Protocol for the Development of a Computerized Battery for Cross-Cultural Neuropsychological Assessment: The EMBRACED Project

• DOI: https://doi.org/10.13169/bethunivj.39.1-2022.01
• Published date: 13 June 2023
• Pages: 31-124
• Date: 13 June 2023
• Author: Inmaculada Ibanez-Casas,Brooke Crespo Leonard,Miquel Perez-Garacia,Antonio Puente

31

Protocol for the Development of a Computerized

Battery for Cross-Cultural Neuropsychological

Assessment: The EMBRACED Project.

Inmaculada Ibanez-Casas1*, Brooke E. CrespoLeonard2, Miguel Pérez-García2, &

Antonio E. Puente3

1Department of Psychology, State University of New York Plattsburgh, U.S.A.

2Mind, Brain, and Behavior Research Center (CIMCYC), University of Granada,

Spain

3Department of Psychology, University of North Carolina Wilmington, U.S.A.

*Correspondence concerning this article should be addressed to Inmaculada Ibanez-

Casas, email: iiban001@plattsburgh.edu

Abstract

Globalization is making our world increasingly diverse. However, the eld of

neuropsychological assessment hasn’t addressed this diversity appropriately and people

around the world are being assessed with instruments that are not culturally adapted for

them. Practitioners are using tests that were originally created for Western culture(s)

to evaluate patients of all demographic backgrounds. The solution is the development

of computerized cross-cultural tests, but there is no established standard procedure for

creating a battery that is comprehensive, modular, psychometrically robust, easy to use,

free, and culturally salient. The EMBRACED battery is intended to be exactly that.

The protocol for its development followed strict, evidence-based scientic methods

for the determination of all its neuropsychological domains, their relevant constructs,

and the best tasks to measure them; the tasks and stimuli are also computerized. The

EMBRACED battery is user-friendly, cost-effective, and patient-guided. The preliminary

results obtained to date show that culture has a signicant effect on neuropsychological

test performance, with bias in favor of Western populations. Our eld has an ethical

responsibility to improve our instruments, increase fairness in testing, and to ght for

social justice around the world, which is precisely the aim of the EMBRACED project.

Keywords: Protocol, neuropsychological assessment, cross-cultural, computerized

tests, fair testing

Disclaimer: The opinions and views expressed in this article do not represent the

opinions of the Journal’s editorial board and staff of the Dean of Research at Bethlehem

University. The accuracy of the material and any errors in this publication are the sole

responsibility of the author.

10.13169/bethuniv.39.1-2022.01

32 Bethlehem University Journal 39 (2022)

 

EMBRACED 

 

 

 



صّ

خلم

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

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



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

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









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





















EMBRACED





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







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

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









EMBRACED















 







































EMBRACED



















33

Bethlehem University Journal 39 (2022)

Background

Cross-Cultural Neuropsychology

Culture has been systematically related to variance in neuropsychological

scores, even to a greater extent than traditional variables such as age, gender,

or education (Ardila, 2020; Fasfous et al., 2017; Melikyan et al., 2019; Puente

et al., 2013; Wilson, 2010). However, neuropsychological instruments have

generally failed to address this issue for decades and most of the worldwide

population has been left to be assessed with instruments that are not culturally

appropriate for them. Most neuropsychological tests are developed and normed

in what have been called WEIRD (Western, Educated, Industrialized, Rich and

Democratic) countries(Henrich et al., 2010; Muthukrishna et al., 2020), referring

to white individuals (Clancy & Davis, 2019) in North America, Australia,

Europe, and Russia. Outside of these regions and this demographic group,

however, neuropsychology is still in the process of developing and is not yet

well recognized (Ardila, 2013; Fasfous et al., 2017; Fernandez, 2019; Puente &

Agranovich, 2004). These tests are then used in migrant populations from non-

WEIRD countries, which constitute ethnic minorities in the host countries (and

thus are not well represented in their norms) and in the non-WEIRD countries

themselves. These tasks, which are not culturally adapted and lack the appropriate

norms, produce erroneous and unfair interpretations that result in misdiagnosis,

a disregard for non-neurological factors, such as time perception or acculturation

in the interpretation of performance, attribution of low scores to brain injury or

cognitive dysfunction, irrelevant tasks for the examinee, increased errors, and lack

of fairness (Daugherty et al., 2017; Fasfous et al., 2017; Melikyan et al., 2019).

This approach, though typical, violates the accepted Standards for Educational

and Psychological Tests (American Educational Research Association et al.,

2014) and the Guidelines for Translating and Adapting Tests of the International

Test Commission (International Test Commission, 2017).

Globalization movements in the last several decades have greatly increased

diversity all over the world (Franzen et al., 2020, 2022; Segal, 2019). However,

this diversity is not reected in the eld of neuropsychology, which continues to

work under the erroneous presumption that the Western perspective is universally

applicable to cultural minorities (Dick et al., 2006). These “minorities” include

migrant groups living in WEIRD countries and the entire population of non-

WEIRD countries, as well as individuals, in general, that are not from the

majority groups that developed the neuropsychological instruments. The

majority of available neuropsychological tests are standardized for middle-class,

monolingual, English-speaking, Caucasian North Americans (Cory, 2021; Leong

& Park, 2016; Manly, 2008; Melikyan et al., 2019). These are being used with