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Demographic shifts in Australia have resulted in a rapidly growing need for provision of neuropsychological services to individuals from culturally and linguistically diverse backgrounds. The assessment of cognitive functioning in these individuals poses considerable challenges and neuropsychologists’ ability to adequately service this subset of the population has been questioned. Evaluate the approaches adopted by clinical neuropsychologists for the assessment of individuals from culturally and linguistically diverse backgrounds and the factors that may affect the validity of these assessments. Refer to examples of clinical populations and/or neuropsychological tests to support your response.

Assessing Neuropsychology Among Diverse Populations

Providing cultural sensitive clinical service has been an essential component in the delivery of neuropsychology among diverse people. Conducting a neuropsychology assessment needs to focus on several areas while dealing with linguistically different and diverse populations.  Assessments play the crucial role in impacting on the general persons. Assessment in neuropsychology refers to the collection and identification of risks and diagnoses which are associated with psychology, which integrates relevant issues. Comprehensive assessments often take multidimensional angles and interdisciplinary approach.

The Diagnostic and Statistical Manual of Mental health Disorders, has put into focus the need of incorporating culture in the diagnostic criteria of patients using this tools, a diagnostic tool utilized has been added which s Neuro-Cognitive Disorders who has been added. Two diagnoses have been added to this category. However, despite these modifications, questions arise as to whether the neuropsychology parameters are effective in testing cultural factors, (APA, 2013).

Research undertaken on neuropsychology assessment has shown that occurs misdiagnosis and observation of false positive has been noted among people with diverse cultural associations,(Norman et al., 2011). Norman et al showed that the application of normative and clinical psychology impairment, memory and visual learning was higher among healthy African-American people.

There has been an increasing demand for mental psychologist within the health services on increase of assessing cognitive functions of culturally and Linguistically Diverse persons. Most of the current research has been undertaken and has made comparisons of test factors among CALD groups having western education and those having the Caucasian background. Using standardization samples of the Weschler Adult Intelligence Scale-Third edition, the African-American and Hispanic subjects showed to have scored lower than Caucasian subjects, (Wechsler, 2008).

Controls undertaken for CALD in Australia showed that persons having CALD background showed low performance compared to those under the Weschler Adult Intelligence Scale. The cultural difference on the Wechsler scale has been undertaken among patient groups and people with mixed neuropsychiatric disorders among other groups, (Boone, Victor, Wen, Razani, & Ponton, 2007).

There have been observed diagnostic disparities on the use of neuropsychology practices. Sensitivity has been noted to be prevalence among various groups. Numerous studies have reported the emergence of false positives errors while conducting the tests. This has led to a lack of specificity with regard to neuropsychology measures and standard of care for CALD persons.

Majority of the Cognitive assessments scales have been developed and focussed on western countries culture, this has influenced the way it was designed. Usage of this assessment on CALD has been shown to offer the wrong diagnosis.

RUDA refers to Rowland University Dementia Assesment tool a tool developed by the University of Rowland which assess cognitive impairment among people experiencing impairment from various educational, cultural and linguistically different populations. Each item under the tools has cultural relevance and ease of making translations easy.

The key potential benefits of RUDAS is that it seems to have less educational and cultural background with regard to assessments and it takes less than 10 minutes to administer. I entail a series of questions which are aimed at assessing the memory, praxis, visuospatial and visuoconstructional memory. It has a cut-off score f 22 or less indicating impairment, 23-30 showing normal neuropsychology state.

The Diagnostic and Statistical Manual of Mental Health Disorders

RUDAS has been found to be free from any cultural connotations and bias in multicultural settings in Australia, however, one study in South India found an impact of education on RUDAS score, (Storey, Rowland, Basci, Confortu &Dickson, 2004)

This refers to the standard mini-mental state examination tool which is used for CALD people. SMMSE is an adaptable tool which assesses mental state and provides critical assessments with regard to psychology state. It has a cut off points ranging 0-30 indicating low scores, (Basic et al 2009).

Various issues have been highlighted with regard to psychology assessment. Usage of standards’ tests with minority and culturally diverse groups has proven to be c challenging task. Important factors which have been observed is that there is an occurrence of overdiagnosis, segregation of persons and mistreatments. Culture has been a confounder in undertaking neuropsychology assessments among different communities and also among the communities who are not from the western origin.

Effects of acculturalization have always been felt on the individual performance of cognitive stets. Neuropsychological assessments have been shown not to be free from cultural and racial biases which are common. While assessing neuropsychology, it is critical for acculturation level to be ascertained as this obtains views from the examinee on the potential factors which might affect assessment. Further factors affecting acculturation needs to be assessed and gathered, (Hwang & Ting, 2008).

