Fetal Alcohol Spectrum Disorder (FASD) and Competency to Stand Trial (CST): A Review for Forensic Evaluators

Fetal Alcohol Spectrum Disorder (FASD) and Competency to Stand Trial (CST): A Review for Forensic Evaluators


1.5 Hours | 1.5 CEs (CEUs)

Program Description

This webinar on Fetal Alcohol Spectrum Disorder (FASD) and Competency to Stand Trial (CST): A Review for Forensic Evaluators is presented by Drs. Patricia Zapf and Jerrod Brown.

Fetal Alcohol Spectrum Disorder (FASD) and Competency to Stand Trial (CST): A Review for Forensic Evaluators is presented by Drs. Patricia Zapf and Jerrod Brown. Fetal Alcohol Spectrum Disorder (FASD) is a permanent disorder caused by prenatal exposure to alcohol. FASD encompasses a range of symptoms including cognitive (e.g., intelligence, executive control, and memory), social (e.g., communication skills and suggestibility), and adaptive (e.g., decision making ability and capacity to solve problems) impairments. In combination with co-occurring disorders (e.g., ADHD, depression, anxiety, and substance use), the identification and assessment of FASD can become a complicated endeavor. To help address these complexities, Neurodevelopmental Disorder Associated with Prenatal Alcohol Exposure (ND-PAE) was identified as a disorder for future study in the Diagnostic and Statistical Manual-5th Edition (American Psychiatric Association, 2013). Nonetheless, many cases of FASD still go unidentified, which is particularly problematic because the disorder increases the likelihood of involvement in the criminal justice system. Further, the symptoms of FASD make it more difficult for an individual to participate in the criminal justice system (i.e., waive rights, enter pleas, stand trial, and abide by community supervision).

Despite limited empirical evidence, it is likely that FASD causes deficits in an individual’s abilities relevant to competence to stand trial (CST). CST refers to a defendant’s capacity to comprehend legal proceedings, make informed legal decisions, serve as a witness, behave in the manner dictated by the court, accurately complete legal paperwork, and contribute to the development of one’s legal defense. Decisions of competency are ultimately made by judges in most jurisdictions. These decisions are made in light of evidence gathered in CST evaluations, which are typically conducted by a psychologist or psychiatrist. These evaluations often include the administration of several validated instruments that assess a range of constructs including cognitive abilities and functioning, psychopathology, and knowledge of the legal system.

The cognitive and social deficits of FASD can complicate the validity of CST evaluations in several ways. First, individuals with FASD often can display average to good verbal skills, which may mask their true developmental level. This highlights the importance of relying on a developmentally sensitive approach when conducting CST evaluations. Second, the combination of deficits in memory and proneness to social pressure might predispose defendants with FASD to suggestibility and confabulation, which could contribute to inaccurate assessments as well as false confessions, false testimony and wrongful convictions. Third, profoundly different impressions of a defendant may be garnered by simply using different styles of interview questions. Specifically, the presence of FASD may not be detected by interviewers who rely on yes/no questions, which could help a defendant conceal these impairments. Fourth, the presence of co-occurring psychiatric disorders and other impairments increase the difficulty of discerning the source of CST deficits. Unfortunately, there is a dearth of professionals who are experts in both CST evaluations and FASD.

Two conceptualizations of CST may be helpful in distinguishing the impact of FASD on CST. Bonnie’s reconceptualization of competence (1992) asserts that competency is a function of the defendant’s capacity to (a) effectively assist in their own legal defense and (b) make informed and valid legal decisions. In contrast, Grisso’s (2003) conceptual model focuses on five components of competency: (1) functional, (2) causal, (3) interactive, (4) judgmental, and (5) dispositional. In combination with the criteria for ND-PAE, these models of CST have the potential to illuminate how FASD can systematically impact different aspects of CST. Evidence of the impact of FASD on CST can be gleaned from several case law, media, and caregiver and professional examples.

The principal aim of this webinar is to familiarize mental health and legal professionals with FASD and its long-ranging impacts on competency to stand trial. Through a review of the current research and case law, participants are trained in four key topics. First, the webinar systematically describes the risk factors, red flag indicators, and symptoms of FASD. During this process, any myths and misconceptions of FASD are dispelled. Second, the webinar reviews major conceptualizations of CST with an eye towards better understanding the different ways that FASD can limit a defendant’s competency to stand trial. Third, the webinar discusses how FASD can impact CST evaluations and highlight ways by which professionals can avoid such pitfalls. Finally, we conclude with an exploration of current gaps in knowledge of FASD and CST and the identification of future research directions.

