Forensic psychiatric assessment in autism spectrum disorder: Experience of a forensic psychiatry inpatient clinic from Türkiye

Autism spectrum disorder (ASD) is a neurodevelopmental condition characterized by marked differences in communication patterns, reciprocal social interactions, and restricted, stereotyped, and repetitive interests and activities. Various behavioral problems in ASD, more so when accompanied by coexisting psychopathology, can sometimes lead to legal problems. In this study, the cases in which an opinion was requested in terms of criminal responsibility with the diagnosis of ASD in the 5-year period between 2018 and 2022 in the expertise department of psychiatric observation, where psychiatric cases were hospitalized and observed in the Council of Forensic Medicine (CFM), which is the official expert institution in Türkiye, were retrospectively evaluated. The mean age of the group whose criminal responsibility was reduced or removed was 22.9 years (±7.52) and the mean IQ score was 76.63 ± 18.94. The most common crime in this group was intentional injury (5/11), and it is noteworthy that the victims of these crimes were usually relatives of people with ASD (5/6). The criminal acts of people with ASD are usually single-movement, spontaneous, unplanned, impulsive acts. In addition, although there is no problem in cognitive perception in people with high functioning ASD (HF-ASD), various forensic situations may arise due to defects in emotional awareness. When we look at the practices of the CFM in Türkiye, it is seen that in cases where the diagnosis of ASD is clear and can be associated with the crime, criminal responsibility is usually completely eliminated. In HF-ASD types, although it is important to be associated with the crime, it is seen that criminal responsibility is generally reduced.

What do we know about autism and policing globally? Preliminary findings from an international effort to examine autism and the criminal justice system

Research has demonstrated that autistic individuals have higher rates of police contact, however, research has seldom explored the fundamental reasons for these interactions and how this might vary across international contexts. To remedy this, the Global Autism and Criminal Justice Consortium created and disseminated the Global Criminal Justice Survey. Descriptive statistics of survey respondents with and without police contact were compared to glean differential characteristics. Frequency and type of recent police interactions (within the last 5 years) among autistic individuals were also examined to better contextualize the reasons that autistic individuals encounter police. Study findings indicated that across a global sample (i.e., North America, Scandinavia, Europe, and Oceania) nearly half of all autistic individuals had an interaction with police and that those with a history of police contact were usually older, had higher educational qualifications, and were more likely to have a co-occurring mental health or developmental disorder. Among types of interactions, noncriminal encounters, such as welfare checks, traffic incidents, wandering, and behaviors associated with autism, were most common, followed by autistic individuals alleging a crime was committed against them. These findings offer important directions for future research and for targeted policy responses that can address the unique needs of autistic individuals within the justice system.

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.

Creating the Global Criminal Justice Survey: A Questionnaire Designed to Gather Perspectives from the Autism Community and Criminal Justice Professionals

Autistic people's perceptions of their interactions with criminal justice professionals are predominantly negative; however, little is known about the state of interactions on a global scale. To further understanding, a comprehensive stakeholder questionnaire was created. Aspects of reliability and validity including evidence for test content and internal structure were gathered using expert reviews, cognitive interviewing, pilot data collection, and a larger data collection effort (N = 1618). Data was gathered from the autism community through perspectives of parents/caregivers as well as from self-reported autistic adults. Criminal justice professionals included law enforcement officers, corrections professionals, probation and parole officers, forensic psychologists and legal professionals. The scale development process was detailed in order to sufficiently document the initial psychometric evidence and share the steps taken to gain diverse stakeholder input. This study is a critical first step in generating further information to facilitate policy and program development with wide applicability.

Pilot Survey: Police Understanding of Autism Spectrum Disorder

This piliot study assessed the experiences of police officers related to persons with Autism Spectrum Disorder (ASD) via a survey assessing prior experience, comfort, knowledge, and ability to identify autistic persons. Fifty-one officers completed the survey: 52.9% reported previous ASD training, 34.8% reported personal experience with ASD, and 56.9% endorsed low overall knowledge of ASD. Officers reported neutral comfort (mean 3.24) and moderate practical knowledge (mean 3.74) [Likert scale 1-5; 5 = highest]. Those with previous training or with personal experience reported higher comfort and knowledge. Those with personal experience were more likely to recognize features of ASD in clinical vignettes. Further study is necessary to understand what additional training about ASD may be helpful to police officers.

A Systematic Review of Autistic People and the Criminal Justice System: An Update of King and Murphy (2014)

The purpose of this paper was to determine whether recommendations made by King & Murphy (Journal of Autism and Developmental Disorders 44:2717-2733, 2014) in their review of the evidence on autistic people in contact with the criminal justice system (CJS) have been addressed. Research published since 2013 was systematically examined and synthesised. The quality of 47 papers was assessed using the Mixed Methods Appraisal Tool. Findings suggest a limited amount of good quality research has been conducted that has focused on improving our understanding of autistic people in contact with the CJS since 2013. Methodological limitations make direct comparisons between autistic and non-autistic offenders difficult. Autistic people commit a range of crimes and appear to have unique characteristics that warrant further exploration (i.e., vulnerabilities, motivations for offending).

