THE INTERSECT BETWEEN AUTISM SPECTRUM DISORDERS (ASD) AND PARAPHILIAS: RAMIFICATIONS WITHIN THE CRIMINAL JUSTICE SYSTEM MARCH 31, 2017

Transcription

1 THE INTERSECT BETWEEN AUTISM SPECTRUM DISORDERS (ASD) AND PARAPHILIAS: RAMIFICATIONS WITHIN THE CRIMINAL JUSTICE SYSTEM MARCH 31, 2017 Kim Spence, Ph.D. Coordinator of Educational & Training Programs Center for Autism & Related Disabilities (CARD) Eric Imhof, Psy.D. President/Clinical Director Specialized Treatment & Assessment Resources, PA

2 CENTER FOR AUTISM & RELATED DISABILITIES (CARD) CARD is a State Funded Technical Assistance Center ALL CARD services are FREE of charge A service provider to enhance existing programs and or services train the trainer model CARD serves constituents from birth to death with a qualifying diagnosis Technical Assistance all community settings

3 FLORIDA CARD SERVICE PROVISION CARD Centers statewide currently provide support to over 50,000 individuals statewide (UCF CARD = 11,000)

4 AUTISM SPECTRUM DISORDERS (ASD)

5 COMMON MISCONCEPTIONS ABOUT ASD Everyone with autism looks & acts like Rain Man People with ASD don t make eye contact People with ASD are not affectionate, don t want to socialize, or have no interest in sexual relationships ASD are mental illness or disease 75% of people with autism have some form of cognitive impairment Magical Therapy Skills

6 COMMON MISCONCEPTIONS ABOUT AUTISM AND SEXUALITY People with ASD have no desire to engage in intimate physical relationships Having a diagnosis of ASD implies a person will only be attracted to characters Individuals with ASD are ONLY attracted to younger kids Under appreciation of homosexuality and/or bisexuality; sexuality in general

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8 AUTISM SPECTRUM DISORDER DSM-5 A. Deficits in social communication and social interaction (3 characteristics) ASD B. Restricted, repetitive patterns of behavior, interests or activities (at least 2 of 4)

9 DSM-5: SOCIAL COMMUNICATION AND SOCIAL INTERACTION 1.Deficits in social-emotional reciprocity 2.Deficits in nonverbal communicative behaviors used for social interaction 3.Deficits in developing, maintaining, and understanding relationships

10 DSM-5: RESTRICTED, REPETITIVE PATTERNS OF BEHAVIOR, INTERESTS, OR ACTIVITIES 1. Stereotyped or repetitive motor movements, use of objects, echolalia, idiosyncratic phrases 2. Insistence on sameness, inflexible adherence to routines, or ritualized patterns of verbal or nonverbal behavior 3. Highly restricted, fixated interests that are abnormal in intensity or focus 4. Hyper- or hypo-reactivity to sensory input or unusual interest in sensory aspects of the environment

11 MISINTERPRETING SOCIAL & COMMUNICATION DEFICITS Deficits in social-emotional reciprocity: Difficulty interpreting different tones of voices and interpreting non-verbal cues May only understand questions or comments in a very literal way May use questioning as a form or responding Often fails to grasp implied meaning of communication

12 MISINTERPRETING SOCIAL & COMMUNICATION DEFICITS Deficits in nonverbal communicative behaviors used for social interaction: Inability to recognize fear, discomfort, disdain, or other clear signs of concern in a communicative partner Socially inappropriate actions (verbally or physically) in various settings Universal failure to understand the rules of engagement

13 MISINTERPRETING SOCIAL & COMMUNICATION DEFICITS Deficits in developing, maintaining, and understanding relationships: Desperate for friendships of all kinds Often seek friendships online Extremely gullible Overall lack of understanding about various types and levels of friendships and the rules associated with making and maintaining them Inability to appreciate that sameaged peers are often not interested in special interest areas

