Exploring Fitness to Participate in Court Proceedings Among Defendants with Fetal Alcohol Spectrum Disorder: A Systematic Scoping Review

Abstract

<title>Abstract</title> Fetal Alcohol Spectrum Disorder (FASD) is a lifelong neurodevelopmental condition resulting from prenatal alcohol exposure, affecting both cognitive and behavioural functioning. Within the legal system, determining whether an individual can effectively participate in court proceedings is essential to ensuring a fair trial. Legal professionals, psychiatrists and psychologists must carefully assess the abilities and limitations of accused individuals, particularly those with FASD, whose cognitive impairments can significantly impact their legal fitness to participate. This scoping review examines empirical studies investigating FASD in relation to fitness to plead or equivalent legal constructs. A systematic search across six databases, following PRISMA guidelines, identified nine empirical studies. The findings highlight key challenges, including the invisibility of FASD within fitness assessments, immaturity-related barriers, the need for adaptive and executive functioning evaluations, limited judicial awareness, insufficient community resources, and the need for specialised legal frameworks such as alternative courts. To ensure fair legal proceedings, there is a pressing need for early recognition of FASD and diversion strategies, particularly within the UK, where research remains limited. This review discusses the legal implications, recommendations, and future research directions necessary to improve fitness to participate assessments and promote equitable access to justice for individuals with FASD.