Policy gaps and opportunities: A systematic review of autism spectrum disorder and criminal justice intersections

Autism spectrum disorder prevalence is rising, and as this population enters adulthood, preliminary research has identified high rates of contact with the criminal justice system. Policy and programmatic reform are crucial given reported negative and violent outcomes for autistic individuals when encountering the criminal justice system. Given the size and scope of the entire criminal justice system, identifying priorities and opportunities for change is critical, and must be rooted in evidence-based findings to maximize impact and scalability. This article provides a systematic review of the literature on autism spectrum disorder and criminal justice system intersections, analyzed through a convergent qualitative synthesis. As the extant literature is diverse and employs a variety of study methods, this review allows for an analysis across study types. The Preferred Reporting Items for Systematic Reviews and Meta-Analysis structure was utilized and captured 89 total articles from six databases. Studies are grouped by the Sequential Intercept Model, which offers a framework for analyzing criminal justice system dimensions, and informs where research at the intersection of autism spectrum disorder and the criminal justice system is most prevalent. Themes were identified at each intercept and described through key study findings to articulate implications and guidance for policy, practice, and future research to promote equitable justice for autistic individuals.

Lay abstract

The number of people with autism spectrum disorder has increased, and as this population ages, research is showing high rates of contact with the criminal justice system among this group. Social and communication differences that autistic individuals experience can act as a risk factor during these interactions, as shown by public reports of negative and violent encounters between autistic individuals and the law enforcement. There is a clear need for evidence-based strategies to reduce high rates of contact and to improve outcomes when an interaction occurs. This article provides a systematic review of research on autism spectrum disorder and criminal justice system to compile this evidence base. The Preferred Reporting Items for Systematic Reviews and Meta-Analysis structure was used to identify 89 articles after searching six databases. The Sequential Intercept Model describes the criminal justice system as different stages, or intercepts, that are connected, and the Sequential Intercept Model serves as an overall framework to organize the included articles. Articles were analyzed to identify research themes at each intercept, which offer guidance for policy and program changes that support equitable justice for autistic individuals.

Autistic adults and their experiences with police personnel: a qualitative inquiry

This study uses a qualitative methodological approach to investigate the experiences that autistic adults have when encountering police personnel. An anonymous, online, semi-structured survey asking open-ended questions about individual experience was used, and the data were analysed thematically. Although only five participants comprised the final sample, the findings illustrate how - despite differences in types of interaction and police contact - similar experiences were reported. Almost all participants reported experiencing a negative interaction with police, coupled with a limited understanding of the events surrounding their encounter. Four participants experienced some form of being stopped and questioned. This study aims to examine alternative perspectives, as previous research has focused on criminal justice personnel perspectives rather than autistic perspectives. This is one of a few qualitative Australian studies to seek individualised experiences from a community-based sample. Sampling and recruitment strategies need revision to attain a larger number of surveys in future research.

Treatment of Aggression in Adults with Autism Spectrum Disorder: A Review

BACKGROUND

Autism spectrum disorder (ASD) is a neurodevelopmental disorder characterized by markedly impaired social interaction, impaired communication, and restricted/repetitive patterns of behavior, interests, and activities. In addition to challenges caused by core symptoms, maladaptive behaviors such as aggression can be associated with ASD and can further disrupt functioning and quality of life. For adults with ASD, these behaviors can portend adverse outcomes (e.g., harm to others or to the individual with ASD, hindering of employment opportunities, criminal justice system involvement). This article reviews the scientific literature to provide an update on evidence-based interventions for aggression in adults with ASD.

METHOD

A search of the electronic databases CINAHL, EMBASE, and PsycINFO was conducted using relevant search terms. After reviewing titles, abstracts, full-length articles, and reference lists, 70 articles were identified and reviewed.

RESULTS

The strongest (controlled trial) evidence suggests beneficial effects of risperidone, propranolol, fluvoxamine, vigorous aerobic exercise, and dextromethorphan/quinidine for treating aggression in adults with ASD, with lower levels of evidence supporting behavioral interventions, multisensory environments, yokukansan, and other treatments.

CONCLUSIONS

Additional randomized, controlled trials using consistent methodology that adequately addresses sources of bias are needed to determine which treatments are reliably effective in addressing aggression in adults with ASD. In the meantime, considering efficacy and adverse effect/long-term risk profiles, a practical approach could start with functional assessment-informed behavioral interventions along with encouragement of regular, vigorous aerobic exercise to target aggression in adults with ASD, with pharmacotherapy employed if these interventions are unavailable or inadequate based on symptom acuity.

Does a Person's Autism Play a Role in Their Interactions with Police: The Perceptions of Autistic Adults and Parent/Carers

This study aimed to describe the impact that autistic characteristics (core features of autism and co-occurring conditions) have on interactions with police. Twelve autistic adults and 19 parent/carers were interviewed about interactions with police in the past 5 years. Using content analysis, it was found that in most (92.3%) interactions, autistic characteristics were described as having a role in the police interaction, either as a causal factor or more commonly by affecting the conduct of the interaction. In the latter case, the impact was associated with negative perceptions of the interaction. By sampling a more representative group across age, gender, functional abilities and context, this study provides insight into factors that underlie many autistic individual's reported dissatisfaction with police interactions.

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.

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.