Assessing Competency to Stand Trial in Defendants with Neurodevelopmental Disorders
In criminal courtrooms, the question of whether a defendant is competent to stand trial is a threshold issue—one that can determine whether a case proceeds or pauses. For defendants with neurodevelopmental disorders, however, this determination can be complex, nuanced, and easily misunderstood without the right forensic expertise.
Neurodevelopmental disorders such as autism spectrum disorder (ASD), intellectual disability (IDD), and attention-deficit/hyperactivity disorder (ADHD) may impair a defendant’s ability to understand the legal process or work effectively with counsel. But not all deficits automatically translate into incompetence. That’s where careful, structured assessment comes in.
The Legal Standard and Clinical Reality
Competency to stand trial is based on the legal criteria outlined in Dusky v. United States, which require that a defendant have both a factual and rational understanding of the proceedings and be able to assist in their defense. These criteria may appear straightforward, but applying them to individuals with neurodevelopmental disorders requires a forensic psychiatrist who understands both the law and the subtle clinical presentations these disorders can take.
Many defendants with ASD or intellectual disability, for instance, may have rote knowledge of legal terms but lack a meaningful grasp of how those concepts apply to their own case. Others may struggle with reciprocal communication, making it difficult to collaborate with counsel or make informed decisions.
Structured Tools Enhance Reliability
To enhance objectivity and reduce bias, I routinely use the CAST-ID, a structured instrument designed to assess competency specifically in individuals with intellectual disability. These tools measure understanding of courtroom personnel, legal terminology, and the ability to engage in defense-related reasoning. In my evaluations, they serve as essential complements to clinical interviews, record reviews, and behavioral observations.
For defendants with autism spectrum disorder, I am certified to administer the Autism Diagnostic Observation Schedule (ADOS), a gold-standard tool for identifying core social and communicative features of ASD. This allows me to accurately determine how autistic traits may influence a defendant’s ability to participate meaningfully in the trial process, distinguishing them from psychiatric symptoms or intentional non-cooperation.
The Value of a Forensically Trained Psychiatrist
What attorneys often need is not just a clinical opinion, but a forensic translation: a clear, well-supported answer to the legal question of whether the defendant is or is not competent, grounded in rigorous assessment and directly tied to the court’s criteria.
I’ve conducted over 10 competency evaluations in individuals with neurodevelopmental disorders, and my reports are crafted to be both clinically comprehensive and legally relevant. Whether appointed by the court or retained by counsel, my role is to offer an impartial, evidence-based opinion that can withstand legal scrutiny and assist the trier of fact.
If you’re working with a defendant who may have autism, intellectual disability, or another neurodevelopmental condition—and competency is in question—consider a referral for a structured forensic evaluation. These cases require specialized tools, careful interpretation, and experience navigating the intersection of psychiatry and the law.
