ForensicAspectsofAutismSpectrumDisorder(ASD)

Presenter:JerrodBrown,Ph.D.

TreatmentDirectorforPathwaysCounselingCenter,Inc.TheAmericanInstitutefortheAdvancementofForensicStudies(AIAFS)

ConcordiaUniversity,St.Paul,Minnesota

Presenter’sBiography

JerrodBrown,Ph.D.,istheTreatmentDirectorforPathwaysCounselingCenter,Inc.Pathwaysprovidesprogramsandservicesbenefitingindividualsimpactedbymentalillnessandaddictions.JerrodisalsothefounderandCEOoftheAmericanInstitutefortheAdvancementofForensicStudies(AIAFS),andtheEditor-in-ChiefofForensicScholarsToday(FST)andtheJournalofSpecialPopulations(JSP).Jerrodhascompletedfourseparatemaster’sdegreeprogramsandholdsgraduatecertificatesinAutismSpectrumDisorder(ASD),OtherHealthDisabilities(OHD),andTraumatic-BrainInjuries(TBI).JerrodiscertifiedasaYouthFiresetterPrevention/InterventionSpecialist,ThinkingforaChange(T4C)Facilitator,FetalAlcoholSpectrumDisorders(FASD)Trainer,andaProblemGamblingTreatmentProvider.Emailaddress:Jerrod01234Brown@live.com

TrainingDescription

Inthis90-minutepresentation,attendeescanexpecttolearnabouttheimpactASDhasoncriminaljusticeandforensicmentalhealthsettingsandtoacquireknowledgeaboutthedeficitscommonlycausedbyASD.Specifically,wewillfocusonhowASDmaycontributetoconfabulation,competencytostandtrial(CST)deficits,diminishedcapacity,falseconfessions,sexuallyinappropriatebehaviors,suggestibility,aggressiveness,self-injuriousandsuicidalbehaviors,andpossiblevictimizationduringincarceration.Relevantresearchfindingswillbepresentedthroughouttheworkshop.Finally,thistrainingwillprovidesuggestedapproachesandinterventionstrategiesthatcriminaljusticeandforensicmentalhealthprofessionalscanutilizewhenworkingwithindividualswhohavesuspectedorconfirmedASD.

TrainingObjectives

•Describetheriskfactors,redflagindicators,anddeficitscommonlyassociatedwithASD•DescribeempiricalresearchoftheimpactofASDonthecriminaljusticesystem•DescribethechallengesanddifficultiesofroutinescreeningforASDinclinicalandforensicpopulationsalongwithwaystolimitmissed,under,andmisdiagnosisofASD•DescribehowASDcanimpactadefendant'scompetencytostandtrialandothertrial-relatedabilities

Agenda

• ASD:ABasicReview• ASD:AReviewofKeyDeficits• ASDandtheCriminalJusticeSystem:ArrestthroughCommunity

Supervision• Challenging,Problematic,andCriminalBehaviors• ScreeningConsiderations• InterventionandTreatmentConsiderations• Conclusion• SupplementalSlides

MyExperience

• Attachment-RelatedDisorders• AutismSpectrumDisorder(ASD)• CriminalJustice-InvolvedPopulations• FetalAlcoholSpectrumDisorder(FASD)• LearningDisorders

• PersonalityDisorders• SeriousandPersistentMentalIllness(SPMI)• SubstanceAbuseDisorders• SleepDisorders• TraumaticBrainInjury(TBI)• Trauma-RelatedDisorders

ASD:TheBasics• Life-long• Beginsinearlychildhood• Pervasivedevelopmentaldisorder• Aseriousdevelopmentaldisorder• Aneurologicalanddevelopmentaldisorder• Abroadrangeofbehaviors,deficits,andsymptoms• Degreesofseveritycandifferbyperson• Fastestgrowingdevelopmentaldisability• Nononecure

Symptom&DeficitProfile

• Socialandcommunicationsskills(socialinteractiondeficits)

• Cognitiverigidity(restrictiveorrepetitivebehaviors)

• Widerangeofbehavioralandemotionalsymptoms

MyObservations• Adaptivefunctioningdeficits• Anxiety• Behavioralandemotionalchallenges• Bluntedaffect• Cognitiverigidity• Communicationandlanguagedeficits• Decision-makingdeficits• Depression• Difficultyinreadingemotions• Difficultydealingwithstress• Digestiveissues• Executivefunctioningdeficits

• Inflexiblebehaviors• Learningchallenges• Limitedrangeofinterests• Loneliness• Obsessiveinterests• Organizationdeficits• Restricted,stereotyped,orrepetitivepatternofinterests• Sensorydeficits• Sleepproblems• Socialinteractiondeficits• Suicidalthinking• Timemanagementissues

GeneralStatistics• AutismSpectrumDisorder(ASD)isthefastestgrowingdevelopmentaldisabilityintheUnitedStates(CentersforDiseaseControl&Prevention,2015;VanNaarden Braunetal.,2015)

withratesofdiagnosisincreasing10-17%peryear(Baio,2014)

• TheCentersforDiseaseControl(CDC)estimatesoneinevery68individualshasbeendiagnosedwithASDinthegeneralpopulation(2015)

• Asof2010,approximately52millionpeoplehaveASDonagloballevel(Baxteretal.,2014)

• Sincethe1990s,theprevalenceofASDdiagnoseshasskyrocketedfrom0.05%(Fombonne,2003)to0.62%(Elsabbagh,Divan,Koh,Young,Kauchali,Marcín,etal.,2012)

SuggestedReference

HansenS.N.,SchendelD.E.,Parner E.T.(2015).Explainingtheincreaseintheprevalenceofautismspectrumdisorders:theproportionattributable

tochangesinreportingpractices.JAMAPediatr,169,56–62.

