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Traits of Autism Spectrum Disorder and Co-Occurring Mental Health Problems Among Prisoners

Authors:

Abstract

Background: The provision of support for people with autism spectrum disorder (ASD) within the community is improving as a consequence of policy and legislative changes. However, specialist services are not currently provided in prisons. Also recent initiatives to improve mental health care within the criminal justice system have not considered people with ASD. As a consequence, ASD and associated vulnerabilities including depression, anxiety and suicidality often go unrecognised and unsupported. Objectives: This aim of the study was to determine the extent of ASD and co-occurring mental health problems among prisoners. We tested the hypothesis that ASD traits would be unrecognised by prisons, and would be significantly associated with increased rates of anxiety, depression and suicidality. Methods: ASD traits were measured among 240 prisoners in a resettlement prison in London, UK using the 20-item Autism Quotient (AQ-20). Anxiety, depression and suicidality were assessed using the Mini International Neuropsychiatric Interview (MINI). Results: There were 39 participants (16%) with an AQ-20 score ≥10; indicating significant autistic traits. 12 prisoners (5%) were above research diagnostic cut off scores for ASD on the ADOS. Only three of these had been previously identified as having ASD. Mental health data were available for 37 ‘high autistic trait’ participants and another 101 prisoners with no/low ASD traits. There was a significant positive association between AQ-20 and suicidality scores (r=.29, p=0.001). Participants with ASD traits had significantly higher suicidality scores (means=15.1 (ASD) vs. 5 (non-ASD), p= 0.001) and chi-square analysis showed that they were more likely to have a high suicidality rating (27% vs. 8 %), p=0.003) than those without ASD traits. Moreover, 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 (GAD) (27% vs. 11% p=0.019) and there were significant positive associations between AQ-20 and current depression (r=.43, p<0.001) and current GAD symptoms (r=.254, p=0.003). Conclusions: We identified high levels of unrecognised ASD traits among prisoners. Our initial data suggests that severity 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.
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
... Так, по данным шведских и британских исследователей [44], распространенность РАС наиболее высока среди низших социально-экономических слоев, особенно в беднейших семьях. По данным американских исследователей, РАС часто встречаются среди мигрантов [45], среди пациентов психоневрологических диспансеров [46], а также среди заключенных в тюрьмах [47]. Так, в психиатрических интернатах доля пациентов, страдающих аутизмом, относительно велика (10%), клинические симптомы у них практически всегда сопровождаются трудностями в обучении, но им реже сопутствует криминальный опыт и/или наркотическаяе зависимостб [46]. ...
... Так, в психиатрических интернатах доля пациентов, страдающих аутизмом, относительно велика (10%), клинические симптомы у них практически всегда сопровождаются трудностями в обучении, но им реже сопутствует криминальный опыт и/или наркотическаяе зависимостб [46]. Напротив, в тюрьмах содержится довольно большое число пациентов с РАС (16%), из которых всего 1,3% был поставлен диагноз до заключения [47]. Такого рода данные получены и в Великобритании [48]. ...
Article
Full-text available
Current studies on the development autism spectrum disorders (ASD) at different ages are reviewed. The review highlights the increasing interest to this problem and converging positions of researchers from different countries, encouraged by the development of international and other classifications of mental diseases, on the terminology, classification and prevalence of ASD in children. An important feature of the present stage is to draw attention to an understudied problem of ASD in adults, including elderly and some population cohorts, and provision of medical and social care to these patients.
... Так, по данным шведских и британских исследователей [44], распространенность РАС наиболее высока среди низших социально-экономических слоев, особенно в беднейших семьях. По данным американских исследователей, РАС часто встречаются среди мигрантов [45], среди пациентов психоневрологических диспансеров [46], а также среди заключенных в тюрьмах [47]. Так, в психиатрических интернатах доля пациентов, страдающих аутизмом, относительно велика (10%), клинические симптомы у них практически всегда сопровождаются трудностями в обучении, но им реже сопутствует криминальный опыт и/или наркотическая зависимость [46]. ...
... Так, в психиатрических интернатах доля пациентов, страдающих аутизмом, относительно велика (10%), клинические симптомы у них практически всегда сопровождаются трудностями в обучении, но им реже сопутствует криминальный опыт и/или наркотическая зависимость [46]. Напротив, в тюрьмах содержится довольно большое число пациентов с РАС (16%), из которых всего 1,3% был поставлен диагноз до заключения [47]. Такого рода данные получены и в Великобритании [48]. ...
Article
Full-text available
Current studies on the development autism spectrum disorders (ASD) at different ages are reviewed. The review highlights the increasing interest to this problem and converging positions of researchers from different countries, encouraged by the development of international and other classifications of mental diseases, on the terminology, classification and prevalence of ASD in children. An important feature of the present stage is to draw attention to an understudied problem of ASD in adults, including elderly, and provision of medical and social care to these patients.
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