Autism and Offending. Dr Jana de Villiers Consultant Psychiatrist for the Fife Forensic Learning Disability Service 28 November 2016

Transcription

1 Autism and Offending Dr Jana de Villiers Consultant Psychiatrist for the Fife Forensic Learning Disability Service 28 November 2016

2 Overview Increasing interest in the implication of a diagnosis of Autism Spectrum Disorder (ASD) and contact with the Criminal Justice system People with ASD often do not fit current service criteria Case study Evidence base Pilot Fife Forensic Autism Assessment Service

3 Evidence base What do we know about the link between autism and criminal offending?

4 Some people call it stalking. I call it love!

5

6 Perceptions Offending attributable to lack of empathy, poor social skills or special interests When violent offences are committed, the violence can be extreme Serial Killer Database study in 2014 suggested 8% of perpetrators had ASD

7 Autism and Offending Hans Asperger s original cohort of 177 patients: Rate and nature of crimes no different from general population Records spanning 22 years and 33 convictions: only 3 cases of bodily injury, 1 case of robbery and 1 case of violent and threatening behaviour

8 Autism/ASD was not a diagnostic entity in DSM until the 1980s Late entry contributes to lack of research Considerable research on intellectual disability and offending, and overlap between the conditions can inform consideration of the issues faced by people with ASD within the Criminal Justice System

9 Impact of ASD on CJS pathway Characteristics of ASD may impact on fitness to plead, culpability, criminal responsibility and ability to survive custodial sentences High levels of social deprivation overwhelmingly important (in people both with and without intellectual disability)

10 Factors that may lead to offending Howlin (2004): 1. Increased social naiveté 2. Disruption of routines or over-rigid adherence to rules may result in aggression 3. Lack of understanding of social situations may lead to aggression 4. Obsessional interest, perhaps exacerbated by a failure to recognise implications of behaviour (eg acquisitive offences)

11 Vulnerability within CJS Not understanding rights More suggestible and acquiescent More likely to falsely confess Intentions can be misinterpreted eg lack of eye contact More likely to make poor decisions if not given good advice Prison environment difficult eg noise levels, vulnerable to bullying and exploitation

12 Newman and Ghaziuddin (2008) Series of single-case and small-scale studies of people with ASD and violent offending Concluded that psychiatric co-morbidity (present in most of these cases) was a major contributory factor to the offending

13

14 ASD and OCD are not associated with violent criminality Children diagnosed with ADHD had a substantially increased risk for violent criminality (OR 4.6) Children with tic disorders had an increased risk for violent crime (OR 2.2)

15 Lack of link between childhood ASD and criminality: ASD leads to difficulties inferring other people s thoughts but not necessarily their distress Psychopathic traits and ASD are not part of the same construct Psychopathic traits reflect an additional impairment

16 Central to identifying people with ASD is recognition that the presence of a specific trait or traits, regardless of prominence, does not imply that an ASD should be diagnosed.

17 Features of ASD can both reduce and raise risk of offending Further high quality research is required before any firm conclusions about whether an ASD diagnosis is related to a raised risk of sexual offending and recidivism [can be reached].

18 Group therapies may need adaptation Offenders with ASD may not deny their offence, given their tendency to believe that their actions were suitable in the particular situation and their insusceptibility to reputation management

19 ASD does not predispose an individual to violence nor increase the likelihood of offending behaviour more generally. Offending is rare among individuals diagnosed with classical autism and is comparable to that in the general population for those diagnosed with AS.

20 a people with ASD do not seem to be disproportionately over-represented in the Criminal Justice System

21 People with ASD could be considered at low risk of offending, as they find rules helpful in surviving the social world, and laws are simply social rules of a particular type.

22 Prevalence of ASD in offender populations Different studies give rates ranging from 3% to 27% Variation due to different methodologies and source of sample Prevalences higher than general population but significant methodological issues Robinson et al (2012) found 4% on screening but no cases following detailed assessment over 12 prisons in Scotland (including two with young offenders)

23 Prevalence of offending in people with ASD Prevalence of offending behaviour in ASD varied greatly between studies Rates for Asperger syndrome varied from 2.74% to 26% (even 48% for self reported crime) Studies that used a comparison group found rates that were the same or lower Definition of offending varied between studies, with self-report giving highest rates

24 Co-morbid psychiatric diagnosis All studies used samples from mental health settings or those referred for forensic assessment General trend of high rates of co-morbidity, particularly psychosis and personality disorder, is unsurprising given the biased samples

