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Autism behind bars: a review of the research literature and discussion of key issues
Abstract
Individuals with autism spectrum disorder (ASD) may experience difficulties coping at all levels of involvement in the criminal justice system. Questions remain, however, regarding the presence and type of difficulties faced by individuals with ASD in the context of incarceration within prison settings. Despite the potential impact for community safety and concerns regarding justice, these issues have received very little academic attention. The research that does exist is generally limited by poor methodology and small sample sizes. The current paper provides a brief review and discussion of the limited extant literature regarding the experiences of prisoners with ASD with the view to summarising areas of difficulties potentially faced by such individuals. It is hoped that this brief review may highlight the need for academic attention in order to inform practice and policy regarding the criminal justice response to this potentially vulnerable population.
... They are likely to be highly vulnerable to being victimised in a custodial environment. 34 In addition, there is the risk that their condition will make the period of incarceration significantly more oppressive than it would be for other prisoners and there is also the danger that the symptoms of their condition will be aggravated by the pressures of the penitential environment. These are all factors which should bear upon judicial assessment of the appropriateness of the imposition of a custodial sentence, as well as its duration if imprisonment is the sentence selected by a court. ...
... It was his report to the police that brought the incident to the forefront of the complainant's mind and caused a renewal of her distress. (R v Balogh, 2015, at [34]) ...
... The Court of Appeal regarded this as "a harsh conclusion" in a case in which the act of non-consensual intercourse had been admitted from the outset: "A discount of about 20% would, we consider, have been appropriate in the circumstances of this exceptional case". (R v Balogh, 2015, at [34]) ...
The challenges for judicial education, for legal representatives representing those with neuropsychiatric impairments such as Autism Spectrum Disorder (ASD), Attention-Deficit/Hyperactivity Disorder (ADHD), Tourette’s Disorder (TD), Obsessive Compulsive Disorder (OCD) and Fetal Alcohol Spectrum Disorder (FASD), or a combination of such disorders, and for mental health expert witnesses are extensive. The potentially criminogenic effects of such conditions are recognised amongst some forensic psychiatrists and psychologists but they are misunderstood within the general community, the disorders are often under-diagnosed by mental health professionals, the conditions frequently exist in what may be a potentiating combination, and their effects on culpability for criminal offending can be subtle. This article outlines the essence of ASD, ADHD, TD, OCD and FASD, reviews their forensic relevance by reference to court judgments, and reflects on the need for enhanced awareness of the disorders within all sectors of the criminal justice system. It argues that these neuropsychiatric disorders constitute an area of specialist expertise foe forensic mental health experts, requiring particular and informed awareness of and capacity to communicate the complex ways in which such disorders can impair (in particular offenders in particular contexts) capacity to exercise reasoned judgment, to be aware of choices, to be conscious of the repercussions of conduct, to empathise with the situation of potential victims, and the need to control impulsivity. In addition, the capacity of persons with such disorders, as well as with their comorbidities, to cope in a custodial environment is identified an important issue deserving of informed analysis to assist humane assessment by sentencing courts.
... Autism prevalence estimates have been found to vary across the criminal justice system (CJS) and are yet to be reliably established (Archer and Hurley, 2013;Moloney and Gulati, 2019;Robertson and McGillivray, 2015). Much of the extant prevalence research has tended to focus specifically on Asperger's Syndrome diagnoses in secure hospital settings. ...
... The final aspect of the prison context that has been found to be impactful for autistic prisoners is the sensory environment (Allely and Wood, 2022;Robertson and McGillivray, 2015;Vinter, 2020;Vinter et al., 2020). Sensory differences, manifesting as sensory hypersensitivity (that is, heightened reactivity) and hyposensitivity (that is, lower reactivity), are common, albeit diverse, in autistic individuals, and can have challenging implications for autistic prisoners living in a prison setting. ...
... Several of the issues raised in this chapter can be traced back to the presence or absence of good autism awareness, and acceptance and understanding from prison staff and other prisoners. Consequently, in recent years, key recommendations for practice in the CJS (including prisons) have consistently centred around increased autism awareness training and education (McCarthy et al., 2015;Michna and Trestman, 2016;Robertson and McGillivray, 2015;Underwood et al., 2016;Vinter et al., 2020). It is the contention of this chapter that this should remain a priority in prisons, and that training should be informed by the voices of, and designed in collaboration with, autistic prisoners, to ensure that it is resonant with their needs and experiences. ...
Taking a predominantly social model perspective, this chapter aims to introduce and explore some of the challenges faced by autistic individuals serving prison sentences, which have been identified in contemporary research literature. In addition, the chapter will also identify and explore potentially supportive features of prisons for autistic prisoners. The chapter will open with a brief introduction to the social model perspective on understanding the challenges autistic individuals may face, before specifically exploring how this could be relevant and understood in a prison context. This will be followed by a discussion of some of the most common challenges faced by autistic individuals living in a prison environment. Examples of challenges include: difficulties in the prison social environment, inconsistencies in the prison routine and regime, and aspects of the prison sensory environment. This chapter will then consider some elements of prison life that have been found to be supportive features for autistic prisoners. For example; specialised support provisions, peer support, and additional simple adjustments or accommodations. The chapter will finally consider the nuances associated with rehabilitating autistic prisoners in a prison environment, exploring how the prison context can be both supportive and hindering to interventions and rehabilitation for offending behaviours. This section of the chapter will focus primarily on rehabilitation to address sexual offending behaviours to illustrate key points. The chapter will conclude with overarching recommendations on how best to work with and support autistic prisoners, with a firm focus on utilising inclusive participatory approaches and listening to the voices of autistic prisoners in the design and development of practical changes.
... As highlighted by Van Roekel et al. (2010), one reason why some adolescents with ASD may be at greater risk for being victimised is that they have deficits in developing and maintaining normal social interactions and relationships; deficits in understanding the behaviour and intentions of others (Frith and Hill, 2004); impaired communication abilities and stereotyped behaviour and interests (Haq and Le Couteur, 2004). Individuals with ASD may be housed in seclusion units to provide them with protection from bullying and victimisation from other prisoners (Newman, 2013;Robertson and McGillivray, 2015). For other individuals with ASD, isolation in a seclusion unit may be a form of behaviour management (Robertson and McGillivray, 2015;Newman et al., 2019). ...
... Individuals with ASD may be housed in seclusion units to provide them with protection from bullying and victimisation from other prisoners (Newman, 2013;Robertson and McGillivray, 2015). For other individuals with ASD, isolation in a seclusion unit may be a form of behaviour management (Robertson and McGillivray, 2015;Newman et al., 2019). However, based on their experience, Lewis et al. (2019) have also found that individuals with ASD can be victims of bullying but can find it particularly difficult and challenging to communicate these negative experiences to prison staff which results in them not receiving access to relevant and necessary support (Lewis et al., 2015). ...
... Also, loud noises can be painful for some individuals with ASD (e.g. car horn; ambulance siren). Even more importantly for a busy prison context, sounds which are combined (such as numerous people talking to each) can be overwhelming for someone with an ASD (Robertson and McGillivray, 2015). It has been suggested that there is an impaired ability to get used to certain types of sensory stimuli in individuals with ASD in the way that individuals with no ASD appear to dowhich is referred to as habituation (Robertson and McGillivray, 2015). ...
Purpose
The purpose of this paper is to add to the relatively limited existing literature exploring the experience of individuals with autism spectrum disorder in the prison environment. Prisoners with autism spectrum disorder (ASD) need to be identified in order that they are given the necessary and appropriate support and safeguards. It is increasingly recognised that, for individuals with ASD, prison can be more challenging. This can be due to ASD traits which can make problems occur in everyday life. Some of these ASD traits include: obsessions, compulsions and difficulties in communicating with others. There is increasing recognition that adults with ASD who are in prison are more vulnerable to bullying, social isolation, sexual victimisation and exploitation confrontations with other prisoners. Given this, more research is warranted in this area highlighting the specific needs and challenges of individuals with ASD in the prison.
Design/methodology/approach
This paper is a case study of Mr C.T., a British Citizen, who is currently serving a life sentence (discretionary). Mr C.T. has spent more than 10 years in prison. At the time of completing the questionnaire for the present study, Mr C.T. was 51 years of age. He pled guilty to charges of lewd, indecent and libidinous practices and behaviour; making an indecent photograph contrary to s52(1)(a) of the Civic Government (Scotland) Act 1982; and possession of indecent photographs contrary to s52(A)(1) of the Civic Government (Scotland) Act 1982. Mr C.T. was convicted of Lewd, Indecent and Libidinous Practices and Behaviour and 2 x Civic Government (Scotland) Act, Section 52 (1) (a) and was sentenced to Life Imprisonment with a punishment part of 6 years.
Findings
The case study discussed in this paper clearly raises a number of issues and concerns that urgently need attention in our criminal justice systems.
Originality/value
There is relatively little research exploring the experiences and challenges faced by individuals with ASD. This paper will add to the existing body of research in this limited field.
... Second, since a prison or jail sentence may cause harm, stress, and negative consequences for defendants with ASD as compared to "normal" defendants, mitigated sentences may help to limit the time that they spend incarcerated or even allow them to avoid jail or prison time altogether (Berryessa, 2021). Prison and jails can cause defendants with ASD to act out and trigger reactive aggression to stressors; due to their social naiveté, periods of incarceration may increase the likelihood of a diagnosed defendant being victimized, exploited, or manipulated by other prisoners (Robertson & Mcgillivray, 2015). Moreover, misinterpretations or confusion surrounding unwritten social rules that may be common in many prison environments can cause physical conflicts or fights with other prisoners. ...
... Moreover, misinterpretations or confusion surrounding unwritten social rules that may be common in many prison environments can cause physical conflicts or fights with other prisoners. Further, communication impairments can negatively impact defendants with ASD since the diagnosis may also encumber interactions with staff (Berryessa, 2021;Robertson & Mcgillivray, 2015). ...
... The third recommendation is that, in each case, legal decision-makers, particularly judges and even prosecutors crafting plea deals, should consider alternative, non-incarceration-based sentences if possible (Berryessa, 2021). As previous findings have indicated that defendants with ASD can struggle with incarceration, experience victimization from other inmates, and may be more likely to self-harm and be socially isolated when in prison or jail (Esan et al., 2015;McCarthy et al., 2019;Newman et al., 2015;Robertson & Mcgillivray, 2015), the potential vulnerabilities of defendants with ASD in incarceration environments should be cautiously weighed against whether imprisonment is necessary. Cea (2014) suggests that non-incarceration-based sentences may actually be more effective in rehabilitating defendants with ASD, while incarceration can be taxing and toxic for them as compared to the other prisoners. ...
Autism Spectrum Disorder (ASD) is a spectrum of neurodevelopmental disorders marked by impairments in social interactions, communication, hypersensitivity, and systematic patterns of behavior. Although the large majority of individuals with ASD are law-abiding, many individuals with ASD continue to become involved in the criminal-legal system as defendants each year. Yet research indicates that legal decision-makers in court are often unaware of the potential forensic significance of ASD, which may lead to negative legal consequences for diagnosed defendants. This chapter provides a thorough overview of how and why defendants with ASD create challenges and issues for decision-makers in criminal cases, including a discussion on the forensic relevance of ASD and its symptomatology to both offending and courtroom behaviors, a review of the limited existing literature on the perceptions and decision-making of potential jurors, judges, and attorneys in cases involving defendants with ASD, and an examination of different stages of the criminal-legal process in which ASD may be forensically significant. Finally, this chapter provides three recommendations for decision-makers on how to potentially reduce negative legal consequences and outcomes for defendants with ASD, as well as calls for and identifies areas of future research at this nexus.