Assessment of language proficiency is an essential component in assessing neuropsychology state. Language proficiency has been shown to affect many facets of psychology assessment across the population. Through assessment on the use of language plays an important role in assessing neuropsychology among CALD community, (Mahendran, Chua, Feng, Kua & Preedy, 2015).

In Australia, cultural diversity plays a crucial role in the healthcare process. In psychology arena, there is an increasing demand for assessment of cognitive function among CALD persons. Research done has shown that conducting neuro assessment for CALD is crucial. Existing research has focused on the comparison of test performance on different CALD groups in Australia. Studies done on western educated and Caucasian blacks showed different variations on the usage of different tools were used. Classifications using Wechsler Adult Intelligence Scale-Third Edition (WAIS-III) and Wechsler Memory Scale showed variations. African Americans were misclassified using a cut off SD below 1, (Weschler, 2008).

Controls of Australian origin had lower performance among English speaking backgrounds using the WAIS-R tool on IQ and WAIS-R on picture completion subtest. Further CALD person test on the first language scored low on WAIS-R. Cultural differences have been observed using this tools and also with people having mixed neuropsychiatric disorders, (Rosenberge, Dethier, Kessesls, Westbrook & McDonald, 2015).

A study to assess the cognitive function among different individuals has shown that linguistically diverse groups of persons often experience challenges. An investigation on the diverse cultural background using WAIS scale showed that English educated diverse group performed dismally compared to English speaking diverse group while the no English speaking diverse group performed very low across the groups being compared to, (Walker, Batchellor, Shores & Jones, 2010). This result indicates divergent assessments are relevant in assessing the CALD group. There extremely challenges in assessing their neuropsychology status.

Conclusion

The high population of divergent and different cultures has portrayed a significant challenge in neuropsychology assessments. In Australia, there is a high rate of migration of different people into the country having diverse backgrounds. There is a need for comprehensive tools which addresses this group of persons and improves on outcomes of treatment. In assessing larger community network, developing linguistically specified data is of the essence. Development of a normative data with acceptable validity and reliability tests is relevant among specific CALD grounds with respect to Australia.  The study trials done have concluded that usage of WAIS matrix is a relatively effective tool lacking culture biases, however, in order to achieve this, assessment of English proficiency, and socioeconomic status needs to be taken care of.

References

American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (DSM-5®). American Psychiatric Pub.

Basic, D., Khoo, A., Conforti, D., Rowland, J., Vrantsidis, F., Logiudice, D., ... & Prowse, R. (2009). Rowland Universal Dementia Assessment Scale, Mini?Mental State Examination and General Practitioner Assessment of Cognition in a multicultural cohort of community?dwelling older persons with early dementia. Australian Psychologist, 44(1), 40-53.

Boone, K. B., Victor, T. L., Wen, J., Razani, J., & Pontón, M. (2007). The association between neuropsychological scores and ethnicity, language, and acculturation variables in a large patient population. Archives of Clinical Neuropsychology, 22(3), 355-365.

Hwang, W. C., & Ting, J. Y. (2008). Disaggregating the effects of acculturation and acculturative stress on the mental health of Asian Americans. Cultural Diversity and Ethnic Minority Psychology, 14(2), 147.

Mahendran, R., Chua, J., Feng, L., Kua, E. H., & Preedy, V. R. (2015). The Mini-Mental State Examination and Other Neuropsychological Assessment Tools for Detecting Cognitive Decline. In Diet and Nutrition in Dementia and Cognitive Decline (pp. 1159-1174).

Norman, M. A., Moore, D. J., Taylor, M., Franklin Jr, D., Cysique, L., Ake, C., ... & Hnrc Group. (2011). Demographically corrected norms for African Americans and Caucasians on the Hopkins verbal learning test–revised, brief visuospatial memory test–revised, Stroop color and word test, and wisconsin card sorting test 64-card version. Journal of clinical and experimental neuropsychology, 33(7), 793-804.

Rosenberg, H., Dethier, M., Kessels, R. P., Westbrook, R. F., & McDonald, S. (2015). Emotion perception after moderate–severe traumatic brain injury: The valence effect and the role of working memory, processing speed, and nonverbal reasoning. Neuropsychology, 29(4), 509.

Storey, J. E., Rowland, J. T., Conforti, D. A., & Dickson, H. G. (2004). The Rowland universal dementia assessment scale (RUDAS): a multicultural cognitive assessment scale. International Psychogeriatrics, 16(1), 13-31.

Walker, A. J., Batchelor, J., Shores, E. A., & Jones, M. (2010). Effects of cultural background on WAIS?III and WMS?III performances after moderate?severe traumatic brain injury. Australian Psychologist, 45(2), 112-122.

Wechsler, D. (2008). Wechsler Adult Intelligence Scale–Fourth Edition (WAIS–IV). San Antonio, TX: The Psychological Corporation.

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