A - 75 Clarifying the Complex: International Adoptees as Exemplars of Culturally-Informed Neuropsychological Assessment

Abstract Objective School-age international adoptees are underrepresented in the literature despite their unique cultural, linguistic, and academic experiences. The lack of representative norms paired with reduced cultural exposure in the United States requires special consideration from the neuropsychologist. This case report of an internationally adopted child with cerebral palsy illuminates the varying responsiveness of measures to changing levels of acculturation, language acquisition, and educational intervention. Method Patient was adopted at age 10 from China. He experienced lifelong institutionalization and limited formal education; he was illiterate at time of adoption. Brain MRI was consistent with his diagnosis of diplegic cerebral palsy (GMFCS Level I). Beginning approximately one year after adoption, he underwent three neuropsychological evaluations over five years. Testing accommodations to support language, behavior, and executive functioning were provided across evaluations. Results Patient’s initial neuropsychological evaluation demonstrated below age expectation performance across nearly all domains of cognitive functioning. Subsequent evaluations evidenced notable improvements across language, memory, mood, behavior, and adaptive functioning, with many areas revealing age appropriate abilities. Improvements across domains commonly affected by cerebral palsy were more limited, and academics were a longstanding, refractory area of difficulty. Conclusions Traditional administration and interpretation of neuropsychological measures can have difficulty characterizing the cognitive skills of medically involved, international adoptees. Thoughtful measure selection, administration, and interpretation are needed to differentiate underlying ability from performance. Interpreting assessment data can be challenging due to dynamic levels of language acquisition, academic proficiency, and acculturation. Rate of skill acquisition/development across multiple evaluations may be a better indicator of underlying ability than normative comparisons.