reflects lhe individual's experience 01'life in lhe absence 01' formal training in school ... in color and line drawings 01'lhe same objects were made. Subjects ...
--"
(
~
Neuropsychology, Section A:
Development.
and Cognition
Journal of Clinical and Experimental Neuropsychology EDlTORS:
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Journal of Clinical and Experimental Neuropsychology 1994, Vol. 16, No, 6, pp, 939-942
Neuropsychology
/
BRIEF REPORT
Influence of Educational LeveI of Non Brain-Damaged Subjects on Visual Naming Capacities * A]exandra Reis, Manuela Guerreiro, and Alexandre Castro-Caldas Language Research Laboratory, Centro de Estudos Egas Moniz, Hospital de Santa Maria, Lisboa, Portugal
ABSTRACT Educationallevel of subjects is a variable often neglected in neuropsychological studies, However, there are pieces of evidence to suggest that illiterate subjects mar perform worse than literate subjects in some tests. Visual naming is une of lhe tasks where a poor performance was reported in illiterate populations. The present study addresses this problem of comparing lhe performance in visual naming tasks of nonbrain-damaged patients of different educationallevels. The test materiais were composed of three subtesls: naming real objects, their photographs, and tine drawings of lhe same objects. Results revealed that there is a clear influence of educationallevel on lhe ability to name photographs and liDe drawings of lhe objects, Naming tine drawings is particularly difficult for lhe lower educated non-brain-damaged subjects. Visual analysis of IWOdimensional representations is a task that requires speciallearning. These results have 10 be taken into consideration in test selection for poorly educated populations,
Tests of visual naming are currently used in batteries for lhe assessment of aphasia. Line drawings of objects are used in most of them, namely: Boston Diagnostic Aphasia ExaminatiDo (Goodglass & Kaplan, 1972), Minnesota Test for Differential Diagnosis of Aphasia (Schuell, 1965), Porch Index ofCommunicative Ability (Porch, 1967), Western Aphasia Battery (Kertez, 1982). As pointed out by Borod, Goodglass, and Kaplan (1980) and also by Kremin et aI. (1991), lhe performance on visual naming tasks of non-brain-damaged subjects is influenced by lhe levei of education, Lecours and colleagues (l987a, 1987b, 1988) reported lower scores on visual naming of liDe drawings by illiterate subjects in comparison with literate
subjects. This was found in control subjects and in patients with either left or right hemispheric lesions. The authors concluded that "when testing brain-damaged patients of different cultural backgrounds ORe runs lhe risk of over or underestimating lhe frequency of aphasia if une does not refer to norms which explicitly take educational levei into account" (Lecours et aI. 1987a, p. 231). Rosselli and Ardila (1990) also reported significant differences in several currently used neuropsychological tests when comparing performances of extreme groups of educationallevel. Our experience on lhe study of illiterate subjects is Ihat Ihere is a greal interindividual variability of performance in tasks requiring lhe
Abslracls,
CurrenlConlenls/Clinical Practice, Excerpla Medica, Index Medicus, Medline, NeuroscienceCitation Index, American Psycho. logical Assoeialion Abslracts: PsycLlT and PsyclNFO, Science Citation Index, Soeial Sciences Citation Index, Soeiological AbstracIs.
* Presented in pari at lhe 15th European Conference
of lhe INS, Funchal, Portugal, 1993, Supported
Junta Nacional de Investigação Científica e Tecnológica (lNICT). Author's address for reprints:
in pari by A, Castro-
Caldas, Language Research Laboratory, Centro de Estudos Egas Moniz, Hospital de Santa Maria, ] 600 Lisboa, Portugal. Accepted for publication March 28, 1994,
-- -----
.... "
940
ALEXANDRA
~--
interpretation 01' drawings. This variability reflects lhe individual's experience 01'life in lhe absence 01' formal training in school (CastroCaldas, Ferro, Guerreiro. Mariano, & Farrajota, in press). In order to choose lhe correct test material to assess illiterate subjects we decided to compare lhe performance 01' illiterate and literate subjects in different tasks 01'visual naming.
METHOD Subjects Sixty-six neurologically healthy subjects were tested. Ali subjects were screened for dementia through a short test battery developed in our laboratory. Subjects with history 01' brain injury, psychiatric illness, or suggestion 01' dementia were not included in lhe study. Twenty-two subjects were illiterate (2 males and 20 females who. for social reasons, had never attended school or had eontact in their lives with written material); Twenty-two subjects were semi-literate (6 males and 16 females who had attended sehool for
(
REIS ET AL.
