. Both etic (universal) and emic (indigenous, culture-specific) approaches have been used to study personality among culturally different groups. Advantages and disadvantages of each approach are addressed in Chapters 2 and 10. Spanish-speaking clients may share a primary language but also represent diverse linguistic and cultural backgrounds; for example, they may vary with regard to country of origin, experiences, religion, and variations of Spanish language. Although many Hispanics do speak Spanish as their first language, some may primarily speak English or a non-Spanish language indigenous to their country of origin, such as Nahuatl of Mexico or Taino of the Caribbean (see Chapter 6). Although the majority of Hispanics have Mexican backgrounds (65%), Hispanics in the United States represent 21 countries, each with its unique sociopolitical and historical contexts and religious and cultural traditions, Spanish language dialects, indigenous roots, and foods. Puerto Ricans constitute 9% of the Hispanic population, those from Central America 8%, those from South America 6%, those from Cuba 4%, and those from the Dominican Republic 3% (5% were “other Hispanics”; Lopez & Dockterman, 2011; see also Chapters 10 and 13, this volume). Prevalence rates of psychiatric disorders may vary among groups. Chavira and Letamendi (Chapter 12, this volume) report, for example, variations in rates of anxiety between Mexican immigrants and Puerto Ricans, Cubans, and other Latinas/os, and Santiago-Rivera, Benson-Flórez, Santos, and Lopez (Chapter 13) describe variations of depression and mood disorders among Latinas/os. Some of the chapters herein focus on and attend to varied groups, including those of Mexican origin (Chapter 2) and Puerto Ricans in Puerto Rico (Chapter 3), and most address a variety of relevant diversity issues among Hispanic subgroups. foreword     

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The translation and adaptation of various tests is thus challenging across Hispanic subcultures and languages, and care must be taken to especially avoid abuses in general, but particularly for certain high-stakes testing, such as intelligence testing, which can be used for admission to educational programs, special education, employment selection, and even death penalty cases. S. O. Ortiz and Melo (Chapter 6) point out that what makes people perform differently on intelligence and cognitive ability tests is less about race or culture and more about the extent to which the individual has been exposed to or had experience with the culture that gave rise to the test. Various strategies are used and recommended in several of this book’s chapters to promote quality adaptation. For example, rewriting items to make them more functionally equivalent, avoiding American idiomatic expressions, identifying different scores for different group norms on various scales, and attending to the variety of cautions to be used in interpreting psychological findings are important and helpful strategies. Raw translations of words from one language to another for a vocabulary test as part of an intellectual assessment, for example, is likely to yield significant problems. Emotional connotations, use, and frequency can vary widely across languages (Chapter 4). Even changing instructions on tests from one language to another can introduce unwanted variability. Cultural factors in assessment may include relevant generational history (e.g., number of generations in the country, manner of coming to the country), citizenship or residency status (e.g., number of years in the country, parental history of migration, refugee flight, immigration), fluency in “standard” English or other language, extent of family support or disintegration of family, availability of community resources, level of education, change in social status as a result of coming to this country (for immigrants or refugees), work history, and level of stress related to acculturation and/or oppression (APA, 2003). Specific cultural values that have been identified as serving as lenses for interacting with the social world with regard to family and nonfamily are key in provision of services and assessment of Latinas/os (Chapters 9 and 11). They include personalismo (focus on the importance of the person-to-person interaction as opposed to tasks, time, etc.), respeto (demonstration of sense of respect, especially to elders and those who hold important societal positions), confianza (trust and confidence in the relationship) simpatía (refers to an individual’s general likeability, based on being congenial, warm, harmonious), and familismo (centrality of the family unit as the source of identity, rather than the individual, and refers to strong feelings of attachment, commitment, loyalty, and obligation to family members). These values refer to the role of the family, interpersonal interactions, and expectations of gender roles and can include religious and spiritual values. Level of adherence to xiv       foreword

these cultural values may be more indicative of how an individual is adapting to the demands of cultural context than language use or generational status; it may be much more useful to understand a particular client’s relationship with her culture (be it Mexican, Puerto Rican, Cuban, South or Central American) than knowing the client’s background (Chapter 11). Individuals and communities vary in the degree to which these values are meaningful. Emphasis on the need for awareness of negative biases and assumptions in the assessment process is critical (APA, 2003; see also Chapters 10 and 11, this volume). The role of the clinician in the assessment and treatment processes is important because the processes are replete with potential pitfalls and instances of unfortunate communication of subconscious cognitive biases. Moment by moment, the professional must decide how to best communicate and interact with clients. Inappropriate communication of existing assumptions and stereotypes can lead to microaggressions and result in ruptures, misunderstandings, and misdiagnoses. Cultural expressions of disorders are also important to understand and assess. Chavira and Letamendi (Chapter 12) describe cultural conceptualizations of anxiety and specific expressions of distress (i.e., ataques de nervios and nervios). The authors advocate for greater emphasis to be placed on establishing the cultural equivalence of existing gold standard anxiety assessments with demographically and linguistically diverse samples, especially given that anxiety disorders are the most numerous in Latino and non-Latino populations. Although studies have reported lower rates of lifetime mood disorders for Latino populations compared with non-Latino Whites, those with a history of mood disorders were at greater risk of a persistent course of illness (Chapter 13), and rates vary among Latino subgroups, with Mexicans showing the lowest rates and Puerto Ricans the highest. The authors of Chapter 13 also describe cultural conceptualizations of mood disorders, including susto (fright), espanto (sudden fright), and perdida del alma (loss of the soul). They also cite evidence that Latinos tend to somaticize mental health problems, reporting more physical symptoms of distress than European Americans. This underscores the need to assess and measure mood disorders accurately among members of this diverse demographic group. Cervantes and Bui (Chapter 14) report studies that indicate that stressrelated disorders such as posttraumatic stress disorder seem to affect Hispanics to a higher degree than other groups in American society. Hispanic youth in particular demonstrate higher rates of behaviors reflective of maladaptive coping, such as alcohol and substance abuse. Early detection of distress among adolescents, as well as adults, is important in reducing the mental health disparities gap in the Hispanic population. This volume makes a substantial contribution to our field. It truly accentuates both the importance of Latinas/os and Hispanics in the U.S. foreword     

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population and the need to provide this significant population with the best psychological assessments and treatment available. Kurt F. Geisinger deserves recognition and appreciation for initiating the development of Psychological Testing of Hispanics, Second Edition: Clinical, Cultural, and Intellectual Issues and for gathering together a competent group of scholars to address assessment and measurement issues for more effective diagnoses and treatment of our populations. REFERENCES American Psychological Association. (2003). Guidelines on multicultural education, training, research, practice, and organizational change for psychologists. American Psychologist, 58, 377–402. American Psychological Association. (2010). Ethical principles of psychologists and code of conduct (2002, Amended June 1, 2010). Retrieved from http://www.apa.org/ ethics/code/index.aspx La Roche, M. J. (2013). Cultural psychotherapy: Theories, methods, and practice. Thousand Oaks, CA: Sage. Lopez, M. H., & Dockterman, D. (2011). U.S. Hispanic country of origin counts for nation, top 30 metropolitan areas. Retrieved from Pew Research Hispanic Trends Project website: http://www.pewhispanic.org/2011/05/26/us-hispanic-countryof-origin-counts-for-nation-top-30-metropolitan-areas/ Schlueter, J., Carlson, J. F., Geisinger, K. F., & Murphy, L. L. (Eds.). (2013). Pruebas publicadas en Español [Tests published in Spanish]. Lincoln, NE: Buros Center for Testing. Vontress, C. E. (2008). Foreword. In P. B. Pedersen, J. G. Draguns, W. J. Lonner, & J. E. Trimble (Eds.), Counseling across cultures (6th ed., pp. vii–ix). Thousand Oaks, CA: Sage.

xvi       foreword

acknowledgments

The time period between the first and second editions of Psychological Testing of Hispanics is over 20 years. Much has happened in the world, in psychology, and indeed in my life during that time period. However, the first edition came out at a critical point in American life when Hispanics/­Latinos/ Latinas were first being imagined as the biggest ethnic minority group in the United States. That time has come and passed. Today, the need for distinctive psychological services for those who are culturally different and especially for Hispanics and Latinos/as continues unabated, as described throughout this book. The experience of being culturally and linguistically different is still not understood by many. For the first edition, I worked hard to find Hispanic Americans able to contribute meaningfully to the book and I was able to find superb psychologists able to write important material, some of whom were themselves Hispanic. I decided to focus this second edition on clinical testing, with intellectual testing seen as part of a clinician’s tool bag. Now many superb Hispanic psychologists are able to contribute. In fact, when the manuscript was submitted, the publishers of this volume reported to me that the volume was too long, but the materials were valuable enough that I argued to keep

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all the chapters and, after review, they agreed. So I would like to begin by acknowledging my beloved profession that has embraced and welcomed ethnic minorities in general and Hispanics and Latinos/as in particular into our discipline. Psychology deserves an acknowledgment for its inclusive orientation. I of course also need to acknowledge the authors of the chapters in this book. They have brought insight, knowledge, critical thinking, and distinction to this book. Although I am biased, it is clear to me that this book makes a real contribution to the literature, still a literature lacking information on testing the culturally and linguistically different. I would like to thank Fordham University once again, because it helped support the first edition of this volume some 20 plus years ago. Thanks to the University of Nebraska–Lincoln and, in particular my chair, Ralph de Ayala, who granted me a much-needed sabbatical that permitted me to begin my work on this edition. Sincere thanks also to the editors at the American Psychological Association. After the first edition and its relative success, they strongly encouraged me to edit a second edition. In particular, I would like to acknowledge the work of Dr. Gary VandenBos and Ms. Linda Malnasi McCarter. I must thank my friends and supporters on the APA Board, which operates much like a close-knit family, and on the International Test Commission Council, which is helping to shrink the psychological world. I would also like to single out a few of my formative professors and professionals who encouraged me to pursue work of this type, either when I was a student or early in my career. Included in such a group would be John Kelton (Davidson College), William A. Owens (University of Georgia), Joseph Hammock (University of Georgia), William Rabinowitz (Pennsylvania State University), Harold Mitzel (Pennsylvania State University), Warren Willingham (Educational Testing Service), Anne ­Anastasi (Fordham University), and Marvin Reznikoff (Fordham University). In short, I would not be who I am today without their input, support, and shared knowledge and insights. Finally, please let me dedicate this book to my wife, Janet, whose ­partnership—personal, professional, and intellectual—in many ways supports, invigorates, and challenges all that I do. As a clinical psychologist, she also was a sounding board throughout this endeavor.

xviii       acknowledgments

Psychological Testing of Hispanics Second Edition

INTRODUCTION KURT F. GEISINGER

Over 20 years ago, when the first edition of this book was published (Geisinger, 1992),1 it would have been impossible or near impossible to include focused discussions on a single type of psychological testing of Hispanics (e.g., clinical assessment, educational testing, employment testing). There simply were too few measures that had been validated for such use, and the research at that time was too sparse. Fortunately, much has changed since then, to which the breadth of the coverage in these pages will attest. The chapters in the first edition covered the gamut of testing: personality and clinical assessment, as well as classroom testing in education, managerial assessment, employment testing, the measurement of acculturation, and also psychometric and legal issues in testing language minorities such The impetus for the first edition of this book was “The Psychological Testing of Hispanics” conference, organized by the author. It took place in 1991 at Fordham University in New York City as part of that University’s sesquicentennial celebration and was partially funded by the American Psychological Association. 1

http://dx.doi.org/10.1037/14668-001 Psychological Testing of Hispanics, Second Edition: Clinical, Cultural, and Intellectual Issues, K. F. Geisinger (Editor) Copyright © 2015 by the American Psychological Association. All rights reserved.

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as Hispanics. This volume concerns clinical and counseling testing almost exclusively. Many of these assessment themes are also covered in this volume; they are augmented by discussions of more specialized forms of testing that have been developed in the interim. Population changes that were likely to come in the next decades were discussed by Eyde (1992) and several other contributors to the first edition. Foci that emerged were the impeding explosion of the Hispanic/Latino population in the United States, the need to ensure fairness in the assessment of Hispanics, concerns over the use of standardized measures developed in English in America with Hispanic populations, the diversity of Hispanics within our society, and the need for research and development of measures more explicitly aimed at Hispanic and Latino cultures. Eyde’s chapter noted, “The demo­ grapher Davis has predicted that ‘Hispanics could number some 47 million and comprise 15% of the population by the year 2020, displacing [non-Hispanic] blacks as the country’s largest minority.’ (Davis, Haub, & Willette, 1983, p. 3)” (p. 168). In fact, these estimates were large underestimates. The U.S. Census Bureau reported in 2013 that the Hispanic population of the United States was 53 million as of July 1, 2012—some 8 years before it had been predicted that they would number only 47 million. These numbers undeniably made individuals of Hispanic or Latino origin the nation’s largest ethnic or racial minority. Hispanics constituted 17% of the nation’s total population. Indeed, 1.1 million Hispanics were added to the nation’s population between July 1, 2011, and July 1, 2012. This number is close to half of the approximately 2.3 million people added to the nation’s population during this same period. And none of these numbers include those Hispanics or Latinos who are in the country illegally and who are not counted by the Census, numbers estimated to be perhaps 9 million individuals (see Chapter 13, this volume). Taken on the basis of its Hispanic population alone, the United States represents the second-largest population of Hispanics in the world, trailing only Mexico. This increase in Hispanic population has dramatically changed the complexion of the United States demographically and, as should be expected, affects the demand for psychological services, including testing. That many members of the Hispanic/Latino population face acculturation, language differences, immigration, and economic concerns enhances the need for psychological services to an even greater extent than might have been anticipated purely from the population increases alone. A third justification for this volume can be found in Chapter 1. In describing a new reference that provides information about tests available in Spanish, Carlson and Gonzalez report, “The impetus to develop PPE [Pruebas Publicadas en Español; Schlueter, Carlson, Geisinger, & Murphy, 2013] owes to a growing recognition that more and more tests in the English language that were included in MMY [Mental Measurements Yearbook; Carlson, Geisinger, 4       kurt f. geisinger

& Jonson, 2014] or TIP [Tests in Print; Murphy, Geisinger, Carlson, & Spies, 2011] offered Spanish versions or components.” Thus, we believe that the need for this volume is clear, considering population increases, the need for psychological services for members of this heterogeneous group, and the changing and improved availability of psychological measures for use with Hispanic clients. It should perhaps be noted that the terms Hispanic and Latino are not interchangeable. Hispanic is more often used when referring to individuals from Caribbean and Spanish cultures and is a more generic term; Latino is used more commonly with those from Mexico and to some extent, Central and South America. (Not all Latinos necessarily speak Spanish.) Because various chapters in this book, and indeed research in psychology more generally, use both terms, the terms used by specific authors have remained as the authors first penned them. They must be understood as overlapping but distinct terms. Indeed, in 2000, the U.S. Census asked people to identify whether they were either Hispanic or Latino; in 2010, they were asked whether they were Hispanic, Latino, or Spanish. That the market influence on the increasing need for psychological assessments of Hispanics has changed the testing of Hispanics in this country cannot be understated. During the early 1990s, as part of a research project on the use of testing with Hispanics, I had a conversation about the quality of the adaptation of a well-known English language measure into Spanish with the chief executive officer of a major U.S. testing company. This executive agreed that the test did not meet professional standards for testing, but was being offered for sale purely as a service for those who needed a measure of intelligence in Spanish. Frankly, the scaling of the test had significant methodological issues (López & Romero, 1988; López & Taussig, 1991; Maldonado & Geisinger, 2005). The chapters of this volume, which detail assessment methods in intellectual, neuropsychological, personality, and other clinical measures, demonstrate that the psychological testing of Hispanics has indeed come of age. In 1991, Velásquez and Callahan (1992) believed that the only measure that could be discussed seriously in terms of clinical use with Hispanic clients was the Minnesota Multiphasic Personality Inventory (MMPI; Hathaway & McKinley, 1940). They cited published studies of commonly used clinical measures with Hispanics. Of the 65 studies they located, 61 used the MMPI, three the Rorschach, and one the Thematic Apperception Test (TAT). No published clinical studies were identified that used the California Personality Test, the 16 Personality Factor Questionnaire (16PF), the Beck Depression Inventory (BDI), or the Comrey Personality Scales. A total of 38 studies using these measures with nonclinical Hispanic populations were found. Of these, 25 used the MMPI, six the Rorschach, two studies each used the TAT and the California Personality Inventory, and one each used the 16 PF, the BDI, and the Comrey introduction     

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Personality Scales. Velásquez and Callahan therefore focused on the MMPI. Since that time, an entire volume has appeared that has demonstrated the appropriateness of using adaptations of the MMPI–2 and the MMPI–A with Hispanic clients (Butcher, Cabiya, Lucio, & Garrido, 2007). That a specific measure constituted the grounding for a chapter in 1992 could now justify an entire research-based volume some 15 years later is indicative of the rapid and science-based changes going on in practice and in the industry today. Chapter 1 in this volume demonstrates the explosion of measures available in Spanish to the extent that a reference was needed to provide guidance in helping users to identify and select the best measures for a given use. As mentioned previously, Carlson and Gonzalez document that many widely used English language measures developed and used in the United States have translations or adaptations in Spanish. In Chapter 2, F. A. Ortiz discusses Mexican personality assessment and documents that many measures adapted for this purpose appear to replicate U.S. results when used with Mexicans. However, some measures were not found to demonstrate equivalent validity in the form of similar factor structure, for example, when used with Mexicans. In other cases, the differences are more subtle. Although replication is relatively common, test developers often need to adapt or exclude the English items that lack cultural relevance in the Mexican culture. In addition, statistical analyses have found some significant decreases in scale reliability or item factor loadings, and statistical evidence has been found of differential item functioning when comparing English items with their Spanish counterparts. Given that at least two thirds of the Hispanic population in the United States is of Mexican origin, it is not surprising that the vast majority of test research with Hispanics has been performed with those of Mexican heritage. Although Puerto Ricans are the second largest population of Hispanics in the United States, they represent only about one sixth of the Mexican pop­ ulation. The psychological testing research with Puerto Ricans is probably proportionate to their smaller population, although in Chapter 3 Boulon-Díaz indicates that much progress is being made, with active psychological associations on the island leading the way to much advancement in testing. In fact, psychological assessment has a strong history in Puerto Rico. Puerto Rico as a commonwealth of the United States is arguably closer culturally to the United States than is Mexico, but much of the testing work there is still based on the translation and adaptation of measures into Spanish. A special focus has been on the development of Puerto Rican norms of many measures that are used there. Boulon-Díaz provides evidence of the growth of advanced instruction in psychology among Puerto Rican colleges and universities and, from my perspective, it could be argued that testing is even more important in Puerto Rican psychology than it is on the mainland. As groups of Hispanics from other countries 6       kurt f. geisinger

and regions immigrate into the United States, research will be needed to justify acceptable test use, especially when cultural differences among the immigrants make these newer Hispanic/Latino immigrants to the United States somewhat different from those other Hispanics and Latinos who have to date been the primary individuals welcomed into our country (although it may be a wishful thought that immigrants are indeed welcomed). In Chapter 5, Weiss, Prifitera, and Munoz demonstrate some optimistic breakthroughs. Although there have been historical differences in the assessment of intelligence between non-Hispanic whites and Hispanics in our society, this chapter provides evidence that these difference are shrinking over time (as also predicted by S. O. Ortiz and Melo in Chapter 6) and are largely influenced by both socioeconomic status (SES) and parental education. As these variables become less differentiated across groups, the resultant indexes of intelligence should become more similar or even identical. In Chapter 6, S. O. Ortiz and Melo also provide excellent examples of some cultural differences between Hispanic groups. Another point made by the authors is the necessity of comprehensive training for those performing assessments of Hispanics. Along with competence in language, competence in the psychometrics of testing and the influence of language fluency and acculturation on tested performance is also critical. S. O. Ortiz and Melo also demonstrate that knowledge of subscale differences among Hispanic test takers can greatly inform the professional delivering and interpreting the assessment. In Chapter 7, Puente, Ojeda, Zink, and Portillo Reyes provide the somewhat surprising result that even in neuropsychological testing, where physiology would appear most important, test results when assessing Hispanics are influenced by language, acculturation, SES, and educational level. These authors believe that the advance in neuropsychological testing of Hispanics has not kept pace with the population growth, and hence the development, validation, and norming of such measures for Hispanics is greatly needed. In Chapter 10, Dana demonstrates that many other measures are now available for use with Hispanic clients as well. The research strategies for determining whether measures can be used with Hispanics are also reasonably available and documented (e.g., Geisinger & McCormick, 2013; van de Vijver & Leung, 1997). Dana also provides both a philosophical and an empirical orientation to the use of adapted, English, and Spanish assessments with those who are not from the dominant culture in our society. Similarly, in Chapter 9, Gallardo and Gomez emphasize that clinical interviewing represents an important set of techniques that help therapists to understand clients within the cultural and contextual settings from which they come and in which they find themselves currently. Such orientations are essential for understanding the behavior of Hispanic/Latino clients, perhaps far more so than for clients from the majority culture. Moreover, Chapters 9 introduction     

7

and 10 both emphasize the extreme need for culturally sensitive and aware therapists and counselors. To become culturally sensitive and aware, such individuals have to understand the cultures from which Hispanic clients have come. That such experiences are quite diverse in and of themselves is a point also made clear in Chapters 6 and 11. In Chapter 11, Edwards and Cardemil describe the need to understand the often culturally based values of Hispanics in our society. They document specifically that cultural experiences and values have been seen as influencing the perception, identification, and definition of mental illness among individuals in addition to the manifestation and expression of psychiatric symptoms. They present a model (ADDRESSING) in which individuals are perceived within a broad framework of individual differences that are based on a number of important sociodemographic characteristics, including age, disability, religion, ethnicity, sexual orientation, SES, indigenous heritage, national origin (including refugee or immigrant status), and gender. Such a perspective is especially useful because it accentuates the need to not see Hispanics and Latinos singly in terms of their ethnicity and heritage. Edwards and Cardemil also describe how such values can be assessed using clinical interviewing or quantitative scales. The central role of the clinician in combining these various influences toward the end of understanding behavior is critical. Ultimately, clinicians must help clients understand their behavior, and attending to these potential influences is of acute importance. Chapters 12 and 13 focus on two of the most common psychological conditions: anxiety and depression. These chapters present culturally appropriate techniques for assessing these conditions and beginning treatment planning. What should be clear from these two chapters is that there are now numerous measures for assessing these conditions within Latino/Hispanic subpopulations in our society. Understanding the differences and similarities between Hispanics and those of European extraction in our society in terms of anxiety and depression is important for understanding the results of such measures. And as noted in Chapters 4, 7, and 10, these measures simply cannot be straight translations of the English measures; they must be adapted to the particular experiential backgrounds of these groups. The measures discussed in these chapters, in the context of a culturally sensitive clinical interview, indeed represent gold standards of the clinical assessment of Hispanics in our society today. Stress is often an underlying and contributing factor in many psychological concerns. Therefore, Chapter 14 presents important information on the assessment of stress in Hispanic populations. Assessment of such stress, including acculturative stress, is clearly not yet at the level of development found in the assessment of anxiety and depression in this population. Nevertheless, assessment of stress may be an important aspect of a comprehensive assessment of a Hispanic or Latina/o client seeking services. Better 8       kurt f. geisinger

measures in this area are needed; it is clear that the kinds and causes of stress found in Americans who are born in the United States are likely to be quite different than those in the Hispanic and Latino populations in this country, especially those of immigrants and their entire families. Moreover, many such individuals are likely to be of low SES, struggling with the English language, and experiencing difficulties as they navigate societal systems so different from their home cultures. Imagine the stresses on married Latino men working in the United States to send funds to their families in other countries. There are few similar stresses that would be felt in the majority culture in our society, even when families are necessarily divided geographically. One central concept in the study of individuality is gender and gender identity. Chapter 15 deals with these concepts and related ones with special reference to the Latino community, where such statuses may have been slower to be accepted than in American society in general. However, some measures are beginning to be developed that help assess these constructs. This area is clearly one where additional research is needed, including validation of the existing measures and the development of new ones. In this chapter, Sánchez provides evidence as to how cultural values influence sexual identity in the Latino community. For example, several chapters in this volume mention the importance of familismo, the critical relevance of extended family to one’s development. In this context, Sánchez reports that Latinos who engage in public disclosure of their gay or lesbian sexuality often do so much closer to home than their non-Hispanic counterparts. Such information underscores both the relevance of culture in understanding behavior and the necessity to understand the complexity of behavior. Psychology’s interest in diversity is one of the true strengths of our field, both academically and professionally. That the nation’s largest minority group is also one that has emerged from a variety of cultures different from the dominant culture of the United States and whose members often use English as a second language makes psychological service provision more complex. The intents of this book are to move our field ahead in its ability to deal with Hispanics and Latinos/as, to celebrate and share the accomplishments that have transpired over the recent decades in this endeavor, to revel in the diversity within the United States, and to open our eyes more to the international community that is increasingly being found in this country.

REFERENCES Butcher, J. N., Cabiya, J., Lucio, E., & Garrido, M. (2007). Assessing Hispanic clients using the MMPI–2 and MMPI–A. Washington, DC: American Psychological Association. http://dx.doi.org/10.1037/11585-000 introduction     

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Carlson, J. F., Geisinger, K. F., & Jonson, J. L. (Eds.). (2014). The nineteenth mental measurements yearbook. Lincoln, NE: Buros Center for Testing. Davis, C., Haub, C., & Willette, J. (1983). U S. Hispanics: Changing the face of the United States. Population Bulletin, 38, 3. Eyde, L. D. (1992). Introduction to the testing of Hispanics in industry and research. In K. F. Geisinger (Ed.), The psychological testing of Hispanics (pp. 167–172). Washington, DC: American Psychological Association. http://dx.doi. org/10.1037/10115-016 Geisinger, K. F. (Ed.). (1992). The psychological testing of Hispanics. Washington, DC: American Psychological Association. http://dx.doi.org/10.1037/10115-000 Geisinger, K. F., & McCormick, C. M. (2013). Testing and assessment in cross-cultural psychology. In J. R. Graham, J. A. Naglieri, & I. B. Weiner (Eds.), Handbook of psychology (Vol. 10): Assessment psychology (pp. 114–139). New York, NY: Wiley. Hathaway, S. R., & McKinley, J. C. (1940). The MMPI manual. New York, NY: Psychological Corporation. López, S. R., & Romero, A. (1988). Assessing the intellectual functioning of Spanish-speaking adults: Comparison of the EIWA and the WAIS. Professional Psychology: Research and Practice, 19, 263–270. http://dx.doi.org/10.1037/07357028.19.3.263 López, S. R., & Taussig, I. M. (1991). Cognitive–intellectual functioning of Spanish-speaking impaired and non-impaired elderly: Implications for culturally sensitive assessment. Psychological Assessment, 3, 448–454. http://dx.doi. org/10.1037/1040-3590.3.3.448 Maldonado, C. Y., & Geisinger, K. F. (2005). Conversion of the Wechsler Adult Intelligence Scale into Spanish: An early test adaptation effort of considerable consequence. In R. K. Hambleton, P. F. Merenda, & C. D. Spielberger (Eds.), Adapting educational and psychological tests for cross-cultural assessment (pp. 213–234). Mahwah, NJ: Erlbaum. Schlueter, J., Carlson, J. F., Geisinger, K. F., & Murphy, L. L. (Eds.). (2013). Pruebas publicadas en Español [Tests published in Spanish]. Lincoln, NE: Buros Center for Testing. U.S. Census Bureau. (2013). Facts for features: Hispanic Heritage Month 2013, Sept. 15– Oct. 15 (Release Number CB13-FF.19). Retrieved from https://www.census.gov/ newsroom/facts-for-features/2013/cb13-ff19.html# van de Vijver, F. J. R., & Leung, K. (1997). Methods and data analysis for cross-cultural research. Thousand Oaks, CA: Sage. Velásquez, R. J., & Callahan, W. J. (1992). Psychological testing of Hispanic Americans in clinical settings: Overview and issues. In K. F. Geisinger (Ed.), Psychological testing of Hispanics (pp. 253–266). Washington, DC: American Psychological Association.

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1 USING PRUEBAS PUBLICADAS EN ESPAñol TO ENHANCE TEST SELECTION JANET F. CARLSON AND SARA E. GONZALEZ

Increases in Hispanic populations in the United States have prompted a need for additional information about clinical tests and intellectual measures in the Spanish language that are available for use in clinical practice and research. The first section of this chapter reviews the development of a new resource for practitioners and researchers that provides descriptive information about educational and psychological measures available in Spanish, in whole or in part. The discussion includes a brief description of the initial challenges encountered, as well as associated resolutions. The second section provides an overview of the structure of the resource and illuminates the descriptive elements associated with test entries. In the third and final section, we describe how clinical practitioners who work with Hispanic clients can use

We wish to thank Jennifer Schlueter for her assistance, especially in preparing the figures. The Buros Center for Testing is a nonprofit research center with a mission to improve the science and practice of testing and assessment. http://dx.doi.org/10.1037/14668-002 Psychological Testing of Hispanics, Second Edition: Clinical, Cultural, and Intellectual Issues, K. F. Geisinger (Editor) Copyright © 2015 by the American Psychological Association. All rights reserved.

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the information contained in Pruebas Publicadas en Español (PPE; essentially, “Tests Published in Spanish”; Schlueter, Carlson, Geisinger, & Murphy, 2013) to support good testing practices, particularly in terms of appropriate test selection. This section delineates some common situations for which the content of PPE may assist in the selection of tests appropriate for specific applications. Using two fictional scenarios, we anticipate and explain how the information provided in PPE may be put to effective use by clinicians and researchers. DEVELOPMENT OF PRUEBAS PUBLICADAS EN ESPAñOL The development of a new reference volume to serve as a new resource for clinical practitioners and researchers was predicated on two observations: 77

77

The dramatic population increases among Hispanic groups over the past several decades in the United States are expected to continue. Many members of these populations speak Spanish as their primary or sole language. As illustrated by Shin and Ortman (2011), the proportional increase expected among Spanish-speaking residents well exceeds those of other nonEnglish speakers, which is expected to demonstrate nominal growth, similar to that observed since 2000. The expansion of Hispanic populations has made more obvious the need for new resources to be developed that assist clinical practitioners in identifying and selecting appropriate measures to use with members of these groups. Specifically, more information is needed concerning tests in the Spanish language that can be used appropriately and effectively in clinical applications. For decades, publications by the Buros Center for Testing— especially the Mental Measurements Yearbook (MMY; Carlson, Geisinger, & Jonson, 2014) and Tests in Print (TIP; Murphy, Geisinger, Carlson, & Spies, 2011) series—have served as vital resources for test users from many psychological and educational backgrounds. These two reference works provide critical reviews (MMY) and descriptions (MMY and TIP) of educational and psychological tests. Practitioners and researchers alike regularly use these resources to help them identify, evaluate, and select measures most suitable to their purposes. Both MMY and TIP provide test information about commercially available (i.e., published) English-language tests. Over the last few volumes, however, Buros Center staff members recognized that more and more tests that were indexed or reviewed were published—in whole or in part—in Spanish.

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Thus, the impetus to develop PPE is owing to a growing recognition that more and more tests in the English language included in MMY or TIP offered Spanish versions or components, coupled with a corresponding awareness of demographic changes in the proportion of Spanish-speaking members of the U.S. population. This awareness prompted consideration of how these reference works could be modified or expanded to improve service to a burgeoning audience. The development of a Spanish edition of TIP appeared to be a logical and feasible starting point. Since about 2010, Buros has engaged in the development of PPE, which represents an initial effort to compile and describe available Spanish measures by building on the established traditions of the Buros Center for Testing and its long-standing publication series—MMY and TIP. Table 1.1 presents the numbers of tests within each of the 18 major test categories that are included in the most recent volumes of each of the three reference works—PPE, the eighth TIP (TIP VIII; Murphy et al., 2011), and the 18th MMY (Spies, Carlson, & Geisinger, 2010). In addition, the relative proportions of each test category are shown parenthetically. Although some variation exists across the volumes in terms of the types of tests included, the columns in Table 1.1 demonstrate considerable parallelism across the three volumes, particularly between PPE and TIP. The personality test category includes the greatest number of tests of any category, followed by vocations. Together, these two categories account for more than 40% of the descriptive entries in PPE and in TIP VIII. In planning the content of PPE, the editors decided to present all material in a bilingual manner throughout the book and to present content in Spanish first, followed by English. One of the first challenges to surface concerned the development of test inclusion criteria. Entire tests developed and normed in Spanish were obvious candidates. Less clear were tests with only a modicum of components available in Spanish. In the end, inclusion was favored over exclusion because the Buros Center staff members most centrally involved in this project believed that the availability of even a single test component in Spanish may well influence test selection. For example, a school-based practitioner or researcher working in an urban area such as Los Angeles, Miami, or New York City likely would favor a test with a Spanish version of its parent rating scale over one without such a form. In addition, the relative scarcity of tests available in Spanish (Puente, 2011) and the rather widespread practice in European countries—including Spain, where English is not the first language (Elosua & Iliescu, 2012; Evers et al., 2012)— of importation and subsequent use of tests developed in the United States (in English) offered support for this decision. Thus, tests with any Spanish components were targeted for acquisition. Following this initial planning, input from the professional community was sought using a 10-item survey that consisted of a combination of using PRUEBAS PUBLICADAS EN ESPAÑOL     

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Table 1.1 Test Entries in Pruebas Publicadas en Español, Tests in Print VIII, and the Eighteenth Mental Measurements Yearbook by Category No. (%) of test entries Category Personality Vocations Intelligence and general aptitude Developmental Miscellaneous Behavior assessment Neuropsychological Language/English & languaged Reading Sensory motor Education Mathematics Speech and hearing Achievement Fine arts Second languages/Foreign languagesd Science Social studies

PPEa

TIP VIII b

130 (30.8) 56 (13.3) 49 (11.6) 40 (9.5) 31 (7.3) 28 (6.6) 19 (4.5) 15 (3.6) 12 (2.8) 9 (2.1) 8 (1.9) 6 (1.4) 6 (1.4) 5 (1.2) 5 (1.2) 3 (0.7) 0 (0.0) 0 (0.0)

644 (21.4) 594 (19.8) 212 (7.1) 145 (4.8) 267 (8.9) 155 (5.2) 128 (4.3) 164 (5.5) 128 (4.3) 60 (2.0) 118 (3.9) 73 (2.4) 92 (3.1) 81 (2.7) 18 (0.6) 47 (1.6) 46 (1.5) 31 (1.0)

18th MMY c 28 (17.7) 26 (16.5) 14 (8.9) 12 (7.6) 9 (5.7) 19 (12.0) 6 (3.8) 10 (6.3) 5 (3.2) 5 (3.2) 3 (1.9) 4 (2.5) 7 (4.4) 7 (4.4) 0 (0.0) 1 (0.6) 1 (0.6) 1 (0.6)

Note.  18th MMY = Eighteenth Mental Measurements Yearbook (Spies, Carlson, & Geisinger, 2010); PPE = Pruebas Publicadas en Español (Schlueter, Carlson, Geisinger, & Murphy, 2013); TIP VIII = Tests in Print VIII (Murphy, Geisinger, Carlson, & Spies, 2011). From Pruebas publicadas en Español (p. xvii), by J. Schlueter, J. F. Carlson, K. F. Geisinger, and L. L. Murphy (Eds.), 2013, Lincoln, NE: Buros Center for ­Testing. Copyright 2013 by Buros Center for Testing. Adapted with permission. aPercentages reflect proportions in PPE; n = 422. bPercentages reflect proportions in TIP VIII; n = 3,003. cPercentages reflect proportions in 18th MMY; n = 158. dThe category name that follows the slash is used in TIP VIII and 18th MMY.

forced-choice and open-ended questions. Respondents were asked to indicate their views regarding content, format, and utility of the developing resource. An e-mail list of testing professionals was developed, comprising individuals known or believed to have relevant experience in multicultural and crosscultural assessment, as well as test translation and adaptation issues. The names included those of prominent researchers in the relevant literature, as well as those of professional contacts of Buros Center staff members. Some survey questions were quite general; others were quite specific. Respondents were asked to share their views about the ideal format, essential test information, potential markets, and so forth. Two questions addressed utility in terms of (a) how helpful PPE would be as a resource for test users and (b) how large the need was for such a resource. Responses to these questions were measured on a 5-point Likert scale, with higher values denoting greater helpfulness and need, respectively. 14       carlson and gonzalez

The survey was e-mailed to 33 individuals and three organizations, including the National Latino/a Psychological Association. Recipients were encouraged to respond to the survey themselves and to forward it to others who they believed would have an interest in the development of this resource. In all, 57 responses were received and tallied. Respondents indicated that PPE would be a highly helpful resource (M = 4.70, SD = .50; n = 56), the need for which is considerable (M = 4.78, SD = .53; n = 56). Results also suggested that the best format would be Spanish and English versions of the same content on the same or adjoining pages, rather than creating two sections in the book—one for Spanish and one for English. In addition, respondents indicated that differences in dialects among prospective users would not be critical but should be addressed somewhere in the volume, most likely via a declarative statement in the introduction. Another open-ended survey question asked respondents to specify what aspect of a test was most important in their selection of a Spanish test. Several respondents emphasized the importance of test development practices and technical features that would support the use of the test with Spanish-speaking clients. Input from survey respondents was evaluated and discussed by members of the Buros Center staff involved with the PPE project. Many of the recommendations were implemented. For example, the volume uses Castilian Spanish, reputably the language standard most often used in formal contexts, and presents Spanish and English text on the same or adjoining pages. Notably, the responses also helped establish a number of test description fields unique to PPE that, it is believed, will help to make the descriptive entries more useful to its audience. DESCRIPTION OF PRUEBAS PUBLICADAS EN ESPAñOL PPE provides descriptive and analytical information about commercially published tests that have components published in Spanish. It represents an initial effort to compile and describe available Spanish measures. In effect, PPE is a Spanish edition of TIP. As a directory of commercially available tests, PPE is not designed to include all known tests. Specifically, PPE does not include research or proprietary instruments. Research instruments are often published in journals and serve the limited uses of test authors. Proprietary tests are frequently designed for specialized audiences (e.g., admissions, licensure, certification) or for highly secured markets (e.g., government, industry) and therefore are not considered commercially available. In addition, PPE does not include reviews of the tests it indexes, as does the MMY series and at least one other volume by Barrueco, López, Ong, and Lozano (2012), which offers reviews similar to those published by Buros for using PRUEBAS PUBLICADAS EN ESPAÑOL     

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19 tests available in Spanish and English that may be used to assess bilingual preschoolers. Although PPE has much in common with TIP, there are several important differences between the two volumes—most notably, the language of the tests for which entries were developed, as well as the languages of the resources themselves. PPE is written in Spanish and English throughout all parts of the volume, whereas the content of TIP is presented solely in English. The original inclination to publish a single volume with all of its content in both languages stemmed from a belief that some prospective users of PPE would be English speakers who work with Spanish-speaking populations. To make the resource useful to speakers of either language, it was developed simultaneously in both languages. PPE was designed to be equally useful for practitioners who work with Spanish-speaking clients who (a) speak Spanish exclusively, (b) are bilingual in Spanish and English, or (c) speak English primarily and have limited proficiency in Spanish. The content is encyclopedic, with test titles arranged alphabetically. A user who knows the name of the test in which he or she is interested may locate the descriptive entry directly. Tests are indexed by their Spanish titles where Spanish titles exist. If a test of English origin has been translated or adapted into Spanish and therefore has a Spanish name, the test is alphabetized by its Spanish name. In this case, a user who knows only the English name can use the Index of Test Titles, which provides the Spanish name for tests that have been translated or adapted from English into Spanish. Tests developed in English that have some elements available in Spanish are alphabetized according to their English names. Shortly after the editors recognized the importance of developing the volume simultaneously in Spanish and in English, they determined that the volume also had to demonstrate a Spanish-first orientation. Thus, test information is provided first in Spanish and then in English. The introduction and most of the indexes follow this basic format. Indexes, which are essential to a reference volume such as PPE, were organized logically and in a manner that anticipated the needs of users. In the Índice de Títulos [Index of Titles] and the Índice de Acrónimos [Index of Acronyms] it was possible to present an introductory paragraph describing the content of the index in Spanish and then in English, followed by a unilingual presentation of the content. For some indexes, such as the Índice de Puntuación [Index of Scores], it was necessary to provide the entire index in Spanish, followed by a second complete index written in English. PPE contains 422 test entries. As with TIP, test descriptions are written using actual test materials rather than test catalogs or publishers’ websites. Using primary rather than secondary sources helps to ensure accuracy of the information published. As suggested previously, PPE content roughly 16       carlson and gonzalez

parallels that of TIP VIII in that the personality and vocational test categories have the greatest number of tests in them. Correspondence with the content of the 18th MMY is less pronounced, perhaps due in part to the smaller numbers of test entries in the yearbook (158 compared with 422 in PPE and 3,003 in TIP), as well as the fact that tests must meet certain review criteria to be included in the MMY. The proportion of tests that meet review criteria may differ across test categories. Similar to its English counterpart, PPE provides extensive and vital information about tests published in the Spanish language so as to acquaint test users with available measures and to facilitate appropriate selection of tests. Through direct correspondence with publishers and through procurement of actual test materials, PPE and TIP offer thorough information about currently available testing products confirmed to be in print. Each test entry is presented in Spanish and in English on the same page using the left column for Spanish content and the right for English. Test entries include descriptive information for up to 22 test features, ordered as shown in Figure 1.1. PPE data fields are similar to those used in TIP. However, to increase its utility, several modifications were implemented in PPE. Five TIP fields were eliminated because the content was rarely present for the tests described in PPE. Relevant information, where it existed, was incorporated into existing fields. The development of PPE over the last 3 years has shown that it is more than a Spanish version of TIP; it is truly a Spanish adaptation of TIP. In developing this volume, the editors routinely asked, “What information will users need to optimize their use of the resource?” Thus, in addition to the fields that were collapsed into other fields, seven fields were added in PPE to provide essential information to test users seeking Spanish language tests. These additions represent our effort not merely to translate a good reference work but to adapt it. Fields were added to indicate (a) whether Spanish norms are available, (b) in what country and language the test originated, (c) how any translation and adaptation processes were implemented, (d) test components available in Spanish, (e) test components available in English, (f) the name(s) of the translator(s) or adaptor(s), and (g) the original name of the test for test names that were translated (e.g., from English to Spanish). The new fields provide essential information for users contemplating whether a particular test can be used appropriately in a given testing situation. For example, a field called “Nombre Original” [Original Name] was added to include information about the earliest version of the test. Information in this field allows prospective users to connect the existing Spanish version of a test to its predecessor that was developed in another language (typically, but not always, English). Particularly for tests developed in a language other than Spanish that are translated or adapted to Spanish, it is essential to evaluate the appropriateness using PRUEBAS PUBLICADAS EN ESPAÑOL     

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Nombre de Prueba/Test Name: Test titles are provided in the language used by the publisher. *Nombre Original/Original Namea: Original test names are given for tests that have been translated from English or another language into Spanish. If known and different than the publisher of the Spanish version of a test, the original publisher’s information is provided in parentheses following the test name. Propósito/Purposeb *Procedencia/Origin: Country (year)/language. *Traducción/Adaptación/Translation/Adaptation: Often includes method of translation or adaptation. Población/Population: If the Spanish version lists grade level (Primaria, ESO, Bachillerato), these are translated to the corresponding ages. 2° Primaria = 7 years

1° ESO = 12

3° Primaria = 8

2° ESO = 13

4° Primaria = 9

3° ESO = 14

5° Primaria = 10

4° ESO = 15

6° Primaria = 11

1° Bachillerato = 16 2° Bachillerato = 17

*Baremos/Norms: Generally, one of two statements is made: Separate norms are not provided for the Spanish [version, translation, adaptation]. No se han provisto baremos para la [versión en, traducción al, adaptación al] español. OR Separate norms are provided for the Spanish [version, translation, adaptation]. Norms were developed using a sample of [insert total number] participants, distributed by [list applicable characteristics: age, grade, gender, race/ethnicity, geographic region, educational level, parental education, income, socioeconomic status].

Figure 1.1.  Descriptive fields in Pruebas Publicadas en Español. The following Tests in Print (TIP; Murphy, Geisinger, Carlson, & Spies, 2011) fields were collapsed into other fields in Pruebas Publicadas en Español (PPE; Schlueter, Carlson, Geisinger, & Murphy, 2013): Manual, Restricted Distribution, Foreign Language and Other Special Editions, Foreign Adaptations, and Sublistings. aFields with explanations are either new fields (*) in PPE or TIP fields that underwent substantial modification. bFields without explanations are populated in the same manner as in TIP. (continues)

18       carlson and gonzalez

Se han provisto baremos para la [versión en, traducción al, adaptación al] español. Los baremos se desarrollaron utilizando una muestra con [#] de sujetos, distribuidos por [enumerar las características que apliquen: edad, grado de instrucción, sexo, nacionalidad, nivel educativo de los padres, ingreso, estatus socioeconómico]. Fecha de Publicación/Publication Date Acrónimo/Acronym Puntuación/Scores Subpruebas/Subtests Administración/Administration Niveles, Ediciones, Partes y/o Formas/Levels, Editions, Parts, and/or Forms Precios, [año]/Prices, [year] Duración/Time Comentarios/Comments Autores/Authors *Traductor(a)/Adaptador(a)/Translators/Adaptors: May also include the name of the department at the publisher that handled the adaptation and translation. Editorial/Publisher *Componentes en Español/Spanish Components: For some tests, “All materials are available in Spanish/Todos los componentes están disponibles en español.” If the test offers only certain parts in Spanish, those parts are specified. For example, “The instructions and answer sheets are in Spanish/Las instrucciones y los formularios de respuesta son en español.” *Componentes en Inglés/English Components: For some tests, “There are no materials available in English/No hay materiales disponibles en inglés.” Tests that have been fully adapted into Spanish or that are translations often offer some or all test materials in English. In these cases, the English components are specified. Cross References: For tests that have been reviewed in the Mental Measurements Yearbook (MMY ) series, a test entry includes a final paragraph that provides a cross reference to the reviews, using the yearbook number and test number. In such cases, the test title in Pruebas Publicadas en Español and MMY will match exactly. Reviews of English tests with Spanish components may offer evaluative statements or commentary specific to the Spanish elements of the test.

Figure 1.1.  (Continued) using PRUEBAS PUBLICADAS EN ESPAÑOL     

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of the test norms (American Educational Research Association, American Psychological Association, & National Council on Measurement in Education, 1999). Thus, the availability of separate norms for the Spanish version of a given test is specifically addressed in the “Norms” field, a field unique to PPE. Similarly, information about the test translation or adaptation process is provided whenever that information is known using a new field called “Translation/Adaptation.” Another new field provides the names of the translators or adaptors, when known. Two other important fields that were added for PPE detail the test components that are available in Spanish, as well as those available in English. An entry for the “Spanish Components” field that says, “All materials are available in Spanish” represents a test that was either developed entirely in Spanish or fully adapted to Spanish from the original language used in test development. For tests that have been reviewed in the MMY series, a test entry includes a final paragraph that contains a cross-reference to the reviews for that test, using the yearbook number and test number. For example, 18:38 refers to the reviews published for Test 38 in the 18th MMY (Developmental Profile 3), and a cross reference to 17:14 refers to the reviews published for Test 14 in the 17th MMY (Batería III Woodcock-Muñoz). For entries with cross-reference information, test titles in PPE and MMY match exactly. Some reviews of English tests with Spanish components offer evaluative statements or commentary specifically directed to the Spanish elements of the test. USING PRUEBAS PUBLICADAS EN ESPAñOL IN CLINICAL AND INTELLECTUAL TESTING APPLICATIONS The encyclopedic organization of PPE facilitates its use. If the title of a test is known, the reader can locate the test description quickly and directly because the tests are ordered alphabetically by title. Many of the major test classifications included in PPE are relevant to clinical and intellectual assessment—for example, personality, intelligence and general aptitude, behavior assessment, neuropsychological, sensory motor, and developmental, among others. In addition to descriptive entries for 422 tests, PPE includes six indexes that serve as valuable aids to effective use, including indexes of test titles, acronyms, names, publishers, scores, and classifications. The organization of PPE and its extensive indexes make it possible to access test information when one has only partial knowledge of a test and is missing certain vital information. For example, by using the indexes one can locate information when one knows only the test title, test author, or test publisher. Test users may search for test titles in the Index of Titles in the language(s) used by the test publisher. In other words, tests originally published in English and later 20       carlson and gonzalez

adapted into Spanish typically have a Spanish title. In this case, both titles are included in the Index of Titles. One can use the Score Index to find a test that contains a particular kind of score that may be a subtest score within a test. For example, a score for hopelessness may be sought and found within many tests that evaluate depressive symptomatology. The Score Index provides an index to all scores generated by the tests included in PPE. Similarly, the Classified Subject Index is of great help to readers who seek a listing of tests in given subject areas, and it can be used to identify a large number of tests in a given assessment domain. PPE can best assist practitioners in the test selection process when consideration is given to such interrelated factors as (a) the language and cultural background of both the test taker and the test giver (Dana, 1998), (b) the understanding of the Spanish language per se (e.g., different dialects, geographic location of the Spanish-speaking normative sample compared with the client being evaluated), and (c) the understanding of test quality in light of the translation and adaptation process used (Geisinger, 1994). PPE provides a wealth of test information, including vital information about the translation and adaptation process, the existence of appropriate norms, and the availability of specific test components in Spanish and in English. All of this information may be used to compare tests across important test features and, thus, optimize test selection. CASE ILLUSTRATIONS The following scenarios serve as case illustrations that demonstrate how clinicians can effectively use the information provided in PPE to aid in test identification and selection. For purposes of illustration, emphasis is given to only a few of the many fields associated with test entries in PPE. Under normal circumstances, clinicians would consider information from all or nearly all descriptive fields. Scenario 1: Seeking a Behavioral and Emotional Screening Test Practitioner A and Practitioner B live and work in the United States and serve predominantly Spanish-speaking clients. Independent of each other, the two practitioners searched for a measure to serve as a behavioral and emotional screening test for their clients. The practitioners vary in their Spanish language proficiency. Practitioner A is fluent in Spanish, whereas Practitioner B has limited proficiency. Both clinicians used the Classified Subject Index in PPE to identify tests that may be used as behavioral and emotional screening test, searching under the Behavior Assessment using PRUEBAS PUBLICADAS EN ESPAÑOL     

21

heading. Each practitioner found the descriptive entry for the BASC–2 Behavioral and Emotional Screening System (Kamphaus & Reynolds, 2007) in PPE (see Figure 1.2) and evaluated whether this measure would meet their assessment needs. Each practitioner considered his or her own level of Spanish language proficiency together with the language needs of the clients and clients’ families. The practitioners may arrive at different judgments about the appropriateness of using this assessment in his or her specific context. Practitioner A, with near-native fluency in Spanish, read the descriptive entry for the BASC–2 found in PPE and noted that the Spanish Components field indicated that the test has select, but not all, forms translated into Spanish (see Figure 1.2). The Norms field revealed that the test provides no norming information for the forms translated into Spanish. Practitioner A prefers a fully adapted test and has the Spanish language proficiency to support continued searching. The practitioner decided to continue searching through PPE for other tests that screen for behavioral and emotional issues that are full adaptations and include norming information with a sample of Spanish speakers in the United States. Practitioner B, with limited Spanish proficiency, read the descriptive entry for the BASC–2 found in PPE and noted the absence of separate norms for the forms translated into Spanish. Practitioner B then carefully considered the information presented in the Translation/Adaptation field and was impressed with the description of the process the forms underwent as they were translated into Spanish. The practitioner took special notice of the fact that the parent forms and the student forms are available in Spanish and also noted the availability of the materials in English. Practitioner B concluded that this measure would be a good screening tool in the context in which the practitioner planned to use it. Primarily because of Practitioner B’s limited Spanish proficiency, the evaluation process and the conclusion reached about the test’s utility differed from that described for Practitioner A. Scenario 2: Seeking an Intellectual Ability Measure Practitioner C wished to use PPE as a resource to help inform a decision for selecting a test. As a bilingual practitioner, Practitioner C sought an in-depth intellectual ability assessment for a Spanish-speaking client who resides in the United States. The clinician used the Classified Subject Index in PPE to identify tests that may be used to assess intelligence and general aptitude. He was especially interested in the Translation/Adaptation field because he believes it is imperative to choose a test that has been fully adapted rather than merely translated. This field describes the process used by the test developer to produce the test (or select test components) in Spanish. Using 22       carlson and gonzalez

Figure 1.2.  Sample entry for the BASC–2 Behavioral and Emotional Screening System (Kamphaus & Reynolds, 2007). From Pruebas publicadas en Español (p. 20), by J. Schlueter, J. F. Carlson, K. F. Geisinger, and L. L. Murphy (Eds.), 2013, Lincoln, NE: Buros Center for Testing. Copyright 2013 by Buros Center for Testing. Adapted with permission. using PRUEBAS PUBLICADAS EN ESPAÑOL     

23

the information in PPE, Practitioner C identified a number of measures that appear to be direct translations of measures developed in English. From the descriptive entries, he ascertained that many of the identified tests provide several forms in Spanish and sometimes provide translated instructions for oral administration as well. Practitioner C also found that although some tests provide for the test instructions to be delivered in Spanish, the actual test materials (e.g., response forms) are entirely in English. After considering several tests as options, he found the test entry for the Wechsler Preschool and Primary Scale of Intelligence (3rd ed.; WPPSI–III; Wechsler, 2002; see Figure 1.3). The test entry for the WPPSI–III revealed several pieces of information that were crucial to Practitioner C’s test selection process. As shown in Figure 1.3, the Translation/Adaptation field describes in considerable detail the process used to adapt the WPPSI–III for use with Spanish-speaking children. Practitioner C believed this test deserved further consideration and reviewed the information provided in the Norms field. Two issues were of concern. First, the practitioner used the information in PPE to ascertain that the standardization sample is representative of children in Spain. Practitioner C considered how or whether cultural and linguistic differences that might exist between a Spanish speaker from Spain versus a Spanish speaker from the United States would affect the use of WPPSI–III test scores. Second, the practitioner used information in PPE to confirm that the normative sample was distributed by the same nine age groupings used for the original English version of the test. Practitioner C regarded this fact as an advantage because it would be easier to compare the performance levels of his clients with performance levels demonstrated by same-age peers. Despite the test being normed in Spain rather than in the United States, Practitioner C affirmed that the WPPSI–III was suitable for use with his clients. Other available tests that are direct translations or that provide only portions of the test in Spanish were ruled out in favor of the WPPSI–III. CONCLUSION The need for a comprehensive bibliography of Spanish tests has never been more pronounced. In the United States alone, Spanish speakers constitute well over 10% of the population, and this proportion will expand in coming years. The demand for tests—clinical and intellectual as well as many other types—that may be used with Spanish-speaking members of society is already high and will continue to grow. The development of PPE is a response to an obvious need and represents a continuation of efforts by the Buros Center for Testing to provide resources for professionals 24       carlson and gonzalez

Figure 1.3.  Sample entry for the Wechsler Preschool and Primary Scale of Intelligence–III (Wechsler, 2002). From Pruebas publicadas en Español (p. 121), by J. Schlueter, J. F. Carlson, K. F. Geisinger, and L. L. Murphy (Eds.), 2013, Lincoln, NE: Buros Center for Testing. Copyright 2013 by Buros Center for Testing. Adapted with permission. using PRUEBAS PUBLICADAS EN ESPAÑOL     

25

who develop, evaluate, study, purchase, and/or use tests. Its development is entirely consistent with the objectives of the Center’s founder, Oscar K. Buros: to improve the science and practice of testing by offering information about commercial products to informed consumers. Similar to its English counterpart, PPE provides extensive and vital information about commercially available tests published in the Spanish language. Its information helps to acquaint test users with available measures, and it facilitates appropriate selection of tests. Its bilingual yet Spanish-first composition makes it accessible to a wide range of practitioners working with a wide range of Spanish-speaking clients. REFERENCES American Educational Research Association, American Psychological Association, & National Council on Measurement in Education. (1999). Standards for educational and psychological testing. Washington, DC: American Educational Research Association. Barrueco, S., López, M., Ong, C., & Lozano, P. (2012). Assessing Spanish–English bilingual preschoolers. Baltimore, MD: Brookes. Carlson, J. F., Geisinger, K. F., & Jonson, J. L. (Eds.). (2014). The nineteenth mental measurements yearbook. Lincoln, NE: Buros Center for Testing. Dana, R. H. (1998). Projective assessment of Latinos in the United States: Current realities, problems, and prospects. Cultural Diversity and Mental Health, 4, 165–184. http://dx.doi.org/10.1037/1099-9809.4.3.165 Elosua, P., & Iliescu, D. (2012). Tests in Europe: Where we are and where we should go. International Journal of Testing, 12, 157–175. http://dx.doi.org/10.1080/ 15305058.2012.657316 Evers, A., Muñiz, J., Bartram, D., Boben, D., Egeland, J., Fernández-Hermida, J. R., . . . Urbánek, T. (2012). Testing practices in the 21st century: Developments and European psychologists’ opinions. European Psychologist, 17, 300–319. Geisinger, K. F. (1994). Cross-cultural normative assessment: Translation and adaptation issues influencing the normative interpretation of assessment instruments. Psychological Assessment, 6, 304–312. http://dx.doi.org/10.1037/ 1040-3590.6.4.304 Kamphaus, R. W., & Reynolds, C. R. (2007). BASC–2 Behavioral and Emotional Screening System. San Antonio, TX: Pearson. Murphy, L. M., Geisinger, K. F., Carlson, J. F., & Spies, R. A. (Eds.). (2011). Tests in Print VIII. Lincoln, NE: Buros Institute of Mental Measurements. Puente, A. E. (2011, August). Testing Spanish-speaking individuals: Challenges, practices, and ethical concerns. Paper presented at the annual meeting of the American Psychological Association, Washington, DC.

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Schlueter, J., Carlson, J. F., Geisinger, K. F., & Murphy, L. L. (Eds.). (2013). Pruebas publicadas en Español [Tests published in Spanish]. Lincoln, NE: Buros Center for Testing. Shin, H. B., & Ortman, J. M. (2011, April 21). Language projections: 2010 to 2020. Paper presented at the meeting of the Federal Forecasters, Washington, DC. Retrieved from http://www.census.gov/hhes/socdemo/language/data/acs/Shin_ Ortman_FFC2011_paper.pdf Spies, R. A., Carlson, J. F., & Geisinger, K. F. (Eds.). (2010). The eighteenth mental measurements yearbook. Lincoln, NE: Buros Institute of Mental Measurements. Wechsler, D. (2002). Wechsler Preschool and Primary Scale of Intelligence—Third Edition (WPPSI–III). San Antonio, TX: Pearson.

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2 EVALUATING AND MEASURING MEXICAN PERSONALITY: ETIC AND CROSS-CULTURAL PERSPECTIVES FERNANDO A. ORTIZ

Among the 50.7 million U.S. Hispanics in the United States, nearly two thirds (65%) self-identify as being of Mexican origin (U.S. Census Bureau, 2012). Evaluating psychologists often struggle with testing these Mexicans due to the scant psychological theory on Mexican personality structure, behavior, and psychopathology; the limited empirical studies reviewing most commonly used personality instruments with Mexicans; and the lack of clear psychometric guidelines for effectively evaluating this population residing in the United States. This chapter critically reviews the research on personality structure and measurement of Mexicans with an eye toward informing evaluating psychologists on how they can enrich their conceptualizations of Mexican personality measurement and testing. The chapter also provides a brief critique of Mexican research on personality structure and measurement because it

http://dx.doi.org/10.1037/14668-003 Psychological Testing of Hispanics, Second Edition: Clinical, Cultural, and Intellectual Issues, K. F. Geisinger (Editor) Copyright © 2015 by the American Psychological Association. All rights reserved.

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is largely through a systematic review and knowledge of the literature that psychologists evaluating Mexicans provide culturally informed psychological conceptualizations and reports. Such reviews can also remind evaluating psychologists that personality theories, constructs, and measures reflect the cultural context from which they have emerged. That is, although European and American psychologists still dominate around the world, they do not provide the only perspective for psychological testing. Unfortunately, for many psychologists assessing Mexicans who only speak Spanish or have limited ability to speak Spanish themselves, it can be difficult to access psychological literature published in Spanish because of language, culture, and access barriers. This chapter seeks to remedy this situation for the Mexican culture by reviewing the extensive literature published in both English and Spanish. Psychologists evaluating Mexicans often approach testing as if culture did not matter. However, Mexican culture differs from mainstream American culture in many ways. For example, Hofstede (1980, 2001) ranked 53 cultures along four value-based dimensions. On the Individualism dimension, Mexico ranked 32nd and the United States ranked first. As noted by others (e.g., Díaz-Loving & Draguns, 1999), Mexican culture is relatively collectivistic, with a strong emphasis on tightly knit family and social relations. On the Power Distance dimension, Mexico ranked much higher (tied for fifth) than the United States (38th), suggesting a greater acceptance of unequal power and status in Mexican culture. Mexico also ranked higher (sixth) than the United States (15th) on the Masculinity dimension, perhaps reflecting the greater differentiation of gender roles in Mexican society. On the Uncertainty Avoidance dimension, Mexico ranked 18th and the United States 43rd, suggesting that there is greater discomfort with uncertainty and ambiguity in Mexican culture than in American culture. In a comparison of behavioral indicators of pace of life in 31 countries, Levine and Norenzayan (1999) ranked Mexico as slowest in pace of life, whereas the United States ranked 16th. Given cultural differences such as these, and assuming that culture affects personality significantly (Triandis & Suh, 2002), one would expect to find some differences in the salience of various personality constructs in Mexican versus American psychology. Indeed, some of the personality-relevant constructs emphasized by Mexican psychologists (e.g., affiliative obedience, respect, abnegation, nonassertiveness, machismo) seem to reflect salient Mexican values or cultural themes. Therefore, when evaluating Mexicans it is important to consider culture-specific constructs. Most personality assessment is conducted from the theoretical perspective of trait psychology. In this perspective, personality traits—defined as relatively stable or enduring individual differences in thoughts, feelings, and behavior—are viewed as central and valid in describing persons and their 30       fernando a. ortiz

behavior across cultures. Typical features of the cross-cultural trait psychology approach include (a) comparisons of multiple cultures in the hopes of demonstrating cross-cultural universals or identifying culture-specifics amidst these universals; (b) treatment of culture, or quantitative variables indexing culture and ecology (e.g., aspects of the physical environment), as variables “outside” the individual, which can be used to predict personality and behavior; (c) use of traditional psychometric scales or inventories to assess both culture and personality; (d) emphasis on issues of cross-cultural equivalence of constructs and measures; and (e) a focus on individual differences in personality traits, values, beliefs, and so forth. For example, in their five-factor personality model, McCrae and Costa (1996) argued that certain basic tendencies, including the trait dimensions of the five-factor or Big Five personality model—Extraversion, Agreeableness, Neuroticism, Conscientiousness, and Openness to Experience—are biologically based and independent of culture. These are distinguished from characteristic adaptations, such as personal strivings, attitudes, habits, and aspects of self-concept, that are influenced by both basic tendencies and external influences such as culture. In general, cross-cultural trait psychologists tend to treat culture as an independent variable that may affect the level, expression, and correlates of traits, but not the underlying structure or dimensions of personality (e.g., Barrett, Petrides, Eysenck, & Eysenck, 1998; McCrae & Allik, 2002). Support for the trait psychology perspective comes from empirical evidence of near universal trait dimensions such as the Big Five (Katigbak et al., 2013), the moderate heritability of traits in different cultures (Loehlin, McCrae, Costa, & John, 1998), the predictive validity of trait assessments across cultures, observer agreement in trait ratings in different cultures (Malloy, Albright, Díaz-Loving, Dong, & Lee, 2004; McCrae et al., 2004), and the finding that people in all cultures use trait terms to describe persons and their behavior (see Church, 2000; McCrae, 2000, for reviews). Personality psychologists who have studied Mexican personality have primarily applied the cross-cultural or etic perspective. Psychologists differentiate between the cross-cultural and indigenous approaches, or the etic (universal) and emic (indigenous, culture-specific) distinction, respectively (Berry, 1969). In the imposed-etic or imported approach, measures of personality constructs in a source culture (usually Western) are transported to new cultural contexts to see how well they generalize across cultures. In the emic approach, researchers identify and measure personality dimensions that are indigenous to particular cultures. Both approaches can address the crosscultural universality of personality structure. The imposed-etic approach may be the best way to disprove claims of universality (if personality structures fail to replicate across cultures), but imported instruments may also tend to impose evaluating and measuring mexican personality     

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their structure on examinees to some extent. Imported measures could also miss salient culture-specific dimensions (Church, 2001). Other advantages of the imported (imposed-etic) approach include efficiency, the use of known constructs within existing theoretical frameworks and nomological networks, and the ability to make mean comparisons across cultures. Advantages of indigenous approaches include the greater opportunity to identify culture-specific dimensions, the ability to tap particularly relevant behavioral indicators of particular traits in the item content, and the opportunity to identify aspects of indigenous psychologies independent of psychologies developed elsewhere. Indeed, if comparable dimensions are found among indigenous dimensions derived independently in diverse cultures, it would provide particularly strong evidence of universality. This chapter focuses exclusively on the imposed-etic psychological literature on personality structure and measurement with Mexicans. ETIC PERSPECTIVES ON THE ASSESSMENT OF MEXICANS Psychologists who evaluate Mexicans using primarily a cross-cultural perspective often administer etic inventories and generally believe (a) in the cross-cultural replicability or universality of the dimensions assessed by such inventories, (b) that the nomological networks (e.g., behavioral correlates) of personality constructs are comparable across cultures, and (c) in the ability to interpret cultural differences in trait levels. The psychological literature on the assessment of Mexicans, particularly in the United States, has predominantly used this approach to measure and evaluate Mexican personality. The following is a detailed review of this approach. Structural Replication How well do the dimensions assessed by etic inventories replicate when administered, scored, and interpreted with Mexican examinees? Psychologists using the Big Five or five-factor model, comprising Extraversion, Agree­ ableness, Conscientiousness, Emotional Stability versus Neuroticism, and Intellect or Openness to Experience, have successfully used this model to evaluate personality in many cultures (McCrae & Allik, 2002). Studies with Mexican participants using this personality model have obtained moderate replicability, as illustrated in Table 2.1. Cheung and Cheung (2003) discussed several issues that should be addressed to ensure structural replicability when importing instruments into new cultures, including the adequacy and equivalence of the translated and adapted instruments, reliability and validity, standardization and the use 32       fernando a. ortiz

TABLE 2.1 Replicability of the Big Five Model of Personality Replicability methodology

Study

Instrument

Rodríguez & Church (2003)

BFI

Factor analysis, Cronbach reliability

McCrae & Terracciano (2005) Eysenck & Lara (1989)

NEO-PI-R

Factor analysis

EPQ

Factor analysis, Cronbach reliability

Barrett, Petrides, Eysenck, & Eysenck (1998)

EPQ

Factor analysis

Church et al. (2006)

IPIP

Factor analysis

Ortiz et al. (2007)

NEO-PI-R

Church et al. (2011)

NEO-PI-R

Factor analysis, Procrustes rotation, congruence coefficient, Cronbach reliability Cronbach reliability, multigroup confirmatory factor analysis, differential item functioning

Findings Fairly well replicated Extraversion, Neuroticism, and Openness to Experience Strong replication of all five dimensions Good replication of Neuroticism, Extraversion, and Psychoticism dimensions Robust replication of Neuroticism, Extraversion, and Psychoticism Full replication of five dimensions of personality Five dimensions replicated well, although reliability was poor for some facets (i.e., assertiveness) Robust replication of five factors with some items exhibiting differential item functioning

Note. BFI = Big Five Inventory (John, Donahue, & Kentle, 1991); EPQ = Eysenck Personality Questionnaire (Eysenck & Eysenck, 1975); IPIP = International Personality Item Pool (Goldberg, 1999); NEO-PI-R = New Personality Inventory (Revised; Costa & McCrae, 1992).

of original versus local norms, interpretation of cross-cultural differences in test scores, and possible omission of culture-specific dimensions. An analysis of instruments based on the five-factor model illustrates that efforts have been made to ensure translation adequacy and equivalence (e.g., using back translation), but bilingual test–retest studies, in which the scores of bilinguals on both language versions are compared, are scarce. Reliability has typically been examined and the most commonly used methodology to establish crosscultural measurement is through exploratory factor analysis. Confirmatory factor analyses and analyses of differential item functioning (DIF) have been rare. evaluating and measuring mexican personality     

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Table 2.1 shows that Rodríguez and Church (2003) factor analyzed the Spanish version of the Big Five Inventory (Benet & Waller, 1995) with a large sample of Mexicans. In a principal components analysis, the Extraversion, Neuroticism, and Openness to Experience dimensions were fairly well replicated, but the Agreeableness and Conscientiousness terms were divided among the remaining two factors. In a Procrustes solution, all five dimensions were replicated, but replication was weakest for the Agreeableness factor, for which only five of nine items had high factor loadings. McCrae and Terracciano (2005) replicated the Big Five dimensions in a sample of undergraduate Mexican students. Factor analyses in the Mexican culture showed that the normative American self-report structure was clearly replicated. Similarly, S. B. G. Eysenck and Lara (1989) and Barrett et al. (1998) reported good replication in Mexico of the neuroticism, extraversion, psychoticism, and lie dimensions of the Eysenck Personality Questionnaires (EPQ; H. J. Eysenck & Eysenck, 1975). Other studies (Church et al., 2006, 2011; Ortiz, Church, Vargas-Flores, & Ibanez-Reyes, 2007) have demonstrated a robust and more conclusive replication of the five dimensions of personality. Evaluating psychologists can reliably and validly use this model when assessing Mexican individuals. Similarly, Mexican psychologists have adapted other personalityrelated measures. Mercado, Fernández, and Contreras (1991) concluded that the scales of the Jackson Personality Inventory (JPI; Jackson, 1967), a measure of Murray’s (1962) needs, have insufficient factorial validity and item homogeneity when used with Mexicans. Factor analyses were conducted at the item level within each scale, rather than in the item pool as a whole. Díaz-Loving, Díaz-Guerrero, Helmreich, and Spence (1981) replicated the four dimensions—positive and negative masculinity and femininity—of Spence and Helmreich’s (1978) Personal Attributes Scale, but the loadings of some items (e.g., dominant, dictatorial, servile) suggested the presence of culture-specific meanings. Díaz-Loving, AndradePalos, and la Rosa (1989) found that the three-dimensional structure of Spence and Helmreich’s (1983) Work and Family Orientation Inventory did not replicate well in a Mexican sample, leading them to develop an emic operationalization of these constructs (see also Díaz-Loving, 1998). Flores-Galaz (1989) found three factors, not the original four, when applying the Rathus (1973) Assertiveness Scale with Mexicans, and she labeled the factors quite differently. La Rosa and Díaz-Loving (1991) identified five dimensions in a factor analysis of Rotter’s (1966) locus of control scale, thus failing to support Rotter’s conception of locus of control as a unidimensional, generalized expectancy of internal versus external control. The multidimensionality of the Rotter measure is not unique to its use with Mexicans, however. Smith, 34       fernando a. ortiz

Dugan, and Trompenaars (1997) conducted a pancultural (i.e., combined sample) factor analysis of locus of control items across 14 countries, including Mexico, and identified four dimensions: socio-political control, effort, luck, and active friendship. The researchers did not attempt to replicate these factors separately within each culture, however. Nadelsticher Mitrani, Díaz-Loving, and Nina (1983) adapted an emotional empathy measure developed by Mehrabian and Epstein (1972). A number of items performed poorly when this instrument was used with Mexicans, and item-level factor analyses produced a scale structure that differed from the original test. Similarly, Díaz-Loving, Andrade-Palos, and Nadelsticher Mitrani (1986) adapted Davis’s (1983) Interpersonal Reactivity Scale to develop the Multidimensional Scale of Empathy. In a factor analysis, they partially replicated three of the original dimensions (i.e., empathic concern, perspective taking, and personal distress). However, based on the item-loading patterns, they relabeled these dimensions to better reflect unique aspects of empathy when used with Mexicans (i.e., emphatic compassion, cognitive empathy, and self-disturbance). The authors wrote items for two new dimensions, indifference towards others and emotional contagion, that they thought would be relevant to empathy when administered to Mexicans. A factor analysis of the Piers-Harris Children’s Self-Concept Scale by Servín-Terrazas (1994) produced six subscales, as in the original test, but the many differences in item loadings led the author to relabel most of the dimensions. Moscoso (2000) developed the Multicultural Latin-American Anger Expression Inventory by adapting Spielberger’s (1988) State–Trait Anger Expression Inventory. In a pancultural factor analysis, conducted across seven Latin American countries, including Mexico, Moscoso replicated quite well the seven dimensions in the original instrument. Similarly, replication of the dimensions of the Center for Epidemiological Studies Depression scale (Mariño, Medina-Mora, Chaparro, & Gonzáles-Forteza, 1993) and the Beck Anxiety Inventory (Robles, Varela, Jurado, & Páez, 2001) in Mexican samples has been fairly good. In summary, these uses of etic inventories with Mexicans have demonstrated that etic personality dimensions sometimes retain their structure when administered to Mexicans. In some cases, this lack of total equivalence may reflect limitations of the adapted measure or the need for the inclusion of new, culture-specific items. However, it also suggests that the domains defined by various personality constructs may differ somewhat when used with Mexicans, as compared with individuals from other cultures. It is recommended that evaluating psychologists who seek to use etic instruments with Mexicans closely examine the psychometric properties suggesting acceptable structural replication of constructs. evaluating and measuring mexican personality     

35

Comparability of Behavioral Exemplars How well do the behavioral exemplars of traits generalize when personality-related instruments are administered to Mexicans? Relevant evidence includes the following: (a) test developer or researcher reports of the need to adapt or exclude items that lack cultural relevance, (b) significant decreases in scale reliability or item factor loadings, and (c) statistical evidence of DIF. It has been common practice to adapt items to make them more culturally meaningful when assessment instruments are used with Mexicans. Unfortunately, test developers and researchers have generally provided illustrations of item modifications but not reported the proportion of items needing adaptation. In adapting the Minnesota Multiphasic Personality Inventory (MMPI; Hathaway & McKinley, 1940), E. Lucio, Reyes-Lagunes, and Scott (1994) noted that only 3% of the items had to be rewritten to make them more functionally equivalent when the MMPI is used with Mexicans. Such items were identified by a panel of 15 Mexican MMPI experts. Researchers have tried to avoid American idiomatic expressions in MMPI items. For example, Núñez (1981) changed the expression “on top of the world” to the Mexican saying “como si viviera en las nubes” [as if I were living in the clouds] and the expression “I feel blue” to the nonidiomatic expression “me siento triste” [I feel sad]. Similarly, because the word for excitement in Spanish has sexual connotations, Núñez (1981) and Reyes-Lagunes (1996) modified an MMPI item containing this term to obtain better linguistic equivalence. Internal consistency reliability data can also address whether behavioral exemplars of personality constructs cohere as well in different cultures. Mexican test developers have commonly reported the reliabilities of imported or adapted scales for Mexicans in evaluating the psychometric properties of the adapted versions. However, they have generally not discussed how these reliabilities compare with those obtained in the culture of origin of the test. Nonetheless, when used with Mexicans, the alpha reliabilities reported for adaptations of such instruments as the Eysenck Personality Questionnaire (LaraCantú, Cortés, & Verduzco, 1992), Millon Index of Personality Styles (Aparicio García & Sánchez-López, 1998), and Big Five Inventory (Rodríguez & Church, 2003) have generally been about .10 lower than in normative or comparison samples in the cultures of test origin (e.g., Benet-Martínez & John, 1998; H. J. Eysenck & Eysenck, 1975; Millon, Weiss, Millon, & Davis, 1994; see also Nadelsticher Mitrani et al., 1983). In contrast, in a Mexican standardization of the Temperament and Character Inventory (Cloninger, Przybeck, Svrakic, & Wetzel, 1994), Sánchez de Carmona, Páez, López, and Nicolini (1996) reported that the internal consistency reliabilities were comparable to those in the U.S. normative sample, except for one scale measuring helpfulness (a = .39). 36       fernando a. ortiz

Nonetheless, given that items fairly frequently fail to load on intended factors, as noted in the previous section on structural replication, one expects that internal consistency reliabilities will frequently be lower with these instruments when they are used with Mexicans than in the cultures of origin. Analyses of DIF also address the cross-cultural equivalence of behavioral exemplars of traits. In a comparison of Anglo Americans, English-speaking Hispanics in the United States, and Mexican college students, Ellis and Mead (2000) found DIF and test functioning in each of the 17 scales of the Sixteen Personality Factors Questionnaire (Cattell, 1949), although the number of items per scale exhibiting DIF was typically small. Items that exhibit DIF are not necessarily irrelevant indicators of a personality construct in Mexico. However, such items can reflect cultural differences in how well the behaviors referred to in the items differentiate individuals on the relevant traits. More DIF studies with widely used personality inventories would be useful. In a recent study, Church et al. (2011) examined the DIF of the Neuroticism–Extraversion–Openness to Experience Personality Inventory (Revised; NEO-PI-R; Costa & McCrae, 1992) with a Mexican and U.S. sample. The study addressed the following questions: How much DIF is exhibited when using this personality instrument for pairwise cultural comparisons between U.S. and Mexican participants? Are there consistencies across cultural comparisons in the items and facets that exhibit the most DIF? When DIF is detected, is there any pattern in which cultural samples exhibit the highest loadings or intercepts? Table 2.2 shows a summary of the NEO-PI-R items and factors in a U.S. and Mexican sample (Church et al., 2011). One noteworthy finding is that loading DIF was relatively infrequent, whereas DIF was quite frequent. This ratio of occurrence is consistent with what is seen in other large standardized tests. The percentage of items that exhibited loading DIF was modest, as indexed by the criterion. In summary, the relatively small amount of DIF in the NEO-PI-R loadings indicates that item-level metric equivalence was generally good for most facets. Thus, when evaluating psychologists used this instrument with Mexican individuals, the behavioral exemplars referred to in most of the items are culturally relevant and meaningful for the individuals taking the test. Currently, one can only conclude that test developers and researchers commonly report that some items are less relevant when these instruments are used with Mexicans, but one cannot confidently quantify the extent to which behavioral exemplars of traits fail to generalize to Mexican examinees for most assessment inventories. Cultural Mean Differences When assessment results from Mexicans are compared with American samples or norms, are mean differences frequently found? And if so, do these evaluating and measuring mexican personality     

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38       fernando a. ortiz

TABLE 2.2 Summary of Noninvariant NEO-PI-R Items and Facets in U.S.–Mexico Comparison Factor loadings

Intercepts

No. of DIF items NEO-PI-R facet Neuroticism N1: Anxiety N2: Angry hostility N3: Depression N4: Self-consciousness N5: Impulsivity N6: Vulnerability Extraversion E1: Warmth E2: Gregariousness E3: Assertiveness E4: Activity E5: Excitement-seeking E6: Positive emotions Openness to Experience O1: Fantasy O2: Aesthetics O3: Feelings O4: Actions O5: Ideas O6: Values

Facet noninvariance

No. of DIF items

Loadings

Dc2

DCFI

Mean DCFI

US:Mex ratio

Dc2

DCFI

Mean DCFI

US:Mex ratio

4 3 4 0 1 0

3 1 2 0 1 0

.02 .01 .01 — .03 —

4:0 1:2 4:0 — 1:0 —

4 2 3 5 6 5

3 2 3 5 3 3

.03 .02 .04 .04 .03 .02

3:1 0:2 3:0 3:2 5:1 2:3

0 0 1 0 1 2

0 0 0 0 0 0

— — .01 — .01 .00

— — 1:0 — 1:0 1:1

6 5 4 6 6 2

5 4 4 5 3 0

.06 .02 .05 .04 .06 .01

0 0 0 5 1 3

0 0 0 5 0 3

— — — .07 .00 .07

— — — 4:1 0:1 3:0

6 7 5 1 6 3

4 4 5 1 1 3

.02 .02 .08 .12 .01 .09

Dc2

Intercepts

DCFI

Dc2

DCFI

— 13.06 M — Anchor — —

— .01 — — — —

26.13 US — 16.28 US 23.23 US 36.00 US —

.01 — .01 .01 .02 —

6:0 2:3 2:2 5:1 5:1 2:0

— — — — Anchor —

— — — — — —

100.26 US — — 22.01 US — —

.06 — — .01 — —

4:2 2:5 5:0 0:1 1:5 1:2

— — Anchor — — —

— — — — — —

— 14.21 M 69.68 US 300.53 M 16.33 M —

— .02 .08 .33 .02 —

evaluating and measuring mexican personality     

Agreeableness A1: Trust A2: Straightforwardness A3: Altruism A4: Compliance A5: Modesty A6: Tender-mindedness Conscientiousness C1: Competence C2: Order C3: Dutifulness C4: Achievement-striving C5: Self-discipline C6: Deliberation

1 0 0 1 2 1

0 0 0 0 1 1

.01 — — .01 .02 .07

1:0 — — 1:0 1:1 1:0

7 4 7 3 6 7

4 3 4 2 6 7

.02 .05 .03 .04 .05 .11

7:0 4:0 7:0 2:1 6:0 2:5

Anchor — — — — —

— — — — — —

141.63 US 67.64 US 58.89 US 27.94 US 92.53 US 16.78 US

.03 .06 .05 .02 .08 .01

0 2 2 1 1 0

0 2 0 0 0 0

— .02 .01 .01 .00 —

— 2:0 2:0 1:0 1:0 —

3 2 1 6 4 4

0 1 1 3 2 3

.01 .03 .05 .02 .02 .02

3:0 2:0 0:1 2:4 2:2 1:3

— 13.61 US — — Anchor —

— .00 — — — —

— — 17.29 M 8.03 M — 9.78 M

— — .00 .00 — .00

Note.  In the Facet noninvariance columns, facets with significant loading or intercept noninvariance (Dc2) are annotated to indicate the culture with the higher loading or intercept. NEO-PI-R = Neuroticism–Extraversion–Openness to Experience Personality Inventory (Revised); CFI = comparative fit index; DIF = differential item functioning; US = United States; Mex = Mexico. Reprinted from “Are Cross-Cultural Comparisons of Personality Profiles Meaningful? Differential Item and Facet Functioning in the Revised NEO Personality Inventory,” by A. T. Church, J. M. Alvarez, N. T. Q. Mai, B. F. French, M. S. Katigbak, and F. A. Ortiz, 2011, Journal of Personality and Social Psychology, 101, p. 105. Copyright 2011 by the American Psychological Association.

