Ann B. Shuttleworth-Edwards

This study aimed to construct preliminary normative indications for educationally disadvantaged, Xhosa-speaking South African individuals on the Tower of London-Drexel University 2nd Edition test (TOL-DX 2nd Edition). The TOL-DX 2nd Edition is a commonly employed neurocognitive measure of executive function across seven indicators. The study sample included 39 Xhosa-speaking participants proficient in English, aged 19 to 40 years, with a Grade 11 or Grade 12 education attained at a poorly resourced school. Descriptive statistics in the form of means and standard deviations were used to describe the TOL-DX 2nd Edition scaled score normative indicators for the present sample. These preliminary norms were broadly equivalent to the United States standardisation for all seven test indexes. Larger studies with wider age, educational, and geographical distributions are suggested to generate norms that may be usable for clinical case interpretations among educationally disadvantaged South African individuals.

Objective: The aim of this paper is to address the issue of IQ testing within the multicultural context, with a focus on the adequacy of nationwide population-based norms vs. demographically stratified within-group norms for valid assessment purposes. Burgeoning cultural diversity worldwide creates a pressing need to cultivate culturally fair psychological assessment practices. Method: Commentary is provided to highlight sources of test-taking bias on tests of intellectual ability that may incur invalid placement and diagnostic decisions in multicultural settings. Methodological aspects of population vs. within-group norming solutions are delineated and the challenges of culturally relevant norm development are discussed. Illustrative South African within-group comparative data are supplied to support the review. A critical evaluation of the South African WAIS-III and the WAIS-IV standardizations further serves to exemplify the issues. Results: A flaw in both South African standardizations is failure to differentiate between African first language individuals with a background of advantaged education vs. those from educationally disadvantaged settings. In addition, the standardizations merge the performance outcomes of distinct racial/ethnic groups that are characterized by differentially advantaged or disadvantaged backgrounds. Consequently, the conversion tables are without relevance for any one of the disparate South African cultural groups. Conclusions: It is proposed that the traditional notion of a countrywide unitary norming (also known as ‘population-based norms’) of an IQ test is an unsatisfactory model for valid assessment practices in diverse cultural contexts. The challenge is to develop new solutions incorporating data from finely stratified within-group norms that serve to reveal rather than obscure cross-cultural disparity in cognitive test performance.

The aim of this study was to establish normative indications for the Rey-Osterrieth Complex Figure (RCF) copy, incidental recall and delayed recall tasks, administered in English on a non-clinical population of Xhosa, unskilled workers (N = 33) (females n = 21; males n = 12), with a background of relatively disadvantaged quality of education up to Grades 11 and 12. The sample was stratified into two age groupings (18 – 29 years, n = 17; 30 – 40 years, n = 16), equally distributed for sex and level of education. Within group statistical analyses compared subgroup test performances for sex and age within the total sample. Between group analyses were used to compare the performance of the present sample with age equivalent data derived from a meta-analysis of US normative data on the RCF task. There was an age effect in favour of the younger group for both the immediate and delayed recall tasks. The local data for all RCF tasks were significantly lower than the US normative data, with the indication that higher levels and/or quality of formal school education might advantage performance on this complex visuoperceptual copy and recall task.

This analytical review serves to highlight pitfalls clinicians in multicultural contexts may encounter when using normed ability tests for the assessment of cognitive dysfunction due to brain injury. Four sources of erroneous practice are: (i) Failure to recognize within-race group heterogeneity on cognitive test performance in association with factors such as quality of education; (ii) Lack of rigorous attention being paid to the exact mode of test administration used in a derived normative base to be used for assessment purposes; (iii) Estimating an expected level of performance for an individual on diverse cognitive tests based on an IQ score; (iv) Adopting a thoroughly rule-bound actuarial approach to test interpretation, over a contextually based clinical approach. Even with locally derived norms, the validity of actuarially based interpretive conclusions in the absence of a conceptually coherent case analysis is not supported.