INFLUENCE
were literate (8 males and 14 females with more than 4 years 01' school attendance and regular habits 01' reading and writing). The mean age 01' lhe subjects were respecti vely 70.8 (SO = 6.4). 71.2 (SO = 6.2) and 67.6 (SLJ = 5.8) (Anova F = 2.29; p = os). Ali subjects lived in lhe same social community in lhe south Df Portugal.
I In Portuguese these words are different and have speeific meaning. knife =faca; penknife =canivete.
Table I: Comparison 01'Performance in Naming Drawings. Group I O -I Errors
Group 2 2 - 5 Errors
Group 3 > 6 Errors
Illiterate
2
12
8
Semi-literate
9
10
3
Literate
17
5
O
= 23.87;
P < .0001
(IlIiterate
Illiterate vs. Semi-literate Semi-literate vs. Literate
vs. Semi-Literate
vs. Literate)
~2= 6.91; P = .0316 X = 7.13; P = .00283
IlIiterate vs. Literate X2= 22.72; P < .0001
Table 2 - Comparison 01'performance in naming photographs.
~
_n__n
Error Type B
C
Correct Answers
24
31
44
341
9
20
31
380
18
4
417
DRA WINGS
A
Illiterate
Literate
Error Type PHOTOGRAPHS
Illiterate
Group 3
> 6 Errors
A
B
C
Correet Answers
9
16
23
392
6
1I
412
7
2
431
Semi-Literate
o
Literate
X2 = 67.56; P < .0001 PholOgraphs X2 = 40.83; P < .0001 Drawings
RESULTS
cantly lower than those obtained in naming photographs (illiterate, t = 3.7, p = .0008; semi-
Ali 20 real objects were correctly named by ali subjects. Errors became apparent on naming photographs and ]ine drawings. The comparison among groups was dane on lhe basis 01'lhe distributions 01' subjects' individual scores. Subjects were divided into three groups, according to lhe number 01'errors produced. Group I was composed 01' subjects who produced one or no errors. Group 2 was composed 01' subjects who produced more than one and less than 6 errors. Group 3 included subjects who produced 6 or more errors. The resulls on naming drawings showed a significant difference related to educational leveI (X2 = 23.87; p < .000]). Illiterate subjects produced more errors than did lhe semi-literate
literate,
(X2 more
Group 2 2 - 5 Errors
Group 1 O -I Errors
p
= 6.91;
p
errors
= .003).
= .032)
than
and lhe latter
did literate
On naming
subjects
01' photographs,
also a significant difference
produced (X2
= 7.13,
there
was
re]ated to educa-
IlIiterate
9
II
2
19
3
tionallevel
(X2
Semi-iterate
O
differences
between illiterate and semi-literate
Literate
21
1
O
subjects
X2 = 20.26; p
= .0004
(1lIiterate vs. Semi-Literate
vs. Literate)
~2= 10.14; P = .0063 Semi-literate vs. Literate X = 1.10;p =0.2943 (ns) Illiterate
vs. Semi-literate
IlIiterate vs. literate X2 = 15.13; P =.0005
941
LEVEL ON VISUAL NAMING CAPACITIES
Table 3. Number and Quality 01'Errors Produced.
Semi-Literate Materiais The test material was composed Df the following sei 01' 20 commonly used objeets: cup, pencil, lamp, watch, book, screw, lighter, cigarette, refi, bottle, eye-glasses, spoon, penknife, scissors, ring, fork, key, glass, mateh box, and candle. These objects were photographed in color and line drawings 01' lhe same objects were made. Subjects were first asked to na me lhe line drawings. then lhe photographs, and finally lhe real objects. The answers were scored as correct or incorrect. Incorrect answers were classified into three possible types: Type A - absence 01' naming ("I don't know"); Type B - acceptable lIames for lhe item but different from lhe one used for lhe real object (kllif'e instead 01'pellkllifi>\); and Type C - lIames reftecting no comprehension 01' lhe item (thermometer instead 01' cigarelte). There was no time limit in stimulus presentation.
less than 4 years, and had learned to read and write but did not do so regularly); Twenty-two subjects
X2
O'LtJUCATIONAL
(X2
literate and 1.1; p = os) For each obtained in
= 20.26;
= 10. ]4;
p p
= .0004).
= .0063),
There whi]e
were semi-
literate subjects did not differ (X2 = (Tables ] and 2). educationallevel, lhe mean scores naming line drawings were signifi-
t
= 3,5,
p
= .0002;
literate,
t
= 2.3,
P
=.03). There was also an influence ofthe educationaI levei on lhe type 01'errors produced naming both line drawings (X2 = 67.56; p < .000 I) and photographs (X2 = 40.83; P < .000 I). Type A and C errors were almost absent in literate subjects (Table 3). ..