... Comparably less autism prevalence research has been conducted in prison settings, and the prevalence of autism in prisons is yet to be reliably established (Archer & Hurley, 2013;Moloney & Gulati, 2019;Robertson & McGillivray, 2015). A recent review paper by Railey et al. (2020) indicated a lack of contemporary research that has investigated the prevalence of autism in the CJS (including prison settings), with wide ranging prevalence estimates and varied methods used across the extant literature. ...
... Problematically, research has indicated that serving a prison sentence is associated with additional unique challenges for autistic individuals, relevant to their autism (Allely, 2015;Helverschou et al., 2018;Newman et al., 2015;Robertson & McGillivray, 2015;Vinter et al., 2020). For example, the prison routine has been consistently highlighted as impactful for autistic prisoners (Allely, 2015;McAdam, 2012;Newman et al., 2015;Vinter et al., 2020). ...
... Interactions with other prisoners and prison staff have also been frequently highlighted as challenging, with regards to prison experiences of autistic individuals (Allely, 2015;Helverschou et al., 2018;Newman et al., 2015;Paterson, 2008;Vinter et al., 2020); which is likely associated with the social communication and interaction difficulties that are characteristic of autism (APA, 2013; Robertson & McGillivray, 2015). Evidence suggests that autistic prisoners can find it difficult to establish and maintain friendships with other prisoners, lacking confidence to interact with others, particularly with non-autistic prisoners who they feel have a different way of being (Helverschou et al., 2018;Newman et al., 2015). ...
Research indicates that autistic individuals are no more likely to offend than anyone else in the general population. However, it has been suggested that when autistic individuals do offend, their offending behaviour can be contextualised by their autism. One of the most common forms of offending reported to be committed by autistic individuals are sexual offences, and research has outlined how autism can contribute to those offences. Additionally, recent research has also indicated that autistic prisoners may experience unique challenges and have specific support needs during their prison sentences, which potentially differ from their non-autistic peers. Despite this, little research has specifically explored how to work with, support and manage autistic individuals with sexual offence convictions (ISOCs) in prison-based interventions to address sexual offending.
This thesis details an exploratory sequential mixed method approach used to explore effective work practices with autistic ISOCs in prison-based interventions to address sexual offending. Specifically, this thesis explored the following research questions; 'How appropriate are current prison-based sexual offending interventions for autistic ISOCs?' And 'What is best practice when working with autistic ISOCs in prison-based sexual offending interventions?'. To answer these research questions, the thesis sought to: (i) identify challenges associated with prison-based sexual offending interventions for autistic ISOCs; (ii) identify beneficial features of prison-based sexual interventions for autistic ISOCs; and (iii) to generate evidence-based, practical recommendations on how to work with autistic ISOCs in prison-based sexual offending interventions.
This thesis is constructed of six chapters. Chapter 1 provides a broad introduction to the topic background and rationale of the thesis, concluding with the overarching research questions and aims. Chapter 2 provides a discussion of the methodological issues that were relevant to the empirical studies of the thesis, including a rationale for the mixed method design. Chapter 3 reports Study 1, which was a qualitative narrative exploration of the life stories of autistic ISOCs (N= 4). This study incorporated an inclusive, participatory autism research approach, and discusses how diversity and similarities in those life stories may be relevant for interventions. Chapter 4 reports Study 2, a multi-perspective qualitative study that utilised a phenomenologically informed thematic analysis to explore the issues surrounding working with autistic ISOCS in prison-based interventions to address sexual offending, from the perspectives of autistic ISOCs (N= 12) and staff (N= 13). Chapter 5 details Study 3, a quantitative study that sought to confirm qualitative findings reported in Chapter 4; relating to the relationships between autistic traits, the prison social climate, mental wellbeing and readiness to 6 engage with interventions in a sample of ISOCs serving prison sentences (N= 177). Finally, Chapter 6 provides a synthesis and general discussion of the collective findings from the empirical studies. Chapter 6 also details practical recommendations for working with autistic ISOCs in prison-based sexual offending interventions, directions for future research, highlights the original contributions of the thesis, considers broader limitations of the research, and offers a final conclusion.
... Fear of social interaction may lead an incarcerated adult with ASD to self-isolate (Gómez de la Cuesta, 2010). Persons with ASD may be housed in seclusion units as a form of protection from bullying and victimisation (Newman, 2013;Robertson and McGillivray, 2015). For others, isolation may be enforced as a form of behaviour management (Robertson and McGillivray, 2015). ...
... Persons with ASD may be housed in seclusion units as a form of protection from bullying and victimisation (Newman, 2013;Robertson and McGillivray, 2015). For others, isolation may be enforced as a form of behaviour management (Robertson and McGillivray, 2015). Behaviour management may be applied in response to disobedience, aggressive outbursts or rude and disruptive behaviour (Michna and Trestman, 2016). ...
... Behaviour management may be applied in response to disobedience, aggressive outbursts or rude and disruptive behaviour (Michna and Trestman, 2016). This behaviour may result from the persons' experience of distress related to the demands of adapting to the environment and frustrations associated with social and communication difficulties (Lewis et al., 2015;Robertson and McGillivray, 2015). ...
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.
... Without understanding the profile of those in care of the system, it is impossible to appropriately plan for services and programs. Offenders with I/DD are less likely to participate in programs that enable early release either because these programs are not adapted to their needs, they are not well informed of their options (Ellem, 2012), or they self-isolate because of bullying and victimization (Riches et al., 2006;Robertson and McGillivray, 2015;Underwood et al., 2013). Furthermore, offenders with these disabilities may display more anger, aggression (Taylor, 2002), or uncooperative behavior due to communication difficulties and, thus, may be subject to more restrictive housing or be labeled as mentally ill and placed in a psychiatric unit (Hayes, 2007;Lewis et al., 2015). ...
... On the consenting page, participants were provided the definition of ID from The Arc and the American Association on Intellectual and Developmental Disabilities[1] as well as the definition of ASD from the Centers for Disease Control and Prevention's page on ASD[2]. These two disorders were focused on because ID encompasses a range of disabilities related to cognitive and adaptive functioning and ASD is an increasingly recognized and diagnosed condition that is qualitatively distinct from ID, yet often leads to similar concerns of accurate identification and misunderstandings of needs in the criminal justice system (Lewis et al., 2015;Robertson and McGillivray, 2015;Underwood et al., 2013). ...
... The difficulty in working toward a solution, however, rests with the fact that criminal justice systems are under resourced. Yet to justify allocating resources toward this cause requires an accurate assessment of the scope of the problem (Robertson and McGillivray, 2015), which itself requires resources. ...
Purpose
The purpose of this study was to assess the training forensic mental health professionals in the United States receive on intellectual and developmental disabilities (I/DD). Given the difficulties obtaining accurate prevalence rates of these disabilities in criminal justice settings, it is important to understand how these disabilities are being evaluated and the level of understanding about these disabilities evaluators hold.
Design/methodology/approach
An online survey was distributed to forensic mental health professionals in the U.S. that included questions on training opportunities in graduate education, post-graduate forensic training, and professional training opportunities. Participants were also asked about their current work, how they assess I/DD, and their estimates on the percentage of cases they see with I/DD.
Findings
Respondents reported some training that focused heavily on assessment methods. Most respondents estimated between 5% an 25% of their cases involving I/DD and reported using a wide range of assessment methods. Finally, many respondents reporting more training needed in this area.
Practical implications
More training is needed for forensic mental health professionals on identifying I/DD. Additionally, professional guidelines on what tools and methods to rely on to identify these disabilities is paramount to ensure homogeneity of methods and, thus, better estimates of overall prevalence in criminal justice settings
Originality/value
This is the first assessment focused on how forensic mental health professionals are trained to identify I/DD and can be used to improve identification of I/DD in forensic settings.
... Some autistic individuals may be allocated to special population units (e.g. vulnerable prisoner units) in an attempt to provide protection from bullying and victimisation from other prisoners [164]. For other autistic individuals, segregation or separation units may come to act as forms of behaviour management [151,164]. ...
... vulnerable prisoner units) in an attempt to provide protection from bullying and victimisation from other prisoners [164]. For other autistic individuals, segregation or separation units may come to act as forms of behaviour management [151,164]. However, autistic individuals may find it particularly difficult to communicate with staff about negative experiences of bullying, resulting in them not receiving access to necessary support [159]. ...
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.
... Prison can be more challenging and distressing for individuals with ASD due to isolation, prisoner politics and aggression or violent relationships, the disruption to or of prison routines, and sensory sensitivities within the prison environment (Allely, 2015a(Allely, , 2015bRobertson & McGillivray, 2015). Newman et al. (2019) have noted there is growing recognition that adults with ASD who are in prison are potentially more vulnerable to bullying, social isolation, sexual victimization, exploitation, and confrontations with other inmates (see English & Heil, 2005; Gómez de la Cuesta, 2010; Lewis et al., 2015;Michna & Trestman, 2016). ...
... Certain sounds, such as a computer fan, overhead lights, and rain on a window, may be experienced by individuals with ASD as intense and extremely distressing. While neurotypical individuals may become used to these sounds via a process known as habituation, those with ASD can struggle to do so (Robertson & McGillivray, 2015). Therefore, many individuals with ASD may be unable to habituate to the noise of the prison environment, including alarms, the slamming of doors, shouting, and the din of TVs and radios, which can all be amplified within the contained environment. ...
Julian Assange is an Australian national and the founder of WikiLeaks, a nonprofit organization that publishes news leaks and classified information provided by anonymous whistle-blowers. In May 2019, a United States federal grand jury returned an 18-count criminal indictment against Assange. If convicted, Assange could face up to 10 years of incarceration for each Espionage Act (1917) charge and up to 5 years for conspiracy to access a government computer network. Due to Assange’s current physical location in the United Kingdom, the United States has requested extradition. However, to date, there has been limited scholarly discussion of the relationship between Assange’s autism spectrum disorder (ASD) diagnosis and his potential extradition and lengthy pretrial or postconviction imprisonment in the United States. This article explores the psychiatric submissions from Assange and the United States in light of available evidence on ASD and the risk of suicide among people who are imprisoned. The analysis will focus on common misperceptions about ASD, the particularly detrimental impacts of the prison environment on individuals with ASD, the varying opinions of Assange’s ASD diagnosis, and the importance of considering Assange’s risk of suicide in the context of ASD. From a human rights and individual fairness perspective, a complete understanding of the significance of these issues which does not minimize a diagnosis of ASD is paramount for Assange and any future case with similar elements.
... The combination of social, emotional, and educational challenges, along with the lifelong persistence of these issues, puts neurodiverse students at a heightened risk [10,11]. As a result, they have difficulties coping with normal conditions of life, especially when they are exposed to stressful events [12]. Moreover, neurodiverse students may have difficulties in sensorimotor functioning, emotional codes, communication, and cognition, albeit causing emotional distress [13]. ...