CausesofASD

AlthoughthebiologicalandenvironmentaloriginsofASDhaveyettobeestablished,evidenceofabiopsychosocialmodelsuggeststhattheetiologyanddevelopmentaltrajectoriesofthedisorderlikelyresult

fromthecomplexinterplayofseveraldifferentbiologicalandenvironmentalfactors.Thus,successfultreatmentlikelyrequires

expertiseinseveraldifferentareas

Higgs&Carter,2015

KeyFacts• ASDisfourtimesmorecommoninmalesthanfemales(APA,2013)

• ASDisnowconsideredthefastestgrowingdevelopmentaldisabilityintheUnitedStates(CDC,2015)

• TheCenterforDiseaseControlestimatesthatonein68individualshasbeendiagnosedwithASD(CDC,2015)

• ASDdiagnosesareincreasingatarateof10%to17%eachyear(NationalHumanGenomeResearchInstitute[NHGRI],2012)

• Between70%and74%ofchildrenwithautismspectrumdisorder(ASD)arediagnosedwithacomorbidmentaldisorder,andabout40%havetwoormorecomorbidmentaldisorders(APA,2013;Mattilaetal.,2010)

ASDintheDSM-5“Autismspectrumdisorderischaracterizedbypersistentdeficitsin

socialcommunicationandsocialinteractionacrossmultiplecontexts,includingdeficitsinsocialreciprocity,nonverbalcommunicativebehaviorsusedforsocialinteraction,andskillsindeveloping,

maintaining,andunderstandingrelationships.Inadditiontothesocialcommunicationdeficits,thediagnosisofautismspectrumdisorderrequiresthepresenceofrestricted,repetitivepatternsofbehavior,

interests,oractivities”

DSM-5,pg.31

ASD:AReviewofKeyDeficits

“…anindividual’slevelofimpairmentultimatelyfallswithinacontinuumrangingfrommildtosevere”

Brownetal.,inpress

HiddenDisability

ASD-PossibleCharacteristics

IndividualswithASDmayexhibitthefollowing:• Rigidness• Obsessionalinterests• Poorverbalandnonverbalcommunicationskills• Impulsivity• Unpredictability• Suggestibility• Sensitivetoextremesensoryexperiences• Dislikephysicalcontactinitiatedbyothers• Highratesofdiagnosticcomorbidity-70%

Freckelton&List,2009

SocialCommunication&SocialInteractionDeficits

CommunicationDeficits-ImportantReminders

CognitiveRigidity(restrictiveorrepetitivebehaviors)

Adaptivefunctioning

Adaptivefunctioningisdefinedbyanindividual’sabilitytocareforone’sselfandmeetthedemandsofsocialresponsibilities

Aperson’sadaptivefunctioningiscomposedofpractical,social,andmentalcapacitiestodealwitheverydaychallengesandproblems

Harrison & Oakland, 2002

ASD&SubstanceMisuse

LanguageDeficits

• Common• Anxiety-provokingsituations• Concretetypeofcommunication• Repetitiveorrigidlanguage• Delayedresponse• Noresponse• Mayrepeatphrasesorcomments• Acquiescence• Considertheimpactonadaptivefunctioningcapabilities

Hyper- orHyposensitivitytoStimuli

• Sirens• Loudnoises• Strongsmells• Brightlights• Rapidfirequestioning• High-stresssituations

TheoryofMind(ToM)• Theoryofmind(ToM)istheskilltoappreciatethatthebehaviorofothersisdrivenbytheirbeliefs,desiresandothermentalstates(Baron-Cohen,1995)

• Researchershavetheorizedthatthecognitive(e.g.,theoryofmind,problemsolvingability)andemotional(e.g.,emotionregulation,empathy)deficitsofASDcouldincreasethelikelihoodofcriminalbehavior(Lerneretal.,2012;Wing,1981)

• SocialcommunicationislimitedbydeficitsintheoryofmindandempathyforindividualswithASD.Socialcommunicationisfurthercomplicatedbydifficultyassigningmeaningtodifferentpiecesofinformationasaresultofweakenedcentralcoherence(Søndenaa etal.,2014)

ASD&Memory

Sourcemonitoring(Bowler,Gardiner&Berthollier,2004)Episodicrecollection(Bowler,Gardiner&Gaigg,2007;Russell&Jarrold,1999)SensoryproblemsSleepproblemsTheoryofMind(ToM)deficitsPsychiatriccomorbidityLowerfunctioningvs.higherfunctioningindividualsRecallimpairmentsEyewitnessmemory

ImportantReminder

Bodymovementissues(e.g.,clumsiness,limitedcoordination,andstrangeposture)aresometimespresentinASD

Allenetal.,2008;Bjørkly,2009

ASDandtheCriminalJusticeSystem

ImportantReminder

Thevastmajorityofindividualswithautismneverhavecontactwiththecriminaljusticesystem

ASDandtheCJS

• Reasonsaremanyandvaried• Unclearandcomplex• Limitedresearch• Victimizationiscommon• Under-diagnosisiscommon• Socialnaivety• Socialskilldeficits• Misunderstandingofintent• Sensoryoverload

ASDandCriminalBehavior:AnImportantReminder

LinksbetweenASDandcriminalbehaviorareusuallyfoundincasestudies,verysmallsamples,orwithinspecificsubsamplesofoffenders

(e.g.,high-securitypsychiatrichospital)

Woodbury-Smith,Clare,Holland,&Kearns,2006

PossibleRiskFactorsforCJSInvolvement

• Lowlevelsofintelligence• Poorschoolperformanceandattendance• Co-occurringmentaldisorders• Restrictedempathy• Cognitiverigidity• Ahistoryofaggression• Limitedabilitytoappreciatethesocialcontextofsituations