14 ADDITIONAL SOCIAL CHALLENGES Near total social isolation VERY often adults with ASD only have online friends Tense & stressed by trying to cope with social demands in most settings May behave in socially inappropriate manner (verbally or physically) Social Fatigue and difficulty with Social Stamina Difficulty with eye contact (appearance of inattention) or odd eye contact

15 DSM-5: RESTRICTED, REPETITIVE PATTERNS OF BEHAVIOR, INTERESTS, OR ACTIVITIES 1. Stereotyped or repetitive motor movements, use of objects, echolalia, idiosyncratic phrases 2. Insistence on sameness, inflexible adherence to routines, or ritualized patterns of verbal or nonverbal behavior 3. Highly restricted, fixated interests that are abnormal in intensity or focus 4. Hyper- or hypo-reactivity to sensory input or unusual interest in sensory aspects of the environment

16 MISINTERPRETING RESTRICTED, REPETITIVE AND STEREOTYPED PATTERNS OF BEHAVIOR CHALLENGES Perseveration and/or highly fixated interests Strong attachments to objects or images Over-attending to unusual topics or items Inappropriate or dangerous repetitive behavior

17 MISINTERPRETING RESTRICTED, REPETITIVE AND STEREOTYPED PATTERNS OF BEHAVIOR CHALLENGES Over adherence to rules Rigidity and need for routine Sensory Issues Socially inappropriate or dangerous routine

18 SPECIFIC CHALLENGES WITH ASPERGER S SYNDROME AND HFA 30 + often undiagnosed Often search for social information or friends online Frustrating disconnect between measured/demonstrated IQ and social understanding Frequently give monologues about pet topics May present as rude or augmentative Loves to list facts Often absentminded, unorganized, and uncoordinated Few (if any) healthy social relationships VERY poor personal hygiene

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20 Criterion A PARAPHILIC DISORDERS Over a period of at least six months, recurrent and intense sexual arousal from non-human objects or specific focus on non-genital body parts, the suffering or humiliation of oneself or one s partner, or children or other non-consenting person as manifested by fantasies, urges, or behaviors Criterion B the individual has acted on these sexual urges [generally with a nonconsenting person] or the sexual urges or fantasies cause clinically significant distress or impairment in social, occupational, or other important areas of functioning Criterion C in some paraphilic disorders minimum age limits or other unique specifiers are imposed

21 VOYEURISTIC DISORDER Observing an unsuspecting person who is naked, in the process of disrobing, or engaging in sexual activity. The individual experiencing arousal and/or acting on the urges is at least 18 years of age

22 Exposure of one s genitals to an unsuspecting person EXHIBITIONISTIC DISORDER

23 FROTTEURISTIC DISORDER Touching or rubbing against a nonconsenting person

24 SEXUAL MASOCHISM DISORDER Arousal from the act of being humiliated, beaten, bound, or otherwise made to suffer

25 SEXUAL SADISM DISORDER Arousal from the physical or psychological suffering of another person

26 PEDOPHILIC DISORDER Sexual activity with a prepubescent child or children (generally age 13 years or younger) The individual must be age 16 years or older or at least 5 years older than the child or children - Do not include an individual in late adolescence involved in an ongoing sexual relationship with a 12- or 13-year-old

27 FETISHISTIC DISORDER The use of nonliving objects or highly specific focus on non-genital body part(s) The fetish objects are not limited to articles of clothing used in cross-dressing (as in tranvestic disorder) or devices specifically designed for the purpose or tactile genital stimulation (e. g., vibrator)

28 TRANSVESTIC DISORDER Cross-dressing With fetishism if sexually aroused by fabrics, materials, or garments With autogynephilia if sexually aroused by thoughts or images of self as female

29 OTHER SPECIFIED PARAPHILIC DISORDER Presentations in which symptoms characteristic of a paraphilic disorder cause clinically significant distress or impairment but do not meet the full criteria for a paraphilic disorder and the clinician chooses to communicate the specific reason the presentation does not meet the criteria of any specific paraphilic disorder

