Psychological Assessment 2003, Vol. 15, No.

3, 243247

Copyright 2003 by the American Psychological Association, Inc. 1040-3590/03/$12.00 DOI: 10.1037/1040-3590.15.3.243

Psychological Assessment in Asia: Introduction to the Special Section

Fanny M. Cheung
The Chinese University of Hong Kong

Frederick T. L. Leong
Ohio State University

Yossef S. Ben-Porath
Kent State University

Psychological assessment with Asians is an important topic not only for psychologists from Asian countries but also for psychologists in multicultural societies with large populations of ethnic Asians. There is a dearth of information in the English language literature on psychological assessment for Asians. This special section is organized to review various forms of psychological assessment in Asia. The objectives of the special section are to inform test users and researchers of the issues related to cross-cultural validity of psychological assessment in Asia and to introduce examples of adapted and indigenously developed instruments that are culturally appropriate.

Psychological assessment constitutes a major function of psychologists in clinical and counseling settings in Asia (D. W. Chan & Lee, 1995; Cheung, 1996, in press; Dai, Zheng, Ryan, & Paolo, 1993; Higgins & Sun, 2002; Matsubara, 1984; Ogawa & Piotrowski, 1992; Tsoi & Sundberg, 1989; Zhang, 1988). Clinicians use psychological tests for diagnostic and treatment decisions; objective tests are the most commonly used assessment methods. Especially in countries where clinical psychology is a relatively young profession, the use of scientific tools enhances the status of the profession and distinguishes it from other allied professions (Cheung, 1996, in press). Major Western instruments such as the Wechsler intelligence scales for adults and children (Wechsler, 1955, 1974) and the Minnesota Multiphasic Personality Inventory (MMPI; Hathaway & McKinley, 1967) have been translated and adapted for use in many areas of Asia, including mainland China, Hong Kong, India, Japan, Korea, Taiwan, Thailand, and Vietnam. Yet, few psychologists outside Asia are aware of these developments. Fewer still are aware of the development of indigenous measures. The influx of Asian immigrants into the United States and other Western countries in recent decades has raised the need for clinicians to become familiar with tests that are prevalently in use in Asia and their cross-cultural validity. According to Kim, Atkinson, and Yang (1999), Asian Americans born overseas constituted over 50% of the Asian American population in the United States. The 7.2 million Asians born overseas also made up 25.5% of the

Fanny M. Cheung, Department of Psychology, The Chinese University of Hong Kong, Shatin, Hong Kong; Frederick T. L. Leong, Department of Psychology, Ohio State University; Yossef S. Ben-Porath, Department of Psychology, Kent State University. Frederick T. L. Leong is now at the Department of Psychology, University of Tennessee. Correspondence concerning this article should be addressed to Fanny M. Cheung, Department of Psychology, The Chinese University of Hong Kong, Shatin, Hong Kong. E-mail: fmcheung@cuhk.edu.hk 243

foreign-born population in 2000 (U.S. Bureau of the Census, 2001). The most common countries of origin are China, the Philippines, India, Vietnam, and Korea. In psychological assessment, these immigrants differ from Asian Americans who are able to use the original English language tests. The fundamental issues of cultural validity of assessment that confront researchers and practitioners working with Asian Americans in general are exacerbated among recent immigrants with limited levels of language proficiency and acculturation (Kim et al., 1999; Kuraski, Okazaki, & Sue, 2002). Personal accounts from practitioners who have assessed Asian immigrants have shown that the language and cultural difficulties of their clients may mislead the evaluating mental health professionals to give ominous diagnoses with detrimental outcomes. A few American practitioners have occasionally requested their Asian colleagues to provide native language versions of psychological tests for assessing their non-English-speaking clients. However, there are few native language versions that can serve the purpose and few practitioners who are familiar with these limited resources. Even when Asian American clients are familiar with English, they vary in their degree of acculturation to American values and behaviors (Kim et al., 1999). There is a need for culturally relevant and sensitive assessment of ethnic Asian minority clients in a multicultural U.S. society (Atkinson, Morten, & Sue, 1998; Kuraski et al., 2002). Pedersen (1991) proposed multiculturalism as a major force in counseling. These observations challenge the ethnocentric assumptions that the theories, research, and practice of psychology originating in the West are universal (Cheung, 2000). In the assessment of Asian populations, it is inadequate just to find a translated version of the popular instruments. Although many Western tests have been translated, the quality of the translation and adaptation varies. For example, Fowler (2002) noted during his visit to India that many of the assessment instruments have been directly translated and adapted from the U.S. and Europe, and there is some doubt as to their adequacy, since most

