The top neuropsychology organizations in North America may soon adopt training guidelines that call on clinicians to use "social justice frameworks," acknowledge "systemic oppression," and pursue "equitable and just scientific knowledge," according to a copy of the guidelines reviewed by the Washington Free Beacon.
The guidelines are the product of two years of meetings between the field’s main professional groups and could reshape board certification for the entire discipline.
Neuropsychology is the branch of medicine that diagnoses brain injuries, including concussions, by administering tests of cognitive function. In 2022, delegates from the field’s membership and credentialing organizations met in Minneapolis to draft a new set of guidelines, or "competencies," meant to guide neuropsychology education.
It was clear from the start that those guidelines would have an ideological bent. A "values statement" for the working group, dubbed the Minnesota Conference, said that neuropsychology was "inherently biased in the western perspective" and called on delegates to "center social justice" by rejecting "structures" and "values" that "privileged certain ways of knowing."
The field "requires paradigmatic changes," the delegates said. "We seek to expand the framework for … competency-based training to be infused with a health justice and equity framework."
That’s exactly what they did. When the Minnesota Conference released a final version of its guidelines on Nov. 26, the document called for "equity, justice, and inclusion" to be incorporated into every aspect of the field, from the conduct of scientific investigations to the application of research findings.
"Clinical neuropsychologists seek to develop an equitable and just scientific knowledge base," the competencies state, and "endeavor to repair historical and contemporary sources of bias and structural and systemic oppression." They also "apply research findings" in ways that are "consistent" with "equity, justice, cultural respect, and inclusion."
While the guidelines have no force on their own, they are meant to "inform" the "accreditation and credentialing standards" of the field’s professional groups, including the American Board of Clinical Neuropsychology, which oversees board certification for the field. Each group will decide independently whether to adopt the standards.
The guidelines are the latest example of how DEI has captured the credentialing apparatus of American health care, transforming what once seemed like an ideological fad into a formal requirement of medical licensure. Board exams for internists now include questions about "health equity," the Free Beacon reported in 2022, and accreditation standards for U.S. medical schools say that students should learn about "systems of power, privilege, and oppression."
Many medical schools have updated their curricula in order to comply with those standards. Some, including at the University of California, Los Angeles, and the University of California, San Francisco, now require entire courses on social justice.
The most immediate effect of the Minnesota guidelines would be on residency and postdoctoral programs in neuropsychology. But they could influence other aspects of the field as well, especially if the American Academy of Clinical Neuropsychology (AACN)—the largest association of board-certified neuropsychologists in North America—decides to adopt the standards.
The organization’s members will vote on the guidelines in three months’ time, according to a Nov. 27 email from the group’s president, Dominic Carone. If a simple majority favors adoption, the document will become binding on the academy, which develops practice guidelines for clinicians and, according to its website, supports the "maintenance of standards" in the field.
Other groups considering the guidelines include the American Board of Clinical Neuropsychology and the American Board of Pediatric Neuropsychology.
The 2022 conference came as the field was mired in controversy over its use of "race-normed" tests, which adjust individuals’ scores based on the average for their racial group. Those tests—used to quantify the loss of cognitive function after a brain injury—had made it more difficult for black football players to obtain payouts from the National Football League’s concussion settlement program, because the tests assumed (based on years of data) that blacks had a lower baseline score. Two former NFL players sued, and in 2021 the league agreed to end the practice.
The AACN, meanwhile, issued a position statement in late 2021 condemning the race-based tests that it had once embraced. The about-face received national attention, and given the optics—black athletes denied major payouts due to what the press portrayed as a form of race science—it was hardly a surprise that the Minnesota Conference, of which the AACN was a sponsor, vowed to make major changes to the field.
But when the conference circulated a first draft of its guidelines in May 2023, many clinicians recoiled at the jargon-ridden document. The guidelines called on neuropsychologists to recognize "power differentials," address "micro and macro aggressions," and "demonstrate awareness of intersectional identities." Some doctors accused the conference of subordinating science to politics and argued that focus on identity would distract from other, more important topics.
"Absent from the guidelines was the recognition that every moment spent on intersectionality, oppression, and equity takes away precious time from learning actual science and clinical expertise," Larry Brooks, a neuropsychologist in South Florida, wrote in an op-ed for National Review. "If our future trainees spend their time learning about microaggressions and systemic racism instead of neuroanatomy, they won’t know the right side of their brain from their left."
The debate spilled onto a listserv maintained by the AACN, according to an annual report from the organization, and became so heated that the forum was temporarily shut down. Amid the hullabaloo, the Minnesota Conference announced that it would give participating organizations more time to offer feedback on the guidelines. It also undertook its own review of "controversial topics" such as the "DEI language," according to a Nov. 2023 update from the group, adding that it had retained the Arredondo Advisory Group—an "equity, diversity, and inclusion" consultancy—to assist with further revisions.
One year later, the final draft looks much the same as the first. While some of the most ideological language was scrubbed from the competencies, they still say that clinicians should understand "intersectionality" and "consider society-wide issues of diversity, equity, power, and injustice."
"Neuropsychologists recognize the importance of using social justice frameworks and principles of cultural respect, equity, justice, and inclusion when engaging in all training/mentoring activities," the guidelines read. "This includes creating training environments that are collaborative, supportive, safe, attentive to power differentials, and accessible to individuals with diverse identities, backgrounds, and needs."
In an email to the Free Beacon, Carone, the president of the AANC, confirmed that a vote would be held in "~ 3 months" but declined to comment further on the guidelines. The Minnesota Conference and the American Board of Clinical Neuropsychology did not respond to requests for comment.