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differences conform to expectations or tell us something about Mexican personality? A Classic Study In a longitudinal comparison of children from Mexico City and Texas, Holtzman, Díaz-Guerrero, and Swartz (1975) administered several imported personality measures (e.g., Holtzman Inkblot Technique, Human Figure Drawing, JPI). Several of the results led the authors to conclude that American children displayed an active style of coping that involved attempts to change the environment, whereas Mexican children displayed a more passive and obedient coping style, involving self-modifying behavior when confronted with stressors (see, e.g., Holtzman, 1979). For example, American children dealt with all aspects of the projective inkblot testing in a more active fashion. They were faster than the Mexican children in reaction time, used more definite form in their responses, and exhibited greater integration of parts of the inkblot stimuli in their responses. Comparisons with the JPI indicated that Mexican children had greater needs for order and autonomy, whereas the American children had greater needs for play, social recognition, affiliation, and impulsiveness. Holtzman et al. (1975) opined that the greater need for autonomy in Mexican children reflected their increasing awareness that they are highly dependent on others within the extended family and affiliative network. Some of these personality themes reappear in more recent research of indigenous Mexican psychologists, as noted later in this chapter. Recent Comparisons Lara-Cantú et al. (1992) found that Mexican adults averaged higher than British norms on the EPQ Extraversion scale, and commented that this finding is consistent with the social and hospitable nature of Mexicans. Mexican scores on the Neuroticism and Lie Scales were close to the British norms, whereas scores on the Psychoticism scale were difficult to interpret because many items had poor item loadings and discrimination. Sánchez de Carmona et al. (1996) did not find significant mean profile differences between Mexican and American standardization samples for the Temperament and Character Inventory (Cloninger et al., 1994). The largest number of cultural mean comparisons has involved the MMPI–2 (Butcher & Pancheri, 1976). With large sample sizes, these studies typically report a number of significant differences between Mexican and American T scores on the basic validity and clinical scales. However, relatively few scales have shown differences that are practically or clinically significant (i.e., differences exceeding one-half standard deviation or 5 or more T-score points). E. Lucio et al. (1994) noted elevations of this size relative 40       fernando a. ortiz

to American norms on Scales L (Lie) and 2 (Depression) in both Mexican male and female college students. They also found an even higher elevation (T > 6) on Scale 5 (Masculinity–Femininity) for Mexican women only. With the Mexican version of the MMPI–A, G. M. Lucio, Ampudia-Rueda, Dúran-Patiño, Gallegos-Mejía, and León-Guzmán (1999) replicated with adolescents the Mexican elevations on Scale L for both men and women and on Scale 5 for women. They also found a difference exceeding half a standard deviation on Scale 4 (Psychopathic Deviance) for women. The authors interpreted the Scale 4 elevation in women as suggesting adolescent issues with hostility and rebelliousness. E. Lucio et al. (1994) and E. Lucio, Ampudia, Durán, León, and Butcher (2001) also reported differences relative to American norms on Scale 5 for both Mexican college men and women, with men scoring slightly lower (T = 74) and women substantially higher (T = 64) than the American norms. Scott, Butcher, Young, and Gomez (2002) also found this elevation on Scale 5 in a Mexican sample, relative to Colombian, Peruvian, Spanish, and U.S. Hispanics. The most consistent MMPI differences involve elevations on Scale L in both and women and elevations on Scale 5 for women relative to the U.S. norms (Farías, Durán, & Gómez-Maqueo, 2003). Mexican psychologists have interpreted the elevations on Scale L as suggesting that Mexicans answer the inventory in a somewhat defensive manner and seek to present a favorable impression. Moral conservatism or religiosity can also increase L scores, so this is another possible interpretation to consider. Regarding the Scale 5 differences, authors have concluded that Mexican women, or at least the more educated women that are typically included in such university studies, tend to conform less to traditional roles of femininity than do women in the United States. E. Lucio et al. (1994) opined that Mexican college women have to be more assertive than American college women to counter traditional Mexican sex-type attitudes and to develop nontraditional interests and careers. These studies suggest that when evaluating psychologists use these etic inventories with Mexicans, they will, at least in some cases, obtain meaningful scores for cross-cultural comparisons and that Mexican profiles on measures of psychopathology such as the MMPI may not differ much from U.S. norms. Van de Vijver and Leung (1997), however, noted that construct, method, and item biases can reduce the direct or full score comparability of inventory scores. One form of method bias, response styles, has also been investigated. Clarke (2000) found that Mexican students, on average, exhibited higher levels of extreme response style (i.e., used the endpoints of rating scales more) than African American, French, and Australian students. Finally, Ellis and Mead’s (2000) study of DIF and test functioning indicated that item bias can also reduce the direct comparability of scores. In summary, evaluating and measuring mexican personality     

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when using these inventories with Mexicans, evaluating psychologists should interpret psychological findings cautiously, especially when examining apparent cross-cultural similarities and differences, because of uncertainties about the cross-cultural measurement equivalence of test scores and the appropriateness of foreign norms. Criterion Validity Consistent with trait perspectives, do imported personality measures predict relevant criteria when used with Mexicans? Researchers have provided evidence that they can. Many of these studies have involved measures of psychopathology, such as the MMPI–2. For example, G. M. Lucio et al. (1999) found significant differences between students and male psychiatric patients on all MMPI–2 basic validity and clinical scales except Scale 3 (Hysteria) and Scale 5. Boscan et al. (2002) showed that the MMPI–2 can differentiate between male university students and incarcerated criminal offenders in Mexico. For example, inmates averaged 5 to 14 T-score points higher on Scale 4, Scale 7 (Psychasthenia), and Scale 8 (Schizophrenia), as well as other supplemental and validity scales (e.g., Bizarre Mentation, Cynicism). Students averaged higher than inmates on the Ego Strength and Social Responsibility scales, among others. E. Lucio, Durán, Graham, and Ben-Porath (2002) found that the MMPI–2 F, F1, and F2 validity scales and the F–K index discriminated adequately between nonclinical adolescents instructed to fake bad and both clinical and nonclinical adolescents who received standard instructions. Lara-Cantú, Verduzco, Acevedo, and Cortés (1993) found that self-esteem was predicted in the manner expected by the EPQ dimensions of extraversion (r = .42), neuroticism (r = -.71), psychoticism (r = -.39), and social desirability (r = .19). Chávez, Allende, and Tinoco (1989) showed that most scales of the Personality Inventory for Children, a measure of attentional, conduct, personal, and social problems, predicted school achievement levels in relatively normal children and adolescents. Ornelas Bolado and Whitaker (1990); Almanza Muñoz, Páez-Agraz, Hernández-Daza, BarajasArechiga, and Nicolini-Sánchez (1996); Robles et al. (2001); and Nicolini et al. (1996) provided evidence of criterion validity for other measures of psychopathology. Fewer researchers have examined the criterion validity of imported measures of normal-range personality. O’Connell, Doverspike, NorrisWatts, and Hattrup (2001) found that an imported conscientiousness scale predicted organizational citizenship behaviors such as altruism and conscientiousness, whereas a measure of negative affectivity correlated negatively with these behaviors. Rodríguez and Church (2003) found that dimensions of 42       fernando a. ortiz

the Spanish Big Five Inventory predicted indigenous Mexican mood dimensions. Kirkcaldy, Furnham, and Levine (2001), in a culture-level analysis of 31 countries including Mexico, found that Spence and Helmreich’s (1983) measures of work ethic, mastery, and competitiveness, and other imported measures of achievement, predicted pace of life indexes (walking speed, postal service speed, and public clock accuracy). Some cultural psychologists have suggested that personality traits may be less predictive of behavior in collectivistic cultures, where the impact of contextual factors may be greater (Church, 2000). From this perspective, a five-culture study by Schimmack, Radhakrishnan, Oishi, Dzokoto, and Ahadi (2002) is noteworthy. Although the influence of Big Five Extraversion and Neuroticism on life satisfaction ratings was largely mediated by hedonic balance (the difference between positive and negative affect) in all five cultures, the two personality traits were stronger predictors of life satisfaction in the individualistic cultures (United States and Germany) than in the collectivistic cultures (Mexico, Ghana, and Japan). From a cultural psychology perspective, one would also expect interrater agreement in trait ratings to be lower in collectivistic cultures because the behaviors observed by raters in different contexts would be more variable. However, contrary to this prediction, Malloy et al. (2004) found that self–other agreement in Big Five trait judgments was as high in Mexico and China as in previous American studies (Malloy, Albright, Kenny, Agatstein, & Winquist, 1997). In summary, there is good evidence that imported inventories can predict relevant criteria in the Mexican context, but the evidence available for normal-range personality measures is limited. In addition, researchers have just begun to test cultural psychology hypotheses regarding the lower predictive validity and interrater agreement of trait measures with individuals from collectivistic cultures such as Mexicans. CONCLUSION This chapter provided an overview of the questions that evaluating psychologists who test Mexicans should critically pose when using etic-derived instruments with this population. It summarized the current status of the evidence regarding these important psychometric questions. It concluded that personality trait dimensions assessed by these inventories replicate sometimes. Psychologists are encouraged to examine the structural replication and psychometric properties of these instruments and pay particular attention to any adaptations of these measures and critically discern their applicability and utility when used with Mexican individuals. Additional psychometric criteria that should be considered are internal consistency evaluating and measuring mexican personality     

43

validity indexes and item functioning to determine the generalizability of behavioral exemplars to Mexican individuals. Once psychological findings are obtained, psychologists may cautiously make mean-level comparisons with the normative sample while paying particular attention to culture-specific explanations of personality and behavior and consider any sources of bias in their measurements. Because most etic instruments have been constructed, normed, and validated with non-Mexican populations, evaluating psychologists should critically examine empirical criteria supporting criterion validity with Mexican populations. REFERENCES Almanza Muñoz, J. J., Páez-Agraz, F., Hernández-Daza, M., Barajas-Arechiga, G., & Nicolini-Sánchez, H. (1996). Traducción, confiabilidad y validez concurrente de dos escalas del trastorno por estrés postraumático [Translation, consistency and concurrent validity of two scales for posttraumatic stress disorder]. Salud Mental, 19, 2–4. Aparicio García, A., & Sánchez-López, M. P. (1998). Medida de la personalidad a través del Inventario Millon de Estilos de Personalidad en España y México [Measurement of personality through the Millon Styles of Personality Inventory in Spain and Mexico]. Revista Mexicana de Psicología, 15, 103–117. Barrett, P. T., Petrides, K. V., Eysenck, S. B. G., & Eysenck, H. J. (1998). The Eysenck Personality Questionnaire: An examination of the factorial similarity of P, E, N, and L across 34 countries. Personality and Individual Differences, 25, 805–819. http://dx.doi.org/10.1016/S0191-8869(98)00026-9 Benet, V., & Waller, N. G. (1995). The “Big Seven” model of personality description: Evidence for its cross-cultural generality in a Spanish sample. Journal of Personality and Social Psychology, 69, 701–718. Benet-Martínez, V., & John, O. P. (1998). Los Cinco Grandes across cultures and ethnic groups: Multitrait multimethod analyses of the Big Five in Spanish and English. Journal of Personality and Social Psychology, 75, 729–750. http://dx.doi. org/10.1037/0022-3514.75.3.729 Berry, J. W. (1969). On cross-cultural comparability. International Journal of Psychology, 4, 119–128. http://dx.doi.org/10.1080/00207596908247261 Boscan, D. C., Penn, N. E., Velasquez, R. J., Savino, A. V., Maness, P., Guzman, M., & Reimann, J. (2002). MMPI–2 performance of Mexican male university students and prison inmates. Journal of Clinical Psychology, 58, 465–470. http:// dx.doi.org/10.1002/jclp.1156 Butcher, J. N., & Pancheri, P. (1976). Handbook of cross-national MMPI research. Minneapolis: University of Minnesota Press. Cattell, R. B. (1949). The 16PF Questionnaire. Champaign, IL: Institute for Personality and Ability Testing.

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Chávez, B. P., Allende, L. M., & Tinoco, M. (1989). El Inventario de Personalidad para Niños (P.I.C.) (Versión en Español) applicado a niños Mexicanos: Influen­ cias de sexo, edad y rendimiento escolar [The Personality Inventory for Children (PIC) (Spanish Version) administered to Mexican children: Influences of sex, age, and achievement]. Revista Mexicana de Psicología, 6, 131–141. Cheung, F. M., & Cheung, S. F. (2003). Measuring personality and values across cultures: Imported versus indigenous measures. In W. J. Lonner, D. L. Dinnel, S. A. Hayes, & D. N. Sattler (Eds.), Online readings in psychology and culture. Bellingham: Center for Cross-Cultural Research, Western Washington University. Church, A. T. (2000). Culture and personality: Toward an integrated cultural trait psychology. Journal of Personality, 68, 651–703. http://dx.doi.org/10.1111/14676494.00112 Church, A. T. (2001). Personality measurement in cross-cultural perspective. Journal of Personality, 69, 979–1006. http://dx.doi.org/10.1111/1467-6494.696172 Church, A. T., Alvarez, J. M., Mai, N. T. Q., French, B. F., Katigbak, M. S., & Ortiz, F. A. (2011). Are cross-cultural comparisons of personality profiles meaningful? Differential item and facet functioning in the Revised NEO Personality Inventory. Journal of Personality and Social Psychology, 101, 1068–1089. http://dx.doi. org/10.1037/a0025290 Church, A. T., Katigbak, M. S., del Prado, A. M., Valdez-Medina, J. L., Miramontes, L. G., & Ortiz, F. A. (2006). A cross-cultural study of trait-self-enhancement, explanatory variables, and adjustment. Journal of Research in Personality, 40, 1169–1201. http://dx.doi.org/10.1016/j.jrp.2006.01.004 Clarke, I. (2000). Extreme response style in cross-cultural research: An empirical investigation. Journal of Social Behavior & Personality, 15, 137–152. Cloninger, C. R., Przybeck, T. R., Svrakic, D. M., & Wetzel, R. D. (1994). The Temperament and Character Inventory (TCI): A guide to its development and use. St. Louis, MO: Center for Psychobiology of Personality. Costa, P. T., Jr., & McCrae, R. R. (1992). Revised NEO Personality Inventory (NEOPI–R) and NEO Five Factor Inventory (NEO–FFI) manual. Odessa, FL: Psychological Assessment Resources. Davis, M. H. (1983). Measuring individual differences in empathy: Evidence for a multidimensional approach. Journal of Personality and Social Psychology, 44, 113–126. http://dx.doi.org/10.1037/0022-3514.44.1.113 Díaz-Loving, R. (1998). Contributions of Mexican ethnopsychology to the resolution of the etic–emic dilemma in personality. Journal of Cross-Cultural Psychology, 29, 104–118. http://dx.doi.org/10.1177/0022022198291006 Díaz-Loving, R., Andrade-Palos, P., & la Rosa, J. (1989). Orientación de logro: Desarrollo de una escala multidimensional (EOL) y su relación con aspectos sociales y de la personalidad [Achievement orientation: The development of a multidimensional scale (EOL) and its relation to social and personality variables]. Revista Mexicana de Psicología, 6, 21–26. evaluating and measuring mexican personality     

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Díaz-Loving, R., Andrade-Palos, R., & Nadelsticher Mitrani, S. (1986). Una escala multidimensional de empatía [A multidimensional scale of empathy]. Revista de Psicologia Social y Personalidad, 2, 1–11. Díaz-Loving, R., Díaz-Guerrero, R., Helmreich, R., & Spence, J. (1981). Comparación transcultural y analisis psicometrico de una medida de rasgos masculinos (instrumentals) y femeninos (expresivos) [Cross-cultural comparison and psychometric analysis of a measure of masculine traits (instrumental) and feminine traits (expressive)]. Revista de la Asociación Latinoamericana de Psicología Social, 1, 3–37. Díaz-Loving, R., & Draguns, J. G. (1999). Culture, meaning, and personality in Mexico and in the United States. In Y. T. Lee, C. R. McCauley, & J. G. Draguns (Eds.), Personality and person perception across cultures (pp. 103–126). Mahwah, NJ: Erlbaum. Ellis, B. B., & Mead, A. D. (2000). Assessment of the measurement of equivalence of a Spanish translation of the 16PF questionnaire. Educational and Psychological Measurement, 60, 787–807. http://dx.doi.org/10.1177/00131640021970781 Eysenck, H. J., & Eysenck, S. B. G. (1975). Manual of the Eysenck Personality Questionnaire. London, England: Hodder & Stoughton. Eysenck, S. B. G., & Lara, M. A. (1989). Un estudio transcultural de la personalidad en adultos Mexicanos e Ingleses [A cross-cultural study of the personality of Mexicans and English]. Salud Mental, 12, 14–20. Farías, J. M. P., Durán, C., & Gómez-Maqueo, E. L. (2003). Un estudio sobre la estabilidad temporal del MMPI–A con un diseño test–retest en estudiantes Mexicanos [A study on the temporal stability of the MMPI–A with a test–retest design with Mexican students]. Salud Mental, 26(2), 59–66. Flores-Galaz, M. (1989). Asertividad, agresividad y solucion de situaciones problematicas en una muestra Mexicana [Assertiveness, aggressiveness, and solutions to problematic situations in a Mexican sample] (Unpublished master’s thesis). National Autonomous University of Mexico, Mexico City, Mexico. Goldberg, L. R. (1999). A broad-bandwidth, public domain, personality inventory measuring the lower-level facets of several five-factor models. In I. Mervielde, I. Deary, F. De Fruyt, & F. Ostendorf (Eds.), Personality psychology in Europe (Vol. 2, pp. 7–28). Tilburg, Netherlands: Tilburg University Press. Hathaway, S. R., & McKinley, J. C. (1940). The MMPI manual. New York, NY: Psychological Corporation. Hofstede, G. (1980). Culture’s consequences: International differences in work-related values. Newbury Park, CA: Sage. Hofstede, G. (2001). Culture’s consequences, comparing values, behaviors, institutions, and organizations across nations (2nd ed.). Thousand Oaks, CA: Sage. Holtzman, W. H. (1979). Concepts and methods in the cross-cultural study of personality development. Human Development, 22, 281–295. http://dx.doi.org/ 10.1159/000272450

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Holtzman, W. H., Díaz-Guerrero, R., & Swartz, J. D. (1975). Personality development in two cultures: A cross-cultural longitudinal study of school children in Mexico and the United States. Austin: University of Texas Press. Jackson, D. N. (1967). Manual for the Personality Research Form. New York, NY: Research Psychologists Press. John, O. P., Donahue, E. M., & Kentle, R. L. (1991). The “Big Five” Inventory— Versions 4a and 5a (Technical Report). Berkeley: University of California Press, Institute of Personality and Social Research. Katigbak, M. S., Church, A. T., Alvarez, J. M., Wang, C., Vargas-Flores, J. J., IbáñezReyes, J., . . . Ortiz, F. A. (2013). Cross-observer agreement and self-concept consistency across cultures: Integrating trait and cultural psychology perspectives. Journal of Research in Personality, 47, 78–89. http://dx.doi.org/10.1016/ j.jrp.2012.09.003 Kirkcaldy, B., Furnham, A., & Levine, R. (2001). Attitudinal and personality correlates of a nation’s pace of life. Journal of Managerial Psychology, 16, 20–34. http:// dx.doi.org/10.1108/02683940110366551 Lara-Cantú, M. A., Cortés, J., & Verduzco, M. A. (1992). Datos adicionales sobre la validez y confiabilidad del cuestionario de personalidad de Eysenck en México [Additional data on the validity and reliability of the personality questionnaire of Eysenck in Mexico]. Revista Mexicana de Psicología, 9, 45–50. Lara-Cantú, M. A., Verduzco, M. A., Acevedo, M., & Cortés, J. (1993). Validez y confiabilidad del Inventario de Autoestima de Coopersmith para Adultos, en población Mexicana [Validity and reliability of the Coopersmith Self-Esteem Inventory for Adults in a Mexican population]. Revista Latinoamericana de ­Psicología, 25, 247–255. la Rosa, J., & Díaz-Loving, R. (1991). Evaluación del autoconcepto: Una escala multi­ dimensional [Evaluation of self-concept: A multidimensional scale]. Revista Latinoamericana de Psicología, 23, 15–34. Levine, R. V., & Norenzayan, A. (1999). The pace of life in 31 countries. Journal of Cross-Cultural Psychology, 30, 178–205. http://dx.doi.org/10.1177/ 0022022199030002003 Loehlin, J. C., McCrae, R. R., Costa, P. T., Jr., & John, O. P. (1998). Heritabilities of common and measure-specific components of the Big Five personality factors. Journal of Research in Personality, 32, 431–453. http://dx.doi.org/10.1006/ jrpe.1998.2225 Lucio, E., Ampudia, A., Durán, C., León, I., & Butcher, J. N. (2001). Comparison of the Mexican and American norms of the MMPI–2. Journal of Clinical Psychology, 57, 1459–1468. http://dx.doi.org/10.1002/jclp.1109 Lucio, E., Durán, C., Graham, J. R., & Ben-Porath, Y. S. (2002). Identifying faking bad on the Minnesota Multiphasic Personality Inventory–Adolescent with Mexican adolescents. Assessment, 9, 62–69. http://dx.doi.org/10.1177/ 1073191102009001008 evaluating and measuring mexican personality     

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Lucio, E., Reyes-Lagunes, I., & Scott, R. L. (1994). MMPI–2 for Mexico: Translation and adaptation. Journal of Personality Assessment, 63, 105–116. http://dx.doi. org/10.1207/s15327752jpa6301_9 Lucio, G. M., Ampudia-Rueda, E., Dúran-Patiño, A., Gallegos-Mejía, L., & LeónGuzmán, I. (1999). La nueva versión del Inventario Multifásico de la Personalidad de Minnesota para adolescentes Mexicanos [The new version of the Minnesota Multiphasic Personality Inventory for Mexican adolescents]. Revista Mexicana de Psicología, 16, 217–226. Malloy, T. E., Albright, L., Díaz-Loving, R., Dong, Q., & Lee, Y. T. (2004). Agreement in personality judgments within and between nonoverlapping social groups in collectivist cultures. Personality and Social Psychology Bulletin, 30, 106–117. http://dx.doi.org/10.1177/0146167203258863 Malloy, T. E., Albright, L., Kenny, D. A., Agatstein, F., & Winquist, L. (1997). Interpersonal perception and metaperception in nonoverlapping social groups. Journal of Personality and Social Psychology, 72, 390–398. http://dx.doi. org/10.1037/0022-3514.72.2.390 Mariño, M. C., Medina-Mora, M. E., Chaparro, J. J., & González-Forteza, C. (1993). Confiabilidad y estructura factorial del CES-D en una muestra de ­adolescentes Mexicanos [Reliability and factorial structure of the CES-D in a sample of ­Mexican adolescents]. Revista Mexicana de Psicología, 10, 141–145. McCrae, R. R. (2000). Introduction. American Behavioral Scientist, 44, 7–9. http:// dx.doi.org/10.1177/00027640021956053 McCrae, R. R., & Allik, J. (Eds.). (2002). The five-factor model of personality across cultures. New York, NY: Kluwer Academic/Plenum. http://dx.doi.org/10.1007/ 978-1-4615-0763-5 McCrae, R. R., & Costa, P. T., Jr. (1996). Toward a new generation of personality theories: Theoretical contexts for the five-factor model. In J. S. Wiggins (Ed.), The Five-Factor model of personality: Theoretical perspectives (pp. 51–87). New York, NY: Guilford Press. McCrae, R. R., Costa, P. T., Jr., Martin, T. A., Oryol, V. E., Rukavishnikov, A. A., Senin, I. G., . . . Urbánek, T. (2004). Consensual validation of personality traits across cultures. Journal of Research in Personality, 38, 179–201. http://dx.doi. org/10.1016/S0092-6566(03)00056-4 McCrae, R. R., & Terracciano, A. (2005). Personality profiles of cultures: Aggregate personality traits. Journal of Personality and Social Psychology, 89, 407–425. http:// dx.doi.org/10.1037/0022-3514.89.3.407 Mehrabian, A., & Epstein, N. (1972). A measure of emotional empathy. Journal of Personality, 40, 525–543. http://dx.doi.org/10.1111/j.1467-6494.1972.tb00078.x Mercado, D. C., Fernández, G., & Contreras, F. (1991). Falta de homogeneidad y validez de la Forma A del inventario de personalidad del D. N. Jackson en México [Lack of homogeneity and validity of the Form A of the personality inventory of D. N. Jackson in Mexico]. Revista Interamericana de Psicología, 25, 71–82.

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Millon, T., Weiss, L. G., Millon, C., & Davis, R. (1994). The Millon Index of Personality Styles manual. San Antonio, TX: Psychological Corporation. Moscoso, M. S. (2000). Estructura factorial del Inventario Multicultural LatinoAmericano de la Expressión de la Cólera y la Hostilidad [Factorial structure of the Multi­cultural Latin American Anger Expression Inventory (ML-STAXI)]. Revista Latinoamericana de Psicología, 32, 321–343. Murray, H. A. (1962). Explorations in personality. New York, NY: Science Editions. Nadelsticher Mitrani, M., Díaz-Loving, R., & Nina, R. (1983). La empatía; ?unidimensional o multidimensional? [Empathy: Unidimensional or multidimensional?]. Enseñanza e Investigación en Psicología, 9, 247–254. Nicolini, H., Herrera, K., Páez, F., Sánchez de Carmona, M., Orozco, B., Lodeiro, G., & Ramón de la Fuente, J. (1996). Traducción al Español y confiabilidad de la Escala Yale-Brown para el trastorno Obsesivo-Compulsivo [Spanish translation and reliability of the Yale-Brown Obsessive–Compulsive Scale]. Salud Mental, 19, 13–16. Núñez, R. (1981). Inventario MMPI–Español [MMPI–Spanish Inventory]. Mexico: Editorial El Manual Moderno. O’Connell, M. S., Doverspike, D., Norris-Watts, C., & Hattrup, K. (2001). Predictors of organizational citizenship behavior among Mexican retail salespeople. The International Journal of Organizational Analysis, 9, 272–280. http://dx.doi. org/10.1108/eb028936 Ornelas Bolado, A. L., & Whitaker, L. C. (1990). Standardization of the Whitaker Index of Schizophrenic Thinking (WIST) in a Mexican population: A multivariable study. Journal of Clinical Psychology, 46, 140–147. http://dx.doi. org/10.1002/1097-4679(199003)46:23.0.CO;2-J Ortiz, F. A., Church, A. T., Vargas-Flores, J. J., & Ibanez-Reyes, J. (2007). Are Indigenous Personality Dimensions Culture Specific? Mexican Inventories and the Five-Factor Model. Journal of Research in Personality, 41, 618–649. http://dx.doi. org/10.1016/j.jrp.2006.07.002 Rathus, S. (1973). A 30-item schedule for assessing assertive behavior. Behavior Therapy, 4, 398–406. http://dx.doi.org/10.1016/S0005-7894(73)80120-0 Reyes-Lagunes, I. (1996). La medición de la personalidad en México [The measurement of personality in Mexico]. Revista de Psicologia Social y Personalidad, 12, 31–60. Robles, R., Varela, R., Jurado, S., & Páez, F. (2001). Versión Mexicana del Inventario de Ansiedad de Beck: Propiedades psicométricas [Mexican version of the Beck Anxiety Inventory Psychometric properties]. Revista Mexicana de Psicología, 18, 211–218. Rodríguez, C., & Church, A. T. (2003). The structure and personality correlates of affect in Mexico: Evidence of cross-cultural comparability using the Spanish language. Journal of Cross-Cultural Psychology, 34, 211–230. http://dx.doi. org/10.1177/0022022102250247 Rotter, J. B. (1966). Generalized expectancies for internal versus external control of reinforcement. Psychological Monographs: General and Applied, 80(609). evaluating and measuring mexican personality     

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Sánchez de Carmona, M., Páez, F., López, J., & Nicolini, H. (1996). Traducción y confiabilidad de Temperamento y Carácter (ITC) [Translation and reliability of the Temperament and Character Inventory]. Salud Mental, 19, 5–9. Schimmack, U., Radhakrishnan, P., Oishi, S., Dzokoto, V., & Ahadi, S. (2002). Culture, personality, and subjective well-being: Integrating process models of life satisfaction. Journal of Personality and Social Psychology, 82, 582–593. http:// dx.doi.org/10.1037/0022-3514.82.4.582 Scott, R. L., Butcher, J. N., Young, T. L., & Gomez, N. (2002). The Hispanic MMPI– A across five countries. Journal of Clinical Psychology, 58, 407–417. http://dx.doi. org/10.1002/jclp.1152 Servín-Terrazas, J. L. (1994). Validez de constructo de la Escala de Autoconcepto de Piers-Harris [Validity of the construct of the Piers-Harris Children’s SelfConcept Scale]. La Psicología Social en México, 5, 76–82. Smith, P. B., Dugan, S., & Trompenaars, F. (1997). Locus of control and affectivity by gender and occupational status: A 14 nation study. Sex Roles, 36, 51–77. http:// dx.doi.org/10.1007/BF02766238 Spence, J. T., & Helmreich, R. L. (1978). Masculinity and femininity: Their psychological dimensions, correlates, and antecedents. Austin: University of Texas. Spence, J. T., & Helmreich, R. L. (1983). Achievement-related motives and behaviors. In J. T. Spence (Ed.), Achievement and achievement motivation: Psychological and sociological approaches. San Francisco, CA: Freeman. Spielberger, C. D. (1988). Manual for the State-Trait Anger Expression Inventory (STAXI). Odessa, FL: Psychological Assessment Resources. Triandis, H. C., & Suh, E. M. (2002). Cultural influences on personality. Annual Review of Psychology, 53, 133–160. http://dx.doi.org/10.1146/annurev.psych. 53.100901.135200 U.S. Census Bureau. (2012). Statistical abstracts of the United States: 2012. Washington, DC: U.S. Government Printing Office. van de Vijver, F., & Leung, K. (1997). Methods and data analysis for cross-cultural research. Thousand Oaks, CA: Sage.

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3 A BRIEF HISTORY OF PSYCHOLOGICAL TESTING IN PUERTO RICO: HIGHLIGHTS, ACHIEVEMENTS, CHALLENGES, AND THE FUTURE FRANCES BOULON-DíAZ

The history of psychological testing in Puerto Rico includes the creation, translation, and adaptation of psychological tests since early in the 20th century. Puerto Rico, a commonwealth with close ties to the United States since 1898, retains Spanish as the first language (Boulon-Díaz & Roca de Torres, 2007). Hispanic traditions are strongly embedded in popular culture, despite more than a century of contact with the English language and U.S. influence. Models of psychological testing from the United States have been important in developing testing instruments, but because it occurs in multi­ cultural research, the adequate translation of measures and instruments into a second language continues to be an important methodological challenge (Bernal, Cumba-Avilés, & Rodríguez-Quintana, 2014). Early works included adaptations of the Pintner Test of Non Verbal Abilities in 1920 (Pintner, 1924) and the Stanford Achievement Test in 1925 (Aiken, 2003), http://dx.doi.org/10.1037/14668-004 Psychological Testing of Hispanics, Second Edition: Clinical, Cultural, and Intellectual Issues, K. F. Geisinger (Editor) Copyright © 2015 by the American Psychological Association. All rights reserved.

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followed by other cognitive tests used primarily in the public school system. More recent standardization projects include Spanish language Wechsler Intelligence Scales for Children (revised in 1992; Wechsler, 1992) and the Wechsler Adult Intelligence Scale III—Spanish in 2008 (Rodriguez et al., 2008), as well as the Minnesota Multiphasic Personality Inventory (MMPI) in 2008 (Garrido Amadeo, Rosario-Hernández, Figueroa Ortiz, Medina Vélez, & Padovani Rivera, 2012). Graduate psychology programs at one public and five private universities are coordinating efforts to create norms for clinical populations using several measures, such as the Stroop Colors and Words Test (Golden, 1978, 2003, 2007) and the Bender Gestalt II Test of Visual Motor Integration (Bender, 1938). The commitment to share research results and databases among universities facilitates the development of norms and training of practitioners. Research efforts and psychological evaluation services face challenges related to public policies, fiscal constraints, and training. This chapter provides a brief survey of these research and practice efforts and a discussion of options for future directions of psychological measures considering complex social and cultural backgrounds. Psychological training, science, and practice in Puerto Rico have been increasing in scope and importance since they emerged at local institutions early in the 20th century. This community’s attention to mental health needs can be traced to as early as pre-Columbian times and the four centuries when Puerto Rico was a part of the Spanish empire (Gonzalez Rivera, 2006). The island territory of Puerto Rico, which includes two smaller islands, Vieques and Culebra, was ceded by Spain to the United States in 1898 at the conclusion of the Spanish American War (Pico, 1988). Soon after, in 1900, the first professional school for training teachers was founded. Since then, psychology has become an important subject in education curricula (Álvarez, 2006), including assessment of schoolchildren. Since the 1920s, psychological testing has become an important component in public education institutions in Puerto Rico, and prominent pioneers of the profession have translated and adapted psychological tests for the assessment of students (Boulon-Díaz & Roca de Torres, 2007). Psychological services have been offered at psychiatric units of hospitals, facilities serving veterans and children, since the 1940s (Bernal, 2006). The second half of the 20th century witnessed the rapid expansion of graduate programs at universities in Puerto Rico, the approval of laws related to psychology licensing and practice (Boulon-Díaz, 2006b), and several notable efforts to standardize and adapt psychological tests (Boulon-Díaz, 2006a, 2008). As the 21st century proceeds, a wide variety of testing projects is underway in Puerto Rico. The intensity of activity in these endeavors merits on optimistic outlook, although significant challenges still need to be addressed. 52       frances boulon-díaz

THE EARLY YEARS: EMPHASIS ON APPLICATIONS TO EDUCATION Psychology as a science in the Western world is less than 200 years old. However, medical historians have identified mental health concerns and interventions among the indigenous people of Puerto Rico by examining the culture and myths of the Tainos (Gonzalez Rivera, 2006). Another early contributor to the study of human behavior was Eugenio Maria de Hostos, who was born in Puerto Rico in 1839. Educated in Spain and known as the “Citizen of the Americas,” he was a sociologist, educator, writer, and political activist who supported the abolition of slavery and efforts of several Latin American nations to become independent from Spain (Maldonado-Denis, 1981). He published elaborate scholarly works that included definitions of psychological concepts, as well as foundations for educational and sociological treatises (de la Torre Molina, 2006). Hostos’s writings integrated education and psychology in a way significant for the future development of psychometrics in Puerto Rico. The history of psychology as an academic discipline in Puerto Rico began with college-level seminars taught at the cultural center known as Ateneo Puertorriqueño during the late 19th century, when this Caribbean island was ruled by Spain. After 1898, when the United States acquired political power over Puerto Rico, the expansion of educational services became a priority (Silvestrini & Luque de Sanchez, 1988). In 1903, the University of Puerto Rico was founded and the professional school for teachers was integrated into the new institution. The first college-level degrees granted in Puerto Rico were in the field of education. Although facing limited resources common to all government programs, public education in Puerto Rico has expanded notably since 1900 for the benefit of the working class (Pico, 1988). The early efforts to educate the population were closely tied to the introduction of psychological and educational tests to determine appropriate educational levels for public school students. The study of psychology was first applied to education and eventually became a separate discipline included in college curricula. Therefore, the use and development of psychological tests and measures in Puerto Rico spans more than a century and has evolved in relation to educational endeavors at all levels, from grade school to the current flourishing of graduate programs in psychology. PSYCHOLOGY BECOMES A SEPARATE DISCIPLINE Ana Isabel Álvarez (2006) described the transition of university courses at the University of Puerto Rico in psychology from the College of Education to the College of Social Sciences, where it became a graduate-level program psychological testing in puerto rico     

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in the 1960s. Most of the mid-20th century decades witnessed the pioneering work of psychologists trained in the United States and other countries who sought to promote practice and scholarship in psychology from university departments, the public educational system, hospitals, and private practice. Several of those pioneers were concerned with developing psychological measures attuned to the language and cultural milieu of Puerto Rico. Six pioneers of psychology in Puerto Rico were identified by Irma Roca de Torres (2006) as the driving forces of scholarship, research, and practice in Puerto Rico. Of these, four made significant contributions to psychological testing: Pablo Roca, Teobaldo Casanova, Juan Nicolas Martinez, and Miguelina Hernández. Another, Efrain Sanchez Hidalgo, was a secretary of education in the department then known as the Department of Public Instruction and was also the founder of the Asociación de Psicología de Puerto Rico [Puerto Rico Psychological Association; APPR] (Boulon-Díaz, 2006a). As early as the 1930s, Puerto Ricans with graduate degrees in psychology contributed to the production of tests geared to identifying cognitive abilities and supporting educational policies of the Department of Public Instruction, now known as the Puerto Rico Department of Education (Roca de Torres, 2006). Some of the early contributions to testing through translation and adaptation of tests in English, notably the Wechsler Adult Intelligence Scale (WAIS; Wechsler, 1955), were performed by Mercedes Rodrigo Bellido and Rafael Garcia Palmieri at the Veterans Administration Hospital in San Juan. At the Department of Public Instruction, Pablo Roca translated the Wechsler Intelligence Scale for Children (WISC; Wechsler, 1949) in 1951 and the Binet Intelligence Scale in 1953 (Roca, 1951, 1953; Roca de Torres, 2006; Terman, 1916). He directed the Office of Assessment and Research and “his greatest contribution was his dedication to promoting the highest standards in reliability, validity, standardization and cultural adaptation of the tests” (Roca de Torres, 2008b, p. 17). Miguelina Hernandez, the first psychologist from Puerto Rico to earn a doctoral degree in school psychology, joined Pablo Roca at the Office of Assessment and Research with the Department of Public Instruction. She also worked with the Wechsler and Binet scales and chaired the standardization of the Draw-a-Person Test (Scott, 1981) for Puerto Rican children age 5 to 10 years, with a sample of 1,322 in 1954 (Roca de Torres, 2006). The projects mentioned are only a few of the many achievements of this prolific team of psychologist–educators. It is significant that the tests mentioned are still in use today, with revised versions having since been developed. Juan Nicolas Martinez, another pioneer of Puerto Rican psychology, chaired the translation and adaptation of the WAIS, known by the Spanish acronym EIWA. He also worked on the standardization of the WISC in the 54       frances boulon-díaz

United States Virgin Islands (Roca de Torres, 2006), which points to the leadership shown by colleagues from Puerto Rico in contributing to other testing projects in the Caribbean. Later, Gabriel Cirino became a consultant on testing issues in several Central and South American countries (BoulonDíaz, 2008). A common concern of all these psychologists was the need to consider the Puerto Rican cultural backgrounds of children and adults and not simply to translate testing materials developed in other cultures. During the second half of the 20th century, psychology in Puerto Rico developed as a science, was taught at major universities at the bachelor’s and graduate levels, and began to flourish as a professional field (BoulonDíaz, 2006a). In 1963, the first graduate courses in psychology were offered at the University of Puerto Rico, Rio Piedras Campus, a public land grant university, where the first master’s program class graduated in 1968. In 1983, doctoral programs in psychology were established. Soon after the first master’s program began, the Psychological Institute of Puerto Rico, a private professional school, began offering master’s degrees in psychology in 1966 and granted the first doctoral degrees in 1977. It is currently known as Carlos Albizu University and achieved APA Accreditation in 1994 (SantiagoNegrón et al., 2006). In 1979, the Interamerican University of Puerto Rico, Metropolitan Campus, established graduate programs in school, counseling, and industrial organizational psychology. All three programs were expanded to the doctoral level in 2001 (Rivera Alicea, 2006). Ley 96 del 4 de junio de 1983 [Law 96 of June 4, 1983], to regulate the practice of psychology in Puerto Rico was approved through the efforts of the APPR and other professional leaders. This led to the creation of an Ethics Code, approved in 1992 and revised in 2003, in which Principle VIII pertains to evaluation and diagnosis (Puerto Rico Board of Psychologist Examiners, 2013). The issue of preferring tests adapted to Puerto Rico’s language and culture was discussed. The First Mental Health Summit, held in 1984 and sponsored by the APPR and Interamerican University, featured psychological testing in Puerto Rico as a prominent topic. In their presentations, Marion Wennerholm (2010– 2011) and Laura Leticia Herrans (2010–2011) jointly discussed the importance of creating versions of tests to be used in Puerto Rico that are not “mere translations” but which are adapted to the society and culture. At the time, some ongoing projects adapting the MMPI and the Bender Gestalt were described. In 1986, the master’s degree in psychology began to be offered at Interamerican University of Puerto Rico, San German Campus. This program expanded to the doctoral level in 2001, with programs in counseling and school psychology (Asencio-Toro, 2006). Other graduate programs in psychology followed at Pontifical Catholic University of Puerto Rico in 1992 and Turabo University in 2000 (Boulon-Díaz, 2006b). psychological testing in puerto rico     

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In 1988, the First Congress of Psychological Measurement was sponsored by the APPR. The proceedings revealed comments on the future of testing in Puerto Rico, which emphasized a difficult situation that was expected to limit activity in this area; the outlook for testing seemed pessimistic. In her presentation, Juana Rodriguez mentioned factors she considered challenges for testing in Puerto Rico: few persons in Puerto Rico with specialized training in psychological tests; high costs of producing tests; lack of sources for financing projects related to test standardization and related research; lack of awareness that tests, once produced, need to be revised periodically; and the legal rights test publishers maintain over such products. Gabriel Cirino was concerned at the time that the only two faculty members supervising research on testing at the University of Puerto Rico were about to retire, and it seemed that no one would take their place (Roca de Torres, 2008b). Notable contributions to testing have been achieved since 1997 by the Institute for Behavioral Research at the Medical Sciences Campus of the University of Puerto Rico, under the direction of Dr. Glorisa Canino. This institute has translated and adapted instruments used for assessment of numerous disorders such as depression, alcohol use, and other mental health issues (Roca de Torres, 2008b). One of its objectives, as indicated on the website is, “To translate, adapt to the Puerto Rican culture and test the psychometric properties of the various diagnostic instruments used in the research performed” (http://www.rcm.upr.edu/CsConductaDAA/, para. 2). In 1998, the Asociación de Psicología Escolar [Puerto Rico Association of School Psychology] (APEP), which is affiliated with the National Association of School Psychology (NASP), was founded. It immediately began working on strategies to enhance psychological services in the schools, which were and still are (in this writer’s opinion), insufficient. Among the concerns of the APEP leadership are the lack of clearly enforced standards for quality psychological evaluation services and adequate use of testing instruments, both of which continue to be prominent issues. In 1999, the graduate clinical PsyD Program at Ponce School of Medicine opened. A PhD program is now also in place. The program’s website lists the following as a major accomplishment: “The standardization of the WAIS III for use with the Puerto Rican population was completed by 2007 and the new test was published in 2009” (Wechsler, 2008). In 2002, an important reference about testing in Puerto Rico was published with the support of Carlos Albizu University. It presented abstracts of test translations and test adaptations and other research on psychological tests done in Puerto Rico and demonstrated the variety of measures, pertinent to several specialties in psychology and related fields, available for use with local populations (Rodríguez Gómez, 2002). Another important publication is the proceedings of the Second Psychological Measurement 56       frances boulon-díaz

Congress sponsored by the APPR in 2008, a special edition of the Puerto Rican Journal of Psychology, Volume 19: Psychological Measurement in Puerto Rico (Roca de Torres, 2008a). The articles in this issue demonstrated the variety and complexity of ongoing research in psychological tests and measurements in Puerto Rico. The articles published included one project funded by the National Institute of Drug Abuse, with coauthors from the University of Puerto Rico, the University of California at San Francisco, and Columbia University (Varas-Díaz, Neilands, Guilamo-Ramos, & Cintron Bou, 2008), and another supported by the National Institute of Mental Health (Rivera Medina & Bernal, 2008). The outlook for these efforts was considerably more optimistic than the one presented in the proceedings of the 1988 Congress (Roca de Torres, 2008b). The APPR and the Puerto Rico School Psychology Association established an alliance in 2012, and part of their joint efforts is the revision of Ley 170 del 12 de agosto de 2000 [Law 170 of August 12, 2000], for Psychological Services in the Schools. Among the salient issues to be addressed is the definition of the competencies required for quality assessment services. The senate of Puerto Rico is supporting this effort, and one of the concerns expressed is the need to improve evaluation services for public school students, especially those who need special education. These concerns, among others, were presented by APEP President Maria Rolon at public hearings for a proposed bill related to educational strategic planning (Banuchi, 2013). A revision of the Law 170 of August 12, 2000, which was not implemented, was presented by Senator Maria de Lourdes Santiago in October, 2013, with the support of the Puerto Rico School Psychology Association and the APPR (Rivera Vargas, 2013). These varied efforts led to current achievements in research related to testing and assessment and to the revision of public policies that are intended to enhance the science and practice of psychological testing and assessment in Puerto Rico. STANDARDIZATION OF INTELLIGENCE TESTS IN PUERTO RICO In the area of psychological tests and measurements in Puerto Rico, Laura Leticia Herrans, an educational psychologist, and Gabriel Cirino Gerena, an industrial–organizational psychologist, have achieved prominence. They were trained in the United States and have taught generations of psychologists at the University of Puerto Rico, Rio Piedras Campus, defining the course of testing endeavors on this island. They applied state-of-theart methodology to the creation of instruments that take into account the Hispanic social and cultural contexts; these have been used in several Latin psychological testing in puerto rico     

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American countries. Their publications are mandatory readings for psychol­­ ogy courses at universities in Puerto Rico (Boulon-Díaz, 2008). The standardization and adaptation of the Spanish version of the Wechsler Intelligence Scale for Children—Revised (EIWN–R–PR for its acronym in Spanish) was an outstanding feat performed by Herrans with help from Juana Myrtea Rodríguez (Wechsler, 1992). This project was funded by the Psychological Corporation and was allowed access to resources of the Puerto Rico Department of Health. The resulting test, Escala de Inteligencia Wechsler para Niños de Puerto Rico (EIWN–R–PR), has been widely used to test generations of Puerto Rican children and children in other Latin American countries, notably Mexico (Herrans, 2001). Through his consulting firm, Test Innovations, Cirino has developed widely used achievement, vocational interest, and professional licensing tests used in educational and work settings (Boulon-Díaz, 2008). Both Cirino and Herrans have received recognition and countless awards from the APPR and other institutions. These include presidencies of APPR, Distinguished Psychologist of the Year (Cirino in 1982 and Herrans in 1986), and presidencies of the Puerto Rico Board of Psychologist Examiners. When Dr. Cirino was honored at the 2008 APPR convention, he mentioned Dr. Herran’s quote, analogous to one by E. L. Thorndike almost 100 years earlier: “If Psychology does not measure, it is not science” (Boulon-Díaz, 2008, p. 53). Juana Rodriguez, mentioned earlier, was also president of APPR and of the Board of Psychologist Examiners and was Distinguished Psychologist of the Year 1993 (Roca de Torres, 2006). Herrans and Rodriguez were consultants to the team chaired by Jose Pons at the Ponce School of Medicine for the standardization of the WAIS, known by the acronym in Spanish, EIWA III. The first of several articles related to this project emphasized the important cultural adaptation process (Rodriguez et al., 2008). Three other articles described reliability (Pons, Matias-Carrelo, et al., 2008) and validity studies (Pons, Flores-Pabon, et al., 2008) and the performance of epileptics on the EIWA III (Laguer et al., 2008). The expansion of graduate programs in psychology continues to contribute to the development of tests and measurements adapted to Puerto Rico. The projects presented here are only some of those available in peerreviewed publications. There have been a considerable number of presentations in professional conferences in Puerto Rico, the United States, Latin America, and other countries, where the contributions of Puerto Rican psychology to testing have been shared. Although there are too many to describe in detail here, these presentations have included panels and poster sessions at American Psychological Association (APA) conventions; Interamerican Society of Psychology Congresses in Mexico, Guatemala, Bolivia, and Brazil; and many others. 58       frances boulon-díaz

CONTRIBUTIONS TO TESTING IN THE UNITED STATES It is said that New York, Chicago, and Orlando are the largest Puerto Rican cities in the world, larger even than San Juan. The political ties between Puerto Rico and the United States facilitate constant migration to and from the island and the continental United States. There are recent partnerships that demonstrate the opportunities for research in testing where the samples integrate the same ethnocultural group residing in different venues. Mary Annette Moreno-Torres of the University of Puerto Rico and Tulio M. Otero of the Chicago School of Professional Psychology worked with Jack Naglieri in the translation and standardization of the Cognitive Assessment System (CAS) and related publications (Naglieri & Pickering, 2010). There are ongoing projects at the Ponce School of Medicine, and the collaboration of other institutions, within and outside Puerto Rico is sought so that the CAS may be standardized for various Hispanic populations (Moreno-Torres, 2013). RESEARCH FOCUSING ON POPULATIONS WITH DIVERSE CHARACTERISTICS AND NEEDS The growth of graduate programs in psychology has provided an opportunity for research related to psychological testing. Dr. Juana M. Rodriguez of the University of Puerto Rico, Rio Piedras Campus, invited professors and researchers of psychological testing from the Universities of Puerto Rico-Mayaguez Campus, Interamerican University, Metropolitan and San German Campuses, Carlos Albizu University, Pontifical Catholic University of Puerto Rico, Ponce School of Medicine, and Turabo University to share data and collaborate in standardization and other projects involving tests and assessment methods. Dr. Luisa Guillemard of the University of Puerto Rico, Mayaguez Campus, developed a website titled “Psicometria PR” that contains a bibliography of psychological testing instruments and research carried out in Puerto Rico (http://www.uprm.edu/psicometriapr/index.html). The second decade of the 21st century has seen intense activity in the testing field. Six graduate programs in psychology are sharing research projects related to the adaptation of tests to different clinical populations and age groups. Studies in progress at Interamerican University Metropolitan Campus, primarily under the direction of Dr. Leila Crespo, are exploring testing issues. Some of these focus on the cognitive performance of populations with health conditions such as epilepsy (Narvaez, Crespo Fernandez, Miranda, & BoulonDiaz, 2013). Other studies are focusing on the performance of different age groups on the Stroop Word–Color Test (Alvarez, 2009; Lopez-Rosa, 2013; psychological testing in puerto rico     

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Martinez-Cruz, 2011) and the performance of normal children at different age ranges on the Vineland II Social Adaptation Scale (Sparrow, Cicchetti, & Balla, 2005). At the University of Puerto Rico, Montilla Báez (2013), under the direction of Juana M. Rodriguez, studied the implications of using the WISC–IV Spanish in Puerto Rico. Questions have been raised about the psychometric properties of the instrument and about the limited representation of Puerto Ricans residing on this island in the WISC–IV standardization sample. This study has provoked debate about Spanish-language instruments produced outside Puerto Rico, which must be used carefully when performing psychological evaluations and diagnosis of children born and raised in this country. The Hispanic experience in the United States is that of a minority group. Puerto Ricans in Puerto Rico are the dominant cultural group and include a complex ethnicity resulting from the close ties of persons from White and Black racial backgrounds, as well as the influence of migrants from Spain, the Caribbean (notably Cuba and the Dominican Republic), and the United States, among other countries. Therefore, to adjust for language by using Spanish-language tests is not sufficient for ensuring the quality use of tests and measurements, as established in our professional standards. DILEMMAS AND CHALLENGES Producing scientific knowledge related to psychological testing and providing services according to rigorous professional standards in Puerto Rico are challenging tasks. Several issues require expanding this discussion with psychologists serving Hispanics in the United States, as well as with colleagues from countries around the globe. One concern is the toll taken on multiple scientific and academic programs, regardless of the discipline, by the financial crisis of the first decades of the 21st century. Researchers have to put forth huge amounts of effort, creativity, and oftentimes, personal resources to achieve goals such as standardization and adaptation of instruments. The notable efforts of graduate students, which frequently depend on personal resources, educational loans, and rare grant monies, are valiantly contributing small studies in the hope that aggregated results will move the field closer to ideal standardization samples. Psychological evaluation services for special education students in Puerto Rico are generally provided by psychologists in private practice and others used by corporations serving public schools. There is widespread concern that this service model is inadequately remunerated and supervised. APEP, associated with NASP, and the APPR, affiliated with APA, have joined forces to promote public policies establishing full-time psychological services in schools 60       frances boulon-díaz

and promoting the enforcement of quality standards. Parents often request reevaluations at university clinics but then express dissatisfaction with the procedures used and the reports provided. Psychological associations have received complaints from school psychologists in the United States about psychological evaluations prepared in Puerto Rico. The complaints concern the perception that the reports are based on limited or confusing information that is considered inadequate for educational decision making. Guidelines for educational and psychological testing, prepared considering particular characteristics of the populations served in Puerto Rico, need to be disseminated widely and adopted by institutions that use and supervise testing services. The PRPA sponsored an initial version of guidelines in 1991(Miranda, 1991). The Professional Affairs Committee of the PRPA published a revised position paper in 2011, available at the Association’s website (http://www.asppr.net; Maldonado Feliciano, 2011). Resources for promoting quality services in testing and related issues are available in English (American Educational Research Association, APA, and National Council on Measurement in Education, 1999; Eyde, Robertson, & Krug, 2009; Thomas & Grimes, 2008) but are rarely applied and discussed. It is important to provide practitioners and graduate students in Puerto Rico with more widespread training and supervision regarding quality in psychological assessment practices. The use of Internet-based testing has been introduced in Puerto Rico and widespread in licensing examinations for psychologists, engineers, nurses, occupational therapists, and other professionals (Cirino, 2008). However, recent innovations, such as the administration of Wechsler Scales using iPads, have not yet reached Puerto Rico; these highly efficient options should be considered in the near future. The future of psychological testing in Puerto Rico is moving forward, and the team of collaborators is growing. Sharing experiences with the Hispanic communities of the United States is an important step in creating more opportunities for culturally sensitive instruments, research, and services. There are exciting opportunities for collaboration and learning regarding the use of psychological testing and assessment in Puerto Rico. REFERENCES Aiken, L. R. (2003). Tests psicologicos y su evaluacion, undecima edicion [Psychological tests and their assessment, eleventh edition]. Mexico City, Mexico: Pearson Education. Álvarez, A. I. (2006). La enseñanza de la psicología en la Universidad de Puerto Rico, Recinto de Río Piedras: 1903–1950 [Teaching psychology at the psychological testing in puerto rico     

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University of Puerto Rico, Río Piedras campus]. Puerto Rican Journal of Psychology, 17, 93–114. Alvarez, L. (2009). Normas para la Prueba Stroop de Colores y Palabras en un grupo de estudiantes puertorriqueños de 9 a, 12 años de edad [Norms for the Stroop Color– Word Test in Puerto Rican students 9 to 12 years old] (Unpublished doctoral dissertation). Interamerican University of Puerto Rico, Metropolitan Campus, San Juan. American Educational Research Association, American Psychological Association, and National Council on Measurement in Education. (1999). Standards for educational and psychological testing. Washington, DC: American Educational Research Association. Asencio-Toro, G. (2006). Del Poly a la Inter: Reflexiones y Apuntes sobre la enseñanza de la psicología en la Universidad Interamericana, Recinto de San German. [From the poly (technic institute) to inter: Reflections and notes about teaching psychology at Interamerican University, San German Campus]. Puerto Rican Journal of Psychology, 17, 115–145. Banuchi, R. (2013). Peek amendments to the draft ten-year education plan. Retrieved from http://www.elnuevodia.com/nota-1583064.html Bender, L. (1938). A visual–motor Gestalt test and its clinical use [American Orthopsychiatric Association Monograph Series Number 3]. New York, NY: American Orthopsychiatric Association. Bernal, G. (2006). La psicología clínica en Puerto Rico [Clinical psychology in Puerto Rico]. Puerto Rican Journal of Psychology, 17, 341–388. Bernal, G., Cumba-Avilés, E., & Rodríguez-Quintana, N. (2014). Methodological challenges in research with ethnic, racial, and ethnocultural groups. In F. T. L. Leong (Ed.), APA handbook of multicultural psychology: Vol. 1, Theory and research (pp. 105–123). Washington, DC: American Psychological Association. Boulon-Díaz, F. (2006a). Hacia una propuesta para el fortalecimiento escolar [Towards a proposal for school improvement]. Revista de la Asociación de Psicólogos Escolares de Puerto Rico, 8, 3–4. Boulon-Díaz, F. (2006b). La psicología como profesión en Puerto Rico: Desarrollo y nuevos retos [Psychology as a profession in Puerto Rico: Development and new challenges]. Puerto Rican Journal of Psychology, 17, 215–240. Boulon-Díaz, F. (2008). Reseña Biográfica de las principales figuras de la medición psicológica en Puerto Rico [Biographical sketches of prominent contributors to psychological measurement in Puerto Rico]. Revista Puertorriqueña de Psicología (Vol. 19, pp. 49–57). San Juan: Asociación de Psicología de Puerto Rico. Boulon-Díaz, F., & Roca de Torres, I. (2007). School psychology in Puerto Rico. In S. R. Jimerson, T. Oakland, & P. T. Farrel (Eds.), The handbook of international school psychology (pp. 309–322). Thousand Oaks, CA: Sage. Cirino, G. (2008). Pruebas en Linea: Una experiencia puertorriqueña [Online testing: A Puerto Rican experience]. Revista Puertorriqueña de Psicologia, 19, 245–255.

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de la Torre Molina, C. (2006). El Pensamiento Psicológico de Eugenio Maria de Hostos. [Eugenio Maria de Hostos as a psychological thinker]. Revista Puertorriqueña de Psicologia, 17, 27–42. Eyde, L., Robertson, G. J., & Krug, S. (2009). Responsible test use: Case studies for assessing human behavior (2nd ed.). Washington, DC: American Psychological Association. Garrido Amadeo, M., Rosario-Hernández, E., Figueroa Ortiz, J. F., Medina Vélez, G., & Padovani Rivera, C. M. (2012). Comparación de las escalas de validez, clínicas y reestructuradas del MMPI–2 en una muestra Puertorriqueña [Comparison of validity scales, clinics and the restructured MMPI–2 in a Puerto Rican simple]. Revista Puertorriquena de Psicologia, 2, 119–145. Golden, C. J. (1978). Stroop Color and Word Test: A manual for clinical and experimental uses. Chicago, IL: Stoelting. Golden, C. J. (2003). Stroop Color and Word Test. Children’s Version for Age 5–14. Chicago, IL: Stoelting. Golden, C. J. (2007). Test de Colores y Palabras [Colors and Words Test]. Madrid, Spain: TEA Ediciones. Gonzalez Rivera, S. (2006). Apuntes sobre las ideas psicológicas en Puerto Rico: Desde el Periodo Precolombino hasta el Siglo XIX [Notes about psychological thought in Puerto Rico: From the pre-Columbian period to the nineteenth century]. Revista Puertorriqueña de Psicologia, 17, 3–26. Herrans, L. L. (2001). Psicología y medición: El desarrollo de pruebas psicológicas en Puerto Rico, Segunda Edicion [Psychology and testing: The development of psychological testing in Puerto Rico, 2nd ed.]. México City, Mexico: Limusa. Herrans, L. L. (2010–2011). Controversias sobre la Medición Psicológica: Una reacción y una alternativa viable [Controversies about psychological measurement: A reaction and a viable option]. Paper presented at the meeting of the Puerto Rican Congress of Psychology and Mental Health, San Juan, Puerto Rico. Laguer, A., Matías-Carrelo, L., Pons, J. I., Rodríguez, M., Rodríguez, J. M., & Herrans, L. L. (2008). Performance of a simple of adults diagnosed with epilepsy on the Wechsler Adult Intelligence Scale III. Puerto Rican Journal of Psychology, 19, 133–146. Ley 96 del 4 de junio de 1983: Para reglamentar el ejercicio de la profesión de psicología en Puerto Rico [Law 96 of June 4, 1983: To regulate the practice of psychology in Puerto Rico]. Ley 170 del 12 de agosto de 2000: Para crear el puesto de Psicólogo Escolar [Law 170 of August 12, 2000: To create the position of School Psychologist]. Lopez-Rosa, M. I. (2013). Normas para la Prueba Stroop de Colores y Palabras para estudiantes puertorriqueños de 6 a 9 años de edad [Norms for the Stroop Color–Word Test for Puerto Rican students, ages 6 to 9] (Unpublished doctoral dissertation). Interamerican University of Puerto Rico, San Juan, Puerto Rico. Maldonado-Denis, M. (1981). Eugenio María de Hostos: sociólogo y Maestro [Eugenio María de Hostos: Sociologist and educator]. Rio Piedras, Puerto Rico: Editorial Antillana. psychological testing in puerto rico     

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Maldonado Feliciano, L. E. (2011). Aspectos éticos y profesionales sobre las credenciales necesarias para realizar evaluaciones psicológicas en Puerto Rico [Ethical and professional aspects necessary for performing psychological evaluations in Puerto Rico]. Retrieved from http://www.asppr.net/index.php?option= com_docman Martinez-Cruz, M. (2011). Normas para la prueba Stroop de Colores y Palabras en un grupo de estudiantes puertorriqueños de 12 a 15 años de edad [Norms for the Stroop Color–Word Test in a group of Puerto Rican students, ages 12 to 15] (Unpublished doctoral dissertation). Interamerican University of Puerto Rico, Metropolitan Campus, San Juan. Miranda, D. (1991). Guías profesionales para la evaluación psicológica [Professional guidelines for psychological evaluations]. San Juan: Puerto Rico Psychological Association. Montilla Báez, S. C. (2013). Validez discriminante y análisis de dificultad de los Reactivos de la Wechsler Intelligence Scale for Children–fourth edition Spanish (WISC–IV Spanish) en una muestra de estudiantes de 10 a 11 años de edad de escuelas públicas y privadas del área sur de Puerto Rico [Discriminant validity and difficulty level item analysis of the WISC–IV Spanish in a simple of 10 to 11 year old public and private school students in the Southern Region of Puerto Rico] (Unpublished doctoral dissertation). University of Puerto Rico, Rio Piedras Campus, San Juan. Moreno-Torres, M. A. (2013). Hacia un modelo neurocognitivo para la evaluación psicologica: implicaciones para el desarrollo de intervenciones en poblaciones escolares [Towards a neurocognitive model for psychological evaluation: Implications for the development of interventions in school populations]. Paper presented at the meeting of the Interamerican Congress of Psychology, Brasilia, Brazil. Naglieri, J. A., & Pickering, E. B. (2010). Helping children learn: Intervention handouts for use in school and at home, with Spanish handouts by Tulio M. Otero and Mary A. Moreno. Baltimore, MD: Brookes. Narváez Pérez, K., Crespo Fernandez, L., Miranda, M. T., & Boulon-Diaz, F. (2013). EIWA–III measures of cognitive function in young Puerto Rico patients with epilepsy. BOLETIN Médico Científico de la Asociación Médica de Puerto Rico, 105, 24–31. Pico, F. (1988). Historia general de Puerto Rico [General history of Puerto Rico]. Rio Piedras, Puerto Rico: Ediciones Huracán. Pintner, R. (1924). Results obtained with the non-language group test. Journal of Educational Psychology, 15, 473–483. http://dx.doi.org/10.1037/h0066683 Pons, J. I., Flores-Pabon, L., Matias-Carrelo, L., Rodriguez, M., Rosario-Hernandez, J. M., Herrans, L. L., & Yang, J. (2008). Reliability of the Wechsler Adult intelligence Scale III. Puerto Rican Journal of Psychology, 19, 112–131. Pons, J. I., Matias-Carrelo, L., Rodriguez, M., Rodriguez, J. M., Herrans, L. L., Jimenez, M. E., . . . Yang, J. (2008). Validity studies of the Wechsler Adult Intelligence Scale–III. Puerto Rican Journal of Psychology, 19, 75–110.

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Puerto Rico Board of Psychologist Examiners. (2013). Reglamento General num. 8333 y Normas Éticas de la Profesión [General bylaws number 8333 and Ethical Norms for the Profession]. San Juan, Puerto Rico: Department of Health. Rivera Alicea, B. (2006). Estudios graduados en la Universidad Interamericana de Puerto Rico [Graduate studies at the Interamerican University of Puerto Rico]. Puerto Rican Journal of Psychology, 17, 187–211. Rivera Medina, C. L., & Bernal, G. (2008). La medición en le cambio psicoterapéutico: Hacia una práctica psicológica basada en la evidencia y la medición [Psychotherapeutic change measurement: Towards an evidence and measurement based psychological practice.]. Puerto Rican Journal of Psychology, 19, 223–244. Rivera Vargas, D. (2013, October 8). Buscan facilitar la contratación de psicólogos en las escuelas [More school psychologists needed for services in schools]. Retrieved from http://www.elnuevodia.com/buscanfacilitarlacontrataciondesicologosen lasescuelas-1614718.html Roca, P. (1951). Manual Escala de Inteligencia Wechsler para Niños [Manual for the Wechsler Intelligence Scale for Children–Spanish Version]. San Juan, Puerto Rico: Department of Public Instruction. Roca, P. (1953). Escala de Inteligencia Stanford Binet para Niños [Stanford-Binet Intelligence Scale for Children–Spanish Version]. San Juan, Puerto Rico: Department of Public Instruction. Roca de Torres, I. (2006). Reseñas biográficas de algunos precursores de la psicología de Puerto Rico [Biographical sketches of some pioneers of psychology in Puerto Rico]. Puerto Rican Journal of Psychology, 17, 61–90. Roca de Torres, I. (2008a). La medición psicológica en Puerto Rico [Psychological measurement in Puerto Rico]. Puerto Rican Journal of Psychology, 19, 1–255. Roca de Torres, I. (2008b). Psychological measurement in Puerto Rico [Special issue]. Puerto Rican Journal of Psychology, 19. Rodriguez, J. M., Herrans, L. L., Pons, J., Matias-Carrelo, L., Medina, G., & Rodriguez, M. (2008). Translation and adaptation of the Wechsler Adult Intelligence Scale III. Puerto Rican Journal of Psychology, 19, 58–73. Rodríguez Gómez, J. R. (2002). Compendio de pruebas validadas para Puerto Rico: una Antología multidisciplinaria [Compendium of tests validated for use in Puerto Rico: A multidisciplinary anthology]. San Juan, Puerto Rico: Carlos Albizu University. Santiago-Negrón, S., Albizu, T., Figueroa-Rodriguez, M., García, L., Rentas, E., & Rodriguez, G. (2006). Universidad Carlos Albizu: A 40 años de su fundación [Carlos Albizu University: Forty years after its founding]. Puerto Rican Journal of Psychology, 17, 165–168. Scott, L. (1981). Measuring intelligence with the Goodenough-Harris drawing test. Psychological Bulletin, 89, 483–505. http://dx.doi.org/10.1037/0033-2909.89.3.483 Silvestrini, B., & Luque de Sanchez, M. D. (1988). Historia de Puerto Rico: Trayectoria de un Pueblo [History of Puerto Rico: Journey of a people]. San Juan, Puerto Rico: Editorial La Biblioteca. psychological testing in puerto rico     

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Sparrow, S. S., Cicchetti, D. V., & Balla, D. A. (2005). Vineland Adaptive Behavior Scales (2nd ed.). Circle Pines, MN: American Guidance Service. Terman, L. M. (1916). The measurement of intelligence: An explanation of and a complete guide for the use of the Stanford revision and extension of the Binet-Simon Intelligence Scale. Boston, MA: Houghton Mifflin. Thomas, A., & Grimes, J. (2008). Best practices in school psychology V. Bethesda, MD: National Association of School Psychology. Varas-Díaz, N., Neilands, T. B., Guilamo-Ramos, V., & Cintron Bou, F. (2008). Desarrollo de la Escala sobre el Estigma relacionado con VIH-SIDA para profesionales de la salud mediante el uso de métodos mixtos [Development of the HIV/AIDS Stigma Scale for health professionals through mixed methods]. Puerto Rican Journal of Psychology, 19, 183–215. Wechsler, D. (1949). Wechsler Intelligence Scale for Children. New York, NY: Psychological Corporation. Wechsler, D. (1955). Manual for the Wechsler Adult Intelligence Scale. San Antonio, TX: Psychological Corporation. Wechsler, D. (1992). Manual de la Escala de Inteligencia Wechsler para Ninos–Revisada, adaptada y normalizada para Puerto Rico por L. L. Herrans y J. M. Rodriguez [­Manual for the Wechsler Intelligence Scale for Children–Revised, adapted and normalized for Puerto Rico by L. L. Herrans and J. M. Rodriguez]. San Antonio, TX: Psychological Corporation. Wechsler, D. (2008). Escala de Inteligencia Wechsler para Adultos–Tercera Edicion (EIWA III). [Wechsler Adult Intelligence Scale, Third Edition, Spanish]. San Antonio, TX: Pearson. Wennerholm, M. A. (2010–2011). Controversias éticas y profesionales en torno a la evaluación psicológica en Puerto Rico [Ethical and professional controversies regarding psychological evaluations in Puerto Rico]. Paper presented at the meeting of the Puerto Rican Congress of Psychology and Mental Health, San Juan, Puerto Rico.

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4 A BRIEF REVIEW OF SPANISH-LANGUAGE ADAPTATIONS OF SOME ENGLISH-LANGUAGE INTELLIGENCE TESTS KURT F. GEISINGER

The measurement of intelligence is perhaps the best-known form of psychological testing and falls within the tests of general abilities (Anastasi & Urbina, 1997). Intelligence tests are the most prevalent and best known of the ability tests. There are a number of common aspects among most intelligence tests. First, these tests generally yield a single overall score, often called an IQ score (intelligence quotient), an overall index of the individual’s performance level. Second, even though they are likely to yield a single overall score, they may be composed of numerous component tests or scales. Each of these scales (e.g., verbal and performance scales) may also provide a score. Third, intelligence and other general ability tests have been found to be useful in a wide variety of settings. From their inception, intelligence tests have been used to identify those who are likely to succeed and to fail in educational settings, An earlier version of this paper was presented at the International Conference on Test Adaptation: Adapting Tests for Use in Multiple Languages and Cultures, Washington, DC, May 20–22, 1999. http://dx.doi.org/10.1037/14668-005 Psychological Testing of Hispanics, Second Edition: Clinical, Cultural, and Intellectual Issues, K. F. Geisinger (Editor) Copyright © 2015 by the American Psychological Association. All rights reserved.

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and they continue to be useful in such settings (Thorndike & Lohman, 1990). They have been so frequently used as predictors of success in current and future academic functioning that many intelligence tests may also be perceived as tests of scholastic aptitude. Their initial success was in the prediction of scholastic performance, and they continue to be validated against future success in educational and training endeavors. They are also used in clinical and counseling settings, in hospitals, and in industry. They may be used as preliminary screening instruments, with more specialized tests used as followup measures (Anastasi & Urbina, 1997). Intelligence tests, because of the wide variety of their uses, exist in a variety of forms: so-called individual tests that are administered to a single individual by a single test administrator or group tests that are given by one or more test administrators to a room full of individuals. Increasingly, these tests may also be administered by computer. Intelligence tests are increasingly seen as measuring general cognitive ability. Some tests are composed of scales measuring specific types of cognitive performance (e.g., solving a maze, placing a number of randomly arranged pictures into a logical sequence), but others are not. In the case of a test that has such scales, general cognitive ability, often considered as developed mental ability, is usually estimated essentially by averaging over the various scales. In tests whose items are not grouped into individual scales, measurement of general cognitive ability is most typically achieved by a balance of various types of test items. Of course, some tests, such as the Peabody Picture Vocabulary Test (Dunn & Dunn, 1997) or the Miller Analogies Test (Miller, 1960), have achieved considerable popularity even though they have remained focused on a single type of test item. The measurement of intelligence and general cognitive ability is reasonably widespread. These tests are used in school, clinical, and industrial settings and increasingly in clinical settings, especially when used by clinical neuropsychologists (see Chapter 7, this volume). However, this widespread use of such measures creates particular difficulties for test translation and adaptation across languages and cultures. It is often stated that the best predictor, or perhaps representation, of intelligence is vocabulary, a common first scale to be administered as part of an intellectual assessment. The Peabody Picture Vocabulary Test assesses intellectual performance of children through a careful sequencing of drawings of items that the test taker identifies orally by name. However, the raw translation of words from one language to another is likely to yield significant problems; their use, frequency, emotional connotations, and hence, difficulty may vary widely across languages (Maldonado & Geisinger, 2005). Similarly, much intellectual assessment is heavily verbally loaded. Many tests have test takers place sentences in logical order, for example. 68       kurt f. geisinger

Culture too is a major factor in the assessment of intelligence. A common item type in many group tests of intellectual performance involves the test taker selecting among four competing interpretations of a common proverb such as “A stitch in time saves nine.” Finally, another component that is assessed in measures of intelligence is performance. Performance measures of intelligence eschew the use of language to the extent possible and focus on task solutions such as solving problems such as mazes. Even changing the instructions on such assessments from one language to another is likely to introduce unwanted variability into a performance assessment. López and Romero (1988) reported some of the abuses in regard to the measurement of intelligence in Hispanic adults using a particular English-language measure, the Wechsler Adult Intelligence Scale—Revised (WAIS–R; Wechsler, 1981b). They stated, Some of the ways in which we have observed the WAIS–R used include (a) administering the instrument in English and attempting to take language differences into account when interpreting scores, (b) administering only the performance subtests, using either English or Spanish instructions, (c) using an interpreter, or (d) referring the testing to a Spanish-speaking colleague or assistant who can translate instructions and test items during test administration. Adherence to any of these procedures is unsatisfactory and in some cases, unethical. (p. 264)

This chapter describes the adaptation into Spanish of several Englishlanguage intelligence tests, three of which are individually administered and one that may be administered in group format. The adaptation from English to Spanish of quality measures of intelligence may be one way to improve this form of assessment and to avoid the problematic testing procedures that López and Romero (1988) identified. Of the three individual tests described in this chapter, two are generally administered to children: the Wechsler Intelligence Scale for Children—Revised (Wechsler, 1974) and the Woodcock-Johnson Psycho-Educational Battery—Revised (Woodcock & Johnson, 1989), and one, the WAIS, is administered to adults. WECHSLER INTELLIGENCE SCALE FOR CHILDREN—REVISED In 1974, the revised version of the Wechsler Intelligence Scale for Children (WISC–R) was published; in 1982, the same publisher issued a Spanish version of the scale, the Escala de Inteligencia Wechsler para Niños—Revisada (EIWN–R; Wechsler, 1982). The publisher acknowledged at that time that it was probably impossible to produce a single scale appropriate for all Spanish-speaking peoples. The test was announced as a translation that “incorporated two independently executed translations” (Wechsler, spanish adaptations of intelligence tests     

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1982, p. iii). After the initial translations, both performed in Miami, Florida, comments and suggestions from 21 bilingual school psychologists from that region were considered. The instrument was also pilot tested at the University of Miami. Alternate words and phrases are provided so that different Spanish groups (e.g., Puerto Ricans, Mexicans) can use the most appropriate words, but the manual cautions against using the English-language norms for the EIWN–R. Since that time a WISC–III (Wechsler, 1991) and a WISC–IV (Wechsler, 2003) have been published. The Spanish version of the WISC–R was adapted into three subsequent versions for Puerto Rico (Herrans & Rodriguez, 1992; Wechsler, 1993a), Spain (Wechsler, 2005), and Mexico (Wechsler, 1981a). The WISC–III was also adapted and published as an Argentinean edition (Wechsler, 1993b). The EIWN–R Puerto Rican manual is entirely written in Spanish and includes appropriate norms and supportive information (Herrans & Rodriguez, 1992). The manual includes information about the history of the EIWN–R, adaptations that made it more appropriate to Puerto Ricans, and information regarding the scale itself. In addition, the manual includes information on the Puerto Rican standardization as well as other psychometric information, such as reliability and validity data. The reliability of each of the subtests of the EIWN–IV was estimated using either internal consistency split-half correlations with a SpearmanBrown correction or test–retest correlations (Psychological Corporation, 2005; Sanchez-Escobedo, 2007). The test–retest reliability estimates were for the tests for which speed was essential (Coding, Symbol Search, and Cancellation subtests, as well as some of the process scores); all the others received split-half reliability coefficients. The range of subtest reliability splithalf coefficients was from .72 to .92 across all age ranges, and in general, these values are comparable to the values for the WISC–IV and are in most cases considerably higher than they were when the WISC–R was first adapted to Spanish. The median subtest internal consistency reliability for both Spanish tests is about .83, just slightly below those of the English version, for which the median is .84 to .85; although in general the English subtest reliability coefficients are slightly higher, the differences are quite minor. The internal consistency reliability coefficients for the EIWN–IV Full Scale IQ value is .97, exactly equal to that of the WISC–IV and higher than it was with the earlier EIWN–R at .94. The standard errors of measurement are mostly higher for the EIWN–IV than for the WISC–IV, with 8 of the 14 higher for the Spanish version and 5 higher for the English version (with one tie). The test–retest reliability coefficient for the EIWN–R over a period averaging 27 days ranged from .65 to .87 for the 14 common subtests and was .90 for the Full Scale IQs. These values are difficult to compare with the analogous values for the English version because the WISC–IV test– 70       kurt f. geisinger

retest analyses averaged 32 days and sometimes were about two weeks longer. Nevertheless, the WISC–IV subtest test–retest values were only slightly higher, and the Full Scale IQ was actually slightly lower at .89. Validity studies are described in the manual in strict accordance with the Standards for Educational and Psychological Testing (American Educational Research Organization, American Psychological Association, & National Council on Measurement in Education, 1999). Correlations among subtests provide interesting information as well: In general, the correlations among tests appear comparable on the Spanish-language than on the WISC–IV. Some other preliminary validation evidence is presented in the manual. Correlations between the Universal Nonverbal Intelligence Test, the Clinical Evaluation of Language Fundamentals—Third Edition, the Clinical Evaluation of Language Fundamentals—Spanish, and the Guide to the Assessment of Test Session Behavior and EIWN–IV Full Scale IQs were generally quite positive, with correlations of Full Scale IQs on subtests of these measures as high as .58, and although most are in the .40s and .50s and all are positive, some fall close to zero. These are probably reasonable values. Both exploratory and confirmatory factor analyses were performed, with the best solution comprising four factors: Verbal Comprehension, Perceptual Reasoning, Working Memory, and Processing Speed. Norms are provided for the EIWN–IV. Like the WISC–R, this measure was standardized on 2,200 children and adolescents split across a number of ages. One cannot use English-language norms on the Spanish version; that is, raw scores on subtests or overall scores on one test do not translate to the same scaled scores on the other language version of the test. The EIWN–IV is probably one of the most frequently used intelligence tests for children in Spanish. It now has a history of improvements and is closely tied to the Wechsler franchise, certainly the most popular of the individually administered intelligence testing programs. BATERíA WOODCOCK-MUñOZ—REVISED The Batería III Woodcock-Muñoz (Schrank et al., 2005) is adapted from and seen as parallel to the Woodcock-Johnson III Battery (Woodcock, McGrew, & Mather, 2007) and is the third such adaptation, with the first version having been published in 1982. It is composed of the same subtests available in the English version and is based on the Cattell-Horn-Carroll theory of cognitive abilities (Carroll, 1993). The cognitive abilities battery of the Batería III Woodcock-Muñoz includes 31 subtests (Schrank et al., 2005), 11 of which are considered supplemental and which may be used as part of diagnostic decision spanish adaptations of intelligence tests     

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making. The Batería III Woodcock-Muñoz includes 12 new subtests that did not appear in the Batería Woodcock-Muñoz—Revised. As an initial step in the adaptation process, “a board of consulting editors was established to review and advise on all aspects of the project including the item content and Spanish language usage” (Woodcock & Muñoz-Sandoval, 1996, p. 3). An additional goal of the process was to design items and the test as a whole so it would be “deemed appropriate across the Spanish-speaking world” (Schrank et al., 2005, p. 11; Woodcock & MuñozSandoval, 1996, p. 3). To accomplish this goal, the editorial board reviewed test materials, including test instructions. Some subtests were directly translated; others required adaptation as well as a change from the English to the Spanish (Geisinger, 1994). “In general most of the comprehensionknowledge, auditory, long-term retrieval, short-term retrieval, memoral, oral language, reading, and writing tests required adaptation” (Schrank et al., 2005, pp. 12–13). The Batería Woodcock-Muñoz is based on a model of intellectual ability that holds that four groups of cognitive abilities contribute to general cognitive performance or intelligence: acquired knowledge, short-term memory, thinking abilities, and facilitator–inhibitors (internal and external). According to the manual, The acquired knowledge measures represent stores of information that are available for use in problem solving. The short-term memory measure represents the proficiency with which an individual apprehends and immediately utilizes information. The thinking abilities (visual processing, auditory processing, long-term retrieval, and fluid reasoning) are grouped together because they represent the processes by which problems are solved and new learning occurs. Processing speed differs from the other types of cognitive abilities because it can either facilitate or inhibit overall cognitive performance, depending on the subject’s proficiency in processing automatic cognitive tasks. (Woodcock & MuñozSandoval, 1996, p. 18)

The Batería Woodcock-Muñoz—Revised is based on a Rasch scaling model, and the Rasch approach (Wright & Stone, 1979) was used throughout the process. In fact, if items were found as differentially difficult across any of five Spanish-speaking groups used in their initial research, the item was dropped. The test manual suggests that such items were seen as biased.1 Because English and Spanish items were also required to have the same levels

Of course, the item might indeed be biased, and such a research finding would be evidence of such. However, it is also possible that one group is simply more or less able than other groups on the content or process represented by the test item. 1

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of difficulty, the tests are perceived as being of equal difficulty in English and Spanish; the same norm tables can be used, for example. One relatively unusual feature of the Batería is its ability to provide a Relative Mastery Index (RMI) of English and a Relative Proficiency Index (RPI) of Spanish-language ability, as well as a Comparative Language Index (CLI) that compares the two other indexes (where CLI = RPI/RMI). In addition, the overall level of cognitive–academic language proficiency, based on the work of Cummins (1984), may be estimated from the RPI. This index is needed because the CLI does not provide an indication of how proficient in an absolute sense the individual’s use of language is, only the relative strengths of the two languages. It is unfortunate that no results of validity studies of these indexes are provided in the manual. Calibration for the Batería is based on 1,413 Spanish-speaking test takers from Mexico (417), the United States (279), Costa Rica (248), Panama (153), Argentina (111), Columbia (101), Puerto Rico (94), and Spain (10). No explanation for the sampling plan across these different countries was provided. Most of the test takers were monolingual, because it was felt that such individuals were likely to be more appropriate than bilinguals; the United States test takers were required to be Spanish dominant. Readers of the manual are encouraged to read the Woodcock-Johnson manual (McGrew, Werder, & Woodcock, 1991; Schrank et al., 2005) for elaboration. The results of the calibration sample were equated to the United States sample using Rasch scaling (Wright & Stone, 1979). In other words, the United States norms are essentially used, with the performance on the Spanish subtests Rasch scaled to be equivalent to the United States performance. Some of the Batería–R subtests have identical item content in both languages; only the test instructions have been changed in the Spanishlanguage version. According to the manual, the test uses the same norms as the English-language version in this instance. This practice is certainly questionable, although it may be consistent with an item response theory perspective. Those subtests that have different item content—that is, differences based on item adaptation that amount to more than translation— were developed through the collection of data so that the subtests could be equated to the English-language form: “Tasks underlying each Spanish test are re­scaled according to the empirical difficulty of counterpart tasks in English” (Woodcock & Muñoz-Sandoval, 1996, p. 23). An excellent rationale for this approach is provided in the manual: The norm group for all test takers, whether Spanish-speaking or English-speaking or whether South American or North American, is English-speaking North Americans. Interpretations from the use of such a norm group may lead to interesting dilemmas, but there is nevertheless a fixed reference group, one which the test authors see as identifiable and relatively stable over time. Such an interpretation can also spanish adaptations of intelligence tests     

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be confusing. Clearly, performance on the examination relative to Englishspeaking American norms may not equate in terms of percentile rank to those of various South American countries. Thus, a child could be identified as below average, even though he or she is much above his or her peer group, if average performance in that country or region is below that of North Americans (or perhaps culturally different from North Americans). And one might question whether it is appropriate to interpret test performance of an Argentinean child, for example, using North American norms. A step-by-step, conceptual explanation of the equating of the Batería is provided in the manual. Several steps in the process are worthy of mention. First, as noted, the English-language test items were calibrated using Rasch methodology. Second, a sampling of test items of varying difficulty was translated into Spanish. These translated items served as “anchor test items” as part of the test translation process and were administered to Spanishspeaking research test takers along with Spanish items that had no English counterpart. All items in the latter group were calibrated to the anchor items, fit statistics were computed, and those items that generated poor fit statistics were dropped from the examination. This process appears efficient but assumption laden. Internal consistency reliability coefficients are presented in the manual and portray most of the tests composing the Batería III as reasonable measures. Internal consistency reliability coefficients are presented for a number of ages (2, 4, 5, 9, 13, and adults). Subtest reliability coefficients for particular ages range from .73 to .98. Estimates of the various Cattell-Horn intelligences (e.g., Gf and Gc) are also provided. The Batería III also provides reliability coefficients for some of the summary indexes (e.g., a broad measure of verbal cognitive ability; the ability to analyze, synthesize, and discriminate auditory stimuli; phonetic coding), again broken down by age ranges; these indexes, which are more heterogeneous than the individual subtests, produce internal consistency reliability coefficients ranging from .86 to .95. A statement in an earlier manual related to validity (Woodcock & Muñoz-Sandoval, 1996), however, must be questioned. The manual stated that readers should look at validity studies in the English-language Woodcock-Johnson manual and that “since the two batteries are parallel in content and structure, the WJ–R [Woodcock-Johnson—Revised] results are generalizable to the Batería–R” (Woodcock & Muñoz-Sandoval, 1996, p. 29). Such findings are not generalizable across language without documented evidence of such generalizability. The current manual (Schrank et al., 2005) takes a decidedly construct validity approach using confirmatory factor analysis. Given that the measure is based on the Cattell-Horn-Carroll model of cognitive abilities, the current manual presents the results of a confirmatory factor analysis of the internal structure of the Batería III. Three sets 74       kurt f. geisinger

of factor analyses were performed, two on specific age groups and one with the entire sample. It is not clear exactly from where the samples were drawn, but it is presumed that they came from the calibration samples. Evidence is provided showing that the results match the Cattell-Horn-Carroll model and also that they are similar to those of the English-language version of the Woodcock-Johnson III measure. No other evidence of validity is presented in the manual. WECHSLER ADULT INTELLIGENCE SCALE The Escala de Inteligencia Wechsler para Adultos—III (EIWA–III) is the Spanish-language adaptation of the WAIS. The EIWA was introduced in 1968 after an adaptation into Spanish of the English-language version (along with associated changes to assure cultural equivalence) and a complete re­standardization in Puerto Rico. The EIWA–III is modeled after the WAIS– III, but has lagged behind the WAIS–IV, which was introduced in 2008 by Psychological Corporation. The EIWA–III was first introduced in 1994, and a revised edition was published in 2008. Like the WAIS–III, the EIWA–III has 14 subtests and yields Verbal, Performance, and Full Scale IQ values for individual test takers. Many subtest items were modified, deleted, or added in an effort to make the test more psychometrically sound, more appropriate, and more culturally relevant for Puerto Ricans and, it was hoped, other Latino populations. For the most part, the EIWA retained the fundamental subtest structure of the WAIS (Green, 1964; Green & Martínez, 1967). When first introduced, the EIWA was the only psychometric instrument with seemingly adequate published norms that could be used for the intellectual assessment of adult Hispanics, and it remains one of the few measures available for this purpose today. It may be used with individuals above the age of 16, which is the cutoff age for which the EIWN–IV is used. Because of this unrivaled position, the EIWA–III has become the foremost individually administered instrument used for the intellectual assessment of Hispanics in the United States, including Puerto Rico. It has been, and continues to be, widely used in making often high-stakes psychodiagnostic decisions. Although reliability and validity data for this revised instrument have been quite reasonable (see Maldonado and Geisinger, 2005, for a brief review of this literature related to the original EIWA), since shortly after its inception, evidence—formal and informal—has indicated that the EIWA frequently yielded inflated IQs for individuals when compared with scores from English-language measures, or when developed cognitive abilities were estimated from known levels of functioning. It was not uncommon for a bilingual individual to score 20, 30, or more IQ points higher on the EIWA than on the spanish adaptations of intelligence tests     

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WAIS or WAIS–R. It should be remembered that 15 points represents a standard deviation. During the 1980s and 1990s, articles in journals and other academic fora disseminated evidence that the EIWA yielded much-inflated scores (e.g., López & Romero, 1988). The reason behind the inflation appears to be primarily that (a) the standardization sample did not model the Puerto Rican population adequately and (b) the Puerto Rican population may have differed with regard to the mainland U.S. population on intelligence (López & Romero, 1988; Maldonado & Geisinger, 2005). Specifically, it was found that the sample of individuals for the standardization sample differed from U.S. Census reports in regard to region of residence within Puerto Rico, occupation, and education. For the original EIWA, an attempt was made to ensure that the language and cultural equivalence of the test was appropriate for all Spanish-speaking test takers by sending draft versions of the EIWA to individuals from a variety of different countries (Herrans, 1973). However, pretesting of the instrument was extremely limited. Melendez (1994) questioned the norms of the EIWA to the extent that he suggested its use might raise ethical issues. He stated, The changes found in the EIWA are so pervasive that they appear to exceed any reasonable cultural correction by altering not only the content of the tests, but their length, cut-off points, and scoring. All of these changes made the EIWA a more lenient test, even to the extent that some answers which are marked wrong in English are marked right in Spanish. There should be no “cultural” or any other reason for scoring incorrect answers as being correct. (p. 389)

Essentially, Melendez questioned the behavior comparability of scoring across the two tests. If one could repeat six digits forward and five backward on the WAIS, one would receive a scaled score of 10; on the EIWA, the same performance would yield a scaled score of 14. To overcome some of the issues related to the original EIWA, the EIWA–III has norms based on 2,450 individuals across the United States ranging from 16 years old to 89, with equal numbers of men and women. An attempt was made to make sure that the education of the norm sample paralleled that of the population as well. Racial groups were balanced, as were regions of the country from which the sample was taken. Scoring is quite reliable. The manual demonstrates that by age group, Full Scale IQs have reliabilities in the .97 to .98 range, verbal IQs .96 to .98, and performance IQs .93 to .96. These are excellent values. Subtest reliability coefficients range from .66 to .94, with the verbal subtest reliabilities notably higher. Both internal consistency and test–retest (with lags between 2 and 12 weeks) reliability coefficients were calculated. Evidence of validity ranges from support for content validity, through criterion-related validity 76       kurt f. geisinger

with appropriate criteria, and correlations with other intelligence tests in both English and Spanish. CONCLUSION Intelligence testing is a common form of assessment for many different purposes. Among these purposes are special education placement, admission to educational programs, employment testing, and certainly, psychodiagnosis in psychiatric and clinical neuropsychological assessments. All of these are often high-stakes testing situations. Buckendahl and Foley (2011) even presented a case study of the importance of intelligence testing in death penalty cases. For this reason, some of the best and most professional test publishers have adapted some of their best intelligence instruments for use, both inside and beyond the borders of the United States, with Spanish-speaking or predominantly Spanish-speaking test takers. In general, I believe that the following conclusions can nevertheless be drawn regarding the Spanish versions of English-language measures of intelligence. 77

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On the basis of this review of three tests, it is clear that these tests are generally of acceptable quality in terms of professional standards. In some cases, such as the EIWA–III, the test appears much improved over its earliest versions. Market forces appear to be driving improvements in these tests. The Spanish versions of these tests appear, in some cases, fully a decade after the publication of the older English-language versions. In general, the documented quality of the Spanishlanguage tests is now approaching the standards set for the English-language versions. In some cases, the tests may become dated well before they are replaced. Market forces apparently do not permit revisions as quickly as they are performed on English-language intelligence tests. At least since the initial publication of the EIWA, all publishers have acknowledged that translations should be adaptations that take into account both cultural and language differences that are far more extensive than a simple language translation. Norms and equating are a necessary focus. It is difficult to know what the appropriate sampling pattern should be. For example, should a test be normed on Hispanics in the United States, in Puerto Rico, in Mexico, in Latin America more generally, or some merged sampling? The three measures described here all used different strategies, although it appears that the procedures of the EIWN–IV and the EIWA–III are somewhat similar. spanish adaptations of intelligence tests     

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The adaptations of these tests into Spanish were originally of lower reliability and validity, but they now appear virtually comparable. It does appear likely that with regard to the adaptation of a language-based intelligence test, it will not be possible to have one Spanish-language adaptation for all Spanish-speaking individuals. Different forms appear minimally to be needed, for example, for Mexicans and Puerto Ricans. Other Spanish variants are also likely to be required.

