Standards-based accountability approaches in education are increasingly being adopted in many industrialised countries. This tends to involve the scrutiny of student performance in national academic tests and then holding schools accountable for subsequent progress. International assessments such as Programme for International Student Assessment (PISA) are not accountability measures in themselves, but are often utilised in a similar way and national policies are judged against performance in these tests. Drawing upon the examples of PISA and national assessments in the USA, this paper explores how students with special educational needs and disability (SEND) are included in, and served by, these assessment policies. The analysis suggests that while these approaches are inclusive in their intent (most obviously through efforts to include students with SEND in testing) they may poorly represent the progress of these students. It is argued that more equitable inclusion of students with SEND must find a balance between accountability measures which measure performance in traditional attainment-focused tests and other relevant assessments which are meaningful to the given student and/or SEND sub-group.