MARA GOVERMAN: Legal questions come up in clinical care of autistic children and adults more often than many of us expect. A parent asks for a custody letter; a school requests documentation for services; a patient asks about disability benefits or driving. When autistic patients face legal systems, clinicians can help, but only if we stay within our role.

JOSH FEDER: I'm Dr. Josh Feder, the editor-in-chief of The Carlat Child Psychiatry Report and co-author of The Child Medication Fact Book for Psychiatric Practice, second edition 2023, and our other book, Prescribing Psychotropics.

MARA GOVERMAN: And I’m Mara Goverman, a licensed clinical social worker in Southern California with a private practice and an avid reader of The Carlat Psychiatry Reports. Today we're talking about legal situations that come up in the care of autistic patients. Clinicians often feel uncertain when legal questions arise, including school services, custody disputes, disability benefits, and even criminal justice issues. A helpful way to stay grounded is to focus on our role: describe function, support autonomy, and leave legal conclusions to forensic experts.

JOSH FEDER: When we focus on function rather than legal issues, we provide very helpful guidance. Let's walk through a few situations clinicians see in practice. Let's start with education. Families often ask for letters or documentation when they're trying to obtain services through an individualized education plan (IEP) or through a 504 plan. I want to break that down just a little bit. There are some federal laws that started in the 1970s and were updated in the 1990s that basically state that kids with disabilities should have help in the public schools. So you get a free and appropriate public education in the least restrictive environment. That means families don't have to pay for it; it's paid for by taxes. And least restrictive environment means that we try, as best as we can, to keep people with everybody else, so not having people in separate places for school. So, we need to do clinical evaluations and make recommendations about what kinds of accommodations or modifications kids might need. Accommodations in a 504 plan would be things like having preferred seating, or modifications might be something like doing half the problems in a problem set because the kid can learn it pretty well that way anyway, but they don't need to do everything in the homework load, things like that. It also includes things like having one-on-one assistance if that's needed or services at schools, such as occupational therapy, speech therapy, and even mental health services.

MARA GOVERMAN: In these situations, disputes often involve services like one-to-one aides, school placement, or sensory supports. Families may feel that the school underestimates or ignores the child's needs.

JOSH FEDER: Our role is not to decide the legal outcomes. Instead, we describe the patient's functional needs. For example, how sensory overload affects attention or how transitions increase dysregulation.

MARA GOVERMAN: Documentation helps. You might write about how noise levels affect the child's ability to remain in class or how following the child's lead improves regulation, as well as be sure to have someone in observation in different environments during the school day. It's very helpful to have an observer, someone who's licensed, who's able to sit and watch what's happening in the classroom to highlight and support what parents are saying.

JOSH FEDER: And we can advocate for supports without stepping into legal arguments.

MARA GOVERMAN: Mm-hmm.

JOSH FEDER: A simple phrase might be, let's clarify what your child needs to learn safely and successfully. Well, we've been doing this work for years, Mara, working with lots of kids in lots of different school settings, and it runs the gamut, right? From kids with very high support needs who need more than what they're getting, and parents want them playing with other kids who don't have as many support needs, so that they can get socialization, all the way to kids who are doing pretty well, pretty able to get to school, do their homework, and stuff like that. But nevertheless, they have trouble reading and responding to the kids around them, and so they're ostracized and not getting included in groups, and so they benefit from social skills groups and things like that at school.

MARA GOVERMAN: Mm-hmm.

JOSH FEDER: So, there's a lot of different things we might be helping families fight for in the schools.

MARA GOVERMAN: Another topic that comes up quite frequently in our practice is divorce and custody. These situations arise when parents separate or divorce. Children with autism sometimes have much more difficulty with transitions between homes and routines.

JOSH FEDER: And families might be asking us to recommend custody arrangements. That's where clear boundaries really help.

MARA GOVERMAN: Instead of making custody recommendations, we focus on the child's experience. For example, we describe how routine changes affect mood or behavior, and you also might refer to other professionals who mediate divorce and custody and have a strength in the special needs community.

JOSH FEDER: We can also encourage co-parenting approaches that support emotional regulation for both sides of the divide.