DISCUSSION Results showed that for illiterate subjects ]ine drawings and photographs are difficult to name. The same results were obtained with semi-literate subjects. This may explain some resulls found in previous works with normal subjects and aphasics (Lecours et aI., 1987a, 1988). On lhe other hand, line drawings are more difficult to name than photographs for ali three groups 01'subjects. Type 01'errar was different according to lhe educationallevel: Type A and C errors denote lhe inability to recognize lhe stimuli and Type B represent a variation within lhe same semantic field, which implies lhe recognition 01' lhe stimulus. Literate subjects produced only Type
......
"
942
ALEXANDRA
B errors, which means that these subjects do not have any difficulty in recognizing drawings or photographs but they occasionally use words different from those used in naming real objects. Drawings represent a certain degree of abstraction of lhe real objects in which a certain amount of conventional representation is used and has to be learned. For lhe majority of subjects learning to draw needs training, which also occurs at school along with learning to read and write (although some exceptions may naturally be accepted, as for example, naive painters). These results do not allow lhe discussion of a general theory on lhe influence of learning on lhe cognitive strategy for visual naming. However, we can concIude that when testing lhe capacity of naming of poorly educated persons, with or without brain lesions, une should use real objects instead of photographs or their liDe drawing representation.
REFERENCES Borod, J.C, Goodglass, H., & Kaplan, E. (1980). Normative data on lhe Boston diagnostic aphasia examination, parietallobe battery, and lhe Boston Naming Test. Journal of Clinical Neuropsychology, 2, 209-215. Castro-Caldas, A., Ferro, J.M., Guerreiro, M., Mariano, G., & Farrajota, L (in press). Influence of literacy (vs. Illiteracy) on lhe characteristic of acquired aphasia in adults. In R.M. Joshi & CK. Leong (Eds.), Developmelltal and acquired dyslexia: Neuropsychological and Ileurolinguistic perspectives. Goodglass, H., & Kaplan, E. (1972). Boston Diagnostic Aphasia Examination. Philadelphia: Lea & Febiger. Kertez, A. (1982). Westem Aphasia Battery. New York: Grune & Stratton.
REIS ET AL.
(
(
Kremin,H., Deloche, G., Metz-Lutz, M., Hannequin, D., Dordain, M., Perrier, D., Cardebat, D., Ferrand, 1., Larroque, C, Naud, E., Pichard, B., & Bunel, G. (] 991). Short Repor!: The effects of age, educational background and sex on confrontation naming in normais; Principies for testing naming ability. Aphasiology, 5, 579-582. Lecours, A., Mehler, J., Parente, M.A., Caldeira, A., Cary, L, Castro, M.J., Dehaut, F., Delgado, R., Gurd, J., Karmann, D.F., Jakubovitz, R., Osorio, Z., Cabral, LS., & Junqueira, A.M.S. (l987a). Illiteracy and brain damage: ]. Aphasia testing in culturally contrasted populations (control subjects). Neuropsychologia, 25, 231-245. Lecours, A., Mehler, J., Parente, M.A. , Aguiar, LR., Silva, A.B., Caetano, M., Camarroti, H., Castro, M.J., Dehaut, F., Dumais, C, Gauthier, L, Gurd, J., Leitão, O., Maciel, J., Machado, S., Melaragno, R., Oliveira, LM., Paciornik, J., Sanvito, W., Silva, E.S., Silifrandi, M., & Torne, CH. (J987b). Illiteracy and brain damage: 2. Manifestations of unilateral neglect in testing "auditory comprehension" with iconographic material. Bmin and Cognitioll, 6, 243-265. Lecours, A., Mehler, J., Parente M.A., Beltrami, M.C, Tolipan, LC, Cary, L, Castro, M.J., Carrono, V., Chagastelles, L, Dehaut, F., Delgado, R., Evangelista, A., Fajgenbaum, S., Fontoura, C, Karmann, D.F., Gurd, J., Torne, CH., Jakubovicz, R., Kac, R., Lefevre, B., Lima, C, Maciel, J., Mansur, L, Martinez, R., Nobrega, M.C, Osorio, Z., Paciornik, J., Papaterra, F., Penedo, M.A.J., Saboya, B., Scheuer, C, Silva, A.B., Spinardi, M., & Teixeira, M. (1988). Illiteracy and brain damage: 3. A contribution to lhe study of speech and language disorders in illiterates with uni'lateral brain damage (initial testing). Neuropsychologia, 26, 575-589. Porch, B. E. (1967). Porch lndex of Communicative Ability - Theory and Development. Paio Alto: Consulting Psychologist Press. Schuell, H. (J965). Minnesota Test jár Differential Diagllosis of Aphasia. Minnesota: University of Minnesota Press. Rosselli, M., & Ardila, A. (1990). Neuropsychological assessment in illiterates: Language and praxic abilities. Bmin and Cognition, 12, 281-296.
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