Forensic psychiatric work, as described in previous issues of this journal, has a variety of fields and variables related to each case and the analysis of the psychiatric consultant. One major factor is the age of the individual being examined. Cases involving children and adolescents generally require specific expertise and consideration and are well illustrated through case vignettes.
Not Competent Due to Immaturity
In Dusky vs. United States, 362 US 402 (1960), the United States Supreme Court ruled that all criminal defendants must be competent to stand trial. The test for competency announced by the Court in Dusky is whether the defendant has a “sufficient present ability to consult with his lawyer with a reasonable degree of rational understanding and whether he has a rational as well as a factual understanding of the proceedings against him.” This commonly has been referred to as a two-prong test—whether the accused understands the charges and legal process against him and whether he is able to assist his lawyer in his own defense.
Dusky prompted changes in legislation throughout the country. All states have enacted legislation to comply with the Dusky standard as applied to defendants in adult criminal court. These statutes typically apply the same Dusky standard to all criminal court defendants, regardless of whether the defendant is suffering from dementia, schizophrenia, or depression, or if the defendant is 14, 34, or 74 years of age.
No state, to the authors' knowledge, alters the standard of competency for juvenile defendants who may be too immature to understand the proceedings. Some states do prescribe what type of intervention for restoration to competency can be undertaken if a juvenile is found not competent to stand trial due to immaturity alone (e.g., in Florida, juveniles found not competent due to immaturity cannot be placed in a residential facility for restoration to competency). Although some states set a minimum age for jurisdiction for juvenile court, once a juvenile defendant achieves that age and is before the court, the same Dusky standard applies.
There are several components to a defendant's understanding of the proceedings. These include an understanding of the charges and the potential consequences of being found guilty of the charges; an understanding of the role of the various court room players (i.e., judge, jury, prosecutor, defense attorney, witnesses); and an understanding of some basic constitutional rights (i.e., innocent until proven guilty, right to remain silent, etc.). Having a factual understanding of these issues, however, is not enough. The defendant must have a rational understanding of these issues and be able to rationally discuss the case with his attorney.
Rational decision making can often be impaired by psychiatric illnesses, such as schizophrenia or major depression. Defendants who lack a present ability to make rational decisions are often court referred for mandated treatment to “restore” competency.
But what if a defendant lacks the ability to make a rationale decision regarding the handling of his case because he is too immature? Further, if a juvenile defendant lacks a rational understanding due to immaturity, how can an evaluator effectively communicate that to the court?
Often young juvenile court defendants of average intelligence can learn most, if not all, of the factual components regarding competency. For instance, children as young as 8 or 9 can learn about the role of the judge, the prosecutor, the witnesses, etc. They watch enough television to understand what evidence is and that they could go to “jail” if the judge believes they are guilty. Juvenile defendants cannot, however, “learn” how to make a rational decision.
A Case Vignette
The following case vignette from the files of one of the authors demonstrates the issue of a child who was deemed not competent to stand trial simply based on immaturity.
John (name changed), a nine-year-old regular education boy with no prior juvenile court involvement, was charged, along with a 12-year-old boy and a 14-year-old boy, with first-degree sexual assault and risk of injury to a minor. The nine-year-old victim, Jamie (name changed), gave a statement to police that largely coincided with John's statement to police when interviewed without the benefit of an attorney.
Essentially, the 14-year-old boy coaxed Jamie to a secluded area. Once there, the 14-year-old boy brandished a knife and told Jamie he would stab her if she did not perform oral sex on him and the two other boys—the 12-year-old and John. Jamie's younger sister ran off to get help.
After Jamie complied with regard to the two older boys, she had just started to touch John when her older siblings arrived to help.
According to records, the 14-year-old boy had numerous prior juvenile court referrals. John's mother reported to evaluators and to John's defense attorney that he was afraid of the 14-year-old boy. Further, John was evaluated, without his attorney's approval, by a sexual offender evaluator who concluded that John was probably as traumatized by the event as Jamie was.
John's competency to stand trial was evaluated by a court appointed team consisting of a child forensic psychiatrist, a psychologist, and a social worker. The team concluded that John did not have the capacity to understand the charges and assist in his defense. The team also found that due to John's chronological age and “associated developmental abilities and limitations,” John would not likely be restored to competency within the statutory time frame (18 months in this jurisdiction).
The court found John not competent, but was not convinced by the testimony of the social worker that he could not be restored to competency. The court ordered John into outpatient treatment, provided by one of the authors, to “restore” competency.
After eight one-hour sessions, John learned to repeat his charges and seemed to understand their meaning. He learned the roles of the various court personnel. He could describe what evidence might be presented in his case and who might be witnesses for him and against him. He could restate the potential consequences of being found guilty. Nonetheless, something was missing. This became clear during the last session in the following exchange:
Evaluator: John, what's your job in court?
John: To do nothing…no, my job is to sit there and…whatever the witness says I can tell my lawyer, and whatever the judge asks me I don't have to answer it.
Evaluator: How come you do not have to answer it?
John: I don't have to…because my attorney can answer for me.
Evaluator: What else is your job?
John: I don't know.
Evaluator: Can you think of anything else that might help your case?
John: No
Evaluator: Well, some people, like your mom and that other doctor you saw after it happened, thought you were afraid of the boy with the knife.
John: Scared of him? No. I was scared of the knife!
At this point, the evaluator placed his pen on the table.
Evaluator: Would you be scared of this pen if it were the sharpest knife in the whole world?
John: No.
Evaluator: Why not? You said you weren't afraid of the boy, just the knife he had.
John: I couldn't run away because that boy with the knife was crazy. He could run after me and stab me in the back.
Evaluator: Wouldn't that be a good thing to tell your lawyer if that might help you out in this case?
John: No, it wouldn't be good for me to tell my lawyer, because I wouldn't want people to know I'm scared of things, but it's safe to tell my lawyer…but I wouldn't tell him things I'm scared of.
Evaluator: But if it helps you so that you don't get on probation or go to juvenile hall, why wouldn't you tell him even if people found out?
John: Because [other kids in the neighborhood] will always make fun of me.
At the conclusion of the eighth session, the evaluator recommended to the court that although John put forth a good effort during the process and clearly learned more about legal proceedings, he continued to lack an ability to assist his attorney and to rationally understand the proceedings. The evaluator opined there was not a substantial probability John would attain competency within the 18-month statutory period. The above exchange with John was included in the evaluator's report to the court. In addition, John was evaluated by yet a third child forensic psychiatrist who provided a similar report and conclusion.
At the hearing, the reason for the judge's reluctance to agree with the initial report became clear. After brief questioning by the prosecutor and defense attorney, the judge began asking many questions about child development. His questions focused on how psychiatrists measure development, maturity, and decision-making capacity in children. His questions went well beyond what usually occurs at these rather perfunctory hearings, but his interest in trying to understand the development of a child's capacity for abstract thought and reasoning was clear.
At one point the judge asked whether all nine-year-olds lacked the capacity to stand trial and to be restored to competency. He was surprised when the question was answered negatively—that although many nine-year-olds lacked capacity due to immaturity and may not “attain” capacity within the statutory period, some nine-year-olds may indeed be sufficiently mature and intelligent to demonstrate competency to stand trial. Each child must be considered individually. This opinion conflicted with the opinion of the social worker at the initial hearing who, according to the judge, stated that all nine-year-olds lacked the maturity to understand the charges and assist in their defense.
This vignette illustrates how critical it is for forensic evaluators to carefully evaluate developmental age when assessing the decision-making capacity of juvenile defendants, particularly very young defendants, such as “John.”