The purpose of this study was to investigate piano instructors’ perceived levels of confidence, success, and preparation in teaching students with neurodevelopmental disabilities. A secondary purpose of the study was to learn about the varied contexts in which piano instructors learn how to teach students with neurodevelopmental disabilities. Specifically, I wanted to examine (a) how confident and successful piano instructors believed themselves to be in teaching students with neurodevelopmental disabilities, (b) to what extent did piano instructors include students with various neurodevelopmental disabilities in their piano studios, (c) which neurodevelopmental disabilities did piano instructors have familiarity and experience with, and to what degree, and (d) in what contexts did piano instructors learn to teach students with neurodevelopmental disabilities. Historically, these exceptional students have been marginalized in educational practice, and while movements in classroom education have sought to ameliorate many issues, research and practice in applied music instruction has not kept pace. To date, there are no requirements for special education coursework for piano pedagogy or applied piano majors at any level, according to the National Association of Schools of Music standards. With millions of people affected by neurodevelopmental disabilities, it is likely that piano teachers will teach students diagnosed with neurodevelopmental disabilities, whether they are prepared or not. Non-collegiate piano instructors were recruited from the Music Teachers National Association and from social media sites to complete the survey and data were collected from N = 749 piano instructor respondents in the spring of 2023. Findings indicated that (a) respondents were willing to teach students with neurodevelopmental disabilities in at least some circumstances, (b) most teachers had taught or were currently teaching at least one student with a neurodevelopmental disability, and (c) that they felt underprepared to do so. Findings also showed that confidence was higher when the respondent had taken at least one course addressing neurodevelopmental disabilities. Implications for piano instructors, future or “pre-service” piano instructors, and piano pedagogy professors are discussed.