Autism Spectrum Disorder (ASD) and Unlawful Behaviour: Where Do We Go from Here?

Identification and support of autistic individuals within the UK Criminal Justice System: a practical approach based upon professional consensus with input from lived experience

BACKGROUND

Autism spectrum disorder (hereafter referred to as autism) is characterised by difficulties with (i) social communication, social interaction, and (ii) restricted and repetitive interests and behaviours. Estimates of autism prevalence within the criminal justice system (CJS) vary considerably, but there is evidence to suggest that the condition can be missed or misidentified within this population. Autism has implications for an individual's journey through the CJS, from police questioning and engagement in court proceedings through to risk assessment, formulation, therapeutic approaches, engagement with support services, and long-term social and legal outcomes.

METHODS

This consensus based on professional opinion with input from lived experience aims to provide general principles for consideration by United Kingdom (UK) CJS personnel when working with autistic individuals, focusing on autistic offenders and those suspected of offences. Principles may be transferable to countries beyond the UK. Multidisciplinary professionals and two service users were approached for their input to address the effective identification and support strategies for autistic individuals within the CJS.

RESULTS

The authors provide a consensus statement including recommendations on the general principles of effective identification, and support strategies for autistic individuals across different levels of the CJS.

CONCLUSION

Greater attention needs to be given to this population as they navigate the CJS.

Autism Training for Law Enforcement Officers: A Scoping Review

Law enforcement officers are the primary individuals called and who respond to situations of heightened concern. They make split-second observations and decisions based on how best to react to given safety situations and those involved. Characteristics of autism spectrum disorders (ASD), if not properly understood and reacted to, may quickly escalate a law enforcement officer call in a negative way, making autism training for law enforcement officers imperative. To ascertain what is known about autism training for law enforcement officers, a scoping review was conducted. Five studies met final inclusion criteria. The trainees, context and development of the training, evaluation procedures, and training outcomes are synthesized to provide guidance for future training implementation teams. Areas for future research are presented.

Vulnerability to Ideologically-Motivated Violence Among Individuals With Autism Spectrum Disorder

People with autism spectrum disorder (ASD) are represented among those who espouse extremist thought and have committed violent acts associated with their beliefs. Media often highlight a perpetrator's psychiatric diagnosis following acts of mass violence, which in some instances has included ASD. ASD may itself not provide useful information for understanding motivations. Instead, understanding specific traits and neuropsychological and other vulnerabilities may offer an opportunity to make sense of these very complex events.

Self-harm and Mental Health Characteristics of Prisoners with elevated rates of autistic traits

BACKGROUND

Prevalence studies among prisoners have found rates of 1-4% for autism spectrum disorder (ASD) or autistic traits. However, little is known about those prisoners with high levels of autistic traits.

AIM

This aim of this study was to compare the mental health characteristics of prisoners with autistic traits with neurotypical prisoners not screening positive for neurodevelopmental disorders.

METHOD

The study recruited 240 male prisoners from a London prison and screened for autism spectrum disorder using the Autism Quotient (AQ) 20 and 10, and Autism Diagnostic Observation Schedule (ADOS). The Mini International Neuropsychiatric Interview was used to assess for depression, anxiety, self-harm behavior and suicide.

RESULTS

Screening using the AQ identified 46 prisoners with significant autistic traits, with 12 meeting the diagnostic threshold for ASD using the ADOS. Those screening positive with autistic traits were significantly more likely to have thought about self-harm and suicide in the past month than neurotypical prisoners and have a comorbid mental disorder. They were also significantly more likely to report having attempted suicide during their lifetime compared to neurotypical peers at a rate of 64.9 % compared to 11.6 % for the neurotypical prisoners.

CONCLUSION

Prisoners with elevated levels of autistic traits were more likely to report self-harm, suicidal thoughts and were more vulnerable to a range of mental disorders than neurotypical prisoners. There is a need for more evidence on the experience of autistic prisoners to inform how pathways should work to improve health outcomes through increased awareness and access to screening and subsequent diagnosis which currently prisons are currently not set up for.

Autism Spectrum Disorder and Substance Use Disorder: A Dual Diagnosis Hiding in Plain Sight

Individuals with autism spectrum disorder (ASD) have a significantly higher risk for developing a substance use disorder (SUD) than the general population yet literature addressing cooccurring ASD and SUD is scarce. This article explores connections between ASD and SUD and the impact on development, screening and treatment. The article proposes culturally constructed narratives associated with both diagnoses may be responsible for the dearth of research and literature. Constructed narratives of ASD and SUD do not naturally intersect and the resulting disconnect can create a cognitive dissonance that could allow the medical and general community to neglect this life-threatening dual diagnosis.

