1. Response to Fitzpatrick, JP; Elliott, EJ and Latimer, J et al.

    Response to Fitzpatrick, JP; Elliott, EJ and Latimer, J et al. The Lililwan Project: study protocol for a population-based active case ascertainment study of the prevalence of fetal alcohol spectrum disorders (FASD) in remote Australian Aboriginal communities. Fitzpatrick, JP; Elliot, EJ and Latimer, J et al state that, 'standardised and locally developed clinical assessments whose interpretation is less biased by culture and language have been chosen carefully with cross- cultural considerations in mind and are considered valid for the purpose of the study'. It appears from reading the article that the only locally developed clinical assessment tools were those used to examine the oral language, phonological awareness and literacy skill development of the Aboriginal children participating in this study. While these particular assessment tools do engage with who the children are as learners and communicators, and, hence, can be considered valid, the validity of using the cognitive and visual-motor integration tests and sensory profiles with the Aboriginal children participating in this study is questionable. A significant limitation of utilising the tests presented in Table 2 is that the gathering of assessment data in this way does not follow the ways in which the Aboriginal people participating in this study typically exchange information. The exchange of information among people is culturally determined. It is not only the interpretation of assessment data we need to consider in terms of cultural influence but the gathering of the assessment data also. So-called 'culturally fair, non-verbal' tests are frequently used to assess the cognitive skill development of Australian Aboriginal children within Australia. However, culture continues to influence how children respond to tasks such as those contained within these 'non-verbal' tests also. Kramsch cites the example of how Navajo children have been observed categorising objects using semantic associations which differ from those associations typically used by English speaking children. Kramsch explains that: "When presented with a blue rope, a yellow rope and a blue stick, and asked to choose which object goes best with the blue rope, most monolingual Navajo children chose the yellow rope, thus associating the objects on the basis of their physical form, whereas monolingual English-speaking children almost always chose the blue stick, associating the objects on the basis of their colour, although, of course, both groups of children are perfectly able to distinguish both colours and shapes." It is arguably not possible for non-Indigenous clinicians and researchers to know when an Indigenous child is presented with a 'non- verbal' assessment task, what thought processes, what cultural learning it is with which the child is engaging when performing this task. What we do know for sure is that if the child provides a result which differs from the one required within the test manual, then that child's response will be scored as being wrong. Even if, as in this study, researchers assert that conducting 'culturally fair' or SE standardised tests with Aboriginal children provides valid assessment data, conducting these tests with Aboriginal children ultimately only provides the assessor with a limited view of how that child is developing. Given the additional considerations involved in conducting cross-cultural developmental assessments, it is questionable whether data such as these could be said to provide sufficient information upon which to base the types of diagnoses of developmental impairment required for the accurate identification of foetal alcohol spectrum disorders. A number of alternatives to using standardised tests actually exist . The development of locally relevant assessment tools can and needs to be factored into a project's research design and research costs. Only through working in trustful and respectful ways with Aboriginal peoples which truly value the cultural and linguistic diversity present, instead of trying to 'account for or work around it', will health researchers be able to move forward from the current inadequate position of utilising SE testing or 'culture fair' testing as diagnostic tools with Aboriginal children who speak SE as a second variety.

    Conflict of Interest:

    None declared

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