FASD and Competency to Stand Trial (CST): An Exploratory Review

Abstract

Fetal Alcohol Spectrum Disorder (FASD) has the potential to complicate an individual’s involvement in the criminal justice system. This disorder is precipitated by prenatal alcohol exposure and results in life course persistent cognitive (e.g. executive function and memory), social (e.g. communication and suggestibility), and adaptive (e.g. decision making and problem solving) deficits. As a result of these deficits, individuals with FASD are disproportionately likely to become entangled in the criminal justice system. Complicating matters, the symptoms of FASD can profoundly impact an individual’s capacity to navigate the criminal justice system. Although empirical research is limited, defendants with FASD may be less likely to demonstrate the abilities necessary to be found competent to stand trial, Competency to Stand Trial (CST) refers to an individual’s ability to understand and rationally participate in court proceedings (i.e. pleas, trial, and sentencing). The goal of this exploratory review is to alert forensic evaluators about the manner in which FASD might impact a defendant’s CST as it relates to criminal cases in the United States. To this end, we (a) review the limited empirical research on FASD and CST, (b) discuss how the common features of FASD can impact various competency domains, (c) highlight which CST models might be most informative for defendants with FASD, (d) provide clinical and media case studies that distinguish the complex relationship between FASD and CST, and (e) offer interviewing suggestions appropriate for individuals with suspected or confirmed FASD. We conclude by providing recommendations for future empirical research on the impact of FASD on CST.