The national football league concussion settlement race-norming incident in context.

Background: A class action lawsuit filed by two ex-players that claimed the use of race-norms within the 2014 National Football League concussion settlement agreement violated the 14th amendment focused national attention on how the field of clinical neuropsychology assesses racially/ethnically diverse adults.

Objective: Review the reasoning behind the introduction of race-norms into clinical neuropsychological practice with the goal of providing concrete assessment and research steps for their replacement.

Results: The need for race-norms stemmed from: (a) research that consistently showed that African Americans as a grouping had lower mean scores than European Americans on a wide range of neuropsychological tests, and (b) estimation of preexisting skill level at the 50th percentile of non-racially stratified norms. They successfully reduced false-positive misclassifications among African Americans. Historically, this was preceded by debate over the causation of African versus European mean score differences on intelligence tests. Advances in genetic research have shown that commonly used racial categories are genetically heterogeneous and lack clearly defined genetic boundaries. U.S. racial (and ethnic) categories define populations that differ in their average levels of social and economic advantage/disadvantage and are better viewed as heterogeneous, nonscientific sociopolitical units.

Conclusion: Replacing race-norms involves using performance-based estimates of preexisting skill level that are individualized and not subject to racial profiling. In research, racial/ethnic group comparisons give way to the study of measurable sociocultural dimensions on which these groupings differ that potentially impact neuropsychological test scores. To date, few such dimensions have demonstrated incremental contributions beyond that of years of education except for qualitative aspects of education and bilingualism.