Cross‐linguistic meta‐analysis of phonological fluency: Normal performance across cultures

Abstract

The Verbal Fluency test is used extensively in clinical neuropsychological assessment as well as in research protocols. The phonological fluency task can be administered to individuals of various ages and different levels of education. Diverse investigations suggest that phonological fluency can be influenced by age and education. Up to now, cross‐cultural studies comparing phonological verbal fluency in different languages are scarce, and those studies that exist do not report subjects' execution comparing the level of education and age ranges. The purpose of the present study was to analyse the influence of education, culture, and primary language on the performance of phonological verbal fluency in neurologically intact subjects from different countries. The performance of phonological fluency in high‐ and lower‐frequency letters of a sample of 926 healthy subjects living in five different countries and speaking diverse languages (Danish, English, Spanish, Hebrew), with a higher level of education (more than 10 years), was analysed. Results of the meta‐analysis suggest that level of education influenced the number of words generated, and higher‐frequency letters produced a higher number of words in all languages. As long as years of education and letter frequency within each language were considered, the number of words generated was remarkably similar across languages and across countries. However, level of education and letter frequency within each language are relevant variables, therefore norms for one type and/or set of letters may be inappropriate for another group. In summary, regardless of the primary language and the ethnic background of the examinee, phonological verbal fluency could be a useful diagnostic tool if the level of education of the subjects being evaluated is considered. More extensive investigations that analyse the influence of culture on neuropsychological tests will clarify its effects on cognitive processes.