Abstracts

Rationale: Current neuropsychology practice in the U.S. increasingly demands awareness and understanding of cross-cultural variables that impact assessment findings, with educational and linguistic diversity of patients and families being at the forefront. More subtly, distinct cultural social norms also affect engagement in assessment processes, and can result in departure from standardization practices on tests designed primarily for Western cultures.Boston Children’s Hospital Epilepsy Center has experienced an increase in international referrals from Arabic-speaking countries and we have adapted neuropsychological assessment strategies to better serve this population. In our cross-cultural assessment methods, we strive to consider individual differences that affect performance and interpretation of findings (i.e., relativism) in the context commonly shared developmental characteristics between diverse populations (i.e. universalism). Methods: International patients from Arabic-speaking countries referred to our pediatric hospital-based neuropsychology practice between the years 2013-2017 were retrospectively reviewed with a focus on reason for referral, demographics, assessment strategy and broad developmental status.  Results: Retrospective review yielded 34 evaluations of 31 separate patients age ranged 1 to 19 years (mean = 9 years), 55% male. The majority of the referrals (19 of the 34) were a part of epilepsy surgery evaluation. Average parental education was 15 years.  Intellectual disability or significant developmental delay was observed in 81% of patients and autism diagnosed in 13%. Around the time of evaluation, 68% of patients were enrolled in school.Due to constraints in available tests, less than half of the evaluations included a measure of verbal IQ or language. The Bilingual Verbal Abilities Test (1998) was administered in 44% of evaluations. No tests of verbal memory were employed; nonverbal memory was assessed in 24%. Nonverbal intelligence was measured utilizing developmentally appropriate tools with US normative data in 79%. Most preschool and older patients also completed a test of visual-motor integration (74%) and fine motor dexterity tests (59%), while younger patients completed a standardized developmental assessment battery. Interpreter services used for all but one evaluation. Conclusions: Our focus in working with Arabic speaking patients has been to address targeted neuropsychological referral questions related to medical treatment utilizing an approach that considers cross-cultural factors that may impact findings. We have reviewed our process and experience over the previous five years assessing children with epilepsy from Arabic speaking countries receiving treatment in our center.Our assessment methods relied heavily on interview and observations with testing tools selected for developmental appropriateness and cultural sensitivity when possible. Referral questions regarding language and memory function were typically not addressed with diagnostic tests. Reliance on detailed clinical interview in addition to or instead of adaptive measures standardized on U.S. populations is advised given different expectation for children in the homes and communities of the U.S. and Arab countries, and differing expectations for adolescents by gender.  Funding: None