H - 61 Towards a Clinical-Cultural Neuropsychological Science: a Case Study of a Bilingual Spanish-Speaker with Untreated Sleep-Wake Disturbance.

Abstract

Access to neuropsychological services for bilingual individuals remains limited and more research is needed to clarify benefits of testing in both languages. Additionally, certain disorders remain underdiagnosed in the Hispanic/Latinx population. This case study describes the use of a comprehensive culturally and linguistically appropriate neuropsychological evaluation to leverage linguistic, cognitive, and social context to assist with establishing needed care and diagnostic clarity. The patient was a 40-year-old right-handed Spanish-bilingual Hispanic male community-referred to rule out attention deficit hyperactivity disorder (ADHD). He learned English at the age of 4. History was remarkable for parasomnias in childhood, sleep disturbance, multiple closed head injuries, cannabis use, and chronic pain. He completed a comprehensive neuropsychological battery with measures in both Spanish and English. Cognitive findings revealed deficits in verbal memory, variable executive functioning, and better performances in English relative to Spanish. Findings from the evaluation supported a diagnosis of mild neurocognitive disorder secondary to untreated sleep-wake disturbance. Recommendations included reasonable occupational accommodations, sleep study, pain management, brief psychotherapy to address sleep hygiene, and re-evaluation in one year. Following the evaluation, the patient received 6-sessions of a highly structured treatment for insomnia and is no longer endorsing clinically significant levels of sleep disturbance. Sleep-wake disorders are underdiagnosed among Hispanic/Latinxs, and these disorders can manifest with similar symptoms to ADHD. Without culturally and linguistically appropriate services, the likelihood of misdiagnosis and issues of access to treatment will persist. Importantly, the present evaluation was able to identify cognitive and linguistic strengths and weaknesses to best direct referral needs.