30 OTHER SPECIFIED PARAPHILIC DISORDER Examples include, but are not limited to: Telephone Scatologia (obscene phone calls) Necrophilia (corpses) Zoophilia (animals) Coprophilia (feces) Klismaphilia (enemas) Urophilia (urine)

31 UNSPECIFIED PARAPHILIC DISORDER Presentations in which symptoms characteristic of a paraphilic disorder that cause clinically significant distress or impairment but do not meet the full criteria for a paraphilic disorder and the clinician chooses to NOT communicate the specific reason the presentation does not meet the criteria of any specific paraphilic disorder

32 LITERATURE RELATED TO ASD & SEXUAL OFFENDING

33 HISTORICAL EVOLUTION OF ASD OFFENDERS IN THE LITERATURE Late 1980s clinicians sought to identify an association between ASD and violence (Baron-Cohen, 1988; Browning & Caulfield, 2011; Gomez de la Cuesta, 2010; Mawson et al. 1985) First large scale study to examine the link between AS (ASD) and violence in 1991 by Ghaziuddin and colleagues (Browning & Caulfield, 2011; Ghaziuddin et al. 1991) debunks previous findings: based on the low number of violent patients with AS estimated in the studies and the relatively common occurrence of violence in the general population, we do not believe that any true association exists between the two conditions. The reports of violence in this syndrome could well have resulted from chance (Ghaziuddin, p. 352)

34 PROPOSED LINK BETWEEN ASD & VIOLENT OFFENDING EVOLVES IN THE LITERATURE Scragg & Shah (1994) reviewed the issue of ASD and offending in Broadmoor Psychiatric Hospital in the UK (out of 392 male patients 17 were identified for the study) and suggested ASD was over-represented in a secure psychiatric setting Hare, Gould, Mills, & Wing (1999) examined numbers of people with ASD in secure hospitals in the UK (Ashworth, Rampton, & Broadmore) and found 31 individuals with ASD across all hospitals (21of whom had an AS diagnosis) and reported an over-representation of people with ASD; particularly AS, in offenders within special hospitals in the UK Scragg & Shah (1994) and Hare et al. (1999) failed to acknowledge that risk factors commonly associated with offending within the general population (social circumstances or co-morbid mental health issues) may have explained specific offending behavior Woodbury-Smith et al. (2006) conducted a study within the community and found the level of offending by those in the ASD group (N=25) slightly lower than their neuro-typical peers (N=20) despite the small numbers they found folks with ASD had a higher propensity towards criminal damage and acts of violence (similar findings in Allen et al. 2008) Mouridsen et al. (2008) conducted the first large-scale study to examine the relationship between PDD (ASD) and all types of offending (933 neuro-typical of those 168 (18%) had offended & 313 ASD of those 29 (9%) had offended) and concluded serious crime is a rare occurrence in people with PDD (Mouridesen, 2012)

35 ASD & OFFENDING Few published reviews have employed methodological rigor (Allen et al. 2008; Gomez de la Cuesta, 2010; King & Murphy, 2014; & Mourisden, 2012) Browning & Caulfield (2011) That there exists a poor understanding of AS and other ASDs within all of the agencies involved in the criminal justice process is inarguable, and is a fact supported by the academic literature, media reporting of trials of offenders with ASDs of varying severity and in the views and professional experiences of the authors. (p. 176) ASD does not make you more likely to offend (Browning & Caulfield, 2011; Gomez de la Cuesta, 2010; Higgs & Carter, 2015; Langstrom et al. 2009; Lerner et al. 2012; Mouridsen, 2012; Mouridsen et al. 2008; Sondenaa et al. 2014; Woodbury-Smith & Dein, 2014; & Woodbury- Smith et al. 2006) According to the literature to date, people with ASD do not seem to be disproportionately represented within the offender population (Allen et al, 2008; Browning & Caulfield, 2011; Gomez de la Cuesta, 2010; Higgs & Carter, 2015; & King & Murphy, 2014) Arson, criminal damage, and sexual offenses appear to be most common offenses by those with ASD (Gomez de la Cuesta, 2010; King & Murphy, 2014; Kumagami & Matsuura, 2009; Mouridsen et al., 2008; Mouridsen, 2012; & Sondenaa et al. 2014) Empirical data assessing recidivism among offenders with ASD is very limited (Higgs & Carter, 2015)

