Challenging and offending behaviour by adults with developmental disorders

Clinical Characteristics and Pharmacological Treatment of Individuals With and Without Intellectual Disability in Pre-trial Assessment-A Population-Based Study

Background: The current lack of knowledge about intellectual disability (ID) in forensic psychiatric contexts can compromise the legal certainty of these individuals during the medico-legal process. To address ambiguous results in previous literature, the aim of the current study was to estimate the prevalence of ID in a pre-trial forensic psychiatric settings. Moreover, as little is known about the characteristics of offenders with ID, we conducted a clinical characterization of individuals with and without ID being subject to forensic psychiatric assessment. Methods: Using data from several Swedish national registers, we conducted a population-based retrospective observational study on 8,442 individuals being subject to pre-trial forensic psychiatric assessments in Sweden in 1997-2013. We performed univariate analyses to compare the characteristics of individuals with (n = 537) and without ID (n = 7,905). Results: The prevalence of ID was 6.4% in the Swedish pre-trial forensic psychiatric context during the observational period. Compared with individuals without ID, individuals with ID were younger at the time of assessment, had a lower educational level, and had less frequently started families. ID was associated with lower frequency of diagnosed psychotic and bipolar disorders. However, a similar prescription rate of antipsychotics, and a comparable rate of previous inpatient care was observed among individuals with and without ID. Individuals with ID had more often been prescribed anti-libidinal treatments often used for treating sexual disorders, although did not present a higher prevalence of sexual disorder. Conclusions: The prevalence of ID among pre-trial individuals being subject to forensic psychiatric assessment was more than twice as high as assumed in the general population. Our results suggest that individuals with ID received pharmacotherapy without clear indication. Remaining challenges in the clinical management of individuals with ID were indicated by the discrepancy between the occurrence of psychiatric diagnoses, pharmacological treatment patterns, and rates of inpatient care.

Managing risk: a qualitative study of community-based professionals working with learning-disabled sex offenders

This study reports on research conducted to examine how community practitioners manage the difficulties of risk assessment in relation to people with a learning disability and a history of sexually offensive or abusive behaviour. Semi-structured interviews were conducted with a number of key professionals from various disciplines, all currently involved in the assessment process with the aim of determining potential referral to community settings. Data analysis revolved around a thematic exposition of factors influencing the relationship between the objective science of psychiatric investigation and the subjective interpretation of real-world practicalities in working with this group. Findings surrounded three major themes, frame conflict, relating to the difficulties of decision making in this area, therapeutic performance, whereby professionals were expected to engage in some form of active intervention, and safety outcomes, involving consideration of the problematic nature of judging the likelihood of re-offending.

Assessing the prevalence of intellectual disability among young male prisoners

BACKGROUND

In recent years, academic debate has (re)focused on the extent of the co-occurrence of intellectual disability (ID) and criminality, although findings from prevalence studies examining this link have been inconsistent. In April 2004, a process for transferring responsibility for commissioning healthcare services in UK prisons to Primary Care Trusts (PCTs) commenced. This development meant that it was important for PCTs to ascertain the need for specialist ID services in prisons in their areas. Because there were no reliable prevalence data, this research was commissioned by one such PCT.

METHOD

Using a stratified random sampling frame, data were collected from 185 young adult male prisoners aged 18 and 21 years old. Participants completed a semi-structured research questionnaire, the Kaufman Brief Intelligence Test (Second Edition) (KBIT2) and the Vineland Adaptive Behavior Scales (Second Edition) (VABS2).

RESULTS

Ten per cent had an IQ composite of 69 or below, indicating a significant impairment in cognitive functioning. A further 10% had IQ composite scores between 70 and 74, and 14% between 75 and 79. None of the sample had an Adaptive Behavior Composite (ABC) score of 69 or less, although 15% scored between 70 and 79 on this measure. While none of the sample could be classified as having an ID in strict diagnostic terms, 4% scored 69 or below on the KBIT2 and in the borderline (71-79) range on the VABS2, 4% had borderline ABCs and IQs between 70 and 74; and 3% had borderline ABCs and IQs less than 79. This equates to a point prevalence of borderline ID of 11%.

