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Traits of autism spectrum disorder and co-occuring mental
health problems among prisoners.
Background
•Support for people with autism spectrum disorder (ASD)
within the community is improving as a consequence of policy
and legislative changes.
•Specialist services are not currently provided in prisons.
•ASD and associated vulnerabilities including depression,
anxiety and suicidality often go unrecognised & unsupported.
H. Hayward , L. Underwood, J. M. McCarthy, E. Chaplin & D. M. Murphy
Email: hannah.hayward@kcl.ac.uk
Method
Participants were screened for ASD using the 20-item Autism
Quotient (AQ-20).
•Mental health was assessed using the Mini International
Neuropsychiatric Interview (MINI) – including anxiety,
depression and suicidality
•Participants who screened positive for ASD received further
assessment using standardised diagnostic tools.
Future research
•Explore the impact of screening further back in the pathway
that people take through the criminal justice system –
recognition and diversion.
•Develop ways of improving the recognition and assessment of
ASD and other comorbidities among offenders – develop
adaptive management skills among staff
Conclusions
•We identified high levels of ASD traits.
•This suggests the presence of unrecognised behavioural and
developmental difficulties in this prison setting which holds
wider implications for forensic services.
•Our data suggests that having high levels of ASD traits is
a risk factor for suicidality and common mental health
problems among prisoners.
•Improvements in prison health care should include improved
recognition of ASD, and the detection (and appropriate
treatment) of commonly occurring mental health symptoms.
Objectives
•This aim of the study was to determine the extent of ASD
and co-occurring mental health problems among
prisoners.
•We tested the hypotheses that ASD traits would be
unrecognised by prisons and significantly associated with
increased rates of anxiety, depression & suicidality.
Participants
•A total of 240 prisoners were screened.
•Sample was representative of the wider prison population:
•Selection: Opportunistic (availability) with 54 self- or staff-
referrals.
.:
Results
ASD traits
•Appeared to be distributed continuously.
•There were 39 participants (16%) with an AQ-20 score ≥10;
indicating significant autistic traits.
Diagnostic assessment
30 prisoners with ASD traits were assessed using the ADOS.
•Nine exceeded the diagnostic threshold for ASD.
•Another 3 prisoners who scored <10 on the AQ-20 but reported
an existing diagnosis also met the criteria for ASD on the ADOS.
•Only four of these 12 prisoners had been previously identified as
having ASD.
ASD & Suicidality
•Participants with ASD traits were significantly more likely to have
a high suicidality rating than those without ASD traits (27% vs.
8%, p=0.003).
ASD & Anxiety & Depression
•Those with ASD were significantly more likely to be suffering
from a current episode of depression (30% vs. 6%, p<0.001) or
Generalised Anxiety Disorder (27% vs. 11% p=0.019).
, p=0.003).
•45% were from a Black or Minority Ethnic background
•Mean age was 34 (ranging from 21 to 72).
Distribution of AQ-20 scores
Range: 1 to 15.
Mean: 6.74 (SD: 3)
•21% were from a Black or Minority Ethnic background
•Mean age was 32.4 (ranging from 21 to 49).
•39% were on the Vulnerable Persons wing.
Chi-square analyses comparing
prisoners who scored high for
ASD traits with those who did
not on measures of Suicidality,
Current depression.
& Generalised Anxiety Disorder
0
5
10
15
20
25
30
35
Suicidality Current
depression GAD
%
ASD traits
Non-ASD
p=0.003
p=0.001
p=0.019