36 A SYSTEMATIC REVIEW OF PEOPLE WITH AUTISM SPECTRUM DISORDER AND THE CRIMINAL JUSTICE SYSTEM (KING & MURPHY, 2014) Systematic review of available literature on people with autism spectrum disorder (ASD) in the criminal justice system (two types of studies considered prevalence of people with ASD in the CJS and those that examined the prevalence of offending in populations with ASD) Due to the variety of methodologies used and focus of research in this area the authors were not able to complete a meta-analysis of the data collected (22 total papers included out of a possible 1,649) Significant variation in overall prevalence of offending by folks with ASD; difficulty with drawing conclusions from most studies due to variability of the definition of offender One (Mouridsen et al. 2008) found higher rates of offenders with AS dx versus other ASD Commonly Reported: more against people versus property offenses; significantly more often involved in school disturbances in comparison to their neuro-typical peers

37 MORE FROM KING & MURPHY, 2014 Some studies examined predisposing factors including adverse childhood experiences and found high rates of physical abuse, neglect and adverse experiences amongst the families of individuals with ASD There is emerging research on people with ASD in the CJS, but the poor quality of much of the research and the variation of both methodologies and specific focus in each study allows only tentative conclusions. A General failing of most studies was that their number of samples were small and/or likely to be biased. (p. 2727) Based upon the specific review, 4 sound studies (see Table 2 on page 2723) that employed non-asd control groups suggest those with ASD are less likely to offend than matched samples of the same age and gender

38 ASD & SEXUAL OFFENDING Insufficient empirical evidence that ASD is related to an elevated risk in sexual offending (Higgs & Carter, 2015; Langstrom et al. 2009) In the current literature, similar characteristics between people with ASD and the general population as it relates to sex offending have been identified (social isolation, poor social skills, difficulty with Theory of Mind, and co-morbid psychiatric disorders) Murphy (2013) suggests that vulnerability for offending appears to be associated with the specific difficulties appearing in ASD rather than conventional risk factors as considered within violence risk assessments such as the HCR-20 Caution significance of ASD traits in offending case studies has not been empirically established (Higgs & Carter, 2015) overwhelming number of AD (ASD) cases have co-existing psychiatric disorders (p. 74 Fabian, 2011) there is no reported evidence that paraphilicrelated psychopathology is preferentially associated with disorders such as AS (p Milton et al. 2016)

39 MORE ON SEXUAL OFFENDING WITH ASD Characteristics of ASD (related to an offense) should be interpreted with caution like their neuro typical peers it is important to look at co-morbid psychiatric disorders, adverse environmental factors (e.g. physical or psychological abuse, domestic violence within the home, or parental neglect) (Higgs & Carter, 2015; Kumangami & Matsuura, 2009; Langstrom et al 2009; & Mouridsen, 2012) General factors that appear to contribute to people with ASD sexually offending include: deficits in empathy; maladaptive sexual behaviors; restrictive, repetitive behavior patterns; and the potential role of co-occurring paraphilias (many hypotheses across the literature) Currently, individuals with ASD convicted of a sexual offense face assessment that will not accommodate their needs in terms of risk management, with selfreport measures un-validated for use with these offenders. Higgs & Carter (2015, p. 116) (Mahoney, 2009)

