The Ohio “House of Horrors” case has entered another complicated phase after Elizabeth Siders’ defense formally raised questions about whether she is mentally competent to stand trial — while she simultaneously faces a widening set of criminal charges.

Siders, the mother of 16 children removed from a Hamden home earlier this summer, has pleaded not guilty to multiple child-endangerment counts as well as separate charges of sexual battery and unlawful sexual conduct with a minor. Her bond has been increased, and she has been ordered to have no contact with her children, her husband, or the alleged victim while the cases proceed.

The newest legal focus is her mental state. A judge previously ordered both a competency evaluation and an insanity evaluation after her attorney argued that the court needed to determine whether she fully understands the proceedings and can assist in her own defense. The results of that evaluation have not yet been made public.

Her attorney has pointed to Siders’ long history of pregnancies, limited medical care and alleged lack of postpartum treatment as reasons the court should examine her mental health more closely. Those assertions are part of the defense argument and have not been established as medical findings by the court.

The competency issue has become especially significant because another defendant in the same family case, Gary Siders Sr., was recently found incompetent to stand trial and unlikely to regain competency. His attorney has said the charges against him could ultimately be dismissed, although prosecutors could still pursue other legal options such as civil commitment.

The broader case began after investigators found the 16 children living in conditions authorities described as severely unsafe and unsanitary. Prosecutors allege the children were largely isolated from school and normal community contact, while some showed serious developmental delays. Siders and the other defendants have denied criminal wrongdoing.

The next major development could therefore come from the psychological evaluation itself. If Siders is found competent, the criminal cases can move forward normally. If she is found incompetent, the court would have to determine whether treatment could restore her ability to participate in her defense.