MARA GOVERMAN: And if the court needs a formal opinion, that's when a forensic evaluator becomes involved.

JOSH FEDER: And one phrase that kind of helps you maintain the boundary so that you're not pulled into these decisions is, my role is to support your child; for court decisions, it may help to involve a neutral expert.

MARA GOVERMAN: Mm-hmm. Another really important conversation we've had with parents is conservatorship and autonomy. Let's talk about autonomy and conservatorship because it's worth thinking about this. Families sometimes worry about safety and decision-making as adolescents move into adulthood.

JOSH FEDER: Sometimes rights are limited earlier than needed because people underestimate the patient's abilities. Conversely, we see a lot of kids who are edging toward age 18, when they're going to be expected to make decisions and take care of themselves in terms of medications, things like that, and they're really not ready to do that.

MARA GOVERMAN: Mm-hmm. One alternative is supported decision-making. Instead of removing autonomy, the patient receives guidance while still participating in choices.

JOSH FEDER: Clinicians can also assess a task in a specific way. A patient might manage daily spending, okay, but need support with complex financial decisions.

MARA GOVERMAN: You might say something like, let's look at which decisions you make and what support might help with others.

JOSH FEDER: This approach preserves independence where possible. So, just to kind of pick up on our experience with this, we meet so many kids who are already 18 or older, and they're having trouble with some of these decisions. They've gotten themselves in trouble with a credit card or other kinds of difficulties. Having a conservatorship in place ahead of time kind of keeps you out of trouble. It's almost like a get-out-of-jail-free card. If you don't have that in place beforehand, and then you get into some kind of difficulty, it's very hard to unwind.

MARA GOVERMAN: You know, another very sensitive topic that we hear all the time is what do you do when one or more of the parents pass, who is going to be responsible for supervising or monitoring that person?

JOSH FEDER: Yeah, long-term planning is super important.

MARA GOVERMAN: Mm-hmm.

JOSH FEDER: We certainly have patients from early childhood but also through adulthood whose parents have passed, and they still need care and are in the care of the state or some other fiduciary. It does get complicated, and we have a really important role clinically to help advise the people who are taking care of these individuals in terms of supporting them in being able to make some of their own choices, but also in trying to figure out what their needs are. Which kind of brings us to another area where we end up having our opinion involved, and that's benefits and insurance, right? So disability benefits are something that are challenging to work with, as well as insurance coverage, because if somebody's still disabled and they're over 26, something like that, if they're going to stay on their parents' insurance, you have to fill out specific forms. You have to know what the insurance company needs, what kind of information is required to continue benefits. And even more complicated, people often have Social Security disability payments from the government when they're disabled, and they're adults in particular, but also for kids. But you have to verify for those systems that the person is disabled or still disabled. Sometimes it's really obvious to us, but somebody still has to fill out the paperwork. Sometimes it's not so obvious because you might have somebody who can drive, maybe even hold a part-time job, but they're sure not able to live independently. However, the Social Security system might have somebody do a separate appointment with them, and they see somebody who drives or even has been to a little bit of college or something, and they say, well, this person doesn't need disability, when they really aren't able to take care of themselves, and we really have to advocate.

MARA GOVERMAN: Families sometimes worry that describing strains might jeopardize benefits, but on the other hand, focusing only on deficits can affect a patient's sense of identity.

JOSH FEDER: So we describe both strengths and challenges. Functional documentation helps clarify why the services are needed.

MARA GOVERMAN: We can also explain that benefits sometimes change as patients move from childhood systems to adult systems. And included in that job description as clinicians is to ensure that we give resources and referrals to families to help them integrate into the community and into the state agencies that assist throughout the lifespans.

JOSH FEDER: And in doing this, we keep the conversation supportive. For example, benefits and services help you grow; they don't define who you are.

MARA GOVERMAN: Let's talk about driving, dating, and employment. It's a really complex discussion. Legal questions also appear when patients start driving, dating, or working.

JOSH FEDER: Some autistic individuals interpret social rules very differently, and that can create misunderstandings in these environments.

MARA GOVERMAN: That's where clinicians can help by teaching social and legal rules directly. Explicit guidance often works better than assuming someone will infer the expectations.