"They're the hardest group to treat, that changes the least". Adapted sex offender treatment programmes for individuals with Autism Spectrum Disorders: Clinician views and experiences

AIMS

Clinicians working with individuals with autism spectrum disorders (ASD) who display sexual offending behaviours may face challenges during treatment, as a result of the cognitive and behavioural profile associated with ASD. This research explored the views and experiences of those running adapted sex offender treatment groups with men with ASD.

METHOD

Semi-structured interviews with group facilitators (n = 12) focused on service user engagement and response to the core components of the treatment programme (e.g. increasing victim empathy, addressing cognitive distortions, etc.), and gathered the experiences of those working with men with ASD who display sexual offending behaviours.

RESULTS

Grounded Theory was used to develop a model conceptualising the potential impact of ASD on treatment outcomes, and this emerged predominantly through clinician's views of risk of re-offending. Benefits of attending a group included: the presence of other group members, a forum to develop pro-social roles and relationships, and increased opportunity for monitoring. Challenges regarding empathy, specifically emotional empathy, and shifts in cognitive distortions were felt particularly pertinent to those with ASD, as well as questions over internalisation of therapy.

CONCLUSION

Despite identification of a number of challenges, adapted sex offender treatment programmes were considered beneficial for men with ASD, especially in light of a dearth of evidenced-based alternatives.

Appropriate adults: Their experiences and understanding of Autism Spectrum Disorder

An appropriate adult (AA) is required by law, to support juveniles and vulnerable adults during custody procedures. This paper explored the opinions and knowledge of AAs and how the characteristics of Autism Spectrum Disorder (ASD) could disadvantage an individual within a police interview. A questionnaire was administered to AAs who had received training to carry out their duties (N = 55). AAs were asked a number of questions concerning suspects with ASD. Overall, the questionnaire found that AAs had some awareness of the key features of ASD. However, AAs were less aware of the possible impact these characteristics could have upon the interview process. Nevertheless, when asked about actual practice, fifteen incidents were reported where it was deemed that the characteristics of ASD disrupted interview procedures. For example, it was reported that suspects with ASD displayed repetitive and rigid behaviour patterns that interfered with the flow of the interview. Encouragingly, the self-reported data suggested that AAs were able to respond effectively to these actual incidents. That withstanding it is suggested that AA training should include information about how those with ASD might be at a disadvantage within the forensic interview environment and outline strategies that AAs could use to help a person with ASD fully engage within the criminal justice process.

Autism Spectrum Disorder and Substance Use Disorder: A Dual Diagnosis Hiding in Plain Sight

Individuals with autism spectrum disorder (ASD) have a significantly higher risk for developing a substance use disorder (SUD) than the general population yet literature addressing cooccurring ASD and SUD is scarce. This article explores connections between ASD and SUD and the impact on development, screening and treatment. The article proposes culturally constructed narratives associated with both diagnoses may be responsible for the dearth of research and literature. Constructed narratives of ASD and SUD do not naturally intersect and the resulting disconnect can create a cognitive dissonance that could allow the medical and general community to neglect this life-threatening dual diagnosis.

Conceptualising social and communication vulnerabilities among detainees in the criminal justice system

More people with autism spectrum disorder (ASD) are now being identified in the criminal justice system, and in parallel with this increase, the prevalence of ASD in the community has risen more than 150 % in the same time period. In this article, I will argue that this increase is due to a reclassification of those individuals whose social, communicative and behavioural function is at the lower end of the normal range. Put simply, extremes of these quantitative traits are now being conceptualised as 'disorder'. This has particular relevance for the criminal justice system as such traits are over-represented in this population: as such, it is likely that increasing numbers of people who are incarcerated will receive an ASD diagnosis. This will have major implications for where best, and how best, to manage such individuals using a framework of 'disorder' versus 'difference'.

Exploring the autistic and police perspectives of the custody process through a participative walkthrough

BACKGROUND

Research suggests that autistic individuals may be more likely to come into contact with police and have more negative experiences in police custody. However, limited information about the difficulties they experience during the custody process is available.

AIMS

This study explores the experiences of autistic individuals and officers during a walkthrough of the custody process to identify specific difficulties in these encounters and what support is needed to overcome these.