BACKGROUND
Neurodiverse students frequently encounter distinct challenges that can adversely affect their mental well-being. This research aimed to investigate emotional distress, depression, and anxiety among neurodiverse students, examine the interrelationships among these factors, and assess the impact of participant characteristics.
AIM
To address the problem of lack of data pointed out in the neurodiversity research in Nigeria, this study aims to examine the emotional distress, depression, and anxiety in neurodiverse students.
METHODS
A cross-sectional study was carried out involving 200 neurodiverse students in Nigeria. Participants filled out self-report questionnaires that measured emotional distress (Brief Emotional Distress Scale for Youth), depression (Center for Epidemiologic Studies Depression Scale Revised), and anxiety (State-Trait Anxiety Inventory). The data were analyzed using descriptive statistics, correlation analyses, Bayesian Mann-Whitney U tests, two-way ANOVAs, and Kruskal-Wallis tests.
RESULTS
Anxiety was found to have the highest prevalence (mean = 68.8), followed by depression (mean = 34.2) and emotional distress (mean = 26.3). Significant positive correlations were identified among all three mental health factors, with the strongest correlation observed between depression and anxiety (rho = 0.492, P < 0.001). Moderate evidence indicated gender differences in emotional distress (BF10 = 2.448). The interaction between educational environment and diagnosis had a significant effect on emotional distress (F = 3.106, P = 0.017). Kruskal-Wallis tests indicated significant variations in anxiety levels across different educational settings (P = 0.002), although post-hoc comparisons did not reveal significant differences among specific settings.
CONCLUSION
This research emphasizes the prevalence of mental health challenges among neurodiverse students, particularly concerning anxiety. The intricate relationships among emotional distress, depression, and anxiety highlight the necessity for thorough mental health support. The impact of educational settings and diagnoses on mental health outcomes stresses the importance of customized interventions. These findings are significant for educators, mental health professionals, and policymakers in formulating targeted support strategies for neurodiverse students.
... 7 ADHD is categorized by symptoms of impulsivity, hyperactivity, and inattention leading to considerable daily impairment. 8,9 Individuals with autism/ADHD and their families have reported many impacts of these conditions such as significant academic underachievement and educational problems, [10][11][12] increased prevalence of depression and anxiety, 13,14 higher rates of offending behavior and imprisonment, [15][16][17] divorce, 18 driving accidents, 19-21 unemployment, 13,22,23 suicidal thoughts and behaviors, 24,25 and other mental health issues. 26,27 Studies have shown that adults with undiagnosed autism/ADHD are more likely to have educational problems, depression, and anxiety; commit crimes; and abuse substances. ...
... This vulnerability becomes evident throughout multiple stages of the criminal justice process, ranging from initial encounters with police [10] through to police interviews [11], to court room proceedings [12] and prison services [13]. This heightened vulnerability is exacerbated by the reported general lack of understanding of ASD within the CJS, among both professionals and the general public [13][14][15][16]. ...
Previous research has suggested that the core features of autism spectrum disorders (ASD) may contribute to offending behaviours and increased vulnerability within the Criminal Justice System. To date, there is a paucity of evidence assessing the effectiveness of interventions for offending behaviour in adults with ASD but without co-occurring intellectual disability (ID) across a broad range of forensic settings. The lack of robust evidence is concerning, as limited effectiveness may contribute to an increased likelihood of prolonged incarceration, particularly in the most restrictive settings. A PRISMA systematic review was conducted with a narrative synthesis to: (a) evaluate the evidence of the effectiveness of interventions aimed at reducing recidivism, (b) assess whether the core features of ASD impact the effectiveness of these interventions, and (c) identify additional factors that may affect the effectiveness of interventions within this population. Seven studies involving ten male participants were identified. The findings suggest that interventions for offending behaviours in adults with ASD without intellectual disability (ID) are largely inadequate, and that core ASD features need to be considered. Additionally, a complex interplay of risk factors potentially impacting intervention effectiveness was suggested. Limitations include heterogeneity across intervention types, measures of effectiveness, and what constitutes effectiveness. Despite the limited number of studies and data quality, the review aligns with a growing body of literature highlighting vulnerability and a need for evidence-based interventions for people with ASD. The review also discusses the broader implications of ineffective interventions.
Supplementary Information
The online version contains supplementary material available at 10.1186/s40359-024-01770-1.
... Consequently, staff felt that such exercises were not well-suited to the learning style of autistic individuals. This is consistent with previous work, showing how these tasks may be difficult for autistic individuals due to a range of cognitive difficulties (e.g., social perspective taking, theory of mind, and cognitive inflexibility; Boucher & Mayes, 2012;Lind, 2010;Lind & Bowler, 2010;Melvin et al., 2017;Robertson & McGillivray, 2015). ...
Research suggests that sexual offending is one of the more common forms of offending behaviour committed by autistic individuals. Despite this, very little research has investigated approaches to rehabilitation for autistic individuals who have sexually offended. The small body of literature that does exist suggests that interventions to address sexual offending may not be sufficiently adapted for this group. In this paper we present an exploratory qualitative study that (i) explores how prison-based interventions to address sexual offending are experienced by autistic individuals with sexual offense convictions and the staff who work with them, and (ii) identifies and explores the features of prison-based sexual offending interventions that may be challenging or beneficial for autistic individuals, from the perspective of those involved in treatment. Semi-structured interviews were conducted with 12 autistic men serving prison sentences for sexual convictions, and 13 members of prison staff. A multi-perspective phenomenologically-informed thematic (MPT) analysis identified three themes of ‘Feeling overwhelmed’, ‘Out of the comfort zone’, and ‘(Dis)connected to others’. These themes highlight some of the key issues relating to the format and delivery of interventions, as well as the impact of the broader prison context on rehabilitation.
... A custodial sentence which is too long may be particularly damaging for individuals with autism spectrum conditions (Cea, 2014;Allely, 2015;Lewis, Pritchett, Hughes, & Turner, 2015;Robertson & McGillivray, 2015). Inmates with autism spectrum conditions have been suggested to be more vulnerable to bullying and social isolation within the prison environment. ...
Cooper, P., Berryessa, C. M., & Allely, C. (2016). Understanding What the Defendant With Asperger’s Syndrome Understood: Effective Use of Expert Evidence to Inform Jurors and Judges. Criminal Law & Justice, 180(44), 792-794.
... Individuals with ASD and/or ADHD (henceforth ASD/ ADHD) report difficulties in obtaining appropriate support, diagnosis, and treatment for difficulties associated with their conditions (Camm-Crosbie et al., 2019;Hayes et al., 2018;Sayal et al., 2018). This leads to poorer outcomes for the individual and their families, such as significant academic underachievement and educational problems (Arnold et al., 2020;Barry et al., 2002;Estes et al., 2011), increased prevalence of depression and anxiety (Howlin & Magiati, 2017;Stewart et al., 2006), higher rates of offending behavior and imprisonment (Haskins & Silva, 2006;Robertson & McGillivray, 2015;Young & Thome, 2011), divorce (Anastopoulos et al., 2009), driving accidents (Daly et al., 2014;Groom et al., 2015;Ulzen et al., 2018), unemployment (Halleland et al., 2019;Hedley et al., 2017;Howlin & Magiati, 2017), suicidal thoughts and behaviors (Cassidy et al., 2022;James et al., 2004) and other mental health issues (Able et al., 2007;Ómarsdóttir et al., 2021). Undiagnosed adults with ADHD are more likely to present with difficulties at work , substance abuse Folgar et al., 2018) or increased medical incidents and injuries Kittel-Schneider et al., 2019;Swensen et al., 2004). ...
... Individuals with ASD and/or ADHD (henceforth ASD/ ADHD) report difficulties in obtaining appropriate support, diagnosis, and treatment for difficulties associated with their conditions (Camm-Crosbie et al., 2019;Hayes et al., 2018;Sayal et al., 2018). This leads to poorer outcomes for the individual and their families, such as significant academic underachievement and educational problems (Arnold et al., 2020;Barry et al., 2002;Estes et al., 2011), increased prevalence of depression and anxiety (Howlin & Magiati, 2017;Stewart et al., 2006), higher rates of offending behavior and imprisonment (Haskins & Silva, 2006;Robertson & McGillivray, 2015;Young & Thome, 2011), divorce (Anastopoulos et al., 2009), driving accidents (Daly et al., 2014;Groom et al., 2015;Ulzen et al., 2018), unemployment (Halleland et al., 2019;Hedley et al., 2017;Howlin & Magiati, 2017), suicidal thoughts and behaviors (Cassidy et al., 2022;James et al., 2004) and other mental health issues (Able et al., 2007;Ómarsdóttir et al., 2021). Undiagnosed adults with ADHD are more likely to present with difficulties at work , substance abuse Folgar et al., 2018) or increased medical incidents and injuries Kittel-Schneider et al., 2019;Swensen et al., 2004). ...
Background:
The two most prevalent neurodevelopmental disorders-Attention Deficit Hyperactivity Disorder (ADHD) and Autism (ASD)-(ASD/ADHD) strongly impact individuals' functions. This is worsened when individuals are undiagnosed and risks such as increased imprisonments, depression or drug misuse are often observed. This systematic review synthesizes the risks associated with late/undiagnosed ASD/ADHD.
Methods:
Four databases were searched (Medline, Scopus, PsychInfor, and Embase). Published studies exploring the impact of undiagnosed ASD/ADHD were included. Exclusion criteria included, lack of diagnosis status, studies not solely on ASD or ADHD, gray literature and studies not in English. The findings were summarize through a narrative synthesis.
Results:
Seventeen studies were identified, 14 on ADHD and three on ASD. The narrative synthesis identified three main themes: (1) Health, (2) Offending behavior, and (3) Day-to-day impact. The risks highlighted a significant impact on mental wellbeing and social interactions, higher risks of substance abuse, accidents and offending behavior as well as lower levels of income and education.
Discussion:
The findings suggest that undiagnosed ASD/ADHD is linked to many risks and negative outcomes affecting individuals, their families, and the wider society. The restricted number of studies on ASD are a limitation to the generalization of these findings Implications for research and practice are discussed, highlighting the importance of screening and acknowledging the possibility of ASD/ADHD in many settings such as psychiatric and forensic.
... Schools would benefit from having diagnosed children as they can implement adapted educational strategies to manage difficult behaviours, directly impacting school and pupils' performance and the classroom learning environment. The long-term costs of ADHD can be severe, such as significant academic underachievement and educational problems [57][58][59], increased prevalence of depression and anxiety [60,61], higher rates of offending behaviour and imprisonment [62,63], divorce [64], driving accidents [65,66], unemployment [67,68], suicide [69,70] and other mental health issues [71]. These considerable risks are attenuated when ADHD is diagnosed, as diagnosis facilitates access to care or support [72]. ...
