Linguistic Barriers in U.S. Neuropsychological Assessment: A State-of-the-Art Review.

In the USA, 67.86 million people speak a language other than English at home. Many of these homes speak both English and a non-English language, with varying degrees of English fluency. A sizable 25.70 million people (8% of the U.S. population) report speaking, reading, or writing English "less than well" or "not at all." These individuals are referred to as limited English proficiency (LEP) speakers. Such persons often need speech interpreters in health care and human service settings. When a speech interpreter is utilized to assess a LEP patient, the typical dyadic clinician-patient interaction shifts to a triadic clinician-interpreter-patient interaction. Although triadic interpreter-mediated interactions are commonplace in neuropsychological assessment when LEP patients are being evaluated, few guidelines exist for these interactions. To illustrate the current state of interpreter-mediated neuropsychological assessment in the USA, literature on the following themes have been reviewed: (1) existing language accessibility options; (2) the history of speech interpretation, clinically; (3) key distinctions in the profile of U.S. patients; (4) what linguistics barriers exist, have been addressed, and have arisen from the implementation of language accommodations in clinical practice; and (5) what recommendations have been established for the neuropsychological assessment of LEP patients. By detailing these five areas in the context of local, state, and national-level variability, this review identifies some of the systemic roots of linguistic barriers in the USA. Updated recommendation guidelines are outlined to promote efficacious and equitable neuropsychological assessment of LEP patients for implementation in clinical practice.