Guardianship Petition for 18-Year-Old with Autism Spectrum Disorder
As a psychiatrist providing documentation for guardianship, you must conduct a decision-specific capacity assessment rather than making a global determination of incompetence, as autism diagnosis alone does not automatically warrant guardianship. 1
Framework for Capacity Assessment
Your evaluation should assess four specific abilities required for decision-making capacity 1:
- Understanding: Can she comprehend basic relevant information about her condition, proposed interventions, alternatives, and their risks/benefits? 1
- Appreciation: Does she acknowledge her situation and probable consequences of different options? 1
- Reasoning: Can she weigh risks and benefits to reach decisions consistent with that assessment? 1
- Expression of Choice: Can she communicate a preferred option? 1
Critical Considerations for Your Documentation
Capacity is decision-specific, not global - your client may lack capacity for complex financial decisions while retaining capacity for healthcare choices or daily living decisions 1. Your documentation must specify which domains of decision-making are impaired and provide concrete examples.
What to Document:
- Specific functional impairments: Detail which life domains she cannot manage independently (finances, healthcare decisions, housing, safety) with concrete examples 1
- Cognitive and adaptive functioning levels: Include formal assessment results if available, as intellectual disability often co-occurs with autism 1
- Communication abilities: Document expressive and receptive language capacity, as this affects informed consent 1
- Safety concerns: Provide evidence of inability to protect herself from exploitation or harm 2, 3
- Alternative supports attempted: Courts prefer less restrictive alternatives before full guardianship 4
Common Pitfalls to Avoid
Do not assume autism diagnosis equals incapacity - many adults with autism retain decision-making capacity for most or all life domains 5. The tremendous heterogeneity in ASD presentation means cognitive abilities, adaptive functioning, and independence vary widely 1.
Avoid recommending full guardianship when limited guardianship suffices - specify only the domains where she lacks capacity 1, 4. Courts and professionals are increasingly reluctant to endorse full guardianship even when evidence supports it, preferring targeted interventions 4.
Consider supported decision-making first - document whether she could make decisions with appropriate support, timing, plain language, visual aids, and corrective feedback 1. This respects autonomy while providing needed assistance 1.
Ethical Framework
Your role involves balancing protection from harm against preserving autonomy 3. The American Academy of Child and Adolescent Psychiatry emphasizes that individuals with intellectual disabilities should participate in decisions according to their developmental ability, with guardians providing consent only when the person lacks retained decision-making capacity 1.
Document whether she was involved in the guardianship discussion and her expressed preferences - this reflects current ethical emphasis on patient autonomy and respecting rights of persons with developmental disabilities 1, 5.
Specific Documentation Elements
Your letter should include 6, 3:
- Diagnosis and severity: ASD level, co-occurring intellectual disability if present, adaptive functioning scores 1
- Functional assessment: Concrete examples of impaired judgment in specific domains (cannot manage money, vulnerable to exploitation, cannot consent to medical treatment) 1
- Prognosis for capacity: Whether deficits are permanent or could improve with intervention 1
- Least restrictive alternative analysis: Why less restrictive options (power of attorney, representative payee, supported decision-making) are insufficient 4
- Guardian recommendations: If appropriate, comment on proposed guardian's understanding of her needs and ability to respect her preferences where capacity exists 6
The court needs evidence that guardianship is necessary to prevent irreversible harm, not simply that she has autism 2. Your documentation must demonstrate specific incapacities that create risk, not just a diagnosis.