sufficient discriminatory power to be used as a short NP screening test
for ARBD. For patients in the present study, 3 modalities were used to
assess the effect of interference on their ability to rem em ber. The first task involved recall of the follow ing words: " d o g . . . m o o n . . . h o u s e " after exposure to a sim ilar interference set: " b i r d . . . t r e e . . . t r u c k " . The words were spoken in english and accom panied by silhouette images from the K aufm an A ssessm ent Battery for Children, fixed to 100 x 75 mm cards. The fo llo w in g instructions introduced the task: "I'm going to show you some pictures... try to reme mbe r their names so y ou can tell me later o n . . . " . P a tie n ts were given one w ord at a tim e fo llo w ed by the interference set of words which they were also asked to rem em ber. The n u m b e r o f s p o n ta n e o u s w ords r e c a lle d (SR ) w as c o n v e r te d to the screening test word error score (ie. SC W O R D E= 3 - SR). In the same m anner, the second task involved recalling the follow ing short sentence: "a big tree f e l l on the old fe nc e" , after being asked to also rem em ber an interference one: "a brown horse was f o u n d in the creek". To account for variatio n s in gram m atical ex p ressio n of aboriginal dialect, the sentence was divided into 5 major elements (ie. "a big/tree/fell on!the o ld ! fe n ce " ) . The num ber of elements recalled (R), the num ber of errors of om ission (O) and the nu m b er of su b stitu tio n s (S) w ere c o m b in e d to form the screening test sentence error score (ie. SC SEN TE= 5-R+S). The last task req u ired patients to copy and later recall the C5 figure of the Benton Visual Retention Test. The figure was presented in the top quarter of an A4 page. Patients were asked to copy the figure and rem em b er it so they could do it again from m em ory. As soon as they had accurately com p leted this figure (prom pted if necessary), they were asked to copy and re m e m b e r B e n to n ’s D7 figure. O nce th ey h ad c o m p le te d this interference activity they were given a blank A4 sheet of paper to draw the first figure again. Errors in the recalled fig u re were defined by c riteria o utlined in the BV R T m anual (B enton 1974; L ezak 1983) and sum m ed to provide the screening test figure error score (SC FIG E). The sum o f e rro rs from the 3 m em ory screen in g tasks p ro v id ed a total screening error raw score (TSCE).
A c c u l t u r a t i o n S c a l e
U rbanization
Bruner considered the process of acculturation (1956, cited in Kearney & Fitzpatrick 1976) to involve the influence and learning of european ways during childhood. The geographic location of a patient's childhood and its p r o x im ity to e u ro p e a n s e ttle m e n t w as a s s u m e d to d e te r m in e the freq u e n cy and e x ten t of c o n ta ct with w e stern cu ltu re. B efore more re c e n t a d v a n c e s in tra n s p o rt and c o m m u n ic a tio n s , the in flu e n c e of w e s te rn c u ltu r e on p a tie n ts w h o g re w up on r e m o te a b o rig in a l com m unities was thought to be less than for those who grew up near large eu ro p ean urban centres (ie. A lice S p rin g s). T hus, the degree of u rbanization of an aboriginal settlem e n t or its d istan c e from a m ajor urban centre was thought to directly influence the degree of acculturation of its residents. As a measure of acculturation in the present study, the nature and rem o ten e ss of a p a tien t's r e s id e n c e du rin g c h ild h o o d was represented by one of 4 ordinal categories (in parenthesis): Patients who grew up on outstations greater than 200 km fro m Alice Springs were assum ed to be isolated with m inim al access to w estern culture (0); those who had lived greater than 100 km but less than 200 km were described as rural (1); those having lived less than 100 km were assum ed to have had more contact by living nearer town (2); and finally those who grew up in town were co n sid ered to have had the m o st co n ta ct (3). The number of patients in each category were 5, 8, 5 and 3 respectively. The questions "where did you grow up" and "where do you usually live now",
r e s u lte d in the sam e re s p o n s e c a te g o r y fo r a lm o s t e v ery p a tien t, suggesting little variation in their residential status since childhood.