METHODS AND PROCEDURES

A participative walkthrough method was developed to provide autistic individuals and officers an interactive opportunity to identify areas where further support in the custody process was needed. Two autistic participants and three officers took part in the study.

OUTCOMES AND RESULTS

Autistic participants reported negative experiences due to: i) the emotional impact of the physical setting and custody process ii) communication barriers leading to increased anxiety and iii) exposure to sensory demands. Officers highlighted three factors which limit their ability to support autistic individuals effectively: i) the custody context ii) barriers to communication and iii) knowledge and understanding of autism.

CONCLUSIONS AND IMPLICATIONS

Adjustments are needed to the custody process and environment to support interactions between autistic individuals and officers and improve the overall wellbeing of autistic individuals.

The narrative coherence of witness transcripts in children on the autism spectrum

BACKGROUND AND AIMS

Autistic children often recall fewer details about witnessed events than typically developing children (of comparable age and ability), although the information they recall is generally no less accurate. Previous research has not examined the narrative coherence of such accounts, despite higher quality narratives potentially being perceived more favourably by criminal justice professionals and juries. This study compared the narrative coherence of witness transcripts produced by autistic and typically developing (TD) children (ages 6-11 years, IQs 70+).

METHODS AND PROCEDURES

Secondary analysis was carried out on interview transcripts from a subset of 104 participants (autism = 52, TD = 52) who had taken part in a larger study of eyewitness skills in autistic and TD children. Groups were matched on chronological age, IQ and receptive language ability. Coding frameworks were adopted from existing narrative research, featuring elements of 'story grammar'.

OUTCOMES AND RESULTS

Whilst fewer event details were reported by autistic children, there were no group differences in narrative coherence (number and diversity of 'story grammar' elements used), narrative length or semantic diversity.

CONCLUSIONS AND IMPLICATIONS

These findings suggest that the narrative coherence of autistic children's witness accounts is equivalent to TD peers of comparable age and ability.

Identification of service development needs for incarcerated adults with autism spectrum disorders in an Australian prison system

PURPOSE

The purpose of this paper is to identify and deliberate the service development needs required for the improvement of service provision for incarcerated adults with autism spectrum disorder (ASD) in NSW, Australia.

DESIGN/METHODOLOGY/APPROACH

Consultation groups were conducted to bring together n=5 key stakeholders from heath and correctional-based services in the prison system. A facilitated asynchronous e-mail-based discussion occurred amongst group members between consultation group meetings.

FINDINGS

Two main themes were identified: detecting persons with ASD and providing appropriate care. Participants discussed current service gaps with regard to the identification of people with ASD at the point of contact with the prison service, and the difficulties associated with diagnosing prisoners with ASD. The need for effective alert systems to detect persons with ASD in custody was identified. The current absence of ASD-specific support services in prison was highlighted, and recommendations for improvement suggested.

PRACTICAL IMPLICATIONS

Current health and correctional-based service provision failed to adequately support incarcerated adults with ASD. Improvements in prison-entry screening processes, alert systems and diagnostic practices are required. Multidisciplinary collaboration between prison-based and external service providers is required for the development of a model of care based on individualised case management to adequately support incarcerated adults with ASD in prison.

ORIGINALITY/VALUE

Given the lack of reported service provision for incarcerated adults with ASD internationally, other prison-based services are likely to experience similar service development needs and see the relevance of the recommendations made directly from the study findings.

Mock Juror Perceptions of Credibility and Culpability in an Autistic Defendant

One-hundred-and-sixty jury-eligible participants read a vignette describing a male who was brought to the attention of police for suspicious and aggressive behaviours and displayed atypical behaviours in court. Half of participants were informed that he had autism spectrum disorder (ASD) and were given background information about ASD; the other half received no diagnostic label or information. The provision of a label and information led to higher ratings of the defendant's honesty and likeability, reduced blameworthiness, and resulted in fewer guilty verdicts, and more lenient sentencing. Thematic analysis revealed that participants in the label condition were more empathetic and attributed his behaviours to his ASD and mitigating factors, while participants in the No label condition perceived the defendant as deceitful, unremorseful, rude and aggressive.

Autistic spectrum disorder and offending behaviour – a brief review of the literature

Purpose

The purpose of this paper to synthesise much of the existing research on autistic spectrum disorder (ASD) and offending behaviour.

