Cross-cultural neuropsychology is a specialty area that attracts the clinical and scientific interests of many but suffers from a paucity of empirical investigations that address disparate performance patterns between cultural groups. While the body of literature from the American landscape is sparsely populated and primarily limited to adults who are African American or Hispanic, information on the cognitive profiles of adults and children from African countries is even more rare. Thus, the Neuropsychology of Children in Africa: Perspectives on Risk and Resilience is a welcomed addition to the Specialty Topics in Pediatric Neuropsychology series and to the field in general. The 347-page book contains 16 chapters which, unfortunately, are not organized into thematic sections but together cover a number of medical and public health conditions which threaten the cognitive development of African children (e.g., HIV, malnutrition, and malaria). The title implies an ambitious aim given the diversity among the countries and cultures on the African continent and the myriad of medical and societal conditions that could compromise cognitive development. Nonetheless, the authors make a pioneering effort at reaching this goal and establishing a strong foundation to support future research and culturally responsive assessment practices in these countries. This book serves as a welcomed introduction to the landscape of pediatric neuropsychology in Africa and significantly expands the range of cultures and conditions included in most academic texts on cross-cultural neuropsychology. The co-edited book has the advantage of being penned by authors who hail from many different countries, including, importantly, Kenya and South Africa. While most of the book's authors seem to be academicians, some appear to be primary clinicians who write with an applied audience in mind, increasing the span of professionals to whom this book will appeal. The diversity of authorship and differences in writing styles add to the utility of the book and provides the reader with a sense of the collaborative effort required to produce a broad reaching text as this.
One of many strengths of the book is its frank discussion of the assessment challenges present in resource-limited environments. Authors offer honest critiques and practical suggestions that will prove invaluable to readers looking for guidance into neuropsychological practice in similar settings, irrespective of the demographic characteristics of the target patient populations. In this way, the text brings to the forefront the array of methods that African practitioners use to leverage available resources to provide the best possible neuropsychological services without the institutional support that Western practitioners take for granted. Reading about the logistical challenges to neuropsychological practice will serve as a humble reminder of some of the ways in which global health and wealth disparities impact the practice of our discipline.
The expansiveness of the book's aims and the authors' efforts to achieve such a broad goal gives the book a bit of a disjointed feel. In the preface, the editors state “… cross cultural neuropsychology as applied to brain/behavior development in African children provides an excellent opportunity to further the frontiers of neurocognitive science in understanding how the human brain copes with pervasive developmental deprivation and stress within an ecosystem. This is the principal reason for this book.” This book is a valuable but incomplete response to this charge given the lack of empirical data or even carefully characterized case studies across medical conditions from which the authors could draw. The text in many of the chapters is unevenly weighted towards the provision of descriptive details on the social/environmental contexts that these children live in without making an explicit connection to how these settings influence the brain's response to disease. Further, the Preface does not offer an overarching framework which could help the reader properly consider this information in light of the book's goals. Another shortcoming is that the title infers an emphasis on resilience for which the text does not deliver. An exploration of cognitive resilience in the context of pediatric HIV infection, for example, would have been a particularly novel and valuable addition to the literature at large. It would have been very informative to gain insight into the ways in which aspects of the sociocultural environment support optimal cognitive development. An important oversight, particularly in the chapters written by American authors, was the lack of reference to investigators who have previously written about cognitive assessment in Africa and psychometric/cultural validity issues surrounding the application of Western assessment instruments to persons in different cultures.
Overall, the pioneering effort of this book's authors produced an important text that helps set a foundation from which future investigators can use to expand the breadth and depth of pediatric neuropsychological practice in Africa. The text will likely be most attractive to brain-related practitioners and educators who work in the referenced regions as well as scientists who are confronting similar challenges in other resource-limited settings. The book will also be of great interest to trainees and aid in providing a global perspective to the practice of neuropsychology.