Journal of Intellectual Disabilities and Offending Behaviour : Autism spectrum conditions and offending (janvier 2013)

vendredi 22 février 2013

Le Journal of Intellectual Disabilities and Offending Behaviour a consacré son numéro de janvier 2013 sur les aspects judiciaires ou médico-légaux des personnes avec autisme qui ont été amené à commettre des crimes ou des délits.

1. Chaplin E, McCarthy J, Underwood L. Autism spectrum conditions and offending : an introduction to the special edition. Journal of Intellectual Disabilities and Offending Behaviour ;2013 ;4(1-2):5-8.

The purpose of this paper is to offer an overview of the issues from studies that have tried to estimate rates of offending. There is currently no consensus on the prevalence of people with autism spectrum conditions who offend, due to the limited evidence base. It is also difficult to generalise findings across the criminal justice system and secure services. This paper brings together a summary of key studies that have estimated the numbers of offenders with autism spectrum conditions over the last 30 years.

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2. Barkham E, Gunasekaran S, Lovelock C. Medium secure care : forensic aspects of autism and Asperger’s syndrome. Journal of Intellectual Disabilities and Offending Behaviour ;2013 ;4(1-2):9-16.

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. 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. 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. This paper offers an overview of the current evidence base relating to the treatment of individuals with autism spectrum disorders within medium secure settings.

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3. Underwood L, Forrester A, Chaplin E, McCarthy J. Prisoners with neurodevelopmental disorders. Journal of Intellectual Disabilities and Offending Behaviour ;2013 ;4(1-2):17-23.

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). 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. 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. The paper highlights the current limited evidence base on prisoners with autism spectrum disorders.

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4. Haw C, Radley J, Cooke L. Characteristics of male autistic spectrum patients in low security : are they different from non-autistic low secure patients ?. Journal of Intellectual Disabilities and Offending Behaviour ;2013 ;4(1-2):24-32.

The purpose of this paper is to describe the characteristics of adult male autistic spectrum disorder (ASD) patients admitted to low secure services and to compare them with non-ASD patients. Case-control study of admissions to two ASD units and one non-ASD unit at a tertiary referral centre. Subjects were compared on demographic, personal, clinical and offending behaviour variables. Findings - In total, 51 ASD and 43 controls were studied. Median age at diagnosis of ASD was 21 years (range 6-56). The ASD group were younger (median age 27 vs 33 years) and more likely to be single than controls. Their age at first contact with psychiatric services was lower and proportionally more were admitted from prison and courts. Almost three-quarters had psychiatric comorbidity, most commonly schizophrenia, but unlike controls, personality disorder and drug and alcohol disorders were uncommon. Lifetime sexually inappropriate behaviour and physical violence were less common, as was non-compliance with medication. However, 78 per cent had a lifetime history of physical violence and a third had a conviction for GBH or homicide. Offending behaviour was sometimes atypical in nature and some had convictions for unusual offences such as harassment and stalking.The age difference between cases and controls is likely to have confounded the results. Findings cannot be generalised to the NHS. This group of ASD patients in low security differed in several important respects from their non-ASD counterparts, which highlights their differing treatment needs, strengths and weaknesses.

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5. Murphy D. Risk assessment of offenders with an autism spectrum disorder. Journal of Intellectual Disabilities and Offending Behaviour ;2013 ;4(1-2):33-41.

Integral to the process of formulating and managing the difficulties of mentally disordered offenders is the assessment of risk. However, the opinion held by many clinicians who work with offenders with an autism spectrum disorder (ASD) is that most conventional risk assessment tools fail to capture the underlying reasons why such individuals may offend. This needs to be explored. The paper presents a screening study of the HCR 20 risk assessment tool and some other characteristics of ’high risk’ individuals with an ASD. Also presented is a brief literature review supported by clinical experience of the assessment of psychopathy in ASD and highlighting potential key factors to be included in a risk assessment of offenders with an ASD. It was found that nine out of the 20 risk items contained in the HCR 20 are present in 50 per cent or less of the sample. Whilst some conventional risk factors are present, clinical experience and the literature suggests that it is the specific difficulties associated with having an ASD that contribute towards an individual’s vulnerability to offend. Although further examination is required, provisional findings from this small screening study of the HCR 20 profiles of high risk individuals with an ASD questions the usefulness of some conventional risk factors in understanding the difficulties within this population. It is proposed that there is a need for good practise guidelines for assessing risk in individuals with an ASD.