The various language-free tests of intelligence, as exemplified by the work of Dr. Bruce Bracken (Bracken & McCallum, 1998) and which are beyond the scope of this chapter, have great promise. Nevertheless, since Binet’s initial success in the development of instruments to assess intelligence and cognitive ability, language is a part of the kinds of thinking fundamental to intelligence. Proper word use (e.g., vocabulary) and thinking that is inextricably tied to language are fundamental components of intelligence and cognitive ability. Nevertheless, the joint use of language-free measures along with the adapted measures discussed in this chapter may have great promise. However, it is noteworthy and surprising that the performance measures on the EIWN–IV appear perhaps to be of lower quality than the verbal tests, although the adaptation of the performance tests is much less extensive. Although this summary may appear somewhat pessimistic, it should also be noted that the quality of Spanish-language adaptations appears to be significantly improved, and the use of these adaptations is much more common at present. As stated earlier, these tests now are of generally acceptable quality for proper test use. REFERENCES American Educational Research Organization, American Psychological Association, & National Council on Measurement in Education. (1999). Standards for educational and psychological testing. Washington, DC: American Educational Research Association. Anastasi, A., & Urbina, S. (1997). Psychological testing (7th ed.). Upper Saddle River, NJ: Prentice Hall. Bracken, B. A., & McCallum, R. S. (1998). Universal non-verbal intelligence test. Itasca, IL: Riverside. Buckendahl, C. W., & Foley, B. P. (2011). A high-stakes use of intelligence testing: A forensic case study. In J. A. Bovaird, K. F. Geisinger, & C. W. Buckendahl (Eds.), High-stakes testing in education: Science and practice in K–12 settings (pp. 191–209). Washington, DC: American Psychological Association. http:// dx.doi.org/10.1037/12330-012

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Carroll, J. B. (1993). Human cognitive abilities: A survey of factor-analytic studies. Cambridge, England: Cambridge University Press. Cummins, J. (1984). Bilingualism and special education: Issues in assessment and pedagogy. Austin, TX: Pro-Ed. Dunn, L. M., & Dunn, L. M. (1997). Peabody Picture Vocabulary Test (3rd ed.). Circle Pines, MN: American Guidance Service. Geisinger, K. F. (1994). Cross-cultural normative assessment: Translation and adaptation issues influencing the normative interpretation of assessment instruments. Psychological Assessment, 6, 304–312. http://dx.doi.org/10.1037/ 1040-3590.6.4.304 Green, R. F. (1964). Desarrollo y estandarización de una escala individual de inteligencia para adultos en español [Development and standardization of a scale of individual intelligence for adults in Spanish]. Revista Mexicana de Psicología, 1, 231–244. Green, R. F., & Martínez, J. (1967). Standardization of a Spanish-language adult intelligence scale (Final Report, Project No. 1963, Contract No. O. E. 3-10-128). Washington, DC: United States Department of Health, Education and Welfare. Herrans, L. L. (1973). Cultural factors in the standardization of the Spanish WAIS or EIWA and the assessment of Spanish-speaking children. School Psychologist, 28, 27–34. Herrans, L. L., & Rodriguez, J. M. (1992). Manual: Escala de Inteligencia Wechsler para Niños–Revisada, David Wechsler: Adaptada y normalizada para Puerto Rico [Manual: Wechsler Intelligence Scale for Children–Revised, David Wechsler: Adapted and normed for Puerto Rico]. San Antonio, TX: Psychological Corporation. López, S. R., & Romero, A. (1988). Assessing the intellectual functioning of Spanish-speaking adults: Comparison of the EIWA and the WAIS. Professional Psychology: Research and Practice, 19, 263–270. http://dx.doi.org/10.1037/07357028.19.3.263 Maldonado, C. Y., & Geisinger, K. F. (2005). Conversion of the Wechsler Adult Intelligence Scale into Spanish: An early test adaptation effort of considerable consequence. In R. K. Hambleton, P. F. Merenda, & C. D. Spielberger (Eds.), Adapting educational and psychological tests for cross-cultural assessment (pp. 213– 234). Hillsdale, NJ: Erlbaum. McGrew, K. S., Werder, J. K., & Woodcock, R. W. (1991). W–J–R technical manual: A reference on theory and current research. Itasca, IL: Riverside. Melendez, F. (1994). The Spanish version of the WAIS: Some ethical considerations. Clinical Neuropsychologist, 8, 388–393. http://dx.doi.org/10.1080/ 13854049408402041 Miller, W. S. (1960). Miller Analogies Test. New York, NY: Psychological Corporation. Psychological Corporation. (2005). WISC–IV Spanish Manual. San Antonio, TX: Harcourt Assessment. spanish adaptations of intelligence tests     

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Sanchez-Escobedo, P. (2007). Validacion y normas para Mexico de Escala Wechsler de Inteligencia para Niños IV [Validation norms for Mexico and the Wechsler Intelligence Scale for Children IV]. Mexico City, Mexico: Manual Moderno. Schrank, F. A., McGrew, K. S., Ruef, M. L., Alvarado, C. G., Muñoz-Sandoval, A. F., & Woodcock, R. W. (2005). Batería III Woodcock-Muñoz: Overview and technical supplement. Chicago, IL: Riverside. Thorndike, R. M., & Lohman, D. F. (1990). A century of ability testing. Chicago, IL: Riverside. Wechsler, D. (1974). Wechsler Intelligence Scale for Children–Revised: Manual. New York, NY: Psychological Corporation. Wechsler, D. (1981a). Escala Wechsler de Inteligencia para Niños Revisada (WISC– R) [Wechsler Intelligence Scale for Children Revised]. Mexico City, Mexico: Manual Moderno. Wechsler, D. (1981b). Manual for the Wechsler Adult Intelligence Scale–Revised. New York, NY: Psychological Corporation. Wechsler, D. (1982). Manual para la Escala de Inteligencia Wechsler para Niños– Revisada [Manual for the Wechsler Intelligence Test for Children–Revised]. San Antonio, TX: Psychological Corporation. Wechsler, D. (1991). Manual for the Wechsler Intelligence Scale for Children–Third Edition (WISC–III). San Antonio, TX: Psychological Corporation. Wechsler, D. (1993a). Escala de Inteligencia Wechsler para Niños—Revisada de Puerto Rico (EIWN–R–PR) [Wechsler Intelligence Scale for Children—Revised Puerto Rico]. San Antonio, TX: Psychological Corporation. Wechsler, D. (1993b). WISC–III, Escala de Inteligencia de Wechsler para Niños III— Edición Argentina [WISC–III, Wechsler Intelligence Scale for Children III— Argentina edition]. San Antonio, TX: Psychological Corporation. Wechsler, D. (2003). Wechsler Intelligence Scale for Children–Fourth Edition (WISC– IV). San Antonio, TX: Pearson. Wechsler, D. (2005). WISC–IV: Escala de Inteligencia Wechsler para Niños–IV [WISC– IV: Wechsler Intelligence Scale for Children–IV]. Madrid, Spain: TEA. Woodcock, R. W., & Johnson, M. B. (1989). Woodcock-Johnson Psycho-Educational Battery–Revised. Chicago, IL: Riverside Publishing. Woodcock, R. W., McGrew, K. S., & Mather, N. (2007). Woodcock-Johnson III Battery. Scarborough, Canada: Nelson Education. Woodcock, R. W., & Muñoz-Sandoval, A. F. (1996). Batería Woodcock-Muñoz: Puebas de Habilidad Cognitiva–Revisada, Supplemental Manual [WoodcockMuñoz Battery: Tests of Cognitive Ability–Revised]. Itasca, IL: Riverside. Wright, B. D., & Stone, M. H. (1979). Best test design: Rasch measurement. Chicago, IL: University of Chicago, MESA Press.

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5 ISSUES RELATED TO INTELLIGENCE TESTING WITH SPANISH-SPEAKING CLIENTS LAWRENCE G. WEISS, AURELIO PRIFITERA, AND MARIA R. MUNOZ

As of 2010, the United States ranked second in the world for number of resident Hispanics (50.5 million) after Mexico (112 million). By 2060, the Hispanic population will have doubled, and one of every three U.S. residents will be of Hispanic origin. Because of the steadily growing Hispanic population in the United States, culturally sensitive assessment of general intelligence and specific cognitive abilities with Spanish-speaking clients is increasingly important to clinical practice. Yet, it is a complex and multi­ faceted area of study, and there is no single solution capable of covering all situations. Spanish-speaking clients may share a primary language but represent diverse linguistic and cultural backgrounds. Individuals from different Hispanic cultures vary greatly with regard to country of origin; sociopolitical, economic, and educational experiences; religion; and language(s) The authors wish to thank Antolin Llorente, Alexander Quiros, and Josette Harris for comments on an earlier draft of this manuscript. http://dx.doi.org/10.1037/14668-006 Psychological Testing of Hispanics, Second Edition: Clinical, Cultural, and Intellectual Issues, K. F. Geisinger (Editor) Copyright © 2015 by the American Psychological Association. All rights reserved.

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spoken. Length of residency in the United States, from recently immigrated to having multiple generations in the country, parent ethnicity (Hispanic or other), and family use of Spanish vary widely among Spanish-speaking clients (Elliott, 2012). Many of these variables affect test taking and, ultimately, test scores. Moreover, these environmental variables in combination with sociological factors may selectively influence the developmental trajectory of specific cognitive abilities in children and adolescents, as well as the form of expression of intelligent behavior in adults. Although there are numerous important issues related to competent psychological assessment of culturally and linguistically diverse clients, in this chapter we restrict our focus to those that are either unique or critical to intellectual assessment with Hispanics. Thus, this chapter should be considered in context with other chapters in this volume. When assessing intelligence with Hispanic clients, it is important to acknowledge the incremental improvement in U.S. school performance observed as acculturation increases (López, Ehly, & García-Vásquez, 2002). This finding is true for children as well as adult clients who have had some, but not all, of their formal education in the United States. Experience in U.S. schools may be associated with variables known to affect cognitive performance, such as exposure to new learning opportunities and novel intellectual stimulation and positive changes in socioeconomic environment. Formal education conveys cultural information and conventions for thinking and categorization skills, all of which may affect both verbal and nonverbal test performance. Customs concerning verbal communication may evolve through exposure to U.S. culture and educational settings. For some immigrants, prior experiences with formal education and acculturation may have been limited due to geographic constraints, economic barriers, or socio­ political constraints affecting access to educational resources. Experience with the testing situation and acquisition of test-taking skills will likely have a positive influence on the individual’s performance on cognitive assessments. Experience with U.S. educational culture is likely to facilitate the development of bilingual skills in native Spanish speakers, which may influence performance on cognitive tests. For example, bilingual children exhibit greater inhibitory control and executive functioning skills than has been observed in monolingual children (Bialystok, Craik, & Luk, 2008; Carlson & Meltzoff, 2008). Younger children acquiring English may take 5 to 7 years, on average, to approach grade level in academic areas (Ramirez, 1991). Establishing rapport within formal assessment situations involving clients from different cultures cannot be emphasized enough. As elaborated by Elliott (2012), individuals from diverse backgrounds, especially children who face unfamiliar adults in unfamiliar test situations, may be more reluctant to interact and perform at their best. Under some circumstances, adults may be 82       weiss, prifitera, and munoz

confused or suspicious about the purpose and use of the testing, and if their child is being tested, may directly or indirectly communicate their discomfort to them. This could potentially compromise the child’s performance and the validity of the evaluation. Testing may be especially stressful for Hispanic clients residing in the United States without documented residency, who may be fearful of any scrutiny by persons in positions of perceived authority. Examiners must be sensitive to these issues. It may be necessary to meet with children and parents over extended periods of time to build rapport and to clarify the nature and purpose of an evaluation, the confidential nature of the evaluations, and the manner in which results will be utilized. As Elliott (2012) observed, the issue of what language to test a child in is a critical question. However, the concept of dominant language may be losing favor because proficiency in two languages occurs on a continuum, with bilingual individuals being able to understand or express some concepts better in one language and other concepts in the other language. Proficiency can shift based on context, with some individuals being able to speak fluently about one topic in one language and other topics in the second language. This is especially true for children learning Spanish first as a home language, then English in school. Best practice is to reduce the influence of school experience and secondary language acquisition on test performance, but there is no single best way of accomplishing this goal because of the myriad of potential influences. ASSESSING HISPANIC CHILDREN WITH THE WECHSLER INTELLIGENCE TESTS The Wechsler Adult Intelligence Scale (4th ed.; WAIS–IV; Wechsler, 2008b), Wechsler Intelligence Scale for Children (4th ed.; WISC–IV; Wechsler, 2003), and Wechsler Preschool and Primary Scale of Intelligence (4th ed.; WPPSI–IV; Wechsler, 2012b) are commonly used intellectual assessment instruments. We assume the reader is generally familiar with these tools, and focus this section on issues related to appropriate use of the tools with Hispanic clients who speak English or both English and Spanish. Later in the chapter, we review issues related to testing Spanish-speaking clients with the Spanish editions of the WISC–IV, Differential Abilities Scale—II Early Years Spanish Supplement (DAS–II Early Years Spanish Supplement; Elliott, 2012), and Woodcock-Johnson III Tests of Cognitive Abilities (WJ III COG; Woodcock, McGrew, & Mather, 2001). Each of the Wechsler normative samples included culturally and linguistically diverse individuals who were judged by the examiner as able to speak English well enough to take the test. All Wechsler norm groups included intelligence testing with spanish-speaking clients     

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Hispanic subjects who spoke some Spanish if their English-language skills were considered by the examiner to be better than Spanish and adequate for assessment purposes. Clearly, the decision to assess a Spanish-speaking client in English must be made based on numerous factors including, but not limited to, language spoken as a child or adolescent, years of school in English-language classrooms, language spoken at home and work, and much more. Such decisions should be carefully considered in each case and not be made based on the preference of the examiner or because of a lack of availability of Spanish examiners. Optimally, this decision would be made by an examiner from the same cultural background or at least one experienced with the client’s cultural and linguistic background. Further, results of assessments administered in English should be interpreted with caution. In this section, we provide some data to encourage the culturally sensitive interpretation of Wechsler intelligence tests administered in English to Hispanic clients. The WAIS–IV, WISC–IV, and WPPSI–IV normative samples were carefully stratified to represent the U.S. population by race and ethnicity for most groups of Hispanics. Thus, the same percentage of Hispanics is included in the sample as in the population. Because the percentage of U.S. Hispanics has increased over the generations and differs by region of the country, the research team carefully matched the census data for Hispanics at each age band and within each region. In this way, the regional distribution of Hispanics from different countries of origin was represented. Perhaps most important, the educational attainment of Hispanics included in the WAIS–IV normative sample and the parents’ educational attainment for Hispanic children included in the WISC–IV and WPPSI–IV normative samples were both carefully matched to the distribution of educational attainment of Hispanics in the population. For adults tested with the WAIS–IV, the mean index scores ranged from approximately 91 to 96. For children and adolescents tested with the WISC–IV, the mean index scores ranged from 91 to 98. For young children tested with the WPPSI–IV, the mean index scores ranged from approximately 94 to 99. In each case, lowest and highest mean scores were for the Verbal Comprehension Index (VCI) and Processing Speed Index (PSI), respectively. Some might argue that these means should be 100. They may say that it is possible that these means are depressed to the extent that some individuals tested did not, in fact, speak English well enough to take the test. Although there is no direct way to test this hypothesis with these data, the research team carefully reviewed each client’s responses to identify and eliminate subjects who exhibited a preponderance of responses in Spanish (although occasional responses in Spanish were accepted and thus may be accepted in practice). One might also think that biased items were a contributing factor. However, because of the use of expert item bias review panels combined 84       weiss, prifitera, and munoz

with the sophisticated statistical techniques for detecting differential item functioning by group that is in routine use by most major test developers these days, item bias is unlikely to have contributed substantially to the lower scores observed for Hispanics. It is more likely that these differences are due to the overall educational level of the Hispanic sample. For example, we know that there are significant differences in mean Full Scale IQ (FSIQ) scores by level of education. The differences are dramatic, ranging about 28 FSIQ points between the most and least educated adults on the WAIS–IV, 17 FSIQ points between young children of the most and least educated parents on the WPPSI–IV, and 20 points between school-age children and adolescents on the WISC–IV. We also know that the average level of education of Hispanics is substantially lower than all other racial and ethnic groups. Hispanic adults, many of whom are the parents of WISC–IV and WPPSI–IV age children, have a much larger high school dropout rate (about 44%) and smaller rate of college entrance (29%) than any other major ethnic group by far. Notably, Hispanics also differ significantly with regard to mean educational attainment between Hispanic subgroups (e.g., South American, Cuban, Mexican American). Given the large educational disparities between racial/ethnic groups and the robust correlation between education and intelligence test scores, somewhat lower mean FSIQ scores might be expected in the Hispanic samples. Mean FSIQ scores for Hispanics are 91.6 for the WAIS–IV, 93.1 for WISC–IV, and 95.3 for WPPSI–IV. These findings are most likely because samples of Hispanics with generally low educational attainment are being compared with a larger U.S. normative sample with significantly more education on average. If the Hispanic normative sample was compared with a sample of people with the same educational distribution—regardless of ethnicity—the mean Hispanic FSIQ would be close to 100. Although some might consider that a fairer approach, we must keep in mind that such an education-adjusted score would tell us nothing about how an individual might be able to succeed in a world made up of largely more educated people. For better or worse, the accepted definition of intelligence involves performance relative to the full population within the country of interest. In clinical practice it is also useful to have a sense of how a client compares with others of the same ethnicity and with similar educational backgrounds. For this reason, in this chapter we provide new Hispanic percentile norms, stratified by the educational distribution of Hispanics living in the United States, for the WAIS–IV, WISC–IV, and WPPSI–IV. The Hispanic percentile norms supplement information is derived from the FSIQ but does not replace the FSIQ. Thus, whenever the Hispanic percentile norms are reported, the FSIQ should also be reported. intelligence testing with spanish-speaking clients     

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Wechsler Adult Intelligence Scale—IV With Hispanic Adults Hispanic percentile norms are provided for the WAIS–IV in Table 5.1. Examination of this table shows that an Hispanic client obtaining a WAIS–IV VCI score of 85 points would have performed better than only 16% of the general population (see WAIS–IV norm tables in the technical manual; Wechsler, 2008b), but better than 36% of other Hispanics. Both pieces of information are useful, and the comparison between them is also informative. To inform culturally sensitive interpretation further, we provide new base rate data of index score discrepancies for Hispanics in Table 5.2. To use this table, calculate the average index score and then compute the difference between the average and each of the four index scores. Inspection of the mean differences by direction reveals that, on average, Hispanic adults show a pattern of slightly lower VCI and Working Memory Index (WMI) scores and slightly higher Perceptual Reasoning Index (PRI) and PSI scores compared with their own mean index score. These data may help prevent misinterpretation of low VCI scores, which are common in Hispanics. At the same time, approximately 40% of Hispanics showed the opposite pattern of VCI higher than their mean by one or more points. According to Table 5.2, a VCI score 12 or more points below the average of the client’s four index scores might be considered unusual in that a difference of that magnitude or larger was observed in only 13.1% of the Hispanic sample. Some practitioners may prefer to use a base rate of 10% or less to signify a discrepancy of an unusual magnitude. However, 15% is often appropriate for hypothesis generation confirmed by other data. In either case, interpretation of these patterns should always take into account the client’s language proficiency, educational level, and general cognitive ability score. To understand the societal factors underlying these score patterns better, Weiss, Chen, Harris, Holdnack, and Saklofske (2010) undertook a systematic investigation of the factors that influence FSIQ scores for Hispanics based on variables available in the WAIS–IV standardization data set. For adults ages 20 to 90, ethnicity alone explained 11% of the variance in Hispanic–White FSIQ score differences, whereas 37% of the variance was explained by a combination of the client’s educational level, occupation, income, and region of the country. After controlling for these socioeconomic variables, ethnicity alone explained 3.8% of the variance. If these findings are true, we might expect to see a trend toward higher Hispanic FSIQ scores across generations as children of Hispanic immigrants assimilate into the new culture, gain access to and achieve more education or better paying jobs, and advance in socioeconomic status (SES). Weiss et al. (2010) examined this hypothesis and found it partially supported. Average WAIS–IV FSIQ scores (which are age-corrected) for Hispanics have 86       weiss, prifitera, and munoz

TABLE 5.1 Wechsler Adult Intelligence Scale—IV Hispanic Percentile Norms Obtained score ≥70 71 72 73 74 75 76 77 78 79 80 81 82 83 84 85 86 87 88 89 90 91 92 93 94 95 96 97 98 99 100 101 102 103 104 105 106 107 108 109 110 111 112 113 114 115 116 117 118 119 ≥120

FSIQ

VCI

PRI

WMI

PSI

 5  7  8  9 11 13 15 17 19 20 22 24 27 30 32 35 38 40 42 44 46 48 50 52 55 58 60 63 66 69 72 75 77 79 81 83 85 86 88 89 90 91 92 93 94 95 96 97 97 98 98

 7  9 10 12 14 16 18 20 22 24 26 28 30 32 34 36 38 40 42 44 46 48 51 53 55 58 60 63 66 69 71 73 76 78 80 82 84 86 87 89 90 91 91 92 93 94 94 95 96 96 97

 2  3  4  5  6  7  8  9 10 11 13 15 18 21 24 27 30 33 36 39 41 44 47 50 53 55 58 61 63 66 68 70 73 75 77 79 81 83 85 87 88 89 90 91 92 93 94 95 96 96 97

 6  8 10 11 13 15 16 18 20 22 24 26 28 30 32 34 36 38 40 43 46 48 51 53 55 58 61 64 66 68 71 74 77 79 81 83 85 86 88 89 90 91 92 93 93 94 94 95 95 96 96

 3  4  5  6  7  8  9 10 11 13 16 18 20 22 24 26 28 29 31 33 35 37 39 41 44 46 48 51 54 57 61 65 68 70 72 74 76 78 79 81 83 84 86 88 89 90 91 92 93 94 95

Note. FSIQ = Full Scale IQ; PRI = Perceptual Reasoning Index; PSI = Processing Speed Index; VCI = Verbal Comprehension Index; WMI = Working Memory Index. Data from Wechsler Adult Intelligence Scale—Fourth Edition: Technical and Interpretive Manual, by D. Wechsler, 2008, Bloomington, MN: Pearson. Copyright 2008 by Pearson. Adapted with permission.

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TABLE 5.2 Base Rates of Wechsler Adult Intelligence Scale—IV Hispanic Sample Obtaining Various Index–Mean Index Score Discrepancies Amount of discrepancy ≥20 19 18 17 16 15 14 13 12 11 10 9 8 7 6 5 4 3 2 1 Mean SD Median

VCI–MIS VCI > MIS 1.4 1.7 2.4 2.8 2.8 3.1 3.8 4.2 4.8 6.2 9 11.1 13.8 15.9 17.6 22.8 26 30.8 35.6 40.5 6.4 5.2 5

VCI < MIS 2.1 3.1 3.5 4.2 6.2 7.3 10 11.4 13.1 15.9 19 22.1 24.9 29.8 34.3 38.1 43.6 47.1 52.2 57.1 7.9 5.5 7

PRI–MIS PRI > MIS 0.7 1.4 1.7 1.7 2.1 3.1 4.5 5.2 8.3 11.1 12.5 15.6 18.7 21.5 28 32.9 37.7 43.9 48.4 53.6 6.6 4.7 6

WMI–MIS

PRI < MIS 0.3 0.3 0.7 0.7 1.4 2.4 2.8 3.5 4.2 6.6 8 11.1 14.5 18.7 22.5 27 30.4 33.6 39.4 43.3 6.3 4.1 6

WMI > MIS 1.4 1.7 2.1 2.4 2.4 2.8 2.8 2.8 3.5 4.8 7.3 10 12.5 14.9 17.6 22.1 26.3 31.1 37 41.2 6.1 5 5

WMI < MIS 0.3 1 1 1.7 4.2 4.5 5.5 8 9.3 12.1 14.5 19 23.5 27.3 32.9 39.8 43.6 47.8 51.9 55.4 7.3 4.4 6

PSI–MIS PSI > MIS 3.5 5.2 6.6 9.3 10.4 11.8 13.5 14.9 18 21.5 25.6 28.4 31.5 34.9 38.8 44.3 47.4 51.2 53.6 57.4 9.5 6.3 8

PSI < MIS 1.4 2.1 2.1 3.5 3.5 4.8 6.6 7.3 8.3 10.4 12.1 14.5 17 18 20.4 24.2 27.7 30.1 33.2 39.8 7.3 5.7 6

Note. MIS = Mean Index Score; PRI = Perceptual Reasoning Index; PSI = Processing Speed Index; VCI = Verbal Comprehension Index; WMI = Working Memory Index. Data from Wechsler Adult Intelligence Scale—Fourth Edition: Technical and Interpretive Manual, by D. Wechsler, 2008, Bloomington, MN: Pearson. Copyright 2008 by Pearson. Adapted with permission.

increased by 8 points from 85 for those born between 1917 and 1942 to 93 for those born between 1988 and 1991, although the trend was not steadily increasing across all birth cohorts. Finally, we must remember that test scores are not completely determined by the societal variables discussed here, but that individual differences account for the largest share of the variance in IQ scores regardless of ethnicity. Such individual differences are largely differences in ability, but noncognitive factors play an important role as well. These might include motivation, persistence or “grit,” goal orientation, curiosity, drive to task mastery, self-efficacy, resiliency in the face of educational and occupational setbacks, and more. Family support and community resources play important roles as well. Two international adaptations of the WAIS are also available in Spanish. The WAIS–IV was adapted and normed in Spain (Wechsler, 2012b). In Puerto Rico, the most recent edition is WAIS–III (Wechsler, 2008a). Both of these versions were carefully adapted according to best practice standards and appropriately normed and validated for use in those countries. U.S. practitioners may find these international editions appropriate for recent immigrants from Puerto Rico or Spain. Wechsler Intelligence Scale for Children—IV With Hispanic Children and Adolescents Hispanic percentile norms for WISC–IV composite scores are provided in Table 5.3. This table can be used to determine how a child’s score compares with other Hispanic children. For example, a WISC–IV VCI score of 85 would be at the 30th percentile compared with other Hispanics, whereas the WISC–IV norm tables in the technical manual show that a score of 85 is at the 16th percentile compared with the general population. Thus, the Hispanic percentile norms provide more culturally specific information to supplement interpretation of test scores. Table 5.4 shows base rates of WISC–IV index score discrepancies from the mean of the child’s four index scores. Inspection of the mean differences by direction reveals that most Hispanic children and adolescents show a pattern of lower VCI and WMI and higher PRI and PSI scores compared with the mean of their own index scores, which is similar to the pattern in adults. At the same time, many Hispanic children show the opposite pattern. For example, 32% of the sample obtained VCI scores one or more points higher than their mean. The pattern of slightly higher PSI scores is somewhat surprising given common clinical lore that speed of performance is a characteristic of U.S. culture not completely shared by all other cultures. Although this might be true as a cultural value, these data suggest no differences in the intelligence testing with spanish-speaking clients     

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TABLE 5.3 Wechsler Intelligence Scale for Children—IV Hispanic Percentile Norms Obtained score ≤70 71 72 73 74 75 76 77 78 79 80 81 82 83 84 85 86 87 88 89 90 91 92 93 94 95 96 97 98 99 100 101 102 103 104 105 106 107 108 109 110 111 112 113 114 115 116 117 118 119 ≥120

FSIQ

VCI

PRI

WMI

PSI

 2  3  4  5  6  7  8  9 10 11 13 15 17 19 21 24 27 31 35 39 43 46 50 53 56 59 61 63 66 68 71 73 76 79 81 83 85 87 89 91 92 93 94 95 95 96 96 97 97 98 98

 7  7  8  9 10 11 12 13 14 16 18 20 22 24 27 30 33 36 39 42 45 48 50 53 56 59 63 66 69 73 76 79 81 83 85 87 88 90 91 92 93 94 95 96 96 97 97 97 97 97 98

 2  2  2  3  4  5  6  7  8  9 10 12 13 15 17 19 21 24 26 29 33 36 40 44 47 51 54 57 60 63 65 68 70 72 74 76 78 81 83 85 87 89 91 92 93 94 95 96 96 97 97

 4  5  6  6  7  8  9 10 11 12 13 14 15 17 19 21 24 28 31 34 37 40 43 46 49 52 55 58 61 64 67 70 73 77 80 82 84 85 87 88 89 90 91 93 94 94 95 95 96 96 96

 1  1  1  2  3  4  5  6  7  9 11 13 15 16 18 21 23 25 27 29 31 33 35 37 39 42 44 47 50 53 56 58 61 64 67 70 73 76 78 80 82 84 85 87 88 90 91 92 93 94 95

Note. FSIQ = Full Scale IQ; PRI = Perceptual Reasoning Index; PSI = Processing Speed Index; VCI = Verbal Comprehension Index; WMI = Working Memory Index. Data from Wechsler Intelligence Scale for Children— Fourth Edition: Technical and Interpretive Manual, by D. Wechsler, 2003, San Antonio, TX: Harcourt Assessment. Copyright 2003 by Pearson. Adapted with permission.

TABLE 5.4 Base Rates of Wechsler Intelligence Scale for Children—IV Hispanic Sample Obtaining Various Index–Mean Index Score Discrepancies intelligence testing with spanish-speaking clients     

Amount of discrepancy ≥20 19 18 17 16 15 14 13 12 11 10 9 8 7 6 5 4 3 2 1 Mean SD Median

VCI–MIS VCI > MIS 0.6 0.6 1.2 1.2 1.5 1.8 2.4 2.7 3.3 3.9 6.9 9.6 11.9 14.9 17.6 19.7 23.6 25.4 29 31.9 6.6 4.4 6

PRI–MIS

VCI < MIS 3.6 4.2 5.4 6.9 8.7 10.1 11.9 14 17.3 21.2 24.2 28.1 30.1 34.9 39.1 44.5 48.4 53.4 58.2 64.8 8.3 6 7

PRI > MIS 0.9 1.5 2.1 2.7 3.3 4.8 7.8 9.3 10.7 13.4 16.1 18.2 23.3 27.5 34 35.5 40 43.9 48.1 51.9 7.6 4.8 7

PRI < MIS 0.3 0.3 0.6 1.5 1.8 2.7 4.2 6 7.8 8.4 11 13.4 17.9 22.1 25.1 30.4 32.8 35.2 39.1 43.6 7 4.4 7

WMI–MIS WMI > MIS 2.1 2.4 2.4 3 3 3.9 5.4 6.3 8.7 9.3 10.4 14.3 18.2 20.6 25.1 29 32.8 37.6 42.1 46.6 7.1 5.5 6

WMI < MIS 3.3 3.3 3.9 4.2 4.5 5.4 7.2 8.4 10.1 12.5 15.5 17.6 20.6 24.8 27.2 31.3 37 40.9 46 50.1 7.7 6 6

PSI–MIS PSI > MIS 6.6 8.1 9 11 11.9 13.4 14.9 17.9 22.1 24.8 28.7 30.1 33.4 35.2 38.5 43 47.5 50.1 52.8 56.7 10.1 6.7 10

PSI < MIS 1.2 1.5 2.1 3.3 4.5 5.4 5.4 6.6 7.5 8.7 11.6 12.8 14.9 17.9 21.2 23 26.3 30.7 36.7 39.7 7.1 5.4 6

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Note. MIS = Mean Index Score; PRI = Perceptual Reasoning Index; PSI = Processing Speed Index; VCI = Verbal Comprehension Index; WMI = Working Memory Index. Data from Wechsler Intelligence Scale for Children—Fourth Edition: Technical and Interpretive Manual, by D. Wechsler, 2003, San Antonio, TX: Harcourt Assessment. Copyright 2003 by Pearson. Adapted with permission.

speed of neurocognitive information processing abilities. This finding is the same pattern as that observed for Hispanic adults on the WAIS–IV. These data are important because they may help prevent overinterpretation of low VCI scores when such scores are in fact common among Hispanics. At the same time, however, some psychologists may tend to overlook even very low verbal scores in Hispanic children on the assumption that such patterns are common due to language variations. Table 5.4 provides culturally specific data to aid in these interpretations. As shown in the table, a VCI score that is 13 or more points below the child’s own mean could be considered unusual because it was obtained by less than 15% of the Hispanic sample. In clinical practice, such findings should be interpreted in the context of the child’s overall ability, years of education in English schools, language dominance, and parents’ level of education. On the basis of variables available in the WISC–IV standardization data set, Weiss et al. (2006) investigated factors that influence FSIQ scores for Hispanics. They showed that ethnicity explained 1.4% of the variance in Hispanic–White FSIQ score differences, whereas 17.5% of the variance was explained by the parents’ educational level. Parent income added an additional 3.5% above parent education. More to the point, after controlling for both parent education and income, ethnicity explained no further variance, and the magnitude of the difference between Hispanic and White WISC–IV FSIQ scores was reduced from 6.3 points to 0.5 points. All of this means that ethnic status is likely a proxy variable for a host of other structural variables that are more directly related to FSIQ, and when controlling for those variables, ethnicity directly accounts for little of the variance in test scores. This view was reinforced by a multinational study that demonstrated a strong relationship between economic factors and education on WISC–III test scores across 12 nations (Georgas, Weiss, van de Vijver, & Saklofske, 2003). We should seek to understand better the underlying societal variables responsible for these differences and cease focusing on the surface variable of group membership. Test scores are not completely determined by societal variables. As mentioned earlier, individual differences in ability likely account for the largest share of the variance, and noncognitive factors such as drive to task mastery are important to cognitive development as well. For children and adolescents, home environment and parental behavior toward children are particularly important. This is because even naturally endowed cognitive abilities must grow and develop over time and require proper doses of nurturance and cognitive stimulation at the right time in the child’s development. To begin to test this idea, Weiss et al. (2006) asked parents some basic questions related to the role of education in the family, including how likely they believed it was that their child would get good grades, 92       weiss, prifitera, and munoz

graduate from high school, attend college, and so forth. Surprisingly, it was found that these questions explained 31% of the variance in FSIQ scores—more than parent education and income combined at 21%. Weiss et al. (2006) then controlled for parent education and income and found that parent expectations still explained 16% of the variance in FSIQ scores. Thus, although the explanatory power of parent expectations reduces by about half after controlling for parent education and income, the size of the remaining effect is meaningful. Parents with high expectations for the educational attainment of their children typically engage in a wide range of parenting behaviors broadly related to academic and cognitive development, such as monitoring and assisting with homework, encouraging exploration, providing meaningful verbal stimulation that improves language development, reading to children and encouraging reading, and so forth. Parent expectations were significantly related to children’s FSIQ scores at all levels of parent education, but more so among parents with high school educations and least among parents who did not graduate from high school. We interpret these findings with regard to the impact of distal environmental constraints on proximal attitudes and behaviors in the home environment. It may be that real societal and economic factors constrain the power of parent expectations among the lowest SES families. Still, parent expectations as expressed through parenting behaviors in the home environment remain a powerful force on the cognitive development of children in all families. The WISC has also been adapted and normed in various Spanishspeaking countries, including Argentina, Chile, Brazil, Mexico, and Spain. These versions may be useful for U.S. practitioners assessing recent immigrants from those countries. Wechsler Preschool and Primary Scale of Intelligence—IV With Hispanic Children The WPPSI–IV (Wechsler, 2012b) is appropriate for children age 2 years, 6 months, to 7 years, 7 months. Compared with previous editions of the measure, verbal expression demands were significantly reduced in the WPPSI–IV subtests through revisions of items and scoring rules to address the needs of psychologists testing children who are English-language learners (ELLs). Recognizing that the verbal composite is the best predictor of school achievement, however, the test development team conducted a series of analyses to determine the minimum number of verbal subtests needed to retain the traditionally high correlation of FSIQ with school achievement. As a result of these analyses, only two verbal subtests are included in the FSIQ score for the WPPSI–IV. intelligence testing with spanish-speaking clients     

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The WPPSI–IV is the first Wechsler test built on a five-factor model of intelligence. Essentially, the PRI was removed from the model and split into Visual Spatial Reasoning and Fluid Reasoning indexes. For older children, the VCI, WMI, and PSI are also available as supplemental scores. However, PSI could not be measured reliably for children younger than 4 years of age. Two additional supplemental indexes were designed to assist practitioners evaluating ELLs. The Nonverbal Index (NVI) consists of Block Design and Object Assembly for the younger children, and Block Design, Object Assembly, Picture Memory, and Zoo Locations for the older children. The Verbal Acquisition Index consists of Receptive Vocabulary and Picture Naming for all children. The WPPSI–IV items were reviewed for potential bias by linguistic and cultural experts and submitted to various statistical procedures to evaluate differential item functioning by race, ethnicity, SES, region of the country, and gender. The WPPSI–IV standardization sample closely matches the percentage of Hispanic children in the U.S. population by parent education level and region of the country. A study was conducted on 33 ELL children (Wechsler, 2012b), 79% of whom were Hispanic. Children were included in this study if they were receiving services for limited English-language proficiency at school or if their parents reported that the child was either an ELL or had a preference to speak a language other than English. As anticipated, the mean VCI score was significantly lower in the ELL group (87.6) compared with matched controls (94.8), with a medium effect size (.62). However, the FSIQ difference between the ELL group (95.2) and matched controls (96.8) was nonsignificant and the effect size negligible. The fact that only two verbal subtests are included in the FSIQ contributes to the lack of difference in FSIQ between ELL and non-ELL groups. Further, on the NVI the ELL group scored slightly higher (100.6) than matched controls (98.2), although the difference was nonsignificant and the effect size was small. This means that there is essentially no meaningful difference between ELL children and matched controls on the WPPSI–IV FSIQ or NVI. Further to the discussion in the earlier WISC–IV section about environmental variables, such factors likely play an even more important role in the cognitive development of preschool and primary grade children than in that of teenagers or adults. Previous research with the WPPSI–III suggested that three home environment variables play an important role in the development of verbal abilities among young children. These variables are the number of hours per week that the parents spend reading to the child and the number of hours per week that the child spends on the computer and watching television. Mean WPPSI–III Verbal IQ (VIQ) scores increased with number of hours spent reading and on the computer and decreased with number of hours 94       weiss, prifitera, and munoz

watching television. There is also a clear relationship between these variables and parent education. Number of hours spent reading and on the computer systematically increased with parent education, whereas number of hours spent watching television decreased. Thus, relative to parents with little formal education, more educated parents read to their children more often, discouraged television watching, and encouraged computer use. Further, children age 2½ to 7 who were read to more often, used computers more often, and watched television less had higher VIQ scores on average (Sichi, 2003). Perhaps SES plays a role in the availability of computers in the home and in parents’ opportunity to interact with children in cognitively stimulating ways (e.g., reading to them vs. allowing unmonitored television watching) in busy single-parent and dual-employment families. At the same time, however, there was substantial variability in the frequency of these behaviors within levels of parent education. Thus, even among young children whose parents have similar levels of education, spending more time reading and using the computer and less time watching television is associated with higher verbal ability test scores. It is for these reasons that practitioners testing very young children should consider the FSIQ score as an indicator of overall cognitive development at that particular time rather than a precise estimate of innate ability that will follow the child for life. This admonition is even more poignant when one considers young children who are in the process of learning the dominant language and assimilating into an unfamiliar culture. Recommendations and interventions based on these environmental influences should be considered as part of the assessment report and followed up, because there is ample evidence that these variables can affect cognitive abilities. Percentile norms for WPPSI–IV composite scores for Hispanic children are provided in Table 5.5. According to this table, whereas a VCI of 85 is at the 16th percentile compared with the general population, it would be at the 23rd percentile compared with other Hispanics. Base rates of discrepancies between WPPSI–IV index scores and the child’s mean index score are provided in Tables 5.6 and 5.7 for younger and older Hispanic children, respectively. At least 60% of the younger and older WPPSI–IV samples demonstrated VCI scores one or more points below their mean. According to Table 5.6, however, a younger child whose VCI is 10 points below his or her own mean might be considered to have an unusual profile because less than 15% of Hispanic children obtained a VCI discrepancy of this magnitude or greater. Whereas the WISC–IV and WAIS–IV samples showed a tendency toward lower WMI scores relative to the child’s mean index score, the WPPSI–IV sample showed a tendency toward higher WMI scores as 57% and 55% of younger and older Hispanic children, respectively, obtained a WMI one or more points higher than their own mean. One hypothesized intelligence testing with spanish-speaking clients     

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TABLE 5.5 Wechsler Preschool and Primary Scale of Intelligence–IV Hispanic Percentile Norms Age 2 years, 6 months, to 3 years, 11 months IQ/Index ≤70 71 72 73 74 75 76 77 78 79 80 81 82 83 84 85 86 87 88 89 90 91 92 93

Age 4 years to 7 years, 7 months

FSIQ

VCI

VSI

WMI

NVI

VAI

FSIQ

VCI

VSI

WMI

PSI

FRI

NVI

 1  2  3  4  5  6  7  9 10 11 12 14 16 17 19 22 24 27 29 32 36 39 43 46

 1  2  2  3  4  5  6  7  8  9 11 13 15 18 22 23 25 27 31 36 39 41 44 47

 2  2  3  3  4  5  6  7  8  8  9 10 11 13 15 17 20 23 26 30 34 38 42 45

 2  2  3  4  5  6  6  7  8  9 10 11 12 14 17 19 22 25 27 30 32 35 37 39

 2  3  4  4  5  5  6  7  8  9 10 12 14 15 17 18 19 21 23 26 28 31 34 37

 1  1  2  3  4  6  7  8 10 12 14 16 18 21 23 26 29 33 36 39 42 44 47 50

 1  1  1  1  2  3  4  5  6  7 10 13 15 17 18 20 22 25 26 28 31 34 37 39

 1  1  1  2  3  4  5  6  7  8 11 13 15 17 20 23 25 26 28 31 34 37 40 43

 1  1  1  2  2  3  3  4  4  5  6  7  8  9 11 13 15 17 19 21 23 26 29 33

MIS 0.0 0.4 0.8 1.2 2.0 2.4 2.8 3.5 4.7 5.1 6.7 9.1 12.2 13.8 15.7 17.7 22.0 26.8 30.3 34.6 6.1 4.5 5.0

VCI < MIS 3.5 4.7 5.5 7.1 7.1 8.7 10.2 13.0 15.4 19.7 21.3 26.4 30.7 37.8 40.9 45.7 50.8 55.9 58.7 61.4 8.9 6.0 7.5

VSI–MIS VSI > MIS 1.6 1.6 3.5 3.9 5.1 5.9 6.3 8.7 10.6 13.8 15.7 18.9 20.9 24.0 26.4 30.7 34.6 39.4 45.3 49.6 7.5 5.7 6.0

FRI–MIS

VSI < MIS

FRI > MIS

FRI < MIS

0.0 0.4 1.2 2.4 3.1 4.3 5.5 5.9 7.5 10.2 11.4 12.6 15.4 20.1 24.8 31.9 35.0 36.6 41.7 46.1 6.9 4.6 6.0

1.2 1.2 2.0 2.8 5.9 6.3 8.7 9.8 13.8 16.1 18.9 20.9 24.8 27.2 29.9 31.9 36.6 39.4 43.3 50.0 7.9 5.4 7.0

2.0 2.0 2.8 3.9 5.5 6.7 7.5 8.7 12.2 14.6 15.7 16.9 18.5 22.4 24.4 29.5 32.7 37.8 41.7 45.7 7.9 6.0 6.0

WMI–MIS WMI > MIS 1.6 1.6 2.0 2.8 3.5 6.7 9.1 12.2 13.0 16.1 19.3 22.8 26.4 30.7 33.5 39.4 42.5 47.2 52.8 54.7 8.0 5.0 7.0

PSI–MIS

WMI < MIS

PSI > MIS

0.8 1.2 3.9 5.1 5.5 6.3 7.5 9.1 10.2 11.0 13.4 15.4 17.7 19.7 22.0 23.6 28.7 34.3 37.8 41.3 7.6 5.6 6.0

2.8 3.9 5.1 6.7 8.3 9.4 11.8 15.0 17.7 19.3 20.9 24.8 27.2 31.5 34.6 38.2 41.3 45.7 50.0 54.7 8.9 6.4 7.0

PSI < MIS 2.0 2.8 3.5 4.3 5.9 7.5 9.8 11.4 12.2 14.6 15.7 18.5 20.1 24.4 26.8 29.5 32.3 35.0 39.0 43.7 8.4 6.2 7.0

Note. FRI = Fluid Reasoning Index; MIS = Mean Index Score; PSI = Processing Speed Index; VCI = Verbal Comprehension Index; VSI = Visual Spatial Index; WMI = Working Memory Index. Data from Wechsler Preschool and Primary Scale of Intelligence (4th ed.), by D. Wechsler, 2012, Bloomington, MN: Pearson. Copyright 2012 by Pearson. Adapted with permission.

reason for this finding is the absence of the Arithmetic subtest on WMI for the WPPSI–IV. For information on the rationale and appropriate use of these tables, the reader is referred to the discussion in the earlier WISC–IV and WAIS–IV sections. TESTING SPANISH-SPEAKING CLIENTS Wechsler Intelligence Scale for Children—IV Spanish The WISC–IV Spanish (Wechsler, 2005) is a translation and adaptation of the WISC–IV for use with Spanish-speaking Hispanic children ages 6 to 16 living in the United States. The trans-adaptation of each item and all subtest directions were reviewed by a panel of expert bilingual psychologists representing the majority of Hispanic countries of origin included in the sample. To further assess the quality of the items across Hispanic cultures, each item was submitted to multiple procedures for identifying differential item functioning (i.e., item bias) among Hispanic children from different countries of origin. Children were excluded from the sample if they reported speaking or understanding English better than Spanish or if they had been in U.S. schools more than 5 consecutive years. Intellectually disabled children were excluded if they had been in U.S. schools more than 7 consecutive years. As part of the standardization research project, 851 U.S. Hispanic children were tested, and this sample was used to evaluate differential item functioning by country of origin and to evaluate results of the norm-equating process (Wechsler, 2005). The reliability sample (n = 500) used to generate the normative information was from Mexico (40%), South and Central America (28%), Dominican Republic (16%), Puerto Rico (12%), and Cuba (4%). Some, but not all, of the Puerto Rican children were tested in Puerto Rico. All children from all other countries were living in the United States when tested. Country of origin was stratified relative to the U.S. Hispanic population within age band, parent educational level, region of the country, and gender. However, the U.S. Mexican population was intentionally undersampled to ensure that sufficient numbers of subjects from other Hispanic countries of origin were represented in the norms (Wechsler, 2005). The WISC–IV Spanish was designed to produce scores equivalent to the WISC–IV. Thus, children can take the test in Spanish and obtain scores that directly compare them with a representative sample of all children in the U.S. population. Because subtest adaptations for the PRI and PSI were restricted to translation of instructions to the child, the norms for these subtests were adopted directly from the WISC–IV. The adaptation of the verbal and working memory subtests required more modifications, including changes to item 100       weiss, prifitera, and munoz

content, item order, and scoring rules, in part to account for variations in the Spanish language. Aligning the verbal and working memory subtests distributions to the U.S. norms was accomplished through equipercentile calibration. The method was evaluated by comparing the WISC–IV Spanish obtained scores with a sample of Hispanics tested with the WISC–IV (n = 538 each) matched on parent education level. The mean FSIQ was 92.1 and 94.1 for the WISC–IV Spanish and WISC–IV samples, respectively, and the effect size of the difference was small (.13). The method was further evaluated by comparing the WISC–IV Spanish obtained scores with a sample of White children on the WISC–IV (n = 582 each), matched on parent education level. In this study the mean FSIQs were 94.3 and 98.6 for the WISC–IV Spanish and WISC–IV, respectively, and the effect size was small (.26). An important limitation of both studies is that it was not possible to match the U.S. samples to the Spanish samples on years of U.S. education because all the education of the U.S. sample was in the United States. We further discuss issues related to U.S. educational experience on intelligence test scores later. As described earlier, it is also useful to compare the performance of Hispanic children with the performance of a subset of children who are culturally similar. Thus, demographically adjusted percentile norms were created for use with the WISC–IV Spanish based the number of years of experience the child had in U.S. schools and the parents’ level of education. These variables combined accounted for 22% of the variance in FSIQ scores, with years in U.S. schools accounting for most of the shared variance. Tables necessary to make this adjustment can be found in Appendix C of the test’s technical manual (Wechsler, 2005). First, the number of grades completed in the United States was calibrated by the total number of grades completed. This is because 2 years in U.S. schools has a different impact for a second versus 10th grade student. A cross tabulation of this rating with the parents’ level of education yields five categories, each resulting in a different set of adjustments for percentile norms. In this way, a student’s obtained scores on the WISC–IV Spanish can be compared with all U.S. children using the standardized scores and then with Hispanic children who have similar experiences in the U.S. educational system and who are from similar parent educational backgrounds. Following this method, an eighth grade student with a WISC–IV Spanish FSIQ score of 85, which is at the 16th percentile of the U.S. population, is found to be better than 70% of Hispanic children who obtained two of their seven completed grades in U.S. schools and whose parents obtained between 9 and 11 years of education. The difference between the 16th and 70th percentile makes a huge difference in interpretation. Although the child scored better than only 16% of all children his or her age, the score was better than 70% intelligence testing with spanish-speaking clients     

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of Hispanic children of that age who have completed only 2 years of school in the United States and whose parents did not graduate from high school. To be clear, this is not an issue of which percentile is more correct. They are both correct, but answer different questions. Both pieces of information are important and necessary to complete the child’s story. Obvious limitations of this method include the inability to control for variables related to the language of instruction in the child’s U.S. classes or for the quality of the parents’ education in the country of origin. Practitioners should consider these issues as they interpret the adjusted percentile scores. Still, this is a useful beginning on the path to more culturally sensitive interpretation of intelligence test scores. It is important because patterns of immigration vary by country of origin and across generations, and these patterns have strong effects on mean test scores. Individuals from some countries come to the United States in search of basic skilled or entrylevel jobs, whereas others have the financial and educational resources to escape unpleasant situations (e.g., political repression, economic turmoil, armed conflict). The average SES of the immigrant populations from each country of origin has a profound impact on the mean intelligence test scores for that group. These patterns of immigration are different for different countries and can change over time for the same country. For example, in San Antonio, Texas, the pattern of immigration from nearby Mexico is changing in part because of the presence of increasingly violent conditions widely associated with drug cartels in several regions of that area. Whereas adults with few years of education have historically emigrated from Mexico to the United States in search of basic skilled jobs, the immigration pattern today includes an increasing number of successful Mexican professionals and wealthy businesspersons bringing their families to generally safer conditions. At present, this shift in the pattern of immigration is beginning to have an observable impact on the housing market, local retail businesses, and school systems in the upper middle class neighborhoods of the city. The adjusted percentile norms could be informative in this situation. As in the earlier example, the same child with a FSIQ of 85 would be performing better than only 15% of Hispanic children who obtained 2 of their 7 completed years of education in the United States and whose parents had graduated from college. This interpretation is likely the more relevant comparison for this child, and failing to identify him or her as in need of support would be a disservice to the family. All of these issues must be considered when evaluating Hispanic children recently arrived in the United States. The methods described here can assist the practitioner in thinking through these issues, but should be considered guideposts only. Clinical judgment by culturally similar or trained psy102       weiss, prifitera, and munoz

chologists knowledgeable about changing conditions in the local community is also necessary for competent, culturally sensitive interpretation. Differential Abilities Scale—II Early Years Spanish Supplement A translation and adaption of the DAS–II (Elliott, 2007), the DAS–II Early Years Spanish Supplement (Elliott, 2012), is appropriate for monolingual and bilingual Spanish-speaking children ages 2½ through 6. To accommodate for varying degrees of second-language acquisition during test administration, English prompts are allowed and English responses are scored correct if they meet criteria for many subtests. Children were excluded from the sample if they resided in English-speaking homes. Out-of-age-level scores can be obtained for lower functioning 7- and 8-year-olds by administering the subtests designed for younger children. During the trans-adaptation process, subtest instructions and items were pilot tested multiple times in the United States and Peru to study language variations. All items were evaluated for bias with respect to all relevant South and Central American languages. In some cases items were changed to reduce items with multiple Spanish names. In other cases, scoring rules were adapted to allow multiple Spanish responses due to regional variations. The Phonological Processing subtest required the most extensive adaptation to accommodate Spanish phonemes and sounds. Nine subtests required translation of the instructions to the child, but the stimuli, subtest administration rules, and scoring rules remained identical to the English-language DAS–II. All of these subtests demonstrated equivalency of the construct measured, response processes used, and raw score performance across languages. For these subtests, the DAS–II raw score to ability score conversions were applied directly to the DAS–II Spanish. Eight subtests required additional modifications to item content and item scoring rules: Verbal Comprehension, Naming Vocabulary, Recall of Digits Forward, Early Number Concepts, Recall of Sequential Order, Recall of Digits Backward, Phonological Processing, and Rapid Naming. A sample of 395 Spanish-speaking preschool children in the United States was used to equate these subtests to the DAS–II norms based on common items. As described in the previous section on the WISC–IV Spanish, this equating process allows children to be tested in Spanish and then compared with the larger population of U.S. children of the same age, regardless of language spoken (English or Spanish). As a result of the equating, it was anticipated that the validity data collected for the DAS–II could be applied to the DAS–II Spanish. To validate this assumption, four clinical groups were collected as part of the DAS–II Spanish project to provide clinical validity data for developmentally delayed, intelligence testing with spanish-speaking clients     

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low cognitive ability, high cognitive ability, and intellectually gifted groups. The General Cognitive Ability (GCA) score for the high cognitive ability and intellectually gifted groups was approximately 130 and 136, respectively. The developmentally delayed and low cognitive ability groups obtained mean GCA scores of approximately 83 and 71, respectively. These data provided validity evidence in support of the DAS–II Early Years Spanish edition. Batería III Woodcock-Muñoz The Batería III Woodcock-Muñoz Pruebas de Habilidades Cognitivas (Batería III COG; Muñoz-Sandoval, Woodcock, McGrew, & Mather, 2005) is a comprehensive battery of cognitive abilities developed for Spanishspeaking individuals between the ages of 2 and 90+. The Batería III COG may be used with Spanish-monolingual individuals or with bilingual individuals for whom Spanish is their native and/or dominant language. The Batería III COG included a sample of 1,413 Spanish-speaking individuals, 279 of which resided in the United States. The remainder of the sample was collected in Spanish-speaking countries, including Mexico, Costa Rica, Panama, Argentina, Colombia, Puerto Rico, and Spain. Regardless of location, individuals were included in the sample only if their native and primary languages were Spanish. The Batería III COG consists of 31 tests, some of which have been translated and others adapted from its English-language counterpart, the WJ III COG, which was developed based on the Cattell-Horn-Carroll model of intelligence (Carroll, 1993). The norms for the Batería III COG were obtained by equating the English and Spanish versions of the test. Thus, children are tested in Spanish and their performance is compared with the general population of English-speaking children of the same age in the United States—much like the norming methods used by the WISC–IV Spanish and DAS–II Spanish. Median reliabilities range from .80 (Palabras incompletas [Incomplete Words and Memory], de trabajo auditiva [Auditory Working Memory]) to .93 (Comprensión verbal [Verbal Comprehension]). Confirmatory factory analysis validated the same factor model in the Batería III COG as in the WJ III COG. In addition to providing norm-referenced scores, the Batería III COG yields cognitive academic language proficiency levels, which are helpful when evaluating a child’s language abilities in a school environment. A Low Verbal scale comprising six tests with lower language demands is proposed for individuals with language delays. Correct responses in languages other than Spanish (English or others) are given credit in some of the tests. 104       weiss, prifitera, and munoz

USE OF INTERPRETERS WITH SPANISH-SPEAKING CLIENTS Best practice is for Spanish-speaking clients to be assessed by a Spanishspeaking examiner administering a validated Spanish edition of the test. Ideally, the examiner would not only speak Spanish but also be from the same cultural and linguistic background as the client. However, this procedure is not always feasible. For non-Spanish-speaking examiners, an interpreter may be needed to administer a validated Spanish edition test such as the DAS–II Spanish, WISC–IV Spanish, or Batería III COG. When using interpreters, it is important to be familiar with the ethical guidelines for the use of interpreters and follow general guidelines for selection, training, and use of interpreters. For example, relatives of the child should not be used as interpreters. Training is required for the interpreter prior to test administration to ensure valid results. Interpreters should receive specific instruction in the importance of following standard procedures and not offering subtle hints to the person being tested. The psychologists should observe practice administrations to ensure the interpreter achieves proficiency prior to the actual testing. It is recommended that the examiner manage the stimulus book, timer, and manipulatives, and record responses to nonverbal items, while the interpreter reads the verbal instructions to the child and interprets the child’s verbal responses. The interpreter should also record verbatim responses in Spanish in addition to interpreting them for the examiner during the assessment so that after the evaluation they can discuss nuances of scoring based on the written record. If an interpreter is used, the psychologist should note this fact in the psychological report, along with the level of training provided. Although a comprehensive discussion of the use of interpreters is beyond the scope of this chapter, the DAS–II Spanish and Batería III COG manuals provide specific guidance on this controversial topic, including a separate interpreter’s manual. Those guidelines can be generalized to other Spanish-language assessment tools. Using interpreters to translate English test questions to Spanish during the evaluation is poor practice. However, the methods described here and in the DAS–II Spanish and Batería III COG manuals can yield acceptable—though not optimal—results when carefully applied with validated Spanish editions of cognitive ability tests. Because the use of interpreters is not best practice, however, these methods generally should not be used in high-stakes legal evaluations such as death penalty cases. CONCLUSION The complexity of questions relating to language, culture, and educational experience that affect the development of cognitive abilities in children and the performance of both children and adults on intelligence tests intelligence testing with spanish-speaking clients     

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preclude simple, singular answers. A set of flexible assessment tools that allow professionals supplemental, alternative perspectives based on the client’s unique cultural and linguistic background is a part of best practices in the assessment of culturally and linguistically diverse children and adults. Toward this goal, this chapter provides Hispanic percentile norms for Wechsler composites and base rates of index score discrepancies between composites not previously available for Hispanics. The Hispanic percentile norms supplement information derived from the FSIQ but do not replace the FSIQ. Both pieces of information may be valuable in psychological evaluations. This chapter also reviews three well-developed and validated trans-adaptations of English-language intelligence tests for use with Spanish-speaking clients. In each case, the Spanish editions allow clients to be tested in Spanish and their performance compared with the general population of U.S. English-speaking children of the same age. REFERENCES Bialystok, E., Craik, F., & Luk, G. (2008). Cognitive control and lexical access in younger and older bilinguals. Journal of Experimental Psychology: Learning, Memory, and Cognition, 34, 859–873. http://dx.doi.org/10.1037/0278-7393.34.4.859 Carlson, S. M., & Meltzoff, A. N. (2008). Bilingual experience and executive functioning in young children. Developmental Science, 11, 282–298. http://dx.doi. org/10.1111/j.1467-7687.2008.00675.x Carroll, J. B. (1993). Human cognitive abilities: A survey of factor-analytic studies. Cambridge, England: Cambridge University Press. http://dx.doi.org/10.1017/ CBO9780511571312 Elliott, C. D. (2007). Differential Ability Scales–II (DAS–II). San Antonio, TX: Pearson. Elliott, C. D. (2012). Administration and technical manual for the Differential Abilities Scale: Second edition. Early years Spanish supplement. San Antonio, TX: Pearson. Georgas, J., Weiss, L. G., van de Vijver, F. J. R., & Saklofske, D. H. (2003). Culture and children’s intelligence: Cross-cultural analysis of the WISC–III. San Diego, CA: Academic Press. López, E. J., Ehly, S., & García-Vásquez, E. (2002). Acculturation, social support and academic achievement of Mexican and Mexican American high school students: An exploratory study. Psychology in the Schools, 39, 245–257. http:// dx.doi.org/10.1002/pits.10009 Muñoz-Sandoval, A. F., Woodcock, R. W., McGrew, K. S., & Mather, N. (2005). Batería III Woodcock-Muñoz: Pruebas de habilidades cognitivas. Itasca, IL: Riverside. Ramirez, J. D. (1991). Executive summary of Volumes I and II of the Final Report: Longitudinal study of structured English immersion strategy, early-exit and late-

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exit transitional bilingual education programs for language-minority children. Bilingual Research Journal, 16(1 & 2), 1–62. Sichi, M. (2003, November). Influence of free-time activities on children’s verbal IQ: A look at how the hours a child spends reading, using the computer, and watching TV may affect verbal skills. Poster session presented at the meeting of the Texas Psychological Association, San Antonio. Wechsler, D. (2003). Wechsler intelligence scale for children—Fourth edition: Technical and interpretive manual. San Antonio, TX: Harcourt Assessment. Wechsler, D. (2004). Wechsler intelligence scale for children—Fourth edition. London, UK: Pearson. Wechsler, D. (2005). Wechsler intelligence scale for children—Fourth edition Spanish: Manual. San Antonio, TX: Harcourt Assessment. Wechsler, D. (2008a). Escala de inteligencia Wechsler para adultos—Tercera edición: Manual. Bloomington, MN: Pearson. Wechsler, D. (2008b). Wechsler adult intelligence scale—Fourth edition: Technical and interpretive manual. Bloomington, MN: Pearson. Wechsler, D. (2012a). Escala de inteligencia de Wechsler para adulto—Cuarta edición. Madrid, Spain: NCS Pearson. Wechsler, D. (2012b). Wechsler preschool and primary scale of intelligence (4th ed.). Bloomington, MN: Pearson. Weiss, L. G., Chen, H., Harris, J. G., Holdnack, J. A., & Saklofske, D. H. (2010). WAIS–IV use in societal context. In L. G. Weiss, D. H. Saklofske, D. Coalson, & S. E. Raiford (Eds.), WAIS–IV clinical use and interpretation (pp. 97–139). San Diego, CA: Academic Press. http://dx.doi.org/10.1016/B978-0-12-375035-8. 10004-7 Weiss, L. G., Harris, J. G., Prifitera, A., Courville, T., Rolfhus, E., Saklofske, D. H., & Holdnack, J. A. (2006). WISC–IV interpretation in societal context. In L. G. Weiss, D. H. Saklofske, A. Prifitera, & J. A. Holdnack (Eds.), WISC–IV advanced clinical interpretation (pp. 1–57). San Diego, CA: Academic Press. Woodcock, R. W., McGrew, K. S., & Mather, N. (2001). Woodcock-Johnson III Tests of Cognitive Abilities. Rolling Meadows, IL: Riverside.

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6 EVALUATION OF INTELLIGENCE AND LEARNING DISABILITY WITH HISPANICS SAMUEL O. ORTIZ AND KRISTAN E. MELO

As a group, Hispanics comprise an extraordinarily large and diverse range of peoples who, in some manner, have a significant and shared heritage rooted in Spanish language and culture. Over time, the various common elements of the culture have taken on unique and idiosyncratic forms often reconciled as an accommodation to geography, aboriginal traditions, and other physical and social factors. For example, the traditional celebratory food for Christmas made by Puerto Ricans is called pasteles, which is made from a plantain meal filled with meat and vegetables, wrapped and tied in a banana leaf, and boiled for hours. In Mexico, however, the same Christmas dish is called tamales, which is made from corn meal filled with meat or vegetables, wrapped and tied in a cornhusk, and boiled for hours. Therefore, the ethnic variation in these foods is due largely to circumstance but represents similar traditions despite the difference between the use of plantains versus corn.

http://dx.doi.org/10.1037/14668-007 Psychological Testing of Hispanics, Second Edition: Clinical, Cultural, and Intellectual Issues, K. F. ­Geisinger (Editor) Copyright © 2015 by the American Psychological Association. All rights reserved.

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In a similar manner, the presumed heritage language (i.e., Spanish) spoken by Hispanics from different countries and regions around the world has also evolved in a way that reflects significant differences between people who are often thought to use a monolithic mother tongue. For example, the most common word for orange in Puerto Rico is china, a nod to the location where oranges were first cultivated and the country from which they were imported to the island. Most other Hispanic cultures commonly use the word naranja for orange, and although Puerto Ricans know and use the word, it remains a key differentiator in distinguishing Puerto Rican speech from other ethnicities that also speak Spanish. Indeed, use of words or phrases such as guagua [bus], espejuelos [eyeglasses], or ay bendito [colloquial phrase similar to “oh, my goodness”] along with the distinctive dropping of second consonants (e.g., ‘eta instead of esta) and sometimes first vowel and second consonant (e.g., ‘ta bien instead of esta bien) are hallmarks of speech that will readily identify an individual as Puerto Rican (or perhaps Cuban, Dominican, or Caribbean) as opposed to Argentinean, Mexican, or Panamanian. MOVING BEYOND RACE IN TESTING OF HISPANICS That Hispanics differ across many dimensions that span the foundations of ethnicity, such as language, highlights an important aspect of psychological testing that is not often or well understood—that race is largely an irrelevant variable (Valdés & Figueroa, 1994). That is, an individual whose family just immigrated to the United States from Columbia cannot be expected to perform on a test that was developed and normed in the United States equally as well as another individual whose family immigrated to the United States six generations ago. Both may well be “Hispanic” in the broad sense of the term’s meaning, but what does that social classification actually have to do with test performance? Moreover, to what extent will the inclusion of a census-proportionate number of Hispanics in the normative sample provide a fair and valid basis for comparison of either individual? Given the preceding example, the answer is clear: not much at all and most likely none. The concept of race bears only an indirect relationship to differences in people that would be expected to become manifest in test performance. Race is sometimes linked to ethnicity, and both can also be related to specific languages and cultures, but they cannot be equated. Whereas race was a central factor in the advent and development of psychological tests, particularly tests of intelligence (Wasserman, 2012), it is important to recognize that color of one’s skin will not be the determining factor in performance. Rather, as will become evident, being able to engage in psychological testing that can be considered fair and equitable 110       ortiz and melo

with Hispanics—or other individuals from racially diverse populations, for that matter—should be based on an understanding of the two most critical variables related to test performance: differences in English-language proficiency and varying degrees of opportunity for acculturative learning. A major and unfortunate consequence of the race-based legacy in intelligence testing is that it coalesced notions regarding fairness and equity as being related to the concept of bias, particularly bias as defined from a psychometric point of view. In this framework, bias in testing exists when the performance of one group differs from the performance of another group as a function of various components of the test, including its item content, accuracy, consistency, sequence or difficulty level, prediction, or factor structure. Decades of research in this vein have been rather unanimous in finding that among the major intelligence batteries there is little evidence of bias (Figueroa, 1983; Reynolds & Ramsay, 2003; Sandoval, Frisby, Geisinger, Scheuneman, & Grenier, 1998; Valdés & Figueroa, 1994). In the simplest terms, this body of research essentially indicates that measurement of an attribute in an individual from one race is as accurate, consistent, and predicts as well as measurement of the same attribute in an individual of another race. Such research has naturally led to a general but erroneous consensus that, all other factors being equal, if one racial group has a higher mean score than another racial group, the difference must be real and attributable to race. Test developers recognize that there are some variables that must be controlled in testing situations: variables that can directly affect test performance. Such variables commonly include age (or grade), gender, socioeconomic status, geographic location, and race. In general, the construction of normative samples is based on stratification of these variables so as to provide a full range of representation of the individuals on whom the test is intended to be used. This means that for each age (or grade, if so constructed), a test provides proportionate representation according to the other variables. In this way, when test performance is compared with others, it is based on a sample of individuals who have similar traits and qualities as the individual being tested, and more important, because of the use of the individual’s age, the comparison provides control for variation in development. This is why 5-year-olds are compared with other 5-year-olds and not with 10-year-olds on a test. Developmental differences alone would account for the variability in performance, and it would be unfair and inequitable to expect a 5-year-old to perform at the same level as a 10-yearold in vocabulary or math, for example. Thus, for tests to demonstrate bias in terms of reliability, they would have to undergo some unique change simply as a function of the individual’s race—a notion that on the surface and because of a long history of socialization does not seem unusual to any one of us. Yet, race simply has no direct effect on measurement of the desired attribute and, more important, has no bearing on the creation of developmental differences either. evaluation of intelligence and learning disability     

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For an attribute to create bias in testing, it must therefore be one that has developmental implications such that age-based comparisons no longer retain the force of comparability. Consider that language acquisition and proficiency, as well as acculturative learning, are developmental processes. As we age, we acquire and learn language and language-related skills (e.g., reading and writing—assuming we receive instruction in such), and we acquire and learn the content and attributes of the culture (or cultures) in which we are being reared. Although there is a natural connection between physical maturation and the progression of these processes, neither of these processes is strictly tied to age, because an individual may begin to learn a new language or start living in a new culture at any point in their life—two factors that describe the nature of the immigrant experience. When viewed in this way, English-language proficiency and acculturative learning opportunity become variables that can operate independent of age and therefore defy expectations of performance by removing the assumption of comparability. According to Salvia and Ysseldyke (1991), We assume their acculturation is comparable, but not necessarily identical, to that of the students who made up the normative sample for the test. When a child’s general background experiences differ from those of the children on whom a test was standardized, then the use of the norms of that test as an index for evaluating that child’s current performance or for predicting future performances may be inappropriate. (p. 18)

In the simplest terms, an individual who has had less time or opportunity to learn English cannot be expected to perform as well as someone who has had relatively more. Likewise, someone who has had less time and opportunity to learn and acquire the elements of the culture that gave rise to a test cannot be expected to perform as well as someone who has had more—particularly when the test is specifically intended to measure aspects of language or acculturative knowledge. For example, an individual who is Hispanic, even if born in the United States, and who is 5 years old, will enter the educational system with far less than 5 years of development in English and acculturative knowledge. To compare the Hispanic 5-year-old in this case with a native-English-speaking 5-year-old who has had all the benefit of parents and a learning environment that provided the necessary language and acculturative development, will be discriminatory. An intelligence test given to both will dutifully provide a score, and even assuming equivalent levels of intelligence, the Hispanic child’s performance will necessarily be below that of the native-English-speaking child. To then interpret such a finding as indicating a general lack of overall ability in the Hispanic child would be unfair and inequitable because it ascribes lower intelligence to inherent ability while misunderstanding the disparity as having been due to developmental differences that arose from circumstance. 112       ortiz and melo

UNDERSTANDING ISSUES OF VALIDITY IN TESTING As a group, Hispanics have historically underperformed on intelligence tests by about 15 to 20 points (from the mean of 100), depending on the sample (Figueroa, 1983, 1990; Mercer, 1979; Rhodes, Ochoa, & Ortiz, 2005; Valdés & Figueroa, 1994). This lower level of performance relative to Caucasians has been attributed primarily to race on the belief that there appears to be no significant evidence of test bias. As noted previously, however, problems with bias are not rooted in factors related to reliability but rather to validity. Unlike reliability, which is concerned with how a scale or test is constructed and for which there are a variety of quantitative methods for establishing this property, validity is concerned more with how a scale is used and is established primarily through the accumulation of various forms of inferential evidence. Support for the validity of a scale comes from both the traditional concepts of content, criterion, and construct and the more recent concepts involving response processes and consequences of test use (American Educational Research Association, American Psychological Association, & National Council on Measurement in Education, 1999). Research on the validity of testing with Hispanics has been rather consistent in pointing out that the fundamental problem revolves around what is being measured—that is, whether the construct intended to be measured by the test is in fact the one that was measured by the test (Mercer, 1979; Ortiz, Ochoa, & Dynda, 2012; Rhodes et al., 2005; Valdés & Figueroa, 1994). One of the best examples of research along these lines comes from Jensen (1974), who has often supported racially bound hereditarian views of i­ ntelligence. Jensen attempted to demonstrate that the measurement of intelligence via one modality (e.g., verbal) would demonstrate equivalent differences in the mean scores for Hispanics (specifically, Mexican American) and Anglo Americans, as would measurement of intelligence conducted in a different modality (e.g., nonverbal). Using the Peabody Picture Vocabulary Test (PPVT; Dunn & Dunn, 1959), which he cited as being culturally loaded, and the Raven Progressive Matrices (Raven, 1938), which be believed to be culturally fair, Jensen found that the Mexican group was similar to the White in rank order of p values and p decrements on both the PPVT and the Raven but that the Mexican group had lower scores on the PPVT than on the Raven. To him, this suggested that some factor was present that depressed the PPVT performance more or less uniformly for all items but did not depress Raven performance, at least to the same degree. Jensen concluded, “It seems plausible to suggest that this factor is verbal and may be associated with bilingualism in the Mexican group” (pp. 239–240). Jensen (1976) reinforced this notion and its biasing effect in a later summary of this experiment in which he admitted, “There is some evidence that a vocabulary test in English may be a biased test of intelligence for Mexican-Americans” (p. 342). evaluation of intelligence and learning disability     

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ACCOUNTING FOR ISSUES OF VALIDITY IN TESTING The delineation of English-language proficiency and the opportunity for acculturative learning effectively move the focus on testing with Hispanics away from race and directly onto the two variables that have historically and continue presently to moderate test performance (Ortiz & Dynda, 2008; Ortiz et al., 2012). In this manner, it is more appropriate to discuss notions regarding testing of Hispanics as an issue of testing English-language learners. And although the term English learner is no less broad than Hispanic, it is a better term because it emphasizes the fact that the individual being tested is not and cannot be presumed to be a native English speaker. Similarly, our use of the term acculturative learning opportunity is intended to reflect that what makes people perform differently on intelligence and cognitive ability tests is less about race or culture and more about the extent to which the individual has been exposed to or has had experience with the specific culture that gave rise to the test. CURRENT TESTING WITH HISPANICS AND ENGLISH LEARNERS Simplistic notions of test bias have apparently led to equally simplistic methods for addressing it in testing. Examiners currently use a range of methods and procedures in the evaluation of intelligence and learning disability (LD) in Hispanics, including modification or alteration of tests, use of nonverbal tests, use of native-language tests, and testing in English without any modification. There are significant differences in each approach, and they merit discussion here particularly in light of the degree to which they meet standards for being evidence based and are defensible in producing valid test results that permit fair and equitable interpretation. Modified Methods of Assessment Modified or altered assessment occurs, as the term implies, when an examiner intentionally modifies or alters the administration, scoring, or aspects of the testing process or standardized procedure. There are a number of ways to do this, and the most common term applied to them as a whole is testing the limits. An additional procedure often used as a result of the language difference when working with Hispanics involves the use of a translator or interpreter. Sometimes, an examiner may alter or modify the administration or scoring or some other component of a standardized test (e.g., those used in measuring intelligence or LD) in an attempt to “see” what the examinee might 114       ortiz and melo

actually be capable of doing if allowances are made for language differences or other factors. For example, an examiner might administer some items but not others or might mediate the task’s concept prior to actual administration to bolster comprehension. Other examples include repeating instructions as necessary, accepting responses in either the language of administration or the examinee’s native language, and eliminating or modifying time constraints that may have inhibited the examinee’s performance (Ortiz et al., 2012). The problem with such procedures, however, is that although the examinee may in fact improve performance, the violation of standardization renders the test results automatically invalid. The purpose of a standardized protocol is to ensure that the only variable affecting test performance is the examinee’s ability or lack thereof. When a test is administered or scored in a way that is different than the manner in which the test was normed, the results become invalid and preclude normative comparisons and interpretation. The introduction of potential sources of error cannot be quantified, and the degree to which such error influences the results is unknown and cannot be established. For the same reasons, the common practice of using a translator or interpreter for test administration is problematic. The use of a translator or interpreter is an undoubtedly noble attempt to help overcome the language barrier. Apart from all the psychometric issues that plague the translation of tests on the fly, until there are tests that have been standardized with the use of a translator or interpreter, it cannot be assumed that such a practice is capable of rendering valid results. Even when the interpreter is highly trained and experienced, test score validity will be compromised in ways that cannot be quantified or accommodated, and the examinee’s performance can no longer be compared fairly or equitably with the normative sample. Despite the limitations regarding test score validity, modified or altered assessment continues to have a potentially useful purpose. The value in altering or modifying a test comes from being able to generate qualitative data and information—that is, in direct observations of testing behavior, assessments of learning propensity in a test–teach–test framework, evaluations of developmental capabilities, and error analysis. Too often, psychologists devalue the importance and significance of such information and its richness and utility in intervention planning and remediation because it is not in the form of test scores. For this reason, a recommended procedure would be to administer a test in the precise manner called for by the publisher and then afterward, if necessary and appropriate, readminister the test using any of these procedures, with a focus on generating qualitative data and information. In this manner, test scores that are generated from standardized administration may prove useful, if it can be established that they are valid—an issue to be addressed in a later section (Ortiz et al., 2012). evaluation of intelligence and learning disability     

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Language-Reduced Assessment For reasons already stated, psychologists have long resorted to the use of so-called nonverbal tests in efforts to measure the intelligence of Hispanics and other groups of English learners. The idea, of course, is that by eliminating the perceived language barrier in test administration, the result is test scores that must be reliable and valid measures of the examinee’s intelligence or cognitive abilities (Ortiz et al., 2012). Few studies, however, have really examined the issue of validity with respect to the use of nonverbal tests that have become popular and that are taught pro forma in training programs for precisely these purposes. Although it is a commonly accepted notion, nonverbal tests do not appear to provide a satisfactory solution to the problem of validity particularly when, as is common practice, a nonverbal IQ is used as an acceptable substitute for a verbally laden IQ (e.g., Full Scale IQ). Consider, for example, that nonverbal tests are often used to qualify Hispanics for gifted and talented programs and the Wechsler Performance IQ (PIQ) serves as the predictor in efforts to identify Hispanics with LD. Yet, according to Lohman, Korb, and Lakin (2008), nonverbal tests are poor predictors of academic achievement and do not demonstrate validity for the purposes of identifying school-age Hispanics and other English learners as possessing gifted and talented abilities. In addition, they recognize the historically inaccurate focus on issues of race or ethnicity at the expense of the true underlying variables related to English proficiency and acculturative learning. They note that the tendency in research is to compare performance of individuals from different racial or ethnic groups and that this is a major problem because “the category Hispanic includes students from diverse cultural backgrounds with markedly different English-language skills . . . .This reinforces the need to separate the influences of ethnicity and ELL [English-language learner] status on observed score differences” (pp. 276–278). The reasons for the apparent failure of nonverbal tests to effectively deal with validity issues are many and include the mistaken belief that it is possible to administer a test without any language at all. Despite advertising claims of utility based on being completely nonverbal, it is impossible to administer any test, including a nonverbal one, without some form of communication occurring between the examinee and the examiner (Ortiz et al., 2012). Even where gestures or pantomime are used, test administration remains reliant on communication, irrespective of the modality in which the interaction occurs (Ortiz et al., 2012). Moreover, the question regarding how the meaning of the gestures or pantomime to be taught to the examinee is accomplished without verbal interaction remains unanswered. Second, some tests remain culturally embedded even when steps have been taken to reduce the language demands. That is, nonverbal tests do not 116       ortiz and melo

suddenly become culture free simply because oral or spoken language is no longer required for administration or responding. Many nonverbal tests continue to rely on and use objects, pictures, and other visual stimuli that are embedded within the culture that gave rise to the test. As such, developmentally based exposure to and experience with these objects remains subject to variation as a function of an individual’s experiences, and being Hispanic may well place an examinee at a corresponding disadvantage. Third, construct underrepresentation can be a problem in nonverbal tests, especially when viewed within the context of the Cattell-Horn-Carroll theory. Because they are, by definition, designed and intended to measure abilities that are not verbal, nonverbal tests may end up measuring a relatively narrow range of broad cognitive abilities and processes compared with verbal tests that contain both types. This can result in two potential problems: (a) generation of a general intelligence score that may not include a wide range of the known cognitive abilities and (b) failure to provide relevancy in the measurement of abilities (e.g., Ga, auditory processing, and Gc, crystallized intelligence) that are central to LDs, particularly those related to verbal academic skills such as reading and writing. Relative to the former issue, it has already been discussed that nonverbal tests do not appear to be acceptable predictors of general intelligence. As for the latter issue, the frequency with which evaluations for reading and writing difficulties occur in practice makes it unlikely that a nonverbal test will reveal helpful information about potential areas of dysfunction that might explain the reasons for the referral. This makes nonverbal tests less than ideal for the purposes of the majority of LD evaluations, the majority of which revolve around problems in learning to read or write. Finally, all nonverbal tests are subject to the same problems with norm sample representation (or lack thereof) as seen in verbal tests. Continuing to rely on the variables of race or ethnicity does nothing to make the test more suitable for individuals for whom the real issue is a language or experiential difference. And whereas it is certainly possible that nonverbal tests may provide more accurate estimates of functioning of abilities that do not rely much on verbal skills or acculturative knowledge than verbal tests, the extent to which they do or they do not must be directly evaluated, not merely assumed. Thus, the limitations discussed in this section continue to make the exclusive use of nonverbal tests in evaluation an incomplete solution with respect to validity and to the related issues of fairness and equity. Native-Language Assessment Although not a recent development, the slow but steady increase in the number of bilingual psychologists keeps this form of assessment a viable option evaluation of intelligence and learning disability     

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for those with the requisite competency. On the surface, native-language assessment appears to be the ideal approach in the evaluation of Hispanics because the psychologist would be in a position to conduct assessment activities directly and in a manner (i.e., in the native language) that is not available to the monolingual psychologist, even with the aid of an interpreter (Ortiz et al., 2012). The ability to observe test behavior without assistance and being able to communicate directly with the examinee are important advantages that seem to make this approach the clear choice for evaluation. All things being equal, this may well be true; however, this approach suffers from a few minor problems and one major issue that undermine its potential for addressing validity in testing. The major issue with native-language assessment is that there is little known about how Hispanics, with varying levels of proficiency in Spanish and English, perform on tests given to them in their native language. Nativelanguage testing represents a relatively new avenue for research, and at present, there is precious little empirical support with which to guide our understanding of how such individuals would be expected to perform and to what extent concerns regarding validity are effectively resolved. Native-language tests used in the assessment of Hispanics and other English learners are often developed exclusively or primarily on a monolingual population. For Hispanics, this means that most Spanish-language tests are normed on monolingual Spanish speakers. Because such individuals reside in a country where there may be only a single native culture and because they may learn, speak, and be educated in only one language, they differ significantly from the typical individuals on whom such tests might be used here in the United States. Hispanic or English learners in the United States learn to live with two cultures, learn to speak two languages, and are most often expected to learn and receive formal education in English only. Therefore, Hispanics in the United States are likely to be linguistically and experientially different than the normative sample of native-language tests developed in the United States. Even when attempts by test publishers are made to accommodate such differences, such as by grouping students according to country of origin or number of years of schooling in the United States, they remain limited in addressing validity because they still miss the mark in terms of English proficiency and acculturative learning. To be evidence based, practice must align itself with an established body of empirical findings. Given the problems in norm sample representation, use of native-language tests should rely on research that supports their validity for this purpose. But to say that the research on the use of native-language tests with Hispanics and other English learners in the United States is sparse would be an overly kind assessment. Little is known about the performance of U.S. bilinguals on monolingual tests administered in their primary language, and there is nothing yet established that would support the notion that simple 118       ortiz and melo

administration of a native-language test to a U.S. bilingual generates fully valid results and is not susceptible to problems in construct measurement as a function of variability in English and native-language proficiency as well as acculturative learning opportunity for either U.S. mainstream content that may appear on the test or cultural content that may be drawn from the culture related to the language of the test. As noted in the introductory portion of this chapter, Hispanics are anything but a homogenous group, and if the content is drawn from the native culture, variation in culture remains problematic. Likewise, if the content of the test is drawn from U.S. culture, variation in acculturative learning opportunity remains problematic. In either case, the performance of U.S. bilinguals is likely to be adversely affected even when tested in their native language, and any presumption that the test results obtained are valid is not defensible. Other minor issues, such as the relative lack of competent, trained, and qualified bilingual psychologists; the dearth of intelligence and cognitive ability tests in languages other than Spanish; and the heterogeneity of Spanish-speaking cultures where the primary language may be an aboriginal language such as Nahuatl or Taíno and not Spanish, all contribute to the unfortunate conclusion that native-language testing with Hispanics is not nearly the panacea it is often thought to be. English-Language Assessment The final major approach to the assessment of Hispanics and other English learners in the United States is the only option left: evaluation through the use of tests designed and developed to be administered in English. From an intuitive perspective, this hardly seems like an approach at all, let alone one that could possibly be thought to produce valid results. After all, the research on bias related to the use of English-language tests has already been discussed, and the degree to which Hispanics score lower than their native-English-speaking peers and the manner in which such attenuation occurs relative to differences in English proficiency and unequal acculturative learning opportunity are well established. But therein lies the irony and the utility of this approach—the manner and the degree to which test performance is affected by these two critical factors is well known. The knowledge base is both substantial and relatively consistent in demonstrating about a 15- to 20-point decline in performance on tests that are highly dependent on developmentally based English proficiency and acculturative knowledge and only a 3- to 5-point decline on tests that rely little on these same dimensions (i.e., nonverbal type tests). Understanding the literature in this way provides psychologists with a virtual norm sample that may be used to determine the degree to which evaluation of intelligence and learning disability     

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obtained test results match or do not match the patterns of performance described by research. In nearly every way, use of this body of empirical findings provides perhaps the only true evidence-based approach to the evaluation of Hispanics and other English learners. As a consequence, there are numerous benefits inherent in this approach. First, it may allow for more fair and equitable interpretation of test scores through use of an appropriate standard for expected levels of performance. Second, testing in English requires neither that the evaluator speak the language of the child or that a nativelanguage test is available, and in this way the approach can be used by any psychologist. However, testing of Hispanics does require specialized knowledge and training in all aspects of nondiscriminatory assessment to ensure that the psychologist has the necessary competency for such evaluation. And last, testing in English with full adherence to standardization effectively permits analysis of test results with respect to the extent to which validity may have been compromised by the presence of the aforementioned attenuating variables (i.e., English proficiency and acculturative knowledge). That is, because the degree to which these variables have been shown to affect test performance, the linearity of the effect (from a slight effect on nonverbal type tests to a strong effect on highly verbal tests) provides an index and pattern of performance that represents what would be ostensibly average performance across the range of tests. In this manner, the question of validity, as expressed in terms of “difference versus disorder,” can be answered, as is described in the following section. DETERMINING THE VALIDITY OF TEST SCORES If valid results cannot be obtained through the use of any of the approaches described in the previous section, testing with Hispanics comes to a virtual standstill. Invalid results preclude assignment of meaning to test scores and eliminates the need for and rationale underlying interpretation. If test results are to be useful in any capacity, they must be examined in some manner that allows the examiner to evaluate and determine their validity. With the approaches described in the previous section, altered or modified testing violates standardization, and as a consequence, validity is automatically undermined, and native-language testing lacks a research base with which to evaluate validity. This leaves testing in English that, of course, also includes the use of nonverbal tests administered in English. By maintaining standardization, test performance will be affected primarily by the individual’s true ability (or lack thereof) with some contributory effect or perhaps no effect at all from differences in English proficiency or acculturative knowledge, or it will be affected primarily by these two variables, which are the only ones related to differences in development, with some contributory effect or 120       ortiz and melo

perhaps no effect at all from actual or true ability. To determine whether test results are likely to be valid thus requires application of research organized in a way that highlights expected performance on any given test or battery of tests. One method designed expressly for the purpose of evaluating test score validity is the Culture–Language Interpretive Matrix (C–LIM; Flanagan & Ortiz, 2001; Flanagan, Ortiz, & Alfonso, 2013; Ortiz, 2001; Ortiz et al., 2012; Rhodes et al., 2005). Use of the term interpretive may be confusing in light of the fact that the C–LIM’s only purpose is to assist in determining the extent to which differences in English proficiency and acculturative knowledge affect test performance as opposed to true ability. The C–LIM is not a diagnostic system and does not establish the presence of any type of disorder; however, various patterns of performance found in the literature may be reflected in the results as organized within the C–LIM (e.g., global cognitive impairment or speech–language disorder). The basic premise behind the construction of the C–LIM is simple: Tests that are low in terms of reliance on language or acculturative knowledge and that typically yield the highest mean values for Hispanics and other English learners (what are historically called nonverbal tests) are placed or classified in the upper left cell of a nine cell (3 × 3) matrix; tests that are high in terms of requiring age-appropriate development of English-language proficiency and acculturative knowledge and that typically yield the lowest mean values for Hispanics and other English learners (historically referred to as verbal tests) are placed in the lower right cell of the matrix. All other tests, depending on the mean values established in the research, fall between these anchor points corresponding to one of three categories: high, moderate, or low (Flanagan et al., 2013). An illustration of the current version of the C–LIM classifications for the Wechsler Intelligence Scale for Children (4th ed.; WISC–IV; Wechsler, 2003) with hypothetical data is provided in Figure 6.1. Although the C–LIM is arranged in two-dimensional fashion, with English proficiency along one side and acculturative knowledge forming the other, the authors assert that the variables are in fact highly intercorrelated and not intended to be viewed otherwise, despite the orthogonal arrangement. Rather, it is the combined effect of differences in both culture and language that reflect the expected attenuation of performance in tests as they are classified from the upper left to the lower right cells in the matrix. This point was noted recently wherein “a statistically significant (decreasing) trend was observed for the effect of linguistic demand and cultural loading combined” (Kranzler, Flores, & Coady, 2010, p. 445). The utility of the C–LIM lies in its deliberate arrangement of tests in a linear and decreasing fashion that represents the linear and increasing attenuating effect that differences in English proficiency and acculturative knowledge have on tests (Sotelo-Dynega, Ortiz, Flanagan, & Chaplin, 2013). evaluation of intelligence and learning disability     

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Figure 6.1.  Culture–Language Interpretive Matrix (C–LIM) for the Wechsler Intelligence Scale for Children (4th ed.; WISC–IV) with hypothetical data where test scores are likely invalid. From Essentials of Cross-Battery Assessment (3rd ed.; p. 333), by D. P. Flanagan, S. O. Ortiz, and V. C. Alfonso, 2013, New York, NY: Wiley. Copyright 2013 by Wiley. Reprinted with permission.