Despite ADHD impacting around 5% of children in the UK, a lot of healthcare professionals are ill-equipped to deal with this disorder, especially in primary care. Untreated and undiagnosed ADHD can strongly impact individuals throughout their lifetime. It is therefore vital that individuals access treatment and diagnosis at an early stage. The diagnosis pathway for ADHD is complex and varies across countries. However, in many countries, specialist services are responsible for ADHD diagnosis and treatment, following a referral from a primary care physician (PCP). Without such referral, individuals are often unable to access care. Previous studies have shown that PCPs are often ill-equipped to deal with individuals with ADHD, highlighting a lack of knowledge and training, directly impacting access to care. To increase PCPs' knowledge of ADHD, a novel online training program was developed. This innovative approach included co-production with PCPs throughout the development process and is the only online ADHD training to date tailored for PCPs that has been evaluated through a randomised control trial. This chapter first presents common ADHD pathways to care and the barriers to PCPs' understanding of ADHD. The chapter then looks at the development and evaluation of an online intervention aimed at increasing PCPs' confidence and understanding of ADHD.
... Yet, although incarceration could be extremely punitive for offenders with ASD, 189 alternative dispositions, such as detention in secure hospitals or psychiatric units, may not better address their needs or ensure they do not experience abuse. 190 Moreover, there may be limited capacity to supervise and support offenders with ASD who are released from prison. 191 In addition to the gravity of the crimes that the offenders committed and their perceived risk of recidivism, these factors may explain why some of the courts did not consider sanctions other than imprisonment, despite acknowledging the burden it would impose on the offenders. ...
The number of defendants raising an Autism Spectrum Disorder (‘ASD’) diagnosis in criminal proceedings is increasing. Australian courts treat this neurodevelopmental disorder as a mental impairment that they may take into account in sentencing. A few studies nonetheless exposed deficiencies in judicial officers’ understanding of ASD symptoms and their potential forensic relevance. Courts’ willingness to rely on expert evidence did not always lead to them sentencing offenders with ASD in a consistent or enlightened manner. Building on those investigations and drawing on research into ASD, this article examines sentencing decisions involving eight offenders with ASD in various Australian jurisdictions between 2014 and 2020. This analysis demonstrates that judicial officers’ knowledge about ASD and appreciation of its possible relevance to sentencing considerations are growing, but there remain gaps in both respects. The article speculates on possible reasons for this and proposes reforms to improve courts’ approaches to sentencing offenders with ASD.
... Contributing factors to an increased risk include social naiveté, difficulties with social situations, obsessional interests, difficulties with change and problems with behavioural planning (Helverschou et al. 2015;Robertson and McGillivray 2015). There have been suggestions that behaviours associated with autism are misinterpreted within the criminal justice system and autistic individuals may consequently be considered to lack remorse (Allen et al. 2008;Berryessa 2016). ...
Previous studies indicate that autistic individuals can experience increased distress in prison, leading to significant disruption in the prison regime and difficulties in rehabilitation (Allely 2015; Allen et al. 2008). This exploratory study investigates autism knowledge and training needs among prison officers. Current understanding, possible training content and a strategy for implementation of autism training for officers are all explored. Methods utilised include a survey and interviews/focus group. Themes identified include specific vulnerabilities, staff skill, training needs and implementation barriers. Participants showed some awareness, but lacked understanding of autism in a prison setting. This article explores whether focused training on one condition is problematic, due to limited resources within the prison system. A wider focus on practical skills to supporting people with neurodiverse conditions and links with non‐prison‐based local health services is seen as more effective than focusing on individual diagnosis within a prison setting.
... This current study found those with elevated levels of autistic traits were significantly more likely to have a diagnosis of depression, anxiety and personality disorders. These findings clearly indicate that there is a need not only identify whether a prisoner has ASD or autistic traits (if it is not already known) but whether that individual also has any comorbid mental health disorders as this psychological complexity may potentially have an adverse impact on their rehabilitation and reintegration (Robertson & McGillivray, 2015). In addition, mental disorders in individuals with autistic traits (such as anxiety and depression) can further exacerbate problems or difficulties they are facing within a prison setting. ...
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.
... This situation has direct implications on how the law enforcement authority should respond to the physical and mental needs of autists. A number of researchers found that most autists face difficulty within the criminal justice system (Archer & Hurley, 2013;Chown, 2010;Gardner et al., 2019;Maras et al., 2017;Robertson & McGillivray, 2015;Talbot & Riley, 2007). According to Syriopoulou-Delli et al. ...
An autist refers to a person who suffers from Autism Spectrum Disorder (ASD), a complex disorder of mental development, causing the person to be adversely affected, especially in social and behavioral aspects of life. Prior to the introduction of a specific Standard Operating Procedure (SOP) for the arrest and detention of autists, the Royal Malaysia Police applied the same standard operating procedure in the Criminal Procedure Code for typical individuals, to autists suspected of criminal offences. However, the issue arising is the legal rights of people with disabilities whereby this SOP is seen as inappropriate and unsuitable to be applied to cases involving autists. As a result, the authorities and parties involved in handling autists came up with the idea of the need for a specific SOP applicable for their arrest and detention. Finally, in the year 2019, the Royal Malaysia Police, in cooperation with NGOs directly involved with autist, successfully launched a specific SOP for autists. The objectives of this article are to study the significance of the specific SOP for autists, and analyse and compare it with the usual SOP for typical people. The methodology of this research is qualitative. Collection of research data used document analysis. Data obtained was thematically and comparatively analysed. Research results find that there are differences between the specific SOP for autists and standard SOP for typical suspects. The differences lie in the legal rights of the autists in Malaysia, namely, in the aspects of arrest and detention of autistic suspects.
... There is a small but growing body of research concerning autistic individuals' contact with police (King and Murphy 2014;Railey et al. 2020). In general, the focus of much of this work has been to determine whether autistic people are more likely to be involved in a range of criminal offences and to what extent this may be due to their autistic nature (Robertson and McGillivray 2015;Rutten et al. 2017). Loureiro et al. (2018) attempted to answer this by examining the prevalence of autistic traits in convicted offenders. ...
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.
... society as a whole has vastly improved awareness of mental health problems within the criminal justice system and the majority of criminal justice or correctional professions receive some training on mental health, rarely do staff and professionals receive training relevant to specific psychological or developmental problems (Kennedy-Hendricks, Huskamp, Rutkow, & Barry, 2016;McCormick, Peterson-Badali, & Skilling, 2015). Lack of training specific to ASD is a barrier for people with ASD to successfully navigating the criminal justice system and being adherent to treatment or correctional conditions because the treatment needs and support services they require are strikingly different from the needs of the neurotypical population (MacDonald, Clarbour, Whitton, & Rayner, 2017;Robertson & McGillivray, 2015). ...
Despite a tremendous amount of research existing on Autism Spectrum Disorder, very little of the literature offers insight into the underlying mechanisms of the disorder, namely the social deficits associated with Autism Spectrum Disorder. This study sought to analyze the social deficits associated with Autism from a social dynamics perspective. A thematic analysis of the exhisting literature on social deficits attributable to Autism was conducted. Several minor themes were elicited that suggests a prectible dynamic interaction process exists between individuals with Autism and those who are neurotypical often plays out. Practical application and exacerbating factors within the social environment are discussed.
... Research on their experiences in prison has been limited (Robertson & McGillivray, 2015). Distress, vulnerability, isolation and relational issues with staff have all been described. ...
Dear Editor,
I read with interest, ‘Autism spectrum disorder and Irish prisoners’ (Moloney & Gulati, 2019). Similar to Ireland, the UK prevalence of autism spectrum disorder (ASD) within the prison estate remains poorly understood. Estimation relies largely on extrapolation from
general populations (Robinson et al. 2012). Reasons for this have been considered (Chaplin & McCarthy, 2014) and cited as: lack of screening programme; lack of suitable screening assessment tool; limited use of
standardised assessment tools (i.e. Autism Diagnostic Observation Schedule or Autism Diagnostic Interview) by in-reach teams and diagnostic difficulties owing to practical limits on attaining corroborating evidence. Furthermore, it has been highlighted, with reference to neurodevelopmental disorders, that prison mental
healthcare and research has historically tended to focus on serious mental illness (Underwood et al. 2013). Complexity, heterogeneity and co-morbidity are all to be borne firmly in mind in the identification of such patients and in adequately meeting their therapeutic and offending behaviour needs...
... Prisons are complex social environments with strong hierarchies where vulnerable prisoners are open to intimidation, emotional, physical or sexual abuse and exploitation. Robertson & McGillivray (2015) comment on the difficulties faced by incarceration in those with ASD where issues with social communication, understimulation or overstimulation and difficulties adapting to change lead to problems including maladaptive coping behaviours, interpersonal conflict and adverse forensic outcomes. The ability of those with ASD to meaningfully engage with rehabilitate, adaptive living programmes or group-based cognitive behavioral therapy may be limited. ...
Autism spectrum disorder and Irish prisoners - Noreen Moloney, Gautam Gulati
... The two reviews to date that have examined the experiences of individuals with ASD in the prison environment (Robertson and McGillivray, 2015;Allely, 2015) both highlight the difficulties individuals with an ASD have within prisons as a result of the mismatch between an individual's difficulties with the social demands and physical constraints of such environments. Worse case scenarios have suggested that individuals with ASD can be more vulnerable to bullying, exploitation, sexual and physical victimisation, social isolation and confrontations with other inmates (English and Heil, 2005). ...
Purpose
The purpose of this paper is to review available literature targeting the assessment and management of individuals with an autism spectrum disorder (ASD) admitted to high secure psychiatric care (HSPC). Key areas of examination include the prevalence of ASD in HSPC, how individuals with an ASD differ from other patient groups in clinical and cognitive characteristics, the views of staff regarding patients with an ASD, an exploration of the experiences and quality of life of patients with an ASD, as well as treatment and interventions.
Design/methodology/approach
A review of the published literature.
Findings
Although individuals with an ASD comprise a relatively small proportion of the total HSPC cohort, they appear to be over represented relative to the general population prevalence. Several research projects suggest that individuals with an ASD present with difficulties and needs different to other patient groups, as well as being viewed by staff as potentially vulnerable and requiring a different care approach. Individuals with an ASD report both positive and negative aspects to life in HSPC.
Practical implications
Suggestions are made with regard to how individuals with an ASD might be better managed in HSPC. Following the spirit of various pieces of government legislation such as the Autism Act (2009) and the Equalities Act (2010) the role of a specialist ASD HSPC service is proposed.
Originality/value
This paper provides a detailed review of the research to date exploring the assessment and management of individuals with an ASD detained in HSPC. It outlines key research findings, highlights limitations with it and provides a personal perspective on future research and clinical targets.
... Many studies have focussed on AS which may be a reflection of the greater numbers of higher-functioning individuals within the CJS (e.g. Cashin and Newman, 2009), and few studies have looked specifically at the experiences of ASD in prisoners (Allely, 2015;Robertson and McGillivray, 2015), which further limits our understanding of how this group may cope with custody. ...
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.
... While there have been numerous studies investigating the offending behaviour of individuals with ASDs, there has been very little research investigating the experience and difficulties faced by such individuals in the prison environment (Haskins and Silva, 2006;Lewis et al., 2015). Two recent reviews highlight the lack of research which has explored the experiences of individuals with ASD in the prison environment (Robertson and McGillivray, 2015;Allely, 2015). For inmates with ASD, numerous issues can result from the social and physical constraints of the prison environment. ...