Farrington,2002;Haskins&Silva,2006;Kawakamietal.,2012;Murrie,Warren,Kristiansson,&Dietz,2002;foundinBrownetal.,inpress

PsychiatricComorbidity

“WhenpeoplewithASDoffenditisimportanttodeterminewhetherotherpsychiatricdisordersarealsopresentbecauseitispossiblethat

suchconditionsinfluencetheriskofoffending”

Rutten,Vermeiren,&Nieuwenhuizen,2017,pg.2

MisinterpretationofSocialCuesandCriminalJusticeSystemInvolvement

ObsessiveInterestsandCriminalJusticeSystemInvolvement

Victimization

• Overlytrusting• Peerpressure• Desireforacceptance• Easilymanipulated• Vulnerabletotheexploitativeactionsofothers

-Bullied-Assaulted-Victimoftheft-Sexualexploitation/victimization

Victimization

“…ratherthanbeingmorelikelytoengageinoffendingbehaviororviolentbehavior,individualswithASDhavebeenfoundtobeathigher

riskofbeingthevictimratherthantheperpetrator”

Allely,Wilson,Minnis,Thompson,Yaksic,&Gillberg,2017,pg.50

SexualVictimization

Edelson (2009)arguedthatthesocial-emotionaldeficits(e.g.,recognitionofsocialcues)ofASDcoulddecreasethelikelihoodof

recognizingdangeroussituationsand,therefore,increasethelikelihoodofsexualvictimization

Sevlever,Roth,&Gillis,2013

ASDandtheJuvenileJusticeSystem

Modeling

“YouthwithASDoftenhaveastrongtendencytorepeattheobservedactionsofothers”

Brownetal.,2016,pg.4

LawEnforcementConsiderations

ImportantSafetyReminder

Individualswithautismhavedifficultyrecognizingdangeroussituations(e.g.,traffic,trespassing,andwatersystems)andtheirconsequences

TheNationalAutisticSociety,2008

InvestigativeInterviewingConsiderationsand

• Suggestibility• Acquiescence• Confabulation• Compliance• Context• Falseconfessions• Sensoryoverstimulation

InterviewandInterrogations:AnImportantReminder

Autismspectrumdisorderscanlimitthecapacityofindividualstoparticipateeffectivelyininterviewswithlawenforcement,

interrogations,andtrials.Further,theimpairmentsofthisdisordercomplicate anindividual’sabilitytocomprehend theirintentionsand

responsibility

Freckelton,2012

FalseConfessions

• High-functioningvs.lower-functioningASD• Agreeableness• Anxiety• Compliant• Overlytrusting• Developmentalage• Processingspeeddifficulties• Cognitivefunctioningabilities• Beawareofthewordsyouuse• Confabulation• Suggestibility

MirandaRightsComprehension:AnImportantReminder

“ManyofthedeficitspresentinindividualswithASDmaydecreaselevelofMirandacomprehensionaswellasincreasesusceptibilitytoinvolvementin

thelegalsystem.Inaddition,languagedeficits,poorsocialskills,andstereotypicalbehaviorsmayincreasevulnerabilitytointerrogation

techniques”

Salseda,Dixon,Fass,Miora,&Leark,2011,pg.84

ASD&MirandaRights

Salseda,L.M.,Dixon,D.R.,Fass,T.,Miora,D.,&Leark,R.A.(2011).AnevaluationofMirandarightsandinterrogationinautismspectrumdisorders.ResearchinAutismSpectrumDisorders,5(1),79-85.

AnImportantReminderforLawEnforcement

“…duetothelanguagedeficits,poorsocialskills,andoddmannerismsfoundinASD,thereisreasontoexpectthatpersonswithASDmayfindthemselvesatahigherriskofsuspicionbylawenforcementofficers”

Salseda,Dixon,Fass,Miora,&Leark,2011,pg.81

ImportantReminders

Individualswithautismmayexperiencehighlevelsofanxietyandpanicinsituations withextremeaudio-visualstimulation orlarge

crowds

Individualswithautismoftenhavelimitedcommunicationskills,particularlywhendistressed.Theyarelikelytostrugglein

comprehendingnon-literalreferencesandsarcasticcomments

TheNationalAutisticSociety,2008

ASDandSuggestibility

Suggestibilitycanbedefinedasthedegreethatyouwillbelievewhatyouaretold,eveniftheinformationismisleading.ThisissueinASDhasbeenattributedtoseveraldifferentsourcesincludinglimitedproblemsolvingabilitiesandtheframingofquestionsbyinterviewersinlegal

settings(Woodbury-Smith&Dein,2014)

Despitepopularbeliefs,individualswithASDarenotmoresuggestiblethanthegeneralpopulation.However,individualswithASDaremore

acquiescenttodemands(Northetal.,2008)

ASDandSuggestibility

IfASDisnotrecognizedinasuspectorwitness,anumberofissuescanariseduringthelegalprocess(Woodbury-Smith&Dein,2014)

Specifically,anindividualwithASDcould:

(a)havedifficultycoherentlyrecallingaseriesofevent(MarasandBowler,2012)

(b)beacquiescentorsuggestibletoquestioningduringinterviews,interrogations,ortestimony(MarasandBowler,2012)

(c)behaveorpresentthemselvesinamannerthatismisinterpretedby othersduringlegalproceedings(Archer andHurley,2013;Woodbury-Smith&Dein,2014)

ASDandSuggestibility-FinalComments

• “ThelimitedworktodatethathasexaminedsuggestibilityinwitnesseswithASDshowsthathigh-functioningpeoplewiththedisorderarenomoresuggestiblethantheirtypicalcounterparts.However,futureresearchisneededtoextendthisworktolowerfunctioningindividualswithASD,whohavebroadermemoryimpairmentsinadditiontodelayedorimpairedlanguagedevelopment”

