An increased focus on diversity, equity, and inclusion in neuropsychology, has led to the development of neuropsychological tests that are tailored to the cultural and linguistic needs of the ever-diversifying landscape of the United States. However, less available are culturally-appropriate and psychometrically-sound assessment measures for “special populations” undergoing neurosurgical interventions, such as those with hearing impairments, major neurocognitive disorders, and pediatric patients with multifactorial neurodevelopmental/ multisensory challenges.  To this end, neuropsychologists are often tasked with interpreting standardized measures administered in non-standardized ways. Diverting from standardized, validated assessment procedures in an attempt to characterize a patient’s relative strengths and weaknesses and assist with often essential surgical and intervention planning and decision-making certainly confers additional risk of psychometric confounds, but are often the only means of collecting any data. Despite having small sections of published manuals devoted to non-standard administrations or suggestions for working with “special populations” consensus among neuropsychologists has yet to be reached, but continues to be critical to ensuring equitable practices and successful outcomes. This case series describes the evaluation of three patients who required specialized considerations and modified test procedures and interpretation to neuropsychological assessment.

Three patients, ranging in age from 15 to 89, presented for neuropsychological evaluation to assist with neurosurgical planning and decision-making.  Patients were medically complex, requiring multiple modifications and adaptions to the assessment battery over a period of multiple visits secondary to: hearing impairment, major neurocognitive disorder, and multisensory impairments.

All of these cases were shown to benefit from multiple, specific adaptations to complete neuropsychological assessment to inform surgical planning and decision-making. For example, a pediatric medically complex patient with limited-to-no speech, required the use of an Augmentative and Alternative Communication device to understand questions and provide responses during a pre-surgical evaluation. Implementing administration modifications, including, but not limited to: adapting test instructions, items, and stimuli, providing more hands-on support, and altering the testing setting, emerged as necessary procedures to ensure equitable practices.

These cases illustrate the urgency for the development of neuropsychological assessments and strategies specific to specialized populations who present with needs beyond linguistic considerations.  Future studies are needed to bridge this gap and ensure that evaluations and outcomes are truly informed by a more comprehensive understanding of a patient’s unique cognitive, physical and emotional presentation. Doing so, would enhance the access to care and clinical applicability of neuropsychological testing to a broader range of patient populations.