Purpose
Patients with autism spectrum disorder (ASD) present with specific assessment, specific difficulties, needs and therapeutic issues and therefore are a challenging group for forensic services. Given the challenge that individuals with ASD present to forensic services, the suggested increase in the number of this group within this setting and the relatively little amount of research which suggests they face a number of difficulties within the prison environment, the purpose of this paper is to identify and review all the studies which have been carried out investigating any aspect of ASD in relation to secure hospital settings.
Design/methodology/approach
Seven internet-based bibliographic databases were used for the present review. The review followed the Preferred Reporting Items for Systematic reviews and Meta-Analyses guidelines.
Findings
A total of 12 studies were included in this review; 3 looked at the prevalence of ASD in secure psychiatric hospitals. One study evaluated the clinical utility of the AQ screening tool to assess self-reported autistic traits in secure psychiatric settings. Three explored any type of characteristics of patients with ASD detained in secure psychiatric hospitals. One study investigated the experiences or quality of life of patients with an ASD detained in secure psychiatric care. Two studies investigated awareness, knowledge and/or views regarding patients with ASD held by staff working within secure psychiatric hospitals. Lastly, three studies (one of which was also included in the prevalence category above) looked at the effectiveness of interventions or treatment of patients with ASD in secure psychiatric hospitals. Clinical recommendations and future research directions are discussed.
Originality/value
To the author’s knowledge, this is the first review to explore what research has been carried out looking specifically at patients with ASD in relation to secure forensic settings.
... Although having ASD is not a risk factor for offending, for some individuals the difficulties associated with having ASD can make them vulnerable to law breaking or social misdemeanour which may result in detention in a secure environment. Despite uncertainty as to the prevalence of ASD among individuals who come into contact with the criminal justice system (King and Murphy, 2014) it is widely accepted that for those who do, the difficulties and needs they present with, and how to accommodate for these, can be a challenge for all levels of the criminal justice system, i.e. from initial police contact and court experience to conviction and detention (Archer and Hurley, 2013;Robertson and McGillivary, 2015). The reasons for these challenges are complex, however, a lack of informed awareness about ASD among professionals and law enforcement officers, coupled with the difficulties characteristic of ASD, are likely contributors. ...
Purpose
Whilst individuals with an autism spectrum disorder (ASD) represent a relatively small proportion of patients detained in high-secure psychiatric care (HSPC), previous research suggests that such individuals present with difficulties and needs significantly different from non-ASD patient groups. However, to date, there has not been any formal examination of how individuals with an ASD are represented in records of key risk management actions (i.e. seclusions and incompatibilities with other patients). The paper aims to discuss these issues.
Design/methodology/approach
An observation of hospital data examining two key risk management actions for a group of individuals with an ASD is detained in one HSPC hospital. These include the number of formal incompatibilities with other patients and the number of, and hours in, seclusion. Both actions require extra staff and security provisions and can decelerate the rehabilitation and recovery process.
Findings
In addition to suggesting an overall increase in the general prevalence of ASD within the hospital compared to previous estimates, individuals with an ASD appear to have a disproportionately higher number of incompatibilities with other patients compared to those patients without an ASD and experience more and longer periods of seclusions.
Originality/value
Although the methodological limitations of the study are acknowledged, explanations for the findings are discussed along with future research and recommendations as to how ASD patients might be best managed in the hospital. It is argued that the findings add further support for a specialist ASD service within HSPC.
... Within each category of impairment there can be much variation and severity of symptoms, hence why the disorder is labelled a "spectrum" (Fakhoury, 2015). However, typical symptoms can include rigid routine behaviours, impairments in communication with, and understanding other people and obsessive interests (Baron-Cohen, 2000;Hill and Frith, 2003;Robertson and McGillivray, 2015). It is proposed that the triad of impairments are related to the individual having a lack or impairment of "theory of mind"; the ability to infer the mental state of others, such as their emotions and intentions (Baron-Cohen, 2000;Baron-Cohen et al., 1985;Heerey et al., 2003). ...
Purpose
The purpose of this paper is to critically review the current police training and criminal justice policy regarding the treatment of suspects with autism spectrum disorder (ASD) during the initial stages of the criminal justice system (CJS), and provide potential policy reform and areas for further research.
Design/methodology/approach
By reviewing extant literature, research and policy documents, this paper provides a critical review of the current policy and training for dealing with suspects with ASD in the current CJS in England and Wales for suspects with ASD.
Findings
This paper proposes that current policy and police staff training is insufficient during all initial stages of the criminal justice process. Although there are emerging policies and schemes which are promising, they require further research and national participation. Policy reform and improved training is required to ensure minimal opportunities for miscarriages of justice to those individuals with ASD.
Originality/value
This paper provides a chronological journey through the initial stages of the CJS in England and Wales for a suspect with ASD, and the challenges that they may face. Suggestions are made based on criminological and psychological research to remedy the potential opportunities for miscarriages of justice.
... Research into the experiences of those with ASD while in prison is sparse. The extant literaturealthough limited by poor methodology and small sample sizes (Robertson & McGillivray, 2015) suggests that they are more vulnerable to bullying, social isolation, victimisation and exploitation (Allely, 2015a). A recent review (Allely, 2015b) identified only four studies examining this issue: all involved case studies and small samples. ...
There has been relatively limited research focus on autism in the context of the criminal justice system. The relationship between autism spectrum disorder (ASD) and criminal responsibility is complex. Furthermore, the features inherent to ASD can have a significant bearing on a wide array of other issues in this context including police interviewing, fitness to be tried, culpability and the appropriateness of custodial disposal. This review explores the background to our understanding of ASD, patterns of offending behaviour and the nature of the relationship between this and characteristic ASD deficits. The clinical and legal challenges posed by ASD defendants in terms of identification, assessment and on a broader service level as they negotiate the criminal justice system are highlighted to illustrate the varied difficulties they may encounter and to draw attention to this field as a worthy area of research and training for the medical, legal and law enforcement professions.
... A case study by Paterson (2007) of two individuals with ASD in a London prison revealed these individuals exhibited difficulty interacting with other inmates and often chose to remain confined to their cells. The symptoms and characteristics of ASD leave many ill prepared to conform to societal norms, let alone in a correctional institution (Robertson and McGillivray, 2015). They may also become targets for physical harm, ridicule, bullying, or manipulation by other inmates (Mayes, 2003;Paterson, 2007). ...
Purpose
There has been growing concern among stakeholders about individuals with autism spectrum disorders (ASD) and sex offending as research supports an indirect association. The purpose of this paper is threefold: first, bring more awareness of the sexuality and deviant/criminal sexual behavior among those with ASD to stakeholders in the criminal justice system (CJS); second, demonstrate that much of the deviant or sexual offending behavior exhibited among those with ASD is often a manifestation of their ASD symptoms and not malice; and third, demonstrate the necessity to address specific needs of individuals with ASD who enter the CJS due to criminal sexual behavior.
Design/methodology/approach
This paper provides an overview of the ASD symptomology, including the diagnostic changes, a review of the literature on ASD and sexuality, which includes deviant sexual behavior and sexual offending.
Findings
The author linked examples of deviant or sexual behavior in the research literature to the ASD symptomology and described how the symptomology explains such behavior.
Originality/value
Sexual offending among those with ASD has received little research outside the mental health field. This review is of particular importance to those in the CJS unfamiliar with ASD, as they should handle them differently with regard to formal interviewing, measures of competency, capacity, and sentencing.
Evidence has shown a high prevalence of neurodevelopmental disorders amongst offenders in custodial institutions. Bringing together the latest knowledge and understanding, this book describes the needs of offenders who present with neurodevelopmental disorders, including autism spectrum disorder, ADHD, intellectual disability and foetal alcohol spectrum disorders. The book covers aetiology, prevalence, comorbid mental disorders, legal issues, assessment including risk assessments, diagnosis and therapeutic approaches. It describes care pathways through the criminal justice system across the UK and internationally, including the current and ongoing developments of services for this group. With contributions from experts in the field including psychiatrists, researchers and psychologists, this book provides a comprehensive summary of the evidence whilst ensuring the focus is for the everyday clinician working in this area. It is an invaluable resource for psychiatrists and other professionals working across the criminal justice system and within forensic services.
Evidence has shown a high prevalence of neurodevelopmental disorders amongst offenders in custodial institutions. Bringing together the latest knowledge and understanding, this book describes the needs of offenders who present with neurodevelopmental disorders, including autism spectrum disorder, ADHD, intellectual disability and foetal alcohol spectrum disorders. The book covers aetiology, prevalence, comorbid mental disorders, legal issues, assessment including risk assessments, diagnosis and therapeutic approaches. It describes care pathways through the criminal justice system across the UK and internationally, including the current and ongoing developments of services for this group. With contributions from experts in the field including psychiatrists, researchers and psychologists, this book provides a comprehensive summary of the evidence whilst ensuring the focus is for the everyday clinician working in this area. It is an invaluable resource for psychiatrists and other professionals working across the criminal justice system and within forensic services.
Individuals with autism spectrum disorder (ASD) are disproportionately represented in the criminal legal system, yet ASD-specific training is rarely provided to frontline clinical staff or legal professionals. This column describes a collaboration between university researchers and a state mental health department to promote ASD awareness, knowledge, and intervention skills among clinical and legal professionals working with autistic individuals with criminal legal involvement. Descriptions of how specific needs were identified, how tailored educational workshops were developed, and how workshop efficacy was assessed are provided. Lessons learned and recommendations for researchers and health care systems interested in similar collaborations are offered.
The US criminal justice system is built on the notion of the liberal, autonomous subject who chooses to engage in criminal activity, rather than one that addresses the underlying factors that lead to crime. I argue that by combining Vulnerability Theory, a feminist legal theory focused on universal human vulnerability, and Universal Design, a disability approach aimed at creating access for the widest range of bodies and minds, we can create a system that necessitates an analysis of how social institutions are related to risk for criminal justice involvement to reduce the harms perpetuated by criminal justice involvement. Applied to criminal justice reform together, I develop a Vulnerability Inspired Universal Design of Justice that identifies important areas of reform throughout our social institutions in order to reduce the harms of the criminal justice system.
Purpose
This paper aims to investigate the use of Part VI of the Criminal Procedure (Scotland) Act 1995 (CPSA) for people with Learning Disability (LD) and/or Autism. This is in the context of a recent review commissioned by the Scottish Government into whether the provisions in the Mental Health (Care and Treatment) (Scotland) Act 2003 (MHA) meet the needs of these groups which would also affect associated legislation such as CPSA.
Design/methodology/approach
All CPSA orders active on the 3 January 2018 were identified and analysed for a number of variables including diagnoses, detention length, level of hospital security and medication use.
Findings
Of the 580 people on CPSA orders, 69 (11.9%) had LD and 27 (4.7%) had possible/definite Autism. Most people with LD (56.5%) did not have a mental illness or personality disorder. Most (81.2%) had mild LD. There were two patients whose only diagnosis was Autism. Mean duration of detention was longer for those with LD than for those without. Most patients with LD alone were prescribed medication (61.5%) and, if in hospital, were managed in low secure units (59%).
Originality/value
The results indicate that people with LD or Autism are differently affected by the application of the CPSA from other people with mental disorders, and that this is potentially discriminatory, if it is not objectively justified . It supports the stance from the recent review that to reduce the potential for discrimination, substantial changes to MHA and CPSA should be considered in the wider review of the MHA in Scotland.
