Unlawful Behaviors in Adolescents and Adults with Autism Spectrum Disorders



Fred R. Volkmar, Brian Reichow and James C. McPartland (eds.)Adolescents and Adults with Autism Spectrum Disorders201410.1007/978-1-4939-0506-5_13
© Springer Science+Business Media New York 2014


13. Unlawful Behaviors in Adolescents and Adults with Autism Spectrum Disorders



Marc Woodbury-Smith 


(1)
McMaster University, Hamilton, ON, Canada

 



 

Marc Woodbury-Smith



Abstract

Adolescents and adults with autism spectrum disorder (ASD) may come into contact with the criminal justice system (CJS) as victims, witnesses, or perpetrators of alleged criminal activity. It is crucial, therefore, that the CJS is able to respond appropriately when faced with such an individual, who may, if higher functioning, appear to all intents and purpose “normal.” It is equally crucial that carers, families, and health professionals have an understanding of the factors that may lead to CJS involvement such that strategies can be put in place to reduce the risk of unlawful behavior. Whilst it is certainly true that people with ASD are vulnerable to being a victim of crime, much of the literature has been concerned with the risks of perpetration. This is driven, in part at least, by the potentially far reaching consequences for the individual who is accused of a crime. As will be discussed subsequently, despite the lack of clear scientific data regarding the epidemiology and etiology of unlawful behavior among people with ASD, many different factors related to the autism phenotype can theoretically impact on risk, and an understanding of these factors can reduce this risk. Understanding these risk factors can also inform the rehabilitation needs of such individuals, who may not necessarily benefit form the generic forensic mental health services. Moreover, for those already in the CJS, much can be done to ensure that their vulnerability is recognized and managed accordingly.


Adolescents and adults with autism spectrum disorder (ASD) may come into contact with the criminal justice system (CJS) as victims, witnesses, or perpetrators of alleged criminal activity. It is crucial, therefore, that the CJS is able to respond appropriately when faced with such an individual, who may, if higher functioning, appear to all intents and purpose “normal.” It is equally crucial that carers, families, and health professionals have an understanding of the factors that may lead to CJS involvement such that strategies can be put in place to reduce the risk of unlawful behavior. Whilst it is certainly true that people with ASD are vulnerable to being a victim of crime, much of the literature has been concerned with the risks of perpetration. This is driven, in part at least, by the potentially far reaching consequences for the individual who is accused of a crime. As will be discussed subsequently, despite the lack of clear scientific data regarding the epidemiology and etiology of unlawful behavior among people with ASD, many different factors related to the autism phenotype can theoretically impact on risk, and an understanding of these factors can reduce this risk. Understanding these risk factors can also inform the rehabilitation needs of such individuals, who may not necessarily benefit form the generic forensic mental health services. Moreover, for those already in the CJS, much can be done to ensure that their vulnerability is recognized and managed accordingly.

The aim of this chapter is to summarize the available evidence concerning unlawful behavior among adolescents and adults with ASD in a practically informative way. The term unlawful will be used as an all-encompassing term to capture any behavior that is a transgression of the laws of society (which may be referred to in other texts as “criminal” or “offending” behavior). Whilst these laws may vary from jurisdiction to jurisdiction, there are certain core “rights” and “wrongs” that are universally accepted and therefore are associated with severe consequences across the world. These are primarily those behaviors that result in a victim, i.e., result in harm to another person, and that are therefore deemed “morally” wrong. It is these behaviors, which include harassment and stalking, assault on others of a physical and/or sexual nature, as well as the more serious crime of murder, which will be the focus of this chapter. Other transgressions, such as criminal damage and theft (larceny) that may not necessarily directly harm another person physically but that almost certainly will result in sadness and/or distress on the part of the victim, will also be discussed. Much of the research literature is concerned with adults with a diagnosis of Asperger Syndrome, although the evidence discussed and its conclusions apply equally to other higher functioning individuals on the autism spectrum. In contrast, individuals with lower intellectual capacity are much less likely to be perpetrators of crime (although are probably more likely to be victims). However, for the sake of simplicity, the term ASD will be used throughout. Finally, by “higher functioning” I refer to those individuals whose intellectual capacity is in the normal range (i.e., they are higher functioning as compared with others on the autism spectrum).


Literature Overview


The risk of unlawful behavior among people with ASD became more widely apparent as a result of a series of case reports published in the literature in the 1980s and early 1990s (for example, Baron-Cohen, 1988; Chesterman & Rutter, 1993; Mawson, Grounds, & Tantam, 1985). Each of these described an individual with an ASD who had engaged in unlawful behaviors, including assault (Baron-Cohen, 1988; Mawson et al., 1985) and theft (Chesterman & Rutter, 1993). Over the next two decades many further case reports were published, each arguing that the unlawful behavior described was in some way a consequence of the ASD (discussed in Woodbury-Smith et al., 2005). Other potential causes, such as mental health comorbidity (Palermo, 2004), have also been put forward as potentially significant etiologically, although this literature is much smaller.