In addition, the C–LIM provides a graphical range whereby the decreasing trend may be adjusted relative to the examinee’s degree of difference (slightly different, moderately different, and markedly different), as presented in Figure 6.2. By entering an examinee’s test scores in the matrix, the C–LIM provides an efficient and systematic method for evaluating individual test scores in a collective manner and when aggregated according to the degree to which performance would be expected to be attenuated compared with the normative mean (i.e., SS = 100; Sotelo-Dynega et al., 2013). Use of the C–LIM in practice is rather simple but can seem counter­ intuitive. The intent is only to determine whether the examinee characteristics known to be present in the evaluation (i.e., the examinee is culturally and linguistically different) might have systematically attenuated test score performance as tests relied more and more on verbal and acculturative knowledge development. Thus, test scores that follow the declining pattern as established through research (and as organized within the C–LIM) can be said to be more a reflection of the direct and primary effect of differences in the examinee’s English proficiency and acculturative knowledge (see Figure 6.2). Hence, such results are likely to be invalid as they primarily 122       ortiz and melo

Figure 6.2.  Culture–Language Interpretive Matrix (C–LIM) for the Wechsler Intelligence Scale for Children (4th ed.; WISC–IV) with hypothetical data where test scores are likely invalid. C = culture; L = language. From Essentials of Cross-Battery Assessment (3rd ed.; p. 334), by D. P. Flanagan, S. O. Ortiz, and V. C. Alfonso, 2013, New York, NY: Wiley. Copyright 2013 by Wiley. Reprinted with permission.

reflect more “difference” than disorder. However, if the test scores do not follow the declining pattern and fail to reach the magnitude or levels of performance as established through research (and as indicated on the C–LIM graph), it can be reasonably concluded that performance was most likely due to the presence of some variable or influence that is not related to English proficiency or acculturative knowledge. In these cases, the results may be deemed to be valid (not subject to the influence of language or cultural variables), and if subsequent interpretation is suggestive of performance deficits, the test scores may well be used to support diagnoses regarding disability if confirmed through other data and information. An example using the same hypothetical data in the WISC–IV, where the scores do not primarily follow the declining pattern, is illustrated in Figure 6.3. There are, of course, other issues and subtleties involved in comprehensive interpretation of test results, particularly for tests that measure language and culture directly (i.e., Gc). Such issues are beyond the scope of this chapter, and the reader is referred to the source for a thorough discussion of the C–LIM and its application in clinical practice (Flanagan et al., 2013). evaluation of intelligence and learning disability     

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Figure 6.3.  Culture–Language Interpretive Matrix (C–LIM) for the Wechsler Intelligence Scale for Children (4th ed.; WISC–IV) with hypothetical data where test scores are likely valid. Figure created with the C–LIM (v2.0). C = culture; L = language. From Essentials of Cross-Battery Assessment (3rd ed.; p. 334), by D. P. Flanagan, S. O. Ortiz, and V. C. Alfonso, 2013, New York, NY: Wiley. Copyright 2013 by Wiley. Adapted with permission.

By itself, the C–LIM is neither an approach to the assessment of Hispanics nor a diagnostic framework. Rather, the C–LIM’s only purpose is to permit evaluation of test score validity, but this is precisely what makes it extremely useful in evaluation. Test scores cannot be interpreted until and unless it has been determined that the results are valid. At this time, the C– LIM represents the only available method by which test score validity can be systematically evaluated. Without being able to do so, evaluation can go no further. Only when test scores are deemed to be valid do they then permit assignment of meaning and interpretation in the service of uncovering or diagnosing problems such as low intelligence or LD. A RECOMMENDED APPROACH FOR TESTING WITH HISPANICS The need to firmly and deliberately establish the validity of test score results differentiates assessment of Hispanics and other English learners from assessment with native English speakers raised in mainstream U.S. culture. 124       ortiz and melo

The other major difference involves confirmation or validation of an area of suspected dysfunction to ensure that it is manifested in the native language. In general, if an individual has difficulty with, say, short-term memory, the difficulty should be evident in both English and the native language. Even in cases where test results have been determined to be valid and where there are apparent indications of deficiencies in one area or another, there is no certainty that the results reflect true dysfunction. Unexplained anomalies in test results are common, and spurious findings, by definition, are an inevitable occurrence in testing. Therefore, although the testing of Hispanics is not exceptionally different from procedures that might be otherwise used in testing native English speakers, two fundamental steps must be specifically carried out to ensure fairness and equity in assessment: evaluation of test score validity and evaluation of diagnostic validity (Ortiz, 2014). Evaluation of Test Score Validity The initial step in evaluation of Hispanics is the process described in the previous section whereby standards and expectations of performance are based first on patterns culled from research on testing of Hispanics and then, if deemed valid, interpreted through comparisons with the normative sample. To accomplish this requires that the examiner first administer and score all tests in a standardized manner in English and without any modification or alteration. Next, examiners must seek to evaluate the extent to which differences in English proficiency and acculturative learning may have had an adverse impact on test performance. Use of the C–LIM provides the means by which examiners may make this important determination. If it is determined that the examinee’s test scores are consistent with the systematic decline of performance expected of bilinguals as a function of increasing developmental language proficiency and acculturative knowledge demands, the results are invalid and no assignment of meaning or interpretation of test scores is permitted. However, invalidation of the results does not end the inferences or conclusions that may be drawn from the whole of the collected test data. Consider that the pattern established by research in terms of the performance of Hispanics or other English learners (and as operationalized and organized within the C–LIM) represents average performance of individuals in the studies who are typically of average intelligence and are not disabled. Thus, it stands to reason that if an individual’s performance is comparable to other individuals with similar levels of difference in English proficiency and acculturative knowledge, then the individual is also likely to be of average ability and not disabled. This determination is itself an answer to the questions of difference versus disorder, and in determining both difference evaluation of intelligence and learning disability     

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and evidence of intact functioning, the evaluation does not merely end but rather concludes with a determination that the observed learning problems or the reasons that prompted the referral were due primarily to differences in English proficiency and acculturative learning rather than intrinsic deficits. If it is determined that the examinee’s test scores are not consistent with the systematic decline of performance expected of bilinguals as a function of increasing developmental language proficiency and acculturative knowledge demands, the results are likely valid, and assignment of meaning and appropriate interpretation can proceed, much as it would in testing with any other individual, with one exception involving tests that measure crystallized intelligence, or Gc, known as the Gc caveat (Ortiz, 2014). The narrow abilities that comprise Gc include language development and cultural knowledge so that the measurement of Gc can only be accomplished through use of language and cultural knowledge. The end result is that the influence of differences in English proficiency and acculturative knowledge cannot be separated from tests designed to evaluate English proficiency and acculturative knowledge. As such, evaluation of performance on tests measuring Gc can only be deemed to be fair through comparisons with other Hispanics or English learners, not against that of native English speakers, as would be the case if using the established norms from a test. Once again, the C–LIM provides a mechanism for determining the equitable classification of performance for Gc tests by examination of the magnitude of the cell with the highest cultural and linguistic loading. As long as the aggregate performance in that cell touches the range specified in the C–LIM and is drawn from the mean values in the literature, it can be assumed that performance in this one ability area is at least average and within normal limits, despite a standard score that may appear to suggest deficiency if evaluated in the usual manner. Evaluation of Diagnostic Validity The second step in assessment of intelligence in Hispanics involves a confirmatory procedure necessary to provide validation for suspected areas of dysfunction. In the previous step, test scores were evaluated for validity, and if found to be valid, were given meaning and interpreted. Areas of deficient performance may well be indications of some type of intrinsic disorder or disability. To bolster any proposed hypotheses regarding potential disability requires some type of confirmation that the results were not unique to testing in English but in fact transcend the language of test administration and manifest themselves irrespective of the language in which they were derived. Note, however, that native-language testing at this point is unconcerned with generating test scores because they still cannot be evaluated for validity. Rather, the primary intent of native-language testing here is to generate qualitative 126       ortiz and melo

data and information that serves to validate inferences made on test scores that have already been determined to be valid. As such, this step is quite flexible and may be accomplished through one of three different ways: (a) use of native-language tests parallel to those administered in English, (b) use of a native-language test administered with the assistance of a trained translator or interpreter, or (c) use of an informally translated English-language test with the assistance of a trained translator or interpreter. The first way requires that the examiner be bilingual and is therefore limited to psychologists with the necessary level of competency. The second may be used by any practitioner and will work for Hispanics because intelligence tests are readily available in Spanish. The third option can be used by any psychologist with any test, and although it seems a somewhat crude approach, it can still generate the type of qualitative and observational data necessary and sufficient to validate most any diagnosis. For all three options, examiners should feel free to administer tests in whatever manner necessary to ensure full comprehension and promote the examinee’s understanding of the task, including use of any modifications and alterations that may reduce linguistic or cultural barriers to performance. Care should be given to documenting important test behaviors, such as the examinee’s approach to tasks, errors in responding, and behavior during testing. After testing is completed, all data and information should be evaluated in light of the areas of weakness or difficulty that were identified through testing in English. If the areas of weakness in native-language testing do not match the corresponding areas of weakness identified previously, the suspected area of disability cannot be confirmed and may indicate that prior results were merely anomalous. In contrast, if the areas of weakness in nativelanguage testing match the corresponding areas of weakness identified previously, the suspected area or areas of disability are confirmed, and powerful evidence has now been generated to firmly support a diagnosis of disability. CONSIDERATIONS IN EVALUATION OF INTELLIGENCE AND LEARNING DISABILITIES IN HISPANICS The previous sections outlined the principles and procedures necessary to generate valid test scores that would permit defensible interpretation. With respect to the measurement of intelligence, the task is relatively easy in that valid scores allow use of the broadest available index of general functioning to serve as a representation of overall intellectual ability. But there are issues specific to Hispanics and other English learners that bear mentioning. For example, in accordance with the rationale behind the Gc caveat, any intelligence index or IQ that is formed with tests that measure evaluation of intelligence and learning disability     

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Gc is likely to be somewhat attenuated. This effect is described in the broad indexes provided in the Kaufman Assessment Battery for Children (2nd ed.; Kaufman & Kaufman, 2004), where the highest score for Hispanics is the Nonverbal Index (NVI) followed by the Mental Processing Index (MPI), and the lowest score is the Fluid-Crystallized Index (FCI). Although the reported decline is slight because it is based on ethnicity, not differences in English proficiency or acculturation, it still follows a consistent pattern. The decline occurs primarily because the NVI uses nonverbal tests almost exclusively, whereas the MPI has a broader mixture of tests, some of which require some degree of language and acculturative knowledge. The FCI is identical to the MPI except that it includes the two tests that measure Gc, and this is the most attenuated. This decline provides a much better example of the effect of differences in English proficiency and acculturative knowledge than the more common Verbal IQ–Performance IQ discrepancy, which tends to erroneously dichotomize the issue and mask the inherent linearity. Fair and equitable estimates of the actual intelligence of Hispanics will necessitate consideration of the degree to which any index or IQ is being attenuated by the presence of tests of Gc in determining its composition. There is no simple way to generate an IQ that can be viewed as wholly valid for Hispanics and that reflects actual or true ability. Whatever the methods used in evaluation, the final determination regarding the intelligence of any individual of Hispanic descent should be predicated on test scores combined with astute clinical judgment derived from a clear understanding of the ways in which differences in English proficiency and acculturative knowledge affect test performance. Fortunately, the historical importance and significance of the IQ has waned considerably and it is no longer widely viewed as the sine qua non of an individual’s intellectual worth. In many ways, advances in the understanding of human cognitive abilities and the important contributions of specific broad and narrow abilities involved in the development and acquisition of academic skills is reducing the misguided reliance on the significance and meaning of IQ. This is perhaps why the one area in which testing is finding a strong foothold is in the evaluation of LDs. Evaluation of LD in Hispanics and other groups is being driven by several factors, including advances in theory related to human cognitive functioning; dissatisfaction with old and discredited methods for identifying LD; the demotion of IQ as the linchpin around which concepts of LD have been built; significant improvements in current tests regarding adequacy in construct representation; the failure of response-to-intervention frameworks as a presumptive panacea in LD identification; and renewed interest in alternative, research-based approaches to identifying LD permitted in the Individuals With Disabilities Education Act (IDEA; 2004) and referred to collectively as third method approaches. 128       ortiz and melo

According to IDEA 2004, individual states may permit the use of other alternative research-based procedures for determining whether a child has a specific LD, as defined in 34 CFR 300.8(c)(10). These types of approaches provide operational definitions of LD that are consistent with IDEA 2004 and that are based on contemporary studies of intelligence and LDs. They serve as substantive and defensible models for psychologists to follow and are appropriate for use with Hispanics and other groups of English learners. The definition of LD as contained in IDEA 2004 noted that LD does not include learning problems that are primarily the result of limited English proficiency (34 CFR 300.309(a)(2)). This wording is especially relevant to evaluation with Hispanics in that many are likely to be nonnative English speakers and quite likely to possess levels of developmental proficiency below that of same-age native English speakers. The basic intent in the law is simply to preclude the equating of a language difference with a disability. The law provides no guidance, however, on how the impact of limited English proficiency is to be teased out of any data that might suggest disorder, including testing. The procedures outlined in the previous sections are intended to guide this process and, when carried out as delineated, can be viewed as likely meeting the requirements for due diligence in this regard under the law. Another issue related to the evaluation of LD with Hispanics involves the manner and type of testing that is required under IDEA 2004. For example, recent revisions to the wording now make it clear that each public agency must ensure that assessments and other evaluation materials used to assess a child under Part 300 are provided and administered in the child’s native language or in another mode of communication and in the form most likely to yield accurate information on what the child knows and can do academically, developmentally, and functionally, unless it is clearly not feasible to provide or administer (34 CFR 300.304(c)(1)(ii)). Similar wording in previous incarnations of IDEA has led state and local educational agencies to believe that native-language testing is required only when the individual has not yet had English as a second language/English for speakers of other languages services withdrawn and that once this has happened, evaluation in English is permitted as if the individual was never an English learner in the first place. Part of the confusion caused by this vague specification can also be traced to simplistic prescriptions regarding testing of bilinguals outlined in earlier wording in IDEA as well as in Standards for Educational and Psychological Testing (American Educational Research Association, American Psychological Association, & National Council on Measurement in Education, 1999), wherein a recommendation is given that testing be conducted in the individual’s “dominant” language. Dominance is a concept that refers only to which language is better developed and does not necessarily speak to the actual evaluation of intelligence and learning disability     

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level of proficiency or fluency. An individual may well be dominant in their native language but still lack proficiency in that language. Conversely, they might be dominant in English given that they are now 10 years old and their entire education and formal instruction has been rendered in English only, combined with a concomitant attrition or loss of their heritage language. Testing in English in this case is no more likely to be valid than testing in the native language. Individuals with varying levels of proficiency in two languages cannot be evaluated fairly or equitably through the application of a simple formula based on dominance. Rather, generation of valid test results will come only from evaluation of the extent of the examinee’s cultural and linguistic differences, the nature of their educational program and the language of instruction, the degree to which the student has been given sufficient opportunity to learn, and parental levels of education and socioeconomic status. Any factors that interrupt or alter development (e.g., learning a new language, receiving instruction in a language not yet learned) will cause corresponding attenuation in test score performance and academic development, both of which will place Hispanics at greater risk of identification of LD. CONCLUSION Fair and equitable evaluation of Hispanics requires specialized training and knowledge in the application of systematic, theoretically based, and empirically grounded procedures in all aspects of the evaluation process, especially with respect to examining the impact of language and acculturative differences and in establishing the validity of test scores. All too often it is thought that the mere act of being able to communicate in an individual’s native language is a sufficient condition for establishing validity. In reality, being able to communicate or administer a test in an examinee’s native language may well be valuable but in no way ensures that assessment is carried out in any manner that attends to potential sources of bias or reflects fair and equitable practice. Whereas a Hispanic individual may feel more comfortable being engaged by an examiner in his or her native language, use of tests will not result in valid inferences or conclusions unless it is accompanied by knowledge of the psychometric properties of tests; how differences in language proficiency and acculturative learning affect test performance; the manner in which the language and type of educational programming interacts with linguistic, cognitive, and educational development; and enough competency and experience in being able to integrate these factors within a theoretically guided and empirically supported framework for practice (Geisinger & Carlson, 1998). 130       ortiz and melo

Until Hispanics reach adulthood in the fourth generation (Valdés & Figueroa, 1994), it cannot be assumed that they will possess at any time prior to that the expected levels of age-appropriate development in English proficiency and acculturative knowledge acquisition, compared with their same-age monolingual English-speaking peers. Most important perhaps, is the understanding that test scores cannot be assigned meaning or used to support diagnoses related to dysfunction if they cannot be established as valid. Although this is not a complicated process, it is necessary that psychologists use methods and processes that permit and facilitate systematic evaluation of the degree to which English proficiency and acculturative learning may have affected test performance. Once over this hurdle, other considerations unique to Hispanics and some common to all English learners must be recognized and resolved as necessary. The overall intent of these procedures is to place the proper focus on the most salient and relevant variables likely to lead to unfair or inequitable conclusions and evaluate them relative to validity so that a defensible position regarding diagnosis, recommendations for intervention, or other instructional or treatment planning can be offered. It is important that psychologists not underestimate or dismiss the impact on test performance of even small differences in English proficiency and acculturative knowledge when working with individuals from Hispanic backgrounds. Rather, it will be necessary for psychologists to develop expectations of performance that are fair and based specifically on the extent to which an individual’s language and acculturative experiences differ from individuals who comprise the normative sample for tests to be used in the evaluation. REFEREN.CES American Educational Research Association, American Psychological Association, & National Council on Measurement in Education. (1999). Standards for educational and psychological testing. Washington, DC: American Educational Research Association. Dunn, L. M., & Dunn, L. M. (1959). Peabody Picture Vocabulary Test (PPVT). San Antonio, TX: Psychological Corporation. Figueroa, R. A. (1983). Test bias and Hispanic children. The Journal of Special Education, 17, 431–440. http://dx.doi.org/10.1177/002246698301700405 Figueroa, R. A. (1990). Best practices in the assessment of bilingual children. In A. Thomas & J. Grimes (Eds.), Best practices in school psychology II (pp. 93–106). Washington, DC: National Association of School Psychologists. Flanagan, D. P., & Ortiz, S. O. (2001). Essentials of cross-battery assessment. New York, NY: Wiley. Flanagan, D. P., Ortiz, S. O., & Alfonso, V. C. (2013). Essentials of cross-battery assessment (3rd ed.). New York, NY: Wiley. evaluation of intelligence and learning disability     

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Geisinger, K. F., & Carlson, J. F. (1998). Training psychologists to assess members of a diverse society. In J. Sandoval, C. L. Frisby, K. F. Geisinger, J. D. Scheuneman, & J. R. Grenier (Eds.), Test interpretation and diversity: Achieving equity in assessment (pp. 375–386). Washington, DC: American Psychological Association. http://dx.doi.org/10.1037/10279-014 Individuals With Disabilities Education Act, 20 U.S.C. § 1400 (2004). Jensen, A. R. (1974). How biased are culture-loaded tests? Genetic Psychology Monographs, 90, 185–244. Jensen, A. R. (1976). Test bias and construct validity. The Phi Delta Kappan, 58, 340–346. Kaufman, A. S., & Kaufman, N. L. (2004). The Kaufman Assessment Battery for Children, Second Edition (KABC–II). San Antonio, TX: Pearson Education. Kranzler, J., Flores, C., & Coady, M. (2010). Examination of the cross-battery approach for the cognitive assessment of children and youth from diverse linguistic and cultural backgrounds. School Psychology Review, 39, 431–446. Lohman, D. F., Korb, K., & Lakin, J. (2008). Identifying academically gifted English language learners using nonverbal tests: A comparison of the Raven, NNAT, and CogAT. Gifted Child Quarterly, 52, 275–296. http://dx.doi. org/10.1177/0016986208321808 Mercer, J. R. (1979). The system of multicultural pluralistic assessment: Technical manual. New York, NY: Psychological Corporation. Ortiz, S. O. (2001). Assessment of cognitive abilities in Hispanic children. Seminars in Speech and Language, 22, 17–36. http://dx.doi.org/10.1055/s-2001-13869 Ortiz, S. O. (2014). Best practices in nondiscriminatory assessment. In P. L. Harrison & A. Thomas (Eds.), Best practices in school psychology: Foundations (pp. 61–74). Bethesda, MD: National Association of School Psychologists. Ortiz, S. O., & Dynda, A. M. (2008). Issues unique to English language learners. In R. J. Morris & N. Mather (Eds.), Evidence-based interventions for students with learning disabilities and behavioral challenges (pp. 321–335). New York, NY: Routledge/Taylor & Francis. Ortiz, S. O., Ochoa, S. H., & Dynda, A. M. (2012). Testing with culturally and linguistically diverse populations: Moving beyond the verbal–performance dichotomy into evidence-based practice. In D. P. Flanagan & P. L. Harrison (Eds.), Contemporary intellectual assessment (3rd ed., pp. 526–552). New York, NY: Guilford Press. Raven, J. C. (1938). Raven’s Progressive Matrices (RPM). Edinburgh, Scotland: Author. Reynolds, C. R., & Ramsay, M. C. (2003). Bias in psychological assessment: An empirical review and recommendations. In J. R. Graham & J. A. Naglieri (Eds.), Handbook of psychology: Vol. 10. Assessment psychology (pp. 67–94). Hoboken, NJ: Wiley. Rhodes, R., Ochoa, S. H., & Ortiz, S. O. (2005). Assessment of culturally and linguistically diverse students: A practical guide. New York, NY: Guilford Press.

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Salvia, J., & Ysseldyke, J. E. (1991). Assessment (5th ed.). New York, NY: Houghton Mifflin. Sandoval, J., Frisby, C. L., Geisinger, K. F., Scheuneman, J. D., & Grenier, J. R. (Eds.). (1998). Test interpretation and diversity: Achieving equity in assessment. Washington, DC: American Psychological Association. http://dx.doi. org/10.1037/10279-000 Sotelo-Dynega, M., Ortiz, S. O., Flanagan, D. P., & Chaplin, W. (2013). English language proficiency and test performance: Evaluation of bilinguals with the Woodcock-Johnson III Tests of Cognitive Ability. Psychology in the Schools, 50, 781–797. http://dx.doi.org/10.1002/pits.21706 Valdés, G., & Figueroa, R. A. (1994). Bilingualism and testing: A special case of bias. Norwood, NJ: Ablex. Wasserman, J. D. (2012). A history of intelligence assessment: The unfinished tapestry. In D. P. Flanagan & P. L. Harrison (Eds.), Contemporary intellectual assessment (3rd ed., pp. 3–55). New York, NY: Guilford Press. Wechsler, D. (2003). Wechsler Intelligence Scale for Children–Fourth Edition (WISC–IV). San Antonio, TX: Pearson.

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7 NEUROPSYCHOLOGICAL TESTING OF SPANISH SPEAKERS ANTONIO E. PUENTE, CARLOS OJEDA, DAVOR ZINK, AND VERONICA PORTILLO REYES

Publication trends in cross-cultural and ethnic minority psychology have historically reflected a disconnection between demographics and psychological knowledge, especially when it comes to Hispanics (Hartmann et al., 2013). This trend is clearly the case in clinical neuropsychology where the growth of the specialty has not matched the growth of Spanish speakers. Some researchers (Ardila, 1996; Buré-Reyes et al., 2013; Rivera Mindt, Byrd, Saez, & Manly, 2010) have indicated that a significant cultural discrepancy in current neuropsychological instruments, procedures, and norms result in conceptual errors in the assessment of Spanish speakers. The emergence of new research has not kept pace with the expanding population of Spanish speakers in the United States and, for that matter, the growth of neuropsychology in Spanish-speaking countries. According to the U.S. Census Bureau (2014), the United States has an estimated population of 318,802,526, of which approximately 54 million individuals are Hispanic. http://dx.doi.org/10.1037/14668-008 Psychological Testing of Hispanics, Second Edition: Clinical, Cultural, and Intellectual Issues, K. F. Geisinger (Editor) Copyright © 2015 by the American Psychological Association. All rights reserved.

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This means that at least 16% of the U.S. population is Hispanic, although this amount is underestimated because the unauthorized immigrant population is estimated at 11.2 million (Passel & Cohn, 2011). Given that the population of Spanish speakers has unexpectedly grown by a 223% increase in the last 30 years (U.S. Census Bureau, 2008), the field of neuropsychology has to meet the challenge of testing this heterogeneous population. In 2009, the Hispanic Neuropsychological Society (HNS) and the National Academy of Neuropsychology (NAN) presented professional guidelines to enhance the quality and accessibility of neuropsychological services for Spanish speakers living in the United States by focusing on service delivery, training, and organizational policy (Judd et al., 2009). Although these helpful guidelines were proposed to improve the quality and accessibility of testing Spanish speakers in the United States, the challenges addressed in the literature (Ardila, Rosselli, & Puente, 1994; Camara, Nathan, & Puente, 2000; Pontón & Ardila, 1999; Puente & Ardila, 2000; Puente & Puente, 2009; Renteria, 2010; Rivera Mindt et al., 2010; Salazar, Perez-Garcia, & Puente, 2007), as well as the lack of awareness and application of the testing standards, will only be overcome with an active and continuous participation in the field. To investigate the issues related to performing neuropsychological evaluations with nonmajority group members such as Spanish speakers, cross-cultural neuropsychology has emerged to gain a better understanding of the cultural variables that affect the neuropsychological testing of Spanish speakers (Ardila et al., 1994; Puente & Perez-Garcia, 2000). Some of the most important variables that affect testing performance are (a) acculturation (Agranovich & Puente, 2007; Razani, Burciaga, Madore, & Wong, 2007), (b) language (Arentoft et al., 2012; Rosselli et al., 2002), (c) education (Ostrosky-Solís, Ramirez, & Ardila, 2007; Pineda et al., 2000; Rosselli, Tappen, Williams, & Salvatierra, 2006), and (d) socioeconomic status (Pineda et al., 2000). To oversee the accuracy of standardized testing, a joint committee was formed to set the standards for all educational, psychological, and employment testing in the United States. The Joint Committee was formed by the American Educational Research Association (AERA), the American Psychological Association (APA), and the National Council on Measurement in Education (NCME). The main purpose of the committee is to develop appropriate and ethical use of all educational and psychological tests (i.e., AERA, APA, & NCME, 1999). The committee considers the evaluation of minority members an important subject; for instance, Chapter 9 of the 1999 Standards for Educational and Psychological Testing is titled “Testing Individuals of Diverse Linguistic Backgrounds” (AERA et al., 1999). The revision of the Standards has an extended chapter on fairness in which issues of construct irrelevant variance frame the issues of measurement (AERA et al., 2014). 136       puente, ojeda, zink, and portillo reyes

Regarding language proficiency, the relevance of linguistic group differences in establishing accurate design, development, selection, administration, and interpretation of tests is recognized in the Standards. In addition, it cannot be assumed that a test taker belongs to the cultural and/or linguistic population on which a test is standardized, because standardized administration procedures and norms might not apply in establishing an accurate comparison of the test taker’s results. In other words, tests are often not developed for use outside the intended population and, by default, a circumscribed geographic region (Thrasher et al., 2011). It is important that the norms match the population being assessed. Possibly more important than linguistic dissimilarities are cultural differences. The new Standards emphasizes reduction of construct irrelevance (AERA et al., 2014). Of the numerous variables addressed in the Standards, validity may be the most important one. Validity becomes an even more important variable to consider when testing Spanish-speaking individuals; because of the variables discussed earlier, many neuropsychological tests lack the appropriate validity to assess Spanish speakers. A major concern is whether cultural and linguistic factors interfere with an accurate assessment of the individual. The widespread use of Western culture–oriented tests and norms for individuals of divergent linguistic and cultural backgrounds and the neglect of an array of cultural variables can deem the results of neuropsychological tests scientifically and clinically problematic (Puente & Agranovich, 2004). Today the status of neuropsychological assessment of Spanish speakers living in the United States is problematic, perhaps due to the challenge of developing neuropsychological tests in Spanish (Puente & Puente, 2009). For example, the FAS test of verbal fluency might not provide accurate results when testing individuals in Spanish because the letters F, A, and S are used less often in the Spanish language than in the English language, thus compromising the scores. Further, there are some letters in Spanish (ñ, ll) that do not exist in English. Puente and Ardila (2000) indicated that differences in language and culture are the main difficulties when translating a test from English to Spanish, and sometimes the literal translation carries a completely different meaning. Sometimes the same words mean different things in different Spanish subcultures (e.g., carro y bote [car and boat]; Peña, 2007). Linguistic equivalence sometimes does not match cultural or cognitive equivalence; cultural or cognitive equivalence is much harder to achieve than simple linguistic equality. Therefore, neuropsychological tests for one intended group that may be living a restricted cultural experience may not be easily applied to people of another culture (Rivera Mindt et al., 2010). In essence, constructs are often culturally bound. Puente and Puente (2009) specified issues in the following areas that represent major challenges neuropsychological testing of spanish speakers     

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in assessing Spanish speakers: (a) problematic translation, (b) copyright barriers, and (c) lack of normative samples. It is common to use translated and adapted tests when assessing Spanish speakers. For useful guidelines and information on how to effectively adapt a test, see the Standards (AERA et al., 1999; Cherner, 2010; Hambleton, Merenda, & Spielberger, 2005; Muñiz, Elosua, & Hambleton, 2013). The most appropriate guidelines to follow when using adapted and/or translated tests are the International Test Commission’s test adaptation guidelines (International Test Commission, 2008). In addition, the NAN guidelines for evaluating Hispanics encourage tests developers and publishers to use the International Test Commission’s test adaptation guidelines and to state in their manuals that their tests conform to the guidelines (Judd et al., 2009). These guidelines include (a) test development and adaptation, (b) administration, and (c) documentation and score interpretations (International Test Commission, 2008). In addition to these challenges, the personnel providing these testing services may not be appropriately trained, knowledgeable, or sensitive to these issues. In 1997, researchers conducted the first comprehensive survey among neuropsychologists in the United States to investigate training and practices with Hispanics (Echemendia, Harris, Congrett, Diaz, & Puente, 1997). They found that 5% (42 out of 840) of neuropsychologists who participated in the survey were unable to read, write, or speak Spanish. In addition, when participants were asked whether they used translators with monolingual Spanish speakers, 53% responded “yes,” whereas 5% responded “yes” when asked about the use of translators with bilingual Spanish speakers. Almost 90% of the sample reported not having any kind of graduate training in providing neuropsychological services to culturally diverse groups. In 2000, Camara et al. surveyed clinical psychologists and neuro­ psychologists to determine the most commonly used tests. Results confirmed the disconcerting situation regarding testing Spanish speakers: None of the top 100 (out of 129) tests was in Spanish, and only a few tests (e.g., Beck Depression Inventory; Beck, Ward, Mendelson, Mock, Erbaugh, 1961) were available in Spanish. Furthermore, although the Wechsler Adult Intelligence Scale (3rd ed.; WAIS–III; Wechsler, 1991) has Puerto Rican, Mexican, and Spanish (Spain) versions, these translations include limited norms that do not apply universally to all Spanish speakers. Moreover, the Beta III (a nonverbal measure of cognitive abilities; Kellogg & Morton, 1999) contains an over­sampling of U.S. Spanish-speaking Hispanics (Puente & Puente, 2009). A few years later, Salazar et al. (2007) addressed cultural issues related to the neuropsychological assessment of Spanish speakers by comparing testing practices in the United States and Spain. Results indicated that assessment patterns of Spanish speakers in either the United States or Spain have 138       puente, ojeda, zink, and portillo reyes

been set by American traditions. This has resulted in the following problems: (a) difficulty integrating the influence of culture and acculturation in the assessment, (b) lack of instruments in Spanish to perform the testing, (c) lack of norms, and (d) few adequate comparison samples. Salazar et al. presented a list of neuropsychological tests used in Spain from two publishing companies: TEA Ediciones and PSYMTEC. Although the list contains 60 tests, the tests presented in that list exhibit most, if not all, of the problems indicated earlier. Similarly, Lazarus and Puente (2009) compared neuropsychological testing practices and test usage in South Africa and the United States. They found discrepancies in test usage between both populations, which were attributed to specific demographic factors of each region, as well as differences in schooling that affect assessment practices. More recently, Muñiz, Fernández-Hermida, Fonseca-Pedrero, CampilloÁlvarez, and Peña-Suárez (2011) conducted a similar study in Spain. They surveyed 3,126 members of the Spanish Psychological Association regarding their test usage and practices and as a result compiled a list of the top 25 most-used tests in Spain. The following are the top 10: (a) Wechsler Intelligence Scale for Children (WISC; Wechsler, 1949), (b) 16 Personality Factors Test, (c) Millon Clinical Multiaxial Inventory, (d) Minnesota Multiphasic Personality Inventory (MMPI; Hathaway & McKinley, 1940), (e) Beck Depression Inventory—II (BDI–II; Beck, Steer, & Brown, 1996), (f) WAIS, (g) State–Trait Anxiety Inventory, (h) Rorschach, (i) Symptom Checklist–90, and (j) Raven Progressive Matrices. Six out of the 25 mostused tests were developed in Spain. In line with the aforementioned challenges in assessing Spanish speakers, the authors noted that even though the BDI–II is in fifth place, it is not marketed in Spain, meaning that it is most likely that photocopies of this test are being used. The results of this study reflect that 76% of the most commonly used tests in Spain are adaptations, and of these, 79% were originally developed in the United States. In fact, the top 10 most widely used tests are all adaptations (Elosua, 2012). Most of the manuals for the top 25 most widely used tests in Spain do not conform to the theoretical framework defended by the AERA, APA, and NCME (1999) standards. Only 11 manuals make reference to content, criteria, and evidence of construct validity. In addition, the adaptation process is not welldocumented in most of the manuals. Only eight tests address issues related to language equivalence in the manual (Elosua, 2012; Muñiz et al., 2011). Renteria (2010) conducted a survey on current neuropsychological practices and test usage with Hispanics. In the United States, results indicated that the most commonly used tests were the Raven’s Progressive Matrices, the Test of Nonverbal Intelligence (3rd ed.), the Batería III Woodcock-Muñoz, the Batería Neuropsicológica en Español, and the NEUROPSI–Attention and Memory, among others. Renteria’s results showed that since Echemendia neuropsychological testing of spanish speakers     

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et al. (1997) there has been a gradual improvement in the appropriate training and expertise of individuals working in the area. However, the following challenges remain: (a) the validity of many tests is not examined, (b) English to Spanish adapted tests may be biased, (c) some tests are not updated and have small sample sizes, (d) tests do not meet criteria from the Standards, and (e) access to tests is difficult. Pruebas Publicadas en Español (Schlueter, Carlson, Geisinger, & Murphy, 2013), published by the Buros Center for Testing, provides a Spanish adaption of Tests in Print (Murphy, Geisinger, Carlson, & Spies, 2011), which includes 422 tests available for use. Unfortunately, the compilation was published so recently that information associated with this promising book was not part of the present investigation. When the HNS was recently polled about the pressing issues in the assessment of Spanish speakers, approximately two dozen responses were obtained. Surprisingly, the heterogeneity of responses made a best practices approach difficult. Concerns included the limited value of nonverbal tests; that language dominance has to be established before tests are chosen; the avoidance of computerized tests, especially with individuals from rural and impoverished backgrounds; that interpreters are in some cases confounds; that symptom validity testing needs much further work before it can be applied to Spanish speakers; that illiteracy complicates the performance on tests and increases false positives; that Spanish is a heterogeneous language with within-culture variation; and that the client should be placed within a sociocultural background. However, the common thread to all the responses was the limited availability of tests that could be used with Spanish speakers in the United States and elsewhere. To address the challenging task of testing Spanish speakers, the following three goals were established: 77 77 77

to develop a current list of neuropsychological and psychological tests available in Spanish; to determine what tests are used by members of the HNS; and to address the issue of whether these tests meet the criteria from the Standards.

To address these goals, an electronic survey of 56 members out of the total 83 from the HNS was performed because these were psychologists who have self-identified as performing neuropsychological evaluations with Spanishspeaking individuals in the United States. This project was approved by the University of North Carolina Wilmington (UNCW) Institutional Research Board, and certifications of the National Institutes of Health and the UNCW Human Research Training were obtained before initiating the study. The demographic data of respondents can be seen in Table 7.1. 140       puente, ojeda, zink, and portillo reyes

TABLE 7.1 Participants’ Demographic Data

Gender  Male  Female Race/ethnicity  Caucasian/White  Hispanic/Latino Degree  PhD  PsyD  Other Board certified  No  Yes Use technicians/ translators   Certified translators   Uncertified technicians   Uncertified translators   None of the above Spanish-speaking clients   Less than 25%   More than 25%   More than 50%   More than 75%  100%

n

%

22 32

40.7 59.3

14 42

25.0 75.0

34 14 7

61.8 25.5 12.7

46 10

82.1 17.9

6 6 1 44

10.9 10.9 1.8 80.0

15 15 10 8 8

26.8 26.8 17.9 14.3 14.3

Primary work setting  Hospital   Outpatient clinic   Private practice  University Level of Spanish proficiency   No proficiency   Limited proficiency   Some proficiency   Extensive proficiency Cultural context knowledge   Limited knowledge   Some knowledge   Extensive knowledge

n

%

15 9 23 8

27.3 16.4 41.8 14.5

2 1 4 49

3.6 1.8 7.1 87.5

1 8 47

1.8 14.3 83.9

CURRENT LIST OF NEUROPSYCHOLOGICAL AND PSYCHOLOGICAL TESTS AVAILABLE IN SPANISH A comprehensive list of Spanish tests was developed by reviewing the following sources: (a) prior research regarding tests in Spanish (e.g., Lazarus & Puente, 2009; Salazar et al., 2007), (b) the Buros Mental Measurements Yearbook (Buros Center for Testing, 2012), (c) the HNS list of tests in Spanish, (d) the databases PsycINFO and WorldCat, and (e) Spanish test publishers (Manual Moderno in Mexico and TEA Ediciones in Spain). Using this procedure, we found 555 psychological and neuropsychological tests in Spanish, exceeding the number of Spanish tests previously reported by Camara et al. (2000), Salazar et al. (2007), Lazarus and Puente (2009), and Renteria (2010). However, the 555 tests represent a small percentage of the total 3,500 listed by the Buros Mental Measurement Yearbook online database in the United States (http://buros.org/mentalmeasurements-yearbook). Compared with the 555 Spanish tests in our list, the list of Spanish tests represents just 16% of the total tests in the United neuropsychological testing of spanish speakers     

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States. Because the population of Spanish speakers is expected to keep increasing in the United States for the foreseeable future, it is clear that the available Spanish tests should increase substantially to meet the challenge of the demographic shift. The small number of tests available in Spanish found in this study is consistent with previous literature. However, test usage surveys in the United States have not included any neuropsychological or psychological tests in Spanish (Camara et al., 2000; Rabin, Barr, & Burton, 2005). Furthermore, although results from this study indicated there are 555 tests available in Spanish, this number exceeds that found in previous tests usage surveys focused on Spanish speakers. For instance, the list published by Salazar et al. (2007) included 60 neuropsychological tests in Spanish, which is only 0.02% (61 out of over 3,500) of the total tests available. Similarly, Renteria (2010) included 0.03% (97 tests) in her study regarding current practices in Hispanic neuropsychology in the United States. In sum, there are two reasons that explain the length of this list: (a) a wide variety of psychological tests were included and (b) a more comprehensive approach was used in finding the tests. Given that the main focus of the study was the neuropsychological assessment of Spanish speakers, psychological tests were also included to get a more comprehensive understanding of the testing practices of the current sample population. In practice, neuropsychologists commonly include psychological testing in their evaluations. Although the 555 tests represent an increase from previously reported accounts of tests available in Spanish, there is still a marked discrepancy between the large number of tests available in English and the small number of tests available in Spanish. USE OF THE NEUROPSYCHOLOGICAL AND PSYCHOLOGICAL SPANISH TESTS SURVEY In this section, we discuss two aspects of using neuropsychological tests. The first relates to the demographics and testing practices of neuropsychologists who work with Spanish-speaking clients in the United States, and the second relates to finding out what Spanish tests are being used by Spanish-speaking neuropsychologists in the United States. Data were collected using the HNS LISTSERV, with the permission of their board of directors. The online survey was developed and administered using SurveyMonkey, a website that allows users to design, collect, and analyze survey responses. The survey asked participants to indicate whether they had used any of the listed Spanish neuropsychological or psychological tests. It also included nine demographic questions and an electronic consent form. For confidentiality purposes, only one response was allowed from each e-mail address 142       puente, ojeda, zink, and portillo reyes

(see Table 7.1). Table 7.2 shows the frequency and rank ordering of the top 25 most-used Spanish tests. Findings indicated that these HNS members used 39% (216) of the 555 Spanish tests included in our list. Furthermore, findings indicated that approximately 4% of tests (25) were used by most of the participants, and 12% of the tests (69) were used by only one participant. A large percentage of tests, 61% (339), were reported as not being used (see Table 7.2). Overall, these results suggest that there is not only a relatively smaller number of tests available in Spanish when compared with English but also that there is a relatively smaller number of Spanish tests being used. Participants are using only 6% of the total tests available in Spanish. In addition, only 25 to 50 tests are used frequently, whereas a larger number of tests are used infrequently or not at all. Because there are more tests available in English TABLE 7.2 Frequency and Rank Order of Top 25 Most Used Spanish Tests Test name

n

%

  1. Trail Making Test (TMT)   2. Beck Depression Inventory—II (BDI–II)   3. Boston Naming Test (BNT)   4. Test of Memory Malingering (TOMM)   5. Beck Anxiety Inventory (BAI)   6. Inventario Multifásico de Personalidad de ­Minnesota—2 (MMPI–2)   6. Stroop Test de Colores y Palabras (Stroop)   7. Batería III Woodcock-Muñoz (Batería III)   8. Vineland Adaptive Behavior Scales (VABS)   9. Color Trails Test (CLT)   9. Escala de Inteligencia de Wechsler para Adultos—III (EIWA–III)   9. Raven Matrices Progresivas (Raven) 10. Escala Wechsler de Inteligencia para Niños—IV (WISC–IV) 10. Evaluación Neuropsicológica Breve en Español (NEUROPSI) 11. Wechsler Adult Intelligence Scale (3rd ed.; WAIS–III) 12. Wechsler Memory Scale (3rd ed.; WMS–III) 13. California Verbal Learning Test (CVLT) 13. Examen Cognoscitivo Mini-Mental (MMSE) 13. Test de Copia de una Figura Compleja de Rey (RCF) 14. Escala de Inteligencia Wechsler para Adultos (EIWA) 15. Test de Vocabulario en Imagenes Peabody (Peabody) 15. Test de Clasificacion de Tarjetas de Wisconsin (WCST) 16. Batería Woodcock-Muñoz (BWM) 17. Adaptive Behavior Assessment System—II (ABAS–II) 17. Prueba Beery Buktenica del Desarrollo de la Integración Visomotriz (VMI)

35 33 29 28 27 26

76.1 71.7 63.0 60.9 58.7 56.5

26 24 23 22 22

56.5 52.2 50.0 47.8 47.8

22 21

47.8 45.7

21

45.7

20 19 18 18 18 17 16 16

43.5 41.3 39.1 39.1 39.1 37.0 34.8 34.8

15 14 14

32.6 30.4 30.4

neuropsychological testing of spanish speakers     

143

than Spanish, differences in test usage are to be expected. In this study, the top five most commonly used tests in Spanish were (a) Trail Making Test (TMT; Reitan, 1974), (b) BDI–II, (c) Boston Naming Test (BNT; Kaplan, Goodglass, & Weintraub, 1983), (d) Test of Memory Malingering (TOMM; Tombaugh, 1996), and (e) Beck Anxiety Inventory (BAI; Beck, 1993). These results are not consistent with previous test usage reports. Only the TMT was included the top five most-used tests previously reported (Camara et al., 2000; Lazarus & Puente, 2009; Rabin et al., 2005). In addition, only the TMT and the BDI–II appeared in the top five tests in the Renteria (2010) study. These differences in test usage might exist because of the gap between tests available in Spanish and English. It is important to note that only the Camara et al. (2000) study included both psychological and neuropsychological tests, whereas the other studies included only neuropsychological tests. Only the BDI–II also appeared in the top five most-used tests in Spain, according to Muñiz et al. (2011). However, comparing the top 25 most-used tests in Spain (Muñiz & Fernández-Hermida, 2010) with those found in the current study showed that the MMPI–2 (Butcher, Dahlstrom, Graham, Tellegen, & Kaemmer, 1989), BDI–II, WISC–IV (Wechsler, 2003), WAIS–III, Mini-Mental State Examination, and Raven’s Progressive Matrices were common to both lists. MEETING THE CRITERIA OF THE 1999 STANDARDS FOR EDUCATIONAL AND PSYCHOLOGICAL TESTING The question of whether the tests reported actually met the Standards criteria was also addressed. The tests reported in the survey were matched to the more applicable and measurable criteria from the Standards. Each test listed was compared using the following criteria: (a) whether the test was available in Spanish, (b) whether the test included Hispanic (U.S.) norms, (c) whether there were non-U.S. Hispanic norms, and (d) whether the test manual was in Spanish. An item was awarded a “yes” if a criterion was met satisfactorily or a “no” if a criterion was not met satisfactorily. Each test was then rated on each of these domains using a 0–4 scale, with 0 being does not meet any criteria to 4, meets all criteria. The tests were rated independently by the main researcher, the senior researcher, and two psychology graduate students. Test manuals and the research literature regarding each test were examined by each researcher. Once rated, results were compared among the raters. There were no discrepancies among the ratings of the four researchers involved. Finally, the frequency of usage of Spanish neuropsychological and psychological tests was determined by counting how often a point was repeated in the distribution of data (see Table 7.3). 144       puente, ojeda, zink, and portillo reyes

TABLE 7.3 Comparison of Top 25 Most Frequently Used Tests With Standards Criteria

Test name TMT BDI–II BNT TOMM BAI MMPI–2 STROOP BATERÍA III VABS CTC EIWAIII RAVEN WISC–IV NEUROPSI WAIS III WMS III CVLT MMSE TCFCR EIWA PEABODY WCST BWM ABAS–II VMI

No. of times selected

Test in Spanish

Hispanic norms (U.S.)

Hispanic norms (Non U.S.)

Test Manual in Spanish

Total

35 33 29 28 27 26 26 24 23 22 22 22 21 21 20 19 18 18 18 17 16 16 15 14 14

0 (No) 1 (Yes) 1 (Yes) 1 (Yes) 1 (Yes) 1 (Yes) 1 (Yes) 1 (Yes) 0 (No) 1 (Yes) 1 (Yes) 1 (Yes) 1 (Yes) 1 (Yes) 1 (Yes) 1 (Yes) 0 (No) 1 (Yes) 1 (Yes) 1 (Yes) 1 (Yes) 1 (Yes) 1 (Yes) 1 (Yes) 1 (Yes)

0 (No) 0 (No) 0 (No) 0 (No) 0 (No) 1 (Yes) 0 (No) 1 (Yes) 0 (No) 1 (Yes) 1 (Yes) 0 (No) 1 (Yes) 0 (No) 0 (No) 0 (No) 0 (No) 1 (Yes) 0 (No) 0 (No) 1 (Yes) 0 (No) 1 (Yes) 0 (No) 1 (Yes)

0 (No) 1 (Yes) 1 (Yes) 1 (Yes) 0 (No) 1 (Yes) 1 (Yes) 1 (Yes) 0 (No) 0 (No) 1 (Yes) 1 (Yes) 1 (Yes) 1 (Yes) 1 (Yes) 1 (Yes) 1 (Yes) 1 (Yes) 1 (Yes) 1 (Yes) 1 (Yes) 0 (No) 0 (No) 0 (No) 0 (No)

0 (No) 1 (Yes) 0 (No) 0 (No) 1 (Yes) 1 (Yes) 1 (Yes) 1 (Yes) 0 (No) 0 (No) 1 (Yes) 1 (Yes) 1 (Yes) 1 (Yes) 1 (Yes) 1 (Yes) 0 (No) 1 (Yes) 1(Yes) 1 (Yes) 1 (Yes) 0 (No) 1 (Yes) 0 (No) 1 (Yes)

0 3 2 2 2 4 3 4 0 2 4 3 4 3 3 3 1 4 3 3 4 1 3 1 3

Note. TMT = Trail Making Test; BDI–II = Beck Depression Inventory II; BNT = Boston Naming Test; TOMM = Test of Memory Malingering; BAI = Beck Anxiety Inventory; MMPI–2 = Inventario Multifásico de Personalidad de Minnesota—2; STROOP = Stroop Test de Colores y Palabras; BATERÍA III = Batería III Woodcock Muñoz; VABS = Vineland Adaptive Behavior Scales; CTC = Color Trails Test; EIWAIII = Escala de Inteligencia Wechsler para Adultos III; RAVEN = Raven Matrices Progresivas; WISC–IV = Escala Wechsler de Inteligencia para Niños IV; NEUROPSI = Evaluación Breve Neuropsicológica en Español; WAIS III = Wechsler Adult Intelligence Scale Third Edition; WMS III = Wechsler Memory Scale, 3rd Edition; CVLT = California Verbal Learning Test; MMSE = Examen Cognoscitivo Mini-Mental; TCFCR=Test de Copia de una Figura Compleja Rey; EIWA = Escala de Inteligencia Wechsler para adultos; PEABODY = Test de Vocabulario en Imagenes Peabody; WCST = Test de Clasificacion de Tarjetas de Wisconsin; BWM = Batería Woodcock Muñoz; ABAS–II = Adaptive Behavior Assessment System; VMI = Prueba Beery Buktenica del Desarrollo de la Integración Visomotriz.

The majority of the 25 most frequently used tests in Spanish do not meet the criteria for the Standards. Four out of the top 25 most frequently used tests in Spanish (TMT, Vineland Adaptive Behavior Scales, Adaptive Behavior Assessment System, and Wisconsin Card Sorting Test) do not have any Hispanic U.S. norms or non-U.S. Hispanic norms, and the testing manuals for these tests are not in Spanish. In addition, the following tests did not have any norms for Hispanics in the United States: BDI–II, BNT, TOMM, BAI, Stroop Test, Raven Matrices Progresivas [Raven’s Progressive Matrices], neuropsychological testing of spanish speakers     

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Evaluación Neuropsicológica Breve en Español [Brief Neuropsychological valuation in Spanish] (NEUROPSI), Wechsler Memory Scale (3rd edition), WAIS–III, and California Verbal Learning Test. Also, although most of the top 25 tests have norms for Hispanics outside the United States, particularly Puerto Rico, Mexico, and Spain, these norms represent only a small section of the diverse Hispanic population. Further, although six of the 25 most frequently used tests meet all the Standards criteria, results from these tests might be problematic because the norms for non-U.S. Hispanics are limited to certain countries. The primary issue in answering the question of whether tests match the Standards relates to test norms. Four out of the top 25 most frequently used tests in Spanish do not have any Hispanic U.S. norms or non-U.S. Hispanic norms, and the testing manual is not in Spanish. In addition, most of the reviewed tests did not have any norms for Hispanics in the United States, and as noted earlier, the nonU.S. norms represent only a small section of the diverse Hispanic population. For example, there are varied versions of the WAIS–III—one from Mexico, one from Puerto Rico, and another from Spain; however, the norms of these versions are not cross-referenced and there are some differences in terms of specific items. In addition, they have no clear cultural equivalence, and they cannot be purchased in the United States. Furthermore, the norms do not match most of the Spanish-speaking population, which is South American. As a result, there would not be a norm group for this population to determine how an individual is performing in comparison with same age peers. In addition, it is noteworthy that some of the top 25 most-used tests (e.g., TMT, BAI, Vineland Adaptive Behavior Scales, Wisconsin Card Sorting Test, and Adaptive Behavior Assessment System) do not have norms for any Hispanics. Finally, although six of the 25 most frequently used tests meet all the Standards criteria, results from these tests could be problematic because the norms for non-U.S. Hispanics are limited to certain countries. Seventeen out of the top 25 most frequently used tests have testing manuals in Spanish. Testing manuals are the bases that dictate not just instructions regarding test administration but also procedures related to scoring and interpretation of results. Hence, it is essential for the test manuals to be in the same language the test administrator uses because language discrepancies (arising from using an English manual with a monolingual test user) can produce administration, scoring, and interpretation errors. The findings indicating that most tests in Spanish do not meet the criteria from the Standards are consistent with previous literature (e.g., Elosua, 2012; Muñiz et al., 2011; Renteria, 2010). Further, Vilar-López and Puente (2010) highlighted the fact that the use of Spanish tests based on idiosyncratic practices produces erroneous and invalid results, which is also unethical because such practices do not meet the Standards criteria. 146       puente, ojeda, zink, and portillo reyes

WHERE ARE WE WITH THE NEUROPSYCHOLOGICAL TESTING OF SPANISH SPEAKERS? In the last 30 years, the population of Spanish speakers has rapidly grown in the United States, which presents a challenge for the specialty of clinical neuropsychology regarding how to accurately assess this diverse and continuously growing population. Overall, findings have suggested that the interface between neuropsychological testing and Spanish speakers has been gradual and limited. The gap between the total number of Spanish tests available (555) and the number of tests in English (3,500) is even more alarming considering that only six of the top 25 most frequently used tests in Spanish meet the criteria emerging from the Standards regarding the assessment of Spanish speakers. Overall, such findings put in doubt the accuracy of the neuro­ psychological tests used to assess Spanish speakers. An additional concern is the small number of Spanish tests used (216) compared with what is available for evaluating Spanish speakers (555). In other words, HNS members are using 39% of tests available to assess Spanish speakers and 0.06% of the total number of tests available in English. It is important to consider that the sample surveyed in the current study was limited to neuropsychologists only. Previous test usage studies in the literature, including those done in Spain, usually surveyed psychologists in general. Another noteworthy characteristic of the sample is that respondents all belonged to the HNS, meaning that they were more proficient and familiar with the Spanish language and culture than psychologists in general. It is important to keep these two factors in mind when drawing conclusions from the current study and comparing results with other studies because the scope of practice (e.g., test selection) of neuropsychologists in the current sample does not generalize to the majority of practicing psychologists and to neuro­ psychologists in the United States. For example, psychologists in general probably use translators more often than was reported by HNS members in this study. RECOMMENDATIONS FOR THE FUTURE The following recommendations are suggested to improve the accuracy of neuropsychological assessment of Spanish speakers: (a) develop and conduct research regarding the validity and reliability of the tests available; (b) develop norms for respective groups; (c) revise current English–Spanish translations; (d) increase Spanish language and cultural knowledge training so that test users will be able to select, administer, score, and interpret Spanish tests with accuracy; (e) address the needs and challenges of testing neuropsychological testing of spanish speakers     

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Spanish speakers in future editions of the Standards; (f) increase the training of personnel in clinical neuropsychology with expertise in Spanish; and (g) develop an institute similar to Buros (or develop a branch within Buros) that focuses on the needs and challenges of testing Spanish speakers. If this study were replicated, the following questions should be addressed: (a) How many members of HNS are also members of NAN and the International Neuropsychological Society (INS)? (b) What percentage of NAN/APA Division 40 members are Spanish speakers? (c) In what states are HNS members located? and (d) Are the primary positions of HNS members academic? Overall, addressing these questions will help to differentiate the organizational membership of HNS compared with other organizations such as NAN or INS. In addition, knowing where HNS members are located might provide a good sense of the background of their clients (e.g., Cubans mainly located in Florida compared with Mexicans who are mainly located in California and the southwestern United States). Finally, determining whether the primary position of an HNS member is academic will allow us to gain a better estimate of the percentage of HNS members conducting research related to issues in testing Spanish speakers. Future studies regarding neuropsychological assessment of Spanish speakers should sample data from multiple groups (e.g., NAN, APA, HNS) or groups more reflective of a community sample nationwide, as well as outside the United States. Of additional importance is that the new Standards for Educational and Psychological Testing was recently published (AERA et al., 2014). The third chapter, immediately after validity and reliability, is on fairness. Many of the issues raised in this chapter are represented there. For purposes of disclosure, the senior author was on the committee that revised those standards. This chapter highlighted some of the main issues and challenges of conducting neuropsychological testing with Spanish speakers. Linguistic and cultural minorities exist throughout the world, and it is likely that the challenges outlined in this chapter are applicable to different minority groups in different contexts. REFERENCES Agranovich, A. V., & Puente, A. E. (2007). Do Russian and American normal adults perform similarly on neuropsychological tests? Preliminary findings on the relationship between culture and test performance. Archives of Clinical Neuropsychology, 22, 273–282. http://dx.doi.org/10.1016/j.acn.2007.01.003 American Educational Research Association, American Psychological Association, & National Council on Measurement in Education. (1999). Standards for educational and psychological testing. Washington, DC: American Educational Research Association.

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American Educational Research Association, American Psychological Association, & National Council on Measurement in Education. (2014). Standards for educational and psychological testing (Rev. ed.). Washington, DC: American Educational Research Association. Ardila, A. (1996). Towards a cross-cultural neuropsychology. Journal of Social and Evolutionary Systems, 19, 237–248. http://dx.doi.org/10.1016/S1061-7361(96)90034-X Ardila, A., Rosselli, M., & Puente, A. E. (1994). Neuropsychological evaluation of the Spanish speaker. New York, NY: Premium Press. http://dx.doi.org/10.1007/ 978-1-4899-1453-8 Arentoft, A., Byrd, D., Robbins, R. N., Monzones, J., Miranda, C., Rosario, A., . . . Rivera Mindt, M. (2012). Multidimensional effects of acculturation on Englishlanguage neuropsychological test performance among HIV+ Caribbean Latinas/ os. Journal of Clinical and Experimental Neuropsychology, 34, 814–825. http:// dx.doi.org/10.1080/13803395.2012.683856 Beck, A. T. (1993). Beck Anxiety Inventory. San Antonio, TX: Pearson. Beck, A. T., Steer, R. A., & Brown, G. K. (1996). Manual for the Beck Depression Inventory–II. San Antonio, TX: Psychological Corporation. Beck, A. T., Ward, C. H., Mendelson, M., Mock, J., & Erbaugh, J. (1961). An inventory for measuring depression. Archives of General Psychiatry, 4, 561–571. http:// dx.doi.org/10.1001/archpsyc.1961.01710120031004 Buré-Reyes, A., Hidalgo-Ruzzante, N., Vilar-López, R., Gontier, J., Sánchez, L., Pérez-García, M., & Puente, A. E. (2013). Neuropsychological test performance of Spanish speakers: Is performance different across different Spanish-speaking subgroups? Journal of Clinical and Experimental Neuropsychology, 35, 404–412. http://dx.doi.org/10.1080/13803395.2013.778232 Buros Center for Testing. (2012). Buros mental measurement yearbook. Retrieved from http://buros.org/mental-measurements-yearbook Butcher, J. N., Dahlstrom, W. G., Graham, J. R., Tellegen, A., & Kaemmer, B. (1989). The Minnesota Multiphasic Personality Inventory—2 (MMPI–2): Manual for administration and scoring. Minneapolis: University of Minnesota Press. Camara, W. J., Nathan, J. S., & Puente, A. E. (2000). Psychological test usage: Implications in professional psychology. Professional Psychology: Research and Practice, 31, 141–154. http://dx.doi.org/10.1037/0735-7028.31.2.141 Cherner, M. (2010). Considerations in the cross-cultural assessment of functional abilities. In T. D., Marcotte & I. Grant (Eds.), Neuropsychology of everyday functioning (pp. 209–221). New York, NY: Guilford Press. Echemendia, R. J., Harris, J. G., Congrett, S. M., Diaz, M. L., & Puente, A. E. (1997). Neuropsychological training and practices with Hispanics. A national survey. Clinical Neuropsychologist, 11, 229–243. http://dx.doi.org/10.1080/1385404 9708400451 Elosua, P. (2012). Tests published in Spain: Uses, customs and pending matters. Papeles del Psicólogo, 33(1), 12–21. neuropsychological testing of spanish speakers     

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Hambleton, R. K., Merenda, P. F., & Spielberger, C. D. (Eds.). (2005). Adapting educational and psychological tests for cross cultural assessment. London, England: Erlbaum. Hartmann, W. E., Kim, E. S., Kim, J. H. J., Nguyen, T. U., Wendt, D. C., Nagata, D. K., & Gone, J. P. (2013). In search of cultural diversity, revisited: Recent publication trends in cross-cultural and ethnic-minority psychology. Review of General Psychology, 17, 243–254. http://dx.doi.org/10.1037/a0032260 Hathaway, S. R., & McKinley, J. C. (1940). The MMPI manual. New York, NY: Psychological Corporation. International Test Commission. (2008). ITC guidelines on adapting tests. Retrieved from http://www.intestcom.org Judd, T., Capetillo, D., Carrion-Baralt, J., Marmol, L. M., Miguel-Montes, L. S., Naverrete, M. G., . . . Valdes, J. (2009). Professional considerations for improving the neuropsychological evaluation of Hispanics: A National Academy of Neuropsychology education paper. Archives of Clinical Neuropsychology, 24, 127–135. http://dx.doi.org/10.1093/arclin/acp016 Kaplan, E., Goodglass, H., & Weintraub, S. (1983). Boston Naming Test. Austin, TX: Pro-Ed. Kellogg, C. E., & Morton, N. W. (1999). Beta III. San Antonio, TX: Pearson. Lazarus, G., & Puente, A. E. (2009). The evolution of neuropsychological test usage in different geographical locations and the role of the neuropsychologist [Abstract]. Archives of Clinical Neuropsychology, 24, 461. Muñiz, J., Elosua, P., & Hambleton, R. K. (2013). Directrices para la traducción y adaptación de los tests: Segunda edición [International Test Commission Guidelines for test translation and adaptation: Second edition]. Psicothema, 25, 151–157. Muñiz, J., & Fernández-Hermida, J. R. (2010). La opinión de los psicólogos españoles sobra el uso de los tests. [The opinion of Spanish psychologists on the use of tests.] Papeles del Psicólogo, 31(1), 108–121. Muñiz, J., Fernández-Hermida, J. R., Fonseca-Pedrero, E., Campillo-Álvarez, A., & Peña-Suárez, E. (2011). Review of tests published in Spain. Papeles del Psicólogo, 32, 113–128. Murphy, L. L., Geisinger, K. F., Carlson, J. F., & Spies, R. A. (2011). Tests in print VIII. Lincoln, NE: Buros Center for Testing. Ostrosky-Solís, F., Ramirez, M., & Ardila, A. (2007). Same or different? Semantic verbal fluency across Spanish speakers from different countries. Archives of Clinical Neuropsychology, 22, 367–377. Passel, J. S., & Cohn, D. (2011). Unauthorized immigrant population: National and state trends, 2010. Retrieved from Pew Research Hispanic Trends Project website: http://www.pewhispanic.org/2011/02/01/unauthorized-immigrant-populationbrnational-and-state-trends-2010/ Peña, E. D. (2007). Lost in translation: Methodological considerations in crosscultural research. Child Development, 78, 1255–1264. http://dx.doi.org/10.1111/ j.1467-8624.2007.01064.x

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Pineda, D. A., Rosselli, M., Ardila, A., Mejia, S. E., Romero, M. G., & Perez, C. (2000). The Boston Diagnostic Aphasia Examination–Spanish version: The influence of demographic variables. Journal of the International Neuropsychological Society, 6, 802–814. http://dx.doi.org/10.1017/S135561770067707X Pontón, M. O., & Ardila, A. (1999). The future of neuropsychology with Hispanic populations in the United States. Archives of Clinical Neuropsychology, 14, 565–580. Puente, A. E., & Agranovich, A. (2004). The cultural in cross-cultural neuro­ psychology. In M. Hersen, G. Goldstein, & S. R. Beers (Eds.), Comprehensive handbook of psychological assessment: Vol. 1. Intellectual and neuropsychological assessment (pp. 321–332). Hoboken, NJ: Wiley. Puente, A. E., & Ardila, A. (2000). Neuropsychological assessment of Hispanics. In E. Fletcher Janzen, T. Strickland, & C. R. Reynolds (Eds.), Handbook of crosscultural neuropsychology (pp. 87–104). New York, NY: Plenum Press. http:// dx.doi.org/10.1007/978-1-4615-4219-3_7 Puente, A. E., & Perez-Garcia, M. (2000). Neuropsychological assessment of ethnic minorities. In G. Goldstein & M. Hersen (Eds.), Handbook of psychological assessment (3rd ed., pp. 527–552). Amsterdam, Netherlands: Pergamon Press. Puente, A. E., & Puente, N. (2009). The challenges of measuring abilities and competencies in Hispanics/Latinos. In E. L. Grigorenoko (Ed.), Multicultural psychoeducational assessment (pp. 417–441). New York, NY: Springer. Rabin, L. A., Barr, W. B., & Burton, L. A. (2005). Assessment practices of clinical neuropsychologists in the United States and Canada: A survey of INS, NAN, and APA Division 40 members. Archives of Clinical Neuropsychology, 20, 33–65. http://dx.doi.org/10.1016/j.acn.2004.02.005 Razani, J., Burciaga, J., Madore, M., & Wong, J. (2007). Effects of acculturation on tests of attention and information processing in an ethnically diverse group. Archives of Clinical Neuropsychology, 22, 333–341. http://dx.doi.org/10.1016/ j.acn.2007.01.008 Reitan, R. (1974). Halstead-Reitan Neuropsychological Battery. Tucson, AZ: Neuropsychology Press. Renteria, L. (2010, February). Current practices survey in the neuropsychological assessment of Hispanics in the U.S. Paper presented at the meeting of the Hispanic Neuropsychological Society, Acapulco, Mexico. Rivera Mindt, M., Byrd, D., Saez, P., & Manly, J. (2010). Increasing culturally competent neuropsychological services for ethnic minority populations: A call to action. The Clinical Neuropsychologist, 24, 429–453. http://dx.doi. org/10.1080/13854040903058960 Rosselli, M., Ardila, A., Santisi, M. N., Arecco, M. R., Salvatierra, J., Conde, A., & Lenis, B. (2002). Stroop effect in Spanish–English bilinguals. Journal of the International Neuropsychological Society, 8, 819–827. http://dx.doi.org/10.1017/ S1355617702860106 neuropsychological testing of spanish speakers     

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Rosselli, M., Tappen, R., Williams, C., & Salvatierra, J. (2006). The relation of education and gender on the attention items of the Mini-Mental State Examination in Spanish speaking Hispanic elders. Archives of Clinical Neuropsychology, 21, 677–686. http://dx.doi.org/10.1016/j.acn.2006.08.001 Salazar, G. D., Perez-Garcia, M., & Puente, A. E. (2007). Clinical neuropsychology of Spanish speakers: The challenge and pitfalls of a neuropsychology of a heterogeneous population. In B. Uzzel (Ed.), International handbook of cross-cultural neuropsychology (pp. 283–301). Mahwah, NJ: LEA. Schlueter, J. E., Carlson, J. F., Geisinger, K. F., & Murphy, L. (2013). Pruebas publicadas en Espanol [Tests published in Spanish]. Lincoln, NE: Buros Center for Testing. Thrasher, J. F., Quah, A. C., Dominick, G., Borland, R., Driezen, P., Awang, R., . . . Boado, M. (2011). Using cognitive interviewing and behavioral coding to determine measurement equivalence across linguistic and cultural groups: An example from the International Tobacco Control Policy Evaluation Project. Field Methods, 23, 439–460. http://dx.doi.org/10.1177/1525822X11418176 Tombaugh, T. N. (1996). Test of Memory Malingering. North Tonawanda, NY: MHS. U.S. Census Bureau. (2008). American Community Survey demographic and housing estimates: 2006–2008. Retrieved from http://factfinder.census.gov/faces/ tableservices/jsf/pages/productview.xhtml?pid=ACS_08_3YR_DP3YR5& prodType=table U.S. Census Bureau. (2014). Facts for features: Hispanic Heritage Month 2014: Sept. 15–Oct. 15. Retrieved from U.S. Census Bureau website: http://www.census. gov/newsroom/facts-for-features/2014/cb14-ff22.html Vilar-López, R., & Puente, A. E. (2010). Forensic neuropsychological assessment of members of minority groups: The case for assessing Hispanics. In A. M. Horton & L. C. Hartlage (Eds.), Handbook of forensic neuropsychology (2nd ed., pp. 309–332). New York, NY: Springer. Wechsler, D. (1949). Wechsler Intelligence Scale for Children. New York, NY: Psychological Corporation. Wechsler, D. (1991). Manual for the Wechsler Intelligence Scale for Children–Third edition (WISC–III). San Antonio, TX: Psychological Corporation. Wechsler, D. (2003). Wechsler Intelligence Scale for Children–Fourth Edition (WISC–IV). San Antonio, TX: Pearson.

