Reply

• neurodevelopmental disorders
• intellectual disability
• autism spectrum disorder
• forensic psychiatry
• criminality
• violence

Editor:

Thank you for the opportunity to respond to Lennon’s letter¹ and his two concerns about our article.² We appreciate the interest that he and others have displayed to us about the topic of neurodevelopmental disorders (NDs) and not guilty by reason of insanity (NGRI) determinations since the article’s publishing.

Lennon perceived us as suggesting that NGRI was the “primary legal frame for considering NDs” (Ref. 1, p 000). We regret that our article was able to be misinterpreted in such a way. NGRI is certainly not the primary legal frame but rather was simply the primary focus of our article. The reason for this, as stated in the abstract and manuscript, is that the assessment of NDs as a basis for NGRI is a common gap in forensic training and practice.² As Lennon noted, NDs are commonly addressed in mitigation.¹ Additionally, NDs frequently arise as bases for questions of criminal diversion, competency to stand trial, competency to waive Miranda rights, competency to be executed, and mens rea defenses. Our article briefly mentions all these topics,² but we chose to primarily focus on NGRI, because it is so rarely addressed in education, training, literature, and even court proceedings. In practice, we have found court officials and mental health experts are often confused by NDs in the context of NGRI, even in the state of Michigan, one of three U.S. jurisdictions that explicitly use the term “intellectual disability” as a criterion for NGRI.^2,3 As a result, we wanted to address the potential for ND diagnoses and related deficits to meet insanity criteria, when applicable.

The second concern that Lennon had was surprising because we specifically addressed the context related to studies showing a correlation between NDs and criminality.¹ We noted that correlations are often explained by co-variables. For example, Lennon mentioned trauma, which we explicitly highlighted in the abstract and manuscript.² We devoted several paragraphs to mediating and confounding variables, such as “trauma, low education, unemployment, and housing instability” (Ref. 2, p 359), “over-inflated numbers, poverty” (Ref. 2, p 360), and “socioeconomics” that render people with NDs vulnerable to every facet of the criminal justice system.² We agree that there are many other studies than the ones we cited, but they only further supported what we already outlined, and we did not aim to create a comprehensive literature review but rather a brief background on criminality before focusing on NDs in the context of NGRI.

We are happy that we could address any confusion that our article may have created here. We are glad that Lennon brought up salient points about mitigation that we think forensic experts should also be aware of in addition to the topics that our manuscript focused on.

• © 2025 American Academy of Psychiatry and the Law