Assessing Phonemic Fluency in Multilingual Contexts: Letter Selection Methodology and Demographically Stratified Norms for Three South African Language Groups

Because of their global clinical utility, phonemic fluency tests are frequently incorporated into neuropsychological assessment batteries. However, in heterogeneous societies their use is complicated by the lack of careful attention to using letters of equivalent difficulty across languages, and the paucity of norms stratified by relevant sociodemographic variables. In accordance with the International Test Commission's guidelines for adaptation of test material in multilingual contexts, this study provides (1) an internationally replicable methodological template for selecting appropriate letter sets; (2) empirical evidence to substantiate the equivalence of a letter set across three languages; (3) a template for evaluating the relative impact of sociodemographic variables on phonemic fluency; and (4) appropriately stratified norms for the letter set SBL (English and Afrikaans) / IBL (Xhosa) in a sample (N = 512) of urban participants (7-25 years with 1-17 years of education) from the Cape Town region of the Western Cape province of South Africa.