Cognitive Testing Using an Interpreter

(The following was originally published on the blog of ATA’s Interpreters Division,

I recently completed an interpreting assignment between a developmental psychologist and a child with autism during which the child was given a cognitive test. I have done many of these sessions over the years and remember being disappointed on several occasions that the session didn’t go as smoothly as I would have liked. I always wished I could have done more to help create a better experience for both the child and the provider—more like a monolingual test.

There are several challenges that are introduced in the evaluation room by having a second language in the mix. Interpreters are trained to use the first person when speaking for the provider and for the child. So, imagine a female provider showing the child three toy cars of different sizes and saying, “Hand me the little one.” In the child’s language, should the interpreter say, “Hand me the little one,” or “Hand her the little one”? Either way, it would be confusing for the child.

If the child is verbal and is learning English as a second language, the mere act of interpreting during the session can sometimes be misunderstood by the child as a correction. They get confused about which language they are supposed to use and feel discouraged from the start.

It’s also difficult for the interpreter to know how much encouragement, clarification of instructions, redirection of focus, and deal-making to offer. In a monolingual setting, the provider can immediately react to the child’s cues with the appropriate response. Typically, the interpreter is not trained or authorized to make those choices.

Planning Ahead

In this recent session, I knew about the test far enough in advance and asked permission to reach out to the provider so we could arrive at some strategies I would now like to share. We spoke by phone, exchanged email, and then met briefly before the family arrived on the day of testing. I didn’t bill for the one hour of preparation time. I was paid a two-hour minimum fee and felt that my total work time was compensated.

The provider, whom I’ll call Nicole, had studied Italian, the primary language of the child. That was clearly a huge asset. I’m not sure whether or not our strategies would have worked had the provider lacked this basic knowledge of the child’s language. Nicole acknowledged that she couldn’t conduct the evaluation in Italian, but she felt confident she could understand the child’s short utterances and would understand my interactions with the child in Italian. That eliminated the need for me to interpret from Italian into English and the resulting dynamic where the child might feel scolded or corrected by hearing the rendition.

Nicole reviewed the various tasks of the test in advance and showed me how most of the commands could be done without using any pronouns representing the provider or the interpreter. (For example: “Which one of these pictures goes here?” “Put the picture here.” “Watch. Make one like this. Now you do it.” “Count the blocks. How many blocks are in the pile?” “Touch the shape that goes in this pattern.” “Touch the letter L.”)

There was one task involving hand movements that was different in this regard, so we decided I would model the three hand movements (like in the game Rock Paper Scissors) and the provider would observe and take notes of the child’s response. The commands were, “Watch my hand and do what I do. Ready? Now you try.” I was to follow the illustrations in a testing book. The sequence of hand movements got progressively longer. Nicole told me that if the child made three mistakes in a row, we would stop and move on to the next task. This was also the guideline with all the tasks in the test.

Before the session, Nicole showed me how the testing books prop up with their own binder on a flat surface. They’re printed like a flip chart so that the child sees an illustration on one side and the provider sees instructions on the back side. The exact words that the provider is to say are printed in a bright red font. For many of the tasks, I was able to simply do a quick sight translation of those red words into Italian without needing Nicole to say them first in English.

Finding the Right Balance

Nicole’s familiarity with Italian afforded her a level of comfort, so she gave me her blessing to offer the child verbal encouragement (e.g., “Come on, you can do it!”), clarifications on the instructions (e.g., “Do it here on the table.”), re-directions (e.g., “Can you please put all four legs of the chair on the floor?”), and deal-making (e.g., “When you finish this task, you’ll get a snack.”). The obvious warning was that I was not to give the child any hints of the correct response during testing. There are one or two designated teaching examples for each task when the child is coached a little toward the correct answer, but no coaching is allowed after those are done.

Since this child, like many children, had a short attention span, it was helpful that there were two of us. I was able to put away the props from one task while Nicole got out the next set of props. Thus we avoided creating dead time and maintained the child’s collaboration. This extra help, of course, is optional.

I feel strongly that if interpreters and psychologists can plan together in this way, the evaluation can go much more smoothly and quickly and lead to more accurate results.

Linda Pollack-Johnson, CT is a freelance translator and interpreter. An ATA-certified Italian>English translator, she has spent several sabbaticals in northern Italy recharging her Italian batteries. During one six-month stay in Genoa, she conducted research that culminated in an article entitled “Screening for Dementia Across Language Differences,” which she co-wrote with Dr. Eric Hardt for Caduceus, the newsletter of ATA’s Medical Division. Her interest in the impact of language on testing has led her to volunteer as a subject matter expert for the Certification Commission for Healthcare Interpreters, researching new ways to conduct medical interpreting certification exams for candidates whose language pair includes English. Contact:

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