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of them do not seem to have been standardized for the Indian population (p. 6). Within India, where psychological assessment has increased, Misra, Sahoo, and Puhan (1997) identified major forms of cultural bias in testing and discussed the need for culturally appropriate tests. In some countries, several translation versions of the same test may be developed without coordination. For example, Clark (1985; see also Butcher, Cheung, & Lim, 2003) reported at least 15 translations of the original MMPI in Japan in the 1980s. Cheung (in press) also found many early translation practices in Asia to be lacking in quality, and those translated versions were interpreted under the assumption that they were equivalent to the original versions. Even with idiographic assessment, which is less sensitive to norm-based sources of error than nomothetic assessment, the issues of ecological validity, crosscultural validity, and generalizability of inferences still remain (Haynes & OBrien, 2000). Without cross-cultural comparisons, local standardization, and validation studies, it is presumptuous to interpret test results according to the original tests. The dangers of these practices are obvious but often ignored. Cross-cultural psychologists have recommended guidelines on the cross-cultural study of personality and assessment (Atkinson et al., 1998; Berry, Poortinga, Segall, & Dasen, 1992; Butcher, 1996; Church & Lonner, 1998; Kurasaki et al., 2002). With greater attention paid to the quality of translations, cultural relevance, psychometric equivalence, and cross-cultural validity of adapted instruments, there has been an improvement in the quality of testing in some Asian countries (Lonner & Berry, 1986; Paunonen & Ashton, 1998). The growth of the profession in these countries has also witnessed an increase in psychological research, including research on the use of psychological assessment. There is a dearth of information in the English language literature on the applications of psychological tests on Asian American minorities in the United States and much less on the different Asian populations. Some information on the cross-cultural applications of individual personality tests may be found in edited books about specific tests, such as the Minnesota Multiphasic Personality Inventory2 (MMPI2; Butcher, 1996). However, full coverage of the range of psychological assessment in different Asian countries is rarely reported in journals to which American readers have more easy access. Although there is increasing re-

search in Asian countries on psychological assessment, those studies are mostly reported in the native language of the country: Professional communication is often restricted to the local community. Even for psychologists who want to reach out to the international community, their level of English proficiency and familiarity with the publication process pose major barriers to publications in English language channels. Western journals have little interest in publishing articles that focus on the cross-cultural applications of specific tests alone and are even less interested in indigenous measures from other countries. Only three reviews on psychological assessment in Asia were found in the Western psychological journals: one on India (Barnette, 1955) and two on Japan (Harris & Cronbach, 1947; Tsujioka, 1989). A search was conducted on PsycINFO to identify articles on psychological assessment with Asian and Asian American samples in English language scientific journals. We chose the three most popular English language journals on psychological assessment: Psychological Assessment, Assessment, and Journal of Personality Assessment. We specified Asian or Asian Americans or the name of a list of Asian countries or ethnic groups as the search terms for each journal. A preliminary list of articles was obtained. We divided the time period into three groups: 19711980, 19811990, and 19912000. We also perused the titles and abstracts to delete those items that were not directly relevant to the specific ethnic group, such as the assessment of Korean or Vietnam combat veterans or Native (American) Indians. The actual article was read when the information from the abstract was ambiguous. Table 1 lists the number of articles identified in these three time periods in the three assessment journals. Only those articles in which the specified ethnic group was the focus or was identified as a distinct group were included. Therefore, articles in which an ethnic group was mentioned only as part of the composition of a larger sample were not included. As shown from the search results, there are very few articles on Asian ethnic groups, even though there has been a slight increase in recent years. Research relevant to clinical assessment is even more limited. The following countries or ethnic groups were not found in the search: Bangladesh, Indonesia, Malaysia, Pakistan, and Singapore. The ethnic group most often reported on is Chinese, especially in the past decade. In terms of population, that is the largest ethnic group, with studies reported

Table 1 Number of Citations in Assessment Journals

Assessmenta Country or ethnic group Chinese (mainland China, Hong Kong, Taiwan) Korea/Korean Japan/Japanese Philippines/Filipino India Thai/Burma Vietnam/Laos/Cambodia/ Indo-chinese Asian
a

Journal of Personality Assessment 19711980 1 0 3 0 4 0 0 0

c

Psychological Assessmentb 19811990 2 0 0 0 0 0 0 0 19912000 10 1 0 2c 0 0 1c 3c

19912000 2 0 1c 1c 0 0 0 1
b

19811990 1 1 0 0 2c 1c 1 0

19912000 3 1 3 0 1 0 0 4

First published in 1994.

