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Comprehensive neuropsychological assessment in complex homelessness: Incorporating performance validity testing and

J Berry^1,2, E A Shores^1,2, K L Wallace^1,2

¹School of Psychological Sciences, Macquarie University, Macquarie Park, Australia.

Applied Neuropsychology. Adult

|May 23, 2026

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This summary is machine-generated.

Adults with complex homelessness exhibit significant cognitive impairments in intellectual ability, memory, and executive functions. Performance-valid neuropsychological assessments are crucial for guiding support and services for this vulnerable population.

Area of Science:

Neuropsychology
Homelessness Research
Cognitive Science

Background:

Complex homelessness affects individuals with persistent housing instability despite available solutions.
This population often experiences multimorbidity, including mental illness, substance use, and neurocognitive conditions.
Limited research has utilized comprehensive, performance-valid neuropsychological assessments in this subgroup.

Purpose of the Study:

To delineate the neuropsychological profile of adults experiencing complex homelessness.
To assess intellectual ability, memory, and executive functioning in this population.
To identify cognitive deficits using performance-valid measures.

Main Methods:

Nineteen adults referred from specialist homelessness services in Sydney, Australia, were assessed.

Keywords:

Cognitive impairment WAIS-IV WMS-IV Wechsler homelessness neuropsychological performance validity

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Comprehensive neuropsychological assessments included the WAIS-IV, WMS-IV, and executive function tests.

Performance validity tests (stand-alone and embedded) were administered to ensure data integrity.

Main Results:

Mean intellectual ability scores were in the low average range, while memory scores ranged from borderline to extremely low.
Full Scale IQ scores were significantly lower than in broader homeless samples.
Nearly half the sample showed significant discrepancies between estimated premorbid functioning and current cognitive abilities, with broad executive functioning impairment. Performance validity test failure occurred in 11% of participants.

Conclusions:

Adults experiencing complex homelessness demonstrate substantial and multifaceted cognitive compromise.
These cognitive deficits exceed those reported in general homeless populations.
Performance-valid neuropsychological assessment offers objective data to inform support planning and service pathways for individuals with complex homelessness.