A growing awareness of justice-involved veterans is revealing how little is known about this population, to what extent they have experienced a traumatic brain injury (TBI), and how this may relate to institutional behavior, participation in programs, and use of institutional resources. The current study identifies the prevalence of incarcerated veterans in Washington State who have experienced a TBI and how a TBI history may affect their prison experience and use of prison resources. The results of our study show that incarcerated veterans in Washington State with a moderate-to-severe TBI are more likely to use medical services, commit violent infractions, be placed in maximum custody (solitary confinement), and less likely to complete vocational and job skills programs. The importance of these findings to policy and practice is discussed.
Whilst it is widely accepted that the majority of individuals with an autism spectrum disorder (ASD) lead law-abiding and productive lives, individual experiences can vary enormously. In some circumstances, poor outcomes might result in individuals with an ASD finding themselves in contact with the psychiatric and nonpsychiatric services of the criminal justice system (CJS). For individuals with an ASD, although contact with the CJS is more likely to be as a victim or witness of crime, some may have contact as a result of being a perpetrator of some form of offending behaviour. However, it is also possible that the same individual may fall into all of these categories. Whatever the circumstances, once within the CJS, such individuals are typically recognised to present with difficulties and needs that challenge mainstream services.
Purpose
Although individuals with an autism spectrum disorder (ASD) represent a small proportion of forensic psychiatric patients as a group they present with specific difficulties and needs. There is also evidence that if detained individuals with an ASD experience particular difficulties within custodial environments as a result of a mismatch between the difficulties associated with their ASD and the environmental demands. The purpose of this paper is to explore the experience of individuals with an ASD admitted to a high secure psychiatric care (HSPC) hospital.
Design/methodology/approach
Using both a semi-structured interview and a quality of life self-report measure (the Lancashire Quality of Life Profile) the experiences and views of seven patients with an ASD detained in one HSPC hospital were qualitatively explored.
Findings
Whilst a diverse range of negative and positive aspects of being within HSPC were identified by patients interviewed, those with prison experience thought HSPC was a less stressful environment with more therapeutic opportunities. As a group, patients with an ASD reported a similar or significantly better quality of life in many domains (global, leisure, financial and living situation) compared to other detained forensic patient groups.
Practical implications
Although most patients with an ASD interviewed reported positive experiences, there are a number of practical improvements that could be made within the hospital to reduce experienced stress levels and perhaps improve therapeutic outcomes.
Originality/value
Within the context of the Department of Health's autism strategy (2010) and subsequent update think autism (2014), the survey highlights continued ASD awareness training for staff as important. In responding to the risks and needs of individuals with an ASD in HSPC there is further support for the development of an ASD specialist service.
This paper describes the experiences of a Forensic Autism Spectrum Disorder Assessment and Liaison team. We reflect upon the processes and complexities of assessment, formulation and care pathway planning for this population within forensic contexts.
Purpose
The purpose of this paper is to determine the extent of autism spectrum disorder (ASD) traits among prisoners. The authors tested the hypotheses that ASD traits would: be continuously distributed among prisoners; be unrecognised by prison staff; and predict whether a prisoner met diagnostic criteria for ASD.
Design/methodology/approach
ASD traits were measured among 240 prisoners in a male prison in London, UK using the 20-item Autism Quotient (AQ-20). Further diagnostic assessment was carried out using the Autism Diagnostic Observation Schedule. Results were compared with ASD data from the 2007 Psychiatric Morbidity Survey.
Findings
There were 39 participants with an AQ-20 score=10; indicating significant autistic traits. The distribution of ASD traits among participants appeared to be normal and was not significantly higher than the rate found in a population-based sample from England.
Originality/value
Few studies have explored ASD traits among prisoners. The authors identified high levels of unrecognised ASD traits among a group of male prisoners, many of whom went on to meet diagnostic criteria for ASD. The study highlights the need for specialist assessment within the criminal justice system for individuals with neurodevelopmental disorders including ASD. The authors discuss the process of carrying out an ASD assessment project in a prison.
Autism spectrum disorder (ASD) is a set of neurodevelopmental disorders that is among the most severe in terms of prevalence, morbidity and impact to the society. It is characterized by complex behavioral phenotype and deficits in both social and cognitive functions. Although the exact cause of ASD is still not known, the main findings emphasize the role of genetic and environmental factors in the development of autistic behavior. Environmental factors are also likely to interact with the genetic profile and cause aberrant changes in brain growth, neuronal development, and functional connectivity. The past few years have seen an increase in the prevalence of ASD, as a result of enhanced clinical tests and diagnostic tools. Despite growing evidence for the involvement of endogenous biomarkers in the pathophysiology of ASD, early detection of this disorder remains a big challenge. This paper describes the main behavioral and cognitive features of ASD, as well as the symptoms that differentiate autism from other developmental disorders. An attempt will be made to integrate all the available evidence which point to reduced brain connectivity, mirror neurons deficits, and inhibition-excitation imbalance in individuals with ASD. Finally, this review discusses the main factors involved in the pathophysiology of ASD, and illustrates some of the most important markers used for the diagnosis of this debilitating disorder.
Copyright © 2015. Published by Elsevier Ltd.
Criminal offending is almost certainly no more common amongst people diagnosed with Asperger Syndrome than in the general population. However, co-morbid mental illness and some of the specific features of AS are particularly relevant to offending behaviour and to the management, care and treatment of people in this group.
In the current study, we used the Adult Autism-Spectrum Quotient (AQ) to assess the
prevalence of autism-spectrum disorders (ASD) in a maximum-security prison in the
United States. Results indicated that, employing a conservative cutoff score, 4.4% of
inmates may meet the criteria for a diagnosis of ASD. While this finding is
commensurate with previous research involving other criminal populations, it is four
times greater than the rate of ASD in the general population. The current study is the
first to examine the prevalence of ASD in criminal populations with a U.S. prison
population sample. Given the important implications for both the judicial system and
offender treatment, further research concerning the prevalence of ASD in forensic
populations is needed.
This paper provides a systemic review of the available literature on people with autism spectrum disorder (ASD) in the criminal justice system (CJS). The review considers two main types of study: those that examined the prevalence of people with ASD in the CJS and those that examined the prevalence of offending in populations with ASD. In addition, types of offences in people with ASD, co-morbid psychiatric diagnoses, and characteristics of people with ASD who commit offences (including predisposing factors) are considered. A combination of search terms was used in a variety of databases in order to find all of the available literature on this topic, and research studies were included based on specified inclusion and exclusion criteria. It was found that whilst there is an emerging literature base on this topic, there are a wide variety of methodologies used, making direct comparison difficult. Nevertheless it can be concluded so far that people with ASD do not seem to be disproportionately over-represented in the CJS, though they commit a range of crimes and seem to have a number of predisposing features. There is poor evidence of the presence of comorbid psychiatric diagnoses (except in mental health settings) amongst offenders with ASD, and little evidence of the oft-asserted over-representation of certain kinds of crimes. It is recommended that further research of good quality is required in this area, rather than studies that examine populations that are not representative of all those with ASD.
Clinical knowledge of Asperger’s Syndrome and other Autistic Spectrum Disorders has developed enormously since Hans Asperger’s early definition of ‘autistic psychopathy’ in 1944, yet societal misunderstandings persist and recent research claims that individuals with Asperger’s Syndrome are potentially over-represented within the criminal justice system. Furthermore, numerous authorities have expressed concern that those working within the criminal justice sector lack the requisite training to respond effectively to those with Asperger’s Syndrome and consequently affected individuals experience particular difficulty in negotiating the criminal justice process. This article critically explores existing research in this area, investigating potential links between Asperger’s Syndrome and criminality and looks at the level of understanding of this syndrome by the criminal justice system. As Asperger’s Syndrome is associated with reasonable intellectual ability, it presents greater issues for the identification and treatment of people with the syndrome if they come into contact with the criminal justice system. The authors highlight the need for further research into this complex issue, and suggest that those who work within the criminal justice system should be aware of and have access to training and/or appropriately trained colleagues in order that the needs of this particularly vulnerable group might be more effectively met.
Accessible summary• Many people with Asperger syndrome face life being misunderstood and having their intentions misinterpreted.• For people who have Asperger syndrome in prison this position is compounded.• This article is based on a research paper that sought to make explicit the type of problems encountered by prisoners with Asperger syndrome.• The findings in this paper reflected limited resources are available for prisoners with autistic spectrum disorders and suggest further research is required for this position to be addressed.SummaryThis article is based on a study undertaken in 2005. It was conducted under the supervision of Professor Carolyn Kagan and with the approval of an ethics committee from the department of psychology and speech pathology at Manchester Metropolitan University. Case examples are explored of two male young offender prisoners who have Asperger syndrome (AS). Their perception of prison life and issues related to them are discussed and the types of problems they encounter in prison that are attributable to their developmental differences are highlighted. Potential areas for future research that became apparent during the study are noted at the conclusion of this article.
The present study compared 21 high functioning individuals with autism, 21 individuals with schizophrenia and 21 healthy individuals in self-reported features of autism, as measured by the Autism-spectrum Quotient (AQ). The individuals with autism reported impairment on all AQ subscales, compared to the neurotypical group. The schizophrenia group reported deficits on all subscales except Attention to Detail, compared to the neurotypical group.The autism group reported more impairment than the individuals with schizophrenia in Social skill, Communication and Attention switching.
Currently there are no brief, self-administered instruments for measuring the degree to which an adult with normal intelligence has the traits associated with the autistic spectrum. In this paper, we report on a new instrument to assess this: the Autism-Spectrum Quotient (AQ). Individuals score in the range 0–50. Four groups of subjects were assessed: Group 1: 58 adults with Asperger syndrome (AS) or high-functioning autism (HFA); Group 2: 174 randomly selected controls. Group 3: 840 students in Cambridge University; and Group 4: 16 winners of the UK Mathematics Olympiad. The adults with AS/HFA had a mean AQ score of 35.8 (SD = 6.5), significantly higher than Group 2 controls (M = 16.4, SD = 6.3). 80% of the adults with AS/HFA scored 32+, versus 2% of controls. Among the controls, men scored slightly but significantly higher than women. No women scored extremely highly (AQ score 34+) whereas 4% of men did so. Twice as many men (40%) as women (21%) scored at intermediate levels (AQ score 20+). Among the AS/HFA group, male and female scores did not differ significantly. The students in Cambridge University did not differ from the randomly selected control group, but scientists (including mathematicians) scored significantly higher than both humanities and social sciences students, confirming an earlier study that autistic conditions are associated with scientific skills. Within the sciences, mathematicians scored highest. This was replicated in Group 4, the Mathematics Olympiad winners scoring significantly higher than the male Cambridge humanities students. 6% of the student sample scored 327plus; on the AQ. On interview, 11 out of 11 of these met three or more DSM-IV criteria for AS/HFA, and all were studying sciences/mathematics, and 7 of the 11 met threshold on these criteria. Test—retest and interrater reliability of the AQ was good. The AQ is thus a valuable instrument for rapidly quantifying where any given individual is situated on the continuum from autism to normality. Its potential for screening for autism spectrum conditions in adults of normal intelligence remains to be fully explored.
There have been concerns that individuals with autism spectrum disorders (ASDs) are over-represented but not recognised in prison populations. A screening tool for ASDs in prisons has therefore been developed.