JOSH FEDER: We also really need to check whether patients understand the risks. For example, do they know what consent means in dating situations? Or how should they respond if they get stopped by authorities during a traffic stop?

MARA GOVERMAN: Practicing scenarios can really help. Try saying things like, let's practice how to handle these situations before you're on your own.

JOSH FEDER: And again, like Mara says, these are complex situations, and the difficulties people bring us sometimes are ones that they've already kind of gotten into some difficulty, like misunderstanding somebody at work or perhaps being too perseverative about asking questions. Or in a dating situation, they might call somebody up way too many times, and someone thinks they're stalking, or they're just confused and not really sure how to proceed in a dating scenario with somebody. And then driving has been a really big issue, with police stops and things like that becoming challenging environments in the first place. And if you're autistic and you present a little bit differently, you may have somebody who has their own misinterpretation of you. We call that a double empathy problem, which really comes up in the last category we're going to talk about, which is criminal justice exposure. So these situations are where autistic patients interact with the criminal justice system.

MARA GOVERMAN: There are two patterns that come up the most. Some patients show very compliant behavior under pressure, and others appear flat or unresponsive during questioning. Both can be misunderstood.

JOSH FEDER: Right. In the first instance, you can get people who are giving basically false confessions. They're saying yes to everything; they're being very compliant. On the other hand, if somebody is just not very connected or responsive, they really look guilty to the authorities. So in either situation, it's really problematic.

MARA GOVERMAN: Clinicians can help by educating legal teams about how autism affects communication and behavior.

JOSH FEDER: And if someone is already in the legal system, diversion to mental health court might be appropriate and really the best way to protect the person, for instance, from being in jail or prison, where they can't read and respond to the people around them and are really going to be easily victimized.

MARA GOVERMAN: Patients may also benefit from simple guidance about their rights. For example, if someone pressures you, it's okay to say, I want to talk to my lawyer.

JOSH FEDER: So these are cases that I've become more involved in in recent years, and they really are complicated, right? I mean, you could have somebody who is arrested, and they're interviewed, and you'll see the video of what that looks like. And you can really see the autism symptoms, but you can also see how authorities are totally misreading what this person is demonstrating. So our job as clinicians, when we have the opportunity, is to educate the people around us about what they're really seeing so that we can reduce the fallout from those misunderstandings and all the damage that that can cause. So across all these situations, the guiding principle is to stay within your clinical role.

MARA GOVERMAN: Which means we describe function, support autonomy, and refer to forensic specialists when legal decisions require formal evaluations.

JOSH FEDER: That approach helps clinicians contribute useful information while maintaining professional boundaries.

MARA GOVERMAN: And it helps patients and families navigate legal systems with clearer expectations.

JOSH FEDER: So we should just say a few more words about the separation between clinical and forensic roles.

MARA GOVERMAN: Mm-hmm.

JOSH FEDER: We have colleague attorneys who really love it when a clinician who's treating a family or a patient comes in and is also qualified as an expert witness. What's an expert witness? An expert witness is somebody who the court deems knows more than somebody in the court, like the judge, the lawyers, and the jury, about a particular topic. Well, that is actually true for most of us clinicians; we know more, and so we could be qualified as experts. However, it really changes our role. We're getting involved in people's lives, and the ethical societies involved in at least psychiatric forensics are really clear in telling us that we should not be mixing those roles. If you're hired as an expert, you're supposed to be objective. You can't be that objective if you're already treating someone. It is probably fair game to be an expert in a case and look at it objectively and later on treat a person, but you can't do it the other way around.

MARA GOVERMAN: Today's podcast isinspired by our forensic table from our article with lawyer Ethan Marcus in our January/February/March 2026 newsletter. We'll link it in the show notes, and if you found this episode valuable, which we hope you did, please share it with others who need to hear this message.

JOSH FEDER: Everything from Carlat Publishing is independently researched and produced. There's no funding from the pharmaceutical industry.

MARA GOVERMAN: The newsletters and books we produce depend entirely on reader support. There are no ads, and our authors don't receive industry funding, which helps us bring you unbiased information that you can trust.

JOSH FEDER: Thanks to all of you for tuning in, and until next time, take care. And remember, when you look for good things, more good can happen.