Intended Audience

This webinar is relevant for mental health professionals and legal professionals who want to understand how FASD can impact a defendant’s competence-related abilities, including those working in forensic, clinical, criminal justice, health care, social service, and educational settings. This webinar is for beginner, intermediate, and advanced level clinicians.

Upon completion of this webinar, participants should be able to:

  • Describe the risk factors, red flag indicators, and symptoms of FASD
  • Describe a basic understanding of the legal requirements of competency to stand trial
  • Describe the process by which competency to stand trial decisions are made in the United States
  • Describe the different ways that FASD can limit a defendant’s competency to stand trial
  • Describe how deficits in memory and proneness to social pressure predispose defendants with FASD to suggestibility and confabulation
  • Describe Bonnie’s (1992) and Grisso’s (2003) conceptualizations of competency to stand trial
  • Describe how the presence of FASD has impacted CST in several case law examples
  • Describe current gaps in knowledge of FASD and CST and identify future research directions


About Drs. Drs. Patricia Zapf and Jerrod Brown

Dr. Patricia A. Zapf obtained her PhD in Clinical Forensic psychology from Simon Fraser University in Canada and currently holds the position of Professor in the Department of Psychology at John Jay College of Criminal Justice, The City University of New York. She is the Editor of the American Psychology-Law Society book series; Associate Editor of Law and Human Behavior; and is on the Editorial Boards of 5 journals in psychology and law. Dr. Zapf is on the Board of Directors for the International Association of Forensic Mental Health Services and is Past-President for the American Psychology-Law Society (AP-LS; Division 41, APA). She has published 8 books and manuals and over 85 articles and chapters, mainly on the assessment and conceptualization of criminal competencies. Dr. Zapf was appointed Fellow of the American Psychological Association and Distinguished Member of the American Psychology-Law Society in 2006 for outstanding contributions to the field of law and psychology for her work in competency evaluation. In addition to her research, she serves as consultant to various criminal justice and policy organizations and has a private practice in forensic assessment. She has conducted over 2500 forensic evaluations in both the United States and Canada and has served as an expert witness in a number of cases, including the competency hearing of Jose Padilla. Dr. Zapf is the author of Best Practices in Forensic Mental Health Assessment: Evaluation of Competency to Stand Trial; editor of Forensic Assessments in Criminal and Civil Law: A Handbook for Lawyers; and Editor-in-Chief of the forthcoming APA Handbook of Forensic Psychology. She served on National Judicial College’s Mental Competency—Best Practices Model panel of experts and travels throughout the United States and Internationally to train legal and mental health professionals on best practices in forensic evaluation.
Jerrod Brown, Ph.D., is the Treatment Director for Pathways Counseling Center, Inc. Pathways provides programs and services benefiting individuals impacted by mental illness and addictions. Jerrod is also the lead developer of an online Master of Arts degree in Human Services with an emphasis in Forensic Behavioral Health from Concordia University, St. Paul, Minnesota, the founder and CEO of the American Institute for the Advancement of Forensic Studies (AIAFS), and the Editor-in-Chief of Forensic Scholars Today (FST) and the Journal of Special Populations (JSP). Jerrod has completed four separate master’s degree programs and holds graduate certificates in Autism Spectrum Disorder (ASD), Other Health Disabilities (OHD), and Traumatic-Brain Injuries (TBI). Jerrod is certified as a Youth Firesetter Prevention/Intervention Specialist, Thinking for a Change (T4C) Facilitator, Fetal Alcohol Spectrum Disorders (FASD) Trainer, and a Problem Gambling Treatment Provider.

“Dr. Zapf and Dr. Brown are extremely knowledgeable and present well together!”

“FASD and CST are very interesting topics! Both Dr. Zapf and Dr. Brown provided excellent resources and case examples.”

Continuing Education Credit

This Distance Learning Recorded Webinar is a Home Study Training Program. To earn CEs you are required to complete all course materials, quizzes, and the evaluation. No partial credit is available. A score of 70% is required to proceed; you will be able to re-take any quiz on which you score less than 70%. Participants will earn 1 CE hour upon completion of these requirements. Each participant will be able to download and print the CE certificate upon completion of the final evaluation.

Board Approvals: APA, ASWB, CPA, NBCC. Click here for state and other regional board approvals.

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