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8 CLINICAL ASSESSMENT OF HISPANIC YOUTH DIAGNOSED WITH ATTENTION-DEFICIT/ HYPERACTIVITY DISORDER AND OTHER EXTERNALIZING DISORDERS JOSé J. CABIYA AND NANET M. LóPEZ-CóRDOVA

Hispanic children and adolescents represent the largest and most rapidly growing minority group of youth in the United States (Pew Hispanic Center, 2011). Youth of Mexican origin are by far the largest single nationalorigin group of Hispanic/Latino youth, numbering about 8 million and accounting for 62% of all Hispanic children and adolescents. Puerto Rican youths number nearly 1 million, accounting for 8% of the total of Hispanic youth. However, Cuban youth number approximately 300,000 and account for 2% of the total Hispanic youth. Thus, these studies taken together demonstrate that youth of Central American and South American origin number 1.5 million and account for 12% of Hispanic youth. Moreover, epidemiological studies (Canino et al., 2004) of Hispanic children living in their country of origin do not differ significantly from children living in the continental United States in their rates of mental disorders, and even

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their rates for externalizing disorders, which have been related to violent behavior, as we will discuss later in the chapter, are comparable (Cabiya et al., 2006). However, Hispanic youths exhibit more antisocial behavior after the first generation living in the United States and especially when their parents lose their cultural ties to their country of origin (Duarte et al., 2008). This finding could be related to the degree of acculturation, as is discussed next. The development of child and youth psychopathology may be associated with direct and continuous contact with a different culture (acculturation) and to distress related to this process (cultural stress), as pointed out by Duarte et al. (2008). According to Rothe (2005), assessing the degree of acculturation is important because it often provides clues to patients’ health-related beliefs and practices and may predict whether these practices stem from the culture of origin or from the American culture. Many researchers, such as García-Coll et al. (2012), have suggested there is an immigrant paradox, which states that Hispanic immigrants exhibit fewer physical and mental disorders when they first migrate to the United States but that these same immigrants and their children tend to exhibit more illnesses after a number of years of residency, and definitely by their second generation. Moreover, Duarte et al. (2008) found that the immigrant parents’ acculturation level was associated with youth antisocial behavior. Specifically, the more acculturated the parents were, the more the youths exhibited antisocial behavior. Thus, the conclusion is that the Hispanic culture serves as a protective factor for these youths in preventing them from developing antisocial behavior. Although Hispanics share a similar language and belief system, there are other significant differences among subgroups. English-language proficiency, socioeconomic variables, and factors known to influence health care outcomes may also differ markedly among Hispanic subgroups. Therefore, strategies to improve the treatment of individuals with attention-deficit/ hyperactivity disorder (ADHD), including those exhibiting aggressive and violent behavior in the Hispanic population, must include overcoming language barriers by increasing the availability of Spanish-speaking professionals and medical translators and using culturally sensitive diagnostic instrumentation. Moreover, improving knowledge of cultural practices of particular Hispanic subgroups may improve the therapeutic relationship between patients and clinicians. English proficiency may differ among Hispanic subgroups. This is an important consideration because language barriers may interfere with the ability of caregivers to report ADHD symptoms to the primary care physician and mental health providers. It is for this reason that researchers and providers should address the importance of culturally

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competent interventions and health variables when addressing issues related to ADHD in the Hispanic population. RESEARCH WITH ADHD AND OTHER EXTERNALIZING DISORDERS WITH HISPANIC YOUTHS The term externalizing disorders is used to describe a set of disorders characterized by disruptive behaviors, including aggression and impulsiveness, that occur during childhood (Achenbach & Rescorla, 2001). The Diagnostic and Statistical Manual of Mental Disorders (fifth ed.; American Psychiatric Association, 2013) classifies these behaviors into two groups of mental disorders: Attention-Deficit/Hyperactivity Disorder and Disruptive, ImpulsiveControl and Conduct Disorders. The three main groups of externalizing disorders include ADHD, oppositional defiant disorder (ODD), and conduct disorder (CD). Although Hispanics have been found to be diagnosed less frequently with ADHD than non-Hispanic Whites and Blacks (Watt & Martinez, 2009), they have the highest rate of increase in the frequency of ADHD diagnoses according to the 2003 data of the National Survey of Children’s Health compared with the 2007 data (Centers for Disease Control and Prevention, 2010). Furthermore, Watt and Martinez (2009) suggested that the lower rates of diagnosed ADHD in Hispanics may be due, in part, to underdiagnoses. Moreover, in recent years, studies have found high levels of psychiatric comorbidity in children diagnosed with ADHD (Bauermeister, Shrout, Chávez, et al., 2007), an observation that has been reported in culturally and regionally diverse epidemiological samples, as well as in clinical samples. Findings from clinic-based samples have indicated that children with ADHD are more likely to meet diagnostic criteria for one or more mood disorders or elevated levels of depression symptoms (Bauermeister, Shrout, Chávez, et al., 2007). Few measures of behaviors associated with ADHD have been developed specifically with Hispanics. One of the most-used indexes to measure these behaviors was developed by Bauermeister and his associates (2005; Bauermeister, Shrout, Ramírez, et al., 2007): the School Behavior Inventory (SBI; Bauermeister, 1994), a separately normed test for Puerto Rican boys and girls ages 6 to 13. The internal consistency (alpha) of the Activity–Impulsivity and Distraction–Motivation scales for both genders ranged from .92 to .95, and the test–retest reliability ranged from .77 to .83 over 4 to 6 weeks. In addition, Bauermeister, Matos, and Barkley (1999) performed a factor analysis with the symptom ratings of teachers with a sample of children 6 to 16 years old (n = 614). The factor analysis yielded two factors: inattention and

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hyperactivity–impulsivity. The authors then performed further cluster analyses that yielded five clusters: (a) hyperactive (high hyperactivity– impulsivity and moderately high inattention scores), (b) inattentive (high inattention and low hyperactivity–impulsivity scores), (c) inattentive– hyperactive (high inattention and high hyperactivity–impulsivity scores), (d) normal (normal scores), and (e) highly adapted (lower scores than the total sample). The authors found that children classified in the first three clusters demonstrated more clinical impairments than children classified in the normal and highly adapted clusters. The group classified as inattentive– hyperactive was rated by teachers as exhibiting significantly more aggressive and self-destructive behavior, as well as more behavioral problems, than the other groups. Bauermeister et al. (2005; Bauermeister, Shrout, Ramírez, et al., 2007) conducted another study in Puerto Rico with 98 children that assessed the relationship between ADHD and oppositional defiant, aggressive, and delinquent behavior. As a result of their analyses, three groups of children were classified into those with high inattention scores, high inattention and hyperactivity–impulsivity scores, and low scores. In addition, Bauermeister et al. (2005) established that mothers exhibited a tendency to rate inattentive and hyperactive–impulsive children as demonstrating more problems associated with oppositional and attentional deficiency than inattentive and normal children. Finally, the authors found that teachers rated inattentive and hyperactive–impulsive children as exhibiting more oppositional defiant and aggressive behaviors leading to delinquent behavior than the inattentive and the normal group. A significant number of studies have suggested that in clinic-based samples, Hispanic youths with the diagnoses of ADHD are more likely to meet the criteria for the diagnosis of one or more mood disorders than nonHispanic children (Biederman, Petty, O’Connor, Hyder, & Faraone, 2012; Cabiya-Morales et al., 2007). Children diagnosed with both ADHD symptoms and depression symptoms also appear to be at higher risk of poor outcomes (e.g., suicide attempts). Furthermore, in community samples, ADHD has been found to be related to higher frequency of depression symptoms in Hispanic youths (Cabiya-Morales et al., 2007). Moreover, research studies have also suggested that emotional self-control and depressed mood may be more problematic for Hispanic ADHD children (Bauermeister et al., 1999). The possibility that this noted association of ADHD with depressed mood in Hispanic youths may, at least in part, stem from a deficiency in emotional self-regulation, according to Bauermeister et al. (1999). These findings merely suggest a link between ADHD and emotional selfregulation, suggesting that the poorest emotion modulation may be within

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the subgroup of ADHD Hispanic youth who exhibit both aggressive behavior and depressed mood. COMPARISON BETWEEN REPORTS OF BEHAVIORAL SYMPTOMS ASSOCIATED WITH ADHD, DISRUPTIVE DISORDERS, AND AGGRESSIVE BEHAVIOR Once established, aggressive behavior in childhood is a stable behavioral pattern. Moreover, a high frequency of impulsive and aggressive behaviors in childhood serves as a predictor for substance use, delinquent behavior, and other detrimental outcomes during adolescence and adulthood (Fite, Colder, Lochman, & Wells, 2008; Powell, Lochman, & Boxmeyer, 2007). Thus, aggressive behavior and risk factors at an early age can be cumulative over time and, without treatment, can cause a great deal of difficulty for the child at risk, the community, and society at large. The magnitude of the aforementioned concerns is further amplified considering that externalizing disorders in children are among the most frequently diagnosed disorders in mental health clinics for children (Kazdin, 2003). Youths with ADHD have been found to exhibit a higher frequency of aggressive behavior and to be at higher risk of developing academic, emotional, and social difficulties than other youths, including those with anti­ social behavior (Haack & Gerdes, 2011). Cabiya-Morales et al. (2007) found that 60% to 76% of aggressive youths with ADHD (n = 154) also qualified as having an ODD, and 93% of the Puerto Rican youths having ADHD were also diagnosed with ODD and/or CD. Assessment of child psychiatric disorders traditionally relies on information obtained from multiple informants, usually the parent, the child, and sometimes others, such as teachers and additional family members. These informants may provide different information about the presence, severity, and duration of a child’s symptomatology or behavior (Achenbach & Edelbrock, 1987). Achenbach and his associates developed the Child Behavior Checklist (Achenbach, 1991; Achenbach & Rescorla, 2001) for general population samples of children age 6 to 16 from 31 societies (N = 55,508). Effect sizes for differences among societies ranged from .03 to .14. Effect sizes for gender differences were ≤.01, with girls generally scoring higher on internalizing problems and boys generally scoring higher on externalizing problems. Effect sizes for age differences were ≤.01 and varied across types of problems. The total number of problems for 19 of 31 societies was within 1 SD of the overall mean of 22.5. Correlations for mean item scores between societies averaged .74. The findings indicated that parents’ reports of the problems of children were

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similar in many ways across highly diverse societies. However, effect sizes for society were larger than those for age and gender, suggesting the need to take into account the multicultural variations in parents’ reports of children’s problems. These findings were further replicated with much larger samples across 31 countries (Rescorla et al., 2007), which included an unspecified number of Puerto Ricans who scored the highest total mean score (34.7) of the 31 countries. Achenbach and his associates developed the Youth Self-Report (YSR; Achenbach & Rescorla, 2001), which has been used to assess self-rated problems in many societies, including Puerto Rico. It enables psychologists to assess its syndrome structure in those societies. The YSR includes self-ratings of 104 specific emotional, social, and behavioral problems. In addition, an open-ended item for describing and rating somatic complaints not included among the more specific items is also included in the test. It may be given to individuals ages 11 to 18. The initial factor structure of the YSR was derived from analyses of clinical samples by Achenbach and Edelbrock (1987) and has subsequently been refined through analyses of new samples (Achenbach, 1991; Achenbach & Rescorla, 2001). The syndromes assessed by the 2001 version of the instrument were derived from self-ratings by 2,581 youths 11 to 18 years old whose total problems scores were at or above the median in a U.S. general population sample. These included clinically referred youths from Australia, England, and the United States (Achenbach & Rescorla, 2001). Ivanova et al. (2007) also found similar results with a larger sample from 23 countries, including 301 youths from Puerto Rico. Several studies have compared parent and child reports of children’s psychiatric symptoms in structured diagnostic interviews such as the Diagnostic Interview for Children and Adolescents (Cabiya et al., 2006; Canino et al., 2004). These studies have documented low to moderate agreement between parents’ and children’s reports of psychiatric symptoms. In general, these reports have found that parents report more behavior symptoms about their children than the children report about themselves, whereas children report having more affective and neurotic symptoms than their parents report about them (Cabiya et al., 2006). In addition, a meta-analysis of more than 200 studies examined agreement among informants and reported moderate to poor agreement for most studies, including those in which agreement was assessed along symptom dimensions rather than by categorical diagnoses (Gonzalez-Cruz, Cabiya, Padilla, & Sánchez, in press). Somewhat better agreement between parents and children has been observed in clinical samples when semistructured interviews were used by clinicians for externalizing compared with internalizing symptoms (Canino et al., 2004). Asymmetrical reporting of certain types of symptoms has been found to be the most frequent source of disagreement. 158       cabiya and lópez-córdova

Parents tend to report externalizing behaviors or problems more often, whereas children tend to report internalizing depression or anxiety symptoms with greater frequency (Cabiya et al., 2006). Canino et al. (2004) used the computerized Diagnostic Interview Schedule for Children (DISC; Shaffer, Fisher, Lucas, Dulcan, & Schwab-Stone, 2000) to assess the rates of mental disorders in children and youths of Puerto Rico. The DISC is the most widely used and studied mental health interview that has been tested in both clinical and community populations (Bauermeister, Shrout, Chávez, et al., 2007). It is a structured interview that assesses 36 mental health disorders for children and adolescents using Diagnostic and Statistical Manual of Mental Disorders (fourth ed.; American Psychiatric Association, 1994) criteria. The current DISC version translated into Spanish and used in research with Hispanics is the DISC–IV (Bauermeister et al., 2011; Bravo et al., 2001), with parallel youth and parent versions. The test–retest reliability of the DISC–IV has been reported in both Spanish and English-speaking clinical samples, yielding comparable results (Bravo et al., 2001; Shaffer et al., 2000). The disorders assessed by the DISC were generalized anxiety, panic, posttraumatic stress, dysthymia, major depression, ADHD, ODD, CD, alcohol abuse/dependence, marijuana abuse/dependence, nicotine dependence and other substance abuse/dependence. In addition, a study completed by Bravo et al. (2001) with a Puerto Rican sample found that parents were generally fair or moderately reliable informants when reporting about their children. Children (11–17 years old) were either excellent or moderately reliable informants on disruptive and substance-related disorders, but were unreliable when reporting about anxiety and depressive disorders. For lifetime diagnoses, Bravo et al. found that parents were fair reporters of their children’s CDs and substance-related disorders, whereas their children were excellent or moderately reliable in reporting about most of these disorders. ASSESSMENT MEASURES USED IN EVIDENCE-BASED RESEARCH WITH HISPANIC YOUTHS WHO EXHIBIT AGGRESSIVE BEHAVIORS ASSOCIATED WITH ADHD AND OTHER DISRUPTIVE DISORDERS Empirical measures of aggressive and disruptive behaviors in youths with ADHD have been widely used in research on empirically based interventions with these populations and have been used to demonstrate their efficacy (Brestan & Eyberg, 1998; Lochman, Powell, Boxmeyer, & JimenezCamargo, 2011). Cognitive–behavioral interventions can have promising effects on youths’ problem-solving skills and behavior (Brestan & Eyberg, assessment of hispanic youth with adhd     

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1998; Lochman et al., 2011). These interventions tend to be comprehensive programs that have multiple components to address the range of risk factors that predict and contribute to youths’ aggressive behavior. Consistent with emerging evidence for comprehensive programming, in recent years multicomponent interventions have also begun to target youths’ functioning at school to reinforce the performance of youths’ new social and behavioral skills in the school environment directly (Powell et al., 2007). An example of an empirically based intervention developed lately based on a contextual social-cognitive model and on existing knowledge of cognitive–behavioral interventions for aggressive youths, including those diagnosed with ADHD, is coping power. This intervention, developed by Lochman and his collaborators (Lochman & Wells, 2003), is based on the model that two relevant sets of potential mediators of adolescent antisocial behavior are (a) child-level factors, including poor social-cognitive and problem-solving skills, poor self-regulation, and inability to resist peer pressure and (b) contextual factors, including poor parental caregiver involvement with, and discipline of, the child. Several types of effectiveness and dissemination studies have been conducted with coping power, indicating positive intervention effects on aggressive behavior and problem-solving skills among aggressive youths (Lochman et al., 2011). These interventions have been also translated for use with Hispanic youths with ADHD who exhibit aggressive behavior (Cabiya, Padilla, Martínez-Taboas, & Sayers, 2008). Cabiya et al. (2008) evaluated the effectiveness of the coping power intervention in reducing disruptive behaviors in youths in a series of studies. In the first one, the researchers assessed 608 students (434 boys and 174 girls) ages 8 to 13 who were attending public schools in the San Juan (capital of Puerto Rico) metropolitan area. These students were referred by their teacher for aggressive classroom behavior and were administered a symptoms checklist based on the Diagnostic and Statistical Manual of Mental Disorders (fourth ed., text rev.; American Psychiatric Association, 2000) diagnostic criteria for disruptive disorders. A total of 354 youths (249 boys and 106 girls) fulfilled the diagnostic criteria for one or more of the disruptive disorders, namely, ADHD, ODD, or CD. The youths who fulfilled the inclusion criteria were then randomly assigned with equal numbers of both genders to the intervention or to waiting list groups. No financial incentive was provided to the participants. Of those diagnosed with disruptive disorders, 278 were assigned to the two experimental groups. The socioeconomic status of all of these youths was low. Of the 174 youths that started the intervention, 170 (120 boys and 50 girls) completed the treatment, and four dropped out. The outcome measures were administered to the two groups before the beginning of the intervention and a week after the 12 sessions were com160       cabiya and lópez-córdova

pleted. Six months after the completion of treatment, 86 (51%) youths were reassessed with the outcome measures. The two study groups were similar in age. The mean age of the intervention group was 10.58 (SD = 1.12), whereas the control group was 10.49 (SD = 1.11). Of the 170 youths who received the intervention, 86 (57 boys and 29 girls) were evaluated again after 6 months for a follow-up. The mean age of this group was 10.13 (SD = 0.86). One of the measures used in this study was the Bauermeister School Behavior Inventory (BSBI; Bauermeister, 1994), which is completed by teachers and consists of six scales for boys and five for girls. For this study, the Irritability/Hostility subscale and High Activity/Impulsivity and Distractibility/ Low Motivation scales were used as measures of disruptive behaviors. The Irritability/Hostility scale specifically was also used as a measure of aggressive behavior and is scored differently for boys and girls. This instrument was developed, validated, and standardized for the Puerto Rican population (Bauermeister, 1994). Bauermeister (1994) found the test’s internal consistency fluctuated between .74 and .96 and that the test–retest reliability (over a 4-week period) fluctuated between .52 and .89. Another measure used in this study was the Child Depression Inventory (CDI; Kovacs, 1985), a self-report scale consisting of 27 items related to depression. The scale was adapted for children and youths by Kovacs (1985). Scores of 0 to 11 are considered to indicate absence of depression. Scores ranging between 12 and 18 are considered indicative of mild depression, whereas scores 19 or higher are considered indicative of severe depression. The scale was translated and adapted for the Puerto Rican culture by Bernal, Rosselló, and Martínez (1997) and has shown an internal consistency of .82 and of .79 (Bernal et al., 1997). Repeated measures analyses of variance were performed with each measure, with type of group (control vs. treatment group) as the betweensubjects variable and the time of evaluation (pre- vs. posttreatment) as the within-subjects variable. Gender was also entered as a between-subjects variable in the analyses of all measures except the Irritability/Hostility subscale of the BSBI, which was analyzed separately for males and females because the scales are gender specific. Effect sizes were calculated for two intervals, baseline to posttreatment and baseline to follow-up. Results indicated that the Distractibility/Low Motivation subscale’s scores of the BSBI were significantly reduced in the treatment group at the posttreatment evaluation relative to the control group, F(1, 127) = 5.426, p = .021. In addition, results also showed a significant reduction at the posttreatment evaluation from the pretreatment levels in the CDI scores in the treatment group, but not in the control group, F(1, 200) = 8.576, p = .004. No Gender × Time of Evaluation interaction effects were found to be significant. Table 8.1 presents the results of these analyses. Repeated measures analyses were then performed assessment of hispanic youth with adhd     

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TABLE 8.1 Mean Scores (M) and Standard Deviations (SD) of Boys and Girls Who Completed Follow-Up at Pretreatment, Posttreatment, and Follow-Up

Measure

Clinical cut-off points

Pretreatment M (SD)

Posttreatment M (SD)

Effect size

Follow-up M (SD)

Effect size

.41

14.90 (7.16) 21.11 (9.95) 29.34 (12.87) 20.69 (8.62)

.21

Boys Children’s Depression Inventory

15

Irritability/hostility (BSBI)

23

High activity/impulsivity (BSBI)

22

Distraction/lack of motivation (BSBI)

30

16.37 (6.67) 25.51 (9.78) 32.52 (15.28) 27.55 (9.64)

13.66 (6.64) 22.28 (9.34) 29.00 (12.26) 24.20 (10.21)

.33 .23 .35

.45 .21 .71

Girls Children’s Depression Inventory

15

Irritability/hostility (BSBI)

21

High activity/impulsivity (BSBI)

21

Distraction/lack of motivation (BSBI)

27

Note. BSBI = Bauermeister School Behavior Inventory.

16.59 (7.77) 26.87 (12.82) 32.62 (16.3) 26.44 (9.09)

16.14 (6.65) 23.53 (9.05) 24.56 (11.59) 19.25 (5.98)

.06 .26 .49 .79

14.31 (5.99) 18.88 (7.1) 16.71 (9.92) 17.11 (6.58)

.29 .62 .97 1.02

to compare the pretreatment and follow-up scores on the BSBI and the CDI subscales of the same set of participants that completed the follow-up. Significant reductions were obtained for the Activity/Impulsivity subscale (p < .001), the Distractibility/Low Motivation subscale (p < .001), and the CDI (p < .02) for both genders. In addition, significant reductions were found in the Irritability/Hostility subscale in males (p < .02) and females (p < .003). The reported effect sizes were moderate (< .40) for most initial comparisons. However, the results showed that the effect sizes were higher when the pretreatment and follow-up scores of the treatment group were compared, as can be seen in Table 8.1. One can observe that at the time of the follow-up measure, the effect sizes ranged from .21 to 1.02. In particular, the effect sizes obtained with the Distractibility/Low Motivation, Activity/Impulsivity, and the medium subscales of the BSBI were 1.02, .97, and .62, respectively, which represent large effect sizes. Also, the results presented in Table 8.1 revealed that girls tended to exhibit larger effect sizes than boys on some measures. In another separate study (Cabiya et al., 2008), all students from the seventh and eighth grades of a junior high school in a low-income neighborhood with a high incidence of substance abuse in San Juan, Puerto Rico, who volunteered were administered the BSBI. Those students who had a high score in the Irritability/Hostility scale were asked to participate. Sixty-six youths (49 boys and 17 girls), ages 12 to 16, with a mean of 13.57, started the intervention. Forty-eight youths (38 boys and 10 girls) completed at least 25 sessions of the 32 scheduled sessions. Thirty-five (30 boys and 8 girls) completed the follow-up measures. The therapeutic intervention was conducted following the treatment manual developed by Lochman et al. (2011) after it was translated directly into Spanish and adapted to the Puerto Rican culture by Cabiya, Padilla, and Sayers (2010). This adaptation included culturally adapting the role-playing sketches in the manual. One of measures used in this study was the Alcohol, Tobacco, and Drug Use Scale (ATOD; Lochman & Wells, 2003), a 12-item scale that asks youths about their use of alcohol, cigarettes, marijuana, inhalants, amphetamines, pills, natural stimulants, cocaine, crack, or ecstasy in the past 30 days. The BSBI was also used. Repeated measures analyses of variance were performed with each measure, with gender entered as a between-subjects variable in the analyses of all measures except for the Irritability/Hostility subscale of the BSBI, which was once again analyzed separately for males and females because the scales are different for each gender. Results indicated that the Irritability/Hostility subscale scores of the BSBI were significantly lower in males, F(1, 28) = 17.427, p = .001, with an effect size of .431 (partial eta2). Effect sizes were calculated by subtracting the change score of the control group from the change score assessment of hispanic youth with adhd     

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for the intervention group and dividing by the pooled standard deviation at baseline (Cohen, 1988). Effect sizes were calculated for baseline or pretreatment to posttreatment. Results also indicated that the Activity/Impulsivity subscale scores of the BSBI were also significantly reduced in both males and females, F(1, 28) = 14.157, p = .001, with an effect size of .336 (partial eta2). No significant reduction was found with the Distractibility/Low Motivation subscale. In addition, results also showed no significant reduction across time in the Activity/Impulsivity scale of the BSBI, nor were Gender × Time interaction effects found to be significant (see Table 8.1). Repeated measures analyses were then performed to compare the pre- and posttreatment scores on the ATOD. No change in substance use was reported by the youths across time. The results show significant reductions in the levels of irritability and hostility that are related to substance abuse. The results also showed that these differences were maintained at the 3-month follow-up. Effect sizes at follow-up usually ranged from medium to large, indicating that, as a rule, youths assigned to treatment were much better off than at pretreatment. Thus, the results of these two studies indicate that the cognitive– behavioral intervention was effective in reducing self-reports of depressed mood as measured in the CDI from pretreatment to posttreatment. The results also showed significant reductions in the levels of distractibility and low motivation at posttreatment relative to the pretreatment measures, as reported by the teachers through the BSBI. The results also showed that these differences were maintained and even enhanced in most cases in the 6-month follow-up. Both boys and girls in the treatment group showed significant reductions from the pretreatment to the follow-up in their scores in all measures of disruptive disorders and depressed mood. Effect sizes at follow-up ranged from medium to large, indicating that, as a rule, youths assigned to treatment are much better off than at pretreatment. It is important to note that these effect sizes are seldom reported in this type of research (Siddle, Jones, & Awenat, 2003). Moreover, the results showed that the reduction in disruptive disorders and depressed mood were not only statistically significant but also clinically significant. Table 8.1 shows that the mean scores of both boys and girls in the control and treatment groups at pretreatment were above the clinical cutoffs for each scale. Furthermore, as one can see in Table 8.2, the mean scores in most scales of the treatment group are below the clinical cutoff points at the follow-up evaluation. These results are consistent with research with Anglo American boys with similar symptomatology who also underwent a socialcognitive intervention (Lochman & Wells, 2004). Outcome studies have evaluated the effects of interventions and found this one to be more effective in reducing disruptive and aggressive behavior in the classroom than either a no-treatment or a goal-setting alone comparison condition. 164       cabiya and lópez-córdova

TABLE 8.2 Mean Scores (M), Standard Deviations (SD), and Effect Sizes on Primary Outcome Measures for the Coping Power Program

Irritability/ hostility (BSBI) High activity/ impulsivity (BSBI) Distraction/lack of motivation (BSBI)

Clinical cutoffs

Pretreatment M (SD)

Posttreatment M (SD)

Follow-up

22

25.21 (9.51) 35.20 (13.95)

18.29 (9.22) 25.53 (13.44)

17.58 (9. 4) 23.87 (10.90)

.43

33.43 (8.2)

28.77 (11.4)

28.47 (9.96)

.06

28 22

Effect size

.34

Note. BSBI = Bauermeister School Behavior Inventory.

CONCLUSIONS AND IMPLICATIONS FOR MENTAL HEALTH SERVICES FOR HISPANIC YOUTHS WITH ADHD This chapter has presented how Hispanic youths who are diagnosed with ADHD, including those who exhibit aggressive and violent behavior, can be tested and assessed both in research-controlled settings and in natural settings, such as schools. This chapter has also shown that manualized interventions can be successfully implemented with Hispanic youths with high levels of comorbidity and applied in day-to-day natural settings. Finally, the cultural, socioeconomic, linguistic, and other factors that distinguish Hispanics from other ethnic groups should be taken into consideration when developing assessment measures for Hispanic youths. This type of research should include provisions to overcome language barriers effectively so that these measures become effective tools to facilitate the increased knowledge among health care providers regarding culture-specific practices that may have an impact on their ability to recognize the symptoms of ADHD in Hispanic youths effectively. REFERENCES Achenbach, T. M. (1991). Manual for the Child Behavior Checklist and revised 1991 Child Behavior Profile. Burlington: Department of Psychiatry, University of Vermont. Achenbach, T. M., & Edelbrock, C. (1987). Manual for the Child Behavior Checklist and Profile. Burlington: Department of Psychiatry, University of Vermont. Achenbach, T., & Rescorla, L. (2001). Manual for the ASEBA School-Age Forms and Profiles. Burlington: Research Center for Children, Youth, and Families, University of Vermont. assessment of hispanic youth with adhd     

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American Psychiatric Association. (1994). Diagnostic and statistical manual of mental disorders (4th ed.). Washington, DC: Author. American Psychiatric Association. (2000). Diagnostic and statistical manual of mental disorders (4th ed., text rev.). Washington, DC: Author. American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Washington, DC: Author. Bauermeister, J. (1994). Development and use of the Bauermeister School Behavior Inventory (BSBI) in assessing Latino children. San Juan, Puerto Rico: Author. Bauermeister, J.  J., Bird, H.  R., Shrout, P.  E., Chávez, L., Ramírez, R., & Canino, G. (2011). Short-term persistence of DSM–IV ADHD diagnoses: Influence of context, age, and gender. Journal of the American Academy of Child & Adolescent Psychiatry, 50, 554–562. http://dx.doi.org/10.1016/j.jaac.2011. 03.017 Bauermeister, J., Matos, M., & Barkley, R. (1999, August). Attention deficit disorder with and without hyperactivity in Hispanic children. Paper presented at the meeting of the American Psychological Association Convention, Boston, MA. Bauermeister, J. J., Matos, M., Reina, G., Salas, C. C., Martínez, J. V., Cumba, E., & Barkley, R. A. (2005). Comparison of the DSM–IV combined and inattentive types of ADHD in a school-based sample of Latino/Hispanic children. Journal of Child Psychology and Psychiatry, 46, 166–179. http://dx.doi.org/10.1111/ j.1469-7610.2004.00343.x Bauermeister, J. J., Shrout, P. E., Chávez, L., Rubio-Stipec, M., Ramírez, R., Padilla, L., . . . Canino, G. (2007). ADHD and gender: Are risks and sequela of ADHD the same for boys and girls? Journal of Child Psychology and Psychiatry, 48, 831–839. http://dx.doi.org/10.1111/j.1469-7610.2007.01750.x Bauermeister, J. J., Shrout, P. E., Ramírez, R., Bravo, M., Alegría, M., Martínez, A., . . . Canino, G. (2007). ADHD correlates, comorbidity, and impairment in community and treated samples of children and adolescents. Journal of Abnormal Child Psychology, 35, 883–898. http://dx.doi.org/10.1007/s10802-007-9141-4 Bernal, G., Rosselló, J., & Martínez, A. (1997). The Child Depression Inventory: Psychometric properties using two Latino samples. Revista Psicológica Contemporánea, 4, 12–23. Biederman, J., Petty, C. R., O’Connor, K. B., Hyder, L. L., & Faraone, S. V. (2012). Predictors of persistence in girls with attention deficit hyperactivity disorder: Results from an 11-year controlled follow-up study. Acta Psychiatrica Scandinavica, 125, 147–156. http://dx.doi.org/10.1111/j.1600-0447.2011.01797.x Bravo, M., Ribera, J., Rubio-Stipec, M., Canino, G., Shrout, P., Ramírez, R., . . . Bauermeister, J. J. (2001). Test–retest reliability of the Spanish version of the Diagnostic Interview Schedule for Children (DISC–IV). Journal of Abnormal Child Psychology, 29, 433–444. http://dx.doi.org/10.1023/A:1010499520090

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Brestan, E. V., & Eyberg, S. M. (1998). Effective psychosocial treatments of conduct-disordered children and adolescents: 29 years, 82 studies, and 5,272 kids. Journal of Clinical Child Psychology, 27, 180–189. http://dx.doi.org/10.1207/ s15374424jccp2702_5 Cabiya, J. J., Canino, G., Chavez, L., Ramirez, R., Alegría, M., Shrout, P., . . . Maritínez-Taboas, A. (2006). Gender disparities in mental health service use of Puerto Rican children and adolescents. Journal of Child Psychology and Psychiatry, 47, 840–848. http://dx.doi.org/10.1111/j.1469-7610.2006.01623.x Cabiya, J., Padilla, L., Martínez-Taboas, A., & Sayers, S. (2008). Effectiveness of a cognitive–behavioral intervention for Puerto Rican Children. Interamerican Journal of Psychology, 42, 195–202. Cabiya, J., Padilla, L., & Sayers, S. (2010). Cognitive–behavioral intervention manual. Unpublished manuscript. Cabiya-Morales, J. J., Padilla, L., Sayers-Montalvo, S., Pedrosa, O., Perez-Pedrogo, C., & Manzano-Mojica, J. (2007). Relationship between aggressive behavior, depressed mood, and other disruptive behavior in Puerto Rican children diagnosed with attention deficit and disruptive behavior disorder. Puerto Rico Health Sciences Journal, 26, 43–49. Canino, G., Shrout, P. E., Rubio-Stipec, M., Bird, H. R., Bravo, M., Ramirez, R., . . . Martínez-Taboas, A. (2004). The DSM–IV rates of child and adolescent dis­ orders in Puerto Rico. Archives of General Psychiatry, 61, 85–93. Centers for Disease Control and Prevention. (2010). Increasing prevalence of parentreported attention-deficit/hyperactivity disorder among children—United States, 2003 and 2007. Retrieved from http://www.cdc.gov/mmwr/preview/mmwrhtml/ mm5944a3.htm?s_cid=mm5944a3_w Cohen, J. (1988). Statistical power analysis for the behavioral sciences (2nd ed.). Hillsdale, NJ: Erlbaum. Duarte, C., Bird, H., Shrout, P., Ping, W., Lewis-Fernandez, R., Sa, S., & Canino, G. (2008). Culture and psychiatric symptoms in Puerto Rican children: Longitudinal results from one ethnic group in two contexts. Journal of Child Psychology and Psychiatry, 49, 563–572. http://dx.doi.org/10.1111/j.1469-7610. 2007.01863.x Fite, P. J., Colder, C. R., Lochman, J. E., & Wells, K. C. (2008). Developmental trajectories of proactive and reactive aggression from fifth to ninth grade. Journal of Clinical Child & Adolescent Psychology, 37, 412–421. http://dx.doi. org/10.1080/15374410801955920 García-Coll, C., Patton, F., Marks, A. K., Dimitrova, R., Yang, R., Suarez, G. A., & Patrico, A. (2012). Understanding the immigrant paradox in youth: Developmental and contextual considerations. In A. S. Masten, K. Liebkind, & D. J. Hernandez (Eds.), Realizing the potential of immigrant youth (pp. 159–180). New York, NY: Cambridge University Press.

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Gonzalez-Cruz, K. M., Cabiya, J., Padilla, L., & Sánchez, J. (in press). Comparison between teacher, children, and parents reports of behavioral symptoms associated with disruptive behaviors. Science and Behavior. Haack, L. M., & Gerdes, A. C. (2011). Functional impairment in Latino children with ADHD: Implications for culturally appropriate conceptualizations and measurement. Clinical Child and Family Psychology Review, 14, 318–328. http:// dx.doi.org/10.1007/s10567-011-0098-z Ivanova, M., Achenbach, T., Rescorla, L. A., Dumenci, L., Almqvist, F., Bilenberg, N., & Bird, H. (2007). The generalizability of the Youth Self-Report syndrome structure in 23 societies. Journal of Consulting and Clinical Psychology, 75, 729–738. http:// dx.doi.org/10.1037/0022-006X.75.5.729 Kazdin, A. E. (2003). Problem-solving skills training and parent management training for conduct disorder. In A. E. Kazdin & J. R. Weisz (Eds.), Evidence-based psychotherapies for children and adolescents (pp. 241–262). New York, NY: Guilford Press. Kovacs, M. (1985). The Children’s Depression Inventory (CDI). Psychopharmacology Bulletin, 21, 995–998. Lochman, J., Powell, N. P., Boxmeyer, C. L., & Jimenez-Camargo, L. (2011). Cognitive– behavioral therapy for externalizing disorders in children and adolescents. Child and Adolescent Psychiatric Clinics of North America, 20, 305–318. http://dx.doi. org/10.1016/j.chc.2011.01.005 Lochman, J. E., & Wells, K. C. (2003). Effectiveness of the Coping Power Program and of classroom intervention with aggressive children: Outcomes at a 1-year follow-up. Behavior Therapy, 34, 493–515. http://dx.doi.org/10.1016/ S0005-7894(03)80032-1 Lochman, J. E., & Wells, K. C. (2004). The Coping Power Program for preadolescent aggressive boys and their parents: Outcome effects at the 1-year follow-up. Journal of Consulting and Clinical Psychology, 72, 571–578. Pew Hispanic Center. (2011, September 28). Childhood poverty among Hispanics sets record, leads nation. Retrieved from http://www.pewhispanic.org/2011/09/28/ childhood-poverty-among-hispanics-sets-record-leads-nation/ Powell, N. R., Lochman, J. E., & Boxmeyer, C. L. (2007). The prevention of conduct problems. International Review of Psychiatry, 19, 597–605. http://dx.doi. org/10.1080/09540260701797738 Rescorla, L. A., Achenbach, T., Ivanova, M., Dumenci, L., Almqvist, F., Bilenberg, N., & Bird, H. (2007). Behavioral and emotional problems reported by parents and children ages 6 to 16 in 31 societies. Journal of Emotional and Behavioral Disorders, 15, 130–142. http://dx.doi.org/10.1177/10634266070150030101 Rothe, E. (2005). Considering cultural diversity in the management of ADHD in Hispanic patients. Supplement to the Journal of the National Medical Association, 97, 17–22.

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Shaffer, D., Fisher, P., Lucas, C., Dulcan, M., & Schwab-Stone, M. E. (2000). NIMH Diagnostic Interview Schedule for Children Version IV: Description, differences from previous versions, and reliability of some common diagnoses. Journal of the American Academy of Child Adolescent Psychiatry, 39, 28–38. http://dx.doi. org/10.1097/00004583-200001000-00014 Siddle, R., Jones, F., & Awenat, F. (2003). Group cognitive behavior therapy for anger: A pilot study. Behavioral and Cognitive Psychotherapy, 31, 69–83. http:// dx.doi.org/10.1017/S1352465803001073 Watt, T. T., & Martinez-Ramos, G. (2009). The developmental health of Hispanic children: Evidence from the 2003 National Survey of Children’s Health. Sociological Focus, 42, 87–106. http://dx.doi.org/10.1080/00380237.2009.10571345

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9 THE CLINICAL INTERVIEW WITH LATINA/O CLIENTS MIGUEL E. GALLARDO AND DOUGLAS I. GOMEZ

The clinical interview is one of the most important processes in psychotherapy (Aklin & Turner, 2006) and assessment. The reason for this is simple: Without viable information about a client, it is impossible to understand reliably and validly the presenting symptomatology and directions for future treatment. Clinicians are taught many different ways to perform a clinical interview, but ultimately, the goal of the various methodologies is the acquisition of information to better understand the client within cultural and contextual frameworks. On its own, the clinical interview seems simple enough, but on closer examination, there are a multitude of factors that must be taken into consideration, ultimately leading to a more complex and delicate initial task. Central to this task when working with all clients, but with Latina/o clients in particular, is culture. Without a cultural and contextual framework at the outset, presenting problems, medical and legal histories, educational history, family history, and myriad other issues may lead http://dx.doi.org/10.1037/14668-010 Psychological Testing of Hispanics, Second Edition: Clinical, Cultural, and Intellectual Issues, K. F. Geisinger (Editor) Copyright © 2015 by the American Psychological Association. All rights reserved.

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well-intentioned clinicians to unintentionally misdiagnose, misunderstand, and develop inconsistent treatment options that are culturally incongruent with their clients. Arnault and Shimabukuro (2012) stated, “Research and clinical practice with diverse populations has been challenged by the need to measure phenomena precisely and uniformly despite recognition that existing tools are generally not culturally relevant” (p. 303). The clinical interview with Latinas/os is of the utmost importance when selecting appropriate measures to use when assessing neurobehavioral, emotional, and psychosocial functioning of clients, but also in the “simple” task of gathering the initial clinical information needed. THE VALUE OF CULTURAL CONTEXT Historically, from a more traditional psychological lens, the clinical intake process has been seen from a specific culture-bound perspective, which may not be consistent with the value systems of diverse ethnocultural communities (Hill, 2003). More recently, there has been a trend toward identifying how to conduct the interview process from a less biased and more inclusive perspective when working with ethnocultural communities. Dadlani, Overtree, and Perry-Jenkins (2012) posited four cultural principles that would help a mental health service provider improve in his or her cultural assessments: (a) all patients have social identities and are affected by cultural contexts, (b) multiple social identities are experienced simultaneously, (c) all clinicians have privileged and marginalized social identities that influence diagnosis and treatment, and (d) the therapeutic relationship is a cultural context that is informed by the social identities of both patient and clinician. These principles allow clinicians performing clinical interviews and other intake procedures to develop a framework for identifying potential biases that can occur if cultural issues are not addressed and a way of protecting against those biases. Their framework should not been seen as a structured set of guidelines but more as a paradigm shift for clinicians to help foster the development of a culturally oriented mind-set. Behavioral rules and skill sets without a culturally oriented mind-set behind them can lead to unintentional violations of ethnocultural clients (Gallardo, 2013). Therefore, the emphasis for this chapter is more on helping clinicians understand the complexities of culture and context, rather than on providing any set of structured guidelines when working with Latina/o clients. Developing a cultural mind-set can present more challenging and complex issues in learning specific behavioral rules and techniques, yet prove more valuable for clinicians. Previous trends in psychotherapy research have focused on validating efficacy studies to create specific evidence-based 172       gallardo and gomez

psychotherapies, which are often laden with behavioral and structured guidelines. Sue (2003) stated, “Although efficacy research is important, emphasis on this approach can hinder the inclusion of and appreciation for other forms of evidence that can provide significant knowledge” (p. 968). Norcross (2001) also stated that although there is value in ensuring some accountability for mental health providers through validating psychotherapeutic treatments with efficacy studies, there are still important aspects to the therapeutic encounter that are missing in these studies. Some of those missing pieces include the nondiagnostic characteristics of an individual seeking treatment (Norcross & Lambert, 2011), which include context and culture. Moreover, researchers are finding that psychological interventions are more effective when they are consistent with clients’ characteristics and needs (Barlow, 2004). Therefore, for the purposes of this chapter, we use the American Psychological Association’s (APA) definition for evidence-based practices in psychology: “The integration of the best available research with clinical expertise in the context of patient characteristics, culture, and preferences” (APA Presidential Task Force on Evidence-Based Practice, 2006, p. 273). We believe this framework allows for the inclusion of culture and context beyond the more narrowly defined forms of “evidence.” Although we are not arguing for the exclusion of empirically supported research evidence, we are arguing for broadening the paradigm by which services are rendered. CULTURAL RESPONSIVENESS Culturally responsive behaviors start in the clinical interview (Fontes, 2009; J. M. Jones, Sander, & Booker, 2013). To be culturally responsive, a term often used interchangeably with cultural competence, implies that when providing services to diverse ethnocultural communities, one must have a set of values and principles that allow for continued growth. Cultural competence implies that a mental health provider has reached a level at which he or she is proficient when providing services to diverse ethnocultural communities. We argue that cultural responsiveness, like culture, is not fixed and that as people and context change, so do culture and being culturally responsive. Cultural responsiveness is a lifelong process and one that is never fully reached (Gallardo, Johnson, Parham, & Carter, 2009). The National Center for Cultural Competence (2004) described cultural responsiveness as enabling individuals, as well as organizations to “have the capacity to value diversity, conduct self-assessment, manage dynamics of difference, institutionalize cultural knowledge, and adapt to diversity and cultural contexts of the communities they serve” (p. vii). the clinical interview with latina/o clients     

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DEFINING CULTURE “Conducting a clinical interview that keeps cultural content as a focus of treatment enhances the likelihood that culturally relevant care is the foundation of the counseling relationship” (J. M. Jones et al., 2013, p. 17). This statement may be misinterpreted if one’s understanding of culture is limited to the idea that culture only encompasses race and ethnicity, a notion that several scholars have argued against (Cohen, 2009; Lakes, López, & Garro, 2006; Warrier, 2008). Hays (2008) also defined culture through her ADDRESSING model, which is an inclusive definition and not limited to race and ethnicity. La Roche (2013) described the evolution of developing culturally responsive interventions from three perspectives: (a) universalist, (b) racial and ethnic, and (c) cultural psychotherapy. La Roche described universalist psychotherapy as viewing all individuals as sharing similar characteristics, while rendering cultural factors as secondary and nonessential in the development of techniques to address specific presenting concerns. According to La Roche, racial and ethnic models describe our attempt to incorporate “culture” in the development of interventions that are culturally congruent with the client and context. Ultimately, these models fall short in that the research and treatment methods that include the effects of race and ethnicity in their formulation are limited, often only including minor, superficial modifications to the intervention (i.e., matching clients with therapists who have a similar ethnic background or language preference; Huey & Polo, 2008). Finally, La Roche proposed a cultural psychotherapy framework that emphasizes the need to measure cultural variables (i.e., levels of acculturation, perceived discrimination, ethnic identity, gender roles, etc.) without assuming that all individuals from the same ethnic and racial group are the same. “Cultural Psychotherapy considers not only the influence of race and ethnicity, but also of multiple cultural (e.g., gender orientation, ethnic identity, acculturation), relational, and contextual variables that could affect psychotherapeutic outcomes” (La Roche, 2013, p. 107). Nowhere is defining culture more important than when addressing the needs of Latina/o communities, whose heterogeneous groups range in terms of ethnicity, physical appearance, cultural practices, traditions, and Spanishlanguage dialects (Comas-Díaz, 2001). Therefore, a culturally responsive clinician must assess the multiple social identities described previously when working with Latina/o clients. Cultural and contextual factors are not static and should be viewed as changing as people change and as their environments change, both of which directly affect the relationships between clinician and client. A clinician’s level of cultural responsiveness has a direct impact on how cultural factors are addressed clinically (La Roche, 2013). Implementation of the various aspects of clinical interviewing described in 174       gallardo and gomez

this chapter ultimately depends on a thorough assessment of what aspects of a Latina/o client’s social identities are the most salient. Several scholars have pointed out salient variables to assess when conducting the initial interview with Latina/o clients, including, but not limited to, ethnic matching, immigration history, nonverbal behaviors, acculturation and acculturative stress, perceptions of mental health services, type of indigenous support systems, culturally mediated help-seeking behaviors, and language preference and ability (Acevedo-Polakovich et al., 2007; Altarriba & Santiago-Rivera, 1994; Paniagua, 2005; Rosado & Elias, 1993; Valdez, 2000). We highlight a few that we believe are more salient, but we encourage readers to examine the other social identities that influence the worldviews of Latina/o clients. ETHNIC MATCHING AND OTHER SOCIAL IDENTITIES Ethnic matching remains one of the more salient factors to be considered in building the relationship when conducting the initial interview with Latina/o clients. Current research has emphasized the importance of ethnic matching, especially early in the provider–client relationship (Abreu & Gabarain, 2000; Cabral & Smith, 2011; Santiago-Rivera, Arredondo, & Gallardo-Cooper, 2002), while simultaneously describing limits to ethnic matching. Abreu and Gabarain (2000) demonstrated that ethnically similar counselors were preferred by their clients; however, they found that when the variance attributed to social desirability was accounted for in their research, only those individuals with low levels of acculturation were found to prefer ethnically similar counselors. Those with medium and high levels of acculturation were not found to have a preference related to the ethnicity of a counselor. Similarly, Cabral and Smith (2011) found a preference for ethnic matching with clients; however, their meta-analytic review of ethnicmatching research found that there were almost no significant benefits to the treatment outcome between ethnically matched therapists and clients. Santiago-Rivera et al. (2002) also found that ethnic matching is in many cases a preference, emphasizing the diverse skills that are more important for a therapist to possess and use when working with Latina/o communities. Some research has demonstrated that a clinician’s worldview is a more important factor than ethnic matching alone (Ancis, 2004; Knipscheer & Kleber, 2004; Smith, Richards, Granley, & Obiakor, 2004). Rosen, Miller, Nakash, Halperin, and Alegría (2012) hypothesized that the greatest indicator of complementarity (a dyad’s interactional harmony) was ethnic matching; however, they found that interpersonal and relational variables were actually the best indicators of complementarity. They further posited, “Relational variables offer the opportunity for providers and clients to work the clinical interview with latina/o clients     

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effectively across social identities” (p. 193). Although there is a significant amount of research that explains the importance of ethnic matching, and we do not want to underestimate the importance of this for some Latina/o clients, there are also advocates for matching cultural characteristic of clients, beyond only race and ethnicity, with psychological interventions (La Roche, 2013). THE THERAPEUTIC RELATIONSHIP AND PERSONALISMO Research has demonstrated the importance of the therapist–client relationship in psychotherapy (Gallardo, 2013; Lambert & Barley, 2001; Norcross, 2001; Norcross & Lambert, 2011; Townsend & McWhirter, 2005; Wampold, 2001). Norcross (2001) contended that it was more important to understand the therapeutic relationship than specific techniques used in psychotherapy and assessment processes. Santiago-Rivera et al. (2002) defined personalismo as “an orientation where the person is always more important than the task at hand, including the time factor” (p. 112). Paniagua (2005) emphasized the importance of personalismo to Latina/o clients and how necessary it is to assessment and treatment when the goal is therapeutic effectiveness. Research has demonstrated that the therapeutic relationship and the Latina/o value of personalismo are important in every aspect of treatment, including the clinical interview. Gallardo (2013) found that Latina/o therapists reported personalismo as one of the most important factors in developing the initial relationship with their Latina/o clients. RESPETO, CONFIANZA, AND SELF-DISCLOSURE Other values to keep in mind when conducting the initial clinical interview include the values of respeto (Andrés-Hyman, Ortiz, Añez, Paris, & Davidson, 2006; Comas-Díaz, 2006; Gallardo, 2013), confianza (Añez, Silva, Paris, & Bedregal, 2008; Bracero, 1998), and self-disclosure (Gallardo, 2013). Gallardo (2013) examined the salient themes from 27 bilingual, bicultural Latina/o therapists who self-rated high on a cultural competence measure, and found that when initially building the therapeutic relationship, demonstrating a sense of respect was critical to establishing the relationship and gathering information. Confianza is defined as, “a special form of intimacy, based on careful management of trust and confidence” (Bracero, 1998, p. 271). Añez et al. (2008) mentioned that it is important to not only notice when those values affect the process of therapy but also to directly assess for those values, going so far as to ask questions such as, “What does it take for you to develop confianza with someone?” or “I understand that 176       gallardo and gomez

confianza can be very important to some Latinos. How important is confianza to you?” (p. 157). Culturally oriented questions allow clinicians to assess the importance of these values to an individual, rather than assume all Latino/a clients hold each value as having the same level of importance. Manoleas, Organista, Negron-Velasquez, and McCormick (2000) surveyed 65 Latina/o mental health providers who were primarily serving Latina/o clients and reported that these clinicians were more likely to self-disclose to their Latina/o clients than to non-Latina/o clients. Gallardo (2013) noted that the Latina/o clinicians in his study also reported using self-disclosure as a way to engage and build respectful relationships with their Latina/o clients. LATINA/O-SPECIFIC CLINICAL INTERVIEWING We believe it is important to distinguish differences between “traditional interviewing” techniques, which focus primarily on obtaining background history about the client, and the “clinical interview,” which emphasizes the identification of diagnostic signs and symptoms that assist in diagnosing (K. D. Jones, 2010). K. D. Jones (2010) delineated differences between unstructured, structured, and semistructured interviews. Unstructured interviews consist of questions the clinician asks the client, with client responses and clinician observations documented by the clinician. In unstructured interviews there are no standardized ways of gathering information, leaving the clinician fully responsible for guiding the information-gathering process, the questions asked, and how the information will be used to aid in overall assessment and treatment planning. Structured interviews include interview procedures that contain a standardized list of questions, standardized sequence of questioning, and the systematic rating of client responses. Semistructured interviews are less standardized than structured interviews and provide some flexibility for clinicians. For the purposes of this chapter, the clinical interview with Latina/o clients implies the process by which clinicians respectfully gather information from their Latina/o clients regardless of format (e.g., unstructured, semistructured) or purpose (e.g., gathering background data only or for clinical diagnosing). Regardless of the format a clinician uses to gather information, the literature addressing culturally responsive work has emphasized the importance of developing respectful therapeutic relationships with Latina/o clients (Gallardo, 2011, 2013). Therefore, it is critical to delineate differences between the “therapeutic relationship” and the “therapeutic alliance.” Some scholars believe that the therapeutic alliance is one aspect of the overarching therapeutic relationship (Meissner, 2006; Saunders, 2000). More specifically, Meissner (2006) stated that the therapeutic relationship is actually made up the clinical interview with latina/o clients     

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of three intermixing parts, which include the therapeutic alliance, transference, and the real relationship. Meissner (1996) defined the real relationship as the interpersonal relationship between clinician and client, which is distinct from the therapeutic alliance. Saunders (2000) stated that the therapeutic relationship is made up of only transference and alliance aspects. A prevailing notion throughout the research is that the therapeutic relationship is the broader and more inclusive term. Norcross and Lambert’s (2011) preferred definition for the therapeutic relationship is “the feelings and attitudes that therapist and client have toward one another, and the manner in which these are expressed” (p. 5). For the purposes of this chapter, this definition is used to describe the importance of establishing respectful therapeutic relationships with Latina/o clients. We believe this definition captures the importance of developing a “real relationship” as a key component in the clinical interviewing process with Latina/o clients. CLINICAL INTERVIEWING MODELS Gallardo, Yeh, Trimble, and Parham (2012) made it clear that it is important to examine unexpressed emotions, body language, and other nonverbal cues in the initial information-gathering sessions with ethnocultural communities. Weiss and Rosenfeld (2012) also made the case that during the clinical interview, a therapist has to pay attention to body language, eye contact, and any other cultural nonverbal cues that may be appropriate. There are several frameworks that clinicians can use to conduct the initial clinical interview, including the Clinical Ethnographic Interview (CEI; Arnault & Shimabukuro, 2012), Manoleas and Garcia’s (2003) engagement algorithm and assessment algorithm, and the Latino skills identification stage model (Gallardo, 2011). Each is briefly described next. Clinical Ethnographic Interview Arnault and Shimabukuro (2012) stated, “Cross-cultural assessments must therefore assess symptoms using the most open-ended methods possible, and allow their patients to group those symptoms in patterns that are meaningful for their cultural reference group” (p. 305). Cultural explanatory models (CEMs), a term used by medical anthropologist Arthur Kleinman (Kleinman, Eisenberg, & Good, 1978), are culturally embedded belief systems that individuals hold. CEMs are vague, dynamic, have emotional meaning, and are embedded in a person’s sociocultural context (i.e., cultural beliefs, socioeconomic factors, and community social networks; Rajaram & Rashidi, 1998). CEMs define how individuals conceptualize an illness, its causes, signs 178       gallardo and gomez

and symptoms, modes of prevention and diagnosis, treatment, prognosis, and roles and expectations of the client. Arnault and Shimabukuro described cultural models in their CEI framework as the lens by which people understand “what to attend to, what to ignore, what things mean and what should be done about them” (p. 305). This is particularly relevant when working with Latina/o clients. Understanding how a Latina/o client understands his or her presenting symptoms or concerns is an essential starting place in understanding how one’s body, emotions, and social contexts may be perceived and, therefore, how one’s mental and physical health are maintained or distress experienced. CEMs influence perceptions and interpretations of illness and are situated within the social and cultural contexts in which they occur. More specifically, individuals may understand their illness through labels and terms defined by their social and cultural contexts and define “normal” versus “abnormal” on the basis of the social networks in which they are embedded. Critical in conducting the initial clinical interview with Latina/o clients is using a referent group that is culturally specific to the Latina/o individual. A comparison with a referent group outside of one’s social and cultural networks potentially yields a misdiagnosis, misunderstandings, and impasses in the assessment process with Latina/o clients. Ultimately, cultural models affect the choices individuals make about how to best alleviate their concerns. We believe the CEI framework is useful in that it allows the clinician to assess and gather information beyond verbal expressions. Relying only on the expression of symptoms and concerns through verbal communication can limit many Latina/o clients in fully expressing their lived experiences, thereby providing insufficient data to clinicians. In fact, the Csordas, Dole, Tran, Strickland, and Storck (2010) research study supported the notion that how clinicians solicit information directly affects what information is received and the overall course of treatment. Csordas et al. examined differences between a semistructured ethnographic interview (EI) and the Structured Clinical Interview for the Diagnostic and Statistical Manual of Mental Disorders (SCID) with participants in the Navajo Healing Project. These researchers found that the EI’s strength was in allowing participants to narrate their experiences of illness, focusing more on the person than the disease, whereas the SCID’s focus on illness and symptoms was viewed, in some cases, as equally beneficial to participants by stimulating more critical thinking about their situations. Csordas et al.’s research demonstrated the importance of implementing and expanding the manner in which information is gathered from clients. The interview framework and questions of the CEI focuses on five different tenets, emphasizing the social implications of patients’ sensations and experiences. Arnault and Shimabukuro (2012) stated, “The interview style used in most mental health clinical encounters in the United States, which is the clinical interview with latina/o clients     

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based on cultural values of explicit verbal expression, abstract concepts, and logical explanation is not typical for many cultural groups” (p. 310). We agree and endorse the utility of implementing the various tenets of the CEI with Latina/o clients when there is a cognitive, cultural, and social match. Arnault and Shimabukuro implemented their CEI with distressed Japanese women and found it to be an effective tool in assessing and gathering information. The first tenet in the CEI asks clients to provide the clinician with the “grand tour” of the client’s social networks. The researchers found that beginning with the social network provided opportunities for clinicians to mobilize social support for these women, which we also believe can be an essential first step when working with Latina/o clients. The “body map” is the next step in the CEI, which includes shifting perspective to more recent sources of stress for clients. Rather than ask a set of questions during this phase of the interview process, the CEI uses a body map as an open-ended technique to allow the individual to express their experiences and how they feel through a visual representation without the stress of having to verbally express these experiences. Often, the emotional stress of Latina/o clients can be manifested physically through headaches, gastrointestinal concerns, and numbness in body parts. The use of the CEI body map in these cases can be instrumental in permitting clients to begin to express their experiences and feeling visually. The “lifeline” follows the body map and is a graphic representation of the client’s life that serves as a holistic representation of experiences, both past and present, while assisting clients to make connections between past experiences and current behaviors. Arnault and Shimabukuro provided the Japanese participants in their study with a line across a blank sheet of paper and asked them to indicate major life events along the line, with another line representing the ups and downs or highs and lows of their lives along the same lifeline. The social network and the lifeline drawings can be referred to throughout the interview to investigate the meaning behind the various events in the client’s life and help-seeking behaviors. The final component of the CEI asks clients to discuss the resources or behaviors they implemented to relieve their distress or get better during the low points highlighted in their lifeline. Arnault and Shimabukuro (2012) demonstrated the importance of gathering information that does not rely solely on verbal self-expression, and they created visual representations of clients’ experiences that can be used throughout the interview to help the clinician and client track information. We believe that the use of visual representations can be a critical alternative for many Latina/o clients who express themselves in ways that are context-specific, do not use linear chronology, or do not use a specific language to describe more abstract concepts and experiences. Arnault and Shimabukuro found that using the CEI with the Japanese women relieved the pressure to make sense of their experiences 180       gallardo and gomez

or to communicate information that matched the clinician’s communication style, which may have been in direct conflict with the clients. Engagement Algorithm and Assessment Algorithm Manoleas and Garcia’s (2003) engagement algorithm and assessment algorithm are another set of useful templates for initially developing respectful relationships and for conducting the clinical interview with Latina/o clients. The six tenets of their engagement algorithm include: (a) assessing the clinician’s readiness and ability to develop a positive therapeutic relationship, (b) assessing the client’s level of comfort or discomfort in the therapy process, (c) assessing the degree of acculturation, (d) assessing the client’s needs and the ability of the therapist to meet those needs, (e) assessing the ability of the therapist to address issues of gender or sexual orientation, and (f) assessing the degree to which there are shared cultural metaphors for communicating. The engagement algorithm links the interviewing and connecting process with the clinician’s own social identities and any assumptions and biases that may be attached to these identities. For example, Manoleas and Garcia (2003) discussed the importance of clinicians being prepared to potentially address differences in social identities between clinician and client, which can include race, ethnicity, gender, class, and so forth. They also addressed in the engagement algorithm the importance of assessing for acculturation, which as we stated previously, can affect therapy outcomes and cultural and social match between clinician and client. The assessment algorithm contextually situates Latina/o clients’ behaviors within the social networks in which they are embedded. Manoleas and Garcia (2003) stated that asking questions about the environmental context is critical to understanding what “normal” and “abnormal” look like within a culturally and contextually relevant referent group for the client. Anything out of context looks wrong. The assessment algorithm also uses a more standard intake and assessment procedures, and we encourage clinicians to implement, with flexibility, some of the other procedures outlined in this chapter when working with Latinas/os. Latina/o Skills Identification Stage Model The Latina/o Skills Identification Stage Model (L–SISM; Gallardo, 2011) is another tool that helps shape clinicians’ responsiveness to core issues that facilitate work with Latina/o clients. The model is not exhaustive, but provides a framework for clinicians, with six specific tenets: (a) connecting with clients, (b) providing assessment, (c) facilitating awareness, (d) setting goals, the clinical interview with latina/o clients     

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(e) instigating change, and (f) providing feedback and accountability. The first two tenets will be highlighted here for the purposes of extending the clinical-interviewing and relationship-building process with Latinas/os. In the L–SISM, “connecting with clients” encourages clinicians to allow the initial interviewing process to be informal and personal, using small talk when needed to implement the concept of personalismo as a priority over any other task at hand. Gallardo (2011) encouraged clinicians to allow some flexibility in the therapeutic hour or process, if needed, when conducting the initial clinical interview. There are occasions when conducting the initial interview can extend beyond a “traditional” therapeutic hour, and it will be important for clinicians to allow for the expansion of time and context when needed. Last, the L–SISM encourages clinicians to self-disclose with clients, when therapeutically appropriate, as a therapeutic intervention and as a way to build respectful relationships. The blank slate does not exist, and the helping relationship is value-laden. Clinicians should assess how comfortable they are self-disclosing and what information they wish to share, to what extent, and in what ways. The use of selfdisclosure can be a powerful tool by which to build a respectful relationship with a Latina/o client. The assessment tenet of the L–SISM encourages clinicians to assess generation status, ethnic identification, education history, and acculturation history; information from these areas will help guide how the interviewing and treatment planning process will unfold. It is important to conduct a trauma assessment, identifying what, if any, traumas exist, either present or past. Language usage should be assessed, both as a way to match the linguistic needs of the client and also to adapt language to meet clients’ educational and acculturation levels. Finally, the L–SISM helps clinicians to understand the influence of family and community relationships by assessing connectedness to social networks, a client’s beliefs about health care (i.e., cultural explanatory model), and by using a culturally relevant referent group by which to define consistent or inconsistent behaviors. CONCLUSION Our intent in this chapter was to provide some relevant “evidence” for clinicians to use when conducting the initial clinical interview with Latina/o clients. We have highlighted the importance of recognizing that the term Latina/o can hold multiple meanings for different individuals and communities, rendering the concept of culture inadequate if used synonymously with race and ethnicity only. The multiple social identities of Latina/o clients must be considered as a first step in gathering information. 182       gallardo and gomez

Applying a universal definition of Latina/o across a multitude of individuals is a disservice and injustice to the client and his or her family and community. As a result of the multitude of social, contextual, and cultural factors that all influence the manner in which individuals see their lives, their presenting concerns, and solutions to these concerns, providing a static or structured set of behavioral skills when conducting the initial clinical interview is a misleading and professionally inadequate solution to meeting the needs of Latina/o communities. We have attempted to provide readers with some overarching conceptual and fundamental tenets that will hopefully guide the clinical interviewing process without limiting a clinician’s capacity to implement reflexivity and flexibility in the process of gathering initial information with Latina/o communities. It is our hope that the conceptual and theoretical frameworks outlined in this chapter provide critical areas of consideration when working culturally and contextually with Latina/o clients and communities. REFERENCES Abreu, J. M., & Gabarain, G. (2000). Social desirability and Mexican American counselor preferences: Statistical control for a potential confound. Journal of Counseling Psychology, 47, 165–176. http://dx.doi.org/10.1037/0022-0167.47.2.165 Acevedo-Polakovich, I., Reynaga-Abiko, G., Garriott, P. O., Derefinko, K. J., Wimsatt, M. K., Gudonis, L. C., & Brown, T. L. (2007). Beyond instrument selection: Cultural considerations in the psychological assessment of U.S. Latinas/os. Professional Psychology: Research and Practice, 38, 375–384. http://dx.doi. org/10.1037/0735-7028.38.4.375 Aklin, W. M., & Turner, S. M. (2006). Toward understanding ethnic and cultural factors in the interviewing process. Psychotherapy: Theory, Research, Practice, Training, 43, 50–64. http://dx.doi.org/10.1037/0033-3204.43.1.50 Altarriba, J., & Santiago-Rivera, A. L. (1994). Current perspectives on using linguistic and cultural factors in counseling the Hispanic client. Professional Psychology: Research and Practice, 25, 388–397. http://dx.doi.org/10.1037/07357028.25.4.388 Ancis, J. R. (2004). Culturally responsive interventions: Innovative approaches to working with diverse populations. New York, NY: Brunner-Routledge. Andrés-Hyman, R. C., Ortiz, J., Añez, L. M., Paris, M., & Davidson, L. (2006). Culture and clinical practice: Recommendations for working with Puerto Ricans and other Latinas(os) in the United States. Professional Psychology: Research and Practice, 37, 694–701. http://dx.doi.org/10.1037/0735-7028.37.6.694 Añez, L. M., Silva, M. A., Paris, M., & Bedregal, L. E. (2008). Engaging Latinos through the integration of cultural values and motivational interviewing the clinical interview with latina/o clients     

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Gallardo, M. E., Johnson, J., Parham, T. A., & Carter, J. A. (2009). Ethics and multi­culturalism: Advancing cultural and clinical responsiveness. Professional Psychology: Research and Practice, 40, 425–435. http://dx.doi.org/10.1037/ a0016871 Gallardo, M. E., Yeh, C. J., Trimble, J. E., & Parham, T. A. (2012). Culturally adaptive counseling skills: Demonstrations of evidence-based practices. Thousand Oaks, CA: Sage. Hays, P. A. (2008). Addressing cultural complexities in practice: Assessment, diagnosis, and therapy (2nd ed.). Washington, DC: American Psychological Association. Hill, N. R. (2003). Promoting and celebrating multicultural competence in counselor trainees. Counselor Education and Supervision, 43, 39–51. http://dx.doi. org/10.1002/j.1556-6978.2003.tb01828.x Huey, S. J., Jr., & Polo, A. J. (2008). Evidence-based psychosocial treatments for ethnic minority youth. Journal of Clinical Child and Adolescent Psychology, 37, 262–301. http://dx.doi.org/10.1080/15374410701820174 Jones, J. M., Sander, J. B., & Booker, K. W. (2013). Multicultural competency building: Practical solutions for training and evaluating student progress. Training and Education in Professional Psychology, 7, 12–22. http://dx.doi.org/10.1037/ a0030880 Jones, K. D. (2010). The unstructured clinical interview. Journal of Counseling & Development, 88, 220–226. http://dx.doi.org/10.1002/j.1556-6678.2010. tb00013.x Kleinman, A., Eisenberg, L., & Good, B. (1978). Culture, illness, and care: Clinical lessons from anthropologic and cross-cultural research. Annals of Internal Medicine, 88, 251–258. http://dx.doi.org/10.7326/0003-4819-88-2-251 Knipscheer, J. W., & Kleber, R. J. (2004). A need for ethnic similarity in the therapist–patient interaction? Mediterranean migrants in Dutch mental-health care. Journal of Clinical Psychology, 60, 543–554. http://dx.doi.org/10.1002/jclp.20008 Lakes, K., López, S. R., & Garro, L. C. (2006). Cultural competence and psychotherapy: Applying anthropologically informed conceptions of culture. Psychotherapy: Theory, Research, Practice, Training, 43, 380–396. http://dx.doi.org/10.1037/00333204.43.4.380 Lambert, M. J., & Barley, D. E. (2001). Research summary on the therapeutic relationship and psychotherapy outcome. Psychotherapy: Theory, Research, Practice, Training, 38, 357–361. http://dx.doi.org/10.1037/0033-3204.38.4.357 La Roche, M. J. (2013). Cultural psychotherapy: Theories, methods, and practice. Thousand Oaks, CA: Sage. Manoleas, P., & Garcia, B. (2003). Clinical algorithms as a tool for psychotherapy with Latino clients. American Journal of Orthopsychiatry, 73, 154–166. http:// dx.doi.org/10.1037/0002-9432.73.2.154 Manoleas, P., Organista, K., Negron-Velasquez, G., & McCormick, K. (2000). Characteristics of Latino mental health clinicians: A preliminary examination. the clinical interview with latina/o clients     

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Community Mental Health Journal, 36, 383–394. http://dx.doi.org/10.1023/ A:1001908912288 Meissner, W. W. (1996). The therapeutic alliance and the real relationship in the analytic process. In L. E. Lifson (Ed.), Understanding therapeutic action: Psychodynamic concepts of cure (pp. 21–39). Hillsdale, NJ: Analytic Press. Meissner, W. W. (2006). The therapeutic alliance–a proteus in disguise. Psycho­ therapy: Theory, Research, Practice, Training, 43, 264–270. http://dx.doi.org/ 10.1037/0033-3204.43.3.264 National Center for Cultural Competence. (2004). Bridging the cultural divide in health care settings: The essential role of cultural broker programs. Washington, DC: Georgetown University Center for Child and Human Development. Norcross, J. C. (2001). Purposes, processes and products of the task force on empirically supported therapy relationships. Psychotherapy: Theory, Research, Practice, Training, 38, 345–356. http://dx.doi.org/10.1037/0033-3204.38.4.345 Norcross, J. C., & Lambert, M. J. (2011). Psychotherapy relationships that work II. Psychotherapy, 48, 4–8. http://dx.doi.org/10.1037/a0022180 Paniagua, F. A. (2005). Assessing and treating culturally diverse clients: A practical guide (3rd ed.). Thousand Oaks, CA: Sage. http://dx.doi.org/10.4135/9781483329093 Rajaram, S. S., & Rashidi, A. (1998). Minority women and breast cancer screening: The role of cultural explanatory models. Preventive Medicine, 27, 757–764. http://dx.doi.org/10.1006/pmed.1998.0355 Rosado, J. W., & Elias, M. J. (1993). Ecological and psychocultural mediators in the delivery of services for urban, culturally diverse Hispanic clients. Professional Psychology: Research and Practice, 24, 450–459. http://dx.doi.org/10.1037/07357028.24.4.450 Rosen, D. C., Miller, A. B., Nakash, O., Halperin, L., & Alegría, M. (2012). Interpersonal complementarity in the mental health intake: A mixed-methods study. Journal of Counseling Psychology, 59, 185–196. http://dx.doi.org/10.1037/ a0027045 Santiago-Rivera, A. L., Arredondo, P., & Gallardo-Cooper, M. (2002). Counseling Latinos and la familia: A practical guide. Thousand Oaks, CA: Sage. Saunders, S. M. (2000). Examing the relationship between the therapeutic bond and the phases of treatment outcome. Psychotherapy: Theory, Research, Practice, Training, 37, 206–218. http://dx.doi.org/10.1037/h0087827 Smith, T. B., Richards, P. S., Granley, H. M., & Obiakor, F. (2004). Practicing multi­culturalism: An introduction. In T. B. Smith (Ed.), Practicing multi­ culturalism: Affirming diversity in counseling psychology (pp. 3–16). Boston, MA: Pearson Education. Sue, S. (2003). In defense of cultural competency in psychotherapy and treatment. American Psychologist, 58, 964–970. http://dx.doi.org/10.1037/0003-066X.58.11.964 Townsend, K. C., & McWhirter, B. T. (2005). Connectedness: A review of the literature with implications for counseling, assessment, and research. Journal of

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Counseling & Development, 83, 191–201. http://dx.doi.org/10.1002/j.15566678.2005.tb00596.x Valdez, J. N. (2000). Psychotherapy with bicultural Hispanic clients. Psychotherapy: Theory, Research, Practice, Training, 37, 240–246. http://dx.doi.org/10.1037/ h0087712 Wampold, B. E. (2001). Contextualizing psychotherapy as a healing practice: Culture, history, and methods. Applied & Preventive Psychology, 10, 69–86. Warrier, S. (2008). “It’s in their culture”: Fairness and cultural considerations in domestic violence. Family Court Review, 46, 537–542. http://dx.doi.org/10.1111/ j.1744-1617.2008.00219.x Weiss, R. A., & Rosenfeld, B. (2012). Navigating cross-cultural issues in forensic assessment: Recommendations for practice. Professional Psychology: Research and Practice, 43, 234–240. http://dx.doi.org/10.1037/a0025850

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10 A PERSONALITY APPROACH TO TESTING HISPANICS RICHARD H. DANA

This chapter begins with a description of extreme within-group and between-group differences among Hispanics. This diversity affects psychological test usage and mandates early evaluation of client language skills, acculturation status, countries of origin, and immigration details. An examination of psychometrics applied to standardized tests precedes description and discussion of adaptations of these tests. Adaptations of standardized tests include translations and adaptations, as well as comparisons between original and translated versions. Some adaptations may include approaches to assess Hispanic ethnic identity and/or one’s cultural self, as opposed to a translated Western self. The Tell-Me-A-Story (TEMAS; Costantino & Malgady, 1999), an underutilized, nonstandardized test, has acceptable psychometrics and provides an instrument comparable to standardized tests with adaptations. Acknowledgment is made to Jennifer Williams, Assistant to the Director, and Tyson Vanover, Information Technology Consultant, Regional Research Institute for Human Services for research and facilitation. http://dx.doi.org/10.1037/14668-011 Psychological Testing of Hispanics, Second Edition: Clinical, Cultural, and Intellectual Issues, K. F. Geisinger (Editor) Copyright © 2015 by the American Psychological Association. All rights reserved.

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Of equivalent and comparable importance to test adaptation is adaptation of intake procedures. For example, attention to cultural issues identified by cultural formulations and culture-bound disorders can reduce cultural issues related to diagnosis and psychiatric treatment. Many community mental health centers use the multicultural assessment–intervention process (MAIP) model, described later in this chapter. Acculturation status categorization can be integrated in these settings to provide competent and ethical multicultural services. As a result, acculturated, bicultural, marginal, and traditional Hispanics receive different assessment services and psychological tests. Fundamental alterations in education and training are necessary to provide enduring changes in how psychological tests are used in a multi­ cultural society. These changes include a cultural competency model associated with practice guidelines and fairness in representing ethnic minority students and faculty. Adequate mentoring and academic supports are required for all program students, and cultural contexts should permeate all program components and activities. Scientific competency and cultural competency are equally important and essential for practice and multicultural societies. Personal and professional language fluency assessment and training are now an ethical imperative for services to Spanish-dominant and bilingual clients. PSYCHOMETRIC ISSUES All providers of psychological services should be required to receive adequate training in sophisticated methodologies to expand understanding of inadequacies and limitations in development, normative data, and applications of psychological tests. Geisinger (1992) described the psychometrics necessary to comprehend standardized test issues of design, construction, measurement objectives, and normative data. Psychometric knowledge is essential to demonstrate equivalence and reduce bias in cross-cultural testing and assessment (Geisinger, 2003). Equivalence may be linguistic, conceptual, functional, and metric and also includes other forms. Equivalence needs to be understood as both instrument-specific and culturespecific. Equivalence examines comparisons of test use with different cultural groups using English-language instruments. Methods for evaluating test equivalence use research designs and statistics (Allen & Walsh, 2000) because tests may be applied with clients in new settings dissimilar from their sites of original development and validation. Disagreement and controversy cloud the research status of these equivalencies (Nichols, Padilla, & Gomez-Maqueo, 2000).

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Bias as distinguished from equivalence and defined by van de Vijver (2000) “refers to the presence or absence of validity-threatening factors in such assessment, whereas equivalence involves the consequences of these factors on the comparability of test scores” (p. 89). Van de Vijver also described strategies for identifying and dealing with unacknowledged method bias during test administration. These strategies were incorporated into multicultural assessment courses by emphasizing student recognition and understanding of their own eisegesis or “interpretive inferences . . . prone to contamination by unacknowledged assessor fantasy, personalization and/or bias” (Dana, 1998c, p. 171). Evidence for these problematic inferences, separated from data-relevant contributions in assessment reports, provided uncontaminated report contents for use in student feedback to the test takers who provided the test data (Dana, Aguilar-Kitibutr, Diaz-Vivar, & Vetter, 2002). Geisinger (1994) emphasized use of the term test adaptation instead of simple test translation because adaptation describes culturally determined revisions reflecting qualitative changes in original instrument usage in the absence of adequate guidelines. Adaptations of standardized tests provide potential corrections for bias whenever new target populations are culturally different from the original standardized test populations. Translating and adapting tests for Hispanics necessitates multiple translations due to variants of standardized Spanish in countries of origin. Translations, however, embody qualitatively different approaches from those that use back-translation, decentering, and bicultural committees. Geisinger (2003) provided an Appendix containing International Test Commission guidelines for adapting tests that included testing context, translation/test adaptation, and test administration. POPULATION DIVERSITY In 2010, there were approximately 52 million Hispanics in the United States representing 21 countries sharing standardized Spanish but differing in street Spanish, cultural identities, family values, behaviors, and customs. Five major groups included Mexicans (63%), Puerto Ricans (9.2%), Cubans (3.5%), Salvadorans (3.3%), and Dominicans (2.8%), as well as others from Central America and South America (18.2%). More recent census figures no longer include country of origin. As a direct consequence of a core of similarities within a complex context of extreme differences among groups, Hispanics can only be adequately understood as individuals on the basis of culturally informed inferences from psychological test data, interviews, and credible service delivery during all provider–client interactions by culturally competent service providers.

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STANDARDIZED TESTS AND MULTICULTURAL POPULATIONS A relatively small number of standardized tests, including the Minnesota Multiphasic Personality Inventory, the Rorschach, and Thematic Apperception Test (TAT), were originally designed and constructed for European Americans (Piotrowski, 1999). Although these tests continue to be used with multi­ cultural populations for diagnosis of psychopathology and description of personality, Malgady, Castagno, and Cardinale (2014) stated that standardized tests remain vulnerable to distortions as a result of using a “White, mainstream lens” (p. 166). Such distortions disguise and exacerbate significant test score differences between ethnic groups by over- or underestimating psychopathology and affect self-presentations by altering affect, general attitudes, motor activity, and speech. These tests have long histories of misuse with Hispanic populations (e.g., Padilla & Ruiz, 1973) and continue to contribute to the underutilization of psychological services, as well as premature termination of community mental health services (Kouyoumdjian, Zamboanga, & Hansen, 2003). Snowden and Yamada (2005) reported that “ethnic minority persons are among the least likely to receive services appropriate to their needs” (p. 144), and there continues to be an egregious lack of specialty care for all persons with limited English proficiency. ADAPTING STANDARDIZED TESTS Methodological adequacy of linguistic equivalencies for diagnostic categories has not been unequivocally established because only the first three steps of a recommended seven-step process in six Minnesota Multiphasic Personality Inventory—2 Spanish translation versions have been applied (Butcher, 1996). Linguistic equivalence demonstrations were not successfully accomplished by field comparisons (Step 4), adequacy of American norms was not demonstrated (Step 5), new norms with a representative national sample were not developed (Step 6), and ongoing cultural validation research did not occur (Step 7). Nichols et al. (2000) were particularly concerned that Step 4, field testing, had not been used by bilingual researchers using interviews with heterogeneous monolingual informants to establish equivalence of stimulus values between target and original languages. Methodological approaches to evaluate the equivalence of different language versions of tests include factor analysis, regression, and item response theory, all of which use hypothesis disconfirmation and do not directly and unequivocally establish multicultural or cross-cultural equivalence (Allen & Walsh, 2000), which is ultimately a judgmental task. Allen 192       richard h. dana

and Walsh concluded that construct validation is a “continuing and unfinished process” (p. 82). This chapter suggests guidelines for the ongoing development of interpretation minimizing acculturation confounds, cultural identity issues, and bias in translations. Such guidelines include (a) cultural formulation, a systematic review of culture-in-illness that informs cultural identity and contributes to clinical diagnosis and ostensible culture-bound disorders (Cuéllar & Gonzalez, 2000) and (b) the MAIP model that reduces bias by incorporating cultural issues affecting clients and providers within a service delivery framework (Dana, 2000; Gamst & Liang, 2013). Roysircar (2014) carefully examined the steps in the MAIP model “multicultural assessment guidelines” and held them to be effective. In some cases, tests need to be developed just for multicultural populations. For example, a nonstandardized instrument, the TEMAS, was designed, constructed, normed, and applied with multicultural populations in the United States and adapted for cross-cultural international populations (Costantino, Dana, & Malgady, 2007). The TEMAS is described in more detail later in the chapter. Minnesota Multiphasic Personality Inventory Flagrant cultural bias in the MMPI (Hathaway & McKinley, 1940), the most widely used psychodiagnostic test, was documented in a 30-year review (Malgady, Rogler, & Costantino, 1987). Culturally determined ethnocentrism, worldviews, and preference for etic tests also provide unintentional bias by minimizing consistent MMPI item response differences (Dana, 1988). The MMPI–2RF (Ranson, Nichols, Rouse, & Harrington, 2009) revised MMPI–2 items and norms and added new scales validated for construct validity (Dana, 2013). The MMPI–2RF Spanish version yielded only modest increments in sensitivity and usefulness for Hispanic populations (Fantoni-Salvador & Rogers, 1997). Criterion-related validity for Hispanics has not been demonstrated and internal factor structures between forms were not found to be invariant. Nonetheless, a variety of other tests with Spanish translations, used primarily for research purposes, have acceptable correlations with English versions for bilingual examinees. Rorschach Comprehensive System Since 2000, the Rorschach Comprehensive System (RCS) has been transitioning from a projective technique toward a performance-based personality test, “a more descriptive and theory-neutral perspective” (McGrath, 2008, p. 466). RCS bias was formally acknowledged by inaugurating an evidence-based, internationally focused Rorschach Performance Assessment a personality approach to testing hispanics     

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System (R–PAS) in a 2011 Society for Personality Assessment presentation by Meyer, Viglione, Mihura, Erard, and Erdberg. This new system transforms the RCS into a behavioral task with both nomothetic and idiographic characteristics for performance evaluation of personality, perception, and cognition, and a meta-analysis suggested construct relevance for 70 RCS variables associated with externally based criteria. R–PAS is now in a position to examine the cross-cultural usefulness of a reconceptualized Rorschach test with international adult normative samples and translations in many languages. Thematic Apperception Test Objective TAT scores were originally developed in the United States for 12 cards used in Spain with national normative data (Ávila-Espada, 2000). The TAT also has a Spanish translation using a psychocultural scoring system and local norms (Ephraim, Sochting, & Marcia, 1997). Jenkins (2008) compiled a handbook of TAT scores and scoring systems for perceptual–cognitive, psychodynamic, and socioemotional variables to encourage future TAT research and eventual application as a more useful instrument for personality assessment. Tell-Me-A-Story Test: A Nonstandardized Test Other nonstandardized tests for multicultural and cross-cultural populations are not available within most training programs in this country. The TEMAS was constructed by Costantino in the late 1970s for children and adolescents. TEMAS is a psychometrically sound picture–story test descendent of the TAT using Hispanic and Black characters in urban settings (Costantino & Malgady, 1999). Dana (1996) heralded TEMAS as a “landmark event . . . [providing] information on problems experienced by visible racial and ethnic groups in the United States” (p. 480). TEMAS conveys life experiences in problem-solving situations elucidating personal and group resources, as well as providing psychodiagnostic information contextualized within culturally relevant life experiences. Dana (2007a) noted, TEMAS meets the following criteria for culturally relevant assessment methods to a much greater extent than other comparative instruments: (a) development by members of informed ethic minority and cultural communities, (b) comprehensive theoretical rationale, (c) administration using credible social etiquette, (d) culturally familiar figures and backgrounds in stimulus pictures, (e) objectives scores derived from theory and/or empirical research, (f) normative data for U.S. ethnic minority populations and nationals in other countries, and (g) research-driven expanding context of cultural knowledge useful for interpretation. (p. xviii)

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TEMAS has an extensive national and international literature (Costantino et al., 2007), with a completed Italian translation and in-progress translations for French, German, Bulgarian, Filipino, Arab, and Chinese versions. The Italian multicultural version includes Arab and Latin American children living in Italy. TEMAS has also been adapted pictorially for Jewish and Israeli populations. It is a measure built to be used with different multicultural populations. TEST ADAPTATION BY TRANSLATION English-only assessment has major pitfalls and limited usefulness because second-language thoughts, feelings, emotions, and nonverbal responses differ in Spanish and English. Flow of thought can be confused and less logical with differing and impaired vocabulary and fluency (Malgady et al., 1987; Malgady & Zayas, 2001). Proposed specialized translation and mental health training for bilingual interpreters (Acosta & Castro, 1981), although feasible, cannot substitute for development of educational programs that include representative ratios of bilingual and bicultural faculty and students, as well as training for services in Spanish to bilinguals. Malgady and Zayas (2001) noted details of fluency measures, including (word, type, sentence counts, ratios), client versus therapist initiated statements, number of self-disclosures, affective expression (affective tone and lability, hostility discomfort, monotone vocal emphasis, and voice level), speech rate latency to respond to query, speech disturbances (hesitations and silent pauses), language switching (English Spanish, Spanish to English), and expressive gestures (body and postural movements suggestive of tension or apprehension or relaxation). (p. 46)

Although translations of standardized tests require consensual methodologies, some have demonstrated that available MMPI translations have been unable to achieve intactness of psychometric characteristics across different versions (Malgady et al., 2014; Nichols et al., 2000). Failure to integrate experience and affect in second-language encoding facilitates emotional detachment and has contributed to erroneous inferences concerning the seriousness of psychopathology (Marcos, 1976). However, interviews and testing in second languages yield more provocative and meaningful client words describing the cultural self than those contained in first languages (Lambert, 1956). Psychometrically adequate translations of standardized tests have been difficult to achieve, although test translations contribute to an ethnic identity research agenda. For example, comparisons between English and first a personality approach to testing hispanics     

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language versions of standardized tests, particularly the MMPI, provide a contextual reality for life experiences. Numerous test translation studies in many languages demonstrate the existence of the cultural self and afford a unique opportunity to describe bicultural/bilingual individuals. Each language is believed to access culture-based memories, attitudes, and values (Cofresí & Gorman, 2004). Spanish-language versions also contain worldview information that may be modified by acculturation status and are consistent with the cultural self. The availability of these different language versions facilitates identification of self-referent thoughts containing group and individual cultural identity components recognized by a number of professional disciplines for various ethnicities (Dana, 1998a). Translated test versions facilitate understanding of Hispanic ethnic identity and cultural self, although Nichols et al. (2000) noted that these identities are generation- and country-oforigin-specific. Information contained in comparisons of translated versions of standardized tests is described as “untranslatable self” (Panayiotou, 2004a; Panayiotou, 2004b, p. 1), “two languages in the self/self in two languages” (Koven, 1998, p. 440), “double consciousness” (LaFromboise, Coleman, & Gerton, 1993, p. 395), and “two sets of memories, mental organizations, and contexts for encoding and retrieval” (Schrauf & Rubin, 2003, p. 121). ETHNIC IDENTITY AND CULTURAL SELF This section describes emic research contributions and personality instruments used with Hispanic populations. A variety of culture-specific instruments for Hispanics have been tabularized (Dana, 1993, p. 123)— for example, the widely accepted 20-item Acculturation Rating Scale for Mexican Americans, with factors for ethnic identity, generation, ethnicity of friends, direct contact with Mexico, and language preference (Cuéllar, Harris, & Jasso, 1980). Ethnic identity for major groups in the United States has been described by composition and organization of contents with diffuse or permeable boundaries (Dana, 2005). For Hispanics, Sena-Rivera (1979) noted firm, relatively impermeable boundaries extending beyond the nuclear family (la casa) to include godparents (comadres/copadres) and friends (la familia) and minimizing other sources of identity. Ethnic identity provides a contextual reality for life experiences articulated by the cultural self (Dana, 1998b). Cultural selves differ across racial and ethnic groups and can be examined using within-group range, overlap between groups, and acculturation status differences. Criteria include boundary permeability and variegated contents, persons and relationships excluded and omitted, and organization, control, and relative importance of contents. Ethnic identity awareness training includes self- and other 196       richard h. dana

examination, familiarity with criteria, and applications to case histories and assessment data. Hispanic ethnic identities differ with countries of origin. For example, Cuban Americans are more assimilated than other Hispanics and share behaviors and values with non-Hispanic middle-class Americans. They tend to have more education and affluence and are predominantly bicultural, less traditional, and use English as their primary language. They have acculturated more rapidly than other Hispanic groups as a result of unique immigration experiences, including official refugee status and resettlement assistance (for a review, see Raffaelli, Zamboanga, & Carlo, 2005). Mexican American psychology originated in historic scholarship illuminating diversity and identity issues by multiple comparisons across nine areas described by associative group analysis, a method culminating in contrasting semantograph images of Mexican Americans, Cubans, Puerto Ricans, Anglo Americans, and Russians (Diaz-Guerrero & Szalay, 1991). Mexican American personal ethnic identity is a complex multidimensional construct that includes language and self-esteem, as well as ethnic unconscious and consciousness (Ruiz, 1990). Mestizo heritage, a combination of indigenous and European origins, integrates a comprehensive and complementary framework for describing personality that has been carefully examined by a questionnaire, the Biculturalism/ Multiculturalism Experience Inventory, and with a variety of other assessment instruments (Ramirez, 1983). Arredondo and Glauner (1992) developed a personal identity model with three sets of dimensions: (a) immutable, visible, relatively permanent (e.g., age, culture, ethnicity, language, well-being, race, sexual orientation, social class); (b) developmental/acquired (e.g., education, location, interests, military and work experience, relationships, religion and spirituality, health care practices and beliefs); and (c) historical–experiential context. This model recognizes focal personal criteria in discriminatory behaviors that provide barriers interfering with multicultural competency for providers in all contacts and intervention strategies (Arredondo, 1999). Awareness of these competencies (Arredondo et al., 1996) is central to social-justice-oriented service delivery in professional education (e.g., Gamst & Liang, 2013) and constitutes an ethical sine qua non for human services in a multicultural society. ACCULTURATION STATUS CATEGORIZATION A need for quantitative measures of individual acculturation was recognized by cross-cultural psychologists before a psychometric perspective was introduced by Olmedo (1979). Schrauf (2002) subsequently articulated this a personality approach to testing hispanics     

