Research Digest – December 2019

Author: Gabriel Qi

For our December ANA Listserv Research Digest, I would like to introduce
neuropsychological research studies in two Asian countries where the majorities of
the populations are Muslims: Saudi Arabia and Pakistan. Inspired by Dr. Judd’s
anecdote of evaluating a Muslim woman with vertigo/dizziness, where praising God
involves kneeling and bowing down one’s head instead of raising it, I was surprised
to find an abundance of Arabic neuropsychological resources.

There are several systematic reviews for various batteries and/or tests in Arabic (e.g.,
Fasfous, Al-Joudi, Puente, & Pérez-García, 2017), and they often involve Arabicspeaking countries in Middle East and North Africa, several of which are
geographically in Asia. In this research digest, I share with you normative data of
verbal and design fluency developed in Saudi Arabia.

Khalil (2010) introduced normative data for Arabic letter fluency, animal fluency and
design fluency (measured by the Five-Point test). As you may be suspecting, the
letter fluency test required the most cultural considerations and adaptations. The
authors initially used the letters taa (T), alef (A), and meem (M), but found them
inappropriate in a pilot study. Increased use of prefixes that modify other words
affected the number of responses generated. Since I do not speak Arabic, I’ll quote
Khalil’s (2010) brief description of some of the morphologic features of Arabic letter,

“In terms of morphology, most Arabic words are derived from a list of roots, to which many affixes can be attached to form surface words. Many of these roots are made up of three consonants that convey semantics (Kadri & Nie, 2006; Xu, Fraser, & Weischede, 2001). In their analysis of the morphological feature of Arabic, Kadri and Nie (2006) described several types of affix that can be attached to the beginning and the end of the words. These include antefixes, prefixes, suffixes, and postfixes (Kadri & Nie, 2006). However, in the present study, the first set of letters (t, a, m) was shown to be problematic as they all have more frequent affixes that can be attached to them, making it rather difficult to apply the scoring system of the original test.”

Therefore, the authors used another set of letters, waaw (W), raa (R), and gaaf (G).
According to Khalil (2010), this set “contained only one letter (w) that can be added
as suffix or prefix. The other two letters are from those that are considered as part of
the root (Al Dakkak, Ghneim, Alshalaby, Sonbol, & Desouki, 2009).” Coincidentally,
the test was given the abbreviated name “WRG,” which is pronounced in Arabic as
“warag,” which means “papers.”

For the second article, let’s shift to Pakistan, in South Asia, and to the adolescent
population. Fatima, Sheikh, and Ardila (2015) examined the association between
parent-child relationships and executive functioning among Pakistani adolescents
living in Lahore, the second-largest city of the country. A total of 370 participants
were given the Delis–Kaplan Executive Function System (D–KEFS): Trail Making Test
(TMT), Design Fluency Test (DFT), Color Word Interference Test (CWIT), and Card
Sorting Test (CST). The authors reported that instructions were translated into Urdu
following a standard translation-back-translation procedure, but I did not find
mentions of adjustment to the English letters in TMT and/or the English color names
in CWIT. The D-KEFS subtests were found to correlate with each other in the
expected directions. The authors also found that overall socioeconomic status (SES)
and parent’s education to be positive predictors of executive functioning (EF). These
findings are consistent with previous studies done in the West. The authors
recognized limitations on the lack of an indigenous measure of EF and emphasized
such needs.

Food for thought this month:

What are some ways that cultures may impact the presentation, measurement and
application of executive functioning? For example, how may problem-solving or
cognitive flexibility look different between cultures that you are familiar with?

Here are the links to access the articles this month:



• Fasfous, A. F., Al-Joudi, H. F., Puente, A. E., & Pérez-García, M. (2017).
Neuropsychological measures in the Arab world: A systematic
review. Neuropsychology Review, 27, 158-173. doi:10.1007/s11065-017-9347-3
• Fatima, S., Sheikh, H., & Ardila, A. (2016). Association of parent–child relationships
and executive functioning in South Asian adolescents. Neuropsychology, Advance
online publication. doi:10.1037/neu0000216
• Khalil, M. S. (2010). Preliminary Arabic normative data of neuropsychological tests:
The verbal and design fluency. Journal of Clinical and Experimental
Neuropsychology, 32, 1028-1035. doi:10.1080/13803391003672305