This article reports on three pre- versus post-season prospective studies in which male university and high school contact sport players predominantly of Rugby Union (hereafter rugby) were compared with age, education, and IQ equivalent non-contact sport controls on the ImPACT (Immediate Postconcussion Assessment and Cognitive Testing) test. All analyses revealed a relative absence of practice effects on the Visual Motor Speed (VMS) composite for contact sport groups compared with controls. The VMS data for rugby players from each study were pooled and subjected to additional analysis (Rugby, n = 145; Controls, n = 106). Controls revealed significant improvement over the season (p < .001), whereas no learning effect was in evidence for rugby players whose performance remained the same (interaction effect, p = .028). It is apparent that practice effects have diagnostic potential in this context, implicating vulnerability on speeded visuomotor processing in association with participation in rugby. Pointers for further research and concussion management in the individual case are explored.

The aim of this article was to provide practitioner guidelines for the use of the Wechsler Adult Intelligence Scale — 4th Edition (WAIS-IV) within the South African context, given the absence of local norms for this edition of the test. Normative indications for WAIS-III test performance (English administration), in respect of South African black African (predominantly Xhosa) first language samples (age range 19–30), demonstrate that Grade 12 and Graduate Xhosa groups with disadvantaged education were significantly lower than the US standardization by 20 to 30 IQ points. This raises the question as to whether practitioners should use the WAIS-III rather than the more clinically advanced WAIS-IV for such testees given the lack of appropriate norms. In response to this dilemma, a mechanism is presented for converting a WAIS-IV raw score test profile into a WAIS-III test profile such that it may be subjected to analysis in terms of available WAIS-III cross-cultural norms. Following this procedure, WAIS-III subtest scaled scores and index scores were calculated from WAIS-IV data for three young adult Xhosa speaking individuals with disadvantaged education. Descriptive comparisons of the original WAIS-IV scores and the derived WAIS-III scores reveal substantial equivalence across each of the three test profiles. Taking both clinical and statistical data into account, a neuropsychological analysis was elucidated in respect of one of these cases, on the basis of which a contextually coherent interpretation of a WAIS-IV brain injury test protocol using the Shuttleworth-Edwards et al. WAIS-III cross-cultural norms is achieved. While further research is warranted, it appears that for diagnostic purposes practitioners can legitimately proceed to the use of the WAIS-IV in respect of such educationally disadvantaged populations by means of cautious application of these WAIS-III local norms.

Within the compressed gas diving arena there is a risk of cerebral damage with deleterious neuropsychological sequelae in association with decompression illness (DCI), hypoxia, gas toxicity, as well as the cumulative subclinical effect of ‘silent’ paradoxical gas embolisms, the last being an area of growing concern. However, within diving medicine there is little evidence of the regular use of neuropsychological evaluation to monitor brain-related sequelae of frequent diving activity. In contrast, in recent years there has been an explosion of interest in the management of sports concussive injury, including emphasis on the pivotal role of neuropsychological evaluation within that context. Taking the cue from sports concussion medicine, it is proposed that there is an urgent need to incorporate neurocognitive baseline and follow-up screening as a core component in the medical management of those involved in intensive commercial and recreational compressed air diving activities. The objective would be to facilitate (i) accurate neurodiagnostic follow-up of frank DCI or an identifiable hypoxic or toxic incident; (ii) timeous identification of cumulative deleterious effects of repetitive subclinical hypoxic/toxic incidents and/or ‘silent’ paradoxical gas embolisms that might affect them in later life; and (iii) disability assessment following any such events or the combination thereof for rehabilitation and compensation purposes.

The aim of this study was to produce preliminary normative indications for the Trail Making Test and the Stroop Test, administered in English, on a non-clinical sample of Black, Xhosa speaking unskilled workers (N = 33), with an educational level of Grade 11 or Grade 12 from traditionally Black township schools with a relatively disadvantaged quality of education. The sample was equally distributed for sex and level of education, and was divided into two age categories (18–29 and 30–40 years). Within-sample age and gender effects were revealed for the Stroop test only. The younger group performed better than the older group on the Colour Word task, and women performed significantly better than men on the Word task. Normative indications for both measures were descriptively compared to available normative data on westernized populations with relatively advantaged education. The research outcome endorses the need for local norms for use with educationally disadvantaged Xhosa speaking individuals.