Objective: Very little is understood in terms of test bias in children based on culture or other considerations in intellectual outcomes particularly in inpatient samples which do not “mirror” normative populations. The current study examined intellectual outcomes accounting for income, race, and educational quality in an inpatient child sample. Method: Retrospective chart reviews were conducted on 187 children ages 6 to 13 consecutively referred for neuropsychological screening within an inpatient children's psychiatric unit between 2010 and 2014. Zip codes with mean income ratings and school rankings were selected as surrogates for SES and educational quality. Race was documented for each child. Comparisons were made on the WASI-II including FSIQ and Subtest scores. Results: Correlation and ANOVA analyses identified a significant impact of income (higher income better) on FSIQ (p = .029) with differences on Similarities (p = .028) but not Vocabulary, Block Design or Matrix Reasoning. FSIQ was also impacted by race (white better than nonwhite) (p =.003) with differences on Block Design (p = .041), Similarities (p = .008), and Vocabulary (p = .039) but not Matrix Reasoning. Significant differences were apparent by school ranking with the lowest quartile doing worse on FSIQ (p = .002) including Block Design (p = .020) Matrix Reasoning (p = .269), Similarities (p = .002), and Vocabulary (p = .004). There were no differences between the upper three quartiles for school rankings. Conclusion: Demographic factors such as income, school quality, and race had a significant impact on broad as well as specific intellectual scores. Results raise questions about validity in the use and interpretation of intellectual screens on extra-normative cultural and SES groups.