Design/methodology/approach

It considers three key areas, namely, first, a discussion about the nature of ASD and how it might be related to offending behaviour; second, a brief commentary about the prevalence of this population; and, finally, an exploration of the effective management and possible treatment outcomes.

Findings

Methodological limitations have resulted in variable findings which has hindered our understanding of this population. Some of the research is based on small, highly specialist samples making prevalence difficult to measure. The link between ASD and offending is still not well understood, and despite advances in staff training, awareness amongst practitioners remains an underdeveloped area, thus yielding variable treatment outcomes.

Originality/value

This review continues to demonstrate the urgent need for robust research in order to better understand the link between ASD and offending behaviour, to provide tailored, needs-led interventions, and reduce the risk of offending amongst this group as a whole.

Mock Juror Perceptions of Child Witnesses on the Autism Spectrum: The Impact of Providing Diagnostic Labels and Information About Autism

Research suggests that autistic children can provide accurate and forensically useful eyewitness evidence. However, members of a jury also rely on non-verbal behaviours when judging the credibility of a witness, and this could determine the verdict of a case. We presented mock jurors with videos (from an experimental study) of one of two child witnesses on the autism spectrum being interviewed about a mock minor crime. Results demonstrated that providing jurors with generic information about autism and/or informing them of the child’s diagnostic label differentially affected credibility ratings, but not for both children. Implications for how to present information about child witnesses with autism to a jury—highlighting the need for approaches tailored to individual children—are discussed.

Higher Autistic Traits Among Criminals, But No Link to Psychopathy: Findings from a High-Security Prison in Portugal

The relationship between autism, criminality and psychopathy has gained increased attention in recent years, although research has focused on autism spectrum disorders, and not autistic traits. We measured autistic traits (with the Autism Spectrum Quotient) in a sample of 101 inmates from a high-security prison and compared them to a control group, using a logistic regression model that included age, education, psychopathology, psychopathy and attention deficit-hyperactivity disorder as covariates. Prisoners had more autistic traits (OR 1.13, p = 0.002) due to higher scores in the communication (OR 1.23) and imagination (OR 1.30) domains. No correlations were found between autistic and psychopathic traits. Our study points to the presence of autistic traits as being independent risk factors for imprisonment, although not associated with psychopathy.

Violent Fantasies in Young Men With Autism Spectrum Disorders: Dangerous or Miserable Misfits? Duty to Protect Whom?

Predictability of dangerousness in association with mental disorders remains elusive, outside of a few relatively well-established risk factors for the prognostication of violence, such as male sex, the presence of a psychotic disorder, and comorbid substance abuse. In clinical practice, inquiry into the presence of aggressive or violent ideation, in the form of ideas of homicide or suicide, is part of a standard mental status examination. Nonetheless, fantasy life, when it concerns harm toward others, may not be as reliable an indicator of imminent danger as it may be in the case of self-harm. Five cases of young Italian men with Asperger syndrome and recurrent and extremely violent femicide fantasies are presented. While there is no direct correlation between autism spectrum conditions and violence, as other humans, persons with an autistic condition are capable of committing crimes, including homicide. All five had in common a number of characteristics and behaviors felt to be pathoplastic: All had been bullied, all had been romantically rejected, all were long-standing First Person Shooter (FPS) game players, and all were avid violent pornography consumers. The potential for an actual neurocognitive impact of violent video games, well documented in the literature, and its combination with personal life history and chronic habituation following long-standing violent pornography use is discussed in the context of social and emotional vulnerabilities. While aggressive fantasies cannot and should not be underestimated, in countries where duty to protect legislation does not exist, a clinical approach is imperative, as, incidentally, should be anywhere.

Autism and Convictions for Violent Crimes: Population-Based Cohort Study in Sweden

OBJECTIVE

Recent systematic reviews have highlighted that the relationship between autism and violent offending is still unclear, but some cases have received extensive media scrutiny. We investigated whether autism is associated with convictions for violent crimes, and studied the associated risk and protective factors.

METHOD

We analyzed data from the Stockholm Youth Cohort, a total population-based record-linkage cohort in Stockholm County comprising 295,734 individuals followed up between 15 and 27 years of age. Of these, 5,739 individuals had a recorded autism diagnosis. The main outcome measure was a conviction for violent crimes identified using the Swedish National Crime Register.