40 REGARDING YOUTH OFFENDERS WITH ASD Several authors express concern with the ability of law enforcement officials to make sound decisions regarding charges, diversion, etc. Overwhelming majority of studies have focused on ASD and criminality via case study examination, individuals in treatment, or individuals who have been convicted Dewinter et al. (2015) found youth with ASD (ages 15-18) appeared more tolerant towards homosexuality compared to the control group Cheely et al (2012) found youth with ASD were: - MORE likely to be charged for offenses that occurred at school (specifically disrupting school) -LESS likely to be prosecuted -MORE likely to have their charges diverted -LESS likely to be charged with probation violations

41 ASD & SEXUAL OFFENDING IN YOUTH Kumagami & Matusuura (2009) the rate of sex-related crimes were significantly higher than in the general population of family courts *noteworthy quote from this article, [Regarding] Sex-related crimes in particular, delinquents with PDD often had mysterious motivations which could not be entirely comprehended (p. 9) Sutton et al PA state facility housing individuals sentenced to the adolescent sexual offender program after they were adjudicated delinquent for a sexually related crime (N=37; 22 [60%] met the criteria for ASD; average age of 17 in study) In a study of 24 adolescents with ASD and sexual behavior problems in a residential treatment center, only 2 (8%) were diagnosed with a Paraphilic Disorder, one with Pedophilic Disorder and the other with Fetishistic Disorder (Hellmans et al., 2007) In a study of 422 in-patient psychiatric subjects with ASD only 2 (0.004%) were convicted of a sexual offense (Langstrom et al. 2009)

42 MILLION DOLLAR QUESTION How do we make the discrimination between ASD-related maladaptive sexual behavior versus paraphilic disorder or correctly identify the presence of both? And why does it matter?

43 REFERRAL CONSIDERATIONS WITH ASD Careful consideration of the description of the problematic behavior Operational Definition of behavior Is there a clear function of the behavior? How long has the behavior occurred? Is there a history of maladaptive behavior across settings? Contribution of ASD Cognitive and adaptive functioning level of the client Previous treatment attempts Possible history of abuse (Maltreatment???) Gender Dysphoria Sexual Orientation Identification of possible client insight

44 CASE STUDY: SENSORY OVERLOAD 14 year old male with ASD and eligible for school-based services for ASD Client attends his designated neighborhood Middle School in general education classes and receives push in support from an ESE teacher for social, emotional, and language supports at school Referral: Summer camp staff report the client appears to be aroused by plastic bags. Staff report the client is stealing the refill (heavy duty) plastic bags out of bathrooms at sites within the community or taking the generic plastic bags used in most stores and stuffing the bags down into the front of his pants - specifically around his genitals. Staff report the client appears sexually aroused by the contact of the plastic bag(s) lodged against his genitals

45 Forensic Questions: When does he do this? Where does he do this? Does he appear to be aroused by this behavior? Any history of sexual abuse? Have staff or parents asked about why he engages in the behavior? Is he using the bags for autoerotic asphyxiation? ASD Questions: Function of behavior FBA (ABA) Are the plastic bags related to an ASD LI area? Is he sexually aroused by this?

46 INTERVENTION & ASSESSMENT Referral to Board Certified Behavior Analyst (BCBA) for assessment and intervention program Referral to CARD for visual support development (social story and rule book ), social/sexual skills training for acceptable community versus home behavior, and follow-up checks for acquisition and generalization Meeting with school-based staff to alert them to the behavior and proposed treatment Meeting with Camp staff to alert them to the behavior and proposed treatment Risk, Needs, Responsivity (RNR)

47 GENERAL INTERVENTIONS FOR ASD RELATED BEHAVIOR Visual supports developed to address attraction to others; sexual arousal at school/in community; general boundaries (self and others); adultrated topics, etc. Social Stories Video Modeling (self, model, or POV) Specific focus on generalization of information (must move beyond acquisition phase of learning)

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49 Touching my penis in public is illegal and if I do this again I will be arrested and I will go to jail.