We aimed to evaluate this tool in Scottish prisoners by comparing scores with standard measures of autistic traits (Autism Quotient (AQ)), neurodevelopmental history (Asperger Syndrome (and High-Functioning Autism) Diagnostic Interview (ASDI)), and social cognition (Ekman 60 Faces test).
Prison officers across all 12 publicly-run closed prisons in Scotland assessed convicted prisoners using the screening tool. This sample included male and female prisoners and both adult and young offenders. Prisoners with high scores, along with an equal number of age and sex-matched controls, were invited to take part in interviews. Prisoners' relatives were contacted to complete a neurodevelopmental assessment.
2458 prisoners were screened using the tool, and 4% scored above the cut-off. 126 prisoners were further assessed using standardised measures. 7 of those 126 assessed scored 32 or above (cut-off) on the AQ. 44 interviews were completed with prisoners' relatives, no prisoner reached the cut-off score on the ASDI. Scores on the screening tool correlated significantly with AQ and ASDI scores, and not with the Ekman 60 Faces Test or IQ. Sensitivity was 28.6% and specificity 75.6%; AUC was 59.6%.
Although this screening tool measures autistic traits in this population, sensitivity for scores of 32 or above on the AQ is poor. We consider that this limits its usefulness and do not recommend that the tool is routinely used to screen for ASDs in prisons.
Prison populations are made up of individuals from disadvantaged, often abusive backgrounds, who are more likely to suffer from psychological problems than the general community.
This study aimed to determine associations between current psychological distress and history of having experienced sexual coercion and/or physical assault among prisoners in two Australian states (Queensland and New South Wales).
We conducted a random sample survey of prisoners by computer-assisted telephone interview. Prisoners were asked about forced sexual encounters in or outside prison, and physical assault in prison. Psychological distress was estimated using a dichotomised score obtained from the Kessler 6-Item Psychological Distress Scale (K6), and a logistic regression analysis was employed to investigate associations.
A total of 2426 prisoners were interviewed of 3055 prisoners invited to participate, a response rate of 79%. We categorised 236 men (12%) and 63 women (19%) as 'severely' psychologically distressed according to the K6, and 13% of the men and 60% of the women reported that they had been sexually coerced prior to imprisonment. Physical assault in prison was common, reported by 34% of the men and 24% of the women. On multivariate analysis, prisoners were more likely to be psychologically distressed if they had ever been threatened with sexual assault in prison or physically assaulted in prison. Sexual coercion outside prison was an important associate of psychological distress among men but not among women.
As psychological distress and experiences of assault are closely statistically linked among male prisoners and both are very common among female prisoners, their screening for psychological distress should include efforts to find out about sexual and violent assaults against them both before and during imprisonment. Further, longitudinal research with prisoners is required to establish causal relationships.
This study examined the incarceration experiences of 16 adolescent males in a maximum-security detention facility. A semistructured interview was conducted with each detainee and recorded on audiocassette. Data were analysed using phenomenological descriptive methodology. Detainees' experiences were characterised by a prison culture of bullying, substance use, and antagonism with youth workers; inadequate service provision and a lack of rehabilitative programming; and a sense of loss through reduced autonomy and dislocation from important others. These experiences gave rise to a range of negative feelings and emotions and promoted thinking about past and future behaviours. The incarceration experience placed detainees into a state of readiness for positive change but failed to provide them with the necessary skills to effect and sustain this change. Promotion of antisocial behaviour, lack of deterrence, and insufficient rehabilitative programming were identified as factors of the incarceration setting likely to contribute to the high rates of recidivism.
Claims that people with autism spectrum disorders (ASD) are overrepresented in offending populations and are more likely to commit crimes than others are explored in this review. Evidence to date makes these claims difficult to substantiate, although methodological difficulties make this area particularly challenging. ASD does not appear to account for a large number of crimes in society, though certain characteristics may render those on the spectrum vulnerable to offending. Comorbid psychiatric conditions such as depression and psychosis, when present in a person that additionally has ASD, are important risk factors. Once in the criminal justice system, people with ASD are often misunderstood and open to bullying. Very little is known about what treatment programmes are effective for offenders in this population. This review summarises some of the important studies in this field.
Forensic psychologists and psychiatrists are commonly asked to ascertain the reliability of statements made by suspects to the police during questioning and to assess an individual's vulnerability to providing information which is inaccurate, unreliable, and misleading during police interview. Autism spectrum disorders (ASD) are characterised by qualitative impairments in social communication and interaction, and a restricted or repetitive pattern of behaviours, interests, and activities. It is not clear whether people with ASD are more vulnerable at interview, or more prone to respond negatively to interrogative pressure, when compared with the general population. In the present study, 26 individuals with high functioning ASD, and 27 gender- and IQ-matched controls, were compared on measures of interrogative suggestibility and compliance as well as on measures of anxiety, depression, the extent to which they feared negative evaluation by others, and whether they had a suspicious outlook. There were no significant between-group differences on the measures of suggestibility, but the group with ASD were rated as significantly more compliant than the controls in terms of both parental and self-report, and also had higher scores on measures of depression, anxiety, fear of negative social evaluation and paranoia. Bi-modal distribution of suggestibility scores within the ASD group indicates that individual characteristics should be taken into account when considering an assessment. Individuals with ASD may be more eager to please or to avoid conflict and confrontation than controls, and may be more prone to respond compliantly to requests and demands.
Purpose
– The purpose of this paper is to offer a general review of care for individuals on the autism spectrum, including Asperger's syndrome within a medium secure setting.
Design/methodology/approach
– The authors undertook a review of the current literature relating to pathways to care, offending characteristics and treatment interventions. They examined the available evidence and current practice.
Findings
– Available evidence suggests offending characteristics of individuals with autism are different to those of mental disorders such as schizophrenia. Limited evidence in treatment interventions and in risk management for those with autism presents a challenge to clinicians. The heterogeneity makes a strong case for an individualised case formulation approach to treatment and risk management.
Originality/value
– This paper offers an overview of the current evidence base relating to the treatment of individuals with autism spectrum disorders within medium secure settings.
Paula McAdam is a Registered General Nurse who works in the primary health care unit of one of the largest prisons in England. She is part of a team responsible for taking care of the health needs of the inmates. This study was prompted when she found five prisoners with an autism spectrum diagnosis within a six-month period, four having Asperger syndrome and one with autism. Two appeared to require little in the way of support, but three really struggled to cope with daily life in the prison. It is likely that there were several others in the prison who were not diagnosed or who did not disclose their diagnosis. Paula therefore set out to explore the knowledge and understanding that prison staff had about the autism spectrum.
The significance of successful completion of a prison term and the eventual release from prison is that it marks not only the end of incarceration, but also the beginning of a second cycle of societal retribution, which inevitably comes, regardless of whether the former offender is reformed or not. The extent of retribution in the second cycle depends upon the offense type and is more pronounced if the offense was a felony, and particularly so if it was sexually-motivated. This study draws from intensive ethnographic interviews with former prison inmates with the aim of estimating the effect of incarceration on their lives while in prison and after release. The study reveals manifest and latent effects of incarceration and finds that further retribution continues upon release when society takes over with vindictiveness that follows the former offenders almost forever. The main policy implications of long-term imprisonment are made, and areas of further research suggested.
Purpose
The purpose of this paper is to review the evidence on providing services to people with neurodevelopmental disorders in prisons, with a focus on those prisoners with autism spectrum disorder (ASD).
Design/methodology/approach
Electronic databases were used to search for literature specifically on ASD in prisons. The literature was supplemented with the authors’ experiences of carrying out research on ASD in prison.
Findings
The searches only identified four articles and therefore the broader literature on people with ASD and other developmental disorders was reviewed in relation to the prison context.
Originality/value
The paper highlights the current limited evidence base on prisoners with autism spectrum disorders.
The autism ‘triad of impairments’ will often disadvantage those with autism when they come into contact with the Criminal Justice System (CJS) when compared with people without autism. Existing research suggests that people with developmental disabilities such as autism are between 4 and 10 times more likely to become victims of crime than those without such disabilities and may be 10 or more times as likely to be victims of sexual assault and robbery. Anecdotal evidence suggests that people with autism are the subject of discrimination in the CJS due to a general lack of awareness and understanding of autism and its implications in that environment.
This study seeks to assess the current understanding of autism awareness and understanding in the UK police service through the means of a questionnaire, and by comparing the results with an earlier study undertaken by researchers in the USA. The long-term aim is to improve responses by CJS personnel to those affected by autism.
Overall, as a broad generalisation, individual self-assessments of competency indicated that, currently, police officers are probably unable to deal appropriately with persons with autism. However, in many cases, self-assessments may exaggerate competence. The US study also found that police officers tended to perceive themselves as competent when they may not have been. Not one respondent in this study had received training from the police service fitting him/her to interact effectively with persons on the autism spectrum.
Clinicians as well as the general public have encountered an increasing amount of information available regarding Asperger's Syndrome (AS) and high functioning autism. While children with Asperger's may have normal verbal intelligence, they are, like other children along the Autistic Spectrum (ASD) and Pervasive Developmental (PDD) disorders, deeply delayed in their understanding of social information. So when they reach adolescence, with its rising social stress, they are doubly lost in negotiating their way through the social complexities of the teenage years. And there is no more confusing issue for young people than sexuality, both in forming their own sexual identity and forging relationships of closeness with appropriate sexual expression. For the clinician, the convergence of the neurobiological impairment of AS and the social confusion of adolescence provides unique challenges for untangling the relative contributions of each factor and for developing treatment interventions that are effective. This challenge is magnified when sexual behavior problems surface in the young person with Asperger's Syndrome. These individuals are faced with an uneven social playing field in which they are constantly trying to catch up with everyone else. A sexual behavior problem adds to their confusion and sense of social rejection. Their odd and unusual manner of engaging in the world can leave others frustrated, which can be interpreted even more as rejection.
The purpose of this study was to increase our knowledge regarding the role that emotional functioning can play in the genesis of bullying and victimization at school for children with autism spectrum disorder (ASD). Therefore, we examined the unique associations of basic emotions (anger and fear) and moral emotions (shame and guilt) with bullying and victimization in children with an ASD and a control group with typically developing (TD) children. The study included 130 children and young adolescents (64 with ASD, 66 TD, M age 140 months), who filled out self-report questionnaires. The main findings showed that in both groups less guilt and more anger were associated with more bullying. More fear was associated with more victimization in TD children only. Yet, more anger was also strongly and uniquely associated with more victimization in children with ASD, but not in TD children. These outcomes support the idea that lack of guilt is a pivotal antecedent of bullying for TD and ASD children. However, unlike TD children, the dysregulation of anger seems to play an important role in victimization as well as bullying in children with ASD.
Researchers and clinicians have devoted increasing attention to Asperger's syndrome during the past two decades. Although Asperger's syndrome is a developmental disorder, professionals in a variety of settings have begun to consider the diagnosis among adults who manifest social and communication abnormalities. Case studies (e.g., Baron-Cohen, 1988; Kohn et al., 1998) and prevalence research (Scragg & Shah, 1994) from forensic settings indicate that a small subset of Asperger's syndrome patients come into contact with the legal system due to their social impairments and idiosyncratic interests. We provide case histories of individuals with Asperger's syndrome encountered in forensic contexts and discuss the implications of this disorder for forensic clinicians. Our six cases were notable for certain commonalties, including deficient empathy. The cases also revealed ways in which Asperger's patients tend to differ from most individuals in forensic settings.
