This report summarizes state-of-the-art approaches for assessing visual stimulus same/different judgments in individuals with severe intellectual disabilities. Methods are described that permit one to conduct assessments on a population-wide basis, excluding few if any participants due to failure to acquire necessary baseline performances. Methodological investigations summarized here indicate that one can obtain reliable same/different judgments with a variety of stimuli in virtually anyone for whom a basal score on the Peabody Picture Vocabulary Test can be obtained. This approach includes judgments involving not only familiar, readily nameable stimuli, but also abstract two-dimensional forms of the type commonly used to minimize extraexperimental influences on performance. Taken together, recent findings lead to the conclusion that past studies have significantly under-estimated the capacity of participants with low MA scores to make same/different judgments. They also suggest a more general methodological approach that can potentially lead to more sensitive assessment of other behavioral capacities in this difficult-to-test population.