Of course, case reports are problematic from a scientific point of view. For example, they offer no information about the prevalence of the behaviors described, and suffer from extreme publication bias, such that only the most “interesting” or “unusual” cases are described, hence limiting any generalizations that can be made and offering little useful information about risk among the wider ASD population. One benefit of case studies, however, is that they can raise potential hypotheses concerning the risk factors for the behavior observed in the individual described. So, for example, Mawson et al. (1985) hypothesized that a sensitivity to certain stimuli, notably babies crying, resulted in irritability and hyperarousal culminating in attacks on others. Baron-Cohen (1988) similarly described assaultative behavior, but he hypothesized that this was occurring in the context of a poorly developed theory of mind, whilst other case reports have described certain behaviors occurring in the context of an obsessive pursuit of an interest (discussed in Woodbury-Smith et al., 2010). These case reports have also offered some insight into the management of the cases described, which has varied between incarceration in jail according to the criminal law of the jurisdiction, incarceration in psychiatric hospitals using the provision of mental health law or court diversion, and management in the community with access to generic or specialist mental health services (Dein & Woodbury-Smith, 2010).

In addition to case reports, case series have also been published (Murrie, Warren, Kristiansson, & Dietz, 2002). Notable is the original work of Asperger himself (Asperger, 1944, translated in Frith 1991). When Asperger described a group of boys with core deficits in social interaction, communication, and inflexible patterns of behavior, he additionally commented on other aspects of their behavior. For example, Fritz V. “never got on with other children [and] quickly became aggressive and lashed out with anything he could get hold of (once a hammer) regardless of the danger to others” (Asperger, 1944, p. 40). Another patient, Harro L., was referred by his school because of his “savage tendency to fight” (Asperger, 1944, p. 51); Asperger commented that “little things drove him/her to senseless fury, whereupon he attacked other children” (Asperger, 1944). Similar conduct-disordered behaviors were seen in Asperger’s other patients. Asperger believed that such “autistic acts of malice” (to use his terminology) reflected a limited ability to reflect upon how much they hurt others, an indication of a poorly developed ability to empathize.

A review has been undertaken of the clinical records of cases seen by Asperger in his clinic in Vienna during the 1960s and 1970s (Hippler & Klicpera, 2003). This review identified more detailed information about behavior. Of the 46 children whose files were available for examination, seven (15 %) had been admitted to the ward because their behavior was no longer acceptable at school and exclusion was imminent. Asperger described the occurrence of “autistic malice” in seven patients (15 %). These children were described as showing intentional acts of malice, “with malicious pleasure and apparent pride in what they had done. Some of the children were said to experiment on others, that is, they seemed to do things on purpose to see how others reacted or to provoke a certain reaction” (Hippler & Klicpera, 2003, p. 294).

Wing (1981), whose characterization defined our subsequent conceptualization of Asperger syndrome, described a series of 34 cases of adults who were phenotypically similar to those described by Asperger. In her account, she made specific mention of a small number of individuals who had engaged in problematic behavior, noting that “a small minority have a history of rather bizarre antisocial acts, perhaps because of their lack of empathy” (Wing, 1981, p. 116). This was true of four of the cases she described. One child, for example, with a special interest in chemistry, injured a colleague during the course of a “scientific” experiment. She also described more specifically how a lack of social understanding could lead to contact with the CJS. For example, “he has no idea of how to indicate his interest and attract a partner in a socially acceptable fashion. If he has a strong sex drive, he may approach or touch or kiss a stranger, or someone much older or younger than him/herself and as a consequence find him/herself in trouble with the police” (Wing, 1981, p. 116). The case series of adults with schizoid traits described by Tantam (1988), many of whom overlapped phenotypically with Wing’s, included a small number with antisocial and violent behaviors. Similarly, Wolff’s longitudinal study of loners emphasized the clinical overlap with Asperger’s, and among those individuals described, a small number had presented with antisocial traits (Wolff, 2000).