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perspective within cultural competency theory, whereas Malgady et al. (1987) noted an historic range from “completely Hispanic” to “completely Anglo,” with a majority in between these extremes. A need for accurate assessment of cultural orientation status using culture-specific and culture-general measures for Hispanics and other immigrant groups was recognized (Rogler, Cortes, & Malgady, 1991; Siatkowski, 2007). These authors strongly recommended the responsible use of instruments for information concerning acculturation status. Cultural orientations describing individual acculturation status affirm the extreme range of differences within each ethnic group (Dana, 1992, 1996). These orientations distinguish between exclusive identification with the majority culture (20% assimilated), competency in original and adopted cultures (40% bicultural), and individuals who do not identify with either culture (30% marginal) or retain an original culture (20% traditional). ADAPTING INTAKE PROCEDURES Despite the numerous adaptation procedures described earlier, exclusive preoccupation with test adaptations per se to minimize bias has proven ineffective. Failure to recognize a narrow assessment perspective continues to restrict recognition that a White mainstream reference population is no longer present in the United States. All relationships with multicultural clients now require credible service delivery behaviors and affect. This social etiquette facilitates the development of cultural formulations contributing to subsequent medical and psychiatric interventions. Social etiquette also increases the likelihood of alternative personality tests for culture-specific and identity-specific problems, as well as cultural interaction stress (Dana, 2000). A mandatory service delivery format, the MAIP (e.g., Gamst, Dana, Meyers, Der-Karabetian, & Guarino, 2009), provides continuous and systematic adaptations during all relationships with multicultural clients and including intake procedures. Service Delivery: Expectations, History, Example Service providers must be willing and able to address cultural issues using credible service delivery styles conforming to expectations and language preferences of Hispanics. High frequencies of affiliative and affectional verbalizations or simpatía exemplifies a cultural script for credible behavioral style (Triandis, Marín, Lisansky, & Betancourt, 1984). Simpatía includes respeto (respect by younger for older persons, women to men, persons in authority or higher socioeconomic position), personalismo (preference for informal, personal, individualized attention), platicando (leisurely 198       richard h. dana

chatting to establish a warm, accepting atmosphere), and confianza en confianza (trusting mutual relationship establishing mutual generosity, intimacy, personal involvement). The following example illustrates differences between American and Mexican service providers and suggests the reciprocal nature of culturally appropriate interaction: The American tester was detached and, to the Mexican observer, cold. The American child was absorbed, challenged, and involved with the tester. He/she gave to most of the observers the impression of competing with the tester. The noise level and commotion were minimal. The Mexican tester was vehement and expressive—to the American observer, overly warm. The Mexican child was responsive and involved in the interpersonal relation; it seemed that he/she wanted to please the tester with good answers to the tests. The noise level and commotion seemed high to the American observers. (Diaz-Guerrero & Diaz-Loving, 1990, p. 491)

Cultural Formulations and Culture-Bound Syndromes These cultural variables are resources preventing or minimizing “over­diagnosing, underdiagnosing, or misdiagnosing psychopathologies” (Paniagua, 2013, p. 25). Cultural formulations have been used with standardized tests to reduce error and facilitate clinical diagnosis of Hispanics (Cuéllar, Dana, & Gonzalez, 1996; Cuéllar & Gonzalez, 2000). A complex, stepwise diagnostic process for increasing monocultural DSM–IV reliability defined symptoms, interviewed patients to classify symptoms and other clinical information, as well as lab findings, reexamined symptoms, and considered presence or absence of etiological factors (Wing, Nixon, Cranach, & Strauss, 1980). This process was subsequently applied to Mexican Americans by Cuéllar (1982), and case study examples in the journal Culture, Medicine, and Psychiatry were continued in book format (Castillo, 1996). Paniagua (2013) warned practitioners to consider but not overemphasize the importance of these combinations of cross-cultural assessment strategies because some symptoms cannot be successfully treated by professional clinicians. However, relatively few diagnosticians have been adequately trained to consider these cultural variables, which have been criticized as misleading and are no longer considered necessary. Multicultural Assessment–Intervention Process Good ethnic science (S. Sue & Sue, 2003) antedates, undergirds, and is functionally exemplified by MAIP (Dana, 1997; Dana, Aragon, & Kramer, a personality approach to testing hispanics     

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2000). MAIP development assumed that etic measures are ultimately desirable and feasible and should be used whenever psychometrically sound instruments are available. MAIP methodology uses available client information and research findings with multicultural mental health center clients during discrete steps identified by component questions. These steps with their component ingredients and specific outcome objectives are embedded in all services. The ingredients specify conditions for client–provider match, client acculturation status, provider cultural competence training status, and pre– post components, including an array of intake and outcome measures. An independent multicultural competency training program uses the California Brief Multicultural Scale (CBMCS; Dana, Gamst, & Der-Karabetian, 2008). MAIP was adopted by the state of California and used nationally for culturally competent training using CBMCS (Gamst, Rogers, Der-Karabetian, & Dana, 2006). The MAIP model provides research-driven and outcomeoriented community applications, and the most recent description (Gamst & Liang, 2013) updates, depicts, and clarifies multicultural competence in clinical settings. An independent appraisal (Roysircar, 2014) depicted MAIP as “multi­ cultural assessment guidelines” with steps for (a) client–clinician match, (b) client cultural identities, (c) client presenting problems, (d) assessment feedback, (e) intervention recommendations, and (f) evaluation of assessment. Roysircar (2014) suggested several semistructured interviews for use with these guidelines. Cultural Competency: Model and Recent Practice Guidelines A proposed cultural competency model (Dana, 2007b) embraces attributes preceding professional socialization; facilitates new learning about other persons; uses construct dimensions of knowledge, attitudes and values, and skills, as well as training modalities. Knowledge about others is consistent with American Psychological Association (APA) program recommendations introduced in 1947 that recognized the importance of ethnicity and race, social class, urban/rural setting, age, gender, and acculturation, as well as personal qualities of curiosity, flexibility, openness, being nonjudgmental, and ambiguity tolerance. The model includes constructs such as multi­ cultural knowledge, attitudes and values (awareness of cultural barriers and sensitivity to consumers), skills (assessment, interventions, research), and socio­cultural diversities. Training modalities include courses, workshops, extended cross-cultural living and experiences with a variety of service populations, and practice specialties in practicum, internship, and continuing education. A desirable personal–professional outcome for individuals adopting this model is ethnocultural relativism. Ethnocultural relativism 200       richard h. dana

as a training model requires engagement by faculty and graduate students in personal transformation activities of self-examination, commitment, and openness to others (Fowers & Davidov, 2006). Rogers and O’Bryon (2014) concurred that training for services to diverse client populations should be consistent with advocacy and practice in counseling psychology “for a transformation away from the prevailing Eurocentric philosophical and epistemological paradigms and the shift toward embedding a racially and ethnically sensitive lens across all features of the curriculum and the institutional setting” (p. 662). This process, however, results in shifting power differentials and a necessity to ensure safe learning environments for all students and faculty. D. W. Sue (2004) suggested that Whites can minimize the realities of racism and discrimination, but racism has persisted in American society, as exemplified by White privilege expectations that contrast with historic and contemporary experiences of racial and ethnic minorities in their daily lives and professional training programs (e.g., Boatright-Horowitz & Soeung, 2009). Issues of student dissatisfaction and research evaluation of proposed remediations have been discussed in program examples (Dana, 2008b, Chapter 6) and by Kiselica (1999). Multicultural competency guidelines developed and instituted by APA (2003) have been proposed by the federal government, a number of states, and psychology, counseling, social work, medicine, psychiatry, and nursing (see Dana, 2008a). The APA Guidelines and Principles for Accreditation of Programs in Professional Psychology (2009) suggest broad and flexible programs should emphasize diversity in terms such as age, disability, ethnicity, gender and gender identity, language, national origin, race, religion, culture, sexual orientation, and socioeconomic status. Program requirements can be designed to facilitate acquisition of competence and understanding of cultural diversity within learning environments conducive for training diverse students. Nonetheless, in recent years, this author shared the belief that clinical psychology has been concerned with scientific knowledge and has examined practice domains to a much more limited extent (Kaslow et al., 2004), despite a countercommitment in counseling psychology uniting advocacy for social justice with cultural competency training and practice for all providers. As a personal addendum, I received over 50 requests during 2013 from students and professionals across disciplines and areas of interest requesting items and reprints describing an Agency Cultural Competence Checklist (ACCL; Dana, 1998a; Dana, Behn, & Gonwa, 1992; Dana & Matheson, 1992). This belated interest in the ACCL suggests that cultural competence per se is now a recognized and necessary social phenomenon requiring measurement by more sophisticated instruments. a personality approach to testing hispanics     

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EDUCATION AND TRAINING FOR MULTICULTURAL COMPETENCE Multicultural competence has origins in concrete strategies and general processes for providers, agencies, and systems for community care (S. Sue, 2006). A multicultural competence review of 1,100 articles subsequently identified associated factors of community context, local population characteristics, organizational infrastructure, and direct service supports, and defined competency as the extent of compatibility among factors (Hernandez, Nesman, Mowery, Acevado-Polakovich, & Callejas, 2009). Provider and clinic cultural competencies were surveyed in 23 agencies (Paez, Allen, Carson, & Cooper, 2008). These authors suggested that measures derived from nursing and primary care research indicated relevant provider characteristics associated with providers and clinic setting linkages. Further, they suggested selection criteria for medical and nursing students and supported improved care for minority patients as a result of integrating cultural competency throughout training. A review of 19 multidisciplinary cultural competency measures meeting reliability, item clarity, broad diversity definition, coherence, lack of social desirability, and social justice were reduced to four scales representing social work, counseling, and nursing (Krentzman & Townsend, 2008). These social work educators defined cultural competency as “an ability to work well with others despite differences of race, ethnicity, age, gender, sexual orientation, physical disability, and other types of difference” (p. 14). Multicultural competence has been measured by more than a dozen instruments evaluated for dimensionality, reliability, validity, and consequences of testing evidence (Gamst & Liang, 2013). Multicultural competence has not been described consensually to date, although the review by Gamst and Liang (2013) also presented psychometric issues and evaluated some 19 measures within a social-justice-oriented service delivery framework reflecting an earlier handbook of multicultural measures (Gamst, Liang, & Der-Karabetian, 2011). Survey results from 1979 to 1991 described some limited improvements in professional training for multicultural competence (Bernal & Castro, 1994), buttressed by the 2009 APA Guidelines describing program responsibilities for eligibility and program contents, including cultural and individual differences and diversity. Nonetheless, only some of the 27 exemplary professional psychology programs used an integration model with separate courses, exposure to diverse populations, and multicultural curriculum models, and some have argued that even these programs provided inconsistent, incomplete, inadequate, and nonconsensual attempts at demonstrating effective

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multicultural competence training (Rogers & O’Bryon, 2014). These findings circa 1979 to 2014 suggest that for Hispanics and other ethnic minorities, psychology has not seriously responded to an ecological and social justice orientation with self-examination for voice and consciousness raising by power sharing and building on strengths and leaving clients with tools for social change (Goodman et al., 2004). Multicultural Competence Definitions and Training Marsella (2008) reminded us that “culture is both external (e.g., artifacts, roles, institutions) and internal (e.g., values, beliefs, perceptions, epistemologies, consciousness patterns, a sense of personhood)” (p. xii). In multicultural societies, cultural competency refers to a combination of provider knowledge, skills, values, and attitudes articulated by guidelines (D. W. Sue, Arredondo, & McDavis, 1992). A basic premise of guidelines recognizes that providers “have multicultural selves” (Miville et al., 2009, p. 521) and that “multicultural competence training emphasizes respect, understanding and nonjudgmentalness so as not to engage in multicultural malpractice” (p. 524). Consistent with Boulder model expectations (APA, 1947), an acceptable training model should recognize and endorse personal qualities of trainees, infusing cultural issues in all aspects of training; adopt available training modalities; and incorporate outcome evaluations. Such a model would use culturally informed assessment instruments, advocate remediation of deficits in cultural competence training, and acknowledge need for minority students and bilingual and bicultural faculty. The MAIP model meets these conditions and embraces four CBMCS factors (Multicultural Knowledge, Awareness of Cultural Barriers, Sensitivity/Responsiveness to Consumers, and Sociocultural Diversity; Gamst et al., 2004). Ethical service outcomes for multicultural clients depend on acknowledgment of equivalent roles and responsibilities for assessors and clients. Implementing multicultural competence training in professional psychology programs has been selective, incomplete, and controversial (Rogers, 2013). Most programs might be characterized as either culture-centered or failing to contextualize cultural issues in training, whereas some APAaccredited programs do not teach multicultural psychology (Arredondo, as cited in Schwartz et al., 2010). Cultural malpractice is still considered to be rampant (Schwartz & Domenech Rodriguez, as cited in Schwartz et al., 2010). There is no consensus concerning competency benchmarks during training (Fouad et al., 2009) or a suggested competency assessment toolkit of methods (Kaslow et al., 2009). As a direct consequence, professional psychologists continue to make inconsistent and inadequate use of their meager

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cultural competency training with multicultural clients (Hansen et al., 2006; Maxie, Arnold, & Stephenson, 2006). Psychological Test Usage and Personality Assessment Nondiscriminatory psychological test usage depends on providers, preferably bilinguals, who understand the ethnic identity and cultural self of their multicultural clients. Programs that include Spanish-language training and increased numbers of bicultural and bilingual ethnic minority students and faculty are sorely needed. Standardized test usage with multi­ cultural populations necessitates test adaptation and translation, as well as modified intake procedures, to embed credible social etiquette and other desiderata in service delivery. When providers rely on untrained translators, psychological assessment may be distorted, misleading, and ineffective for those Hispanics who are bicultural, traditional, or marginal. Using adequately trained translators, however, does not ameliorate inherent training problems and may curtail adequate usage of suggested models for embedding cultural competency training at all levels in academic and community settings. Potentially damaging outcomes of personality assessment can be reduced when bilingual clients complete standardized tests in both English and Spanish to present independent sets of memories and affects for comparison. These comparisons of identity conceptualizations can inform services in Spanish by conveying the familiarity and comfort of bilingual providers who use conversational and country-specific street Spanish, as well as language switching. The 26 million marginal or traditional Hispanics with limited English proficiency who speak Spanish at home fail to receive or comprehend the necessary mental health or specialty care (Snowden, Masland, & Guerrero, 2007). In many cases non-English-speaking clients continue to receive services from providers without relevant training and preparation (Rogers & O’Bryon, 2014). The vast majority of psychologically trained providers receive inadequate and insufficient training for Spanish-language fluency or assessment of client language preference and abilities prior to selecting instruments (Castaño, Biever, Gonzalez, & Anderson, 2007; Verdinelli & Biever, 2009), as recognized by APA (2002, 2003). It should be noted that the immediate antecedent of this chapter (Dana, 2014) elaborates scientific and professional issues and describes assessment strategies relevant to contemporary education and training for services to multicultural individuals from traditional and emergent national and global client populations. Readers seeking elaboration of points made in this chapter are encouraged to review this additional chapter. 204       richard h. dana

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11 CLINICAL APPROACHES TO ASSESSING CULTURAL VALUES AMONG LATINOS LISA M. EDWARDS AND ESTEBAN V. CARDEMIL

Understanding an individual’s worldview has profound implications for assessment and intervention. Without knowledge about a client’s attitudes toward others and her or his environment, certain treatment approaches may be inappropriate and ineffective. In contrast, assessing for values and integrating them into practice can provide the opportunity for clients’ increased engagement and retention in treatment (Añez, Silva, Paris, & Bedregal, 2008; Smith, Rodriguez, & Bernal, 2011). Specifically, understanding the degree to which Latino clients adhere to common Latino cultural values, such as familismo, personalismo, and respeto, can provide a wealth of information beyond simply preferred language, ethnic label, or even acculturation status (Rivera, 2008). Indeed, researchers have noted that acculturation by itself provides little useful information for clinicians and that level of adherence to cultural values may be more indicative of how an individual is adapting to the demands of cultural contexts than language http://dx.doi.org/10.1037/14668-012 Psychological Testing of Hispanics, Second Edition: Clinical, Cultural, and Intellectual Issues, K. F. Geisinger (Editor) Copyright © 2015 by the American Psychological Association. All rights reserved.

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use or generational status (Rivera, 2008; Schwartz, Unger, Zamboanga, & Szapocznik, 2010). In this chapter, we argue, as others have (González-Prendes, Hindo, & Pardo, 2011; Marín & Gamba, 2003; Rivera, 2008), that the assessment of cultural values is a critical component of client conceptualization. Using specific examples for researchers and clinicians, we describe the rationale for and importance of assessing cultural values among Latinos, and we review prominent Latino cultural values and their association with relevant psychological variables. Finally, we provide specific suggestions for assessing cultural values, particularly during the clinical interview. IMPORTANCE OF ASSESSMENT OF LATINO/A CULTURAL VALUES Over the past 2 decades, researchers and theorists have provided ample evidence for the importance of attending to culture in psychology. Culture has been purported to influence the perception and definition of mental illness in individuals (Kleinman & Good, 1985), as well as the manifestation and expression of symptoms (Draguns, 1973; Guarnaccia & Rogler, 1999; Romero, Edwards, & Corkery, 2013). From guidelines that direct psychologists to integrate culture into education, training, research, practice, and organizational change (American Psychological Association [APA], 2003), to meta-analyses that indicate cultural adaptation in psychotherapy is effective (e.g., Benish, Quintana, & Wampold, 2011; Smith et al., 2011), there is an increased emphasis on understanding and applying knowledge about cultural differences when working with diverse individuals. For Latinos in particular, the stakes are high with respect to the implementation of culturally appropriate assessment and intervention. Latino youth and adults experience numerous mental health disparities compared with their counterparts from other ethnic groups, and they face challenges with respect to mental health care. For example, Latinos are less likely than European Americans to receive formal mental health services (Alegría et al., 2002; Wells, Klap, Koike, & Sherbourne, 2001), especially if they are less acculturated or recent immigrants (Alegría et al., 2007; Cabassa, Zayas, & Hansen, 2006). Moreover, when they seek formal mental health services, they are more likely to prematurely terminate them (e.g., Organista, Muñoz, & Gonzalez, 1994; Rios-Elliot et al., 2005). These disparities have been found even when controlling for sociodemographic and clinical characteristics (Lagomasino et al., 2005; Padgett, Patrick, Burns, & Schlesinger, 1994), suggesting that mental health care disparities may result in part from the inattention to issues of culture in the treatment process. 216       edwards and cardemil

Adapting assessment and intervention practices for working with Latino/a populations, therefore, is critical to addressing these challenges and health disparities. In fact, in addition to providing important information for assessment purposes, we contend that assessing cultural values can also serve as a mechanism for addressing disparities in this population. By better understanding Latinos and seeking methods to provide better interventions, professionals make progress in eliminating barriers to effective treatment. LATINO HETEROGENEITY: SOCIODEMOGRAPHICS As others have noted in this volume, Latinos represent a dynamic and growing population in U.S. society. They are diverse in terms of country of origin, generation level, language, socioeconomic status, and a multitude of other factors that can affect mental health and treatment. Researchers have noted that ignoring this diversity among Latinos can be problematic because it may obfuscate important distinctions between many different subgroups (Carlo, Villaruel, Azmitia, & Cabrera, 2009; Umaña-Taylor & Fine, 2001). One useful framework for assessing the multiple, diverse aspects of identity has been proposed by Hays (2008): the ADDRESSING model. In this framework, the practitioner is encouraged to consider his or her client across a number of important sociodemographic characteristics, including age, disability (acquired), disability (developmental), religion, ethnicity, sexual orientation, socioeconomic status, indigenous heritage, national origin (including refugee or immigrant status), and gender. With this heuristic in mind, it is easy to see how a 47-year-old heterosexual, Catholic, fourth-generation Chicana growing up in a wealthy California suburb would differ from an 18-year-old recent immigrant male Mexican American who is working class and has a physical disability. Indeed, the ways in which individuals can differ, even if they are categorized under the umbrella of Latino/a, are endless. These aspects of identity provide important information about historical and contextual influences on functioning as well (Hays, 2008). For example, knowing that a client is an 18-year-old recent immigrant young woman could suggest to a clinician that she has come to the United States during a particularly challenging time with respect to an anti-immigrant political climate (Romero et al., 2013). This information will clearly shape the conceptualization of the client and assessment of his or her functioning, in addition to treatment planning. Although Hays’s ADDRESSING framework provides a useful heuristic for assessment, it is critical that clinicians push beyond these category labels to understand the meaning and enactment of these identities for their clients. When working with Latinos, a deeper assessment of a client’s national origin within the ADDRESSING framework would likely mean attending to the approaches to assessing cultural values     

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impact of immigration and acculturation status (preferred language, foods, social groups). Although not mentioned specifically in the framework, these constructs have relevance in the lives of Latino/as and should be attended to in any assessment (Rivera, 2008). These concepts have received considerable attention in the field, including in this volume, and so therefore are not discussed in detail in this chapter. However, they represent key dimensions of diversity among Latinos and so should be included in any comprehensive assessment approach. LATINO HETEROGENEITY: CULTURAL VALUES Although the assessment of sociodemographic characteristics can provide important information in conducting clinical work with Latinos, it is important to recognize that sociodemographic characteristics provide little information about any particular client. Indeed, demographic characteristics such as age, religion ethnicity, national origin, and gender serve as proxies or representations of some underlying psychological processes, worldviews, or attitudes that may be more relevant and important to the psychotherapy process. That is, although knowing that a client is from Puerto Rico may be useful, it is more useful to understand that particular client’s relationship with Puerto Rican culture. One way that this determination can be accomplished is through an assessment and deep understanding of our clients’ level of adherence to particular cultural values. These cultural values serve as lenses for interacting with the social world, both with regard to family and nonfamily members. They include values that refer to the role of the family, interpersonal interactions, and gender roles, as well as religious and spiritual values. Although there has been increased attention to these cultural values and their potential impact on mental health, treatment, and outcomes, there is still a dearth of literature regarding how psychologists can actually engage in multicultural assessment or how they should assess for cultural values in particular. In the following section, we review prominent Latino cultural values and research associated with each of them. Following this review, we provide suggestions for how to assess for these values and integrate them into psychological practice. LATINO CULTURAL VALUES Centrality of the Family Latino culture has been described as moderately collectivistic and organized around the family. The cultural value familismo reflects this central role of the family and refers to strong feelings of attachment, commitment, loy218       edwards and cardemil

alty, and obligation to family members (Arredondo & Perez, 2003; Gloria, Ruiz, & Castillo, 2004; Lugo Steidel & Contreras, 2003). These feelings commonly extend beyond the immediate nuclear family to include extended family members (e.g., cousins, grandparents, uncles and aunts) and even nonfamily members (e.g., godparents, godchildren, close family friends). Highly familistic individuals tend to conceptualize the family as a source of support that is readily available and provided when needed; external sources of support may be less welcome (Campos et al., 2008; Ishikawa & Cardemil, in press). In many of these families, decisions are often considered for their effects on the overall family. Early conceptions of familismo suggested that it might function as a protective factor against mental health problems because it would promote family cohesion and support (Cuéllar, Arnold, & González, 1995). More recently, however, researchers have suggested that the effects of familismo may be more nuanced. In particular, although familismo has been found to buffer against emotional distress (Peña et al., 2011), researchers have speculated that it could also be associated with a greater sense of obligation to the family, which can lead some Latinos to take on difficult family oriented responsibilities, including caretaking of ill or elderly relatives or providing financial support to extended family members. These additional responsibilities could at times be burdensome and stressful, thus increasing the risk of emotional distress (Gloria et al., 2004). In addition, some recent research has suggested that in the context of high family conflict, high levels of familismo can increase distress (Hernández, Ramírez García, & Flynn, 2010). Thus, clinicians working with Latinos would be well-advised to understand the role that family plays in their clients’ lives. In many instances, this cultural value will likely elicit stories of strength and unity, but in some circumstances, there may be stress associated with the sense of obligation that often accompanies adherence to this value. Familismo has long been assumed to play an important role in the helpseeking process, with early theories speculating that individuals with a strong sense of familismo might be less likely to seek formal mental health services because of a desire to keep problems within the family (e.g., Vega & Alegría, 2001). However, more recent research has found evidence that familismo may not be directly related to help seeking per se, but rather plays an indirect role, with highly familistic individuals being more likely to value and be influenced by the attitudes and opinions of their family members with respect to the use of formal mental health services (Ishikawa, Cardemil, & Falmagne, 2010). That is, the influence of family members may be stronger among highly familistic individuals. Thus, finding ways to include family considerations in clinical work with Latinos may prove beneficial. In some instances, these considerations may simply consist of asking clients about approaches to assessing cultural values     

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their family members’ attitudes and understanding of mental health treatment; in other instances, it could consist of a few family sessions designed to provide psychoeducation around mental health and mental health treatment (Cardemil, Moreno, & Sanchez, 2011). Interpersonal Interactions The cultural values of respeto, personalismo, and simpatía are values that guide interpersonal interactions, both within the family and with individuals outside the family. Interestingly, the values provide very different guides for interaction styles, depending on the social context. Respeto refers to an interaction style that is formal and generally serves as a guide for navigating hierarchical relationships, often within families (Arredondo & Perez, 2003; Calzada, Huang, Anicama, Fernandez, & Brotman, 2012). Thus, individuals are expected to show respeto when interacting with those who are more senior in age, those who are in a higher social class, or those who hold traditionally important societal positions (e.g., doctors, teachers, professionals). Respeto generally provides an implicit guide for interpersonal interactions that include prescriptive language use (e.g., use of the formal form of usted instead of the more informal tú), conversational style (e.g., waiting to speak until the other has spoken), and conflict management (e.g., showing deference to the other’s beliefs and perspective; Añez et al., 2008). Individuals, particularly youth and young adults, who show proper respect are generally described as bien educado [well-educated], whereas those who fail to show a proper amount of respeto may be described derisively as mal criado [poorly raised]. Some authors (e.g., Carbonell, 2000) have suggested that respeto toward authority figures may lead a client, for example, to agree to an appointment even if he or she was not interested in meeting again. When the client does not keep the appointment, the failure to comply can be seen as the consequence of the client’s initial act of accommodation to the professional in a position of authority (Tiemann, 2005). In contrast, personalismo and simpatía highlight the implicit expectations for more personable interactions that focus on the experience of the individual. Personalismo refers to an interpersonal interaction style that promotes personal connection, whereas simpatía refers to an individual’s general likeability (Añez et al., 2008; Gloria et al., 2004). These interactions tend to be more congenial, warm, friendly, and harmonious and are often less formal. Context matters, however, because expectations for personable interactions depend on the circumstances and specific social interactions. Some of these interactions include those among family members and friends, but they can also include professional interactions among relative equals. Thus, it would not be unusual for some professional interactions to begin with the partici220       edwards and cardemil

pants inquiring about each other, asking about family members, and possibly including a social component (e.g., food, drinks) as a way to help promote a more relaxed and personable environment. Several researchers have recommended that clinicians find ways to incorporate these three cultural values into their clinical work with Latinos (e.g., Añez et al., 2008; González-Prendes et al., 2011). In particular, recommendations have emphasized the use of more formal language in the context of a warm, personable style that might include some limited self-disclosure from the clinician (Cardemil et al., 2011). The untested assumption underlying these recommendations has been that the incorporation of these values into clinical work can help Latino clients feel more comfortable and welcome in a novel clinical setting, thus facilitating the development of a strong working alliance. Gender Roles The most commonly described gender-based cultural values in Latino culture are marianismo, machismo, and caballerismo. Marianismo refers to a traditional female role connected to the Virgin Mary in Catholic culture and is characterized by self-sacrifice, ability to endure suffering, and caretaking of the family (Arredondo & Perez, 2003; Gloria et al., 2004). Machismo and caballerismo refer to the traditional male gender roles, with machismo generally conceptualized in the literature as embodying negative characteristics of masculinity and caballerismo representing the more positive aspects of masculinity (Arciniega, Anderson, Tovar-Blank, & Tracy, 2008; Félix-Ortiz, Abreu, Briano, & Bowen, 2001; Santiago-Rivera, Arredondo, & GallardoCooper, 2002). Thus, Latino men who self-identify as machista would be likely to endorse dominance of men over women, sexual promiscuity, the importance of strength and power, and emotional restrictiveness. Latino men who adhere to the value of caballerismo would be likely to endorse the importance of protecting and supporting one’s family, caring for those who are less able and in need, and the promotion of responsibility, commitment, and fairness. The research linking gender roles to mental health issues is limited. Some have speculated that Latina women who adhere strongly to the value of marianismo may be overly passive and submissive (Arredondo & Perez, 2003). While acknowledging the pressure placed on Latina women who adhere to the marianismo value, Gloria and colleagues (2004) pointed out that more research is needed to understand how Latina women might use some of the central aspects of marianismo (e.g., strength and perseverance) to help them in their daily functioning. With regard to the male gender roles, the limited research has found that strong adherence to the cultural value of machismo is a risk factor for depression (Fragoso & Kashubeck, 2000), approaches to assessing cultural values     

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risky sexual behavior (Herbst, Kay, Passin, Lyles, Crepaz, & Marín, 2007), and domestic violence (Gonzalez-Guarda, Vasquez, Urrutia, Villarruel, & Peragallo, 2011). Even less research has examined the relationship between caballerismo and mental health, although one recent study found that men who adhere to caballerismo experience more gender role conflict when they encounter high levels of perceived discrimination (Liang, Salcedo, & Miller, 2011). Researchers have also speculated that these gender-based cultural values may play an important role in the treatment-seeking process, although again the research support is currently lacking. For example, women who adhere to the value of marianismo may subsume their own needs for mental health care if they believe it may interfere with their ability to care for their family. Similarly, Latino men who adhere strongly to machismo values are likely to emphasize the importance of projecting images of strength and self-reliance (Abreu, Goodyear, Campos, & Newcomb, 2000; Torres, Solberg, & Carlstrom, 2002), values that are at odds with seeking help. Latino men who adhere to machismo values may also be likely to be dismissive of feelings of sadness, anxiety, and uncertainty, a characteristic that would also likely interfere with both recognition of these emotions and subsequent treatment seeking. Thus, clinicians would likely to do well to recognize the powerful influence these gender-based cultural values may contribute to some of their Latino clients’ ambivalence about psychotherapy. Understanding these influences could help clinicians consider how to make sense of ambivalent behavior and then possibly better engage their clients in the treatment process. Religion and Spirituality Research has indicated that the overwhelming majority of Latinos in the United States report that they are committed to a particular religion, with over 90% self-identifying as Christian and 70% as Catholic (Espinoza, Elizondo, & Miranda, 2003; Moreno & Cardemil, 2013). More recently, researchers have acknowledged the important role that spirituality also plays among many Latinos (e.g., Cervantes & Parham, 2005). In addition, some Latinos, particularly those who are older or less acculturated, make use of faith healers such as curanderos, espiritistas, or santeros (Arredondo & Perez, 2003; Gloria et al., 2004). For some Latinos, the connection to religiosity and spirituality can be expressed in part through the cultural value fatalismo. This value refers to a worldview that one’s future is predetermined, that things happen for some external reason, or that life events are outside of one’s control (Ishikawa & Cardemil, in press; Schraufnagel, Wagner, Miranda, & Roy-Byrne, 2006). Most commonly, fatalismo is expressed in the context of spirituality, with God or some other transcendental power being the determiner of one’s destiny. 222       edwards and cardemil

Considerable research has documented that higher levels of religious commitment are associated with a range of positive mental health outcomes (Hill & Pargament, 2003; Sternthal, Williams, Musick, & Buck, 2010). Among Latinos, higher religiosity has been associated with greater life satisfaction (Herrera, Lee, Nanyonjo, Laufman, & Torres-Vigil, 2009; Merrill, Steffen, & Hunter, 2012) and less risky sexual activity (Edwards, Fehring, Jarrett, & Haglund, 2008; Edwards, Haglund, Fehring, & Pruszynski, 2011; Edwards & Stubbs, 2012). Researchers have suggested that religiosity can help individuals cope with adversity by providing social support, hope and meaning, and even formal counseling services (Moreno & Cardemil, 2013). Interestingly, religiosity has also been associated with more negative attitudes toward formal mental health treatments and decreased use of such services (e.g., Harris, Edlund, & Larson, 2006). This relationship has also been found in the limited research that has been conducted with Latinos, with highly religious Latinos being more likely to express doubt about the utility of formal mental health services and more likely to prefer the use of religious or pastoral counseling approaches (Alvidrez, 1999; Moreno & Cardemil, 2013). Although no research has specifically investigated whether fatalismo might be associated with use of mental health services, it is plausible that highly fatalistic individuals might demonstrate more passive coping approaches and so be less likely to make use of formal mental health services (Ishikawa & Cardemil, in press; Tiemann, 2005). In summary, these cultural values play important roles in the lives of many Latinos, and as a consequence have considerable potential to be highly relevant in therapy. Importantly, clinicians would do well to remember that variability in adherence to these values can be found both across and within Latino families. Indeed, there is some research demonstrating that discrepancies in cultural values between parents and children can lead to familial conflict (e.g., Baumann, Kuhlberg, & Zayas, 2010; Hernández et al., 2010). Taken together, there is good reason to believe that understanding the role that cultural values play in the lives of Latino clients and their families can help clinicians understand their clients’ possible ambivalence about starting psychotherapy, foster a good working alliance, and focus the clinical work in ways that are maximally beneficial to their clients. ASSESSING CULTURAL VALUES AMONG LATINOS: SUGGESTIONS FOR CLINICIANS For the clinician who seeks to understand his or her Latino clients better, the issue now becomes how to assess for cultural values and how to integrate this information about values into case conceptualizations and approaches to assessing cultural values     

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treatment planning. Most assessment begins with a standard clinical or diagnostic interview involving questions about basic demographics, presenting problem, history and background, as well as past and present functioning in various life arenas (Jones, 2010). To gain information about adherence to Latino/a cultural values, however, clinicians will likely need to probe further by asking specific questions during the clinical interview and/or gathering data from measures about values. Importantly, clinicians should also become aware of biases and assumptions they may hold and how these can influence their conceptualizations and interventions with Latino clients. The next section begins with a brief discussion of the possible impact of assumptions as they relate to Latino cultural values and clients, encouraging practitioners to become aware of their own worldviews. We then provide suggestions for the assessment of Latino cultural values within the context of all therapy interactions—in other words, from the first encounter (e.g., in a waiting room, on the phone) to ongoing sessions and therapeutic intervention. Specific strategies for assessing for Latino cultural values are described, and ways to integrate information about values into conceptualization of the client and the therapeutic process are also suggested. Becoming Aware of Biases and Assumptions For years, multicultural researchers and theorists have emphasized the need for clinicians to be aware of their own biases and assumptions, but this important suggestion warrants mention again, given how the process of assessment is replete with potential pitfalls or instances in which clinicians might use heuristics and cognitive biases (Garb, 1998, 2005) that can lead to misdiagnosis and/or misunderstanding (APA, 2003). Indeed, although an emphasis on cultural values is intended to help clinicians understand the particular worldview of each client, a careful self-assessment of one’s own values, worldviews, and biases is critical. Without this self-assessment, clinicians run the risk of using cultural values in the service of validating preexisting assumptions and stereotypes they have about their clients. For example, a female clinician working with a 76-year-old Puerto Rican male might assume that he adheres to the traditional gender role of machismo given his advanced age. This assumption might in turn shape both the questions she asks about his relationships and the meaning she ascribes to his answers. It is not difficult to imagine the clinician developing a conceptualization of a man who rigidly adheres to traditional gender roles and who might be reluctant to working with a female clinician, given the stereotypical negative characteristics of machismo as being sexist, domineering, and controlling. Conversely, if the clinician is able to suspend her assumptions and push beyond this preliminary assessment, she might learn about this 224       edwards and cardemil

client’s adherence to other relevant cultural values that provide her with a more nuanced and complex understanding of who this client is. In particular, this male client may also adhere to the cultural values of caballerismo and familismo. Moreover, he might feel conflicted about how the macho gender norm is affecting his interpersonal interactions but not have a clear sense of how to enact changes in his life. Clearly, working to bring assumptions and biases to awareness and attempting to keep them at bay is critical in working effectively with a client (APA, 2003). First Interactions With Clients Even for clinicians who take the time to understand their own assumptions, the assessment of cultural values can still be challenging. After all, clinicians first become acquainted with their clients in different ways: Some are assigned clients during team meetings, others read case notes about them before they meet; some have phone conversations, and others meet clients for the first time in the waiting room before a session. Every initial interaction provides opportunities to foster a strong working alliance and the notion that being purposeful about using cultural values in these interactions is important. This recommendation may seem odd because clinicians will not yet have had the opportunity to conduct an assessment of cultural values. And one certainly would not recommend that clinicians assume that their clients will adhere to the cultural values listed earlier. Nevertheless, we suggest that clinicians can make effective use of the cultural values that provide guidance for interpersonal interactions (i.e., respeto, personalismo, and simpatía), even in first interactions with Latino clients. The rationale behind this recommendation is that there is little risk in offending a client with their use, even if the client does not strongly adhere to them. Indeed, it is hard to imagine clients from any cultural or ethnic background being put off by respectful, yet warm and friendly, initial interactions. And for clients who value these guides to interpersonal interactions, being respectful and personable can be an important way to begin the therapeutic relationship positively. As noted earlier, showing an awareness of these values can be as simple as asking clients of Latino background their language preference and using the more formal usted when speaking in Spanish (González-Prendes et al., 2011). Similarly, engaging in plática [small talk] before beginning a session and using self-disclosure when appropriate may convey personalismo and simpatía to the client. It is not unusual for Latino clients to ask direct questions of the clinician during these first encounters, such as whether she or he is married or has children. Similarly, it is almost standard procedure for Latinos to ask other Latinos about their immigration history, including their approaches to assessing cultural values     

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country of origin, how long they have lived in the United States, and how often they have returned to their country of origin. Many Latino clients ask their clinicians whether they have ever been to the clients’ country of origin. Clinicians should remember that these questions likely do not represent efforts at pushing boundaries or seeking too much information; rather, these clients may be seeking to connect on a more familiar level with the professional from whom they have sought help. Clinical Interview Questions Beyond the initial clinical encounter, most of the important information clinicians acquire about their clients is gathered in the context of a clinical assessment. In much the same way, the assessment of cultural values should also be purposeful. In this section, we describe strategies for assessing cultural values through interviewing and directed questions. These are likely the most common way that clinicians will choose to measure values. Others (e.g., Grieger, 2008) have provided examples elsewhere for assessing cultural topics with clients who are ethnically diverse, but here we provide suggestions for probing the specific Latino cultural values that have been reviewed earlier in this chapter. To this end, readers may refer to the Interview Guide that can be found in Table 11.1. In this guide we provide definitions of the five groups of cultural values, as well as questions that practitioners can use to elicit information about clients’ adherence to them. Finally, information about how the responses to these questions (i.e., whether they reflect adherence to the particular value) might influence case conceptualization, assessment, and treatment is included. To illustrate the use of the Interview Guide, consider the following case example: A male clinician conducts an intake session with a 16-year-old Mexican American girl. From the intake forms that the adolescent completed in the waiting room, the clinician knows that the client prefers to speak English and identifies as “Mexican American” or “American.” The clinician’s first interactions with this young woman have been friendly and somewhat casual, and the clinician has engaged in plática about the weather, school that day, and whether she had trouble finding the clinic. As the clinician begins asking questions about her presenting concerns, he discovers that she is experiencing conflict with her parents and is frustrated about her lack of freedom to be with her friends and “live her life” as she wants. The clinician continues to assess and inquire about the general aspects of her functioning, but he also asks specific questions to elicit information about her level of adherence to cultural values. When asking about family, for example, he inquires about expectations that her family has for her and whether she finds these to be different from 226       edwards and cardemil

TABLE 11.1 Interview Guide for Assessing Latino/a Cultural Values

Latino/a cultural value

Definition of cultural value

Possible interview questions to assess for adherence to value

Implications of endorsement/adherence to value for clients

approaches to assessing cultural values     

Familismo [Familism]

•  Sense of attachment, commitment, and loyalty toward family members, including extended family

•  Tell me about your rela­ tionship with your family. •  What role do you play in your family? •  What are some impor­ tant expectations that your family has for you?

•  Client may have multiple caretaking roles (older and younger relatives). •  Client may prioritize relationships with rela­ tives over other relation­ ships and obligations. •  Family may be a source of support and strength.

Respeto [Respect]

•  An attitude toward others, especially those in authority and elders, that is more formal and polite

•  How would you like me to address you? •  Who has authority in your family or community? •  How do you (or your fam­ ily) manage disagree­ ment with others (or each other)?

•  Client may show defer­ ence to people in posi­ tions of authority in his or her life, even if they are not treated respect­ fully by these people. •  Client may value a hier­ archical family structure and may experience distress at challenges to the structure.

Implications of endorsement/adherence to value for therapeutic process •  May consult with family members as therapy proceeds or when mak­ ing decisions •  May benefit from bring­ ing family members into sessions •  May appreciate when a clinician shows respect for their family values •  May show respect and deference to clinician as expert •  Overt expressions of agreement with clini­ cian may not reflect internal ambivalence or disagreement

(continues)

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TABLE 11.1 Interview Guide for Assessing Latino/a Cultural Values   (Continued)

Latino/a cultural value

Definition of cultural value

Possible interview questions to assess for adherence to value

Implications of endorsement/adherence to value for clients •  May prioritize harmony in interpersonal inter­ actions over conflict or the fulfillment of certain obligations •  May prefer to associate with people who also demonstrate warmth and friendliness •  May find strength and comfort in spiritual tradition •  May feel as though mental health issues or other concerns are his or her “cross to bear”

Personalismo and simpatía

•  Style of personal inter­ actions that reflect warmth, harmony, friendliness, and less formality

•  What friendships and relationships are most important to you? •  What are they like? •  How do you prefer to relate to others (formally, casually)?

Religion and  spirituality (including fatalismo)

•  Connection to a higher power, spirits, saints, or other for meaning •  Belief that one’s future is predetermined

•  Tell me about the role that religion and spiritu­ ality play in your life. •  In what ways do you use religion and spirituality to help you cope with difficulty?

Marianismo and machismo/ caballerismo

•  Traditional female gen­ der role that empha­ sizes nurturance and self-sacrifice •  Traditional male gender role that emphasizes both protection/strength and responsibility

•  What does it mean to you to be a Latina woman or Latino man? •  What expectations do you (your family, your community, your culture) have about how you should act as a Latino or Latina?

Note.  Data from Añez et al. (2008), Cardemil and Battle (2003); and Grieger (2008).

•  May experience lack of congruence if gender role expectations are different from societal or community context •  May experience intra­ familial conflict if family members report dif­ ferential adherence to gender roles

Implications of endorsement/adherence to value for therapeutic process •  May engage clinician in platica [small talk] and appreciate when clini­ cian is not overly formal •  May not feel comfortable self-disclosing unless clinician demonstrates warmth and openness •  May choose to also seek help from spiritual healer (e.g., curandera, priest) •  May not feel as though changing beliefs or behaviors are within his or her control •  Gender differences between clinician and client may need to be addressed •  May have difficulty admitting need for help

other families’ expectations. With this line of questioning, the clinician discovers that the client’s parents expect her to attend all family events, even if there are school activities or events with friends at the same time. Her parents do not allow her to spend the night at her friends’ houses, and they clearly expect her to put her family’s wishes ahead of her own. The client continues to describe that she predominantly interacts with “Americans” (White adolescents) who she feels have parents who are much more understanding and give their children much more freedom. With these questions, the clinician begins to gain a better understanding of the tension that exists between the client’s desires to be like her White friends and her parents’ highly familistic values and expectations. One important point about the Interview Guide is that it does not suggest direct questions about cultural values. In particular, it may not be productive to ask clients directly about the extent to which they adhere to particular values. Instead, the questions found to be most useful are those that ask about the implications of the cultural values on the lives of the clients (e.g., What does family mean to you? What friendships are important to you? What role do religion and spirituality play in your life?). The answers to these questions can offer clinicians insight into the client’s worldview, as well as into familial and other interpersonal relationships that would help the assessment of adherence to cultural values. Quantitative Scales to Measure Latino/a Cultural Values In addition to thoughtful interviewing, a clinician may choose to administer a quantitative scale to measure Latino cultural values. Although it is beyond the scope of this chapter to review all the available measures that assess Latino/a cultural values, a few of the prominent measures that specifically assess Latino cultural values are highlighted. As mentioned earlier, we believe that cultural values are distinct from acculturation, because as it has been noted, most acculturation measures do not assess cultural values or worldview (Schwartz et al., 2010). Therefore, this chapter focuses on measures that assess worldview and cultural values orientations specifically and that do not focus on markers of acculturation such as language use and so forth. There are specific measures that assess cultural values individually. For example, there are measures of familismo (Lugo Steidel & Contreras, 2003) and machismo/caballerismo (Arciniega et al., 2008) developed for use with Latino populations. Two relatively recent contributions to the measurement of Latino cultural values include the Mexican American Cultural Values Scales for Adolescents and Adults (MACVS; Knight et al., 2010) and the Latino/a Values Scale (Kim, Soliz, Orellana, & Alamilla, 2009), each of approaches to assessing cultural values     

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which assesses several values. The MACVS includes six subscales reflecting Mexican values (familism-support, familism-obligation, familism-referent, respect, religion, traditional gender roles) and three subscales reflecting mainstream values (material success, independence and self-reliance, and competition and personal achievement). The Latino/a Values Scale focuses on pan-ethnic Latino values and includes four subscales about cultural pride, simpatía, familismo, and espiritismo. Although relatively new, both the measures have strong evidence of validity and reliability for the groups on which they were developed and appear to be promising tools for practitioners and researchers alike. Putting It All Together: Treatment Planning and Intervention Information about a client’s level of adherence to particular Latino cultural values, whether gathered through questioning or quantitative measures, can provide insight into potential treatment strategies and intervention and increase the probability of retaining the client in treatment (González-Prendes et al., 2011). For example, clients who endorse familistic values might benefit from assessment and treatment practices that involve important others in their lives, including extended family. These clients can be encouraged to bring relatives to sessions if they believe it will be helpful. Reflecting an attitude of respect toward a client’s family and being open to their presence in sessions is likely to improve the working alliance. Similarly, clients with strong religious or spiritual beliefs may elect to integrate religious practice into sessions or to involve religious healers in their community to help them with their concerns. Just discussing these treatment options can convey to clients that a clinician honors his or her cultural background and recognizes that the work of psychotherapy can be enhanced by engaging authentically and holistically with the client. In addition, an understanding of clients’ cultural values can offer clinicians guidance in discovering areas of strength and challenges in the lives of clients. An accurate assessment of a client’s familistic values can help a clinician understand why a 21-year-old Latina college student may be struggling with her life choices after graduation. Understanding a 45-year-old man’s adherence to caballerismo might offer insight into the meaning of a recent period of unemployment. A comprehensive awareness of the variation in adherence to cultural values in a multigenerational family can help a clinician navigate the complicated family dynamics that invariably emerge over the course of therapy. Insofar as cultural values provide a lens through which clients perceive and interact with the world, understanding these values in the lives of our clients can provide valuable insight and guidance into the healing process. 230       edwards and cardemil

CONCLUSION In this chapter, concrete strategies to aid clinicians in assessing cultural values and integrating this information into client conceptualizations and treatment planning were provided. As noted by Pieterse and Miller (2009), “The role of the clinician cannot be overemphasized, as the clinician is the instrument through which a culturally inclusive assessment is undertaken” (p. 662). Indeed, every action taken by the clinician provides the opportunity to increase treatment engagement and retention, build the working alliance, and by default, improve the odds for effective treatment. A comprehensive and accurate assessment of cultural values can improve this process. REFERENCES Abreu, J., Goodyear, R. K., Campos, A., & Newcomb, M. (2000). Ethnic belonging and traditional masculinity ideology among African Americans, European Americans, and Latinos. Psychology of Men & Masculinity, 1, 75–86. http:// dx.doi.org/10.1037/1524-9220.1.2.75 Alegría, M., Canino, G., Ríos, R., Vera, M., Calderón, J., Rusch, D., & Ortega, A. N. (2002). Mental health care for Latinos: Inequalities in use of specialty mental health services among Latinos, African Americans, and non-Latino Whites. Psychiatric Services, 53, 1547–1555. http://dx.doi.org/10.1176/appi. ps.53.12.1547 Alegría, M., Mulvaney-Day, N., Woo, M., Torres, M., Gao, S., & Oddo, V. (2007). Correlates of past-year mental health service use among Latinos: Results from the National Latino and Asian American Study. American Journal of Public Health, 97, 76–83. http://dx.doi.org/10.2105/AJPH.2006.087197 Alvidrez, J. (1999). Ethnic variations in mental health attitudes and service use among low-income African American, Latina, and European American young women. Community Mental Health Journal, 35, 515–530. http://dx.doi. org/10.1023/A:1018759201290 American Psychological Association. (2003). Guidelines on multicultural education, training, research, practice, and organizational change for psychologists. American Psychologist, 58, 377–402. http://dx.doi.org/10.1037/0003-066X.58.5.377 Añez, L. M., Silva, M. A., Paris, M., & Bedregal, L. E. (2008). Engaging Latinos through the integration of cultural values and motivational interviewing principles. Professional Psychology: Research and Practice, 39, 153–159. http://dx.doi. org/10.1037/0735-7028.39.2.153 Arciniega, M. G., Anderson, T. C., Tovar-Blank, Z., & Tracy, T. C. (2008). Toward a fuller conception of machismo: Development of a traditional machismo and caballerismo scale. Journal of Counseling Psychology, 55, 19–33. http://dx.doi. org/10.1037/0022-0167.55.1.19 approaches to assessing cultural values     

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of Community Psychology, 23, 339–356. http://dx.doi.org/10.1002/1520-6629 (199510)23:43.0.CO;2-7 Draguns, J. G. (1973). Comparisons of psychopathology across cultures. Journal of Cross-Cultural Psychology, 4, 10–47. Edwards, L. M., Fehring, R., Jarrett, K., & Haglund, K. (2008). The influence of religiosity, gender, and language preference acculturation on sexual activity among Latino/a adolescents. Hispanic Journal of Behavioral Sciences, 30, 447–462. http:// dx.doi.org/10.1177/0739986308322912 Edwards, L. M., Haglund, K., Fehring, R. J., & Pruszynski, J. (2011). Religiosity and sexual risk behaviors among Latina adolescents: Trends from 1995 to 2008. Journal of Women’s Health, 20, 871–877. http://dx.doi.org/10.1089/ jwh.2010.1949 Edwards, L. M., & Stubbs, L. (2012). Towards the prevention of sexual risk-taking among Latina youth. In L. Vera (Ed.), Oxford handbook of prevention in counseling psychology (pp. 285–298). New York, NY: Oxford University Press. Espinoza, G., Elizondo, V., & Miranda, J. (2003). Hispanic churches in American public life: Summary of findings. Retrieved from http://www.hispanicchurchesusa.net/ hcapl-rpt-1.pdf Félix-Ortiz, M., Abreu, J. M., Briano, M., & Bowen, D. (2001). A critique of machismo measures in psychological research. In F. Columbus (Ed.), Advances in psychology research: Vol. III (pp. 63–90). Huntington, NY: Nova Science. Fragoso, J. M., & Kashubeck, S. (2000). Machismo, gender role conflict, and mental health in Mexican American men. Psychology of Men & Masculinity, 1, 87–97. http://dx.doi.org/10.1037/1524-9220.1.2.87 Garb, H. N. (1998). Studying the clinician: Judgment research and psychological assessment. Washington, DC: American Psychological Association. Garb, H. N. (2005). Clinical judgment and decision making. Annual Review of Clinical Psychology, 1, 67–89. http://dx.doi.org/10.1146/annurev.clinpsy.1. 102803.143810 Gloria, A. M., Ruiz, E. L., & Castillo, E. M. (2004). Counseling and psychotherapy with Latino and Latina clients. In T. Smith (Ed.), Practicing multiculturalism: Affirming diversity in counseling and psychology (pp. 167–189). Boston, MA: Allyn & Bacon. Gonzalez-Guarda, R. M., Vasquez, E. P., Urrutia, M. T., Villarruel, A. M., & Peragallo, N. (2011). Hispanic women’s experiences with substance abuse, intimate partner violence, and risk for HIV. Journal of Transcultural Nursing, 22, 46–54. http://dx.doi.org/10.1177/1043659610387079 González-Prendes, A. A., Hindo, C., & Pardo, Y. F. (2011). Cultural values integration in cognitive–behavioral therapy for a Latino with depression. Clinical Case Studies, 10, 376–394. http://dx.doi.org/10.1177/1534650111427075 Grieger, I. (2008). A cultural assessment framework and interview protocol. In L. A. Suzuki, J. G. Ponterotto, & P. J. Meller (Eds.), Handbook of multicultural assessapproaches to assessing cultural values     

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ment: Clinical, psychological and educational applications (3rd ed., pp. 132–161). San Francisco, CA: Jossey-Bass. Guarnaccia, P. J., & Rogler, L. H. (1999). Research on culture-bound syndromes: New directions. The American Journal of Psychiatry, 156, 1322–1327. Harris, K. M., Edlund, M. J., & Larson, S. L. (2006). Religious involvement and the use of mental health care. Health Services Research, 41, 395–410. http://dx.doi. org/10.1111/j.1475-6773.2006.00500.x Hays, P. A. (2008). Addressing cultural complexities in practice (2nd ed.). Washington, DC: American Psychological Association. Herbst, J. H., Kay, L. S., Passin, W. F., Lyles, C. M., Crepaz, N., & Marín, B. V. (2007). A systematic review and meta-analysis of behavioral interventions to reduce HIV risk behaviors of Hispanics in the United States and Puerto Rico. AIDS and Behavior, 11, 25–47. http://dx.doi.org/10.1007/s10461-006-9151-1 Hernández, B., Ramírez García, J. I., & Flynn, M. (2010). The role of familism in the relation between parent–child discord and psychological distress among emerging adults of Mexican descent. Journal of Family Psychology, 24, 105–114. http:// dx.doi.org/10.1037/a0019140 Herrera, A. P., Lee, J. W., Nanyonjo, R. D., Laufman, L. E., & Torres-Vigil, I. (2009). Religious coping and caregiver well-being in Mexican-American families. Aging & Mental Health, 13, 84–91. http://dx.doi.org/10.1080/ 13607860802154507 Hill, P. C., & Pargament, K. I. (2003). Advances in the conceptualization and measurement of religion and spirituality: Implications for physical and mental health research. American Psychologist, 58, 64–74. http://dx.doi.org/10.1037/ 0003-066X.58.1.64 Ishikawa, R. Z., & Cardemil, E. V. (in press). Depression among Latinos across the lifespan. In H. Grey (Ed.), The cultural context of mental health. Oxford. Ishikawa, R. Z., Cardemil, E. V., & Falmagne, R. J. (2010). Help seeking and help receiving for emotional distress among Latino men and women. Qualitative Health Research, 20, 1558–1572. http://dx.doi.org/10.1177/1049732310369140 Jones, K. D. (2010). The unstructured clinical interview. Journal of Counseling & Development, 88, 220–226. http://dx.doi.org/10.1002/j.1556-6678.2010.tb00013.x Kim, B. S. K., Soliz, A., Orellana, B., & Alamilla, S. (2009). Latino/a Values Scale: Development, reliability and validity. Measurement and Evaluation in Counseling & Development, 42, 71–91. http://dx.doi.org/10.1177/0748175609336861 Kleinman, A. M., & Good, B. (1985). Culture and depression. Berkeley, CA: University of California Press. Knight, G. P., Gonzales, N. A., Saenz, D. S., Bonds, D. D., Germán, M., Deardorff, J., . . . Updegraff, K. A. (2010). The Mexican American Cultural Values Scales for Adolescents and Adults. The Journal of Early Adolescence, 30, 444–481. http://dx.doi. org/10.1177/0272431609338178

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Lagomasino, I. T., Dwight-Johnson, M., Miranda, J., Zhang, L., Liao, D., Duan, N., & Wells, K. B. (2005). Disparities in depression treatment for Latinos and site of care. Psychiatric Services, 56, 1517–1523. http://dx.doi.org/10.1176/appi. ps.56.12.1517 Liang, C. T. H., Salcedo, J., & Miller, H. A. (2011). Perceived racism, masculinity ideologies, and gender role conflict among Latino men. Psychology of Men & Masculinity, 12, 201–215. http://dx.doi.org/10.1037/a0020479 Lugo Steidel, A. G. L., & Contreras, J. M. (2003). A new familism scale for use with Latino populations. Hispanic Journal of Behavioral Sciences, 25, 312–330. http:// dx.doi.org/10.1177/0739986303256912 Marín, G., & Gamba, R. J. (2003). Acculturation and changes in cultural values. In K. M. Chun, P. B. Organista, & G. Marín (Eds.), Acculturation: Advances in theory, measurement, and applied research (pp. 83–94). Washington, DC: American Psychological Association. Merrill, R. M., Steffen, P., & Hunter, B. D. (2012). A comparison of religious orientation and health between Whites and Hispanics. Journal of Religion and Health, 51, 1261–1277. http://dx.doi.org/10.1007/s10943-010-9432-x Moreno, O., & Cardemil, E. V. (2013). Religiosity and mental health services: An exploratory study of help seeking among Latinos. Journal of Latina/o Psychology, 1, 53–67. Organista, K. C., Muñoz, R. F., & Gonzalez, G. (1994). Cognitive–behavioral therapy for depression in low-income and minority medical outpatients: Description of a program and exploratory analyses. Cognitive Therapy and Research, 18, 241–259. http://dx.doi.org/10.1007/BF02357778 Padgett, D. K., Patrick, C., Burns, B. J., & Schlesinger, H. J. (1994). Ethnicity and the use of outpatient mental health services in a national insured population. American Journal of Public Health, 84, 222–226. http://dx.doi.org/10.2105/ AJPH.84.2.222 Peña, J. B., Kuhlberg, J. A., Zayas, L. H., Baumann, A. A., Gulbas, L., HausmannStabile, C., & Nolle, A. P. (2011). Familism, family environment, and suicide attempts among Latina youth. Suicide and Life-Threatening Behavior, 41, 330–341. http://dx.doi.org/10.1111/j.1943-278X.2011.00032.x Pieterse, A. L., & Miller, M. J. (2009). Current considerations in the assessment of adults: A review and extension of culturally inclusive models. In J. Ponterotto, L. A. Suzuki, C. Alexander, & J. M. Cases (Eds.), Handbook of multicultural counseling (3rd ed., pp. 649–666). Thousand Oaks, CA: Sage. Rios-Elliot, B., Aguilar-Gaxiola, S., Cabassa, L., Caetano, R., Comas-Diaz, L., Flores, Y., . . . Ugarte, C. (2005). Critical disparities in Latino mental health: Transforming research into action. Washington, DC: National Council of La Raza. Rivera, L. M. (2008). Acculturation and multicultural assessment: Issues, trends, and practice. In L. A. Suzuki & J. G. Ponterotto (Eds.), Handbook of multicultural assessment (3rd ed., pp. 73–91). San Francisco, CA: Jossey-Bass. approaches to assessing cultural values     

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Romero, A. J., Edwards, L. M., & Corkery, S. (2013). Assessing and treating Latinos: Overview of mental health research. In F. Paniagua & A. Yamada (Eds.), Handbook of multicultural mental health (2nd ed., pp. 327–343). San Diego, CA: Elsevier. Santiago-Rivera, A., Arredondo, P., & Gallardo-Cooper, M. (2002). Counseling Latinos and la familia: A practical guide. Thousand Oaks, CA: Sage. Schraufnagel, T. J., Wagner, A. W., Miranda, J., & Roy-Byrne, P. P. (2006). Treating minority patients with depression and anxiety: What does the evidence tell us? General Hospital Psychiatry, 28, 27–36. http://dx.doi.org/10.1016/j. genhosppsych.2005.07.002 Schwartz, S. J., Unger, J. B., Zamboanga, B. L., & Szapocznik, J. (2010). Rethinking the concept of acculturation: Implications for theory and research. American Psychologist, 65, 237–251. http://dx.doi.org/10.1037/a0019330 Smith, T. B., Rodríguez, M. D., & Bernal, G. (2011). Culture. Journal of Clinical Psychology, 67, 166–175. http://dx.doi.org/10.1002/jclp.20757 Sternthal, M. J., Williams, D. R., Musick, M. A., & Buck, A. C. (2010). Depression, anxiety, and religious life: A search for mediators. Journal of Health and Social Behavior, 51, 343–359. http://dx.doi.org/10.1177/0022146510378237 Tiemann, J. (2005). A Hispanic American assessee (Spanish and English TAT/ Rorschach CS Versions). In R. Dana (Ed.), Multicultural assessment: Principles, applications and examples (pp. 213–242). Hillsdale, NJ: Erlbaum. Torres, J. B., Solberg, V. S., & Carlstrom, A. H. (2002). The myth of sameness among Latino men and their machismo. American Journal of Orthopsychiatry, 72, 163–181. http://dx.doi.org/10.1037/0002-9432.72.2.163 Umaña-Taylor, A. J., & Fine, M. A. (2001). Methodological implications of grouping Latino adolescents into one collective ethnic group. Hispanic Journal of Behavioral Sciences, 23, 347–362. http://dx.doi.org/10.1177/0739986301234001 Vega, W. A., & Alegría, M. (2001). Latino mental health and treatment in the United States. In M. Aguirre-Molina, C. W. Molina, & R. E. Zambrana (Eds.), Health issues in the Latino community (pp. 179–208). San Francisco, CA: JosseyBass. Wells, K., Klap, R., Koike, A., & Sherbourne, C. (2001). Ethnic disparities in unmet need for alcoholism, drug abuse, and mental health care. The American Journal of Psychiatry, 158, 2027–2032. http://dx.doi.org/10.1176/appi.ajp.158.12.2027

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12 ASSESSMENT OF ANXIETY IN LATINOS DENISE A. CHAVIRA AND ANDREA LETAMENDI

Anxiety disorders are the most common category of psychiatric disorder in the United States. Data from large-scale epidemiological studies suggest a lifetime prevalence rate of 29% for any anxiety disorder (Kessler et al., 2005). Among Latinos, lifetime rates of anxiety disorders range from 15% to 25%, and higher rates have been found for women than men (Karno et al., 1987; Vega et al., 1998; Vega, Sribney, Aguilar-Gaxiola, & Kolody, 2004). Findings have been inconsistent regarding differential prevalence rates across ethnic groups. In epidemiological studies, prevalence rates of anxiety disorders for Latinos have been reported as higher, lower, and comparable to non-Latino Whites (Alegría et al., 2007; Breslau et al., 2006; Hernandez, Plant, SachsEricsson, & Joiner, 2005). The reasons for these differences are multiple and include factors related to measurement variance, conceptualizations of anxiety, and sample differences related to country of origin, acculturation, migration status, and other socioeconomic factors. http://dx.doi.org/10.1037/14668-013 Psychological Testing of Hispanics, Second Edition: Clinical, Cultural, and Intellectual Issues, K. F. Geisinger (Editor) Copyright © 2015 by the American Psychological Association. All rights reserved.

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In a landmark epidemiological survey of psychiatric disorders that focused on Latinos and Asian Americans (The National Latino and Asian American Study [NLAAS]; Alegría et al., 2004), extensive efforts were made to recruit Latinos and Asians from various ethnic subgroups and to ensure cultural appropriateness in all aspects of design. Findings from this study suggest that rates of anxiety disorders vary by Latino subethnicity, nativity, and gender (Alegría et al., 2007, 2008; Breslau et al., 2006). Specifically, Mexican immigrants had lower rates of anxiety disorders than other non-Latino groups; however, this was not the case for Cubans, Puerto Ricans, and “Other Latinos.” Further, Mexican and “Other Latina” women were less likely than Puerto Rican women to have had an anxiety disorder in the previous year. In general, Puerto Ricans had similar rates of anxiety disorders as non-Latino Whites. Such findings underscore the importance of within-group differences among Latinos with anxiety disorders. TREATMENT UTILIZATION Despite the prevalence of anxiety disorders, Latinos are less likely to use mental health services than other groups (Alegría et al., 2008). Underutilization of mental health services by Latinos has been associated with a variety of barriers, including logistical factors, beliefs about causes, stigma, and the potential influence of social networks. Spanish-speaking Latinos also report more dissatisfaction with provider communication and language barriers than English-speaking Latino and non-Latino White participants (Morales, Cunningham, Brown, Liu, & Hays, 1999; Vega, Kolody, & Aguilar-Gaxiola, 2001). A related barrier faced by Latinos is that many assessments have been normed only on non-Latino White samples, and few have been subjected to rigorous translation and cultural equivalency methods. ASSESSMENTS OF ANXIETY IN LATINOS: WHAT IS THE EVIDENCE? In the presence of limited research on the cross-cultural equivalence of measures, the task of finding appropriate assessments for Latinos with anxiety disorders is often difficult. Many of the most well-established measures have limited psychometric support with Latinos, and even less support when considering Latinos from varying acculturation levels, socioeconomic backgrounds, language, and literacy levels. In this chapter, we provide a discussion of some of the gold standard measures to assess anxiety and their use with Latinos. In doing so, we discuss the psychometric properties of existing 238       chavira and letamendi

assessments with Latinos, as well as broader issues such as cultural idioms of distress and differential rates of specific anxiety disorders. Given limited data on this topic, a broad literature search was initially conducted using the databases PubMed and PsycINFO with the following relevant keywords: anxiety, Latino/Hispanic, Spanish, and assessment, in various combinations. Additional searches were then conducted to identify scales that may have been used with Latinos who have anxiety disorders: Latino/Hispanic and panic disorder, posttraumatic stress disorder (PTSD), social phobia, phobia, worry, generalized anxiety disorder, obsessive–compulsive disorder, nervios, and ataque de nervios. Although Spanish translations of many anxiety measures were identified, in this chapter, we focus on those that are most commonly used across the anxiety disorders and that have the most available psychometric support with Latinos. CLINICAL DIAGNOSTIC INTERVIEWS Semistructured Diagnostic Interviews The Anxiety Disorders Interview Schedule (ADIS; Brown, Di Nardo, & Barlow, 1994; Di Nardo, Moras, Barlow, Rapee, & Brown, 1993) is a well-established semistructured, clinician-administered interview that corresponds to Diagnostic and Statistical Manual of Mental Disorders (fourth ed.; DSM–IV; American Psychiatric Association, 1994) and includes modules for anxiety, mood, somatoform, and substance use disorders. The reliability of the ADIS for almost all diagnoses has been good to excellent, with kappas ranging from .60 to .86 (Blanchard, Gerardi, Kolb, & Barlow, 1986; Brown, Di Nardo, Lehman, & Campbell, 2001). At present, the ADIS has been used in various clinical trials with U.S. Latino samples who are English speaking, as well as with foreign-born Spanish-speaking participants from Mexico and Spain (Casa, del Carmen Delgado Alvarez, Lopez, & Aranda, 2012; GarcíaLópez, Olivares, & Vera-Villarroel, 2003; Quero, Banos, Botella, & Gallardo, 2003). Although the ADIS has been used with Latino samples, specific psycho­ metric properties of the ADIS–Spanish version have not been presented. The Structured Clinical Interview for DSM–IV Axis I Disorders (SCID; First, Spitzer, Gibbon, & Williams, 1995; Spitzer, Williams, Gibbon, & First, 1990) is the most widely used semistructured interview for a large range of psychiatric disorders. In contrast to the ADIS, its focus is broad, including mood, substance use, eating, anxiety, and psychotic disorders. In general, acceptable reliabilities have been found for anxiety disorders, although some uncertainty exists with regard to reliabilities for obsessive–compulsive dis­order and agoraphobia. The SCID was initially translated in 1995 by a multisite assessment of anxiety in latinos     

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collaborative group with significant expertise in psychiatric disorders, Latino mental health, and Spanish translation methods (First, Spitzer, Gibbon, & Williams, 1999). It is frequently used with both U.S. and foreign-born Spanish-speaking Latinos in cross-sectional studies and randomized controlled trials (Torrens, Serrano, Astals, Pérez-Domínquez, & Martín-Santos, 2004; Vázquez, Torres, Otero, & Díaz, 2011). Although psychometric studies are few, among foreign-born Spanish speakers (from Spain) data suggest good to excellent concordance with a clinical gold standard for any anxiety disorder and for panic disorder with or without agoraphobia (kappa = .58–.76; Torrens et al., 2004). The Schedule for Affective Disorders and Schizophrenia (SADS; Endicott & Spitzer, 1978) is a semistructured interview, with supplemental versions focused on bipolar illness and anxiety disorders (SADS—Lifetime Anxiety; SADS–LA). Diagnoses are made according to specific research diagnostic criteria, and the SADS–LA has been modified to adhere to DSM criteria. A broad range of psychiatric disorders is assessed, and dimensional summary scales are also included. The SADS has substantial reliability and validity data (criterion, concurrent, and convergent) supporting its use (Rogers, 1995). It has been translated into 10 languages; however, limited psychometric data are available regarding its use in Spanish (Alvarez, Urretavizcaya, Benlloch, Vallejo, & Menchón, 2011; Vizcarro, Leon, Garcimartin, & Garcia, 1986). Structured Diagnostic Interviews The Diagnostic Interview Schedule (DIS; Robins, Helzer, Croughan, & Ratcliff, 1981) is a structured interview that assesses the full range of DSM psychiatric diagnoses and can be administered by both professional and lay interviewers. It has good to acceptable interrater and test–retest reliability (Erdman et al., 1987), but some problems have emerged with reliability for panic disorder and social phobia (Greist et al., 1987; Neufeld, Swartz, Bienvenu, Eaton, & Cai, 1999; Robins, Helzer, Ratcliff, & Seyfried, 1982). The DIS has been translated into Spanish and there are considerable data supporting its use in U.S.-based epidemiological and cross-sectional studies (Karno, Burnam, Escobar, Hough, & Eaton, 1983; Rogers, 1995). Specifically, adequate test–retest reliability among U.S. monolingual patients and fair to good agreement among U.S. bilingual patients have been reported (Karno et al., 1987; Rogers, 1995). In a study based in Spain, which compared the DIS with a clinical standard, sensitivities for 14 diagnoses ranged from .64 to 1.00, and specificities were above .93 for all diagnoses; kappa values ranged from .50 to 1.00 and were greater than .60 for 11 of 14 categories (Alcázar et al., 1992). Although there is psychometric support with Latinos, given 240       chavira and letamendi

its moderate reliability with some anxiety disorders, it may be advisable to supplement the DIS with other anxiety assessments. The Composite International Diagnostic Interview (CIDI; Kessler & Ustün, 2004) is a structured diagnostic interview that broadened the DIS to allow for its use across cultures and to assess diagnoses according to both DSM and international criteria (Andrews & Peters, 1998). Clinical reappraisal studies that have included samples from France, Spain, Italy, and the United States have shown good concordance for anxiety and mood dis­order diagnoses using the SCID (Haro et al., 2006). In a clinical reappraisal study of NLAAS data, which included both English- and Spanish-speaking Latinos living in the United States, concordance rates with the SCID were marginally lower than rates from other studies, particularly for PTSD and generalized anxiety dis­ order (GAD); however, rates were good for panic disorder (Alegría et al., 2009). According to Alegría et al. (2009), possible strategies that may improve the diagnostic concordance for structured interviews with Latinos include (a) expanding the screening questions, (b) incorporating greater flexibility regarding time frames, (c) gathering more information within each section before ending the session, (d) clarifying the threshold for severity and giving more information on impairment, and (e) loosening the criteria for certain disorders that may not be entirely consistent with illness expressions typical of Latinos. SELF-REPORT MEASURES OF ANXIETY WITH LATINO ADULTS The State–Trait Anxiety Inventory (STAI; Spielberger, Gorsuch, & Luschene, 1970) is a 40-item self-report scale that distinguishes between a general proneness to anxious behavior rooted in the personality (trait anxiety) and anxiety as a transitory emotional state (state anxiety). The STAI contains questions relating to self-confidence, as well as to physical and psychological manifestations of anxiety. Although not directly intended to assess for the presence of psychiatric disorders, the STAI–Trait is highly correlated with psychopathology, particularly with anxiety and depression (Endler, Cox, Parker, & Bagby, 1992; Spielberger et al., 1970). Both the State and Trait versions have been translated to Spanish (Spielberger & Diaz-Guerrero, 1975) and show good internal consistency (.82–.95) and validity across language versions in U.S.- and foreign-born Latinos (Novy, Nelson, Goodwin, & Rowzee, 1993; Novy, Nelson, Smith, Rogers, & Rowzee, 1995; Virella, Arbona, & Novy, 1994). Mixed findings have emerged regarding the factor structure of the Spanish STAI, suggesting the need for possible revision to improve the validity of the measure with Spanish speakers (Virella et al., 1994). The Beck Anxiety Inventory (BAI; Beck, Epstein, Brown, & Steer, 1988) is a widely used measure with established psychometric properties, assessment of anxiety in latinos     

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including good internal consistency, test–retest reliability and convergent and discriminant validity (Beck et al., 1988). It consists of 21 items that assess somatic symptoms of anxiety that are not specific to an anxiety disorder. The reported internal consistency for the Spanish language version among bilingual adults living in the United States (alpha = .94) and the convergent validity of the BAI with other anxiety measures (r = .67) have been good (Novy, Stanley, Averill, & Daza, 2001). In a study examining the factor structure of the BAI among college students in the United States, a twofactor solution emerged for both Latino and non-Latino Whites (Contreras, Fernandez, Malcarne, Ingram, & Vaccarino, 2004). Latinos had slightly higher mean scores than non-Latino Whites on some symptoms; however, these differences were not considered clinically meaningful. The Depression and Anxiety Stress Scales (DASS; Lovibond & Lovibond, 1995) was developed to provide a highly discriminating measure of anxiety and depression. The DASS consists of 42 items and has three scales—Depression, Anxiety, and Stress—each consisting of 14 items. The Anxiety scale assesses autonomic arousal, muscular tension, and anxious affect. Factor-analytic studies of the DASS using both clinical and nonclinical samples supported the intended three-factor structure (Antony, Bieling, Cox, Enns, & Swinson, 1998; Lovibond & Lovibond, 1995). The DASS has good reliability and construct and divergent validity across Spanish-speaking Latinos in the United States (Daza, Novy, Stanley, & Averill, 2002; Norton, 2007). Multigroup confirmatory factor analyses suggested that the item loadings on the respective scales were consistent across racial groups; however, the factors were differentially interrelated across groups, suggesting that caution may be warranted when using the scale across groups (Norton, 2007). The Anxiety Sensitivity Index (ASI; Reiss, Peterson, Gursky, & McNally, 1986) is a 16-item measure that assesses fear of anxiety-related symptoms that results from beliefs that such symptoms have harmful social, psychological, and somatic effects. Good internal consistency (.79–.90) and test–retest reliability (r = .75) have been noted for both non-Latino White and ethnic minority samples (Reiss et al., 1986). The Spanish version of the ASI has been found to have a coefficient alpha of .94 among bilingual adults residing in the United States, and the convergent validity of the Spanish version with other anxiety measures has been good (Cintrón, Carter, Suchday, Sbrocco, & Gray, 2005; Novy et al., 2001). Among non-Latino Whites, a factor structure with three factors is commonly reported (Physical Concerns, Social Concerns, and Mental Incapacitation Concerns), as well as a general higher-order factor (Zinbarg, Mohlman, & Hong, 1999). However, in a study that examined the revised ASI across six countries (including Mexico, Spain, and the United States; Zvolensky et al., 2003), and in studies of island-based Puerto Ricans, separate and distinct two-factor structures 242       chavira and letamendi

have emerged (Cintrón et al., 2005). Additional studies are necessary to understand the validity of the construct of anxiety sensitivity across different Latino subgroups. CULTURAL EQUIVALENCY IN ASSESSMENTS At present, the literature supporting the psychometric properties of anxiety measures with Latinos, both clinician-administered and self-report, is limited. Although some gold standard anxiety measures are widely used in Latino and Spanish-speaking samples, there is often an absence of data to support the use of the instrument with the given sample. In addition, studies have only begun to consider the effects of acculturation, education level, and language proficiency or preference on psychometric properties of measures. Given that Latinos are an incredibly heterogeneous group with diverse linguistic, national, political, social class, and immigration backgrounds, ensuring cultural measurement equivalency can be a complicated, timeconsuming, and costly undertaking. However, given the growing presence of Latinos, the increasing rates of anxiety disorders across acculturation levels, and the associated impact of anxiety disorders, such efforts are necessary. A model to guide cultural equivalence in assessments has been suggested by leaders in the field of cultural psychology and psychiatry (Bravo, Canino, Rubio-Stipec, & Woodbury-Fariña, 1991; G. Canino & Bravo, 1994). In this model, equivalency in the following domains is suggested: (a) semantic equivalence (similar meaning of items across cultures), (b) content equivalence (items are relevant to the study population), (c) technical equivalence (formats and layouts are similar, and the assessment strategy has same effect across cultures; e.g., use of telephone interviews across cultures), (d) criterion equivalence (similar evaluation and interpretation of results), and (e) conceptual equivalence (the same construct is being evaluated). To achieve these goals, qualitative and quantitative studies, bilingual and multi­national committees, and modern test adaptation methods are required. Future psychometric efforts are well-advised to adhere to such guidelines to further improve the assessment of anxiety among Latinos. CULTURAL EXPRESSIONS OF ANXIETY Ataques de Nervios In addition to establishing the psychometric properties of measures with Latino and Spanish-speaking samples, efforts to understand cultural assessment of anxiety in latinos     

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conceptualizations of anxiety and specific expressions of distress are critical to improving anxiety assessment among Latinos. Much research surrounds the cultural idiom of distress called ataques de nervios and its overlap with anxiety disorders and symptoms. Translated as “nervous attacks,” symptoms of ataques de nervios include trembling, crying spells, uncontrollable screaming, and sudden verbal and physical aggression (López & Guarnaccia, 2000). Additional symptoms may include dizziness or fainting, dissociation, and suicidal gestures. These attacks are most prevalent among Puerto Rican and Caribbean populations, and episodes often occur after a stressful life event or significant loss (López & Guarnaccia, 2000). Like panic attacks, ataques de nervios are acute, out-of-control episodes that occur with higher frequency in individuals who are generally nervous, even though all people under stress may experience an ataque at some point in their lives (Guarnaccia, LewisFernández, & Marano, 2003). Indeed, reports show overlap between ataques de nervios and panic disorder (Lewis-Fernández et al., 2002; Salmán et al., 1998). However, only a third of ataques fulfill DSM–IV criteria for panic attacks, and only 17% fulfill panic disorder criteria, suggesting that ataques are not completely accounted for by DSM criteria. When co-occuring with a DSM–IV affective disorder, ataques are associated with more anger, screaming, and aggression. To further examine ataques de nervios, Guarnaccia and colleagues (2009) included items to assess for ataques in the NLAAS. Ataques de nervios were reported among 7% to 15% of the entire Latino sample, with Puerto Ricans reporting the highest frequency. Interestingly, ataques de nervios were more likely reported by those more acculturated to the United States (based on nativity, language), which may be related to loss of social support and discrimination among those with higher levels of acculturation (Guarnaccia et al., 2009). Ataques de nervios is included in Appendix A of DSM–IV, but this form of distress is not captured by most commonly used measures of anxiety. Questions regarding ataques should be included in assessments with Latinos, and efforts are necessary to educate clinicians and researchers about this cultural expression of distress. Nervios Another cultural idiom of distress that has been studied among Latinos and is related to anxiety disorders is nervios. Nervios differs from ataques because it represents more of a generalized state of distress rather than a discrete episode. The phenomenon of nervios has been found in numerous cultures and is therefore not a culture-bound syndrome. However, according to leading cultural anthropologists, among Latinos the concept of nervios represents an expression of both physical and emotional distress that emerges from conflicts in various life domains (e.g., family, legal status, parenting, 244       chavira and letamendi

gender roles) and most often occurs in the context of social oppression and disadvantage (Guarnaccia & Farias, 1988). In many Latin American countries, nervios often represents a culturally acceptable mode of distress and is not synonymous with mental illness. According to experts in the field, nervios is more of a process that weakens the person as a whole rather than an isolated crisis. Indeed, a spectrum approach can be applied where not all individuals with nervios have a mental illness; however, the ongoing presence of nervios may increase risk of pathology such as mood and anxiety disorders in these individuals, especially in the context of numerous stressors (Salgado de Snyder, Diaz-Perez, & Ojeda, 2000). Somatic symptoms associated with nervios include headaches, backaches, trembling, lack of appetite and sleep, fatigue, physical agitation, menstrual irregularity, vomiting during entire pregnancy, lump in the throat, difficulty breathing, chest pain, stomachache, nausea, diarrhea, flatulence, dizziness, blurred vision, fevers, and sweating among others (Salgado de Snyder, Diaz-Perez, & Maldonado, 1995). Psychological symptoms associated with nervios include irritability, anger, sadness, obsessive ideation, overwhelming concerns, lack of concentration, confusion, crying spells, fears, anxiety, and erratic behavior (Finkler, 1985; Salgado de Snyder et al., 1995). Many of these complaints overlap with symptoms of depression and anxiety (generalized anxiety, in particular), and individuals who report problems with nervios also have higher scores on depression and anxiety scales (Salgado de Snyder et al., 1995). In a prevalence study of nervios (Salgado de Snyder et al., 2000), questions were included to screen for nervios; these items queried (a) having “an idea stuck to one’s mind,” (b) feeling distracted or absentminded, (c) feeling sad or down, and (d) feeling irritable and angry. A final question asked, “Have you ever suffered from nervios?” Similar questions or reworded items should be added to intake interviews and assessments with Latino populations to ensure that expressions of distress characterized as nervios are not overlooked and that appropriate differentials, using a cultural framework, are considered. SOMATIZATION OF ANXIETY DISORDERS Several studies have found that Latinos are more likely to endorse somatic symptoms as a key feature of anxiety or worry. In particular, findings from clinical samples of patients with anxiety and depressive disorders have suggested that Latinos report more somatic and physiological sensations than their non-Latino White counterparts (Escobar, Gomez, & Tuason, 1983; Mezzich & Raab, 1980). However, differences by Latino subgroups and language use have been noted. In adult epidemiological studies, Puerto Ricans assessment of anxiety in latinos     

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endorse higher rates of somatic symptoms compared with non-Latino Whites and Mexican Americans, even after controlling for relevant demographic factors (I. A. Canino, Rubio-Stipec, Canino, & Escobar, 1992). In a study of 87 bilingual U.S. Latinos with GAD who completed various anxiety measures, factor analyses supported two factors for subjects who completed the scales in Spanish (a somatic factor accounting for 59% of the variance and a psychological factor accounting for 19% of the variance) and one main factor for subjects who completed the measures in English (accounting for 64% of the variance; Hirai, Stanley, & Novy, 2006). In this study, the construct of psychological worry predicted GAD severity for the English speakers only, whereas physiological and somatic symptoms predicted GAD severity for both language cohorts. The reasons for differential endorsement rates of somatic symptoms are varied. Some have proposed that Latinos may perceive somatic complaints as less stigmatizing and therefore more readily report such symptoms. Others have explained that Latinos believe that they are more likely to receive care if they disclose physical problems rather than mental health problems (I. A. Canino et al., 1992). Measurement issues may also contribute to these differences. Findings have suggested that clinicians may be well-advised to exercise flexibility when assessing somatic symptoms among patients with anxiety, particularly because of variations across cultures (Hirai et al., 2006; Lewis-Fernández et al., 2010). Measures that tap into both the physiological and cognitive components of anxiety should be administered, especially to individuals who are primarily Spanish speaking. THE CASE OF POSTTRAUMATIC STRESS DISORDER Research with Latino populations has suggested that they may be at higher risk of PTSD and trauma-related events that lead to the disorder than are non-Latino groups (Alcántara, Casement, & Lewis-Fernández, 2013; Pole, Best, Metzler, & Marmar, 2005). In a study examining prevalence rates of PTSD in Vietnam veterans, Latinos had a higher point prevalence of PTSD than non-Latino Whites and Blacks, even after controlling for trauma exposure and demographic characteristics (Kulka et al., 1990). In a separate study of 5,475 treatment-seeking veterans, Puerto Rican veterans had more severe PTSD symptoms than did non-Latino Whites or non-Latino Black veterans (Rosenheck & Fontana, 1996). Similarly, in civilian samples, higher rates of PTSD symptoms have been found among Latino police officers compared with their non-Latino White and Black counterparts (Pole et al., 2001), and higher rates of PTSD were also reported by Latinos following the September 11th terrorist attacks (Galea et al., 2007). 246       chavira and letamendi

