Neuropsychological assessment of competency to stand trial evaluations: a practical conceptual model

Competency for adjudication is a complex concept that, despite judicial efforts to articulate functional criteria, has presented conscientious clinicians with the need to filter through multiple levels of psychological data to adequately evaluate and describe the germane functional capacities and deficits of a given defendant. Practitioners are confronted with preparing evaluations that are either psychologically inclusive and too broad to be judicially useful or too brief (opinions with inadequate descriptions of how a specific defendant's abilities and impediments affect the legal criteria). The trend toward harsh sentencing guidelines has further increased defendants' incentives either to postpone adjudication or to attempt to establish a foundation for an insanity plea. Therefore, accurate identification of malingered deficits has become a more significant problem in evaluating competency to stand trial than it previously was. When neuropsychological factors are introduced, competency assessment becomes complex. This article presents a methodology for managing these complexities. Strategies for preparing concise competency evaluations for defendants presenting neuropsychological symptoms are provided along with examples that help illustrate the evaluation process.