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Objective:The world’s 8 billion people speak about 7000 languages; 3.2 billion of those people natively speak the top 10 languages. Currently neuropsychology is moderately well-developed in 6 of the top 10 languages, serving roughly 2.5 billion. Developing robust neuropsychology in all 7000 languages to serve everyone equitably in their native language seems impractical within the next few decades. However, 1-2 billion people speak a major language as their second language so a pragmatic strategy may be to develop an alternative approach of second-language neuropsychology (SLN) to serve clients who speak rare languages natively but widely-diffused languages as their second language. This strategy involves adapting all levels of neuropsychological services to the second language user.Participants and Methods:Intended participants are those who speak a language of limited (e.g., <1 million speakers) diffusion as their first language and a language of wider diffusion (historically-colonial languages such as English, Russian, Mandarin, or Arabic; regional trade languages such as Swahili or Lingala; or nationalized languages such as Indonesian or Tagalog) as their second or more language. Intended participants are those with Basic Interpersonal Communication Skills (BICS) in their second language, but not necessarily Cognitive and Academic Language Proficiency (CALP). SLN will adapt current neuropsychology techniques in the following domains:1. Oral language: interview, feedback, treatment, and communication among professionals;2. Detailed language use evaluation;3. testing and norms;4. written materials: reports, client education materials, treatment materials, professional education materials, etc.The language style for such communication will use standard versions of such traditional or national languages, as commonly taught as a second language. It will use basic vocabulary, simple grammatical structures, and broadly-understood cultural referents. It will minimize grammatical complexity, slang, regionalisms, figures of speech, and metaphor. Materials will be available in the specified language both for those who are literate and for those with inadequate literacy. The development of such language style will require both written materials and training of neuropsychologists and allies. Once core SLN materials are developed, these may be further localized for specific communities to contribute to acceptance and effectiveness. These general strategies will need modification to the specifics of each major language, writing system, and population. This will be particularly true for testing language functioning itself, a particular challenge for the SLN strategy. The SLN strategy will require empirical verification of its viability in each major language and population. Some may perceive SLN as neo-colonialist and culturally insensitive; this may be mitigated in part through diversifying the neuropsychology workforce, community-based research, piloting, focus groups, and localization of materials.Results:Because this is a proposal and not yet a research project, prototype neuropsychological screening protocols for English-as-a-Second-Language and Spanish-as-a-Second-Language will be presented as examples.Conclusions:Cultural and linguistic diversity present major challenges to providing equitable neuropsychological services to the world’s population. Current neuropsychology resources are least accessible to major populations that may be most in need. The SLN strategy is not perfect or universal but may reach the next 1-2 billion underserved population

The history of psychological test translation includes problems of inaccuracy and unintentional or intentional racial, ethnic, and linguistic discrimination. Methods for accurate and fair psychological test translation, adaptation, and development have advanced, but neuropsychology has been slow to implement these methods. Inadequate translations and adaptations of neuropsychological tests may substantially impact their psychometric properties for target populations, increasing risk of clinical errors and other harms. The International Test Commission's (ITC) 2017 Guidelines for Tests Translation and Adaptation summarize current technologies for tests whose constructs depend upon the semantic content of the items. This is helpful, but insufficient because many neuropsychological tests focus on cognitive, linguistic, and emotional constructs that are measured by processes other than semantic content. Neuropsychological tests may depend on word length, familiarity, written form, visual stimuli, culture-dependent behavioral expectations, or other features apart from meaning. Furthermore, the ITC Guidelines were developed primarily from experiences of translation and adaptation among European languages, with populations with a restricted range of education and cultures, hindering their generalization to more diverse populations. To make the guidelines practical for neuropsychological users, the Assessment Workgroup of the INS Cultural Neuropsychology Special Interest Group has developed neuropsychological commentary on the ITC Guidelines. The Workgroup has also sponsored a discussion group among members involved in neuropsychological test translation, adaptation, and development projects around the world. Our objectives in this symposium are to present an overview of our neuropsychological commentary on the ITC Guidelines and illustrate the relevance of these guidelines and commentaries through presentations of projects from around the world. At the 2022 INS New Orleans meeting our group presented lessons learned from Africa, Australia, Europe, South America, and South Asia. In the current Part 2 presentation we will present projects from Australia, India, and Vietnam and lessons derived from comparisons among many projects. Our panel will discuss lessons learned from these projects and outline potential future diversity strategies, including the following: The concept of universal or culture-fair tests is unrealistic, naive, and potentially harmful. The concept of culture-broad tests and test paradigms is viable but requires empirical verification in all applications. Even with viable culture-broad tests, multicultural neuropsychology requires specific cultural and linguistic knowledge, skill, and sensitivity. Drawing is a learned skill that is viable for neuropsychological testing only when baseline abilities are well-understood. Verbal fluency is a cognitive task that varies in its nature depending upon characteristics of specific languages and their writing systems as well as the nature of education. One pragmatic possible strategy for better serving speakers of relatively rare languages is to develop ways of doing neuropsychology designed for those who speak popular languages moderately well as their second language.

The number of test translations and adaptations has risen exponentially over the last two decades, and these processes are now becoming a common practice. The International Test Commission (ITC) Guidelines for Translating and Adapting Tests (Second Edition, 2017) offer principles and practices to ensure the quality of translated and adapted tests. However, they are not specific to the cognitive processes examined with clinical neuropsychological measures. The aim of this publication is to provide a specialized set of recommendations for guiding neuropsychological test translation and adaptation procedures. The International Neuropsychological Society's Cultural Neuropsychology Special Interest Group established a working group tasked with extending the ITC guidelines to offer specialized recommendations for translating/adapting neuropsychological tests. The neuropsychological application of the ITC guidelines was formulated by authors representing over ten nations, drawing upon literature concerning neuropsychological test translation, adaptation, and development, as well as their own expertise and consulting colleagues experienced in this field. A summary of neuropsychological-specific commentary regarding the ITC test translation and adaptation guidelines is presented. Additionally, examples of applying these recommendations across a broad range of criteria are provided to aid test developers in attaining valid and reliable outcomes. Establishing specific neuropsychological test translation and adaptation guidelines is critical to ensure that such processes produce reliable and valid psychometric measures. Given the rapid global growth experienced in neuropsychology over the last two decades, the recommendations may assist researchers and practitioners in carrying out such endeavors.