25 Types of offending Relatively few differences in types of offences between ASD and non-asd offenders Only one controlled study reported an increased rate of arson in one sub-sample Other studies showing high rates of violent conduct and/or arson likely due to source of sample (eg forensic settings), as no comparisons made with control groups

26 Abiding by the rules People with ASD were less likely to commit probation violations than those without ASD (Cheely et al, 2012)

27 The Autism Defence in Child Pornography Cases Common traits between child pornography offenders and ASD: Lack of victim empathy Lack of intuition regarding social norms vs cognitive distortions Repetitive behaviour Large collections of images with a rigid taxonomy

28 But If took steps to conceal, then aware actions are wrong = mens rea

29 The use of Asperger s syndrome as an excuse for criminal conduct does a disservice to all of the law-abiding individuals with AS in the community and represents a misapplication of psychology.

30 Cybercrime = illegal use of computers and the internet, or crime committed by means of computers and the internet Cyber offenders seldom fit a recognised criminal profile reported to come less frequently from lower socio-economic groups.

31 Recent study of college students by Siegfried- Spellar et al 2015) found only a tiny proportion (0.01 per cent) of those engaged in deviant computer use had a clinically significant AQ score. A diagnosis of autism offers no protection from prosecution. Some Courts may take ASD diagnosis into consideration when sentencing.

32 Problems with current evidence base Other than Swedish population register study, none of the studies attempted to match groups for factors known to affect criminal offending (eg social deprivation, physical abuse and neglect) Lack of research on women with ASD in CJS Lack of consistent diagnostic assessments Biased sample selections

33 It must be concluded that the examination of the relationship between ASD and offending is in its infancy.

34 Fife Forensic Autism Assessment Service Pilot service established January 2015 Provides advice and consultancy to other professionals or agencies Referral criteria: Reasonable grounds to support a diagnosis of ASD Individual is displaying behaviour that poses a significant risk to others (resulting in contact with CJS)

35 Prevalence of Offenders with ASC in Fife 1% of adult population have an ASC (50% ASC + LD) (National Autistic Society) Population of Fife approx. 350,000 ( = 3500 with an ASC)? 8% of people with an ASC have a criminal record (CR) ( = 280 ASC + CR) Assuming 2 yr criminal justice contact over age range (16 50) = 16 people with ASC in Fife CJS at any one time. = 8 ASC + ID; 8 ASC ID = 8 ASC ID referrals per year?

36 Referrals received 9 referrals were received, all male Mean age at referral was 22 (range 17-36) Cognitive functioning within normal range for 8 referrals (1 patient had an identified ID)

37 Referral source Referral Source Location ID Psychiatry General Adults Psychiatry Criminal Justice Social Work Community Psychiatric inpatient

38 Basis for autism diagnosis Multidisciplinary assessment in childhood: n=6, including ADOS Diagnosis by single clinician in childhood: n=2 No formal diagnosis but possible ASC : n=1

39 Co-morbidities n=9 Mental illness/psychosis ADHD Tourette's syndrome Foetal Alcohol Spectrum Disorder

40 Primary Offence Type n=9 Sexual (Child) Sexual (Adult) Violence

41 Early psychological trauma Drug and alcohol history Sexual abuse Physical abuse Early separation No history of early psychological trauma Significant drug use Significant alcohol use No significant use

42 Assessments undertaken Review of all available documentation Screening/structured assessments Multiple interviews with patient Interview of parent/carer Formal assessment of theory of mind, emotion recognition and executive functioning Joint discussion of assessments and recommendations

43 Outcome of assessments Diagnosis of ASC agreed: n=2 Management recommendations made Diagnosis not agreed: n=6 Personality Disorder (n=4) Foetal Alcohol Spectrum Disorder (n=1) Schizophrenia (n=1) One patient not assessed, but document review indicated ASC unlikely

44 Summary People with ASD do not appear to be overrepresented in CJS settings ASD in isolation does not increase risk of offending Offenders may have traits that resemble ASD eg obsessive collection of pornographic images, but comorbid factors more likely to be relevant

45 In short ASD may be relevant as mitigation or to inform ongoing risk management in individual cases Known criminogenic factors remain highly relevant eg early trauma, deprivation, comorbid mental disorders and personality traits

46 To note Children who experience significant neglect and abuse may meet criteria for ASC, but if removed from abusive environment may over time grow out of the diagnosis Raises questions about the robustness and validity of the diagnosis in these circumstances In individual cases ASC may have a significant impact on ability to participate in CJS proceedings, ability to cope in custody or ability to engage in (non-adapted) treatment programmes

47

48