The field of neuropsychology is becoming increasingly responsive to addressing the specific needs of an ever-growing Hispanic/Latinx population. As such, bilingualism and bilingual education are at the forefront of considerations for neuropsychologists. This paper examines models of bilingual academic instruction and levels of bilingualism and how they impact neuropsychological findings and diagnostic determinations in pediatrics. The present case series highlights five children assessed in a pediatric medical setting. Various profiles are analyzed to highlight the intricacies in assessment that must be considered. These findings present a set of considerations as a step toward a systematic approach to bilingual neuropsychological assessment.