• Maras&Wilcock,2013,pg.164;inRidley,Gabbert,&LaRooy,2013

OtherVariablestoConsider

• LowerIQscores(Mline,Clare,&Bull,2002)

• HighTraitAnxiety(neuroticism)(Gudjonsson,1983)• NegativeLifeEvents(Drake,2010;Drake,Bull,&Boon,2008)• Assertiveness(Gudjonsson,1988b)• AngerandSuspiciousness(Gudjonsson,1992a)• AvoidanceCopingStrategies(Gudjonsson,1988b)• Self-Esteem(Gudjonsson&Singh,1984;Singh&Gudjonsson,1984)

Personalityandaffectmeasuresassociatedwithinterrogativesuggestibilityareinneedoffurtherscrutiny

FoundinBianco&Curci,2015,pg.259

ASD&ConfabulationReference

Spitzer,D.,White,S.J.,Mandy,W.,&Burgess,P.W.(2017).Confabulationinchildrenwithautism.Cortex,87,80-95.

Acquiescence

• Acquiescenceoccurswhensomeonedoesorsayssomethingtopleaseanotherpersonbecausetheythinkthisstatementoractionisconsistentwiththeotherperson’swishes.Duringinterrogationsorinterviewers,thiscanhappenwhensomeonewantstoendtheinterviewasfastaspossibleorwantstopleasetheinterviewer

• Individualswithautismmaybelikelytodemonstrateacquiescence,whichoccurswhensomeonedoesorsayssomethingtopleaseanotherpersonbecausetheythinkthisstatementoractionisconsistentwiththeotherperson’swishes

Woodbury-Smith&Dein,2014

Compliance

Complianceiswhereanindividualoutwardlyagreeswithinformationfromanothersource,butdoesnotinternallyaccepttheinformationasfact

Suggestibilityinvolvestheacceptanceofinformationastruth

Gudjonsson,2003;foundinBrownetal.,inpress

Context

Thecontextofaninterviewmayalsoplayanimportantroleinincreasingthelikelihoodofsuggestibility

Contextscouldincludetheinterviewer’sstatements,actions,andtonepriortoandduringtheinterview

Suggestivequestionsandcontextscancreateaninterviewerbiasthatthreatensthevalidityofinformationprocuredduringtheinterview

Cleveland,Quas,&Lyon,2016;Goodman&Quas,2008;Leichtman &Ceci,1995;foundinBrownetal.,inpress

LegalConsiderations

ImportantReminder

ThepresenceofASDrequirescarefulconsiderationinseverallegalsituationsincludingpoliceinterviews,interrogations,evaluationsof

competencytostandtrial,andsentencing

ImportantRemindersLegalProfessionalsNeedtoTakeintoAccount

ASDRelatedDeficits

TheroleofASDinlegalproceedingsrequirescarefulconsiderationofthedefendant’ssymptomseverityandenvironmentalcontext IndividualswithASDmayexperiencethefollowingbehaviorsanddeficits:

• Dislikephysicalcontactinitiatedbyothers• Diminishedabilitytorecognizesocialcues• Diminisheddecisionmakingabilities• Obsessionalinterests• Rigidness• Poorverbalandnonverbalcommunicationsskills• Impulsivity• Increaseddesiretopleasepeopleinauthoritativepositions• Sensitivetoextremesensoryexperiences• Unpredictability

Cascioetal.,2012;Freckelton,2013;Freckelton&List,2009;Luke,Clare,Ring,Redley,&Watson,2012

PossibleIssuesArisingDuringtheLegalProcess

IfASDisnotrecognizedinasuspectorwitness,anumberofissuescanariseduringthelegalprocess

(A) havedifficultycoherentlyrecallingaseriesofevent

(B) beacquiescentorsuggestibletoquestioningduringinterviews,interrogations,ortestimony

(C) behaveorpresentthemselvesinamannerthatismisinterpretedbyothersduringlegalproceedings

ArcherandHurley,2013;MarasandBowler,2012;Woodbury-Smith&Dein,2014

ASD&EyewitnessTestimony

ASD&EyewitnessTestimonyReferences

• Maras,K.L.,&Bowler,D.M.(2010).Thecognitiveinterviewforeyewitnesseswithautismspectrumdisorder.JournalofAutismandDevelopmentalDisorders,40(11),1350-1360.

• Maras,K.L.,&Bowler,D.M.(2014).Eyewitnesstestimonyinautismspectrumdisorder:Areview.Journalofautismanddevelopmentaldisorders,44(11),2682-2697.

• Maras,K.L.,Memon,A.,Lambrechts,A.,&Bowler,D.M.(2013).Recallofaliveandpersonallyexperiencedeyewitnesseventbyadultswithautismspectrumdisorder.Journalofautismanddevelopmentaldisorders,43(8),1798-1810.

ImplicationsforMemoryImpairmentintheCJS

• Defense-relatedinformation• Forgottenappointments• Investigativeinterviews• Cross-examination• Eyewitnesstestimony• MirandaRightsWaiver• Policeline-ups• CompetencytoStandTrial• Probationrequirements• Court-orderedtreatment

SuggestedResource

Kristiansson,M.,&Sorman,K.(2008).Autismspectrumdisorders:legalandforensicpsychiatricaspectsandreflections. Clinical

Neuropsychiatry:JournalofTreatmentEvaluation, 5(1),55-61.

