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Comprehensive neuropsychological assessment in complex homelessness: Incorporating performance validity testing and
J Berry1,2, E A Shores1,2, K L Wallace1,2
1School of Psychological Sciences, Macquarie University, Macquarie Park, Australia.
Applied Neuropsychology. Adult
|May 23, 2026
Summary
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.
- 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.