It was nice in the police cell. It was almost a perfect cube, 2 metres long by 2 metres wide by 2 metres high… . [The policeman asked], “Are you telling the truth?” I said, “I always tell the truth.” And he said, “Right. I am going to give you a caution.” I asked, “Is that going to be on a piece of paper like a certificate I can keep?” He replied, “No, a caution means that we are going to keep a record of what you did, that you hit a policeman but that it was an accident and that you didn't mean to hurt the policeman.” I said, “But it wasn't an accident.”M Haddon, The Curious Incident of the Dog in the Night-Time (David Fickling Books, London 2004)Asperger's syndrome was only formally accepted into the ICD and DSM classifications of psychiatric disorders in the 1990s. It has been written about extensively in the scholarly literature for two decades, but diagnostic tools are continuing to evolve, as well as understanding of its genetic component and its brain development features. In the criminal law context it poses difficult issues at trial and at sentencing. Contextualising Asperger's disorder within current knowledge about autism spectrum disorders, this article identifies relevant court decisions internationally, and particularly scrutinises selected decisions in the United Kingdom (Sultan v The Queen [2008] EWCA Crim 6), Victoria, Australia (Parish v DPP [2007] VSC 494), and Nova Scotia, Canada (R v Kagan (2007) 261 NSR (2d) 285; (2008) 261 NSR (2d) 168). It argues that Asperger's disorder needs to be distinguished by the courts from other disorders, such as personality disorders and intellectual disability, and should be recognised as having the potential to affect in important, albeit subtle, ways defendants' thinking and understanding, as well as their emotional responses to situations that are to them traumatic. This makes Asperger's disorder relevant to a number of threshold issues in relation to criminal responsibility as well as to criminal culpability.
Background: Autism spectrum disorder (ASD) is characterized by notable phenotypic heterogeneity, which is often viewed as an obstacle to the study of its etiology, diagnosis, treatment, and prognosis. On the basis of empirical evidence, instead of three binary categories, the upcoming edition of the DSM 5 will use two dimensions – social communication deficits (SCD) and fixated interests and repetitive behaviors (FIRB) – for the ASD diagnostic criteria. Building on this proposed DSM 5 model, it would be useful to consider whether empirical data on the SCD and FIRB dimensions can be used within the novel methodological framework of Factor Mixture Modeling (FMM) to stratify children with ASD into more homogeneous subgroups.
Methods: The study sample consisted of 391 newly diagnosed children (mean age 38.3 months; 330 males) with ASD. To derive subgroups, data from the Autism Diagnostic Interview-Revised indexing SCD and FIRB were used in FMM; FMM allows the examination of continuous dimensions and latent classes (i.e., categories) using both factor analysis (FA) and latent class analysis (LCA) as part of a single analytic framework.
Results: Competing LCA, FA, and FMM models were fit to the data. On the basis of a set of goodness-of-fit criteria, a ‘two-factor/three-class’ factor mixture model provided the overall best fit to the data. This model describes ASD using three subgroups/classes (Class 1: 34%, Class 2: 10%, Class 3: 56% of the sample) based on differential severity gradients on the SCD and FIRB symptom dimensions. In addition to having different symptom severity levels, children from these subgroups were diagnosed at different ages and were functioning at different adaptive, language, and cognitive levels.
Conclusions: Study findings suggest that the two symptom dimensions of SCD and FIRB proposed for the DSM 5 can be used in FMM to stratify children with ASD empirically into three relatively homogeneous subgroups.
Suppose two people commit the same crime and are sentenced to equal terms in the same prison facility. I argue that they have identical punishments in name only. One may experience incarceration as challenging but tolerable while the other is thoroughly tormented by it. Even though people vary substantially in their experiences of punishment, our sentencing laws pay little attention to such differences. I make two central claims: First, a successful justification of punishment must take account of offenders' subjective experiences when assessing punishment severity. Second, we have certain obligations to consider actual or anticipated punishment experience at sentencing, at least when we can do so in a cost-effective, administrable manner. Though it may seem impossible or prohibitively expensive to take punishment experience into account, we should not accept this excuse too quickly. In civil litigation, we often make assessments of emotional distress. Even if we cannot calibrate the punishments of individual offenders, we could enact broad policies that are better at taking punishment experience into account than those we have now. I do not argue that more sensitive offenders should receive shorter prison sentences than less sensitive offenders who commit crimes of equal blameworthiness. I do, however, argue that when they are given equal prison terms, more sensitive offenders receive harsher punishments than less sensitive offenders and that it is a mistake to believe that both kinds of offenders receive punishments proportional to their desert.
The prevalence of offenders with learning difficulties and learning disabilities is not agreed upon. What is clear, however, is that, regardless of actual numbers, many offenders have learning difficulties that reduce their ability to cope within the criminal justice system, for example, not understanding fully what is happening to them in court or being unable to access various aspects of the prison regime, including some offending behaviour programmes. Offenders with learning difficulties are not routinely identified and, as a result, often do not receive the support they need. No One Knows is a UK wide programme led by the Prison Reform Trust that aims to effect change by exploring and publicizing the experiences of people with learning difficulties who come into contact with the criminal justice system. The article highlights the aims of No One Knows and describes what, for the purpose of the programme, we mean by ‘learning difficulties and learning disabilities’. Problems in identifying precise numbers of offenders with learning difficulties and learning disabilities are discussed and attention drawn to recent research on prevalence. The context and some of the challenges of ‘prison life’ are identified and a number of early research findings from No One Knows are presented.
Objective:
Frontline health professionals need a "red flag" tool to aid their decision making about whether to make a referral for a full diagnostic assessment for an autism spectrum condition (ASC) in children and adults. The aim was to identify 10 items on the Autism Spectrum Quotient (AQ) (Adult, Adolescent, and Child versions) and on the Quantitative Checklist for Autism in Toddlers (Q-CHAT) with good test accuracy.
Method:
A case sample of more than 1,000 individuals with ASC (449 adults, 162 adolescents, 432 children and 126 toddlers) and a control sample of 3,000 controls (838 adults, 475 adolescents, 940 children, and 754 toddlers) with no ASC diagnosis participated. Case participants were recruited from the Autism Research Centre's database of volunteers. The control samples were recruited through a variety of sources. Participants completed full-length versions of the measures. The 10 best items were selected on each instrument to produce short versions.
Results:
At a cut-point of 6 on the AQ-10 adult, sensitivity was 0.88, specificity was 0.91, and positive predictive value (PPV) was 0.85. At a cut-point of 6 on the AQ-10 adolescent, sensitivity was 0.93, specificity was 0.95, and PPV was 0.86. At a cut-point of 6 on the AQ-10 child, sensitivity was 0.95, specificity was 0.97, and PPV was 0.94. At a cut-point of 3 on the Q-CHAT-10, sensitivity was 0.91, specificity was 0.89, and PPV was 0.58. Internal consistency was >0.85 on all measures.
Conclusions:
The short measures have potential to aid referral decision making for specialist assessment and should be further evaluated.
Researchers continue to pursue a better understanding of the symptoms, comorbidities, and causes of autism spectrum disorders. In this article we review more than 30 twin studies of autism spectrum disorders (ASDs) and autistic traits published in the last decade that have contributed to this endeavor. These twin studies have reported on the heritability of autism spectrum disorders and autistic traits in different populations and using different measurement and age groups. These studies have also stimulated debate and new hypotheses regarding why ASDs show substantial symptom heterogeneity, and what causes their comorbidity with intellectual disability, language delay, and other psychiatric disorders such as ADHD. These studies also reveal that the etiology of autism and autistic traits assessed in the general population is more similar than different, which contributes to the question of where the boundary lies between autism and typical development. Recent findings regarding molecular genetic and environmental causes of autism are discussed in the relation to these twin studies. Lastly, methodological assumptions of the twin design are given consideration, as well as issues of measurement. Future research directions are suggested to ensure that this decade is as productive as the last in attempting to disentangle the causes of autism spectrum disorders.
The 16p11.2 deletion is a recurrent genomic event and a significant risk factor for autism spectrum disorders (ASD). This genomic disorder also exhibits extensive phenotypic variability and diverse clinical phenotypes. The full extent of phenotypic heterogeneity associated with the 16p11.2 deletion disorder and the factors that modify the clinical phenotypes are currently unknown. Multiplex families with deletion offer unique opportunities for exploring the degree of heterogeneity and implicating modifiers. Here we reported the clinical and genomic characteristics of three 16p11.2 deletion carriers in a Chinese family. The father carries a de novo 16p11.2 deletion, and it was transmitted to the proband and sib. The proband presented with ASD, intellectual disability, learning difficulty, congenital malformations such as atrial septal defect, scoliosis. His dysmorphic features included myopia and strabismus, flat and broad nasal bridge, etc. While the father shared same neurodevelopmental problems as the proband, the younger brother did not show many of the proband's phenotypes. The possible unmasked mutation of TBX6 and MVP gene in this deleted region and the differential distribution of other genomic CNVs were explored to explain the phenotypic heterogeneity in these carriers. This report demonstrated the different developmental trajectory and discordant phenotypes among family members with the same 16p11.2 deletion, thus further illustrated the phenotypic complexity and heterogeneity of the 16p11.2 deletion.
Little is known about the experience of people with autism in custody. A review of the literature that explored the relationship between autism and criminality and the criminal justice detention system was conducted. Literature suggests that people with autism are potentially overrepresented within the criminal justice system. There is little research that has examined the experiences of people with autism spectrum disorders in custody. There is very little to guide service design to develop autism support services for people in prison.
Despite the focus on the increasing number of mentally ill in prisons and jails, very little actually is known about the psychological effects of prison on this high-risk group. A qualitative study was conducted to explore the inmate subculture and its effect on a person who is mentally ill. Interviews were conducted with 13 subjects who were both inmates and staff members in a forensic halfway house. The results suggest that the victimization that is a way of life within the prison system poses particular problems for mentally ill inmates, whose lack of social and economic resources, dependence, and need for attention make them particularly vulnerable. The implications of victimization of the mentally ill for health care professionals working in prisons also are discussed.
Considerable speculation is evident both within the scientific literature and popular media regarding possible links between Asperger syndrome and offending. A survey methodology that utilised quantitative data collection was employed to investigate the prevalence of offending behaviour amongst adults with Asperger Syndrome in a large geographical area of South Wales, UK; qualitative interviews were then conducted with a sub-sample of those identified. A small number of participants meeting the study criteria were identified. For those who had offended, their experience of the criminal justice system was essentially negative. Possible implications of the results were discussed.
Psychiatric services for adolescents and adult with Asperger syndrome and other autistic-spectrum disorders
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Morris, A. P., Arnaut, G., & Schaeffer, B. (2009). Offenders with Asperger's syndrome:
Experiences from within prison [Conference Abstract]. Paper presented at the
Annual American Psychological Association Convention. Toronto, ON.
On the borderline? People with learning disabilities and/or autistic spectrum disorders in secure, forensic and other specialist settings. Edinburgh: Scottish Development Centre for Mental Health
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