Evaluating Competency in Defendants with Fetal Alcohol Spectrum Disorder

The purpose of this chapter is to provide an overview of the relevance of fetal alcohol spectrum disorder (FASD) in the context of adjudicative competency, from initial interactions with police at arrest through interrogation and adjudication at trial. Individuals with FASD experience contact with the criminal justice system at elevated rates and are overrepresented in forensic, legal, and correctional contexts. The complex range of functional and neurodevelopmental impairments experienced by many individuals with FASD raise concerns about their ability to competently navigate adjudicative proceedings. Growing awareness about FASD among legal professionals and courts, coupled with policy calls to more effectively address their overrepresentation in legal contexts, suggests that forensic clinicians are increasingly likely to be tasked with identifying and evaluating justice-involved individuals with FASD. However, limited FASD training, knowledge, and skill among forensic clinicians, in addition to an array of challenges identifying individuals with FASD in clinical and legal settings, render this a complex task. This chapter begins with a brief overview of adjudicative competency and FASD, followed by practical strategies to support best practices in competency evaluation for forensic clinicians.