ImportantRemindersforLegalProfessionals

• Independentcorroboration

• Avoidsuggestiveinterviewingtechniques

• LimittheuseofYesandNoquestioning

• Utilizeopenendedquestioningapproaches

• Consultwithamemoryexpert

• Memoryconfidencedoesnotequalmemoryaccuracy

ForensicMentalHealthConsiderations

MentalHealthProfessionals:ImportantReminders

Freckelton(2013)highlightedanumberofchallengesfacedbymentalhealthprofessionalswhoareevaluatingASDortestifying

aboutASDinlegalsettings(1)accuratediagnosis(2)effectivelycommunicatinghowASDimpactsanindividual’sglobalfunctioning(3)providecontextforthebehaviorofindividualswithASD,particularlyduringinterviewsandlegalproceedings(4)evaluatethepotentialcomorbidityofASDwithinternalizingandexternalizingdisorders(5)conveyhowASDcontributestocriminalbehaviorandunderstandingofconsequences(6)avoidstigmatizingASDorthedefendant

ASD&CST• Dearthofempiricalresearchonthetopic• DeficitsinherenttoASD—thesocialandcommunicationimpairmentsinparticular—canhaveanegativeimpactonanindividual’scompetencytostandtrial(CST;Foster,2015;Freckelton,2013)• Itremainsunclearhowmanyofthe50,000to60,000CSTevaluationsconductedeachyearintheUnitedStatesinvolveadefendantwithASD(Morris&DeYoung,2012;Pirelli,Gottdiener,&Zapf,2017,2011;Zapf,Roesch,&Pirelli,2014),butexperiencesuggeststhatarelativelylimitednumberofforensicmentalhealthprofessionalswhoperformCSTevaluationshaveadvancedtrainingintheareaofASD

ASD&ConfinementSettings

ASDinCorrectionalSettings:ImportantReminders

OffenderReentry

Toincreasethelikelihoodofsuccessfulreintegrationafterincarceration,offenderswithASDrequiremoresocialandeconomic

supportthangeneraloffenders

Myers&Plauché-Johnson,2007

ASD&CorrectionsReference

Johnstone,E.C.(2012).Evaluationofascreeninginstrumentforautismspectrumdisordersinprisoners.PloS one,7(5),1-8.

ASD&CorrectionsReference

Michna,I.,&Trestman,R.(2016).CorrectionalManagementandTreatmentofAutismSpectrumDisorder.ThejournaloftheAmerican

AcademyofPsychiatryandtheLaw,44(2),253-258.

CommunitySupervision

ASD&CommunitySupervision• AlthoughprobationinitiallysoundslikeanidealsolutiontothechallengesofincarcerationforsomeonewithASD,onemajorconcerniswhethertheseindividualsarecapableofadheringtotheconditionsofprobation(Allenetal.,2008;Schellack,2014)

• CommondeficitsinASD,suchaslearningdisabilities,lackoflanguagedevelopment,socialdeficits,difficultyunderstandingabstractconcepts,andothercommunicationproblems,maymakemeaningfulengagementincourt-orderedrehabilitationprogramsdifficult(Rayetal.,2004;Robertson&McGillivray,2015)

CommunitySupervision

• Regularlyreportingtoaprobationofficer• Electronichomemonitoring• Completingchemicaldependencytreatment• Abstainingfromalcoholandchemicals• Takingmedicationsasprescribed• Gettingpermissionfromaprobationofficerbeforeleavingthestateifneedbe• Payingrestitution• Havingnocontactwiththevictim• Performingcommunityservice• Maintainingfull-timeemploymentorstudentstatus• Attendingregularlyscheduledprogrammingortreatment• Sustainingfromcommittinganyotherviolationsorunlawfulacts

Challenging,Problematic,andCriminalBehaviors

CriminalBehavior

ViolentBehavior

• Socialnaivety• Perspectivetakingdeficits•Misreadingsocialcues• Changeofroutine• Environmentalchanges• Specialandfixatedinterests• Diagnosticcomorbidity

Violence&Aggression

Despiteawealthofknowledgeonviolenceriskfactorsforpsychosis,substanceuse,andotherdisorders,fewriskfactorsforviolencehavebeen

establishedforthosewithASD

Arseneault,Moffitt,Caspi,Taylor,&Silva,2000;Fazel&Grann,2006;Grann &Fazel,2004;Johnsonetal.,2000;Långström,Grann,Ruchkin,Sjöstedt,&Fazel,2008

KeyPoint

“Althoughcliniciansknowthatsomepeoplewithautismdisplaychallengingbehaviorsandcomeincontactwiththecriminaljusticesystem,whether

autismitselfincreasestheriskofviolenceisstillunclear”

Heeramun etal.,2017,pg.1

AngerReference

Pugliese,C.E.,Fritz,M.S.,&White,S.W.(2015).Theroleofangerruminationandautismspectrumdisorder–linkedperseverationinthe

experienceofaggressioninthegeneralpopulation.Autism,19(6),704-712.

SexuallyInappropriateBehaviors

Firesetting Behaviors

ASD&Firesetting KeyPoint

Despitegeneralacceptanceinthescientificliterature,relativelylimitedevidencesupportsclaimsthatindividualswithADareatadisproportionate

riskforfiresettingbehaviors

Allenetal.,2007;Barry-Walsh&Mullen,2004;Everall&Lecouteur,1990;Haskins&Silva,2006;Murrieetal.,2002;Tantam,2003;foundinFreckelton,2013

ImportantReminder

“Theprevalenceofarson,likeotherformsofoffendingamongpeoplewithdevelopmentaldisabilities,isdifficulttoestimatewithanydegree

ofconfidence”

Lindsay,Tcaylor,&Sturmey,2004,pg.225

OtherTypesofCriminalBehavior

ASD&ComputerCrimes

AnothertypeofcrimelinkedtoASDiscomputercrime,whichcouldprovidealessthreateningandmoreprivateenvironmentfor

individualswithASD

Freckelton,2013

ASD&Stalking

Somecombinationofapropensityforobsessionandfixationandaninabilitytoidentifyandrecognizesocialcuesmaycontributeto

individualswithASDbeingarrestedforstalking

Freckelton,2013

StalkingReference

Post,M.,Storey,K.,Haymes,L.,Campbell,C.&Loughrey,T.(2014).StalkingBehaviorsbyIndividualswithAutismSpectrumDisordersin

EmploymentSettings:UnderstandingStalkingBehaviorandDevelopingAppropriateSupports.EducationandTraininginAutismand

DevelopmentalDisabilities,49(1),102–110.

