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Cultural Neuropsychology
Cultural neuropsychology deals with the rapidly changing and diverse nature of the population by taking into account the cultural, linguistic, and educational background of the people assessed in all aspects of practice, including the used measures and normative standards, languages in which individuals are assessed, and the provided educational materials. Nowadays, neuropsychological testing among culturally and linguistically diverse people is an area of a critical vulnerability in the theoretical and empirical foundation for neuropsychological practice. Many neuropsychological measures do not have acceptable diagnostic accuracy when used among people who are not Caucasian, well-educated, native English-speaking, and middle to the upper class.

The term cultural neuropsychology was first introduced into the research literature lexicon by Kennepohl in 1999. It emerged from a lack of generalizability and ecological validity in representing the global community, and also the diverse patient population emerging in the United States. Since then, there was a significant uptick in manuscripts addressing cultural issues in neuropsychology. There is a difference between cultural and cross-cultural perspectives. While cross-cultural perspectives compare one cultural or ethnic group with another in order to examine the differences between the two, cultural psychology, on the other hand, assumes that culture and cognition are linked and that one cannot fully be understood without the other.

Historical evolution of cultural neuropsychology
Wundt coined the name Völkerpsychologie to define the complexity and diversity of human experience, which was minimized by experimental psychology in order to give way to more universalist perspective. Lev Vygotsky regarded the turn towards a universalist perspective studying the brain as a science of groups, the crisis in psychology. Therefore, Vygotsky’s sociocultural and sociohistorical theory includes a culturally subjective approach. However, cultural neuropsychology was present from its inception in the work of Luria, one of the founding fathers of neuropsychology. Luria assumed that culture and cognition are inextricably linked and that one cannot be understood without the other simultaneously considered. Luria’s studies of the brain, which regarded a cultural historical theory as a point of departure, reveals a degree of depth that has withstood the test of time and can serve a guideline for the modern cultural neuropsychologist. His research of a rural community which began to acquire literacy practices in Uzbekistan revealed that in standard assessment this population performed differently than most educated adults on the same tests. With participation in cultural practice acquiring literacy, the people began to perform in more predictable ways, though still differing qualitatively from the normative population.

Differences within and between cultural groups
The word "cultural" draws attention to the role that human cultural practices and diverse life experiences play in brain-behavior relationships. Without reflecting on cultural neuropsychology there would be an impoverished understanding of brain-behaviour relationship that reflects the experience of only a select subset of human population. The modern clinical neuropsychologist faces populations that are not representative of the standardization samples for the available instruments. However, in our fiercely egalitarian and politically correct society, the mere suggestion of functional brain differences among people from different backgrounds leads to criticism. Caution should be exercised in the interpretation of the results of cultural and linguistic aspects of the neuropsychological assessment tool. Measures cannot provide accurate assessment across cognitive domains because they do not capture how cognition is expressed across culture. Hopefully, this will lead to a different standard of care for those who do not fit within the current cadre of available measures.

In preparing neuropsychologists for the linguistic needs of the population, consideration should be given not only to first language and language spoken at home, but also to test translations, education, immigration age (if relevant), acculturation, socioeconomic status, bilingualism, and racial socialization.

Test translation
The linguistic and ethnic group differences in the cognitive measure may be caused by improper translations of tests or when using inappropriate normative standards with well-translated measures. It is common practice in dealing with non-English-speaking populations to simply translate English language measures into a new language. Those translations are often provided by people who are not neuropsychologists or are not specialized in the target language.

Bilingualism
The effects of bilingualism on cognitive development are also possible contributors to ethnic and linguistic group differences. Findings show bilingual advantage on measures of executive control and episodic memory. There is now an emerging of controversial literature examining the effects of bilingualism on cognitive function among older adults. The claim is that the continuous task of managing competing representations of two languages provides the type of cognitive stimulation that leads to cognitive reserve. However, the results of these studies are mixed and suggest that when bilinguals and monolinguals are properly matched with respect to educational experience and acculturation, the bilingual advantage for cognitive decline or risk of dementia is less clear. The impact of bilingualism on neuropsychological test performance is a relatively new, but incredibly exciting, area for future work, offering the opportunity to explore critical questions about how culture and language affect brain function, as well as challenge our instruments to a high standard for construct validity.

Education
Extreme differences in educational level are often found between ethnic minorities and whites or between people of developed and undeveloped countries. Investigators commonly use techniques to “equate” ethnic groups on years of education before interpreting neuropsychological test performance, but nevertheless, these techniques often ignore ethnic discrepancies in the quality of education. Therefore, disparate school experiences could explain why many ethnic minorities obtain lower scores on cognitive measures even after controlling for years of education. Even more, some studies show that the number of years in education is an inadequate measure of the educational experience among multicultural adults and that adjusting for quality of education may improve the specificity of certain neuropsychological measures across racial groups.

Acculturation
Level of acculturation may also explain differences in cognitive test performance across groups. Acculturation is defined as the level at which an individual participates in the values, language, and practices of his or her own ethnic community versus those of the dominant culture. Previous studies have identified ideologies, beliefs, expectations, and attitudes as important components of acculturation, as well as cognitive and behavioral characteristics such as language and customs. Several studies show that individuals whose background and experiences are similar to the culture in which the tests were developed and normed obtain higher scores than do individuals whose cultural experiences are less mainstream and bound to their own ethnic culture.

Racial socialization
Neuropsychologists must take into account that level of comfort and confidence during the testing session may vary among test takers according to racial socialization and experience of stereotype threat. Stereotype threat describes the effect of attention diverting from the task at hand to the concern that one’s performance will confirm a negative stereotype about one’s group and has been described among African Americans, women on math tests , and among White males (when comparisons with Asians were invoked). The role of stereotype threat in neuropsychological testing is severely understudied and thus represents an exciting and much-needed direction for future research in cultural neuropsychology.

Innovations, trends and future prospects
Modern methods in brain science make it possible to investigate cultural neuroscience and the hypothesis that culture wires the brain. With neuroimaging cultural differences due to individualism and collectivism, personality traits and social identity, educational practices and mechanisms for imitation are already being studied. Besides its critics, cultural neuropsychology is experiencing an explosion in research also under the rubric of biocultural coconstructivism. Also, the modern neuropsychologists has to familiarize himself with these new interdisciplinary developments, since cultural neuropsychology represents the bridge between the neurosciences and clinical practice. The limits of neuropsychology in explaining brain-behavior relationships reveal that a true cultural neuropsychology must go beyond cross-cultural or ethnic group comparisons and instead attempt to understand an individual’s brain as completely culturally constituted. Therefore, any attempt of understanding a brain-behavior relationship must integrate culture, cognition and behavior. Diversity must be considered the point of departure, with a direct examination of the individual’s cultural practices. To conclude, the term cultural neuropsychology should define neuropsychology itself, because it is, unlike neural homogeneity, able to explain brain diversity and is empowered to be representative of all humans.