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6. Raggi C, Xenitidis K, Moisan M, Deeley Q, Robertson D. Adults with autism spectrum disorder and learning disability presenting with challenging behaviour : how tolerant should we be ?. Journal of Intellectual Disabilities and Offending Behaviour ;2013 ;4(1-2):42-52.

Reporting to the police incidents of challenging behaviour displayed by inpatients with autism spectrum disorders (ASD) and learning disability (LD) represents an important but often controversial issue. The purpose of this paper is to contribute to this topic through a brief literature review and the presentation of a clinical case. Case study and literature review. The action of reporting to the police can be a useful tool within the therapeutic input provided to patients with ASD and LD who present with challenging behaviour. This can enable staff to feel legally supported, and can promote patients’ learning of social rules, in respect of their rights and duties. The clinical case highlighted that reporting to the police can be effective when it is part of a comprehensive, multi-professional therapeutic process. This should aim at directing patients towards rehabilitation rather than incarceration. This should also entail the identification of clear pathways and ongoing involvement of patients and families. Despite the relevance for clinical practice of the above debate, little has been published on this topic. This paper contributes to this discussion through the presentation of a clinical case and by describing how this issue was addressed within a secure inpatient setting.

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7. Archer N, Hurley EA. A justice system failing the autistic community. Journal of Intellectual Disabilities and Offending Behaviour ;2013 ;4(1-2):53-59.

The purpose of this paper is to offer a personal perspective and highlight perceived shortcomings in the criminal justice system (CJS) when people with autism come into contact with it ; and provide ideas for improvement. The first author’s work as the Criminal Justice Sector Development Coordinator at Autism West Midlands has given him first-hand experience in all aspects of the CJS as it relates to autism. The paper highlights the reasons why raising autism awareness is crucial in the CJS and provides a current overview of the present position. There is a need for increased awareness of autism in the CJS. Too often people with autism enter the system because of misunderstandings about their condition. Although a few police forces have undertaken autism awareness training, there is a need for further training for the remainder and for the other organisations that make up the wider CJS. Additionally, there are simple and cost-effective changes or services that could be implemented now, both by the CJS and local authorities, to address the issues but which are not being implemented due to a lack of clear policy and direction from government. This paper gives a unique perspective on the needs of people with autism when they encounter the CJS. It highlights the lack of information on how many people with autism encounter the CJS. Furthermore, it explains the impact that lack of autism awareness in the CJS can have on a person with autism.

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8. Kelbrick M, Radley J. Forensic rehabilitation in Asperger syndrome : a case report. Journal of Intellectual Disabilities and Offending Behaviour ;2013 ;4(1-2):60-64.

People with Asperger syndrome are at increased risk of co-morbid mental health problems. The core features underlying autism are likely to play an important role in offending behaviour amongst this population. Forensic rehabilitation includes a multidisciplinary approach and combination of therapeutic interventions. However there is limited evidence in the literature of what constitutes effective treatment within this setting, and how the process of rehabilitation is experienced by patients. The purpose of this paper is to describe a case of Asperger syndrome with co-morbid psychosis and offending behaviour and the process of forensic rehabilitation. The authors briefly review the literature related to Asperger syndrome, offending in this population and co-morbidity. The authors then describe and reflect on a case of a young man with Asperger syndrome, sexual offending and the process of forensic rehabilitation, and offer an insight from the patient’s perspective. Co-morbid mental illness, when detected early, can be successfully managed with limited additional disability. The process of forensic rehabilitation includes a multidisciplinary approach. Therapeutic interventions specifically aimed at addressing core features of autism, risk and offence-related factors are effective in promoting recovery amongst those with autism and offending behaviour. The paper highlights how core features of autism can lead to offending behaviour, the importance of early recognition and treatment of co-morbidity, and the process of forensic rehabilitation and recovery. Also included are quotes from the patient’s perspective on what it is like to have Asperger syndrome, and what has been the key learning from the rehabilitation process.

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