First published in 1989.

One article contains more than one ethnic group.

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from mainland China, Hong Kong, and Taiwan. The increased number of studies also reflects the opening up of China to Western psychology. Test users and researchers expect to find the most up-to-date information on the application of assessment with clinical populations in Psychological Assessment. With a more global focus on psychology, a specific section that focuses on the cross-cultural validity of psychological assessment in Asian countries would be valuable to researchers and practitioners. It is with this objective that we have invited international scholars who are experts in psychological assessment in Asia to contribute articles to this special section.

The Special Section

This special section covers the major psychological instruments used in clinical assessment in Asian countries, with a focus on East Asia, where test use is more prevalent. The instruments include comprehensive personality inventories, measures of specific disorders, behavioral measures for children and adolescents, and neuropsychological assessment. Each article reviews, when appropriate, the methodological issues in cross-cultural adaptations of assessment instruments, the cross-cultural similarities and differences, and the clinical validity of the various instruments. In addition to adaptations of Western instruments, the trend of developing indigenously derived psychological measures and successful examples of those measures are introduced. With the multicultural background of the authors, the reviews cover some of the literature published in native languages. However, we are aware that there is much more information available within individual countries, such as China, Japan, and India, which we have not accessed. These reviews are not exhaustive, and the coverage of materials is specified in each article. Furthermore, because we used PsycINFO to identify the relevant literature for our reviews, the coverage in each article was therefore restricted mainly to those journals that are abstracted by PsycINFO. One of the clinical assessment measures that has been successfully adapted internationally is the MMPI2. Butcher et al. (2003) examine the cross-cultural generalizability and utility of comprehensive personality inventories, with a more detailed review of the adaptation of the Chinese, Filipino, Korean, Japanese, Thai, Laotian, and Vietnamese versions of the MMPI2. The international adaptations of the MMPI2 provide an example of good practice in test translation and adaptation. Butcher et al. identify the problems in the early history of the translation and adaptation of the MMPI, which mirror some of the general problems of psychological assessment still found in different parts of Asia. They also summarize information about the cross-cultural equivalence and validity of the MMPI2, illustrating the program of research that should be expected of translated and adapted instruments. Despite the usefulness of comprehensive personality inventories, one major barrier in their application is the length of the instruments. This is particularly problematic in Asia, where the literacy rate is generally lower, especially among clinical populations. Assessment using self-report paper-and-pencil tests often has to be conducted over two or three separate sessions. Some clinicians prefer to use shorter measures of specific disorders. Leong, Okazaki, and Tak (2003) review the literature on research with self-report measures of depression and anxiety in Asia. They

limit their review to articles published in English language journals that assess depression or anxiety in East Asian populations adopting widely used instruments. Two trends are noteworthy. First, research on depression and anxiety in East Asia has relied heavily on the use of translated instruments, namely, the Beck Depression Inventory (Beck, Ward, Mendelson, Mock, & Erbaugh, 1961) and the StateTrait Anxiety Inventory (Spielberger, Gorsuch, & Lushene, 1970), respectively. Second, available research suggests that the Asian language versions of these instruments are reliable and valid for uses with Asian populations. On the basis of their review, Leong et al. also provide a critique of the existing literature as well some recommendations for future research. For example, they note that some subpopulations in East Asia (e.g., Hong Kong) have been studied extensively with respect to depression and anxiety but that there are many regions of Asia (inside and outside East Asia) where little research literature is available except what is published in native language journals. Leung and Wong (2003) review the rating scales used for assessing general psychopathology as well as specific emotional and behavior disorders among children and adolescents. They identify 16 imported measures of self-report and others ratings that are in use in different Asian countries. Whereas some measures are designed specifically for children and adolescents, other measures, particularly those on emotional disorders, tend to be extensions of adult versions of self-report scales. Leung and Wong highlight issues of cross-cultural equivalence that should be taken into account when adapting imported Western measures. These considerations demonstrate that accurate translation is not sufficient to ensure cross-cultural equivalence. Although there is a paucity of empirical data on these measures, active research with a few imported measures suggests the usefulness of these instruments in Asia. Leung and Wongs (2003) review of an initial attempt in Singapore to develop a parents rating scale for Asian children illustrates the important theoretical and methodological considerations in designing indigenous measures. The weak psychometric properties of the scale and the failure to include culture-specific dimensions relevant to Asian children raise important issues for indigenous measures. Is there a need to develop indigenous measures if the Asian test users are proficient in English? For countries like India and Singapore, where use of English is more widespread, there is still room to improve the cultural relevance of measures by including culturally sensitive characteristics or dimensions that have not been included in universal measures. Including items that are relevant for the local culture and that are representative of the constructs being measured is an important requirement for the content validity of the measure. This point is illustrated by the practice of adding culture-specific items to the Child Behavior Checklist (Achenbach, 1991), as reported by Leung and Wong, and in the discussion of the need to develop local measures in the following two articles on cognitive and neuropsychological assessment and on indigenous measures of personality inventories. A. S. Chan, Shum, and Cheung (2003) review the psychological literature on cognitive and neuropsychological tests that are in use in Asian countries. Like other assessment approaches, cognitive and neuropsychological assessment in Asia began with direct test translation, test adaptation, and then original test construction. A. S. Chan et al. specify a set of criteria for evaluating the adapted

