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

OBJECTIVE: People experiencing complex homelessness, defined as persistent homelessness despite housing solutions, often present with multimorbidity, including mental illness, substance use, and neurocognitive conditions. Few studies have applied comprehensive, performance-valid neuropsychological assessment in this subgroup. This study delineated the neuropsychological profile of adults experiencing complex homelessness. METHOD: Nineteen adults consecutively referred from specialist homelessness services in Sydney, Australia, completed comprehensive assessment of intellectual ability, memory, and executive functioning. Measures included the WAIS-IV, WMS-IV, executive function tests, and both stand-alone (i.e., Word Choice) and embedded (e.g., Reliable Digit Span) performance validity tests. RESULTS: Mean WAIS-IV index scores were in the low average range, whereas WMS-IV index scores ranged from borderline to extremely low. Mean Full Scale IQ (M = 78.9) was significantly lower than values reported in quantitative reviews of broader homeless samples. Discrepancy analyses indicated substantial divergence between premorbid estimates and current intellectual and memory functioning, with nearly half the sample showing base-rate differences occurring in <5% of the normative population. Executive functioning was broadly impaired, and performance validity test failure occurred in 11%. CONCLUSIONS: Adults experiencing complex homelessness show marked, multifaceted cognitive compromise exceeding that reported in general homeless populations. Performance-valid neuropsychological assessment provides objective evidence to guide support planning and service pathways.