Recent work attempting to clarify possible mediating factors for these differences has suggested that elevated rates of combat PTSD are not solely accounted for by greater trauma exposure (Dohrenwend, Turner, Turse, Lewis-Fernández, & Yager, 2008). In addition, studies have suggested that higher rates of PTSD are not simply an artifact of greater emotional expressiveness among Latinos (Lewis-Fernández et al., 2008; Pole et al., 2005). Among veterans, military race-based discrimination and mistreatment have emerged as possible mediators for higher rates of trauma-related stress (Ruef, Litz, & Schlenger, 2000). In addition, some studies have suggested that higher rates of “peritraumatic” responses among Latinos (e.g., dissociative symptoms, altered state of consciousness during or immediately after the trauma), may increase risk of PTSD (Alcántara et al., 2013; Pole et al., 2005). In the presence of differential risk and prevalence, it is particularly important to consider issues of culture and measurement equivalence when assessing Latinos with trauma-related stress. Given low concordance rates between clinician administered and lay-person administered diagnostic interviews for PTSD with Latino samples (Alegría et al., 2009; Lewis-Fernández et al., 2008), as well as inherent weaknesses in self report measures, trauma-related assessment should be multimethod, including both objective and subjective measures of PTSD-related symptoms and impairment (Alcántara et al., 2013). CONCLUSION Culturally competent practice should strive for assessments that are developed and validated using diverse samples. Further, a greater emphasis should be placed on establishing the cultural equivalence of existing gold standard anxiety assessments with demographically and linguistically diverse samples. Given that anxiety disorders are as numerous as their assessment tools, the charge is great. However, at present, there is emerging literature to support the use of a small number of anxiety measures with Latinos, and important findings in cultural psychology and psychiatry continue to inform assessment practices. Continued efforts in these directions have the potential to lessen the impact of measurement artifact on assessment practices and improve mental health services for Latinos. REFERENCES Alcántara, C., Casement, M. D., & Lewis-Fernández, R. (2013). Conditional risk for PTSD among Latinos: A systematic review of racial/ethnic differences and sociocultural explanations. Clinical Psychology Review, 33, 107–119. http:// dx.doi.org/10.1016/j.cpr.2012.10.005 assessment of anxiety in latinos     

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Guarnaccia, P. J., Lewis-Fernandez, R., Pincay, I. M., Shrout, P., Guo, J., Torres, M., . . . Alegria, M. (2009). Ataque de nervios as a marker of social and psychiatric vulnerability: Results from the NLAAS. International Journal of Social Psychiatry, 56, 298–309. http://dx.doi.org/10.1177/0020764008101636 Haro, J. M., Arbabzadeh-Bouchez, S., Brugha, T. S., de Girolamo, G., Guyer, M. E., Jin, R., . . . Kessler, R. C. (2006). Concordance of the Composite Inter­national Diagnostic Interview Version 3.0 (CIDI 3.0) with standardized clinical assessments in the WHO World Mental Health surveys. International Journal of Methods in Psychiatric Research, 15, 167–180. http://dx.doi. org/10.1002/mpr.196 Hernandez, A., Plant, E. A., Sachs-Ericsson, N., & Joiner, T. E., Jr. (2005). Mental health among Hispanics and Caucasians: Risk and protective factors contributing to prevalence rates of psychiatric disorders. Journal of Anxiety Disorders, 19, 844–860. http://dx.doi.org/10.1016/j.janxdis.2004.11.002 Hirai, M., Stanley, M. A., & Novy, D. M. (2006). Generalized anxiety disorder in Hispanics: Symptom characteristics and prediction of severity. Journal of Psychopathology and Behavioral Assessment, 28, 49–56. http://dx.doi.org/10.1007/s10862006-4541-2 Karno, M., Burnam, A., Escobar, J. I., Hough, R. L., & Eaton, W. W. (1983). Development of the Spanish-language version of the National Institute of Mental Health Diagnostic Interview Schedule. Archives of General Psychiatry, 40, 1183–1188. http://dx.doi.org/10.1001/archpsyc.1983.01790100029003 Karno, M., Hough, R. L., Burnam, M. A., Escobar, J. I., Timbers, D. M., Santana, F., & Boyd, J. H. (1987). Lifetime prevalence of specific psychiatric dis­ orders among Mexican Americans and non-Hispanic Whites in Los Angeles. Archives of General Psychiatry, 44, 695–701. http://dx.doi.org/10.1001/ archpsyc.1987.01800200021004 Kessler, R. C., Berglund, P., Demler, O., Jin, R., Merikangas, K. R., & Walters, E. E. (2005). Lifetime prevalence and age-of-onset distributions of DSM–IV disorders in the National Comorbidity Survey replication. Archives of General Psychiatry, 62, 593–602. http://dx.doi.org/10.1001/archpsyc.62.6.593 Kessler, R. C., & Ustün, T. B. (2004). The World Mental Health (WMH) Survey Initiative Version of the World Health Organization (WHO) Composite International Diagnostic Interview (CIDI). International Journal of Methods in Psychiatric Research, 13, 93–121. http://dx.doi.org/10.1002/mpr.168 Kulka, R. A., Schlesenger, W. E., Fairbank, J. A., Hough, R. L., Jordan, B. K., & Marmar, C. R. (1990). Trauma and the Vietnam War generation: Report of findings from the National Vietnam Veterans Readjustment Study. New York, NY: Brunner/ Mazel. Lewis-Fernández, R., Guarnaccia, P. J., Martínez, I. E., Salmán, E., Schmidt, A., & Liebowitz, M. (2002). Comparative phenomenology of ataques de nervios, panic attacks, and panic disorder. Culture, Medicine, and Psychiatry, 26, 199–223. http://dx.doi.org/10.1023/A:1016349624867 assessment of anxiety in latinos     

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Lewis-Fernández, R., Hinton, D. E., Laria, A. J., Patterson, E. H., Hofmann, S. G., Craske, M. G., . . . Liao, B. (2010). Culture and the anxiety disorders: Recommendations for DSM–V. Depression and Anxiety, 27, 212–229. http://dx.doi. org/10.1002/da.20647 Lewis-Fernández, R., Turner, J. B., Marshall, R., Turse, N., Neria, Y., & Dohrenwend, B. P. (2008). Elevated rates of current PTSD among Hispanic veterans in the NVVRS: True prevalence or methodological artifact? Journal of Traumatic Stress, 21, 123–132. http://dx.doi.org/10.1002/jts.20329 López, S. R., & Guarnaccia, P. J. J. (2000). Cultural psychopathology: Uncovering the social world of mental illness. Annual Review of Psychology, 51, 571–598. http://dx.doi.org/10.1146/annurev.psych.51.1.571 Lovibond, P. F., & Lovibond, S. H. (1995). The structure of negative emotional states: Comparison of the Depression Anxiety Stress Scales (DASS) with the Beck Depression and Anxiety Inventories. Behaviour Research and Therapy, 33, 335–343. http://dx.doi.org/10.1016/0005-7967(94)00075-U Mezzich, J. E., & Raab, E. S. (1980). Depressive symptomatology across the Americas. Archives of General Psychiatry, 37, 818–823. http://dx.doi.org/10.1001/ archpsyc.1980.01780200096012 Morales, L. S., Cunningham, W. E., Brown, J. A., Liu, H., & Hays, R. D. (1999). Are Latinos less satisfied with communication by health care providers? Journal of General Internal Medicine, 14, 409–417. http://dx.doi.org/10.1046/ j.1525-1497.1999.06198.x Neufeld, K. J., Swartz, K. L., Bienvenu, O. J., Eaton, W. W., & Cai, G. (1999). Incidence of DIS/DSM–IV social phobia in adults. Acta Psychiatrica Scandinavica, 100, 186–192. http://dx.doi.org/10.1111/j.1600-0447.1999.tb10844.x Norton, P. J. (2007). Depression Anxiety and Stress Scales (DASS–21): Psycho­ metric analysis across four racial groups. Anxiety, Stress, & Coping, 20, 253–265. http://dx.doi.org/10.1080/10615800701309279 Novy, D. M., Nelson, D. V., Goodwin, J., & Rowzee, R. D. (1993). Psychometric comparability of the State–Trait Anxiety Inventory for different ethnic subpopulations. Psychological Assessment, 5, 343–349. http://dx.doi.org/ 10.1037/1040-3590.5.3.343 Novy, D. M., Nelson, D. V., Smith, K. G., Rogers, P. A., & Rowzee, R. D. (1995). Psychometric comparability of the English- and Spanish-language versions of the State–Trait Anxiety Inventory. Hispanic Journal of Behavioral Sciences, 17, 209–224. http://dx.doi.org/10.1177/07399863950172005 Novy, D. M., Stanley, M. A., Averill, P., & Daza, P. (2001). Psychometric comparability of English- and Spanish-language measures of anxiety and related affective symptoms. Psychological Assessment, 13, 347–355. http://dx.doi.org/ 10.1037/1040-3590.13.3.347 Pole, N., Best, S. R., Metzler, T., & Marmar, C. R. (2005). Why are Hispanics at greater risk for PTSD? Cultural Diversity and Ethnic Minority Psychology, 11, 144–161. http://dx.doi.org/10.1037/1099-9809.11.2.144

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Pole, N., Best, S. R., Weiss, D. S., Metzler, T., Liberman, A. M., Fagan, J., & Marmar, C. R. (2001). Effects of gender and ethnicity on duty-related posttraumatic stress symptoms among urban police officers. Journal of Nervous and Mental Disease, 189, 442–448. http://dx.doi.org/10.1097/00005053-200107000-00005 Quero, S., Banos, R. M., Botella, C., & Gallardo, M. (2003). Delimitacion de subtipos clinicos en la fobia social [Limitation of clinical subtypes in social phobia]. Psicología Conductual Revista Internacional de Psicología Clinica de la Salud, 11, 429–458. Reiss, S., Peterson, R. A., Gursky, D. M., & McNally, R. J. (1986). Anxiety sensitivity, anxiety frequency and the prediction of fearfulness. Behaviour Research and Therapy, 24, 1–8. http://dx.doi.org/10.1016/0005-7967(86)90143-9 Robins, L. N., Helzer, J. E., Croughan, J., & Ratcliff, K. S. (1981). National Institute of Mental Health Diagnostic Interview Schedule: Its history, characteristics, and validity. Archives of General Psychiatry, 38, 381–389. http://dx.doi. org/10.1001/archpsyc.1981.01780290015001 Robins, L. N., Helzer, J. E., Ratcliff, K. S., & Seyfried, W. (1982). Validity of the Diagnostic Interview Schedule, Version II: DSM–III diagnoses. Psychological Medicine, 12, 855–870. http://dx.doi.org/10.1017/S0033291700049151 Rogers, R. (1995). Diagnostic and structured interviewing: A handbook for psychologists. Odessa, FL: Psychological Assessment Resources. Rosenheck, R., & Fontana, A. (1996). Race and outcome of treatment for veterans suffering from PTSD. Journal of Traumatic Stress, 9, 343–351. http://dx.doi. org/10.1002/jts.2490090215 Ruef, A. M., Litz, B. T., & Schlenger, W. E. (2000). Hispanic ethnicity and risk for combat-related PTSD. Cultural Diversity and Ethnic Minority Psychology, 6, 235–251. Salgado de Snyder, V. N., Diaz-Perez, M. J., & Maldonado, M. (1995). Los nervios de las mujeres Mexicans de origin rural como motivo para buscar ayuda [Nervios of Mexican women from rural areas as a motive to seek help]. Salud Mental, 18, 50–55. Salgado de Snyder, V. N., Diaz-Perez, M. J., & Ojeda, V. D. (2000). The prevalence of nervios and associated symptomatology among inhabitants of Mexican rural communities. Culture, Medicine, and Psychiatry, 24, 453–470. http://dx.doi. org/10.1023/A:1005655331794 Salmán, E., Liebowitz, M. R., Guarnaccia, P. J., Jusino, C. M., Garfinkel, R., Street, L., . . . Klein, D. F. (1998). Subtypes of ataques de nervios: The influence of coexisting psychiatric diagnosis. Culture, Medicine, and Psychiatry, 22, 231–244. http://dx.doi.org/10.1023/A:1005326426885 Spielberger, C. D., & Diaz-Guerrero, R. (1975). IDARE Inventario de Anxiedad: Rasgo–Estado [IDARE Anxiety Inventory: State–Trait]. D. F., Mexico: El Manual Moderno. Spielberger, C. D., Gorsuch, R. L., & Luschene, R. E. (1970). STAI Manual for the State–Trait Anxiety Inventory (“Self-Evaluation Questionnaire”). Palo Alto, CA: Consulting Psychologists Press. assessment of anxiety in latinos     

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Spitzer, R. L., Williams, J. B. W., Gibbon, M., & First, M. B. (1990). User’s guide for the Structured Clinical Interview for DSM–III–R: SCID. Arlington, VA: American Psychiatric Association. Torrens, M., Serrano, D., Astals, M., Pérez-Domínguez, G., & Martín-Santos, R. (2004). Diagnosing comorbid psychiatric disorders in substance abusers: Validity of the Spanish versions of the Psychiatric Research Interview for Substance and Mental Disorders and the Structured Clinical Interview for DSM–IV. The American Journal of Psychiatry, 161, 1231–1237. http://dx.doi.org/10.1176/appi. ajp.161.7.1231 Vázquez, F. L., Torres, Á., Otero, P., & Díaz, O. (2011). Prevalence, comorbidity, and correlates of DSM–IV Axis I mental disorders among female university students. Journal of Nervous and Mental Disease, 199, 379–383. http://dx.doi.org/10.1097/ NMD.0b013e31821cd29c Vega, W. A., Kolody, B., & Aguilar-Gaxiola, S. (2001). Help seeking for mental health problems among Mexican Americans. Journal of Immigrant Health, 3, 133–140. http://dx.doi.org/10.1023/A:1011385004913 Vega, W. A., Kolody, B., Aguilar-Gaxiola, S., Alderete, E., Catalano, R., & CaraveoAnduaga, J. (1998). Lifetime prevalence of DSM–III–R psychiatric disorders among urban and rural Mexican Americans in California. Archives of General Psychiatry, 55, 771–778. http://dx.doi.org/10.1001/archpsyc.55.9.771 Vega, W. A., Sribney, W. M., Aguilar-Gaxiola, S., & Kolody, B. (2004). 12-month prevalence of DSM–III–R psychiatric disorders among Mexican Americans: Nativity, social assimilation, and age determinants. Journal of Nervous and Mental Disease, 192, 532–541. http://dx.doi.org/10.1097/01.nmd.0000135477.57357.b2 Virella, B., Arbona, C., & Novy, D. M. (1994). Psychometric properties and factor structure of the Spanish version of the State–Trait Anxiety Inventory. Journal of Personality Assessment, 63, 401–412. http://dx.doi.org/10.1207/ s15327752jpa6303_1 Vizcarro, C., Leon, O., Garcimartin, J., & Garcia, J. (1986). Aportaciones de una entrevista estructurada (SADS) al acuerdo interjueces en el diagnostico por medio de los criterios de diagnostico para la investigacion [Contributions of a Structured Interview (SADS) to diagnostic interrater reliability through research diagnostic criteria]. Evaluación Psicológica, 2, 99–114. Zinbarg, R. E., Mohlman, J., & Hong, N. N. (1999). Dimensions of anxiety sensitivity. In S. Taylor (Ed.), Anxiety sensitivity: Theory, research, and treatment of the fear of anxiety (pp. 83–114). Mahwah, NJ: Erlbaum. Zvolensky, M.  J., Arrindell, W.  A., Taylor, S., Bouvard, M., Cox, B.  J., Stewart, S.  H., . . . Eifert, G. H. (2003). Anxiety sensitivity in six countries. Behaviour Research and Therapy, 41, 841–859. http://dx.doi.org/10.1016/S0005-7967(02)00187-0

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13 LATINOS AND DEPRESSION: MEASUREMENT ISSUES AND ASSESSMENT AZARA L. SANTIAGO-RIVERA, GREGORY BENSON-FLóREZ, MARIA MAGDALENA SANTOS, AND MARISELA LOPEZ

Census figures indicate that the Latino population grew from 35 million in 2001 to 52 million in 2011, making it the largest ethnic minority group in the United States (U.S. Census Bureau News, 2012). This increase does not include the undocumented Latino immigrant population, which is estimated to be about 9 million people (Passel & Cohn, 2012), or the 3.7 million Puerto Ricans who live on the island of Puerto Rico, a U.S. territory. By 2050, the U.S. Census Bureau projects that 29% of the nation’s population will be of Latino heritage (Taylor & Cohn, 2012). Mexicans are the largest subgroup, accounting for about 65% of the U.S. Latino population, followed by Puerto Ricans (9%) and Cubans (4%). Also, Latinos in the United States include individuals with ancestries from Central America (8%), South America (6%), and the Dominican Republic (3%; Lopez & Dockterman, 2011). Individuals of Latino heritage represent 21 Spanish-speaking countries, each with unique sociopolitical and historical contexts, religious and cultural traditions, Spanish http://dx.doi.org/10.1037/14668-014 Psychological Testing of Hispanics, Second Edition: Clinical, Cultural, and Intellectual Issues, K. F. Geisinger (Editor) Copyright © 2015 by the American Psychological Association. All rights reserved.

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language dialect(s), indigenous roots, and foods. Likewise, their diversity is reflected in the blending of indigenous people (e.g., Mayan, Aztec, Inca) and Spaniards from Spain for some groups, whereas other Latino groups are a mix of African or Asian and Spanish ancestries (Acosta-Belén & Sjostrom, 1988). UNDERSTANDING DEPRESSION IN THE LATINO CONTEXT The Latino population’s projected growth, prevalence of depression, course of illness, and service utilization rates underscore the need to assess and measure depression accurately among members of this diverse demographic group. Earlier studies examining depression rate estimates based on aggregated data revealed that Latinos reported lower rates of lifetime mood disorders compared with non-Latino Whites (Kessler et al., 2005). However, Latinos with a history of mood disorders were at greater risk of persistent course of illness, almost twice that of non-Latino Whites after controlling for socioeconomic status (Breslau, Kendler, Su, Gaxiola-Aguilar, & Kessler, 2005). More recent investigations, accounting for the diversity within the population, have examined depression rates by subgroup. In particular, the National Latino and Asian American Study (NLAAS; Alegría et al., 2004) results indicated differential rates of depression by subgroup, with Mexicans showing the lowest rates and Puerto Ricans the highest (Alegría, MulvaneyDay, et al., 2007). Consistent with NLAAS results, previous findings showed high prevalence rates among Puerto Ricans when compared with other Latino subgroups (Moscicki, Rae, Regier, & Locke, 1987). Cuban-origin individuals, as a group, have shown lower levels of depression symptomatology than other Latino subgroups (Narrow, Rae, Moscicki, Locke, & Regier, 1990). Although data are limited, there is evidence suggesting higher prevalence rates among Latinos of Central and South American origin compared with Mexican Americans (Hovey, 2000a, 2000b), but lower rates compared with Puerto Ricans (Alegría, Mulvaney-Day, et al., 2007). In sum, the findings of higher rates of depression for Puerto Ricans and Central and South Americans indicate that the burden of depression and other potentially related health problems is significant. Acculturation has been widely studied to explain how Latinos adjust and adapt to a new host country. Some research based on aggregate data or on Latino samples representing various subgroups has suggested that increased psychological distress and mental health problems are associated with higher levels of acculturation, a phenomenon known as the immigrant paradox (Alegría, Shrout, et al., 2007). Specifically, native-born Mexican Americans who are more acculturated to the American way of life demonstrate higher lifetime prevalence of major depression and dysthymia compared with foreign-born 256       santiago-rivera et al.

Mexicans who have recently arrived in the United States (Burnam, Hough, Karno, Escobar, & Telles, 1987). This finding suggests that nativity may serve as a protective factor for foreign-born Mexicans, whereas acculturation has potentially negative effects on mental health (Grant et al., 2004). However, the immigrant paradox has not been observed across all Latino subgroups, including those experiencing psychiatric disorders (Alegría, Shrout, et al., 2007). Although differences in depression rates have been observed in individuals of Mexican origin, based on nativity (i.e., U.S. vs. foreign born), the same pattern has not been observed among Puerto Ricans. Likewise, the rapidly growing proportion of U.S.-born Mexicans, expected to account for most population growth in the years to come, may lead to a significance increase in the rates of depression. MEASUREMENT ISSUES IN THE ASSESSMENT OF DEPRESSION One of the major challenges often faced by clinicians is finding the appropriate measure to assess depression accurately. First and foremost, it is difficult to establish measurement equivalence because of cultural differences in the meaning and expression of symptoms. This perspective is evident in the culture-bound syndromes described in the Diagnostic and Statistical Manual of Mental Disorders (fourth ed.; American Psychiatric Association, 1994) that are specific to Latinos, such as ataque de nervios [nervous attack or breakdown] and nervios [nervousness], susto [fright], espanto [sudden fright], and perdida del alma [loss of the soul], and whose symptoms may be a manifestation of distress among Mexicans, Puerto Ricans, Central Americans, and South Americans (Aguilar-Gaxiola, Kramer, Resendez, & Magaña, 2008). Likewise, there is sufficient evidence suggesting that Latinos tend to somaticize mental health problems, reporting more physical symptoms of distress than European Americans (Canino & Alegría, 2009). Despite these challenges, efforts to investigate measurement equivalence have yielded interesting results. For example, Crockett, Randall, Shen, Russell, and Driscoll (2005) investigated within- and across-ethnic-group equivalence of the Center for Epidemiologic Studies Depression Scale (CES–D; Radloff, 1977) in a sample of Mexican, Cuban, Puerto Rican, and Anglo American adolescents. They found that the four factor domains (i.e., positive affect, negative affect, somatic, and interpersonal) were similar for the Mexican and Anglo American adolescents, but not for the Puerto Rican and Cuban adolescents. For Cuban adolescents, five different factors emerged that could not be meaningfully interpreted by the investigators. Second, research has suggested possible gender differences in the expression of depression symptoms. For example, Posner, Stewart, Marín, latinos and depression     

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and Pérez-Stable (2001) found that the original four-factor structure of the CES–D proposed by Radloff (1977; i.e., depressive affect, positive affect, somatic, and interpersonal domains) was a good fit to the data for the women and, more important, when controlling for acculturation and age, but not for the men in the sample. Third, it is widely acknowledged that most psychological assessment tools have been developed using middle class, highly educated, and White European samples. The lack of Latino representation in studies designed to develop such measures has led to a lack of culture-specific norms, raising concerns about their appropriateness (Butcher, Cabiya, Lucio, & Garrido, 2007). Finally, there has been a growing interest in Spanish-language measures because of the significant number of monolingual Spanish-speaking Latinos in the United States. Recent surveys show that 30% to 35% of Latinos are not fluent in English (e.g., Taylor & Cohn, 2012). The lack of Spanish-language psychological assessments has been problematic in accurately diagnosing and treating depression. In an attempt to address this concern, more attention has been given to the translation from English to Spanish of well-established measures of depression such as the Beck Depression Inventory—II (A. T. Beck, Steer, & Brown, 1996), CES–D (Radloff, 1977), and the Geriatric Depression Scale (Yesavage et al., 1982) and in investigating the psychometric properties of the translated version (e.g., Penley, Weibe, & Nwosu, 2003). It is important to note that having a translated version of a commonly used English-language depression inventory may seem better than not having one; however, simply translating the measure does not make it viable. It is essential to determine that the English and Spanish versions of a particular measure are equivalent in content, reliability, and validity (Fernandez, Boccaccini, & Noland, 2007). ASSESSMENTS The focus of this section is to describe a number of commonly used assessment instruments for depression screening for which the psychometric properties have been examined. However, this listing of measurement tools is not exhaustive due to the chapter page limitations. The measures described are those used to assess depression in Latino adults who reside in the United States.1

For a more detailed review of assessments for both adults and children, please refer to Aguilar-Gaxiola and Gullotta, 2008. 1

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Beck Depression Inventory—II The Beck Depression Inventory (BDI; A. T. Beck, Ward, Mendelson, Mock, & Erbaugh, 1961) is one of the most widely used and well-established self-report measures of depression symptoms in nonclinical and clinical samples. There is an extensive body of research indicating that it has sound psychometric properties. The BDI–II (A. T. Beck et al., 1996) is a revised version of the BDI consisting of 21 items assessing a variety of symptoms occurring in the 2 weeks prior to assessment and that correspond more closely to major depressive disorder (Penley et al., 2003). On a scale from 0 to 3 (0 = no depressive symptom and 3 = severe depressive symptom), participants rate the 21 items, with higher scores indicating more depression symptoms. The total score indicates the level of depression as minimal (1–13), mild (14–19), moderate (20–28), or severe (29–63). According to Wiebe and Penley (2005), the BDI–II was translated into Spanish by a diverse group of psychologists, but normative data are virtually nonexistent. Results of earlier studies provide considerable support for the use of the English version of the BDI among older Mexican Americans. The internal consistency coefficient was .80 for this group (Gatewood-Colwell, Kaczmarek, & Ames, 1989); .98 for a community sample of diverse bilingual Latinos from Mexico, South and Central America, Cuba, and Puerto Rico (Novy, Stanley, Averill, & Daza, 2001); and .82 for a college student sample (Contreras, Fernandez, Malcarne, Ingram, & Vaccarino, 2004). More recently, Gloria, Castellanos, Kanagui-Muñoz, and Rico (2012) conducted a comparison study of the BDI–II, CES–D, and Self-Rating Depression Scale (SDS; Zung, 1965) to explore the internal consistency, as well as the construct and convergent validity of these measures. For purposes of this discussion, they found that the BDI–II yielded an internal consistency coefficient of .88 and was significantly correlated with the CES–D (.75) and the SDS (.61). Several studies have examined the English and Spanish versions of the BDI–II, adding another level of complexity to the internal consistency and factor structure of the scale. Specifically, Novy et al. (2001) used an elaborate translation and adaptation process for the BDI–II and other measures and found that the correlation between the Spanish and English versions was .94 in a bilingual community sample. More recently, Wiebe and Penley (2005) examined the internal reliability and factorial validity of both language versions of the BDI–II and found the following: (a) the English version yielded a reliability coefficient of .89, (b) the Spanish version yielded a coefficient of .91, (c) respectable test–retest reliability coefficients for the English and Spanish versions were obtained (.73 and .86, respectively), and (d) confirmatory factor analysis for each version resulted in a good fit with A. T. Beck and colleagues’ (1996) model. Essentially, this study showed strong support latinos and depression     

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for the language equivalence of the English and Spanish versions in a college student sample. The psychometric properties of the Spanish version of the BDI–II with Latinos residing in the United States has also received some attention in recent years. Penley and colleagues (2003) recognized, like many others, the need to develop reliable Spanish translations of measures to accurately assess depression symptoms in those who are either Spanish dominant or Spanish monolinguals. In their study, they examined the Spanish BDI–II in a sample of Mexican Americans undergoing hemodialysis for end-stage renal disease and found good internal consistency (.92) and a less than ideal factor structure that, according to the researchers, still provided “an adequate fit to the Spanish BDI–II patient data” (p. 574). Furthermore, when comparing the English and Spanish versions of the BDI–II, they found no statistical difference between the English and Spanish total scores, suggesting equivalency. However, the authors recommended interpreting these results with caution because of the small sample size in the comparison of the two measures (n = 23). Nonetheless, their study was one of the first to examine the equivalence of the Spanish and English BDI–II and showed promising results. Likewise, Bonilla, Bernal, Santos, and Santos (2004) revised, pilot tested, and conducted a study with a Puerto Rican college student sample (on the island of Puerto Rico) and found that their Spanish version of the BDI (BDI–S) demonstrated high internal consistency (.88) and a factor structure that, according to the authors, is comparable with the domains identified by other studies (e.g., sadness, hopelessness, somatic, negative thoughts) and consistent with how depression has been conceptualized. In sum, these studies have clearly demonstrated that the Spanish version of the BDI, either the BDI–S developed by Bonilla et al. (2004) or the Spanish version of the BDI–II (e.g., Penley et al., 2003), is a reliable screening tool that can be used with a diverse Latino population. Center for Epidemiologic Studies Depression Scale The CES–D was originally developed to assess somatic and affective symptoms of depression in adult community samples. It is a 20-item, selfreport, paper-and-pencil measure that assesses depression symptoms and mood during the past week. The responses to each item are: 0 (less than one day), 1 (one to two days), 2 (three to four days), and 3 (five to seven days). The items include symptoms such as depressed mood, feelings of guilt and worthlessness, feelings of helplessness, loss of appetite, and sleep disturbance (Gloria et al., 2012). Although the CES–D is widely used, studies have shown differences in mean scores and prevalence rates among various ethnic and racial groups (e.g., Kim, Chiriboga, & Jang, 2009). Moreover, a recent meta-analytic study 260       santiago-rivera et al.

by Kim, DeCoster, Huang, and Chiriboga (2011) examined the factor structure of the CES–D using confirmatory factor analyses and found support for the original four-factor structure in African Americans, American Indians, Latinos, and Whites, but not in Asians. Using exploratory factor analysis, they discovered that the four original factors were present in all five ethnic and racial groups; however, they found that for Latinos the structure was actually different in that the item loadings of depressed affect and somatic symptoms “switched between the two factors” (p. 388). The Spanish version has shown adequate internal consistency, with alphas ranging from .88 to .90 (Piedra & Byoun, 2012). A meta-analysis investigating the practicality of the measure in primary care settings showed that the 20- and 10-item versions of the measure are valid for depression screening (Reuland et al., 2009). Another study found the CES–D to be an accurate measure of depression symptoms in a sample of 303 middleaged Spanish-speaking Puerto Ricans living in the northeastern United States (Robison, Gruman, Gaztambide, & Blank, 2002). As stated earlier, Posner et al. (2001) gathered data from three studies of urban Latinos and found gender differences, concluding that the measure was not a good fit for Latino men. With respect to Latino subgroup differences, Crockett and colleagues (2005) found equivalent factor structures for Anglo and Mexican Americans but not for Puerto Rican and Cuban youth. The authors attributed these results to potential cultural differences in the expression of depression symptomatology. Another study using a short version of the CES–D found it to be an accurate measure of depression symptoms for Mexican American farm workers (Grzywacz et al., 2010). Patient Health Questionnaire—9 The Patient Health Questionnaire—9 (PHQ–9; Spitzer, Kroenke, & Williams, 1999) is a nine-item self-report measure that assesses depression and is mainly used in primary care settings. The PHQ is a version of the Primary Care Evaluation of Mental Disorders (Kroenke & Spitzer, 2002). Respondents indicate the degree to which nine symptoms are present (depressed mood, difficulties sleeping, changes in appetite, suicidality, difficulties concentrating, anhedonia, worthlessness or guilt, agitation, and fatigue; Merz, Malcarne, Roesch, Riley, & Sadler, 2011) and are experienced during the 2 weeks prior to assessment using a 4-point scale from 0 (not at all) to 3 (nearly every day). Scores range from 0 to 27, with higher scores indicting more depression symptoms. Scores ranging from 5 to 9 are considered mild, 10 to 14 moderate, 15 to 19 moderately severe, and 20 to 27 severe (Kroenke & Spitzer, 2002). Alpha reliability coefficients ranging from .86 to .89 and latinos and depression     

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good criterion validity were found using the clinical diagnostic interview (Spitzer, Williams, Kroenke, Hornyak, & McMurray, 2000). More than 3 decades of research and practice have determined that the PHQ–9 is a valid and reliable measure of depression among racial and ethnic populations, including Latinos (Huang, Chung, Kroenke, Delucchi, & Spitzer, 2006). In a study examining the internal consistency of the PHQ–9 with a mostly female mixed Spanish- and English-speaking sample, researchers found a coefficient alpha of .80, demonstrating good reliability (Huang et al., 2006). This measure has been translated into many languages, including Spanish, making it popular for use with different ethnic and cultural groups. Although research is limited, a few studies have examined the appropriateness of the PHQ–9 for Spanish-speaking Latinas. Merz et al. (2011) assessed the structural validity of the English and Spanish versions of the PHQ–9 with a community sample of English- and Spanish-speaking Latinas. In this mixed sample of primarily Mexican descent, the internal consistency of the English and Spanish versions showed coefficient alphas of .84 and .85, respectively. Exploratory factor analysis determined that the PHQ–9 had good structural validity. In addition, the PHQ–9 has been found to be an adequate measure of depression in Latina college students (Granillo, 2012). Although these studies show promising results, future studies using the PHQ–9 should include men and a more heterogeneous sample. ASSESSMENTS IN CRITICAL NEED AREAS Latinas and Postpartum Depression There is considerable concern that postpartum depression is on the rise, and yet, according to Le, Perry, and Ortiz (2010), as much as “50% of postpartum cases go undetected and untreated” (p. 249). There has been a growing interest in validating measures for Latinas residing in the United States and in South America because of their high risk of developing postpartum depression (e.g., Affonso, De, Horowitz, & Mayberry, 2000; Kuo et al., 2004). One of the measures receiving attention in recent years is the Postpartum Depression Screening Scale Spanish version (PDSS; C. T. Beck & Gable, 2005), a 35-item self-report measure that assesses symptoms of postpartum depression and consists of seven dimensions: sleeping and eating disturbances, anxiety and insecurity, emotional lability, cognitive impairment, loss of self, guilt and shame, and thought of hurting oneself. In addition, a shorter seven-item version exists, consisting of one item from each of the dimensions. Respondents indicate the level of agreement with each item using a 5-point 262       santiago-rivera et al.

scale ranging from 1 (strongly disagree) to 5 (strongly agree), with higher scores indicating depression. The total score can range from 7 to 175 on the full version and 7 to 35 on the short version; 59 or less is considered normal adjustment, 60 to 79 indicates minor symptoms of postpartum depression, and 80 or greater indicates major postpartum depression. The English version of the PPSD has adequate reliability and validity, yielding an internal consistency coefficient of .98 for the total scores, and content validity ranging from .80 to .91 (C. T. Beck & Gable, 2002). C. T. Beck and Gable (2003) studied the Spanish version of the PPDS (PPDS–S) in a diverse sample of primarily Latinas of Puerto Rican and Mexican heritage and found a reliability coefficient of .95 for the total scores, with a range of .76 to .90 for the seven dimensions. Likewise, C. T. Beck and Gable (2005) reported strong reliability coefficients for Mexicans (.95), Puerto Ricans, (.96), and Central and South Americans (.95). Interestingly, they reported a cutoff score of 60 for both minor and major postpartum depression, meaning that the Spanish version was unable to differentiate these two levels. In a more recent study Le and colleagues (2010) examined the psychometric properties of the short and long forms of the PPDS–S in a sample of women, mostly from different countries in Central America, in particular, El Salvador and Mexico, and found good internal consistency across the three subgroups (.97). They also found that the short seven-item version did not perform as well but was still within what those researchers considered acceptable ranges (i.e., .85 for women from El Salvador, .77 for Mexican women, .83 for women from other Central American countries). The overall coefficient for the short version was .83. In essence, the PPDS, both the English and the Spanish versions, shows adequate usefulness. Older Latino Adults The interest in accurately assessing depression in older adults is gaining momentum because the population of individuals age 65 and older is growing quickly (U.S. Census Bureau, 2010), and as a group, a significant percentage of older adults experience depression (Chavez-Korell et al., 2012). Although the body of research is limited, several studies have shown that older Latino adults may be at greater risk of depression (e.g., Falcón & Tucker, 2000). More recently, Diefenbach, Disch, Robison, Baez, and Coman (2009) reported higher prevalence of major depressive disorder and anxiety among Puerto Ricans compared with African Americans age 60 and older living in an urban setting. One of the challenges in assessing depression in older adults is that it is often difficult to differentiate the symptoms of depression from those associated with the natural aging process, such as deterioration of cognitive functioning, as well as changes in physical heath and activity latinos and depression     

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(Fernández-San Martín et al., 2002). Nonetheless, it is important to assess and treat depression in older adults. The Geriatric Depression Scale (GDS; Yesavage et al., 1982) is a popular measure used to assess depression symptoms in older adults. There is a 30-item and 15-item version of the GDS. Respondents are asked to answer yes or no to a series of questions about how they felt during the past week. The 15-item version has received considerable attention and has been translated and validated in Spanish. The GDS–15 scores range from 0 to 15, with 0 to 4 considered normal, 5 to 8 mild depression, 9 to 11 moderate depression, and 12 to 15 severe depression. Validation studies have shown that the GDS is 91% to 100% sensitive and 72% to 82% specific (e.g., Scogin & Shah, 2006). In a recent meta-analysis comparing the diagnostic accuracy of both the GDS 15- and 30-item measures in a primary care setting, the 15-item scale was 81% sensitive and a 78% specific for the presence of depression, whereas the 30-item measure was 77% sensitive and 65% specific (Mitchell, Bird, Rizzo, & Meader, 2010). The results are mixed for the Spanish version of the GDS. In a review of the literature on the diagnostic accuracy of measures of depression in the Spanish language, Reuland et al. (2009) found sensitivities ranging from 76% to 89% and specificities ranging from 64% to 98%, suggesting that there is support for the GDS’s utility. FUTURE DIRECTIONS On the basis of the literature review, we make a number of suggestions for further work with respect to the reliability and validity of measures of depression. First, future studies should expand the sample to include other subgroups that have been largely ignored. A good example is Le et al.’s (2010) study that examined the psychometric properties of the PDSS–S with a sample of mothers predominantly from El Salvador. In particular, they pointed out that many of these women experienced significant trauma due to the political unrest in their country of origin. Equally important, they recommended conducting interviews with participants from the different subgroups when validating measures to see how the items on the measure are understood. Second, there is a small but significant body of work on the validation of measures in Spanish, primarily from Spain. Examples of such efforts are (a) a brief version of the CES–D (CES–D–7) administered to a community sample of adults, ages 18 to 80, living in a metropolitan area (Herrero & Garcia, 2007); (b) the Hospital Anxiety and Depression Scale administered to a sample of patients with various chronic diseases, including a control group of students and community participants (Quintana et al., 2003); and (c) the GDS administered to a sample of older adults 64 and older treated 264       santiago-rivera et al.

in a primary care setting (Fernández-San Martín et al., 2002). Considering the strong support for the translated versions, perhaps future studies should focus on comparing U.S. Latinos with those from other Spanish-speaking countries to determine the reliability and validity of the scores emerging from the measure. Third, a significant number of studies did not consider levels of acculturative stress in determining the utility of a particular measure, which is surprising given the extensive research on the psychological impact of acculturation and acculturative stress (e.g., Hovey, 2000a, 2000b; Wiebe & Penley, 2005). As such, it is recommended that a measure of acculturation and acculturative stress be included when examining the psychometric properties of any measure that assesses depression. Fourth, measurement equivalency continues to be a challenge. For instance, there is a need to address gender differences reported in the literature suggesting that some measures may not be appropriate to use with males (Posner et al., 2001; Rivera-Medina, Caraballo, Rodríguez-Cordero, Bernal, & Dávila-Marrero, 2010). Measurement equivalency includes conducting comparative studies within and across Latino subgroups, as well as comparing English and Spanish versions of the same measure (e.g., Crockett et al., 2005). Although this is a complex process, it is necessary to address this issue to accurately screen, diagnose, and treat individuals. Fifth, we found that few studies described the steps taken to translate a measure or the method(s) used. Considering that there are regional variants of the Spanish language (i.e., various Spanish dialects) that can result in using different words to describe psychological phenomena, it is imperative that translation processes address this issue. Novy and colleagues (2001) provided a thorough description of various steps taken to translate measures that only had English versions, as well as measures that had Spanish versions. For instance, one of the steps involved a review of the measures by a group of bilingual individuals from various Latino subgroups (Mexico, Central America, and South America). Their elaborate method addressed not only the need to establish cultural equivalence of translated measures but also word or phrase equivalence. Thus, future attempts to establish measurement equivalency should incorporate similar translation approaches. Sixth, more attention should be given to how language choice influences the reporting of symptoms. Research has suggested that the severity of symptoms is greater when assessment of bilinguals is conducted in Spanish compared with English (e.g., Guttfreund, 1990). Therefore, the severity of symptoms may be reported differently depending on the language being used. Finally, computer-assisted methods of screening for depression may be a viable alternative. Some of the advantages noted are that it (a) increases latinos and depression     

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the accuracy and ease with which the test is administered and reduces possible human error and (b) may be more cost-effective by streamlining the screening process (González, 2008). For example, research has shown that a computerized Spanish version of the BDI–II has good reliability and validity (González & Shriver, 2004). Likewise, computer-assisted methods developed by Gerardo González (2008), such as the Voice-Interactive Depression Assessment System, and the earlier work by Ricardo Muñoz and colleagues (e.g., Muñoz, McQuaid, González, Dimas, & Rosales, 1999) using voice recognition, demonstrate sound psychometric properties. REFERENCES Acosta-Belén, E., & Sjostrom, B. R. (Eds.). (1988). The Hispanic experience in the United States. New York, NY: Praeger. Affonso, D. D., De, A. K., Horowitz, J. A., & Mayberry, L. J. (2000). An international study exploring levels of postpartum depressive symptomatology. Journal of Psychosomatic Research, 49, 207–216. http://dx.doi.org/10.1016/ S0022-3999(00)00176-8 Aguilar-Gaxiola, S. A., & Gullotta, T. P. (Eds.). (2008). Depression in Latinos: Assessment, treatment, and prevention. New York, NY: Springer. Aguilar-Gaxiola, S. A., Kramer, E. J., Resendez, C., & Magaña, C. G. (2008). The context of depression in Latinos in the United States. In S. A. Aguilar-Gaxiola & T. P. Gullotta (Eds.), Depression in Latinos: Assessment, treatment, and prevention (pp. 3–28). New York, NY: Springer. http://dx.doi.org/10.1007/978-0-38778512-7_1 Alegría, M., Mulvaney-Day, N., Torres, M., Polo, A., Cao, Z., & Canino, G. (2007). Prevalence of psychiatric disorders across Latino subgroups in the United States. American Journal of Public Health, 97, 68–75. http://dx.doi.org/10.2105/ AJPH.2006.087205 Alegría, M., Shrout, P. E., Woo, M., Guarnaccia, P., Sribney, W., Vila, D., . . . Canino, G. (2007). Understanding differences in past year psychiatric dis­ orders for Latinos living in the US. Social Science & Medicine, 65, 214–230. http:// dx.doi.org/10.1016/j.socscimed.2007.03.026 Alegría, M., Takeuchi, D., Canino, G., Duan, N., Shrout, P., Meng, X. L., . . . Gong, F. (2004). Considering context, place and culture: The National Latino and Asian American Study. International Journal of Methods in Psychiatric Research, 13, 208–220. http://dx.doi.org/10.1002/mpr.178 American Psychiatric Association. (1994). Diagnostic and statistical manual of mental disorders (4th ed.). Washington, DC: Author. Beck, A. T., Steer, R. A., & Brown, G. K. (1996). Manual for the revised Beck Depression Inventory. San Antonio, TX: Psychological Corporation.

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9 among English- and Spanish-speaking Latinas. Cultural Diversity and Ethnic Minority Psychology, 17, 309–316. http://dx.doi.org/10.1037/a0023883 Mitchell, A. J., Bird, V., Rizzo, M., & Meader, N. (2010). Diagnostic validity and added value of the Geriatric Depression Scale for depression in primary care: A meta-analysis of GDS30 and GDS15. Journal of Affective Disorders, 125, 10–17. http://dx.doi.org/10.1016/j.jad.2009.08.019 Moscicki, E. K., Rae, D. S., Regier, D. A., & Locke, B. Z. (1987). The Hispanic Health and Nutrition Examination Survey: Depression Among Mexican Americans, Cuban Americans, and Puerto Ricans. In M. Gaviria & J. Arana (Eds.), Health and behavior: Research agenda for Hispanics, Research monograph no. 1 (pp. 145–159). Chicago: The University of Illinois at Chicago. Muñoz, R. F., McQuaid, J. R., González, G. M., Dimas, J., & Rosales, V. A. (1999). Depression screening in a women’s clinic: Using automated Spanish- and Englishlanguage voice recognition. Journal of Consulting and Clinical Psychology, 67, 502–510. http://dx.doi.org/10.1037/0022-006X.67.4.502 Narrow, W. E., Rae, D. S., Moscicki, E. K., Locke, B. Z., & Regier, D. A. (1990). Depression among Cuban Americans. Social Psychiatry and Psychiatric Epidemiology, 25, 260–268. http://dx.doi.org/10.1007/BF00788647 Novy, D., Stanley, M., Averill, P., & Daza, P. (2001). Psychometric comparability of English and Spanish-language measures of anxiety and related affective symptoms. Psychological Assessment, 13, 347–355. Passel, J. S., & Cohn, D. (2012). Unauthorized immigrants: 11.1 million in 2011. Retrieved from Pew Research Hispanic Trends Project website: http://www. pewhispanic.org/2012/12/06/unauthorized-immigrants-11-1-million-in-2011/ Penley, J. A., Wiebe, J. S., & Nwosu, A. (2003). Psychometric properties of the Spanish Beck Depression Inventory—II in a medical sample. Psychological Assessment, 15, 569–577. http://dx.doi.org/10.1037/1040-3590.15.4.569 Piedra, L. M., & Byoun, S. J. (2012). Vida Alegre: Preliminary findings of a depression intervention for immigrant Latino mothers. Research on Social Work Practice, 22, 138–150. http://dx.doi.org/10.1177/1049731511424168 Posner, S. F., Stewart, A. L., Marín, G., & Pérez-Stable, E. J. (2001). Factor variability of the Center for Epidemiological Studies Depression Scale (CES–D) among urban Latinos. Ethnicity & Health, 6, 137–144. http://dx.doi.org/10.1080/ 13557850120068469 Quintana, J. M., Padierna, A., Esteban, C., Arostegui, I., Bilbao, A., & Ruiz, I. (2003). Evaluation of the psychometric characteristics of the Spanish version of the Hospital Anxiety and Depression Scale. Acta Psychiatrica Scandinavica, 107, 216–221. http://dx.doi.org/10.1034/j.1600-0447.2003.00062.x Radloff, L. S. (1977). The CES–D scale: A self-report depression scale for research in the general population. Applied Psychological Measurement, 1, 385–401. http:// dx.doi.org/10.1177/014662167700100306 Reuland, D. S., Cherrington, A., Watkins, G. S., Bradford, D. W., Blanco, R. A., & Gaynes, B. N. (2009). Diagnostic accuracy of Spanish language depression-

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screening instruments. Annals of Family Medicine, 7, 455–462. http://dx.doi. org/10.1370/afm.981 Rivera-Medina, C. L., Caraballo, J. N., Rodríguez-Cordero, E. R., Bernal, G., & Dávila-Marrero, E. (2010). Factor structure of the CES–D and measurement invariance across gender for low-income Puerto Ricans in a probability sample. Journal of Consulting and Clinical Psychology, 78, 398–408. http://dx.doi. org/10.1037/a0019054 Robison, J., Gruman, C., Gaztambide, S., & Blank, K. (2002). Screening for depression in middle-aged and older Puerto Rican primary care patients. Journal of Gerontology: Series A. Biological Sciences and Medical Sciences, 57, M308–M314. http://dx.doi.org/10.1093/gerona/57.5.M308 Scogin, F., & Shah, A. (2006). Screening older adults for depression in primary care settings. Health Psychology, 25, 675–677. http://dx.doi.org/10.1037/02786133.25.6.675 Spitzer, R. L., Kroenke, K., & Williams, J. B. W. (1999, November 10). Validation and utility of a self-report version of PRIME–MD: The PHQ Primary Care Study. JAMA, 282, 1737–1744. http://dx.doi.org/10.1001/jama.282.18.1737 Spitzer, R. L., Williams, J. B., Kroenke, K., Hornyak, R., & McMurray, J. (2000). Validity and utility of the PRIME–MD Patient Health Questionnaire in assessment of 3000 obstetric-gynecologic patients: The PRIME–MD Patient Health Questionnaire Obstetrics–Gynecology Study. American Journal of Obstetrics and Gynecology, 183, 759–769. http://dx.doi.org/10.1067/mob.2000.106580 Taylor, P., & Cohn, D. (2012). A milestone en route to a majority minority nation. Retrieved from Pew Research Social & Demographic Trends website: http:// www.pewsocialtrends.org/2012/11/07/a-milestone-en-route-to-a-majorityminority-nation/ U.S. Census Bureau. (2010). Annual estimates of the resident population by race and Hispanic origin for the United States. Retrieved from http://www.census.gov/ U.S. Census Bureau News. (2012). Profile America, facts for features: Hispanic Heritage Month 2012. Retrieved from https://www.census.gov/newsroom/releases/archives/ facts_for_features_special_editions/cb12-ff19.html Wiebe, J. S., & Penley, J. A. (2005). A psychometric comparison of the Beck Depression Inventory–II in English and Spanish. Psychological Assessment, 17, 481–485. http:// dx.doi.org/10.1037/1040-3590.17.4.481 Yesavage, J. A., Brink, T. L., Rose, T. L., Lum, O., Huang, V., Adey, M., & Leirer, V. O. (1982). Development and validation of a geriatric depression screening scale: A preliminary report. Journal of Psychiatric Research, 17, 37–49. http:// dx.doi.org/10.1016/0022-3956(82)90033-4 Zung, W. W. K. (1965). A Self-Rating Depression Scale. Archives of General Psychiatry, 12, 63–70. http://dx.doi.org/10.1001/archpsyc.1965.01720310065008

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14 CULTURALLY INFORMED PSYCHOSOCIAL STRESS ASSESSMENT FOR HISPANICS RICHARD CERVANTES AND THUY BUI

There is a striking lack of culturally informed mental health assessments, procedures, and tools to facilitate detection and accurate diagnosis for Hispanics seeking mental health care (Cervantes & Acosta, 1992; Cervantes, Fisher, Córdova, & Napper, 2012; Malgady & Zayas, 2001). Many psychological assessment tools for Hispanics today are still limited to translations of existing clinical and research measures that are not normed on appropriate Hispanic populations (Cervantes & Acosta, 1992; Yamada, Valle, Barrio, & Jeste, 2006). Instead, according to O. Rodriguez (1992), assessments are made of how Hispanics perform on psychological tests that are generally developed, validated, and standardized on a nonminority, White, middle-class population. The lack of reliable and valid tests normed on samples of Hispanic populations, both Spanish-speaking and English-speaking, is a significant obstacle in the overall assessment of Hispanics (Bird et al., 1988; Loewenstein, Argüelles, Argüelles, & Linn-Fuentes, 1994; Velasquez, Ayala, & Mendoza, 1998). http://dx.doi.org/10.1037/14668-015 Psychological Testing of Hispanics, Second Edition: Clinical, Cultural, and Intellectual Issues, K. F. Geisinger (Editor) Copyright © 2015 by the American Psychological Association. All rights reserved.

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Psychological testing can also be affected by many factors, especially language and cultural factors. Several studies have found that language ability and level of acculturation as well as socioeconomic issues must be taken into consideration when providing assessments to Hispanic populations (Schwartz, Unger, Zamboanga, & Szapocznik, 2010). To date, few measures have been developed and disseminated that are specifically tailored to the contexts of the Hispanic population. In addition, research has made it evident that Hispanics, in response to stressful events, may manifest symptoms that are culturally bound—culture bound syndromes, such as susto [fright], mal de ojo [evil eye] and nervios [nerves] or ataque de nervios (Guarnaccia, Canino, Rubio-Stipec, & Bravo, 1993; Guarnaccia, Lewis-Fernández, & Rivera-Marano, 2003). This chapter provides the current knowledge on what is known about Hispanic mental health assessments and presents new assessments that are focused on culturally informed stressor evaluations for children and adults, as well as implications for treatment planning and cultural tailoring of clinical interventions. POPULATION OVERVIEW AND MENTAL HEALTH OF HISPANICS Constituting the largest minority group in the United States, the Hispanic population has grown by 56% over the past 10 years, and the population is expected to constitute one fourth of the U.S. population (an estimated 97 million) by the year 2050. Approximately 40% of Hispanics are foreign born and migrate to the United States for a variety of reasons, ranging from economic and social advancement to political freedom (Suárez-Orozco & Suárez-Orozco, 2001). In one important ongoing national survey conducted by the Centers for Disease Control and Prevention (CDC), Hispanic youth, compared with non-Hispanic White and African Americans, consistently demonstrated higher rates of depressive thinking, feelings of hopelessness, suicidal ideation and suicide attempts requiring medical treatment, most categories of substance abuse, and violent behavior (CDC, 2006). Moreover, many of these mental health disparities have persisted over time. In the 1997 national survey, Hispanic youth endorsed more suicidal ideation and behaviors (U.S. Department of Health and Human Services, 1999). Further, the negative impact of being a minority group member, minority-related stress, acculturation, and exposure to prolonged and chronic discrimination has been shown to result in poor mental health among minority youth (Brody et al., 2006). Stress-related disorders (e.g., posttraumatic stress disorder) also seem to affect Hispanics to a higher degree than other groups in American society (Galea et al., 2002; Perilla, Norris, & Lavizzo, 2002; Pole, Best, Metzler, & Marmar, 2005). Other behavioral health disparities exist, with Hispanic youth demonstrating higher rates than White and African Americans for 274       cervantes and bui

current alcohol use; alcohol use to intoxication; and current and lifetime marijuana, cocaine, and heroin use (Edwards et al., 2007; Tani, Chavez, & Deffenbacher, 2001; Vaccaro & Wills, 1998). KEY ASSESSMENT ISSUES FOR HISPANIC ADULTS Quality mental health care requires the use of valid diagnostic and clinical assessment tools and procedures (Cervantes & Acosta, 1992). There have been numerous advances in the development of mental health assessment and diagnostic tests and inventories for adults in general (Hunsley & Mash, 2005). Most of this development and research has been aimed at specifying psychological symptomatology and distinct emotional disorders. Various studies have also assessed Spanish translated tools for psychological testing for mental disorders (Butcher, Dahlstrom, Graham, Tellegen, & Kaemmer, 1989), personality assessment (Morey, 1991), and projective tests (Cuéllar, 1998; Grossman, Wasyliw, Benn, & Gyoerkoe, 2002). Further, the role of acculturation in diagnosing and understanding mental health from an emic, Hispanic perspective has gained considerable attention over the past 2 decades (Schwartz et al., 2010), yet this construct is measured inconsistently at best. Related specifically to culture and stress, work has also been done in the development of culturally appropriate measures for assessing stress among Hispanic adults (Barona & Miller, 1994). Cervantes, Padilla, and Salgado de Snyder (1991) developed both immigrant and nonimmigrant versions of the Hispanic Stress Inventory (HSI) to assess stress events across six life domains, including acculturation stress. There is now also an abbreviated version of the HSI (Cavazos-Rehg, Zayas, Walker, & Fisher, 2006). Other culturally based stress and diagnostic assessment tools specific to Hispanics do exist. For example, the Acculturation Rating Scale for Mexican Americans– II (Cuéllar, Arnold, & Maldonado, 1995) was developed as a multidimensional measure of levels of acculturation in Mexican Americans and is widely used. N. Rodriguez, Myers, Mira, Flores, and Garcia-Hernandez (2002) created the Multidimensional Acculturative Stress Inventory. Recently, Butcher, Cabiya, Lucio, and Garrido (2007) also revised the Minnesota Multiphasic Personality Inventory (Butcher et al., 1989) for use with Hispanic clients. KEY ASSESSMENT ISSUES FOR HISPANIC ADOLESCENTS There have also been numerous advances in the development of mental health assessment and diagnostic tests and inventories for children and adolescents in the general population (Kotsopoulos, Walker, Copping, Cote, & culturally informed psychosocial stress assessment     

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Stavrakaki 1994). As with adults, most of this development and research has focused on psychological symptomatology and distinct emotional disorders. A major gap remains, however, in measures specific to ethnic minority group adolescents in the United States, including Hispanic youths. This void is particularly relevant because Hispanic youths are at greater risk of exposure to community-based challenges and acculturation stressors relative to their European American counterparts (Córdova & Cervantes, 2010). The development of assessment tools specifically for Hispanic youth populations has largely been limited to translation and cultural adaptation of existing tools and measures and has not assessed acculturation-related stress exposure (e.g., Eisen et al., 2010). Several tools have been developed for Hispanic youth populations, although most have been designed specifically to address unique research hypotheses in cross-sectional studies of Hispanic populations. Originally developed for adult Hispanics, the Social, Attitudinal, Familial, and Environmental Scale (Mena, Padilla, & Maldonado, 1987; Padilla, Cervantes, Maldonado, & Garcia, 1988) and the HSI (Cervantes et al., 1991) have been used for children and adolescents in a few published studies (Alva & de los Reyes, 1999; Chavez, Moran, Reid, & Lopez, 1997; Hovey, 1998; Hovey & King, 1996). The Bicultural Stressors Scale (Romero & Roberts, 2003), which focuses on age-appropriate domains of perceived stress in a bicultural Mexican American context, has been developed as well. ASSESSING STRESS EVENTS WITHIN THE ACCULTURATION CONTEXT The acculturation process may best be framed within a stressful life events paradigm (Rudmin, 2009). This theory postulates that social organization plays a significant role in the origins and consequences of stressful life experiences (Aneshensel, 1992). Further, Lazarus and Folkman (1984) articulated the concept of stress appraisal, the subjective (negative) psychological reaction to a specific stress event or set of events. Similarly, negatively appraised stressor events related to acculturation within the Hispanic population are an important antecedent for mental health problems in both adults and children (Cervantes et al., 1991; Rogler, Cortes, & Malgady, 1991; Vega & Gil, 1998). Berry (1991) described acculturation stress as the result of one’s culture of origin interacting with host culture values, attitudes, customs, and behaviors. Individuals and families from one cultural orientation who are constantly being exposed to new, novel, and challenging events and situations require some form of psychological and behavioral adjustments. Exposure to racial or ethnic discrimination (negative behaviors toward Latino youths) can constitute a source of daily stress (Romero & Roberts, 2003). 276       cervantes and bui

As a group, many Hispanics face particularly chronic stressful circumstances. For example, Hispanics experience stress related to socioeconomic status (U.S. Census Bureau, 2010), discrimination, and family separation due to immigration (Taylor & Seeman, 1999). Research on stressful events in adolescents has also resulted in a proliferation of measures (Mullis, Youngs, Mullis, & Rathge, 1993) and has substantiated adolescent stress as an important factor in the development of psychological and physiological risk factors (Compas, Davis, Forsythe, & Wagner, 1987). Existing measures of child and adolescent stress fall into four categories (Grant et al., 2001): (a) response-oriented measures that assess the effects of the stress experience (e.g., Children’s Depression Inventory [CDI]—Kovacs, 2006; Kovacs & Beck, 1977; Sitarenios & Kovacs, 1999); (b) interactional measures that largely deal with how individuals cope with stressors (e.g., Stress Response Scale—Curtis & Adams, 1991); (c) stimulus–event measures that assess the types of stressors endured, as well as some perceived aspect of the experience (e.g., Adolescent Perceived Events Scale—Compas et al., 1987; Life Events and Difficulties Schedule—Duggal et al., 2000); and (d) a combination of these (e.g., Responses to Stress Questionnaire—Connor-Smith, Compas, Wadsworth, Thomsen, & Saltzman, 2000; Stress Inventory for Children—Marcil, 1996). Perhaps the most promising of the newer measures of adolescent stress is the Responses to Stress Questionnaire (RSQ; Connor-Smith et al., 2000). Overall, the RSQ demonstrated excellent reliability and validity with its original samples (Connor-Smith et al., 2000), as well as with a sample of 332 Navajo adolescents (Wadsworth, Rieckmann, Benson, & Compas, 2004). Many of these tests are translated and used in clinical settings with Hispanic children and adolescents despite the lack of culturally specific norms (Cervantes & Acosta, 1992). Cervantes, Cardoso, and Goldbach (in press) compared clinical and nonclinical Hispanic adolescent youth, including a sample of youth presenting with diagnosed behavioral health issues. Comparing levels of culturally based stress between clinical and nonclinical youth using the HSI—Adolescent Version (HSI–A; Cervantes, Fisher et al., 2012), they showed that, in fact, cultural stress is much more profound among those youth who present with clinical disorders. Nearly all aspects of HSI–A-related stress factors were found to be significantly higher in that clinical sample. Culturally based stressors, including chronic stress related to discrimination, personal and family experienced immigration issues, and school-based peer and social stress, among others, were all found to be significantly higher in the clinical sample. The study also demonstrated a significant link between cultural stress and CDI-assessed depression, suggesting that more prospective, longitudinal studies are needed to demonstrate the cultural stress etiology of depression, particularly among Latina adolescents. culturally informed psychosocial stress assessment     

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Cervantes, Padilla, Goldbach, and Napper (in press) also examined the role of generational status related to different categories of stressor experience. Using survey data from the HSI–A, they examined psychosocial stress across eight domains, including family economic stress and acculturation gap stress, in a national sample of three generations of Hispanic adolescents (N = 1,263). Research questions addressed generation differences in frequency of stressor events (i.e., discrimination), appraisal of these events, and resulting behavioral health outcomes. Similar levels of discrimination stress were reported by participants regardless of generation, but depression and behavioral health outcomes differed across the groups. An acculturation paradox was found, with greater stress exposure and higher stress appraisals in first generation youth but with lower negative behavioral health outcomes than later generations. Family integrity and more traditional family values may buffer the negative impact of greater stressor exposure among immigrant and second-generation youth when compared with third-generation adolescents. Culturally based stressors have been linked to mental health problems (Rogler et al., 1991; Vega & Gil, 1998). For example, a recent study by Cervantes, Fisher et al. (2012) found that Hispanic adolescents experience culturally based stressors in eight discrete domains and that these are significantly related to both internalized (i.e., anxiety) and externalized (i.e., conduct disorder) behavioral health problems as well as depression as measured by the CDI. Other studies have also found that young Hispanics in the United States adapt to the values of a new culture more quickly than do their parents (Phinney, Madden, & Ong, 2000), which may increase tension in the family and contribute to psychological maladjustment and suicide attempts (Zayas, Lester, Cabassa, & Fortuna, 2005). DEVELOPMENT OF THE HISPANIC STRESS INVENTORIES FOR ADULTS AND ADOLESCENTS The HSI was developed to aid researchers and clinicians in the assessment of culturally based stress in both U.S. born and foreign-born Hispanic adults (Cervantes et al., 1991). The HSI includes two versions, one for immigrants (five subscales) and one for nonimmigrants (four subscales). The immigrant version of the HSI includes an Immigration Stress subscale (e.g., “I thought I would be deported if I went to a social or governmental agency”), and both versions include Marital Stress (e.g., “There have been cultural conflicts in my marriage”), Occupation/Economic Stress (e.g., “I have been forced to accept low paying jobs”), Parental Stress (e.g., “I thought that my children were not receiving a good education”), and Family/Cultural Conflict Stress (e.g., “Being too close to my family interfered with my own goals”) subscales. All subscales were empirically derived using factor analysis and 278       cervantes and bui

TABLE 14.1 Pearson Correlations of Hispanic Stress Inventory Subscales With Criterion Measures Symptomatology Scales SCL–90–R Anxiety

SCL–90–R Somatization

U.S. born version (n = 188) .31* .22 .10 .07 .17 .19 .40* .38*

.17 .04 .19 .34*

-.07 .05 .12 .29*

Immigration version (n = 305) .27* .26* .31* .22 .10 .07 .17 .19 .40* .38*

.17 .17 .04 .19 .34*

.16 -.07 .05 .12 .29*

Subscale

CES–D

Occupational/Economic Parental Marital Family/Culture Immigration Occupational/Economic Parental Marital Family/Culture

SCL–90–R Depression

Note. CES–D = Center for Epidemiological Studies Depression Scale (Data are from Radloff [1977]); SCL–90–R = Symptom Checklist–90–Revised (Data are from Derogatis [1992]). * p < .05.

proved to have strong relationships to other standardized measures of mental health (see Table 14.1). A second series of studies funded by the National Institutes of Health to restandardize the original HSI with a national sample of Hispanic adults found new stressor themes and valid item content for a new version of the instrument (HSI—Version 2 [HSI2]; Cervantes, Goldbach, & Padilla, 2012). The largest number of new HSI2 stress items was generated for the Access to Healthcare Stress subscale (37 items), followed by Immigration Stress Domain (33 items), Parent Stress (32 items), Cultural Conflict Stress (26 items), Occupational and Economic Stress (21 items), Marital Stress (20 items), and Family Stress (18 items) subscales. Hispanic Stress Inventory—Adolescent Version Studies of cultural stress among adolescents have found important differences in the specificity and context of adolescent stressors (Córdova & Cervantes, 2010), the impact of discrimination stress exposure among Hispanic adolescents (Cervantes & Córdova, 2011), and the impact of school-related stress on mental health outcomes (Cervantes & Shelby, 2013). In addition, these studies have articulated eight distinct cultural contexts of Hispanic adolescent stress and how these stressors vary and affect the mental health of first, second, and later generations of youth (Cervantes et al., in press). culturally informed psychosocial stress assessment     

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Cervantes, Fisher, et al. (2012) systematically developed an instrument that has high utility to both professionals and researchers who, respectively, practice and conduct research with foreign-born and U.S. born Hispanic adolescents. The development of the HSI–A was based on the previous pioneering work of Cervantes et al. (1991) in assessment in Hispanic populations. Exploratory factor analysis procedures were implemented and yielded an interpretable eight-factor solution, with factors labeled Family Economic Stress (e.g., “My family had problems paying rent”), Acculturation-Gap Stress (e.g., “My parents want me to maintain customs and traditions from our home country”), Culture and Educational Stress (e.g., “Teachers think I am cheating when I am speaking Spanish”), Immigration-Related Stress (e.g., “I had to leave family members behind in my home country”), Community and Gang-Related Stress (e.g., “There was a lot of pressure for me to get involved in gangs”), Discrimination Stress (e.g., “Students made racist comments”), Family and Drug-Related Stress (e.g., “A family member had a drug problem”), and Family Immigration Stress (e.g., “Family members were afraid of getting caught by immigration officials”). This study further demonstrated that the HSI–A has strong concurrent validity with measures of psychological symptomatology. The HSI–A total and subscale stress appraisal scores also show acceptable estimates of internal consistency. Future research on the final HSI–A eight-subscale version is needed to determine the utility of the tool and to determine whether it is appropriate for use in clinical settings. The HSI–A subscales and correlations with concurrent mental health measures are presented in Table 14.2.

TABLE 14.2 Hispanic Stress Inventory–Adolescent Version Subscales and Correlations With Concurrent Mental Health Measures—Children’s Depression Inventory and Youth Self-Report Total N = 786 HSI–A Total Stress-Appraisal score Family Economic Stress Culture and Educational Stress Acculturation-Gap Stress Immigration-Related Stress Discrimination Stress Family Immigration Stress Community and Gang-Related Stress Family and Drug Stress

CDI Total

YSR Total

.41*** .28*** .23*** .40*** .15*** .36*** .14*** .23*** .27***

.49** .32** .29** .51** .11* .34** .22** .29** .36**

Note. CDI = Children’s Depression Inventory (Data are from Kovacs [2006]; Kovacs & Beck [1977]; and Sitarenios & Kovacs [1999]); YSR = Youth Self-Report (Data are from Achenbach & Rescorla [2001]). *p < .05. **p < .01. ***p < .001.

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Findings from the study by Cervantes, Fisher et al. (2012) suggest that appraisals of stress as measured by the HSI–A are associated with higher levels of symptoms related to psychopathology and behavioral and conduct problems, as well as higher levels of emotional disturbance among youth participants. Separately, many of the HSI–A subscales have shown unique relationships with particular behavioral and emotional syndromes. One subscale, Acculturation-Gap Stress, appears to be one of the more robust measures of psychosocial stress in Hispanic adolescents, with high scores corresponding to increased risk of childhood depression as measured with the CDI. The HSI–A, when compared with other assessment measures, has the unique ability to screen for culturally based stressor events such as acculturation gaps, family immigration stress, and discrimination stress. The role of acculturation gaps and related problems among youths and the potential for these problems to increase depression in this population is in need of much more study. The HSI–A has also been used in a number of other studies, including the drug prevention trial, the Familia Adelante (Cervantes, Goldbach, & Santos, 2011), to develop or measure prevention- and intervention-related outcomes in Hispanic adolescents. The HSI–A has also been used to inform other interventions including culturally informed and flexible family-based treatment (Santisteban & Mena, 2009). Using the Hispanic Stress Inventory and the Hispanic Stress Inventory— Adolescent Version for Cultural Tailoring of Interventions Cultural tailoring, as defined by Pasick, D’Onofrio, and Otero-Sabogal (1996) and Resnicow, Baranowski, Ahluwalia, and Braithwaite (1999), is generally characterized as the process of developing or modifying interventions or materials to ensure their cultural sensitivity—that is, their conformity to pertinent characteristics of the population targeted. The developers of health promotion programs are often advised to engage in cultural tailoring (Boles, Casas, Furlong, Gonzalez, & Morrison, 1994; Kandel, 1995; Pasick et al., 1996; Sanders, 2000) to incorporate into their prevention materials the norms, values, and experiences of the populations targeted (Marín & Posner, 1995). Support for cultural tailoring is also provided by several theoretical perspectives. Successful culturally based interventions, Demmert and Towner (2003) contended, comprise several key elements, including the use of individuals’ primary language, congruence of strategies with traditional cultural characteristics, and references to community values and mores. The literature has suggested important core values that preventive interventions should consider—for example, respect for elders, familismo, fatalism, and positive social interactions or simpatía among Hispanics (Kreuter & Wray, 2003; Marin, Perez-Stable, Marin, Sabogal, & Otero-Sabogal, 1990; Resnicow et al., 1999). culturally informed psychosocial stress assessment     

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The HSI and HSI–A will have a potentially large impact on mental health service systems in the United States and are two of the few culturally appropriate measures of psychosocial stress for the fastest-growing population in the country (U.S. Census Bureau, 2010). Both instruments provide knowledge that is directly applicable to the design, delivery, and support of effective mental health coping and risk prevention services for an underrepresented and understudied population of Hispanic adolescents. Clinicians who use the HSI and HSI–A measures can more effectively 77 77 77

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identify clusters of problematic culturally based stressors, including chronic and acute stress exposure; use information from the HSI and HSI–A to develop a culturally tailored individualized treatment plan; provide clients with assessment information about their own cultural life experience that is not commonly provided (i.e., help Hispanic clients “normalize” their stress experiences); use the HSI and HSI–A in the context of family treatment to identify unique parent–child patterns of stress; and use the HSI and HSI–A for reassessment and monitoring of progress related to cultural stress issues. CONCLUSION

The need to reduce the mental health disparities in the Hispanic population through the use of accurate early detection and screening assessments has been well documented. Research on the development of Hispanic specific assessment tools has lagged far behind the general research in this area. Moreover, much of the development has been limited to translation (and test adaptation) of existing objective assessments, with in­appropriate use of White non-Hispanic norm or reference groups and a lack of established validity for use with the Hispanic population. To the best of our knowledge, there currently are no readily available and accessible Hispanic-based assessment tools for use in screening, diagnosis, or treatment planning efforts. Not to take into account factors embedded within the Hispanic experience that mediate mental health (e.g., acculturation, language use, citizenship status), arguably, can result in a risk of misdiagnosis, inappropriate treatment, and premature termination (Cervantes & Acosta, 1992; Prieto, McNeill, Walls, & Gomez, 2001). This is remarkable given the sheer size of the Hispanic population and their need for behavioral health services. To begin addressing this gap in psychometrically sound, sensitive, and culturally appropriate coping measurement, future research should test the 282       cervantes and bui

feasibility of producing a culturally relevant coping instrument for Hispanic adolescents. In the absence of such measures, both explanatory research and informed mental health promotion and prevention programs lack the specificity needed to advance these respective discipline areas. Research into the utility of the HSI and HSI–A as screening and early detection tools is needed. Culturally informed early screening and assessment with tools such as the HSI–A may prove beneficial to school personnel, as well as to trained clinicians who desire more relevant diagnostic information for treatment planning purposes. REFERENCES Achenbach, T. M., & Rescorla, L. A. (2001). Manual for ASEBA school-age forms and profiles. Burlington: University of Vermont, Research Center for Children, Youth, & Families. Alva, S. A., & de los Reyes, R. (1999). Psychosocial stress, internalized symptoms, and the academic achievement of Hispanic adolescents. Journal of Adolescent Research, 14, 343–358. http://dx.doi.org/10.1177/0743558499143004 Aneshensel, C. S. (1992). Social stress: Theory and research. Annual Review of Sociology, 18, 15–38. http://dx.doi.org/10.1146/annurev.so.18.080192.000311 Barona, A., & Miller, J. A. (1994). Short Acculturation Scale for Hispanic Youth (SASH-Y): A preliminary report. Hispanic Journal of Behavioral Sciences, 16, 155–162. http://dx.doi.org/10.1177/07399863940162005 Berry, J. W. (1991). Understanding and managing multiculturalism. Psychology and Developing Societies, 3, 17–49. http://dx.doi.org/10.1177/097133369100300103 Bird, H. R., Canino, G., Rubio-Stipec, M., Gould, M. S., Ribera, J., Sesman, M., . . . Moscoso, M. (1988). Estimates of the prevalence of childhood maladjustment in a community survey in Puerto Rico: The use of combined measures. Archives of General Psychiatry, 45, 1120–1126. Boles, S., Casas, M., Furlong, M., Gonzalez, G., & Morrison, G. (1994). Alcohol and other drug use patterns among Mexican-American, Mexican, and Caucasian adolescents: New directions for assessment and research. Journal of Clinical Child Psychology, 23, 39–46. http://dx.doi.org/10.1207/s15374424jccp2301_6 Brody, G. H., Chen, Y.-F., Murry, V. M., Ge, X., Simons, R. L., Gibbons, F. X., . . . Cutrona, C. E. (2006). Perceived discrimination and the adjustment of African American youths: A five-year longitudinal analysis with contextual moderation effects. Child Development, 77, 1170–1189. http://dx.doi.org/10.1111/j.14678624.2006.00927.x Butcher, J. N., Cabiya, J., Lucio, E., & Garrido, M. (2007). Assessing Hispanic clients using the MMPI–2 and MMPI–A. Washington, DC: American Psychological Association. http://dx.doi.org/10.1037/11585-000 culturally informed psychosocial stress assessment     

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15 ASSESSING SEXUAL ORIENTATION AND GENDER IDENTITY AMONG LATINOS FRANCISCO J. SáNCHEZ

Within U.S. Latina/o (henceforth Latino, for simplicity) pop culture, it has been common for gender atypical and/or nonheterosexual characters— especially male characters—to play the role of comic relief. From highly rated talk shows to numerous telenovelas, gay men have often appeared in a caricatured manner (Tate, 2011). Unlike the dominant U.S. mainstream media, Spanish-speaking media has been slower at challenging and/ or omitting such pejorative images (Hernandez, 2011). To some degree, this may reflect the evolution of these issues among Latinos in the United States. Although, Latino communities are becoming more accepting of their lesbian, gay, bisexual, and transgender (LGBT) counterparts (Lopez & Cuddington, 2013), positive media representation of LGBT people is lacking (Hernandez, 2012). As Latinos are now the largest minority group in the United States and as they continue to grow in numbers, it will become increasingly important http://dx.doi.org/10.1037/14668-016 Psychological Testing of Hispanics, Second Edition: Clinical, Cultural, and Intellectual Issues, K. F. Geisinger (Editor) Copyright © 2015 by the American Psychological Association. All rights reserved.

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that the experience of Latino LGBT people is represented in the psychological literature. Thus, in this chapter the assessment of sexual orientation and gender identity is discussed, and findings specific to Latinos are offered. The main focus is on the experience of Latinos in the United States, and evidence is drawn from empirical articles published in peer reviewed journals. However, given the limited number of studies focused on the experience of Latinos, this chapter also extrapolates from research on non-Latinos. Transgender issues in this chapter are included; however, it is important to understand that the issues related to this group are unique and complex. People usually conflate transgender issues with sexual orientation. This is in part due to the fact that the “trans” community has been included within the LGBT community to increase their power to secure equal rights. Although sexual orientation and gender identity are highly correlated (i.e., people who identify as male are almost always attracted to females), they are not the same. Consequently, sexual orientation is intentionally separated from gender identity. DEFINITIONS The following are some key definitions used in this chapter: 77 77

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Birth sex refers to the sex assigned to a baby at birth, which is typically based on the external genitalia (Vilain, 2000). Gender identity is our psychological sense of maleness or femaleness (Stoller, 1968), which may or may not be congruent with our birth sex. Transgender is an umbrella term that refers to people whose gender identity and/or gender expression differs in significant ways from their birth sex (Davidson, 2007). Transsexual refers to a person who lives or desires to live fulltime as a person opposite to their birth sex; often the person takes significant steps to modify his or her anatomy and physiology so that it is congruent with his or her identity (American Psychological Association, Task Force on Gender Identity and Gender Variance, 2009). Cross-dressers are people who dress in clothing customary for the opposite sex; cross-dressing does not necessarily mean that a person is a transsexual or that he or she is doing it for sexual reasons (Brown et al., 1996). Sexual orientation is defined on the basis of a person’s emotional, romantic, sexual, or erotic attraction to males, females, or both.

