ABSTRACT
American Indians (AIs) and Alaska Natives (ANs; collectively AI/ANs) experience a disproportionately high incidence of many serious health diseases and mortality and morbidity from disease and injury (Centers for Disease Control and Prevention, 2003; Jaiyeola & Stabler, 2009; Jones, 2006; World Health Organization, 2002). For example, AI/ANs experience high rates of cardiovascular disease, various cancers, unintentional injuries, stroke, hypertension, diabetes mellitus, and infant mortality. Furthermore, AIs experience increased rates of mental health disorders (Gone & Trimble, 2012), with a lifetime prevalence rate of 36% to 50%, with high comorbidity including suicide, alcohol dependence, and post-traumatic stress disorder (Beals et al., 2005). Neuropsychological assessment is often used to assist in the diagnosis and treatment planning of various cognitive-related health and mental health illnesses; however, most neuropsychological assessments have been developed for and normed on the White majority population. Thus, the validity of neuropsychological tests may be in question when used in these disparate groups, leading to inaccurate interpretation of data and ultimately misdiagnosis and inefficient treatment planning. This chapter will first offer an overview of the incredible diversity of AI/AN peoples and then review the literature of neuropsychological assessment in AI/AN populations. We will review the many varied cultural considerations in neuropsychological assessments of AI/ANs that may affect the validity of neuropsychological assessment, including different aspects of education, culture (including language and cultural adaptation), and socialization factors. Finally, we will offer guidelines for clinical practice and directions for research.