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51 I can masturbate in my bedroom at home with my door closed.

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54 Rules in the Men s Restroom I will keep my eyes level I will only talk to someone if they speak to me I will keep my pants over my butt Sometimes men who appear to be women will use the men s room I will put my clothes back on correctly before I leave the bathroom

55 I will follow the rules in the bathroom I will not look in or under other people s stalls or through the cracks between the stalls I will not remind other people about the rules in the bathroom I will not comment on the noises other men make in the rest room I will not try to help other men adjust or fix their clothing in the bathroom

56 CASE STUDY: EXHIBITIONIST? Referral: 19-year-old male with possible ASD charged with indecent exposure. Request for psychosexual evaluation, assessment for ASD, risk assessment, and treatment recommendations. Brief History: At age 11 client was exposed to pornography by friends At age 12 client was discovered viewing adult pornography on-line including Anime and Henti. He admits interest in Ecchi, Lollicon, some Furaffinity. Family removed computer access as a consequence. Psychologist evaluates and determines treatment not indicated. Later discovered to have created sexually explicit drawings involving graphic images.

57 PROGRESSION OF DANGEROUS BEHAVIOR: Age 14 - Exposure to 4 year old Age 16 - Exposure to 6 year old Age 17 - Exposure to 8 year old

58 MULTIPLE OCCURRENCES OF INAPPROPRIATE BEHAVIOR Age 18 the client exposes himself to a female classmate at a college In addition to the actual exposure he is charged for the client describes drawing a picture of his genitals and showing another classmate

59 Forensic Questions: Does the client have ASD? Is the client sexually attracted to children? What is the client s risk level? Appropriate treatment interventions ASD Questions: Does the client have ASD? Does he have a history of any ASD-related behavior? Was he supported in school for special education services? What is his level of functioning?

60 ASSESSMENT & INTERVENTION Comprehensive Evaluation: Interview of family (via home visit and phone) and interview of client by ASD expert and forensic expert. ASD assessments: ADOS-2, ADI-R, ABAS-3. Psychosexual/Risk assessment included AASI-3, PCL-R, MMPI-2-RF, and Static-99R Dx with Autism Spectrum Disorder, Pedophilic Disorder, Exhibitionistic Disorder, Persistent Depressive Disorder and deemed a Moderate Risk Intensive treatment program developed by local provider, ASD expert, and forensic expert in conjunction with referral to local providers for on-going support Legal team sought juvenile probation sanctions to possibly prevent SO registration

61 CASE STUDY: SUSAN Referral: High School teachers and support staff expressed concerns about an18 year old male with autism frequently dressing as a woman (specifically the character Susan/Ginormica from the movie Monsters vs Aliens). The initial referral was closely followed with concerns expressed by his parents about sexually graphic material on his computer depicting the character Susan/Ginormica in provocative poses or engaged in a variety of sexual activity.

62 Forensic Questions: Does there appear to be sexual arousal when he is dressed as Susan? Has he ever expressed a desire to be female versus male? Does he tend to engage in other activities that are stereotypically female? Is he dressing up as other characters? ASD Questions: Related to the young man s sexuality - is this beyond an LI with the character Susan? Should we be concerned that he enjoys dressing as a female?

63 INTERVENTION Met with the family to discuss specific concerns and to review internet safety, child pornography (definition and warnings), and warn against unsafe use of the internet Developed and enforced specific rules about wearing costumes to nonappropriate community locations/events (home and school) Met with the school to discuss the client s specific recommendations and encouraged the school to endorse recommended rules/boundaries related to dressing in character at school and/or school related events

64 CASE STUDY: LOVES THE MEN S ROOM? 16 year old male with ASD and a cognitive impairment who qualified for school-based services in ASD, IDD, and LI Educationally the client was served full-time in a self-contained special education classroom with additional specialized services provided by therapists who push in during the school day for language and social instruction Noteworthy client had no history of maladaptive behavior prior to this referral Referral: School-based staff called to request assistance because the client was eloping from his classroom to various restrooms while other students were using them. The staff were very concerned about the client and his fellow high school students because the client was frequently eloping to bathrooms in a dangerous manner.