Stokes,M.,Newton,N.,&Kaur,A.(2007).Stalking,andsocialandromanticfunctioningamongadolescentsandadultswithautism

spectrumdisorder.Journalofautismanddevelopmentaldisorders,37(10),1969-1986.

SuicidalBehaviors

ASD&SuicideSuggestedResource

Salvatore,T.,Brown,J.,Hastings,B.,Luskin,B.,&Martindale,J.(2016).SuicideRiskinAdultswithAutismSpectrumDisorder:AnExploratory

Discussion.TheJournalofSpecialPopulations,1(1).

ScreeningConsiderations

RecognizingSignsofASD1.“Stimming”– self-stimulatingbehaviorthatismoreunusualorextreme,suchashand-flapping,body-rocking,twirling,orrepetitivespeech2.Repetition– repetitivebehaviorsthatmayberelatedto“stimming”butcouldalsoincludebehaviorswithobjects,suchasspinningobjectsorliningthemupinpatterns.Lashleynotedthatthesebehaviorsshouldnotbeinterferedwith3.Acclimation– manyindividualsneedtoacclimatetoanunfamiliarenvironment.Thiscanincludewanderingaround,touchingobjects,ortouchingpeople.Theymayalsoinvadepersonalspace,butthegoalfortheseindividualsistomakesuretheenvironmentissafe4.Delayedresponse– Inresponsetocommands,theymayreactmoreslowly.Lashleynotedthisisnotduetostubbornness,butratheranincreaseintimeneededforprocessingtheinformation andcomplyingwithcommands.

RecognizingSignsofASD5.Dissociatedspeech– Somehavenoorlimitedabilitytocommunicateverbally.Othersmayreplywithseeminglymeaninglessanswersordiscussirrelevanttopics.Thisisnotanattempttobenoncompliant,butinsteadisanattempttosocializegiventheskillspossessed6.Unusualtoneofvoice– Toneandvolumeofvoicemaynotbeappropriateforthesituation.Forexample,thevoicemaybetooloudorsoft,theymayinterruptortalkoverothers,orthevoicemaynotdemonstratetheappropriateemotionforthesituation(orbemonotone).7.Lackofeyecontact–maymakelittleornoeyecontact.Thisisnotasignofdisrespectorlackofattentionandindividualsinteractingwiththemshouldnotforceeyecontactonsomeonewithautism8.Unusualorunbalancedgait–mayhaveanunsteadystanceorgaitanddifficultybalancing

Lashley,2009,pp.6-17http://www.autismsocietyofwa.org/v2/wp-content/uploads/2011/09/Autism-Guide-for-Police-Officers-0311.pdf

OtherScreeningConsiderations

Theimpairmentsinsocialization,communicationandimaginationmeanyoumayalsosee:

• TheoryofMind(ToM)deficits

• ExecutiveFunctioningDifficulties

• CentralCoherenceDifficulties

• Self-RegulationDifficulties

RecognizingSignsofASD

SpecializedASDscreeningandassessmenttoolsarenecessaryinpsychiatricandcorrectionalfacilities

Anckarsäter,Nilsson,Saury,Råstam,&Gillberg,2008

ScreeninginJuvenileJusticeSettings

JuvenilejusticesettingsshouldroutinelyscreenforASDinadolescentoffenderpopulations

Suttonetal.,2013

ScreeninginLegalSettings

Anabsenceofproperassessmentandidentificationlikelylimitsthepossibilityofmitigationduringlegalproceedingsforagroupthatcan

bevulnerabletoexploitation

Allenetal.,2008;Robinsonetal.,2012

Screening:AnImportantReminder

“ItisimportanttodiagnoseASDcarefullyandtodifferentiateautismsymptomssuchasalackofempathyfrompsychopathictraits,andthiscansometimesbedifficult.EarlierdiagnosisshouldensurethatpeoplewithASDreceivebettercareandmayhelptopreventthemoffending”

Rutten,Vermeiren,&Nieuwenhuizen,2017,pg.8

InterviewandScreeningConsiderations

ScreeningofASDinAdults-SuggestedArticles• Eriksson,J.M.,Anderson,L.M.J.,&Bejerot,S.(2013).RAADS-14Screen:Validityofascreeningtoolforautismspectrumdisorderinanadultpsychiatricpopulation.MolecularAutism,4(49),1-11.• Grodberg,D.,Weinger,P.M,Halpern,D.,Parides,M.,Kolevzon,A.&Buxbaum,J.D.(2014).Theautismmentalstatusexam:SensitivityandspecificityusingDSM-5criteriaforautismspectrumdisorderinverballyfluentadults.JournalofAutismandDevelopmentalDisorders,44(3),609-614.• Grodberg,D.,Weinger,P.M,Kolevzon,A.,Soorya,L.&Buxbaum,J.D.(2012).Briefreport:TheAutismMentalHealthStatusExamination:Developmentofabriefautismfocusedexam.JournalofAutismandDevelopmentalDisorders,42(3),455-459.• Murphy,C.M.,Wilson,C.E.,Robertson,D.M.,Ecker,C.,Daly,E.M.,Hammond,N.,...&McAlonan,G.M.(2016).Autismspectrumdisorderinadults:diagnosis,management,andhealthservicesdevelopment.Neuropsychiatricdiseaseandtreatment,12,1669.

