Volume 16 Number 3
May 1977

Charles J. Golden, John Roraback, and Bruce Pray Sr.

A NUMBER of recent studies have shown the usefulness of neuropsychological evaluation in the identification and treatment of brain-related learning disorders in children (Golden, 1977; Rourke, 1975). In general, it has been contended that neuropsychological tests are able to identify specific dysfunctions in the brain without being affected by social and cultural factors (Klove, 1974). If this is the case, neuropsychological evaluation offers potentially powerful assessment procedures in the case of the learning impaired American Indian child.

The most widely used battery of neuropsychological tests today is that devised by Ward Halstead (1947) and Ralph Reitan (1966). This battery has been demonstrated to be useful in many countries (Klove, 1974) as well as in school assessment (Golden, 1977; Golden, in press). The present study was run to discover whether Halstead-Reitan tests were insensitive to cultural differences seen in the Indian adolescent.

Subjects. Subjects were 18 American Indian adolescents enrolled at Flandreau Indian School (South Dakota). The adolescents were aged 15 to 18 with a mean age of 16.7. There were 10 men and 8 women in the sample. All were progressing normally in school at the time of the testing.

A second sample of Caucasian adolescents were matched from the files of the senior author. Subjects were matched on age and sex. All of these subjects were showing normal progress in school.

Materials and Procedure. Tests were given to each student in blocks of one to two hours. On the average, it took two to three sessions to finish all the tests with all subjects. The tests have been described thoroughly elsewhere (Golden, 1977; Halstead, 1947; Reitan and Davison, 1974). Consequently, they will be described here only briefly.

Halstead Category Test. This is a test of abstraction ability on which the subject must abstract rules or principles that connect a series of pictures. The test yields a single score reflecting the number of errors made by the subject. The maximum possible errors is 208.

Halstead Tactual Performance Test. This test consists of a modified Seguin-Goddard form board test which must be completed while the subject is blindfolded. Time scores for each subject are derived for the dominant, non-dominant and both hands. The subject is also tested for his ability to remember the shapes he has felt (memory score) and where they were located on the form board (localization score). A total time score is also calculated.

Halstead Speech-Sounds Perception Test. The subject is presented a series of nonsense sounds which he must match with one of four choices of letters which represent the sound. The score for the test is the number of errors on 60 items.

Seashore Rhythm Test. The subject listens to a recording on which is presented pairs of rhythmic patterns. The subject must indicate whether they are the same or different. The score is the number of errors on 30 items.

Halstead Finger Tapping Test. The subject must tap a telegraph key as rapidly as possible in 10 seconds with his extended index finger. The score is an average of five trials, and one score is obtained for each band.

Wechsler Adult Intelligence Scale. Scale scores are reported for each of the 11 Wechsler subtests: Information, Similarities, Comprehension, Digit Span, Arithmetic, Vocabulary, Picture Completion, Digit Symbol, Block Design, Picture Arrangement, and Object Assembly.

Trail Making Test. This consists of two parts. Part A requires the subject to connect circles labeled with numbers, starting with 1 and increasing to 25. Part B requires the subject to connect circles labeled with letters and numbers, alternating between them (e.g., 1 to A to 2 to B and so on). The score for each section is the total time to complete the items.

Perceptual Exam. This test includes procedures for indicating the intactness of the visual, auditory and tactile channels. Each subject with intact channels is tested for suppressions when stimulated on both the right and left sides (e.g., touching the right and left hand). If the subject fails to perceive the stimulation on one of the sides, this is scored as a suppression on that side. Scores are derived for the number of suppressions for the right and left hands, visual fields, and ears. If a channel is not intact (e.g, the patient is blind) a score of zero is automatically assigned.

Numbers are then written on the subject’s finger tips and the subject is asked to identify the number. Errors were recorded for both the right and left hands (fingertip number writing). A Finger Agnosia score is determined for each hand by touching a finger and asking the subject to determine by the touch which finger was involved. On both of these tests there are 20 trials on each hand, four to each finger. Subjects have their hands placed inside A stage open to the examiner so they may not use visual cues but are dependent on purely tactile cues.

A summary score (Perceptual Disorders--Total) as described by Russell, Neuringer and Goldstein (1970) was also determined for the overall perceptual function.

Aphasia Screening Exam. This includes a survey of the major forms of aphasia including problems with naming, spelling, calculating, reading, writing, and talking. Each item is weighted according to a system proposed by Russell, Neuringer, and Goldstein (1970).

Spatial Relations Score. The patient draws two crosses each of which is rated on a scale from 1 to 5 using criteria derived by Russell, Neuringer, and Goldstein (1970).

The means and standard deviations for each group are described in Table 1. In no case was the difference between the two groups significant at the .05 level, indicating that the performance of the groups was essentially equivalent. An examination of the means and standard deviations also confirms this basic equivalency.

On all tests, the mean performance was well above cutoff points indicating brain dysfunction. In addition, the mean scores were comparable to those reported by Halstead (1947), and Reitan (1955).

The test results clearly demonstrate that the neuropsychological tests developed by Halstead and Reitan are not influenced by cultural demands with an American Indian population. The data clearly indicates that these neuropsychological tests may be used in the educational evaluation of Indian adolescents.

The basic process of using neuropsycbological tests in rehabilitation and educational planning has been described elsewhere (Golden, 1976, 1977, in press; Gudeman, Golden and Craine, 1977; Luria, 1963). The process consists of first identifying the areas of the brain that have been involved in the learning disorders. This allows the diagnostician to precisely define the brain-based abilities that have been impaired. The educator can then use this information to develop a program based on using the strengths of the child to overcome the specific deficits.

Although neuropsychological tests have been been used heavily with Indian children, the current study shows that such tests are potentially very valuable. Diagnosis based on these tests can pinpoint the deficit skills in the brain-impaired child without the cultural bias shown by a number of psychological tests. This in turn will allow remediation efforts to be directed more closely to the specific deficits the child possesses.

Table 1

Means and Standard Deviations on Halstead-Reitan

Variables for American Indians and Caucasians