Transcript Asperger Syndrome & Offending Behaviour

Asperger Syndrome &
Offending Behaviour
Exploring the Links
David Allen1,2, Carys Evans1, Andrew Hider3 & Helen Peckett1
1 -Special Projects Team, Bro Morgannwg NHS Trust, 2- University of Glamorgan, 3- Caswell Clinic, Bro Morgannwg NHS Trust,
Possible Predisposing Factors
(Howlin, 2004;Berney, 2004)
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Innate lack of empathy can lead to offence that is
disproportionately intense/damaging. Individuals often lack
insight, deny responsibility, blame others. May be due to
inability to see inappropriate behaviour as others do
Innate lack of awareness of outcome allows individuals to
embark on actions with unforeseen consequences
Impulsivity, sometimes violent, can be a component of comorbid ADHD or of anxiety that turns into panic
Social naivety and misinterpretation of relationships can
result in exploitation as a stooge
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Misinterpreting rules, especially social rules, can find
individuals unwittingly embroiled in offences such as
date rape
Difficulty judging the age of others may lead to illegal
relationships, sexual advances to minors etc.
Over-riding obsessions can lead to offences such as
stalking or compulsive theft.
Lacking motivation to change, individuals may remain
stuck in risky patterns of behaviour
Forensic presentations possibly indicative of
undiagnosed Asperger Syndrome (Berney,
2004)
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Obsessive harassment (stalking)
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Inexplicable violence
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Computer crime
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Offences arising out of misjudged social relationships
Asperger & Offending
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‘While the majority of persons with Asperger’s
syndrome are scrupulously law abiding..a small
subset does come into contact with the legal system’
(Murrie et al, 2002)
‘Although there is little evidence of any significant
association between autism and criminal offending,
occasional and sometimes lurid publicity has led to
suggestions that there may be an excess of violent
crime amongst more able people with autism or
those diagnosed as having Asperger syndrome ’
(Howlin, 2004)
Media Reports (US)
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DM –35 year old, obsessed with subway maps, trains,
timetables. 18 arrests. First ‘borrowed’ subway train
aged 15; recent incidents involved pulling emergency
break during rush hour, impersonating transit worker
(New York Times, 2001)
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RD – 60 year old, heir to multi-million property
fortune. Living in disguise as a woman, killed &
systematically dismembered neighbour. Implicated in
two other disappearances (Telegraph, 2003)
Media Reports (UK)
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13 year old (ASD) - killed 85 year old woman in Dorset
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TM –shot & killed 18 year old burglar (Norfolk Eastern
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(Daily Mail, 1994)
Daily Press)
SH – assaults against police etc. Experienced periods in
prison and detained under MHA. Misdiagnosed as
psychotic, depressed (BBC Newsnight)
TM-detained in Rampton following conviction for
murder of 9 year old boy who had provoked him
(Times, 2000)
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BG – killer of Jill Dando (Telegraph, 2001)
12 year old, killed 6 month old baby brother in cot,
cut off his left hand. Asked why he had done it: ‘I
want to be with my mother’(Telegraph, 2001)
SH – stalked, threaten to hack to death Tina Barrett
of S Club 7 (Telegraph, 2003)
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AC – sent computer virus that caused ‘potentially
catastrophic’ crises at port of Houston, Texas
(Telegraph, 2003).
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PB – diagnosed as schizophrenic, detained in
Broadmoor for over 10 years following single act of
violence (Telegraph, 2003)
PS – aged 18; murdered 10 year old girl who had
teased him while at a party attended by 60 guests
(Telegraph, 2004)
Popular Media
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CSI
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The Brief
Professional literature: Case
studies
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Mawson et al (1985)
Baron-Cohen (1988)
Everall & LeCouter (1990)
Tantam (1991)
Chesterman & Rutter (1994)
Kohn et al (1998)
Milton et al (2002)
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Murrie et al (2002): Analysis of six case histories
from forensic settings. Commonalities across cases
included:
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Deficient empathy
Interpersonal Naivety
Sexual Frustration
Immediate confession
Links to preoccupations
Barrie-Walsh & Mullen (2004): Analysis of five cases.
Similar themes raised, especially deficient empathy
Studies on rates of offending in Asperger
Groups
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Tantum (1988):Study of long-term users of mental
health services regarded as socially isolate/eccentric.
77% subsequently diagnosed as AS. 3% had been
committed to secure hospitals, 44% had committed
isolated offences & 23% actual criminal offences
(primarily violence against others)
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Ghaziuddin, Tsai & Ghaziuddin (1991):
reviewed 21 publications, n=132,on people with AS.
Only 2.3% had clear history of violent behaviour
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Scragg & Shah (1994): 1.5% prevalence of AS in
Broadmoor (as compared to 0.36% population base rate
established by Ehlers & Gillberg, 1993)
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Siponmaa et al (2001): 3% of consecutive referrals
aged 15-22 to forensic psychiatric service in Stockholm
met criteria for AS
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Hare et al (1999): Study of ASD in three special
hospitals in England. 31/1305 had definite ASD
(2.4%); 21/31 had AS.
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Myers (2004): ASD/LD in secure, forensic other
specialist settings in Scotland.6/216 ASD only; 34
ASD & LD.