RESULTS

Individuals with autism, particularly those without intellectual disability, initially appeared to have a higher risk of violent offending (adjusted relative risk = 1.39, 95% CI = 1.23-1.58). However, these associations markedly attenuated after co-occurring attention-deficit/hyperactivity disorder (ADHD) or conduct disorder were taken into account (adjusted relative risk = 0.85, 95% CI = 0.75-0.97). Among individuals with autism, male sex and psychiatric conditions were the strongest predictors of violent criminality, along with parental criminal and psychiatric history and socioeconomic characteristics. There was some evidence that a delayed diagnosis of autism was associated with a greater risk of violent crime. Better school performance and intellectual disability appeared to be protective.

CONCLUSION

An initially observed association between autism and violent crimes at a population level was explained by comorbidity with ADHD and conduct disorder. Better understanding and management of comorbid psychopathology in autism may potentially help preventive action against offending behaviors in people with autism.

Personal experiences of the Criminal Justice System by individuals with autism spectrum disorders

The processes of arrest, investigation, trial and imprisonment are often extremely difficult for individuals with autism spectrum disorders. In this study, nine offenders with autism spectrum disorders were interviewed about the circumstance surrounding the criminal acts, their views of the arrest, the police interrogation, the trial and the defence and their experiences of being in prison and/or life following the offence. The nine individuals described a range of different and often negative experiences with the Criminal Justice System. However, the majority of those given a custodial sentence coped well in prison, probably due to the high levels of structure and firm frameworks in that environment. Explanation factors associated with the offences indicated that autism spectrum disorder characteristics such as misunderstandings, obsessions and idiosyncratic beliefs and/or behaviours were frequently involved, but stress was the most common explanation provided by the participants. The findings suggest limited understanding of autism spectrum disorders within the Criminal Justice System which needs to be significantly improved in order to secure their legal protection.

Autism and offending behaviour: needs and services

Purpose

Autism spectrum disorder (ASD) brings out the limitations of the Criminal Justice Service. The purpose of this paper is to review some of the salient issues and their remedies.

Design/methodology/approach

A narrative review based on the literature and the clinical experience of the authors.

Findings

ASD’s hidden disabilities, even without the frequent coexistence of other disorder, derail the standard responses to offending.

Practical implications

Management of these individuals as offenders depends on awareness of the issues, adaptation and the input of a variety of other services, especially health, social care and employment.

Originality/value

Although this is a very active field of work, there is relatively little written about it.

A preliminary study of autism and cybercrime in the context of international law enforcement

Purpose

– The purpose of this paper is to explore the association of cybercrime, autistic spectrum conditions and international law enforcement, the past decade having seen a significant growth in reported cybercrimes involving autistic individuals.

Design/methodology/approach

– Interest in the profile of autism and cybercrime and the pathways whereby such offences are committed is shared by key law-enforcement agencies worldwide. This was explored by literature review and survey.

Findings

– The authors identified a presence of persons with Autism Spectrum Disorders but no empirical evidence to suggest a prevalence or an over representation of autistic individuals committing cybercrime offences. At present profiling, pathways, and recording is under developed.

Research limitations/implications

– Paucity of literature on cybercrime and autism. Awareness of autism within law-enforcement agencies and the absence of key diagnostic and other data from the cross-section of agencies surveyed.

Practical implications

– Improve detection, diversion, profiling, risk and pathways into cybercrime.

Social implications

– Better prediction of risk of cybercrime and improved responses.

Originality/value

– Original paper believed to be the first to look at cybercrime and ASD in the context of international law enforcement.

Offending profiles of individuals with autism spectrum disorder: A study of all individuals with autism spectrum disorder examined by the forensic psychiatric service in Norway between 2000 and 2010

This study examined the characteristics of adults with autism spectrum disorder who have undergone a forensic examination and explored any relationships between the diagnosis and the offence. The reports described 41 men and 7 women. The autism spectrum disorder was diagnosed late (mean age: 25.3 years), and 22 of the 48 cases were diagnosed with autism spectrum disorder for the first time by the forensic experts. The education level and employment status were low. Family networks were close, but social networks outside the family were limited. Co-morbid diagnoses were common, and more than half of the group knew their victims. The examined individuals constitute a vulnerable and heterogeneous group, as do offenders within other diagnostic categories. Unlike most others who commit criminal acts, the majority of the individuals with autism spectrum disorder in this study showed no evidence of substance abuse, had a close relationship to their victims and were willing to confess to the accused crime. No clear association between the characteristics of autism spectrum disorder and the criminal act were identified, but in most cases, autism spectrum disorder characteristics, such as idiosyncratic comprehensions and obsessions appeared to be related to the motive for the offence.