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SEXUAL ORIENTATION Sexual and romantic attraction play a major role in people’s lives. Although most people are attracted to the opposite sex, it is estimated that 5% to 6% of men and 2% to 3% of women are attracted to the same sex (Diamond, 1993). There are no estimates specific to the Latino community, yet it is reasonable to believe that the general population estimate applies to them as well. One should keep in mind, however, that not all people who engage in same-sex sexual and romantic relationships identify as LGBT. In this section, the reasons for same-sex attraction are considered before reviewing how sexual orientation is assessed. A brief review of empirical research focused on Latinos is provided along with some areas for advancing this line of research. Sexual Orientation Basis Although much about human sexual behavior is reasonably well understood, science has yet to unequivocally explain what influences our sexual orientation. Most theory and research has focused on nonheterosexual communities. Within the social sciences, numerous theories have been proposed, including childhood developmental disruptions (Freud, 1957), pleasurable same-sex experiences early in life (Churchill, 1967), and incest or unpleasant opposite-sex experiences (Cameron & Cameron, 1995). Yet, social theories lack empirical support. If anything, social science research has helped eliminate such wrong ideas by failing to link them together (Bell, Weinberg, & Hammersmith, 1981). The life sciences offer some hint that our biology may play a role in our sexual orientation, but even here the picture is mixed. Studies in this area have mainly focused on the effect of hormones, correlations with anatomical traits, and the role of genetics. Here three findings are highlighted. Interested readers can find further information in Ngun, Ghahramani, Sánchez, Bocklandt, and Vilain (2011) and Sánchez, Bocklandt, and Vilain (2009). The first line of research focuses on the fraternal birth order effect (Blanchard & Bogaert, 1996): The more older brothers a man has, the greater the odds that he will be gay. Each older brother increases the odds of being gay by approximately 33%. However, this is relative to the baseline frequency of 5% to 6% of men identifying as gay. This finding has been replicated in several studies (Cantor, Blanchard, Paterson, & Bogaert, 2002). The dominant theory for this effect—which lacks empirical support—is that the mother’s immune system may increasingly develop antibodies with each male pregnancy that adversely affect subsequent male fetuses (Puts, Jordan, & Breedlove, 2006). sexual orientation and gender identity     

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The second area focuses on the brain. Studies have found structural and functional brain differences between heterosexual and nonheterosexual people (e.g., Allen & Gorski, 1992; Savic & Lindström, 2008). These differences include the size of brain regions that are known to differ between men and women, differences in performing cognitive tasks (e.g., mental rotation and judgment of line orientation), and differences in cerebral blood flow when exposed to male or female odors (Rahman & Wilson, 2003; Savic, Berglund, & Lindström, 2005). Finally, findings from genetics studies have suggested that genes play a role in our sexual orientation. The first compelling evidence came from the National Institutes of Health where researchers found that relatives who identified as gay shared a specific region of the X chromosome known as Xq28 (Hamer, Hu, Magnuson, Hu, & Pattatucci, 1993)—a result later supported by a meta-analysis of several contradictory studies (Sanders & Dawood, 2003). Subsequently, additional potential regions of the genome involved in sexual attraction were identified on chromosomes 7, 8, and 10 (Mustanski et al., 2005). Although the specific genes involved in sexual orientation have yet to be identified, there are several studies underway that are attempting to help answer this question by focusing on twins discordant for sexual orientation (i.e., one identifies as heterosexual and the other as gay), gay brothers, and other specialized populations (e.g., men with Klinefelter’s syndrome). Assessing Sexual Orientation Assessing sexual orientation has shown some evolution in the literature. Self-report, or simply asking what someone’s sexual orientation is, is the most common form of assessing this trait, which usually yields an accurate response. This method, however, may lead to error when interviewing people who are not exclusively heterosexual yet do not identify as gay. Realizing this dilemma, epidemiologists adopted the term MSM (men who have sex with men) to include men who may not identify as gay or bisexual. More recently WSW (women who have sex with women) has been used as well (Young & Meyer, 2005). More objective methods have been used to try to assess sexual orientation. Historically, this approach focused on one’s physiological responses to sexual stimuli (e.g., pupil dilation, heart rate, galvanic skin response). For instance, the penile plethysmograph, which measures volumetric or circumferential changes in the penis (Freund, 1963), has been used to gauge the level of arousal men experience while viewing sexual images (e.g., Chivers, Rieger, Latty, & Bailey, 2004); a female version has also been developed (Sintchak & Geer, 1975). Recently, noninvasive technology, such as thermal imaging or “heat cameras” that measure body temperature changes (Kukkonen, Binik, 294       francisco j. sánchez

Amsel, & Carrier, 2007) and functional MRI technology, has been used to measure sexual arousal as well (e.g., Arnow et al., 2002). There is some concern that cultural issues may complicate assessing sexual orientation among racial and ethnic minorities. Some of these issues may be related to the specific cultural group one is from, including the prevailing attitudes toward LGBT people within that culture and the desire to not want to alienate oneself from the cultural group that is already alienated from mainstream culture. For instance, in a study of 616 Northern Californians of Mexican descent (66% women; 51% born in Mexico), Herek and GonzalezRivera (2006) found that attitudes were consistent with studies focused on nonHispanic participants—namely, that male participants, compared with female participants, held more negative views toward gay men. However, the female participants held more negative attitudes toward lesbian women than toward gay men; the male participants were equally negative toward lesbian women and gay men. For both males and females, support for traditional gender roles was the strongest predictor of attitudes toward homosexuality. Furthermore, compared with White families, Latino families, which are often central to Latino cultural values, may express greater negative reactions toward a nonheterosexual orientation (Ryan, Huebner, Diaz, & Sánchez, 2009). At the same time, there are factors within the LGBT culture that may alienate non-White people, including discrimination and sexual objectification or exoticism (Choudhury et al., 2009; Díaz, Ayala, & Bein, 2004). For instance, Ibañez, Van Oss Marin, Flores, Millett, and Diaz (2009) found that among a sample of 911 Latino gay men, 58% of the men reported experiencing some form of discrimination within the gay community (e.g., made to feel uncomfortable in a predominately White gay club and being “turned down” for sex because they were Latino). Furthermore, reports of discrimination were greater for those who had darker skin tone compared with lighter skin tone. Given the negative messages Latinos receive from both their cultural group and mainstream gay culture, it may be unsurprising that internalized homophobia and heterosexism likely affect self-esteem and the degree to which they disclose their sexual orientation. This internalization can be further complicated by personal attitudes and values, including religion (Barnes & Meyer, 2012) and notions regarding traditional gender roles (Carballo-Diéguez et al., 2004). How then can one assess these characteristics among people who may not want to marginalize themselves even further from both the dominant culture and their primary ethnic group? This may be further complicated given that Latinos may be less open about their sexual orientation compared with other groups. Although Latinos’ timing of coming out is similar to other racial and ethnic groups (Parks, Hughes, & Matthews, 2004), many disclose to fewer people—especially early in their coming-out process—than do their sexual orientation and gender identity     

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White counterparts (Rosario, Schrimshaw, & Hunter, 2004). Moreover, whereas many White LGBT people come out when they are far from home, many Latinos remain closer to home, which may result in being less open about their sexual orientation. Some scales often used in the literature may assist in assessing sexual orientation. Three are reviewed here. It should be noted that the psychometric properties of these scales have been questioned because of the limits of relying on self-report, the limitations of using bipolar and dichotomous scales, and the mixing of psychological and behavioral components of sexual orientation (Moradi, Mohr, Worthington, & Fassinger, 2009; Sell, 1997). Kinsey Scale The Kinsey Scale is a 7-point continuum that helps classify people’s sexual orientation: 0 = Exclusively heterosexual; 1 = Predominantly heterosexual, only incidentally homosexual; 2 = Predominantly heterosexual, but more than incidentally homosexual; 3 = Equally heterosexual and homosexual; 4 = Predominantly homosexual, but more than incidentally heterosexual; 5 = Predominantly homosexual, only incidentally heterosexual; and 6 = Exclusively homosexual. Kinsey, Pomeroy, and Martin (1948/1975) developed this scale on the basis of hundreds of interviews conducted throughout the United States, during which time his team discovered that sexuality was neither a dichotomous nor a stable variable for all people. The scale takes into account a person’s interests, fantasies, and behaviors—which may or may not coincide with how they self-identify. Klein Sexual Orientation Grid Klein, Sepekoff, and Wolf (1985) expanded on the Kinsey Scale by taking into account past, present, and future (or ideal) experiences with sexuality. The Klein Sexual Orientation Grid also uses a seven-point scale: 1 = Other sex only/Heterosexual only, 2 = Other sex mostly/Heterosexual mostly, 3 = Other sex somewhat/Heterosexual more, 4 = Both sexes equally/Heterosexual-Homosexual equally, 5 = Same sex somewhat/Homosexual more, 6 = Same sex mostly/ Homosexual somewhat, and 7 = Same sex only/Homosexual only. Participants are asked to rate their identity on seven different dimensions of sexuality, which include attraction, behavior, fantasies, emotional preference, social preference, lifestyle preference, and self-identification. Although the Klein Scale seems to address many different aspects of sexuality, research has found that it adds little to what can be assessed from the much shorter Kinsey Scale (Weinrich et al., 1993). That is, the 21 items of the Klein Scale all seem to tap into a single construct. Furthermore, the dimension of future/ideal may be confusing for some participants to respond to. 296       francisco j. sánchez

The Storms Scale Michael Storms (1980) proposed a two-dimensional model of sexual orientation, which places same-sex and opposite-sex attraction on separate x- and y-axes based predominantly on one’s erotic fantasies. Unlike the previous two scales, the Storms Scale accommodates for asexuality in addition to heterosexuality, bisexuality, and homosexuality. Furthermore, it allows for the inclusion of asexuality as a sexual orientation, whereby a person merely scores low on both opposite-sex and same-sex attraction versus simply being excluded altogether. Sexual Orientation Research Focused on Latinos Although the amount of sexual orientation research has been increasing over the years, most of the research has focused on White, non-Hispanic participants (Huang et al., 2010). When racial and ethnic minorities have been included in research studies, the experience of different groups may be difficult to understand because of how samples are described or because nonWhite participants are grouped together (e.g., Bith-Melander et al., 2010; Hotton, Garofalo, Kuhns, & Johnson, 2013; Taylor, Bimbi, Joseph, Margolis, & Parsons, 2011). Furthermore, the experience of men is more represented in both nonempirical and empirical articles than it is for women (Huang et al., 2010). Of the studies that focus on Latinos, most concentrate on sexually transmitted diseases, high-risk behaviors, and problematic substance use. For instance, the degree to which Latinos internalize negative views regarding being nonheterosexual is related to high-risk sexual behavior (Díaz et al., 2004; Jarama, Kennamer, Poppen, Hendricks, & Bradford, 2005; Nakamura & Zea, 2010). Furthermore, the role that people play during sex may be related to the degree to which they feel stigmatized and thus subordinate to other groups (Carballo-Diéguez et al., 2004; Clark et al., 2013; Jeffries, 2009). Although such research is of great importance to public health, it offers a limited view of the experience of LGBT Latinos. Given the degree to which the Latino community is growing, it is important for researchers to focus more attention on the experience of Latinos. There are several areas in which research should continue. First, it will be important to either validate existing measures or develop new measures that are valid for use with Latinos. Specifically, the cultural appropriateness of measures should be evaluated, including assessing whether sexual orientation concepts are equivalent among Latinos and whether terms used in measures are linguistically appropriate. In addition, appropriately translated measures should be developed. sexual orientation and gender identity     

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Second, a major hurdle in studying Latinos is the number of possible intersecting variables that could affect data interpretation. These variables may include sex, age, education, social class, generation status, acculturation, languages spoken, specific ethnic background (e.g., Mexican, Cuban, Puerto Rican), the density of Latinos in one’s neighborhood, and religiosity. Although it would be extremely difficult to measure every possible intersecting identity of value, researchers should attempt to assess as many variables that are meaningful and feasible for the research questions being investigated. Third, more attention should be given to the positive experiences of being a Latino LGBT person. For instance, are there specific cultural values or experiences that may buffer against the effects of antigay bigotry (e.g., the importance of family and community)? How may the positive aspects of gender role norms (e.g., caballerismo) positively influence relationship satisfaction and longevity? A final caveat when considering research with Latino populations is the possible influence of social desirability. Some studies have found that Latino participants score higher on measures of social desirability (e.g., the MarloweCrowne Social Desirability Scale) compared with non-Latinos, especially White participants (Hopwood, Flato, Ambwani, Garland, & Morey, 2009). Some hypotheses for this difference include that Latinos may not want to reflect poorly on their family or cultural group and that more collectivistic communities may wish to be “harmonious” with interviewers and researchers (Triandis, Marín, Lisansky, & Betancourt, 1984). Regardless of the reason, researchers may wish to control for social desirability by including such a measure in their studies. GENDER IDENTITY Gender plays a critical role from the time of birth. Although gender identity usually remains constant throughout life and reflects birth sex (i.e., an infant assigned as a female at birth will later identify as a female; Bem, 1989; Chauhan, Shastri, & Mohite, 2005; Gouze & Nadelman, 1980), some people do not identify with their birth sex. Such cases have played a significant role in understanding how and why gender identity develops. This chapter focuses on gender roles and norms in general but also on Latinos who identify with the transgender community. Gender Identity Development Although the lines of research on gender identity mirror those on sexual orientation, far less is known about the influence of the environment and 298       francisco j. sánchez

biology on gender identity. Although social environments likely influence gender-related attitudes and behaviors, it is difficult to determine to what degree the social environment affects one’s sense of being a man or a woman. Within the social sciences, several theories have been proposed as to why someone may experience gender dysphoria, or the feeling that one’s birth sex does not reflect the person’s true sense of gender. Many theories that lack empirical support have been proposed, including the absence of the same-sex parent during childhood (Stoller, 1979), enmeshment between a child and their opposite-sex parent (Loeb & Shane, 1982), and parents wishing that they had had a child of the opposite sex (Green, 1974). The most compelling research from the social sciences consists of longitudinal studies on gender atypical children: The majority of such children will eventually identify with their birth sex, though most will report a same-sex sexual orientation (Cohen-Kettenis & Pfäfflin, 2003; Drummond, Bradley, Peterson-Badali, & Zucker, 2008; Green, 1985, 1987; Wallien & Cohen-Kettenis, 2008; Zucker & Bradley, 1995). Consequently, most children who are considered gender atypical will not experience gender dysphoria as adults. Within the life sciences, the lines of research on gender identity have paralleled the aforementioned lines of research on sexual orientation: hormonal influences, correlations with anatomical traits, and genetic influences (see Ngun et al., 2011; Sánchez et al., 2009). Likewise, the life sciences offer a mixed picture. For instance, there have been conflicting findings regarding possible genes involved in gender identity (cf. Hare et al., 2009; Ujike et al., 2009). The strongest findings thus far come from neuroscience. Over a dozen studies using different methodologies (e.g., brain autopsies, PET, MRI) have been published since an “accidental finding” of an “extremely large” suprachiasmatic nuclei in two autopsied male-to-female transsexuals was reported in 1987 (Swaab et al., 1987, p. 307). Yet, it has been proposed that there were several problems with this research, including measurements being taken after participants had been treated with cross-sex hormones (Hulshoff Pol et al., 2006) and the potential influence of sexual orientation (i.e., differences found may be due to same-sex attraction versus gender dysphoria; Cantor, 2011). Researchers are beginning to control for these potential confounds and have found differences in gray matter concentration and fiber-tract organization when comparing trans­sexuals with controls (Rametti et al., 2011). Although it is likely that more clarity will be derived as technology advances and becomes more economical, for now there is no objective measure for determining gender identity. Assessing Gender Identity Unlike sexual orientation, measuring gender identity is a more difficult procedure. Lewis Terman and Catherine Miles (1936) conducted sexual orientation and gender identity     

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one of the earliest and largest studies aimed at assessing gender identity. They developed the Masculinity–Femininity Test, which consists of several subtests (e.g., word association, interest, introversion) aimed at differentiating the sexes. Since then, several methods have been used to try to measure gender-related traits. These have included bipolar, unidimensional masculinity–femininity scales (e.g., Hathaway & McKinley, 1964); orthogonal scales or scales that separate masculinity and femininity (e.g., Bem, 1974; Spence, Helmreich, & Stapp, 1974); scales that assess sexually dimorphic interests and traits (Lippa & Connelly, 1990); and direct observation of behaviors (e.g., toy preference; Hines, 2011; Jadva, Hines, & Golombok, 2010). All have their unique limitations, including their generalizability to non-White communities in the United States. Furthermore, no self-report measure—such as the aforementioned Kinsey Scale—exists that is both valid and widely used for assessing gender identity. Thus, at this point one can merely ask two key questions: What sex were you assigned at birth? Do you identify as male, female, or something else? Gender Identity Research Focused on Latinos Most research on gender identity has focused on the transgender community, a diverse group of people. In general, those who identify with this community resist society’s conception of what it means to be a man or a woman. Such people may adopt any number of identity labels, including transsexual, transman, transwoman, cross-dresser, agender, bigender, trigender, and genderqueer. Consequently, the numerous identities and terms associated with the community may be confusing for those not familiar with the community. Furthermore, it makes studying the experience of the transgender community rather complicated. The vast majority of the research on this community has focused on the experience of transsexuals—namely, male-to-female transsexuals—and most of this research has focused on etiology and psychopathology versus quality of life issues and the more positive aspects of their experience. Yet, few published reports have focused on the experience of Latino transgender people. In addition, studies have often lumped transgender people with lesbian, gay, and bisexual people (e.g., Ramirez-Valles, Molina, & Dirkes, 2013). Of the approximately 61 peer reviewed, empirical articles retrieved from PsycINFO (using an “advanced search”) and that intentionally included Latinos—and other transpeople of color—the majority focused on sexually transmitted infections and sexual health (e.g., Finlinson, Colón, Robles, & Soto, 2008; Ramirez-Valles, Garcia, Campbell, Diaz, & Heckathorn, 2008).

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For instance, Nemoto, Operario, Keatley, and Villegas (2004) interviewed 48 transwomen of color (12 were Latina) and concluded that discrimination and financial hardship influenced the degree to which transwomen of color engaged in sex work. Even though such research is important in addressing pressing public health concerns, this research presents a narrow view of being transgender. Consequently, research on other aspects of being a transgender person (e.g., quality of life issues and a sense of connection with the transgender community) may not reflect the reality of Latinos because those results are based primarily on White participants. As research on transgender Latinos continues to develop, several points should be kept in mind. First, researchers should be clearer when describing the population being sampled. Specifically, with what aspect of the transgender community does the participant identify (e.g., cross-dresser, transsexual, genderqueer)? This should be further described by asking relevant transition-related questions of transsexuals, including age of coming out and beginning transition, when they began specific treatments, and whether they would like to undergo all physical treatments if there were no barriers to such treatment. Second, researchers should avoid general sexual orientation labels (i.e., gay or lesbian) when describing transgender participants. Instead, the object of sexual attraction (i.e., attracted to men, women, both, or neither) should be specified. Such specific description will avoid confusion, especially for readers less experienced with the transgender community. Finally, more research should focus on the positive aspects of being transgender. Such topics may include resiliency, the benefits of having a community, and satisfaction with life. Furthermore, research on healthy romantic and sexual relationships can help provide answers to these questions, which are often of major concern to transsexuals when they begin their transition. CONCLUSION The population of Latinos continues to grow in size in U.S. society. Consequently, it is becoming increasingly important that the experience of this community become better understood. Specific to this chapter has been sexual orientation and gender identity related to the Latino community. Both of these characteristics play a major role in people’s quality of life. Thus, it is important that researchers validate or develop culturally appropriate measures for these traits, as well as expand research beyond disease-related and etiology issues.

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Hulshoff Pol, H. E., Cohen-Kettenis, P. T., van Haren, N. E. M., Peper, J. S., Brans, R. G. H., Cahn, W., . . . Kahn, R. S. (2006). Changing your sex changes your brain: Influences of testosterone and estrogen on adult human brain structure. European Journal of Endocrinology, 155(Suppl. 1), S107–S114. http://dx.doi. org/10.1530/eje.1.02248 Ibañez, G. E., Van Oss Marin, B., Flores, S. A., Millett, G., & Diaz, R. M. (2009). General and gay-related racism experienced by Latino gay men. Cultural Diversity and Ethnic Minority Psychology, 15, 215–222. http://dx.doi.org/10.1037/a0014613 Jadva, V., Hines, M., & Golombok, S. (2010). Infants’ preferences for toys, colors, and shapes: Sex differences and similarities. Archives of Sexual Behavior, 39, 1261–1273. http://dx.doi.org/10.1007/s10508-010-9618-z Jarama, S. L., Kennamer, J. D., Poppen, P. J., Hendricks, M., & Bradford, J. (2005). Psychosocial, behavioral, and cultural predictors of sexual risk for HIV infection among Latino men who have sex with men. AIDS and Behavior, 9, 513–523. http://dx.doi.org/10.1007/s10461-005-9022-1 Jeffries, W. L., IV. (2009). A comparative analysis of homosexual behaviors, sex role preferences, and anal sex proclivities in Latino and non-Latino men. Archives of Sexual Behavior, 38, 765–778. http://dx.doi.org/10.1007/s10508-007-9254-4 Kinsey, A. C., Pomeroy, W. B., & Martin, C. E. (1975). Sexual behavior in the human male. Bloomington: Indiana University Press. (Original work published 1948) Klein, F., Sepekoff, B., & Wolf, T. J. (1985). Sexual orientation: A multi-variable dynamic process. Journal of Homosexuality, 11, 35–49. http://dx.doi.org/10.1300/ J082v11n01_04 Kukkonen, T. M., Binik, Y. M., Amsel, R., & Carrier, S. (2007). Thermography as a physiological measure of sexual arousal in both men and women. Journal of Sexual Medicine, 4, 93–105. http://dx.doi.org/10.1111/j.1743-6109.2006.00399.x Lippa, R., & Connelly, S. (1990). Gender diagnosticity: A new Baysian approach to gender-related individual differences. Journal of Personality and Social Psychology, 59, 1051–1065. http://dx.doi.org/10.1037/0022-3514.59.5.1051 Loeb, L., & Shane, M. (1982). The resolution of a transsexual wish in a five-year-old boy. Journal of the American Psychoanalytic Association, 30, 419–434. http://dx.doi. org/10.1177/000306518203000205 Lopez, M. H., & Cuddington, D. (2013). Latinos’ changing views of same-sex marriage. Retrieved from http://www.pewresearch.org/fact-tank/2013/06/19/latinoschanging-views-of-same-sex-marriage/ Moradi, B., Mohr, J. J., Worthington, R. L., & Fassinger, R. E. (2009). Counseling psychology research on sexual (orientation) minority issues: Conceptual and methodological challenges and opportunities. Journal of Counseling Psychology, 56, 5–22. http://dx.doi.org/10.1037/a0014572 Mustanski, B. S., Dupree, M. G., Nievergelt, C. M., Bocklandt, S., Schork, N. J., & Hamer, D. H. (2005). A genome-wide scan of male sexual orientation. Human Genetics, 116, 272–278. http://dx.doi.org/10.1007/s00439-004-1241-4 sexual orientation and gender identity     

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Nakamura, N., & Zea, M. C. (2010). Experiences of homonegativity and sexual risk behavior in a sample of Latino gay and bisexual men. Culture, Health & Sexuality, 12, 73–85. http://dx.doi.org/10.1080/13691050903089961 Nemoto, T., Operario, D., Keatley, J., & Villegas, D. (2004). Social context of HIV risk behaviors among male-to-female transgenders of color. AIDS Care, 16, 724–735. http://dx.doi.org/10.1080/09540120413331269567 Ngun, T. C., Ghahramani, N., Sánchez, F. J., Bocklandt, S., & Vilain, E. (2011). The genetics of sexual differentiation of brain and behavior. Frontiers in Neuroendocrinology, 32, 227–246. http://dx.doi.org/10.1016/j.yfrne.2010.10.001 Parks, C. A., Hughes, T. L., & Matthews, A. K. (2004). Race/ethnicity and sexual orientation: Intersecting identities. Cultural Diversity and Ethnic Minority Psychology, 10, 241–254. http://dx.doi.org/10.1037/1099-9809.10.3.241 Puts, D. A., Jordan, C. L., & Breedlove, S. M. (2006). O brother, where art thou? The fraternal birth-order effect on male sexual orientation [Commentary]. Proceedings of the National Academy of Sciences of the United States of America, 103, 10531–10532. http://dx.doi.org/10.1073/pnas.0604102103 Rahman, Q., & Wilson, G. D. (2003). Large sexual-orientation-related differences in performance on mental rotation and judgment of line orientation tasks. Neuro­ psychology, 17, 25–31. http://dx.doi.org/10.1037/0894-4105.17.1.25 Rametti, G., Carrillo, B., Gómez-Gil, E., Junque, C., Segovia, S., Gomez, Á., & Guillamon, A. (2011). White matter microstructure in female to male transsexuals before cross-sex hormonal treatment. A diffusion tensor imaging study. Journal of Psychiatric Research, 45, 199–204. http://dx.doi.org/10.1016/ j.jpsychires.2010.05.006 Ramirez-Valles, J., Garcia, D., Campbell, R. T., Diaz, R. M., & Heckathorn, D. D. (2008). HIV infection, sexual risk behavior, and substance use among Latino gay and bisexual men and transgender person. American Journal of Public Health, 98, 1036–1042. http://dx.doi.org/10.2105/AJPH.2006.102624 Ramirez-Valles, J., Molina, Y., & Dirkes, J. (2013). Stigma towards PLWHA: The role of internalized homosexual stigma in Latino gay/bisexual male and transgender communities. AIDS Education and Prevention, 25, 179–189. http://dx.doi. org/10.1521/aeap.2013.25.3.179 Rosario, M., Schrimshaw, E. W., & Hunter, J. (2004). Ethnic/racial differences in the coming-out process of lesbian, gay, and bisexual youths: A comparison of sexual identity development over time. Cultural Diversity and Ethnic Minority Psychology, 10, 215–228. http://dx.doi.org/10.1037/1099-9809.10.3.215 Ryan, C., Huebner, D., Diaz, R. M., & Sánchez, J. (2009). Family rejection as a predictor of negative health outcomes in white and Latino lesbian, gay, and bisexual young adults. Pediatrics, 123, 346–352. http://dx.doi.org/10.1542/ peds.2007-3524 Sánchez, F. J., Bocklandt, S., & Vilain, E. (2009). Gender role conflict, interest in casual sex, and relationship satisfaction among gay men. Psychology of Men & Masculinity, 10, 237–243. http://dx.doi.org/10.1037/a0016325

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Sanders, A. R., & Dawood, K. (2003). Nature encyclopedia of life sciences. London, England: Nature. Savic, I., Berglund, H., & Lindström, P. (2005). Brain response to putative pheromones in homosexual men. Proceedings of the National Academy of Sciences of the United States of America, 102, 7356–7361. http://dx.doi.org/10.1073/ pnas.0407998102 Savic, I., & Lindström, P. (2008). PET and MRI show differences in cerebral asymmetry and functional connectivity between homo- and heterosexual subjects. Proceedings of the National Academy of Sciences of the United States of America, 105, 9403–9408. http://dx.doi.org/10.1073/pnas.0801566105 Sell, R. L. (1997). Defining and measuring sexual orientation: A review. Archives of Sexual Behavior, 26, 643–658. http://dx.doi.org/10.1023/A:1024528427013 Sintchak, G., & Geer, J. H. (1975). A vaginal plethysmograph system. Psychophysiology, 12, 113–115. http://dx.doi.org/10.1111/j.1469-8986.1975.tb03074.x Spence, J. T., Helmreich, R. L., & Stapp, J. (1974). The Personal Attributes Questionnaire: A measure of sex role stereotypes and masculinity–femininity. Journal Supplement Abstract Service Catalog of Selected Documents in Psychology, 4, 43–44. Stoller, R. J. (1968). Sex and gender: On the development of masculinity and femininity. New York, NY: Science House. Stoller, R. J. (1979). Fathers of transsexual children. Journal of the American Psycho­analytic Association, 27, 837–866. http://dx.doi.org/10.1177/000306517902700405 Storms, M. D. (1980). Theories of sexual orientation. Journal of Personality and Social Psychology, 38, 783–792. http://dx.doi.org/10.1037/0022-3514.38.5.783 Swaab, D. F., Roozendaal, B., Ravid, R., Velis, D. N., Gooren, L., & Williams, R. S. (1987). Suprachiasmatic nucleus in aging, Alzheimer’s disease, transsexuality and Prader-Willi syndrome. Progress in Brain Research, 72, 301–310. http:// dx.doi.org/10.1016/S0079-6123(08)60216-2 Tate, J. (2011). From girly men to manly men: The evolving representation of male homosexuality in the twenty-first century telenovelas. Studies in Latin American Popular Culture, 29, 102–114. http://dx.doi.org/10.1353/sla.2011.0004 Taylor, R. D., Bimbi, D. S., Joseph, H. A., Margolis, A. D., & Parsons, J. T. (2011). Girlfriends: Evaluation of an HIV-risk reduction intervention for adult transgender women. AIDS Education and Prevention, 23, 469–478. http://dx.doi. org/10.1521/aeap.2011.23.5.469 Terman, L. M., & Miles, C. C. (1936). Sex and personality: Studies in masculinity and femininity. New York, NY: McGraw-Hill. Triandis, H. C., Marín, G., Lisansky, J., & Betancourt, H. (1984). Simpatía as a cultural script for Hispanics. Journal of Personality and Social Psychology, 47, 1363–1375. http://dx.doi.org/10.1037/0022-3514.47.6.1363 Ujike, H., Otani, K., Nakatsuka, M., Ishii, K., Sasaki, A., Oishi, T., . . . Kuroda, S. (2009). Association study of gender identity disorder and sex hormone-related sexual orientation and gender identity     

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genes. Progress in Neuro-Psychopharmacology & Biological Psychiatry, 33, 1241–1244. http://dx.doi.org/10.1016/j.pnpbp.2009.07.008 Vilain, E. (2000). Genetics of sexual development. Annual Review of Sex Research, 11, 1–25. Wallien, M. S. C., & Cohen-Kettenis, P. T. (2008). Psychosexual outcome of gender-dysphoric children. Journal of the American Academy of Child & Adolescent Psychiatry, 47, 1413–1423. http://dx.doi.org/10.1097/ CHI.0b013e31818956b9 Weinrich, J. D., Snyder, P. J., Pillard, R. C., Grant, I., Jacobson, D. L., Robinson, S. R., & McCutchan, J. A. (1993). A factor analysis of the Klein sexual orientation grid in two disparate samples. Archives of Sexual Behavior, 22, 157–168. http://dx.doi.org/10.1007/BF01542364 Young, R. M., & Meyer, I. H. (2005). The trouble with “MSM” and “WSW”: Erasure of the sexual-minority person in public health discourse. American Journal of Public Health, 95, 1144–1149. http://dx.doi.org/10.2105/ AJPH.2004.046714 Zucker, K. J., & Bradley, S. J. (1995). Gender identity disorder and psychosexual problems in children and adolescence. New York, NY: Guilford Press.

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16 SOME CONCLUSIONS REGARDING THE TESTING OF HISPANICS: A LOOK AT THE PAST, THE PRESENT, AND THE FUTURE KURT F. GEISINGER

There are a number of trends regarding the testing of Hispanics at present, as may be gleaned from the chapters in this volume. These trends include the development of measures, research on assessments, identification of gold standard measures, training concerns, use of psychological services, and continued cross-cultural research. Each of these is discussed in this chapter. DEVELOPMENT OF MEASURES In the past 20 to 30 years, there have been many new measures developed for use with Hispanic and Latino populations, but there are still considerable needs. To provide some evidence for this point, the Buros Center’s volume, Tests in Print (Murphy, Geisinger, Carlson, & Spies, 2011), enumerates some 3,000 plus commercially available psychological and educational tests http://dx.doi.org/10.1037/14668-017 Psychological Testing of Hispanics, Second Edition: Clinical, Cultural, and Intellectual Issues, K. F. Geisinger (Editor) Copyright © 2015 by the American Psychological Association. All rights reserved.

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available for use and evaluation. Comparably, Pruebas Publicadas en Español (Schlueter, Carlson, Geisinger, & Murphy, 2013), the recently produced Spanish-language equivalent to Tests in Print, lists some 422 commercially available tests in Spanish, published in the United States and elsewhere in the world (see Chapter 1, this volume). Thus, there appears to be at least seven times as many tests available in English as in Spanish; such data appear highly similar to those reported by Puente, Ojeda, Zink, and Portillo Reyes in Chapter 7 of this volume. As mentioned in the introductory chapter to this volume, the market is rapidly increasing for Spanish-language measures. Many such measures are translations of English-language measures. However, as should be clear, simple translations do not work well when cultural differences influence behavior, as they do with both American and Hispanic/Latino populations. Translations should be adaptations where cultural differences as well as language translation change the items from the original language (and culture) to the target language and culture, where the target language is Spanish. We know that there are language differences across a number of Spanishdominant countries, including Spain, the countries of Central and South America, and the Caribbean. Adaptations of English-language measures are likely to continue to be developed, but this work must be performed in a culturally sensitive manner. Moreover, given cultural differences among these countries, it is likely that we will see measures adapted specifically for a particular subpopulation, especially where the need is great. New measures not based on existing English-language measures are also likely to be developed. In Chapter 14, Cervantes and Bui point to the need for instruments that aid in the assessment and treatment planning for Hispanics and hold that perhaps no acceptable instrument is available presently to meet this goal. CONDUCTING RESEARCH ON MEASURES DEVELOPED FOR HISPANIC AND LATINO POPULATIONS In developing such assessment instruments they are likely to be subjected to several distinct types of research. Three such types of research are discussed next: psychometric research, identification of subgroup differences, and relationship to new psychological and psychiatric systems. Psychometric Research Psychometric research is traditional and common to the development and use of all psychological and educational measures. In Chapter 7, Puentes and colleagues make the point that many of the Spanish-language 310       kurt f. geisinger

tests available in the United States do not meet professional standards in terms of the psychometric analyses available for them. Data must be gathered on new and revised measures so that these instruments can be subjected to reliability, validity, and fairness analyses, among others. Validity in particular is highly relevant; one can neither translate nor adapt a measure sensitively across cultural and language boundaries and simply assume that the new measure is valid in the target language and culture. Research checks are needed, although perhaps the need for conclusive research is somewhat reduced by the existence of a body of work in the original language and culture. When one understands the impact of culture on the psychological construct to be measured, has successfully adapted the content of the measure vis-à-vis the target culture, and has used language appropriate to the culture, the requirement for conclusive research is perhaps reduced. Nevertheless, some research is always required. Such research can include reliability analyses, criterionrelated validity studies, and analyses typical of construct validity. In terms of construct validity, one often should look at both variables external to the new measure itself (e.g., other validated measures, behavioral antecedents) as well as the internal structure of the tests (e.g., see Byrne, 2008). Finding that the items that compose specific factors in one language and culture continue to do so when translated and adapted into the new language and culture is a strong finding of construct equivalence. Discussions with psychologists from South America have indicated that there are few psychometrists in South America and that the knowledge base of psychometrics is quite limited as well. We can expect these deficiencies to be remediated in coming years, as indeed there are presently numerous graduate students from South American countries studying quantitative techniques in the United States and elsewhere. New norms for newly developed or adapted measures also are needed. The key to developing such norm tables, however, is to carefully delineate the population for which the measure is relevant and then gather appropriate and representative samples from that population. Such work is both painstaking and yet critical to proper test interpretation. Studies of Subpopulation Differences As noted previously, there are many differences in culture and even language usage among Hispanic and Latino populations. Using the same measure for different subpopulations (e.g., Mexican Americans and Puerto Rican Americans) requires that one analyze data to determine whether differences among these different cultural groups lead to differences in average scores, differences in the validity of the scores that emerge from the assessments, and differences in responses to specific questions (i.e., differential item some conclusions     

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functioning research). If such differences are found, different norm tables would be required at the least, and it is possible that a measure could be valid for one group and not others. As some groups become more acculturated into American culture, it is possible that other differences can emerge again, both to average scores and to the relationships between scores from the measure and measures of other related assessments. Relationships to New Psychological and Psychiatric Systems When the chapters for this volume were being written, probably the most common psychiatric system for evaluating individuals in the United States was the Diagnostic and Statistical Manual of Mental Disorders (fourth ed., text rev.; DSM; American Psychiatric Association, 2000). As the book was being finalized, a new edition of the DSM emerged, the DSM–5 (American Psychiatric Association, 2013). As the DSM continues to be the most commonly used system to diagnose psychiatric clients in the United States, measures discussed in the foregoing chapters will likely need to be related to the new version of the DSM. In most cases, these considerations will be minor. However, it should be noted that the DSM has sometimes been criticized for being culturally bound to Americans of European heritage. If such criticisms are valid, then the extent to which the system works for individuals from other cultures is not clear. Moreover, confusing cultural differences with psychological disorders would be a clear indication of a system bias. The International Classification of Diseases (ICD; World Health Organization, 2014) has a comparable classification system, one that is used worldwide rather than just in the United States. Although the 10th edition of the ICD is currently in use and has been used around the world for some time, an updated version of the 10th edition has only recently come to be used in the United States. The 11th edition is due in 2017, although it is unclear when it will be used in the United States. Presently, the ICD approach is used less frequently by individual practitioners in the United States. This situation appears to be changing, however, as requirements will push practitioners to use the ICD. Goodheart (2014) provided a primer for psychologists and others to help them learn to use the ICD for many psychological and behavioral concerns. There are clear advantages of using the ICD for classifications. First, it is the approach used by insurance companies to provide reimbursement to practitioners. Second, because it is used inter­ nationally, it may make more sense for it to be used for immigrants rather than using a nation-based system. Finally, the DSM has had questions raised regarding its limited inclusion of ethnic minorities; in recent years the DSM approach has included some cultural factors, but this critique has continued. This criticism implies 312       kurt f. geisinger

that the DSM may not be as appropriate for some groups as a system that was built internationally rather than nationally. Thus, determining how various Spanish-language measures can be used to diagnose clients in terms of the ICD should be an important arena for researchers and practitioners working together. IDENTIFYING GOLD STANDARD MEASURES AND ASSESSMENTS As assessments for Hispanics in the United States are developed and researched, some will become seen as the preferred measures for use in specific contexts with specific types of individuals. These are the gold standard measures that are commonly used and preferred by well-informed clinicians. The identification of such measures is something of a communal activity among professionals; a single clinician, even a well-established expert, cannot declare a particular measure as the gold standard. And the communal acceptance of a particular measure as the gold standard for a particular assessment need in a particular context does grant that measure lifetime tenure as such. Newer measures may improve assessments in terms of validity, cost, ease of use, or other important criteria. Also, people and environmental conditions change, and in such instances, assessments must change to continue to yield valid and useful results. TRAINING CONCERNS Many programs in counseling psychology, and perhaps to a lesser extent school and clinical psychology, emphasize cultural differences among clients and strenuously endorse acceptance and celebration of these differences. This inclusion in the doctoral curricula is critically important and represents a fundamental component of professional psychology today. In addition, however, to assess and treat Hispanic and Latina/o clients most effectively, skills and specific knowledge are needed. These skills include knowledge of Hispanic and Latino culture. One must have more than acceptance of such differences to be most effective; one must also have specific knowledge of the life experiences encountered by these individuals. To address such training, specific course materials on Hispanic cultures should be included in the doctoral curricula. These suggestions are elaborated by S. O. Ortiz and Melo (Chapter 6), Puente and his colleagues (Chapter 7), and Cervantes and Bui (Chapter 14) in this volume. Just as important, practica in working with diverse individuals (in this case, Latinos) should be available. Finally, internships should also some conclusions     

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include components in which one experiences dealing with individuals from a variety of cultures and countries. Clearly, such practica and internships should be supervised by professionals with cultural expertise who can help guide students and interns, while assuring that the clients receive first-rate services. For some educational and internship institutions these requirements would prove to be difficult given the populations comprising and surrounding their geographic communities. It must be remembered that the graduates of such programs may leave those communities and provide services to the broader community. A small number of programs have been developed that require the training of bilingual practitioners. Such developments should be encouraged. However, it may be difficult to fill classes with students who enter the program as bilinguals, and including comprehensive training to the standard of true bilingualism would add substantially to the length of the program. Nevertheless, such programming would represent a gold standard in educational offerings. UTILIZATION OF SERVICES Several authors in this volume note that Hispanics in our society do not use psychological services to the extent that members of other groups do. Increasing their use of services may prove beneficial. Some of the reasons for this lower utilization may include cultural considerations such as the involvement of one’s family in one’s psychological concerns. Another reason may be lower socioeconomic status and the need to use one’s limited funds for basic life necessities. However, relative to the need for the training improvements discussed in the section immediately preceding this one, it may also be that practitioners in one’s geographical region may not have the skills to deal effectively with a Hispanic or Latino client. Solutions are in process, however, with some of the most important vehicles being better and more inclusive training programs and the use of culturally competent therapists who will be able to connect with clients electronically rather than being in the same location. The American Psychological Association, the Association of State and Provincial Psychological Boards, and the Trust (formerly the American Psychological Trust) recently combined their efforts to investigate the use of telepsychology services, whereby licensed psychologists can treat clients using a variety of electronic media. When state lines are crossed with such communication, state psychology boards may question the legitimacy of such service provision. That such media could couple Hispanic therapists of comparable background with similar clients would be a justification alone for such relaxation of state standards of service, this writer believes. The guidelines may be found at http://www.apa.org/practice/guidelines/telepsychology.aspx. 314       kurt f. geisinger

CROSS-CULTURAL RESEARCH Psychologists have much to learn from others, such as anthropologists, in regard to cross-cultural research. Presently, in many of the subdisciplines of psychology, psychologists are working effectively with scientists and professionals from other disciplines, such as neuroscience, biology, communication studies, dietary science, and the like. Psychologists have to better understand the cultures some of our clients come from. Research, perhaps performed in conjunction with anthropologists, community health specialists, and physicians, that clarifies the cultures from which clients come vis-à-vis psychological and other health concerns should prove invaluable in understanding both the cultures Hispanic and Latino clients may come from and the concerns that they present. Such research could also help us decide which countries and cultures can be combined for validity, norms, and related research, and which need to be kept separate. CONCLUSION This chapter has attempted to summarize briefly both how far we have come in the past 20 to 25 years in terms of assessing Hispanic and Latino clients and how much farther we should go. Movement today, however, is clearly occurring and perhaps even accelerating. We have much to look forward to in this regard. Yet we must do more than provide assessments for Hispanics; we must offer assessments that meet professional standards. In my professional jobs and positions, I have always felt that I wanted to leave whatever unit I directed (e.g., programs, departments, colleges, universities) in better shape than I found it. I think that psychologists generally feel the same way about their patients and about psychology in general. In the case of assessing Hispanics, we should all feel good; much progress has been made. There is still a long way to go to reach parity, however, and it will be exciting getting there. REFERENCES American Psychiatric Association. (2000). Diagnostic and statistical manual of mental disorders (4th ed., text rev.). Washington, DC: Author. American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Washington, DC: Author. Byrne, B. M. (2008). Testing for multigroup equivalence of a measuring instrument: A walk through the process. Psicothema, 20, 87–882. some conclusions     

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Goodheart, C. D. (2014). A primer for ICD–10–CM users: Psychological and behavior conditions. Washington, DC: American Psychological Association. http:// dx.doi.org/10.1037/14379-000 Murphy, L. L., Geisinger, K. F., Carlson, J. F., & Spies, R. A. (2011). Tests in print VIII. Lincoln, NE: Buros Center for Testing. Schlueter, J., Carlson, J. F., Geisinger, K. F., & Murphy, L. L. (Eds.). (2013). Pruebas publicadas en Español [Tests published in Spanish]. Lincoln, NE: Buros Center for Testing. World Health Organization. (2014). International statistical classification of diseases and related health problems, 10th revision (ICD–10). Retrieved from http://www.cdc. gov/nchs/icd/icd10cm.htm#10update

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INDEX Agency Cultural Competence Checklist (ACCL), 201 Aggressive behavior, in childhood, 157 Ahadi, S., 43 Alcohol, Tobacco, and Drug Use Scale (ATOD), 163 Alegría, M., 175–176, 241 Allen, J., 192–193 Allende, L. M., 42 Altered methods, of assessment, 114–115 Álvarez, Ana Isabel, 53–54 American Educational Research Association (AERA), 136 American Psychological Association (APA), xi, 136, 173, 201, 202 Ampudia, A., 41 Ampudia-Rueda, E., 41 Andrade-Palos, P., 34 Andrade-Palos, R., 35 Añez, L. M., 176–177 Antisocial behavior, 154 Anxiety cultural expressions of, 243–245 effect of culture on, 8 and nervios, 245 Anxiety assessment, 237–247 and clinical interviews, 239–241 cultural equivalency in, 243 and cultural expressions of anxiety, 243–245 and posttraumatic stress disorder, 246–247 research on, 238–239 self-report measures, 241–243 and somatization of anxiety dis­ orders, 245–246 Anxiety disorders prevalence of, 237–238 somatization of, 245–246 Anxiety Disorders Interview Schedule (ADIS), 239 Anxiety Sensitivity Index (ASI), 242–243 APA. See American Psychological Association

Abreu, J. M., 175 ACCL (Agency Cultural Competence Checklist), 201 Acculturation assessment of, with engagement algorithm, 181 and ataques de nervios, 244 as bias in intelligence evaluations, 112 as consideration in validation of depression assessments, 265 by Cuban Americans, 197 and cultural values, 215–216, 229 and depression, 256–257 developments in measurements of, 275 and education, 82 and ethnic matching, 175 and personality approach, 197–198 and psychological stress assessment, 276–278 stress from, measured in HSI–A, 281 and youth psychopathology, 154 Acculturation paradox, 278 Acculturation Rating Scale for Mexican Americans, 196 Acculturation Rating Scale for Mexican Americans–II, 275 Acculturation stress, 8, 276 Acculturative knowledge, in C–LIM, 121 Acculturative learning opportunity, 114 Acevedo, M., 42 Achenbach, T. M., 157–158 Adaptations, translations vs., 191 ADDRESSING model, 217–218 ADHD. See attention-deficit/ hyperactivity disorder ADIS (Anxiety Disorders Interview Schedule), 239 ADIS–Spanish version, 239 Adolescents, effect of parent expectations on, 92–93. See also Hispanic adolescents AERA (American Educational Research Association), 136 Affective disorders, 244

317

APA Ethics Code (APA), xi APEP (Asociación de Psicología Escolar de Puerto Rico), 56, 57 APPR (Asociación de Psicología de Puerto Rico), 54, 57 Ardila, A., 137 Arnault, D. S., 172, 178–181 Arredondo, P., 197 ASI (Anxiety Sensitivity Index), 242–243 Asociación de Psicología de Puerto Rico (APPR), 54, 57 Asociación de Psicología Escolar de Puerto Rico (APEP), 56, 57 Assertiveness Scale with Mexicans, 34 Assessment(s). See also specific assessments adaptation of, in personality approach, 192–196 altered methods of, 114–115 cultural factors in, xiv of cultural values, 216–217, 223–230 development of culturally appropriate, 275, 297 of gender identity, 299–300 language-reduced, 116–117 modified methods of, 114–115 not developed for use with Hispanics, 273–274 of sexual orientation, 294–297 Assessment algorithm, 181 Assessment measures, 159–165 Assumptions. See Bias(es) Ataques de nervios, 243–244 Ateneo Puertorriqueño, 53 ATOD (Alcohol, Tobacco, and Drug Use Scale), 163 Attention-deficit/hyperactivity disorder (ADHD) assessment measures of aggressive behaviors associated with, 159–165 comorbidity with, 155 Hispanic youths with, 155–157 language barriers and treatment of, 154–155 reports of behavioral symptoms associated with, 157–159 Autonomy, need for, 40

318       index

Baez, E., 263 BAI (Beck Anxiety Inventory), 35, 241–242 Barkley, R., 155–156 BASC–2 Behavioral and Emotional Screening System, 22, 23 Basic tendencies, in five-factor personality model, 31 Batería III Woodcock-Muñoz, 71–75 Batería III Woodcock-Muñoz Preubas de Habilidades Cognitivas (Batería COG), 104 Batería Woodcock-Muñoz—Revised, 71–75 Bauermeister, J., 155–156, 161 Bauermeister School Behavior Inventory (BSBI), 161–164 BDI (Beck Depression Inventory), 259 BDI–II (Beck Depression Inventory—II), 259–260 BDI Spanish version (BDI–S), 260 Beck, C. T., 263 Beck Anxiety Inventory (BAI), 35, 241–242 Beck Depression Inventory (BDI), 259 Beck Depression Inventory—II (BDI–II), 259–260 Behavioral and emotional screening tests, 21–23 Behavioral exemplars, 36–39 Behavioral symptoms, 157–159 Bellido, Mercedes Rodrigo, 54 Ben-Porath, Y. S., 42 Bernal, G., 161, 260 Berry, J. W., 276 Bias(es) about cultural values, 224–225 acculturation as, 112 in adaptation of English-language tests, 72 attributes creating, 111–112 in clinical interviews, 172 cultural, 116–117, 137 English-language proficiency as, 112 item, 41 language proficiency as, 112 method, 41 in Peabody Picture Vocabulary Test, 113

in personality measures, 41 as psychometric issue, 191 Biculturalism/Multiculturalism Experience Inventory, 197 Bicultural Stressors Scale, 276 Big-five model of personality. See Fivefactor personality model Bilingualism and intelligence tests, 82 Pruebas Publicadas en Español, 16 of psychologists, 117–118 Binet Intelligence Scale, 54 Birth sex, 292 Body map, in clinical ethnographic interview, 180 Bonilla, J., 260 Boscan, D. C., 42 Bracero, W., 176 Bracken, Bruce, 78 Bravo, M., 159 BSBI (Bauermeister School Behavior Inventory), 161–164 Buckendahl, C. W., 77 Buros Center for Testing Pruebas Publicadas en Español developed by, xiii, 12–15 publications from, 12–13 testing resources provided by, 24, 26 Butcher, J. N., 41, 275 Caballerismo as cultural value, 221–222 interview guide for assessing, 228 Cabiya, J., 160–163, 275 Cabiya-Morales, J. J., 157 Cabral, R. R., 175 California Brief Multicultural Scale (CBMCS), 200, 203 Callahan, W. J., 5 Camara, W. J., 138 Campillo-Álvarez, A., 139 Canino, Glorisa, 56, 159 Cardinale, J. A., 192 Cardoso, J. B., 277 Carlos Albizu University, 55, 56 CAS (Cognitive Assessment System), 59 Castagno, R. M., 192 Castellanos, J., 259 Catholicism, among Latinos, 222

CBMCS (California Brief Multicultural Scale), 200, 203 CDC (Centers for Disease Control and Prevention), 274 CDI (Child Depression Inventory), 161–164 CEI (clinical ethnographic interview), 178–181 CEMs (cultural explanatory models), 178–179 Center for Epidemiological Studies Depression Scale (CES–D), 35 in depression assessment, 260–261 measurement issues with, 257–258 Spanish version of, 261 Centers for Disease Control and Prevention (CDC), 274 Cervantes, A., 275 Cervantes, R., 278 Cervantes, R. C., 275, 277, 278, 280, 281 CES–D. See Center for Epidemiological Studies Depression Scale Characteristic adaptations, in five-factor personality model, 31 Chávez, B. P., 42 Chen, H., 86 Chicago, IL, 59 Child Depression Inventory (CDI), 161–164 Children. See also Hispanic children effect of parent expectations on, 92–93 verbal abilities of, 94–95 Chiriboga, D. A., 260–261 Chronic stress, faced by Hispanics, 277 Church, A. T., 34, 37, 42–43 CIDI (Composite International Diagnostic Interview), 241 Cirino Gerena, Gabriel, 55–57 Clarke, I., 41 Clients. See also Spanish-speaking clients concept of illness by, 178–179 level of adherence to cultural values by, xiv–xv, 218, 226, 229 C–LIM (Culture–Language Interpretive Matrix), 121–124 Clinical ethnographic interview (CEI), 178–181 index

      319

Clinical interviews, 171–183 and anxiety assessment, 239–241 in assessment process, 224 cultural responsiveness in, 7–8, 173 cultural values in, 226–229 and defining culture, 174–175 and ethnic matching, 175–176 Latina/o specific, 177–178 models for, 178–182 value of cultural content in, 172–173 values to consider during, 176–177 Clinical testing applications, 20–21 Clinicians, self-understanding of, 224–225 Coady, M., 121 Cognitive ability and Batería III Woodcock-Muñoz, 71–72 measured with intelligence tests, 68 and parent expectations, 92–93 tested in nonverbal tests, 117 Cognitive Assessment System (CAS), 59 Cognitive–behavioral interventions, 159–165 Collectivism in Mexican vs. American cultures, 30 personality models and individualism vs., 43 Coman, E., 263 Coming out, of nonheterosexual Latinos, 295–296 Communication, and nonverbal tests, 116 Composite International Diagnostic Interview (CIDI), 241 Computer-assisted testing, 265–266 Computerized Diagnostic Interview Schedule for Children (DISC), 159 Computerized Diagnostic Interview Schedule for Children—IV (DISC–IV), 159 Confianza in clinical interview, 176–177 as cultural value, xiv Confianza en confianza, 198–199 Contreras, F., 34 Coping power (intervention), 160–163 Coping styles, 40

320       index

Correlations, among subtests of WISC–IV, 71 Cortés, J., 42 Costa, P. T., Jr., 31 Costantino, G., 194 Crespo, Leila, 59 Crockett, L. J., 257, 261 Cross-cultural neuropsychology, 136 Cross-cultural research, 315 Cross-cultural trait psychology approach, 31–32 Cross-dressers, 292 Crystallized intelligence (Gc), 126, 128 Csordas, T. J., 179 Cuban Americans, 197 Cultural bias in neuropsychological tests, 137 in nonverbal tests, 116–117 Cultural competence and cultural responsiveness, 173 defined, 202, 203 MAIP model for training in, 200 model and practice guidelines for, 200–201 need for, 7 in provision of mental health services, xi–xii training concerns about, 313–314 Cultural content, in clinical interviews, 172–173 Cultural equivalency in anxiety assessment, 243 in depression assessment, 265 Cultural explanatory models (CEMs), 178–179 Cultural expressions, of anxiety, xv, 243–245 Cultural formulations, 199 Cultural mean differences, 37, 40–42 Cultural psychotherapy, 174 Cultural responsiveness, 173 Cultural self and ethnic identity, 196–197 and test translations, 195–196 Cultural tailoring, of interventions, 281–282 Cultural values, 215–231. See also specific values assessment of, 223–230 biases and assumptions about, 224–225

in clinical interviews, 226–229 common Latino, xiv–xv, 218–223 to consider during clinical interviews, 176–177 in cultural tailoring of interventions, 281 and gender identity and sexual orientation, 9 gender roles as, 221–222 importance of assessing, 216–217 importance of understanding, 8 interpersonal interactions as, 220–221 and Latino heterogeneity, 217–218 level of adherence to, xiv–xv, 218, 226, 229 Mexican, 30 quantitative scales for, 229–230 religion and spirituality as, 222–223 Culture(s) defining, 174–175 in development of individuals, xii diversity among Hispanic, xiii, 81–82, 109–110, 191, 197, 274, 311–312 diversity among Latino, 217–218, 255–256 in five-factor personality model, 31 importance of, in clinical interview, 171–172 individualist vs. collectivist, 43 and intelligence tests, 69 Mexican, 30 and neuropsychological assessment, 138–139 Culture, Medicine, and Psychiatry, 199 Culture-bound syndromes, 199, 257, 274 Culture–Language Interpretive Matrix (C–LIM), 121–124 Dadlani, M., 172 Dana, R. H., 191, 194 DASS (Depression and Anxiety Stress Scales), 242 DeCoster, J., 260–261 Demmert, W. G., Jr., 281 Depressed mood, 156–157 Depression effect of culture on, 8 gender differences in expression of, 257–258

in Latino context, 256–257 and machismo, 221–222 and nervios, 245 in older Latinos, 263–264 postpartum, 262–263 Depression and Anxiety Stress Scales (DASS), 242 Depression assessment, 255–266 Beck Depression Inventory—II, 259–260 Center for Epidemiologic Studies Depression Scale, 260–261 in critical need areas, 262–264 depression in Latino context, 256–257 future research on, 264–266 measurement issues in, 257–258 Patient Health Questionnaire—9, 261–262 Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM–IV) ataques de nervios in, 244 culture-bound syndromes in, 247 in diagnosis of minorities, 312 Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM–5), 155, 312 Diagnostic Interview Schedule (DIS), 240–241 Diagnostic validity, 126–127 Diaz, R. M., 295 Díaz-Guerrero, R., 34, 40, 199 Díaz-Loving, R., 34, 35, 199 Diefenbach, G. J., 263 DIF (differential item functioning), 33, 37 Differential Abilities Scale—II Early Years Spanish Supplement, 103–104 Differential item functioning (DIF), 33, 37 DIS (Diagnostic Interview Schedule), 240–241 DISC (Computerized Diagnostic Interview Schedule for Children), 159 Disch, W. B., 263 DISC–IV (Computerized Diagnostic Inter­view Schedule for Children— IV), 159 index

      321

Discrimination effect of, on mental health, 274 and sexual orientation, 295 as source of daily stress, 276 Disruptive disorders, 157–159 Dole, C., 179 Domestic violence, and machismo, 221–222 Dominant language, 129–130 Doverspike, D., 42 Draw-a-Person Test, 54 Driscoll, A. K., 257 DSM approach, 312–313 DSM–IV. See Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition DSM–5 (Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition), 155, 312 Duarte, C., 154 Dugan, S., 34–35 Durán, C., 41, 42 Dúran-Patiño, A., 41 Dzokoto, V., 43 Economic factors, and FSIQ scores, 92 Education and acculturation, 82 and Full Scale IQ scores, 85 of parents, 92, 95 and psychological testing, in Puerto Rico, 53, 60–61 EI (ethnographic interview), 179 EIWA (Escala de Inteligencia Wechsler para Adultos), 54, 76–76 EIWA–III (Escala de Inteligencia Wechsler para Adultos—III), 58, 75–77 EIWA–IV (Escala de Inteligencia Wechsler para Adultos—IV), 70–71 EIWN–R (Escala de Inteligencia Wechsler para Niños—Revisada), 69–70 EIWN–R–PR (Escala de Inteligencia Wechsler para Niños de Puerto Rico), 58, 70 Elliott, C. D., 83 Ellis, B. B., 37, 41 Emic approach, to personality study, 31–32

322       index

Emotional self-regulation, 156–157 Empathy, in Mexican personality measures, 35 Engagement algorithm, 181 English-language assessments adaptations and translations of, xiv, 310 adapting, for neuropsychological testing, 137–141 in intelligence and learning disability evaluations, 119–120 used in Spain, 139 English-language intelligence tests, 67–78 Batería Woodcock-Muñoz—Revised, 71–75 Spanish versions of, 77–78 Wechsler Adult Intelligence Scale, 75–77 Wechsler Intelligence Scale for Children—Revised, 69–71 English language learners learning disabilities assessments for, 129 testing, with WPPSI–IV, 93–94 and validity in testing, 114 English-language proficiency as bias in intelligence evaluations, 112 in C–LIM, 121 and learning disabilities, 129 EPQ (Eysenck Personality Questionnaires), 40, 42 Equivalence, 190, 192–193 Erard, R. E., 194 Erdberg, P., 194 Escala de Inteligencia Wechsler para Adultos (EIWA), 54, 75–76 Escala de Inteligencia Wechsler para Adultos—III (EIWA–III), 58, 75–77 Escala de Inteligencia Wechsler para Adultos—IV (EIWA–IV), 70–71 Escala de Inteligencia Wechsler para Niños de Puerto Rico (EIWN– R–PR), 58, 70 Escala de Inteligencia Wechsler para Niños—Revisada (EIWN–R), 69–70 Ethical guidelines, for use of interpreters, 105

Ethics Code (Puerto Rico), 55 Ethnic identity, and cultural self, 196–197 Ethnicity in definitions of culture, 174 race vs., 110 Ethnic matching, 175–176 Ethnocultural relativism, 200–201 Ethnographic interview (EI), 179 Etic approach, to personality study, 31–32 Evidence-based practices in psychology, 173 Externalizing disorders, 153–165 assessment measures used in research on, 159–165 Hispanic youths with, 155–157 reports of behavioral symptoms associated with, 157–159 research on Hispanic youths with, 155–157 Eysenck Personality Questionnaires (EPQ), 40, 42 Familismo as cultural value, xiv, 218–220 and gender identity and sexual orientation, 9 interview guide for assessing, 227 Family, centrality of, 218–220, 228. See also Familismo Family considerations, in treatment process, 219–220 Fatalismo as cultural value, 222–223 interview guide for assessing, 228 Fernández, G., 34 Fernández-Hermida, J. R., 139 First Congress of Psychological Measurement, 55–56 First Mental Health Summit, 55 Fisher, D. G., 278, 280, 281 Five-factor personality model in cross-cultural trait psychology, 31 and individualist vs. collectivist cultures, 43 replicability of, 32–34 Flores, C., 121 Flores, S. A., 295 Flores, T., 275 Flores-Galaz, M., 34

Fluid Reasoning Index (FRI) Hispanic children scores, 96–97, 99 on WPPSI–IV, 94 Foley, B. P., 77 Folkman, S., 276 Fonseca-Pedrero, E., 139 Fraternal birth order effect, 293 FRI. See Fluid Reasoning Index Full Scale IQ (FSIQ) scores and educational level, 85 effect of economic factors on, 92 effect of ethnicity on, 86, 92 of Hispanic children, 96–97 and parent expectations, 93 Furnham, A., 43 Gabarain, G., 175 Gable, R. K., 263 Gallardo, M. E., 176–178, 182 Gallegos-Mejía, L., 41 Garcia, B., 181 Garcia-Hernandez, L., 275 Garrido, M., 275 Gc (crystalized intelligence), 126, 128 GCA (General Cognitive Ability) score, 104 GDS (Geriatric Depression Scale), 264 GDS–15, 264 Geisinger, K. F., 190, 191 Gender, and depression, 257–258 Gender dysphoria, 299 Gender identity, 298–301 assessment of, 299–300 and cultural values, 9 defined, 292 development of, 298–299 research on, 300–301 Gender roles and attitudes toward sexual orientation, 295 and cultural values, 221–222 interview guide for assessing, 228 General Cognitive Ability (GCA) score, 104 Genetics, and sexual orientation, 294 Geriatric Depression Scale (GDS), 264 Glauner, T., 197 Gloria, A. M., 221, 259 Goldbach, J. T., 277, 278 Gomez, N., 41 index

      323

González, Gerardo, 266 Gonzalez-Rivera, M., 295 Goodheart, C. D., 312 Graham, J. R., 42 Guarnaccia, P. J., 244 Guidelines and Principles for Accreditation of Programs in Professional Psychology (APA), 201, 202 Guillemard, Luisa, 59 Halperin, L., 175–176 Harris, J. G., 86 Hattrup, K., 42 Hays, P. A., 174, 217 Helmreich, R., 34 Help-seeking process familismo in, 219–220 gender roles in, 222 Herek, G. M., 295 Hernandez, Miguelina, 54 Herrans, Laura Leticia, 55, 57, 58 Hispanic Stress Inventory—Version 2 (HSI2), 279 Hispanic(s) defined, 5 diversity of cultures among, xiii, 81–82, 109–110, 191, 197, 274, 311–312 population growth among, 4–5, 12, 274 psychological stress assessment with, 274–275 utilization of services by, 314 Hispanic adolescents assessing, with Wechsler Intelligence Scale for Children—IV, 89–93 psychological stress assessment for, 275–276 Hispanic adults intelligence testing with Wechsler Adult Intelligence Scale—IV, 86–89 psychological stress assessment for, 275 Hispanic children assessing, with Wechsler Intelligence Scale for Children—IV, 89–93 assessing, with Wechsler Intelligence tests, 83–100 assessing, with Wechsler Preschool and Primary Scale of Intelligence—IV, 93–100

324       index

Hispanic Neuropsychological Society (HNS), 136, 140, 148 Hispanic percentile norms for Wechsler Adult Intelligence Scale—IV, 86, 87 for Wechsler Intelligence Scale for Children—IV, 89, 90 for Wechsler Preschool and Primary Scale of Intelligence—IV, 95–97 Hispanic Stress Inventories (HSI), 275, 276, 278–282 Hispanic Stress Inventory—Adolescent Version (HSI–A), 277–281 Hispanic youth diversity among, 153 mental health disparities among, 274–275 HNS (Hispanic Neuropsychological Society), 136, 140, 148 Hofstede, G., 30 Holdnack, J. A., 86 Holtzman, W. H., 40 Hostos, Euginio Maria de, 53 HSI (Hispanic Stress Inventories), 275, 276, 278–282 HSI2 (Hispanic Stress Inventory— Version 2), 279 HSI–A (Hispanic Stress Inventory— Adolescent Version), 277–281 Huang, C. H., 260–261 Ibañez, G. E., 295 ICD (International Classification of Diseases), 312 IDEA 2004, 128–129 Illness, client’s concept of, 178–179 Immigrant paradox, 154, 256–257 Immigration trends, 102 Indexes, in Pruebas Publicadas en Español, 16, 20–21 Indigenous trait psychology approach, 31–32 Individualism in Mexican vs. American cultures, 30 personality models and collectivism vs., 43 Inkblot tests, 40 Institute for Behavioral Research, 56

Intake procedures, adapting, 198–201 Intellectual testing applications, 20–21 Intelligence assessments and culture, 69 purpose of, 67–68 selecting, with Pruebas Publicadas en Español, 22, 24, 25 standardization of, in Puerto Rico, 57–58 Intelligence evaluations, 109–131 considerations in, 127–130 English-language assessment, 119–120 language-reduced assessment, 116–117 modified methods of assessment, 114–115 moving beyond race in, 110–112 native-language assessment, 117–119 recommended approach for, 124–127 validity issues in, 113–114 validity of test scores, 120–124 Intelligence testing, 81–106 assessing Hispanic children with Wechsler Intelligence tests, 83–100 Batería III Woodcock-Muñoz, 104 Differential Abilities Scale—II Early Years Spanish Supplement, 103–104 improvements in, 7 with Spanish-speaking clients, 100–104 and use of interpreters, 105 Wechsler Adult Intelligence Scale—IV with Hispanic adults, 86–89 Wechsler Intelligence Scale for Children—IV Spanish, 100–103 Wechsler Intelligence Scale for Children—IV with Hispanic children and adolescents, 89–93 Wechsler Preschool and Primary Scale of Intelligence—IV with Hispanic children, 93–100 Interamerican University of Puerto Rico, 55, 59 International Classification of Diseases (ICD), 312

International Test Commission’s Test Adaptation Guidelines, 138, 191 Internet-based testing, 61 Interpersonal interactions, as cultural values, 220–221 Interpersonal Reactivity Scale, 35 Interpreters and diagnostic testing, 127 intelligence testing and use of, 105 and test validity, 115 Interventions cognitive–behavioral, 159–165 considering cultural values in, 230 coping power, 160–163 cultural tailoring of, 281–282 Interview(s) clinical. See Clinical interviews clinical ethnographic, 178–181 ethnographic, 179 semistructured, 177, 239–240 structured, 177, 240–241 unstructured, 177 IQ, historical importance of, 128 Item bias, 41 Jackson Personality Inventory (JPI), 34, 40 Japanese women, clinical ethnographic interview with, 180–181 Jensen, A. R., 113 Jones, J. M., 174 Jones, K. D., 177 Kanagui-Muñoz, M., 259 Kaufman Assessment Battery for Children, 2nd ed., 128 Keatley, J., 301 Kim, G., 260–261 Kinsey, A. C., 296 Kinsey Scale, 296 Kirkcaldy, B., 43 Klein, F., 296 Kleinman, Arthur, 178 Klein Sexual Orientation Grid, 296 Korb, K., 116 Kovacs, M., 161 Kranzler, J., 121 Krentzman, A. R., 202 Lakin, J., 116 Lambert, M. J., 178 index

      325

Language culture accessed by, 196 dominant, 129–130 selection of, as cultural competence, xii selection of, in intelligence testing, 83 variations within, 110 Language barriers, 154 Language proficiency as bias in intelligence evaluations, 112 in neuropsychological testing, 137 Language-reduced assessments, 116–117 Lara-Cantú, M. A., 41, 42 La Roche, M. J., 174 La Rosa, J., 34 Latina/o(s) acceptance of LGBT individuals by, 291 Catholicism among, 222 coming out of non heterosexual, 295–296 common cultural values of, 218–223 cultural diversity among, 217–218, 255–256 defined, 5 defining culture in communities of, 174–175 and depression, 256–257 depression among older, 263–264 multiple social identities of, 182–183 population growth of, 255–256 prevalence of posttraumatic stress disorder among, 246 rates of anxiety disorders among, 238 specific clinical interviews for, 177–178 underutilization of mental health services by, 238 Latina/o skills identification stage model (L–SISM), 181–182 Latino/a Values Scale, 229–230 Law 96 (Puerto Rico), 55 Law 170 (Puerto Rico), 57 Lazarus, G., 139 Lazarus, R. C., 276 Le, H. N., 262–264 Learning disabilities evaluations, 109–131 considerations in, 127–130 English-language assessment, 119–120

326       index

language-reduced assessment, 116–117 modified methods of assessment, 114–115 moving beyond race in, 110–112 native-language assessment, 117–119 recommended approach for, 124–127 validity issues in, 113–114 validity of test scores, 120–124 León, I., 41 León-Guzmán, I., 41 Lesbian, gay, bisexual, and transgender (LGBT), 291 Leung, K., 41 Levine, R. V., 30, 43 LGBT (lesbian, gay, bisexual, and transgender), 291 Lifeline drawings, in clinical ethnographic interview, 180 Life sciences on gender identity, 299 on sexual orientation, 293 Lochman, J. E., 160, 163 Locus of control scale, 34–35 Lohman, D. F., 116 López, J., 36 López, S. R., 69 L–SISM (Latina/o skills identification stage model), 181–182 Lucio, E., 36, 40–42, 275 Lucio, G. M., 41, 42 Machismo as cultural value, 221–222 interview guide for assessing, 228 MACVS (Mexican American Cultural Values Scales for Adolescents and Adults), 229–230 MAIP (multicultural assessment– intervention process) model, 199–200, 203 Malgady, R. G., 192, 195 Malloy, T. E., 43 Manoleas, P., 177, 181 Marianismo as cultural value, 221–222 interview guide for assessing, 228 Marín, G., 257–258 Marsella, A. J., 203 Martin, C. E., 296

Martínez, A., 161 Martinez, Juan Nicholas, 54–55 Masculinity (cultural dimensions theory), 30 Masculinity–Femininity Test, 300 Matos, M., 155–156 McCormick, K., 177 McCrae, R. R., 31, 34 McGrath, R. E., 193 Mead, A. D., 37, 41 Mean differences, cultural, 37, 40–42 Meissner, W. W., 177–178 Melendez, F., 76 Mental health outcomes for Hispanic adolescents, 279 and religious commitment, 223 Mental health services competent provision of, xi–xii and religiosity, 223 underutilization of, by Latinos, 238 use of, by Latinos, 216 utilization of, by Hispanics, 314 Mental Measurements Yearbook (MMY; Carlson, Geisinger, & Jonson), 12–13, 15, 20 Mercado, D. C., 34 Mestizo heritage, 197 Method bias, 41 Mexican American Cultural Values Scales for Adolescents and Adults (MACVS), 229–230 Mexican Americans ethnic identity of, 197 personality assessment with, 6 use of BDI with, 259 Mexican culture, 30 Mexican personality measures, 29–44 comparability of behavioral exemplars among, 36–39 criterion validity of, 42–43 cultural mean differences in, 37, 40–42 structural replication of, 32–35 Mexico, immigration from, 102 Meyer, G. J., 194 Mihura, J. L., 194 Miles, Catherine, 299–300 Miller, A. B., 175–176 Miller, M. J., 231 Millett, G., 295

Minnesota Multiphasic Personality Inventory (MMPI), 36 adaptations of, 193 American vs. Mexican scores on, 41 Spanish version of, 275 studies including, 5–6 Minnesota Multiphasic Personality Inventory—2 (MMPI–2) American vs. Mexican scores on, 40–41 criterion validity of, 42 student vs. criminal scores on, 42 studies on use of, 6 Minnesota Multiphasic Personality Inventory—Adolescent (MMPI–A) Mexican version of, 41 studies on use of, 6 Mira, C. B., 275 Miville, M. L., 203 MMPI. See Minnesota Multiphasic Personality Inventory MMPI–2. See Minnesota Multiphasic Personality Inventory—2 MMPI–2RF, 193 MMPI–2RF Spanish version, 193 MMPI–A. See Minnesota Multiphasic Personality Inventory—Adolescent MMY. See Mental Measurements Yearbook Modified methods, of assessment, 114–115 Montilla Báez, S. C., 60 Mood disorders, among Latinos, 256 Moreno-Torres, Mary Annette, 59 Moscoso, M. S., 35 MSM (men who have sex with men), 294 Multicultural assessment–intervention process (MAIP) model, 199–200, 203 Multicultural competence. See also Cultural competence implementing training in, 203–204 and personality approach, 202–204 Multicultural Latin-American Anger Expression Inventory, 35 Multicultural populations, 192 Multidimensional Acculturative Stress Inventory, 275 Multidimensional Scale of Empathy, 35 Muñiz, J., 139 Muñoz, Richard, 266 index

      327

Muñoz-Sandoval, A. F., 72–74 Myers, H. F., 275 Nadelsticher Mitrani, M., 35 Nadelsticher Mitrani, S., 35 Naglieri, Jack, 59 Nakash, O., 175–176 Napper, L., 278 National Academy of Neuropsychology (NAN), 136, 138 National Center for Cultural Competence, 173 National Council on Measurement in Education (NCME), 136 National Institutes of Health, 294 National Latino and Asian American Study (NLAAS), 238 on ataques de nervios, 244 clinical reappraisal of, 241 on depression, 256 Native-language assessment. See also Spanish-language assessments and diagnostic validity, 126–127 in intelligence and learning disability evaluations, 117–119 for learning disabilities, 129–130 NCME (National Council on Measurement in Education), 136 Negron-Valasquez, G., 177 Nemoto, T., 301 NEO-PI-R (Neuroticism–Extraversion– Openness to Experience Personality Inventory, Revised), 37–39 Nervios, 244–245 Neuropsychological testing, 135–148 adapting English-language measures for, 137–141 effect of culture on, 7 measures available in Spanish, 141–144 recommendations for, 147–148 and Standards for Educational and Psychological Testing, 144–147 Neuroticism–Extraversion–Openness to Experience Personality Inventory, Revised (NEO-PI-R), 37–39 New York City, NY, 59 Nichols, D. S., 192, 196 Nicolini, H., 36 Nina, R., 35

328       index

NLASS. See National Latino and Asian American Study Nonverbal cues, in clinical ethnographic interviews, 179 Nonverbal Index (NVI), 94, 96–97 Nonverbal tests in C–LIM, 121 validity of, 116–117 Norcross, J. C., 173, 176, 178 Norenzayan, A., 30 Norris-Watts, C., 42 Novy, D., 259 Núñez, R., 36 NVI (Nonverbal Index), 94, 96–97 O’Bryon, E. C., 201 O’Connell, M. S., 42 Oishi, S., 43 Operario, D., 301 Organista, K., 177 Orlando, FL, 59 Ortiz, G., 262 Otero, Tulio M., 59 Overtree, C., 172 Padilla, A., 278 Padilla, L., 163 Páez, F., 36 Palmieri, Rafael Garcia, 54 Paniagua, F. A., 176, 199 Panic attacks, 244 Parents expectations of, for education of children, 92–93 reports of children’s psychiatric symptoms by, 157–159 Parham, T. A., 178 Patient Health Questionnaire—9 (PHQ–9) in depression assessment, 261–262 Spanish version of, 262 PDSS (Postpartum Depression Screening Scale), 262–263 PDSS–S (Postpartum Depression Screening Scale Spanish version), 263 Peabody Picture Vocabulary Test (PPVT) bias in, 113 problems translating, 68

Peña-Suárez, E., 139 Penley, J. A., 259, 260 Perceptual Reasoning Index (PRI) Hispanic adult scores on, 86–88 Hispanic children/adolescent scores on, 89–91 on WPPSI–IV, 94 Pérez-Stable, E. J., 257–258 Peritraumatic responses, 247 Perry, D. F., 262 Perry-Jenkins, M., 172 Personal Attributes Scale, 34 Personal identity model, 197 Personalismo as cultural value, xiv, 220–221 importance of, 176 interview guide for assessing, 228 in Latina/o skills identification stage model, 182 and simpatía, 198–199 Personality approach, 189–204 and acculturation status, 197–198 and adapting assessments, 192–196 adapting intake procedures in, 198–201 ethnic identity and cultural self in, 196–197 and multicultural competence, 202–204 and population diversity, 191 and psychometric issues, 190–191 Personality assessment. See also Personality approach with Mexicans, 6 and psychological test usage, 204 Personality Inventory for Children, 42 PHQ–9. See Patient Health Questionnaire—9 Piers-Harris Children’s Self-Concept Scale, 35 Pieterse, A. L., 231 Plática, in first interactions, 225 Platicando, 198–199 Pomeroy, W. B., 296 Ponce School of Medicine, 56, 58, 59 Pontifical Catholic University of Puerto Rico, 55 Population diversity, 191 Population growth, among Hispanics in United States, 4–5, 12

Posner, S. F., 257–258, 261 Postpartum depression, 262–263 Postpartum Depression Screening Scale (PDSS), 262–263 Postpartum Depression Screening Scale Spanish version (PDSS–S), 263 Posttraumatic stress disorder (PTSD), 246–247 Power differentials, shifting, 201 Power distance (cultural dimensions theory), 30 PPE. See Pruebas Publicadas en Español PPVT. See Peabody Picture Vocabulary Test PRI. See Perceptual Reasoning Index Problem-solving skills, 159–160 Processing Speed Index (PSI) Hispanic adult scores on, 86–88 Hispanic children/adolescent scores on, 89–91 Hispanic children scores, 96–97, 99 mean index scores of Hispanics on, 84 on WPPSI–IV, 94 Proprietary tests, 15 Protective factor, 219 Pruebas Publicadas en Español (PPE), 11–26 case illustrations using, 21–25 in clinical and intellectual testing applications, 20–21 description of, 15–20 development of, 12–15 and need for Spanish-language tests, 24, 26 Spanish tests listed in, 140, 310 PSI. See Processing Speed Index Psychiatric disorders, prevalence of, xiii Psychological assessments, Spanish standardization of, 51–52 Psychological Institute of Puerto Rico, 55 Psychological stress assessment, 273–283 within acculturation context, 276–278 and development of Hispanic Stress Inventories, 278–282 Hispanic adolescents, key issues for, 275–276 index

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Hispanic adults, key issues for, 275 and mental health of Hispanics, 274–275 Psychology as academic discipline in Puerto Rico, 53–57 cross-cultural trait, 31–32 evidence-based practices in, 173 indigenous trait, 31–32 trait, 30–31 Psychometric issues in personality approach, 190–191 of Spanish-language tests, 310–311 PTSD (posttraumatic stress disorder), 246–247 Puente, A. E., 137–139, 146 Puente, N., 137–138 Puerto Rican Journal of Psychology, 56–57 Puerto Rico, 51–61 ADHD assessments tested in, 155–156 ataques de nervios in, 244 dilemmas and challenges of psychological testing in, 60–61 and populations of Puerto Ricans in United States, 59 psychological testing and education in, 53 psychological testing in, 6–7 psychology as academic discipline in, 53–57 research on psychological testing in, 59–60 somatization of symptoms in, 245–246 standardization of intelligence tests in, 57–58 variations in Spanish spoken in, 110 Puerto Rico School Psychology Association. See Asociación de Psicología Escolar Race in definitions of culture, 174 and intelligence assessments, 110–112 Radhakrishnan, P., 43 Randall, B. A., 257 Rapport, establishing, 82–83 Rasch scaling model, 72

330       index

Raven Progressive Matrices, 113 RCS (Rorschach Comprehensive System), 193–194 Real relationship, 178 Reliability of Batería III COG, 104 of Batería III Woodcock-Muñoz, 74 of EIWA, 75–76 of EIWA–III, 76–77 of EIWN–IV, 70–71 validity vs., 113 Religion and spirituality as cultural value, 222–223 interview guide for assessing, 228 Renteria, L., 139–140 Reporting, of behavioral symptoms, 157–159 Research tests, 15 Respeto in clinical interview, 176–177 as cultural value, 220–221 interview guide for assessing, 227 and simpatía, 198–199 Responses to Stress Questionnaire (RSQ), 277 Response styles, 41 Reuland, D. S., 264 Reyes-Lagunes, I., 36 Rico, M. A., 259 Robison, J. T., 263 Roca, Pablo, 54 Roca de Torres, Irma, 54 Rodríguez, C., 34, 42–43 Rodríguez, Juana Myrtea, 56, 58, 59 Rodriguez, N., 275 Rodriguez, O., 273 Rogers, M. R., 201 Rolon, Maria, 57 Romero, A., 69 Rorschach Comprehensive System (RCS), 193–194 Rorschach Performance Assessment System (R–PAS), 193–194 Rosen, D. C., 175–176 Rosenfeld, B., 178 Rosselló, J., 161 Rotter, J. B., 34–35 Roysircar, G., 193, 200 R–PAS (Rorschach Performance Assessment System), 193–194

RSQ (Responses to Stress Questionnaire), 277 Russell, S. T., 257 SADS (Schedule for Affective Disorders and Schizophrenia), 240 SADS—Lifetime Anxiety (SADS–LA), 240 Saklofske, D. H., 86 Salazar, G. D., 138–139 Salgado de Snyder, N., 275 Salvia, J., 112 San Antonio, Texas, 102 Sánchez de Carmona, M., 36 Sanchez Hidalgo, Efrain, 54 Santiago, Maria de Lourdes, 57 Santiago-Rivera, A. L., 175, 176 Santos, A., 260 Santos, D., 260 Saunders, S. M., 178 Sayers, S., 163 SBI (School Behavior Inventory), 155 Schedule for Affective Disorders and Schizophrenia (SADS), 240 Schimmack, U., 43 School Behavior Inventory (SBI), 155 Schrank, F. A., 72 SCID (Structured Clinical Interview for DSM Disorders), 179, 239–240 Scott, R. L., 36, 41 Second Psychological Measurement Congress, 56–57 Self-disclosure in clinical interview, 176–177 in first interactions, 225 and incorporation of cultural values, 221 in Latina/o skills identification stage model, 182 Self-report measures, anxiety, 241–243 Semistructured interviews, 177, 239–240 Sena-Rivera, J., 196 Sepekoff, B., 296 Service delivery, 198–199 SES (socioeconomic status), 95 Sexual behavior, and machismo, 221–222 Sexual orientation, 293–298 assessment of, 294–297 basis of, 293–294

and cultural values, 9 defined, 292 research on, 297–298 Shen, Y. L., 257 Shimabukuro, S., 172, 178–181 Simpatía, 198–199 as cultural value, 220–221 interview guide for assessing, 228 Sixteen Personality Factors Questionnaire, 37 Small talk, in first interactions, 225 Smith, P. B., 34–35 Smith, T. B., 175 Snowden, L. R., 192 Social, Attitudinal, Familial, and Environmental Scale, 276 Social desirability, controlling for, 298 Social identities and engagement algorithm, 181 of Latina/os, 182–183 Social networks, 180 Social science on gender identity, 299 on sexual orientation, 293 Socioeconomic status (SES), 95 Somatization of anxiety disorders, 245–246 of nervios, 245 South America, 311 Spanish BDI–II, 259–260 Spanish Big Five Inventory, 42–43 Spanish-language assessments. See also specific assessments for depression assessment, 258 discussion of, in Pruebas Publicadas en Español, 13, 15–20 increase in market for, 5, 310 lack of research on, 118–119 need for, 24, 26 for neuropsychological testing, 141–144 research on, 7 translations vs. adaptations, 77 validation studies of, 264–265 Spanish-speaking clients growth among populations of, 4–5, 12, 135–137, 147 inadequate providers for, 204 intelligence testing with, 100–104 selection of testing language for, 84 index

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Spanish STAI, 241 Spense, J., 34 STAI (State–Trait Anxiety Inventory), 241 Standardized assessments adaptations of, 192–196 and multicultural populations, 192 Standards for Educational and Psychological Testing native-language assessment in, 129–130 neuropsychological tests meeting standards of, 144–147 on test adaptations, 138 on testing individuals of diverse linguistic backgrounds, 136–137 on validity, 137 on validity studies, 71 State–Trait Anger Expression Inventory, 35 State–Trait Anxiety Inventory (STAI), 241 Stewart, A. L., 257–258 Storck, M. G., 179 Storms, Michael, 297 Storms Scale, 297 Stress appraisal of, 276 assessment of, 8–9 associated with familismo, 219 chronic, faced by Hispanics, 277 culturally based, 278 types of, measured in HSI–A, 280 Stressful life events paradigm, 276 Strickland, M., 179 Structured Clinical Interview for DSM Disorders (SCID), 179, 239–240 Structured interviews, 177, 240–241 Sue, D. W., 201 Sue, S., 173 Swartz, J. D., 40 TAT (Thematic Apperception Test), 194 Telepsychology services, 314 Tell-Me-A-Story Test (TEMAS), 189, 194–195 Temperament and Character Inventory, 36, 40 Terman, Lewis, 299–300 Terracciano, A., 34

332       index

Testing the limits, 114–115 Test Innovations, 58 Test score validity, 125–126 Test selection process, 20–21 Tests in Print (TIP) (Murphy, Geisinger, Carlson, and Spies), 12–13, 16, 17, 309–310 Thematic Apperception Test (TAT), 194 Therapeutic alliance, 177–178 Therapeutic relationship, 176–178 Third method approaches, 128–129 Thorndike, E. L., 58 Tinoco, M., 42 TIP. See Tests in Print Towner, J. C., 281 Townsend, A. L., 202 Trait psychology, 30–31 Tran, A., 179 Transgender (term), 292 Transgender issues, 292, 301 Translations adaptations vs., 191 issues with methods of, 265 test adaptation by, 195–196 Translators. See Interpreters Transsexual(s) defined, 292 research on, 300–301 Treatment planning, 230 Trimble, J. E., 178 Trompenaars, F., 34–35 Turabo University, 55 Uncertainty avoidance (cultural dimensions theory), 30 Universalist psychotherapy, 174 University of Puerto Rico, 53, 55, 56, 60 Unstructured interviews, 177 U.S. Census Bureau, 4, 135–136 VAI. See Verbal Acquisition Index Validity of Batería III Woodcock-Muñoz, 74–75 of EIWA–III, 76–77 of EIWN–IV, 71 evaluation of diagnostic, 126–127 evaluation of test score, 125–126 in intelligence and learning disability evaluations, 113–114

in neuropsychological testing, 137 of test scores, in intelligence and learning disability evaluations, 120–124 Van de Vijver, F., 41, 191 Van Oss Marin, B., 295 VCI. See Verbal Comprehension Index Velásquez, R. J., 5–6 Verbal abilities, of children, 94–95 Verbal Acquisition Index (VAI) evaluation of English language learners with, 94 Hispanic children scores, 96–97 Verbal Comprehension Index (VCI) English language learner scores on, 94 Hispanic adult scores on, 86–88 Hispanic children/adolescent scores on, 89–92 Hispanic children scores on, 95–99 mean index scores of Hispanics on, 84 on WPPSI–IV, 94 Verbal IQ (VIQ) scores, 94–95 Verbal tests, in C–LIM, 121 Verduzco, M. A., 42 Viglione, D. J., 194 Vilar-López, R., 146 Villegas, D., 301 VIQ (Verbal IQ) scores, 94–95 Visual Spatial Index (VSI), 94, 96–99 WAIS. See Wechsler Adult Intelligence Scale WAIS–III. See Wechsler Adult Intelligence Scale, 3rd ed. WAIS–IV. See Wechsler Adult Intelligence Scale, 4th ed. WAIS–R (Wechsler Adult Intelligence Scale, Revised), 69 Walsh, J. A., 192–193 Wechsler Adult Intelligence Scale (WAIS) Spanish adaptations of, 75–77. See also Escala de Inteligencia Wechsler para Adultos—III use of, in Puerto Rico, 54 Wechsler Adult Intelligence Scale, Revised (WAIS–R), 69 Wechsler Adult Intelligence Scale, Third Edition (WAIS–III), 75 Spanish adaptations of, 89 standardization of, for Puerto Rico, 56

Wechsler Adult Intelligence Scale, 4th ed. (WAIS–IV), 75 Hispanics in normative samples of, 83–86 Spanish adaptations of, 89 Wechsler Intelligence Scale for Children (WISC) Spanish versions of. See Escala de Inteligencia Wechsler para Niños de Puerto Rico used in Puerto Rico, 54–55 Wechsler Intelligence Scale for Children, 3rd ed. (WISC–III), 70 Wechsler Intelligence Scale for Children, 4th ed. (WISC–IV) assessing Hispanic children and adolescents with, 89–93 Hispanics in normative samples of, 83–86 Spanish adaptations of, 70 Wechsler Intelligence Scale for Children–IV Spanish (WISC–IV Spanish) development of, 100–103 used in Puerto Rico, 60 Wechsler Intelligence Scale for Children—Revised (WISC–R) Spanish adaptations of, 69–71. See also Escala de Inteligencia Wechsler para Niños— Revisada Wechsler Preschool and Primary Scale of Intelligence, 3rd ed. (WPPSI–III), 24, 25 Wechsler Preschool and Primary Scale of Intelligence, 4th ed. (WPPSI–IV) with Hispanic children, 93–100 Hispanics in normative samples of, 83–86 verbal expression demands on, 93 Weiss, L. G., 86, 89, 92–93 Weiss, R. A., 178 Wennerholm, Marion, 55 Wiebe, J. S., 259 WISC. See Wechsler Intelligence Scale for Children WISC–III (Wechsler Intelligence Scale for Children, 3rd ed.), 70 WISC–IV. See Wechsler Intelligence Scale for Children, 4th ed. index

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WISC–IV Spanish. See Wechsler Intelligence Scale for Children–IV Spanish WISC–R. See Wechsler Intelligence Scale for Children—Revised WMI. See Working Memory Index Wolf, T. J., 296 Woodcock, R. W., 72–74 Woodcock-Johnson III Battery, 71 Work and Family Orientation Inventory, 34 Working Memory Index (WMI) Hispanic adult scores on, 86–88 Hispanic children/adolescent scores on, 89–91 Hispanic children scores on, 95–100 on WPPSI–IV, 94

334       index

WPPSI–III (Wechsler Preschool and Primary Scale of Intelligence, 3rd ed.), 24, 25 WPPSI–IV. See Wechsler Preschool and Primary Scale of Intelligence, 4th ed. WSW (women who have sex with women), 294 Yamada, A.-M., 192 Yeh, C. J., 178 Young, T. L., 41 Youths, self-reports of, 158–159 Youth Self-Report (YSR), 158 Ysseldyke, J. E., 112 Zayas, L. H., 195

ABOUT THE EDITOR

Kurt F. Geisinger, PhD, is director of the Buros Center for Testing and Meierhenry Distinguished University Professor at the University of Nebraska–Lincoln. His previous positions include professor and chair of the Psychology Department at Fordham University, psychology professor and dean of arts and sciences at the State University of New York (SUNY) at Oswego, and psychology professor/vice president for academic affairs at two other institutions. He served two terms on the American Psychological Association (APA) Council of Representatives and then on the Board of Directors. He represented APA on the International Organization for Standardization’s Test Standards Committee and served on seven other APA task forces. Dr. Geisinger was an APA delegate and chaired the Joint Committee on Testing Practices (1992–1996). He served on APA’s Committee on Psychological Testing and Assessment and APA’s Committee on International Relations in Psychology and was president of the Coalition for Academic, Scientific, and Applied Psychology caucus in 2009. He was elected president of the Division of Psychological Assessment and Evaluation of the International Association of Applied Psychology.

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Dr. Geisinger’s primary academic interests concern proper test use, testing individuals with disabilities and language minorities, and adapting tests across languages and cultures. He chaired the College Board’s Research Advisory Committee, the Graduate Record Examination (GRE) Board, and the GRE Technical Advisory Committee. He was a member of the SAT Advisory Committee and a member of the National Council of Measurement in Education’s Committee to Develop a Code of Ethical Standards, and he has been involved in numerous other task forces and panels. He is also a council member and treasurer of the International Test Commission and editor of Applied Measurement in Education, and he has served on the editorial committees of eight other journals. Dr. Geisinger edited the APA Handbook of Testing and Assessment in Psychology, Psychological Testing of Hispanics, Test Interpretation and Diversity: Achieving Equity in Assessment, High-Stakes Testing in Education: Science and Practice in K–12 Settings, and the 17th, 18th, and 19th Mental Measurements Yearbooks as well as Tests in Print VIII and Pruebas Publicadas en Español. He has worked in virtually all areas of psychology and has published approximately 130 chapters and journal articles. His awards include APA fellow status as well as a charter fellow status in the American Educational Research Association and the Association for Psychological Science. APA’s Division 5 (Measurement, Evaluation, and Statistics) awarded Dr. Geisinger the Jacob Cohen Award for Distinguished Teaching and Mentoring; the Northeastern Educational Research Association gave him the Donlon and the Doherty Awards for mentoring and service, respectively; and SUNY–Oswego honored him with their Distinguished Research Award.

336       about the editor