Wednesday, 30 January 2013

Autism and the criminal justice system

I assume most people with a connection to autism, either personal or professional, will have heard about the case of Gary McKinnon and his long-running battle against extradition from the UK to the United States to face charges of alleged hacking into various US Government systems.
Order @ Wikipedia 

The politics have, over the 10-year period of this saga, tended to focus more on the extradition arrangements between the UK and US over and above the actual person, his Asperger syndrome diagnosis (and some possibly conflicting reports about his mental state) and the reasons given for his alleged actions.

I'm sure, like me, many people (but not all apparently) were happy to hear that this ordeal for Gary has now come to some kind of end with the news that he will not face charges here in the UK. When however it comes to other people such as Syed Talha Ahsan, also diagnosed with Asperger syndrome but nonetheless extradited to the US, things have not turned out so well. Indeed there has also been some debate about possible double-standards.

I'm not here to talk politics and political decisions but I did wonder if it might be time to revisit autism, or rather the autism spectrum, and the law in light of the Gary McKinnon news (and it was big news) and also the paper by Catherine Cheely and colleagues* on the prevalence of youth with an autism spectrum disorder in the criminal justice system.

Regular readers of this blog might remember a post I wrote a while back on autistic symptoms and offending. The crux of that entry was the quite generalised assertion being raised by Geluk et al** detailing autistic symptoms as being "more prevalent in childhood arrestees compared to the general population and are uniquely associated with future delinquent behavior". I hasten to add that, as in the last post, I'm not intending to generalise, demonise or any other -ise in this entry on this quite delicate topic particularly with other recent tragic events still very much in mind.

Back to the paper by Cheely:

  • The aim of the study was three-fold: (i) look at the types of charges against youths with an autism spectrum disorder (ASD), (ii) examine adjudication outcome compared with a control cohort and (iii) see what was different about those with ASD charged compared with a cohort not charged.
  • Six hundred and nine youths with an ASD were identified from the South Carolina Autism and Developmental Disabilities Monitoring Project (SC-ADDM). That's right, one of the CDC surveillance sites used to formulate things like their prevalence estimates (see the 1 in 88 post) based on 8-year olds.
  • Five percent (32/609) of the cohort had contact with the criminal justice system and were charged with 103 offences (mean 3.3 offences per child).
  • Compared with non-ASD control youths, there was a tendency for more crimes to be committed against a person over property and generally more likely to be school-based.
  • Adjudication-wise, youths with ASD were significantly more likely to have their cases diverted and less likely to be prosecuted; indeed none of the cohort were sentenced to detainment.
  • The differences between charged youths with ASD vs. controls ASD participants? Well, the presence of intellectual disability (ID) (learning disability if you will) was less likely to occur in ASD youths committing offences.

As the authors point out, there is a feeling that most of the charges made against the youths with ASD in their study seem to eminate from spontineity over pre-meditation; something perhaps reflected in the zero percent detainment rate.

That and the fact that school seemed to be a focal point for such behaviours perhaps offers further clues about factors such as stress and anxiety as being involved and combining with anger (see the study by Quek and colleagues***), even whether inclusion might be part and parcel of the issue here (see this blog post by Zoe on a recent paper published in the autism special edition of Pediatrics).

One could try and get really technical and start talking about issues with empathy and inferring mental states as also being involved in such behaviours too, but to tell you the truth I doubt any adolescent, whether diagnosed with autism or not, truly uses such functions in this type of scenario which seems more probably like 'lashing out'. I must also make mention of the issue of bullying as potentially being related to offences highlighted by the authors in light of what has been discussed in this area in recent times and continues to be talked about.

I don't want to come across as an apologist or anything like that in this post given that an individual's diagnosis of ASD has (rightly or wrongly) been discussed in relation to some very serious crimes**** (open-access) down the years, bearing in mind that we cannot tar everyone with ASD with the same brush. One also needs to put the numbers of offences linked to ASD into context with all the other crimes carried out by non-autistic people, which I'm sure impact on many, many more people and indeed the number of occasions where people with autism themselves are a victim of crime, even in some cases by those who are meant to protect and serve.

In terms of where next with this topic of research, I'd actually like to see more done in a few areas. Things like looking at long-term outcome for that 5% who committed offences in terms of developmental course, any additional comorbidity which developed and were identified and importantly whether there was any further contact with the criminal justice system would be a good start. At least then we might get some ideas about whether we are indeed talking more about individual lapses in behaviour over something more chronic as per the literature so far on this topic*****.

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Additional note: The majority of this post was conceived and written in November 2012 based on the peer-reviewed research literature available at that time. I would kindly ask that any comments or opinions posted about this entry be confined to discussions about the scientific papers mentioned. Thanks.

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* Cheely CA. et al. The prevalence of youth with autism spectrum disorders in the criminal justice system. J Autism Dev Disord. 2012; 42: 1856-1862.

** Geluk CA. et al. Autistic symptoms in childhood arrestees: longitudinal association with delinquent behavior. J Child Psychol Psychiatry. 2012; 53: 160-167.

*** Quek LH. et al. Co-occurring anger in young people with Asperger's syndrome. J Clin Psychol. 2012; 68: 1142-1148.

**** Haskins BG. & Arturo Silva J. Asperger's disorder and criminal behavior: forensic-psychiatric considerations. J Am Acad Psychiatry Law 2006; 34: 374-384.

***** Hippler K. et al. No increase in criminal convictions in Hans Asperger's original cohort. J Autism Dev Disord. 2010; 40: 774-780.

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ResearchBlogging.org Cheely CA, Carpenter LA, Letourneau EJ, Nicholas JS, Charles J, & King LB (2012). The prevalence of youth with autism spectrum disorders in the criminal justice system. Journal of autism and developmental disorders, 42 (9), 1856-62 PMID: 22187108