Language Use
All patients in the present study spoke a d ialec t of English and could speak or understand at least one aboriginal language. Of the 21 who were a sk ed to in d ic a te how m any a b o r ig in a l l a n g u a g e s they sp o k e or
understood, 7 were fam iliar with only one aboriginal language, 7 two, 4 three, 1 four and 2 five languages. W hen patients were asked how often they spoke their own territorial language, 76% indicated they had strong c u ltu ra l a ffilia tio n s th ro u g h fre q u e n t tra d itio n a l lan g u a g e ex p re ssio n , despite the influence of the dom inant w estern culture. The frequency of tra d itio n a l a b o rig in a l lan g u a g e use can be a ff e c te d by g eo g rap h ical lo catio n , m ix ed m a rria g e , clan status, in te lle c tu a l ab ility , deg ree of eu ro p e an c o n tact, etc. M any of these facto rs w ere assu m ed to be inversely related to degree of w estern accu ltu ratio n , with less frequent use of an in d iv id u al’s traditional language reflecting greater acculturation. In the p resen t study, this re la tio n sh ip was re p re s e n te d by an ordinal scale of language use (in parenthesis): " n e v e r " (3), "a little" (2), "a lot" (1) and "big m o b s " (0); with 1, 4, 1 and 15 p atien ts in each category, resp ectiv ely . C o n v ersely , the freq u en cy of e n g lish language use was assum ed to be directly related to degree of accu ltu ratio n and was also represented by an ordinal scale (in parenthesis): "never" (0), "a little" (1), "a lot" (2), "big m o b s " (3); with 0, 8, 5 and 8 patients in each category, respectively. At least 62% of the patients in the sam ple reported being fluent in an english language dialect despite 76% of w hom m aintained their traditional language affiliation. Thus, patients were apparently able to identify with their cultural origin w ithout p reclu d in g the adoption of the language and ways of western culture (and hopefully western tactics for solving N P p ro b lem s). The ordinal scores o f each m easure were sum m ed to form a relatively norm al distribution o f language use scores for the factor analysis of acculturation variables.
Western Ways
Bruner (1956, cited in Kearney & Fitzpatrick 1976) defined acculturation as degree of european influence and the learning of european ways. This was op eratio n alised in the p resen t study as two separate variables. The first m e a s u re d the f re q u e n c y by w h ich p a tie n ts had u sed vario u s
w estern artifacts and the second determ ined how long they had experienced western work practices:
1. Western Artifacts The amount of use by aboriginals of western
technological artifacts was measured by asking patients how often they drove a motor vehicle, watched television or video, played video games and used computing equipment (ie. calculator, cash register or computer). Patients were asked to indicate on the Likert scale which category represented their usual exposure or m anipulation of such equipment. These categories were either described as (score in parenthesis): "a little”
(1), "a lot" (2), " big mobs” (3) or alternatively, "few times a year” (1 ),
"once a w eek” (2), "most n ig h ts ” (3). If patients had never used a particular artifact, their response to that item scored zero. Responses to 4 ordinal artifact questions were summed to form the Western Artifact Use score: 0-3 (0), 4-6 (1), 7-9 (2), 10-12 (3); with 7, 8, 5 and 1 patient responding to each category, respectively.
2. Western Employment Work history was recorded in the present
study for most patients. The type of job and number of patients who had experienced such work (in parenthesis) included: storem an or shopkeeper (2), stockman (8), art & craft work (2), fencing (3), truck driver (4), building industry (7), plant operator (2), motor mechanic (2), gardener (2), school aid (3), health worker (1), mining (1), army service (1), fruit picking (1). Some patients had never worked (3) while the others had experienced 1 to 5 different jobs in their lifetime. Apart from high rates of unemployment, job opportunities are often at best seasonal for aboriginals in remote areas (Healy et al 1985). Thus, the duration of exposure to western work practices was considered to be a better indicator of degree of acculturation than the number of jobs actually experienced. Patients were asked how long they had worked for and used the visual Likert scale to indicate durations from "never” (0), "a little " (1), "a lot" (2), to "nearly all the time" (3). The ordinal scores in