Clinical Psychology and Neuropsychology at the Intersection of Neurodiversity and Complex Criminal Cases

Clinical psychology and Clinical Neuropsychology occupy a unique space at the interface of mental health, law, and public safety. In medical-legal work, specialist clinical psychologists are increasingly required to address and apply their deep expertise to highly specialised issues of neurodiversity while navigating complex criminal and medical neuropsychological cases. It is precisely the challenges of these cases that raise profound ethical, clinical, and legal questions. Many of these cases bridge clinical trauma psychology and medical neuropsychology, examine how neurodiversity may impact cognitive decision-making, and address the complex behaviours that led to the person violating the law in the first place. This work demands not only diagnostic expertise but also a nuanced understanding of how neurodevelopmental differences interact with legal responsibility, risk, and rehabilitation. Complex cases such as sexsomnia (a specific parasomnia where the person exhibits sexualised behaviour that they most frequently have no memory of while they were asleep) brings many of the neurodevelopmental and cognitive processing demands into the clinical detective work required to make sense of what happened and why..

Neurodiversity refers to natural variations in cognitive functioning, including autism spectrum conditions, ADHD, learning disabilities, and other neurodevelopmental profiles.  All of these affect a person’s personality, health behaviour, and risk profile. In forensic contexts, these differences are often overrepresented, particularly among individuals involved in the criminal justice system. Neurodivergent individuals may present with communication difficulties, atypical emotional expression, sensory processing sensitivities, or rigid thinking styles—factors that can be misinterpreted as defiance, lack of remorse, or manipulation if not properly understood.

Medical-legal assessments conducted by specialist clinical psychologists play a critical role in clarifying how neurodiversity impacts medical health behaviour, and understanding these issues can profoundly impact many key areas, such as whether the person is competent to stand trial, has criminal responsibility, if they even have the capacity and are fit to plead (or not), and their risk of reoffending. For example, an individual with autism may struggle to understand court processes, engage effectively with legal counsel, or respond appropriately during police interviews. Without informed assessment, these challenges can lead to unjust outcomes, including false confessions or inappropriate sentencing.

Complex criminal cases further amplify these challenges. Serious violent or sexual offences often involve individuals with co-occurring conditions such as trauma histories, personality difficulties, substance misuse, or psychosis alongside neurodevelopmental differences. Specialist clinical psychologists must disentangle these overlapping factors to provide courts with balanced, evidence-based opinions that can outline a reasoned and effective plan to address these challenges and risks. This includes distinguishing between intentional criminal behaviour and actions influenced by cognitive rigidity, impaired social understanding, or manipulation by another person to commit the crime, if the person acted without intent due to heightened stress vulnerability.

Working in this space requires careful adherence to ethical and professional standards. Specialist clinical and neuropsychologists must remain objective while advocating for reasonable adjustments and equitable treatment within legal processes. Reports must be clear, accessible, and firmly grounded in empirical research, translating complex psychological formulations into language that judges, lawyers, and juries can understand. Importantly, neurodiversity should neither be pathologised nor used to excuse harmful behaviour, but rather contextualised within risk management and intervention needs. It is this expert understanding and balance, even that can come from developing insight-driven specialist risk profiles and clinical case formulations, that can transform the criminal case in profoundly important ways.

Beyond the courtroom, specialist clinical psychologists contribute to treatment planning and risk reduction. Neuro-affirmative approaches can inform tailored interventions within secure hospitals, prisons, and community settings at all stages of the criminal justice pathway. When rehabilitation programmes are adapted to integrate and understand the importance of cognitive profiles—using concrete language, structured delivery, and sensory-aware environments—outcomes for neurodivergent individuals can improve significantly, enhancing both individual wellbeing and public safety, reducing costs, and improving outcomes for all concerned.

In an evolving legal landscape, specialist clinical psychology skill sets play a vital role in ensuring that neurodiversity and the handling of highly complex cases are properly recognised within medical-legal work, and that expertise is brought to bear to solve what can appear impossibly complicated cases. By combining clinical expertise with legal understanding, specialist psychologists help ensure fairness, accuracy, and humanity in the assessment and management of a wide range of complex criminal cases.

For complex cases involving neurodiversity, mental health, or criminal responsibility, our team can help you identify the right specialist and move forward with clarity. Contact Foresight to discuss your case.

Dr Richard Sherry, 

Consultant Chartered Clinical Psychologist, HCPC reg. BPS CPsychol, FBPsS, CSci, 

Consultant Chartered Counselling Psychologist, HCPC reg. BPS CPsychol, FBPsS, CSci, 

Clinical Neuropsychologist HCPC reg. BPS CPsychol, FBPsS, CSci, (SRCN), 

Psychoanalytic Psychotherapist, BPC reg. & UKCP reg.,

Consultant Chartered Coaching Psychologist, BPS CPsychol, FBPsS,

BPS Clinical Aviation and Aerospace Psychologist, HCPC reg. BPS CPsychol, FBPsS, CSci, and

Member Academy of Experts (MAE)(3707), BPS Directory of Expert Witnesses,