Four fatal flaws of brain injury assessment in the cross-cultural context

This analytical review serves to highlight pitfalls clinicians in multicultural contexts may encounter when using normed ability tests for the assessment of cognitive dysfunction due to brain injury. Four sources of erroneous practice are: (i) Failure to recognize within-race group heterogeneity on cognitive test performance in association with factors such as quality of education; (ii) Lack of rigorous attention being paid to the exact mode of test administration used in a derived normative base to be used for assessment purposes; (iii) Estimating an expected level of performance for an individual on diverse cognitive tests based on an IQ score; (iv) Adopting a thoroughly rule-bound actuarial approach to test interpretation, over a contextually based clinical approach. Even with locally derived norms, the validity of actuarially based interpretive conclusions in the absence of a conceptually coherent case analysis is not supported.