CONCLUSIONS

Eleven per cent of the sample had borderline ID, supporting suggestions that this group are prevalent--and easily hidden--in mainstream criminal justice settings. Differences between borderline ID inmates and non-ID counterparts are discussed, and implications for service delivery are considered.

Are we there yet? Screening processes for intellectual and developmental disabilities in jail settings

Early identification of intellectual and developmental disabilities in persons in the criminal justice system is essential to protect their rights during arrest and trial, ensure safety when incarcerated, and maximize the opportunities to receive services while incarcerated and postrelease. Using telephone interviews of jail administrators (N=80) in 1 state, this study examined how people with intellectual and developmental disabilities were identified in jails. Findings indicated that administrators varied widely in awareness of individuals with intellectual and developmental disabilities in their jails. Few jails (6%) used formal screening instruments for intellectual and developmental disabilities, others relied on officer observation and self-report (53%), and some provided no screening at all; in addition, officers received little training in this regard. Findings suggest that few jails are operationalizing best-practice screening processes for intellectual and developmental disabilities.

Persons with intellectual disabilities in the criminal justice system: review of issues

Although the vast majority of individuals with intellectual disabilities (ID) are law-abiding citizens, there is a small percentage with offending behaviour that is considered antisocial, socially inappropriate, or defined as illegal. It has long been recognised that individuals with ID or mental-health needs who break the law should be dealt with differently from the general population. There have been an increasing number of empirical studies in this area; however, these have been plagued by various definitional and methodological issues. Prevalence estimates of offenders with ID are complicated by diagnostic variations and inconsistencies in the criminal justice process. International studies have shown a large range, from 2% to 40%, depending on methodological approaches. The following review will highlight the salient issues including prevalence of offending, characteristics of offenders, vulnerabilities within the legal system, assessment, and a brief overview of intervention and treatment approaches.

Trends and challenges in forensic research on offenders with intellectual disability

BACKGROUND

The Journal of Intellectual & Developmental Disability has a well-respected history of establishing the parameters and contributing to developments in the field of offenders with intellectual disability (ID).

METHOD

The field has seen a number of developments over the past 15 years, and this paper identifies several trends that have emerged in the research during this period, including work on prevalence of ID in prison populations, development of risk assessment, consideration of staff issues, developing the psychometrics of offence-specific assessments, evaluating treatment methods, and testing the underlying theoretical frameworks which attempt to account for offending.

RESULTS AND CONCLUSIONS

We refer to a number of studies which have advanced these developments in the field and draw the reader's attention to the way in which papers in this special issue contribute to and further develop each of these research trends.

Research and literature on sex offenders with intellectual and developmental disabilities

The present paper sets out to review the literature on several aspects of sex offenders with intellectual and developmental disabilities, including the relationship between sex offending and developmental disabilities, the prevalence and characteristics of sex offenders in this client group, assessment, treatment, and outcome of intervention. Several important variables were identified as influencing the disparate results found in different prevalence studies. These include variations in inclusion criteria, differences in the source of the sample, differences in determination of IQ, the impact of deinstitutionalization, and the effect of changing social and penal policies in the area where studies have been conducted. Although some studies have suggested an increasing incidence, there is no clear evidence for the over- or under-representation of people with developmental disabilities amongst sex offenders. One of the main methodological flaws in several reports listing the characteristics of sex offenders is that considerations are based on clinical samples. Therefore, there is no control group to show that these characteristics do not exist in other samples of individuals with intellectual disability (ID). It does appear that sex offenders with ID are more likely to commit offences across categories and to be less discriminating in their victims. There may also be an association with sexual abuse in childhood. The primary issue considered has been assessment of competency, in that people with ID are considered to be disadvantaged by the criminal justice process. While several authors have delineated the important areas for assessment, there are few assessment measures with robust psychometric properties. Pharmacological, behavioural, educational and cognitive treatments are reviewed. Several comprehensive treatments which include all of the aforementioned methods are also considered. Although most studies do not report particularly positive outcomes, several authors have found better outcomes with treatment lasting at least 2 years.