A – 84 When Educational Attainment Is Not Enough: Assessing Literacy Skills in Adult Immigrant Patients

Abstract Objective To examine the relationship between educational attainment and foundational literacy skills in a diverse non-English speaking immigrant clinical sample. Method Two hundred seventy-one adult immigrant patients (71% female; M age = 63.6, SD = 14.4; M education = 5.6, SD = 4.4) completed a literacy screen in their dominant language (44% Portuguese, 23% Haitian Creole, 22% Spanish, and 10% Other). Foundational literacy skills of alphabet recitation and writing, letter recognition, high-frequency word reading and writing, number recitation, number recognition, and numeric writing were compared across education groups of 0 (16%), 1–4 (35%), 5–8 (27%), and 9+ (23%) years. Results Significant group differences emerged across literacy tasks (Fisher’s Exact Test, p < .001), except for number recitation (p = .672) and number recognition (p = .105). Participants with 0 years of education showed the lowest literacy rates: 5% could recite/write the alphabet, 26% read words correctly, and 14% wrote words correctly. Those with 1–4, 5–8, and 9+ years of education showed significant improvements to 0 years in alphabet recitation (28%, 25%, 41%, respectively), written alphabet (19%, 30%, 40%), reading (84%, 93%, 90%) and writing words (83%, 82%, 89%) though rates remained below ceiling across all these groups. Conclusion Foundational literacy skills (with the exception of numeracy) vary widely across different educational levels and cannot be inferred solely from years of education. Findings support the clinical utility of directly assessing literacy skills in neuropsychological evaluations with immigrant populations to better inform test selection, contextualize performance, and promote culturally responsive assessment practices.