The significance of the role of students' interpretation and creation of multiple forms of representation in science learning has long been established and advocated, but there is a paucity of research into the extent to which this emphasis in science education is reflected in high stakes final year high school science examinations. This study investigated the inclusion of visualizations in the questions within such examinations that require students to construct a response, and also the extent to which such questions required students to create or modify diagrams or graphs within their responses. Examinations in physics, biology and chemistry from the Cambridge International Examination, New Zealand, Singapore and the States of New South Wales and Victoria in Australia over a six-year period (2014-2019) were analysed. The results indicate that less than one third of constructed response item (CRI)questions include visualisations, with most occurring in physics, then biology and then chemistry. An infinitesimally small percentage of questions across all subjects and in all butone of the jurisdictions required the creation or augmentation of visualisations. The misalignment between the integral role of visualizations in science pedagogy and the paucity of visualizations in CRIs in final year high school examinations as well as implications for examination re-design and associated further research are discussed.