Abstract
In this study, we sought to explore if linguistic factors impact the diagnosis of mild traumatic brain injury (mTBI). More specifically, we examined if the meaning of acute injury characteristics that determine whether an mTBI was sustained systematically differed across linguistically diverse populations. A total of 296 participants (68% female; 33% of South Asian descent; 42% second generation Canadian) were administered an mTBI Criterion Questionnaire where they were asked to define the diagnostic terms “dazed,” “disoriented,” and “confused.” These words were analyzed and placed into an appropriate validated word category scale (i.e., self-reference, social, positive emotion, negative emotion, and cognitive) using the Linguistic Inquiry and Word Count software program. There were no significant differences between native-English and limited English proficiency (i.e., non-native-English) speaker groups for the diagnostic terms “dazed” and “confused.” However, there were significant differences between these language groups for the diagnostic term “disoriented.” Our findings suggest that individuals that have limited English proficiency may be subject to additional distortions in symptom reporting. Clinicians should be particularly mindful of linguistic differences in patient interpretation of acute injury characteristics in the context of establishing a diagnosis of mTBI.
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References
American Congress of Rehabilitation Medicine. (1993). Definition of mild traumatic brain injury. Journal of Head Trauma Rehabilitation, 8(3), 86–87.
American Psychological Association. (2016). Revision of ethical standard 3.04 of the “Ethical principles of psychologists and code of conduct” (2002, as amended 2010). American Psychologist, 71, 900.
Bianchini, K. J., Curtis, K. L., & Greve, K. W. (2006). Compensation and malingering in traumatic brain injury: A dose-response relationship? Clinical Neuropsychologist, 20(4), 831–847.
Binder, M., & Rohling, L. (1996). Money matters: A meta-analytic review of the effects of financial incentives on recovery after closed-head injury. American Journal of Psychiatry, 153, 7–10.
Bryant, R. A. (2008). Disentangling mild traumatic brain injury and stress reactions. The New England Journal of Medicine, 358(5), 525–527.
Cohen, J. (1988). Statistical power analysis for the behavioral sciences (2nd ed.). Erlbaum.
Curtis, K. L., Thompson, L. K., Greve, K. W., & Bianchini, K. J. (2007). Verbal fluency indicators of malingering in traumatic brain injury: Classification accuracy in known groups. Clinical Neuropsychologist, 22(5), 930–945.
Giosan, C., Glovsky, V., & Haslam, N. (2001). The lay concept of ‘Mental Disorder’: A cross-cultural study. Transcultural Psychiatry, 38(3), 317–332.
Harvey, A. G., & Bryant, R. A. (2000). Two-year prospective evaluation of the relationship between acute stress disorder and posttraumatic stress disorder following mild traumatic brain injury. The American Journal of Psychiatry, 157(4), 626–628.
Harvey, A. G., & Bryant, R. A. (2002). Acute stress disorder: A synthesis and critique. Psychological Bulletin, 128(6), 886–902.
Harzing, A. W. (2006). Response styles in cross-national survey research: A 26-country study. International Journal of Cross Cultural Management, 6(2), 243–266.
Heilbronner, R. L., Sweet, J. J., Morgan, J. E., Larrabee, G. J., Millis, S. R., & Participants, C. (2009). American Academy of Clinical Neuropsychology Consensus Conference Statement on the neuropsychological assessment of effort, response bias, and malingering. The Clinical Neuropsychologist, 23(7), 1093–1129.
Howe, L. L. S. (2009). Giving context to post-deployment post concussive like symptoms: Blast related potential mild traumatic brain injury and comorbidities. The Clinical Neuropsychologist, 23, 1315–1337.
International Organization for Migration. (2020). World migration report. International Organization for Migration: Geneva, Switzerland.
Langlois, J. A., Kegler, S. R., Butler, J. A., Gotsch, K. E., Johnson, R. L., Reichard, A. A., ... & Thurman, D. J. (2003). Morbidity and mortality weekly report. Morbidity and Mortality Weekly Report: Surveillance Summaries, 52(4), 1–20.
Marion, D. (2012). Current Diagnostic and Therapeutic Challenges. In J.W. Tsao (ed.), Traumatic brain injury: A clinician’s guide to diagnosis, management, and rehabilitation, Springer Science and Business Media, Switzerland.
