A Joint Statement by the Sports Neuropsychology Society
and the National Academy of Neuropsychology
on the Use of Demographically Adjusted Norms in Neuropsychological Evaluations
The purpose of this joint statement is to address the recent controversy surrounding race as one variable in the demographic adjustments used by neuropsychologists when interpreting neuropsychological test scores. Unfortunately, this demographic adjustment has erroneously been referred to as “race-based norms.” The goal of a neuropsychological evaluation is to assess an individual’s cognitive and behavioral strengths and weaknesses. This is done by using standardized and well-validated methods to diagnose and determine the effects of a brain disease or disorder and to provide recommendations for treatment planning. In order to achieve this goal, it is critical that the test scores and data from the evaluation provide an accurate representation of an individual’s functioning to reduce the risk of an inaccurate diagnosis. An inaccurate diagnosis can prevent access to treatment, care, and support or can inappropriately restrict access to resources. It can also result in unnecessary treatment and expense.
Neuropsychologists rely on many pieces of data (e.g., patients’ longstanding abilities, level of education, age, vocational attainment, collateral reports, sociocultural factors), as well as evidence-based “norms” (normative data) to help determine whether or not test scores are within the expected range for the individual. Norms tell us how healthy individuals, with characteristics similar to those of the individual being examined (normative reference group), perform on the same tests.
As the science of neuropsychology has evolved, the normative reference groups used for neuropsychological tests have become increasingly complex and diverse in order to better represent the individuals being tested. Early in the history of neuropsychology, the normative reference groups consisted primarily of individuals from western countries and lacked significant sociocultural diversity. Differences between races on neuropsychological tests have been recognized for decades and are explained by variations in socio-economic status, environmental enrichment, quality of education, language, access to healthcare, early intervention resources, test design, and other factors that affect life experience and brain development. A normative reference group that includes race as one of the factors does so as one way of taking into account variations in sociocultural factors. While utilization of demographic norms that include race as one of the variables is considered acceptable practice, clinicians must use their judgement to determine which demographic norms should be used when interpreting neuropsychological results.
We, the National Academy of Neuropsychology and the Sports Neuropsychology Society, are committed to the fair treatment of all individuals and to providing accurate and unbiased neuropsychological services. We also affirm our commitment to advancing knowledge of how systemic inequities affect neuropsychological testing and associated health outcomes so that we may improve diagnostic accuracy within and across groups and provide fair and balanced assessments. We will continue to support research into health inequities and work with other stakeholders to improve the representativeness of our measurement and testing tools.