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10 | Bulletin vol. 34 no. 1 Kadunc, Nguyen, & Jacobs, 2014). This, among other factors, such as insufficient funding, homogeneity of the research workforce, and oppression, has led to the historic underrepresentation and subsequent mischaracterization of racial/ethnic minorities in neuropsychological research (Rivera Mindt et al., 2010). Best practices cannot be formulated, and research conclusions cannot be reached without proper racial/ethnic minority representation in clinical neuropsychological research. Thus, using research methods that demystify the research process and actively engage the community through relationship building using the biopsychosociocultural approach is essential to ensuring greater representation of racial/ethnic minorities in neuropsychological research (Rivera Mindt et al., 2008). Appropriately characterizing racial/ethnic minorities is required to inform culturally-responsive clinical neuropsychological research and intervention in these groups. This requires the use of neuropsychological instrumentation and norms that account for various demographic factors, such as race/ ethnicity, age, sex, gender, language, and level of education. While demographically-adjusted norms do not provide a full explanation for differences observed among racial/ethnic minorities, they provide a useful and necessary adjustment required in characterizing the neuropsychological profiles of healthy and clinical racial/ethnic minority groups. For a review of appropriate instrumentation and norms to use in research with racial/ethnic minorities, see Rivera Mindt et al.'s book chapter (2019), which provides a comprehensive review of considerations for working with racially/ethnically diverse older adults. Further, resources on instrumentation and norms for use in Alaska Native/ American Indian groups can be found in Verney et al. (2016). Using appropriate norms and instrumentation is essential in research with racial/ethnic minorities; however, clinicians and researchers must understand and recognize the shortcomings of instrumentation and norms and consider them when forming conclusions. Finally, considering sociocultural factors that may influence neuropsychological performance is essential in conducting ethical and culturally-responsive research. Relevant sociocultural factors in neuropsychological evaluations include quality of education, language and/or bilingualism, acculturation, socioeconomic status, discrimination and stereotype threat, views towards medical/ assessment procedures, nutrition, housing and employment, and family circumstances. Thus, using a "sociocultural lens" when conducting neuropsychological research among racial/ethnic minorities is a useful and essential way to ensure that a participant is evaluated in a culturally-responsive manner (Rivera Mindt et al., 2019). See Rivera Mindt et al. (2019) for a more in-depth review of sociocultural considerations in neuropsychological research. Evidence-based assessment & intervention/ Implementation In 2015, the American Academy of Clinical Neuropsychology (AACN) implemented a new taskforce, Relevance 2050, to address the growing concern that, without immediate action, the field of clinical neuropsychology would become irrelevant to their clientele. The AACN President encapsulated the dilemma eloquently: "By the year 2050, a full 60% of the American population will be 'un-testable' with our current toolkit of largely mono-lingual, mono-cultural neuropsychological assessment strategies" (Postal, 2015). This highlights the paucity of available neurocognitive tests with empirically-supported construct validity among racial/ethnic minority populations. Yet, in accordance with the American Psychological Association (APA) Ethics Standard 9.02(b), neuropsychologists should thoughtfully consider the individual being evaluated when making test selections to ensure that the tests are appropriate (APA, 2017). Further, Standard 9.02(c) states that the evaluation should be conducted in a language appropriate to the individual's preference and competence (APA, 2017). Given the limited number of assessments that fit this description, for now, neuropsychologists must find the most appropriate tests for their patients and the evaluation question. Importantly, the goodness-of-fit of the available normative data for a measure should be reflected in the test selection process (Brickman, Cabo, & Manly, 2006). Considerations for normative data sets include education, age, sex, gender, and race/ethnicity, as well as clinical population (e.g., epilepsy). With respect to racial/ ethnic minorities, the most appropriate normative sample may not always be readily apparent at the outset of the evaluation. Thus, the clinical neuropsychologist would benefit from creating a cost-benefit matrix of each diagnosis in the context of the patient's performance to avoid missing a diagnosis or over pathologizing (Manly & Echemendia, 2007). It is important not to overlook genuine impairment solely because there are cultural or language differences, but also to avoid misattributing low scores to impairment when culture and language may have affected test performance. Rivera Mindt et al. (2019) provide a list of assessments with normative data available for racial/ethnic minority groups. While appropriate normative samples are essential to clinical neuropsychological evaluations, there are several sociocultural factors (described above) that are known to affect test performance that are not accounted for in normative samples (e.g., quality of education). Nevertheless, these sociocultural factors should be considered qualitatively during interpretation of the patient's data. The clinical/neurobehavioral status interview, which may be longer with racial/ethnic minority patients, provides an avenue to discuss relevant sociocultural constructs. However, the clinical interview with a sociocultural lens will only be as effective as the interviewer is knowledgeable about the patient's culture. Therefore, the clinical neuropsychologist should consult with colleagues and research the patient's culture prior to the interview. In some cases, it may be best for the neuropsychologist to refer out to a colleague who is considered competent in the patient's culture. The clinical interview also affords the opportunity to develop rapport by showing a genuine interest in the patient's racial/ethnic background, set the patient at ease about testing, and ensure that the patient is prepared for the evaluation (e.g., is she hungry, has her glasses). Readers are encouraged to review Ardila (2005) and Rivera Mindt et al. (2019) for sociocultural factors that should be assessed during the interview. Other issues that should be considered when assessing racial/ ethnic minorities are the use of interpreters (which should be limited to cases when referrals to another provider, such as a bilingual neuropsychologist, are not available), the physical space (the waiting area and testing space should be inviting to a diverse group of individuals), test wiseness (e.g., using test strategies, such as process of elimination or context cues, to answer questions when the correct answer is unknown), test attitudes, cultural response set bias (e.g., prone to reply in a positive or negative manner), field-dependent/independent perception of the world, and interpersonal relational style (with particular regard to formal, evaluative settings; Ardila, 2005; Ardila, 2010; Manly et al., 2002; Rivera Mindt et al., 2010).

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