InterventionandTreatmentConsiderations

Intervention&TreatmentStrategies

• Screeningandassessment• Earlyintervention• Developmentallyappropriate• Socialskilltraining• Intensivecasemanagement• Sleep-improvementstrategies• Treatsecondarysymptomsanddisorders• Multidisciplinaryapproach

SuggestedApproach-D.E.A.R.Model

• DirectLanguage

• EngageSupportSystems

• AccommodateNeeds

• RemainPatient

BecomingASD-Informed

• Communitycorrections• CompetencytoStandTrialEvaluators• Competencyrestorationfacilities• Courtrooms• Confinementsettings• Detoxificationcenters• Domesticviolenceshelters

• Forensicmentalhealthcounselingcenters• Forensicstatehospitals• Homelessoutreachprograms• Lawenforcementagencies• Legalarenas• Pretrialevaluationcenters• ProbationDepartments• Sexoffendertreatmentprograms

Summary-MyOpinion

• Complex• Multifaceted• Confusingattimes• Extremelyimportanttopic• Notontheradarofmanycriminaljusticeandmentalhealthprofessionals• Fewforensictrainingopportunitiesavailable• Additionalresearchisneeded

Questions

ThankYou…

ContactInformation

• JerrodBrown• Jerrod01234Brown@Live.com• 651-734-5517• AmericanInstitutefortheAdvancementofForensicStudies(AIAFS)(http://www.aiafs.com/)• AIAFSFacebookPage(https://www.facebook.com/AIAFSeducation?fref=ts)• ForensicScholarsToday(http://online.csp.edu/forensic-scholars-today)• AdultFASDProviderNetwork(https://www.facebook.com/AdultFASDProviderNetwork)

SupplementalResources

ASD&ViolenceReferences• Allely,C.S.,Wilson,P.,Minnis,H.,Thompson,L.,Yaksic,E.,&Gillberg,C.(2016).Violenceisrareinautism:whenitdoesoccur,isitsometimesextreme?TheJournalofPsychology,1–20.

• Baron-Cohen,S.(1988).AnassessmentofviolenceinayoungmanwithAsperger’ssyndrome.JournalofChildPsychologyandPsychiatry,29,351–360.

• Faccini,L.(2016).Theapplicationofthemodelsofautism,psychopathologyanddeficientEriksonian developmentandthepathofintendedviolencetounderstandtheNewtownshooting.ArchivesofForensicPsychology,1(3),1–13.

• Faccini,L.,&Allely,C.S.(2016).MassviolenceinindividualswithAutismSpectrumDisorderandNarcissisticPersonalityDisorder:AcaseanalysisofAndersBreivikusingthe“PathtoIntendedandTerroristicViolence”model.Aggressionandviolentbehavior,31,229-236.

ASD&ViolenceReferences• Im,D.S.(2016).Templatetoperpetrate:Anupdateonviolenceinautismspectrumdisorder.HarvardReviewofPsychiatry,24(1),14–35.

• Langstrom,N.,Grann,M.,Ruchkin,V.,Sjostedt,G.,&Fazel,S.(2009).Riskfactorsforviolentoffendinginautismspectrumdisorder:Anationalstudyofhospitalisedindividuals.JournalofInterpersonalViolence,24,1358–1370.

• Lazaratou,H.,Giannopoulou,I.,Anomitri,C.,&Douzenis,A.(2016).Casereport:Matricidebya17-yearoldboywithAsperger'ssyndrome.Aggressionandviolentbehavior,31,61-65.

• Lerner,M.D.,Haque,O.S.,Northrup,E.C.,Lawer,L.,&Bursztajn,H.J.(2012).Emergingperspectivesonadolescentsandyoungadultswithhigh-functioningautismspectrumdisorders,violenceandcriminallaw.JournaloftheAmericanAcademyofPsychiatryandLaw,40,177–190.

ASD&ViolenceReferences• Mawson,D.,Grounds,A.,&Tantam,D.(1985).ViolenceandAsperger’ssyndrome:Acasestudy.BritishJournalofPsychiatry,147,566–569.

• Murphy,D.(2010).Extremeviolenceinamanwithanautisticspectrumdisorder:Assessmentandtreatmentwithinhighsecuritypsychiatriccare.JournalofForensicPsychiatryandPsychology,21,462–477.

• Newman,S.,&Ghaziuddin,M.(2008).ViolentcrimeinAspergersyndrome:Theroleofpsychiatriccomorbidity.JournalofAutismandDevelopmentalDisorders,38,1848–1852.

• Søndenaa,E.,Helverschou,S.B.,Steindal,K.,Rasmussen,K.,Nilson,B.,&Nøttestad,J.A.(2014).Violenceandsexualoffendingbehaviorinpeoplewithautismspectrumdisorderwhohaveundergoneapsychiatricforensicexamination.Psychologicalreports,115(1),32-43.

Perseveration

Arora,T.(2012).Understandingtheperseverationdisplayedbystudentswithautismspectrumdisorder.Education,132(4),799-809.

SuggestedResource

Allely,C.S.,Wilson,P.,Minnis,H.,Thompson,L.,Yaksic,E.,&Gillberg,C.(2017).Violenceisrareinautism:whenitdoesoccur,isitsometimes

extreme?.TheJournalofpsychology,151(1),49-68.