Present study aimed to identify:
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Number of adults with Asperger
Syndrome and offending behaviour
within defined catchment area
Characteristic patterns of offending
Disposal patterns within CJS & MH
systems
Support services received
Procedure
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Conducted in area served by 7 LHBs in
South Wales
General population 1.2 million1
Contacted all relevant services within
area
Identify numbers of people with Asperger
served and numbers with offending
behaviour
Predicted prevalence of Adults with Asperger in Locality (Based on average 43 cases /10,000)
3,932 (Averaged from rates in Ehlers & Gilberg, 1993; Kadesjo et al, 1999; Chakrabarti &
Fonbonne, 2001(all child studies)
1
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Three-stage interview process
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98 services contacted
(I. Personal
Characteristics II. Nature of offending-informant III. Service
user views)
forensic, probation, prisons)
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(mental health, learning disability,
235 staff surveyed
Information sheet & consent form sent direct
to potential participants
Could consent to all stages or just informant
stages
Results
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Total of 126 people identified
33 were identified as having offended
10 lived independently, 9 in secure
forensic settings, 3 in prison, 8 in
mental health facilities, 2 in specialist
ASD services, and 1 in service for pwld
16 gave informed consent
Participants
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Mean age 34.8 years (range )
All male
15/16 single
13/16 met at least 4/6 diagnostic
criteria on the ASDI (Gillberg et al, 2001)
Mean age first offence 25.8 years
(range 10-61)
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Variety of additional diagnoses (LD &
schizophrenia most common)
History of behavioural problems
common (88% verbal aggression, 75% physical
aggression, 69% destructiveness, 69% inappropriate sexual
behaviour, 38% substance abuse, 38% over-activity)
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Most frequent services: psychiatry (69%), clinical
psychology (56%), social work (38%); 50% receiving antipsychotics, 33% antidepressants.
Nature of offending
Type
%
Type
%
Violent
Conduct
81
Theft
25
Threatening
Behaviour
75
Sexual
Offences
19
Property
Destruction
50
Fraud
6
Drug Offences
25
Motoring
Offences
6
Mean no. of offences=3 (range 1-7)
Example offences
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Violent assault on couple following social
rejection
Put hidden camera in step daughter’s room to
monitor self-harm & under-age sexual activity
Stalking & indecent assault
Sent knife with red substance on it to
consultant psychiatrist. Petrol bombs found in
home
Arson
Murder
Predisposing factors
Factor
%
Lack of concern for outcome
94
Lack of awareness of outcome
82
Impulsivity
63
Social Naivety
88
Misinterpretation of rules
63
Overriding obsessions
44
Precipitating Factors
Factor
%
Factor
%
Bullying
50
Mental Health
onset/
deterioration
31
Social
Rejection
69
Change
domicile
25
Sexual
Rejection
50
Change in
professional
support
19
Family Conflict
50
Bereavement
13
Disposal
Disposal
%
Not processed/arrested
44
Prison
31
Hospital
6
Community
19
The Experience: Being arrested
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‘The whole time between arrest and getting settled
in prison was traumatic’
‘There was a loud banging on the door..my mother
said it was the police…I obviously knew what it was
about…I admitted it straight away’
‘To be honest with you, the police down the station
were absolutely great. They kept my cell door
open, they kept the yard open so that I could just
go out for a cigarette whenever I wanted. It was
great down there’
Being interviewed
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‘Particularly difficult…they were very long’
‘The whole experience was really confusing ‘cos I
didn’t know what was going to happen next’
‘I felt the police trying to pressure me into a
conviction…trying to get me charged with
something’
‘It was awful because in my mind I can’t take too
many things in at once’
‘My appropriate adult reassured me and he was
caring’
In court
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‘Pressure…plenty of pressure..but I just blanked it
really...I don’t do emotion, I don’t do emotion at
all. Smiling is few and far between’
‘The judge just seemed to disregard the
reports…she’d obviously made up her mind’
‘It didn’t help me the first time in that there was a
photographer there trying to take pictures of me’
‘My barrister didn’t have much time to look into to
it…I was only diagnosed the week before’
In prison
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‘It’s been awful too be honest..’
‘I’m just convinced that something bad will
happen to me here’
‘People speak to like you’re a piece of crap’
‘ I’ve grown in confidence since attending prison’
‘Being moved to a smaller wing with less people
on it (was good)’
‘I became settled and then they moved
me…upset my equilibrium’
‘It’s just been a bad experience’
Mental health disposal
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‘Being there was better than being in
prison…I felt safer in there and I could cope
better’
‘Staff are fantastic, they’re helpful, they’re
courteous…they’re well trained’
‘The psychiatrists diagnosed me with
Asperger’s…but no one really explained to me
what it is. I still don’t understand it to be
honest’.
Room for improvement
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‘Just improving general awareness’
‘…then they could understand me more’
‘Some kind of person just explaining what
was going to happen would have been really
helpful’
‘More things to do’
‘Eventually I got a therapist & that
helped..since I’ve been seeing her things
have got a bit easier’
Discussion points
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Adult sample
Sampling frame Overall prevalence of
offending very low (0.84%?)
…but quite high (26%) amongst those in
touch with specialist MH/LD services?
Causality?
Moderator variables (Woodbury-Smith et al,
2005)?
Future research