Neurodevelopmental Disorders, Criminality, and Criminal Responsibility

Although individuals with neurodevelopmental disorders (ND), such as intellectual disability (ID) and autism, are overrepresented in the criminal justice system, most psychiatry training is limited regarding NDs, and forensic psychiatry training tends to focus on psychotic and mood disorders. This article explores the complex interactions between NDs and criminality, including direct etiological explanations and potential mediating variables (e.g., trauma), to address common training gaps. We compare and contrast current laws relevant to assessing NDs in criminal responsibility evaluations. Not guilty by reason of insanity (NGRI) criteria vary by jurisdiction, with some specifying ID as one possible insanity defense prerequisite while most jurisdictions are nonspecific. NDs in the absence of psychosis or mania often involve impaired cognition (e.g., comprehension, reasoning, social cognition) and behavioral dysregulation. This article provides potential scenarios by which those with NDs might be competent to stand trial but qualify for one or more NGRI prongs. Suggestions for assessment methods (including for malingering) are addressed for this unique population.