ASD&theJuvenileJusticeSystemReferencesCheely,C.A.,Carpenter,L.A.,Letourneau,E.J.,Nicholas,J.S.,Charles,J.,&King,L.B.(2012).Theprevalenceofyouthwithautismspectrumdisordersinthecriminaljusticesystem. Journalofautismanddevelopmentaldisorders, 42(9),1856-1862.Lerner,M.D.,Haque,O.S.,Northrup,E.C.,Lawer,L.,&Bursztajn,H.J.(2012).Emergingperspectivesonadolescentsandyoungadultswithhigh-functioningautismspectrumdisorders,violence,andcriminallaw.JournaloftheAmericanAcademyofPsychiatryandtheLawOnline,40(2),177-190.Rutten,A.X.,Vermeiren,R.R.J.M.,&Nieuwenhuizen,C.(2017).Autisminadultandjuveniledelinquents:aliteraturereview.ChildandAdolescentPsychiatryandMentalHealth,11(1),1-12.

ASD&SuggestibilityReferences• Bruck,M.,London,K.,Landa,R.,&Goodman,J.(2007).Autobiographicalmemoryandsuggestibilityinchildrenwithautismspectrumdisorder.DevelopmentandPsychopathology,19(1),73–95.• Maras,K.L.,&Bowler,D.M.(2012).Briefreport:Suggestibility,complianceandpsychologicaltraitsinhigh-functioningadultswithautismspectrumdisorder.ResearchinAutismSpectrumDisorders,6(3),1168-1175.• McCrory,E.,Henry,L.A.,&Happé,F.(2007).Eye-witnessmemoryandsuggestibilityinchildrenwithasperger syndrome.JournalofChildPsychologyandPsychiatry,48(5),482–489.• North,A.S.,Russell,A.J.,&Gudjonsson,G.H.(2008).Highfunctioningautismspectrumdisorders:Aninvestigationofpsychologicalvulnerabilitiesduringinterrogativeinterview.TheJournalofForensicPsychiatry&Psychology,19(3),323-334.

Berryessa,C.M.(2014).Judicialperceptionsofmediaportrayalsofoffenderswithhighfunctioningautisticspectrumdisorders.Internationaljournalofcriminologyandsociology,3,46-60.

ASD&SuicideReferences• Cassidy,S.,Bradley,P.,Robinson,J.,Allison,C.,McHugh,M.,&Baron-Cohen,S.(2014).SuicidalideationandsuicideplansorattemptsinadultswithAsperger'ssyndromeattendingaspecialistdiagnosticclinic:aclinicalcohortstudy.TheLancetPsychiatry,1(2),142-147.

• Kato,K.,Mikami,K.,Akama,F.,Yamada,K.,Maehara,M.,Kimoto,K.,...&Ichimura,A.(2013).Clinicalfeaturesofsuicideattemptsinadultswithautismspectrumdisorders.GeneralHospitalPsychiatry,35(1),50-53.

• Mayes,S.D.,Gorman,A.A.,Hillwig-Garcia,J.,&Syed,E.(2013).Suicideideationandattemptsinchildrenwithautism.ResearchinAutismSpectrumDisorders,7(1),109-119.

• Mikami,K.,Onishi,Y.,&Matsumoto,H.(2014).Attemptedsuicideofanadolescentwithautismspectrumdisorder.TheInternationalJournalofPsychiatryinMedicine,47(3),263-271.

ASD&SuicideReferences• Richa,S.,Fahed,M.,Khoury,E.,&Mishara,B.(2014).Suicideinautismspectrumdisorders.ArchivesofSuicideResearch,18(4),327-339.

• Raja,M.,Azzoni,A.,&Frustaci,A.(2011).Autismspectrumdisordersandsuicidality.Clinicalpracticeandepidemiologyinmentalhealth:CP&EMH,7,97.

• Shtayermman,O.(2007).PeervictimizationinadolescentsandyoungadultsdiagnosedwithAsperger'ssyndrome:Alinktodepressivesymptomatology,anxietysymptomatologyandsuicidalideation.Issuesincomprehensivepediatricnursing,30(3),87-107.

• Storch,E.A.,Sulkowski,M.L.,Nadeau,J.,Lewin,A.B.,Arnold,E.B.,Mutch,P.J.,...&Murphy,T.K.(2013).Thephenomenologyandclinicalcorrelatesofsuicidalthoughtsandbehaviorsinyouthwithautismspectrumdisorders.Journalofautismanddevelopmentaldisorders,43(10),2450-2459.

ASD&Self-Injury• Adler,B.A.,Wink,L.K.,Early,M.,Shaffer,R.,Minshawi,N.,McDougle,C.J.,&Erickson,C.A.(2015).Drug-refractoryaggression,self-injuriousbehavior,andseveretantrumsinautismspectrumdisorders:achartreviewstudy.Autism,19(1),102-106.

• Hof,P.R.,Knabe,R.,Bovier,P.,&Bouras,C.(1991).Neuropathologicalobservationsinacaseofautismpresentingwithself-injurybehavior.Actaneuropathologica,82(4),321-326.

• O’Reilly,M.,Sigafoos,J.,Lancioni,G.,Edrisinha,C.,&Andrews,A.(2005).Anexaminationoftheeffectsofaclassroomactivityscheduleonlevelsofself-injuryandengagementforachildwithsevereautism.JournalofAutismandDevelopmentalDisorders,35(3),305-311.

• Singh,N.N.,Lancioni,G.E.,Winton,A.S.,Fisher,B.C.,Wahler,R.G.,Mcaleavey,K.,...&Sabaawi,M.(2006).Mindfulparentingdecreasesaggression,noncompliance,andself-injuryinchildrenwithautism.JournalofEmotionalandBehavioralDisorders,14(3),169-177.