Nijdam-Jones, A., & Rosenfeld, B. (2017). Cross-cultural feigning assessment: A systematic review of feigning instruments used with linguistically, ethnically, and culturally diverse samples. Psychological Assessment, 29(11), 1321–1336.
Nolin, P., Villemure, R., & Heroux, L. (2006). Determining long-term symptoms following mild traumatic brain injury: Method of interview affects self-report. Brain Injury, 20(11), 1147–1154.
Pennebaker, J.W., Booth, R.J., Boyd, R.L., & Francis, M.E. (2015). Linguistic inquiry and word count: LIWC2015. Austin, TX: Pennebaker Conglomerates. (www.LIWC.net)
Ponsford, J., Downing, M., & Pechlivanidis, H. (2018). The impact of cultural background on outcome following traumatic brain injury. Neuropsychological Rehabilitation, 30(1), 85–100.
Rantanen, E., Alm, C. O., Worrell, T., Valentage, N., & Iuliucci, N. (2014). Linguistic analysis of clinical communications: A novel method for study of diagnostic errors. Proceedings of the International Symposium on Human Factors and Ergonomics in Health Care, 3(1), 207–213.
Rogers, R. (2008). Clinical assessment of malingering and deception (3rd ed.). Guilford.
Ruff, R. M., Iverson, G. L., Barth, J. T., Bush, S. S., & Broshek, D. K. (2009). Recommendations for diagnosing a mild traumatic brain injury: A national academy of neuropsychology education paper. Archives of Clinical Neuropsychology, 24(1), 3–10.
Ruff, R. M., & Jamora, C. W. (2008). Forensic neuropsychology and mild traumatic brain injury. Psychological Injury and Law, 1(2), 122–137.
Saltapidas, H., & Ponsford, J. (2008). The influence of cultural background on experiences and beliefs about traumatic brain injury and their association with outcome. Brain Impairment, 9(1), 1–13.
Simpson, G., Mohr, R., & Redman, A. (2000). Cultural variations in the understanding of traumatic brain injury and brain injury rehabilitation. Brain Injury, 14(2), 125–140.
Sbordone, R. J., & Ruff, R. M. (2010). Re-examination of the controversial coexistence of traumatic brain injury and posttraumatic stress disorder: Misdiagnosis and self-report measures. Psychological Injury and Law, 3(1), 63–76.
Suhr, J. A., & Gunstad, J. (2005). Futher exploration o the effect of “diagnostic threat” on cognitive performance in individuals with mild head injury. Journal of the International Neuropsychological Society, 11(1), 23–29.
Sussman, E. S., Pendharkar, A. V., Ho, A. L., Ghajar, J. (2018). Mild traumatic brain injury and concussion: Terminiology and classification. In B. Hainline & R. A. Stern (Eds.), Handbook of Clinical Neurology, Elsevier.
Weiss, R. A., & Rosenfeld, B. (2012). Navigating cross-cultural issues in forensic assessment: Recommendations for practice. Professional Psychology: Research and Practice, 43(3), 234–240.
Wilkinson, G. S., & Robertson, G. J. (2006). Wide range achievement test–Fourth edition. Lutz, FL: Psychological Assessment Resources.
Young, G. (2020). Thirty complexities and controversies in mild traumatic brain injury and persistent post-concussion syndrome: A roadmap for research and practice. Psychological Injury and Law, 427–451.
Zakzanis, K. K. (2001). Statistics to tell the truth, the whole truth, and nothing but the truth: Formulae, illustrative numerical examples, and heuristic interpretation of effect size analyses for neuropsychological researchers. Archives of Clinical Neuropsychology, 16(7), 653–667.
Zakzanis, K. K., & Yeung, E. (2011). Base rates of post-concussive symptoms in a nonconcussed multicultural sample. Archives of Clinical Neuropsychology, 26(5), 461–465.
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Dhillon, S., Sekely, A., Gujral, P. et al. Linguistic Interpretation of Acute Injury Characteristics That Define Mild Traumatic Brain Injury: an Exploratory Study of Native and Non-native English Speakers. Psychol. Inj. and Law 14, 153–160 (2021). https://doi.org/10.1007/s12207-021-09416-y
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DOI: https://doi.org/10.1007/s12207-021-09416-y