65 INITIAL INTERVENTION School FBA reveals complicated and dangerous behavior in addition to elopement In-home/Community FBA reveals similar behavior of concern Intervention team convenes to review data and attempt to construct school and home supports to prevent the elopement and public masturbation Significant concern expressed by intervention team and the family about the function of the behavior and how to extinguish the behavior of concern

66 Forensic Questions: Has he had any contact offenses? Is there any evidence of sexual arousal surrounding the elopement, entry into the bathroom, or viewing/interacting with others? Any history of sexual abuse? Trials of medication to help reduce impulsivity and sexual arousal?

67 ASSESSMENT & INTERVENTION BIPs (home and school), social stories (4 in total), and visual supports developed by school intervention team and private BCBA Intervention team focus included: safety in all settings, social skills instruction, sexuality skills training, and targeted supports detailing masturbation Entire team was focused upon QOL He appears to meet the criteria for other specified paraphilic disorder (coprophila) Continued behavioral programming recommended long-term to ensure generalization with a specific focus on safety and attempting to reshape the deviant sexual interest to more appropriate areas

68 AUTISM & CP Client is originally referred in September of years old attending his neighborhood Middle School. He was diagnosed with depression, sleep problems, and Sensory Integration Dysfunction. The client s mother sought an ASD diagnosis to explain the social problems and need for additional intervention supports at school (he was identified with an IEP at school for EBD and OT) Significant evidence of the client being bullied at school; long history of being disruptive at school, not doing his school work, social problems at school, SIB (hitting his face) across settings, and possible sexual abuse by his father Neuropsychological evaluation in 2002 added an AS diagnosis and updated his IQ scores (WISC-III - VIQ = 102, PIQ = 95, & FSIQ = 99) and academic performance scores Reported problems of the client viewing pornography at 15 by his mother and the school. Later that year, after an extended period of refusing to go to HS the client dropped out of school Client was re-referred in the Spring of 2016 at 29 years of age with 79 counts of CP

69 FORENSIC INTERVENTION Confirm ASD diagnosis and correspondence with ASD Forensic expert Confirm or rule out sexual interest in children; assessment for other co-morbid mental health issues; conduct risk assessment and make recommendations for mitigation of risk and/or treatment Comprehensive evaluation including: interview of client and consultation with ASD forensic expert about client s history. Assessments included: AASI-3, PCL-R, and MMPI-2-RF Dx with Pedophilic Disorder and Pervasive Depressive Disorder. Deemed Low Risk Intensive treatment program to be developed in collaboration with local provider, ASD expert, and forensic expert

70 CAUTION REGARDING CP & ASD NO evidence to support the theory that ASD makes one more likely to view CP The ASD made him do it defense Noteworthy all of the young men we have worked with and evaluated have understood viewing CP is wrong and expressed remorse for their actions (many of whom demonstrated embarrassment) In most cases a single issue polygraph is recommended to rule out any hands-on offending and is extremely helpful in defending the client

71 Don t assume sexual deviance at face value Don t write off behavior as being related to ASD No empirical support that ASD causes aberrant sexual acting out or problems Multi-disciplinary consultation and specified assessments as prescribed by team members No evidence to suggest that standardized assessments are not applicable with clients with ASD Recommended team members may include: forensic psychologist, ASD specialist, neuropsychologist, board certified behavior analyst (BCBA), therapist, SO treatment provider FINAL THOUGHTS

72 THANK YOU FOR ATTENDING! Kim Spence, Ph.D Eric Imhof, Psy.D