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and locally developed tools. Given the heavy emphasis on the verbal nature of cognitive assessment, the issue of cross-cultural validity is particularly prominent. Even with accurate translation, identical test items may not be covering the same cognitive function at the same difficulty level. Many Asian languages, such as Chinese, have fundamentally different linguistic systems from Western languages and may involve different cognitive processes, particularly in the assessment of older adults whose lower literacy rate challenges the suitability of translated Western measures on dementia. There is a strong need for developing local measures that are ecologically valid for the purpose of assessment; several such examples are described in A. S. Chan et al.s article. Cheung, Cheung, Wada, and Zhang (2003) also demonstrate the need for indigenous personality assessment measures that are sensitive to Asian culture. Although good adaptation of imported Western measures provides the means to examine cross-cultural comparability of universal personality dimensions, there are indigenous characteristics relevant to local contexts that are missing from such measures. Those indigenous characteristics enrich our understanding of the cultural meaning of personality patterns and increase the prediction of clinical manifestations. Efforts to construct indigenous personality inventories follow the same methodological considerations in test development as in mainstream psychology. To date, there are few indigenous comprehensive personality inventories constructed for Asian populations. Some early instruments were extensions of adapted Western measures developed by local practitioners for applied purposes. Others were developed by cross-cultural psychologists with theoretical interests in indigenous personality constructs. The example of the Chinese Personality Assessment Inventory (CPAI; Cheung et al., 1996, 2001) is used to illustrate the kind of research program that should be undertaken to develop an indigenous instrument that is psychometrically sound and culturally relevant. The test developers adopted population sampling and expert review procedures to derive constructs and items relevant in Chinese culture. They also conducted large-scale studies to select the items and standardize the scales. Research on the cross-cultural relevance of the indigenous personality dimension identified in the CPAI has led to a reflection on mainstream personality theories and the renaming of the CPAI2 as the Cross-Cultural Personality Assessment Inventory2.

These guidelines are not yet widely known among Asian psychologists. The only Asian language version of the ITC guidelines under preparation is in Chinese. There are no comparable guidelines adopted or published by Asian professional organizations. Despite the adoption of the scientist-practitioner model in some of the training programs of clinical psychologists in Asia (Cheung, 1997), the practitioners role is often detached from the scientists role. The level of practitioners academic training and the practical constraints of their clinical work limit their research opportunities, exacerbating similar concern expressed by their American counterparts (Nathan, 2000). In contrast, few Asian researchers in academic positions have direct access to clinical populations. As a result, much of the research on psychological assessment is based on university samples. Norms built on representative community samples as well as clinical validation studies are rare. To promote research in psychological assessment, there is a need not only to strengthen the collaboration between practitioners and scientists but also to integrate the roles of the scientist-practitioner in Asian countries. By the same token, the ethnocentrism of Western psychology poses a barrier to the broadening of scientific knowledge and to responsible practice of the profession as psychology expands its international horizon. Issues of cross-cultural validity of psychological assessment inform mainstream psychology of the blind spots that have been neglected. Indigenously derived constructs provide alternative frameworks to understand the phenomenology of psychological experiences in different cultures. Learning from these experiences will strengthen the future of psychological assessment.

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Reflections
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Received December 4, 2002 Revision received February 25, 2003 Accepted March 18, 2003