Prevalence of Unlawful Behavior


Insight into the numbers of individuals with ASD managed within secure mental health facilities was provided by two studies that attempted to measure the prevalence of Asperger Syndrome in maximum secure psychiatric hospitals (“Special Hospitals”) in England and Wales (Hare, Gould, Mills, & Wing, 1999; Scragg & Shah, 1994). Both studies found that the prevalence in these hospitals was higher than the community prevalence figure, ranging between 2.4 and 4.8 % according to the stringency of diagnostic criteria used. In contrast, however, the only study of the prevalence in the Scottish State Hospital (maximum secure), Carstairs, identified no cases (Myres, 2004). This same study also investigated the prevalence of ASD in the prison population of Scotland and found two cases, representing 0.03 % of the prison population. Unlike the other two studies, however, this study was based on staff-reported diagnoses rather than a total population screening and diagnosis approach. Nonetheless, this is the only study at the time of writing that has measured prevalence in prisons. It is also important to note that although the proportion formally identified was small, the perception among prison respondents was that this represented only a proportion of a larger number of prisoners who possibly had ASD, but who had not been assessed or diagnosed.

Based upon these data, it seems reasonable to conclude that a small, yet significant, number of individuals with ASD engage in unlawful behaviors of a severity that warrants incarceration. Although the figures may be higher than the population prevalence, little is known about the true prevalence in jails, which, if all individuals are being diverted to mental health or community care, may be significantly lower, as evidenced by Myres’ study. The quoted prevalence figures may also be a consequence of the methods of ascertainment employed, and the diagnostic practice used at the time, which differed somewhat from current methods.

There are also no epidemiological community studies of unlawful behavior in ASD. One study did attempt to measure the prevalence of offending in an “administrative” community sample of 30 adults with Asperger Syndrome using a self-reported offending questionnaire and a matched non-ASD comparison group similarly recruited in the community (Woodbury-Smith, Clare, Holland, & Kearns, 2006). Self-report was further validated by official criminal justice data for each participant. The researchers found that both self-report and official data were consistent with a low rate of law breaking among the ASD group, and significantly lower than the non-ASD comparison group. There were some differences between groups, however. For example, the ASD group were less likely to have used illicit substances but more likely to have engaged in behavior categorized as “criminal damage.” Moreover, they tended to have a greater history of violent behaviors. The small sample size and bias in ascertainment do limit the extent to which these data can be truly extrapolated to the wider community ASD population. Nonetheless, these data do suggest that small numbers of adults with ASD may be predisposed to violent unlawful behavior. The evidence to date is summarized succinctly by Maughan, who commented nearly 20 years ago that “Asperger individuals do not appear to show a seriously increased likelihood of violent or aggressive acts in adulthood, and will make up only a very small proportion of adjudicated violent offenders. But they are of concern because of the unusual, unpredictable, and distressing pattern of their aggressivity, and, in the context of assessment of dangerousness, their apparent inability to consider the effects of their actions on others” (Maughan, 1993, p. 121).


The Nature of Unlawful Behavior


Whether or not the prevalence is high, what is clear is that some adults with ASD engage in unlawful behavior. The case reports and case series along with the Special Hospital studies all describe a range of unlawful activity, including behaviors at the mild end of the criminal spectrum such as theft, and the most severe behaviors including sexual assault and murder. There is some emerging evidence that fire-setting may be more common among offenders with AS than the non-AS offending population (Hare et al., 1999; Mouridsen, Rich, Isager, & Nedergaard, 2008; Siponmaa, Kristiansson, Jonson, Nyden, & Gillberg, 2001). Moreover, whilst there is some evidence that people with ASD may commit sexual offences, this is a rare occurrence if all the literature is considered together. In conclusion, a range of problematic behaviors have been described, with no specific observable pattern. As will become apparent in subsequent paragraphs, however, relatively minor transgressions that occur as a direct result of social misunderstanding, or as a result of the pursuit of circumscribed interests, are perhaps those that are seen most frequently in clinical practice, and are not reflected well in the literature which has focused on the rarer and more serious crimes.


Causes of Unlawful Behavior


Factors that may mediate unlawful behavior can crudely be classified into those factors related to (1) the socio-communicative phenotype, (2) the neuropsychological phenotype, and (3) the circumscribed patterns of behavior and interest, including rigidity and resistance to change. Of course, it is also likely that factors associated with criminal behavior in the population at large are also relevant among those with ASD. These include family factors (large family size, poor housing, poor or inconsistent parenting, and a parent with a history of convictions), peer factors (i.e., having friends who are delinquent), and individual factors (low IQ and poor school achievement, truancy, aggressive behavior, and hyperactivity-impulsivity-inattention, summarized in Farrington, 2001). However, the focus of these subsequent sections will be the evidence for an association between core autism phenotypic features and risk of unlawful behavior.

Only gold members can continue reading. Log In or Register to continue

Stay updated, free articles. Join our Telegram channel

Nov 27, 2016 | Posted by in PSYCHOLOGY | Comments Off on Unlawful Behaviors in Adolescents and Adults with Autism Spectrum Disorders

Full access? Get Clinical Tree

Get Clinical Tree app for offline access