On the "co-occurrence of autism and delinquency": no association for the majority

"The extant research shows that for most people with ASD [autism spectrum disorder] there is no association between ASD and delinquent behavior."

That was one of the primary conclusions reached in the literature review published by Alexa Rutten and colleagues [1] (open-access) looking at the collected peer-reviewed science from 1990 to 2015 on this topic. Boiling down the literature to 12 papers "five of which report the prevalence of delinquency in patients with ASD and seven the prevalence of ASD in a forensic population", authors reported on quite a lot of variability when it came to delinquency and offending behaviours but overall, offending behaviour was "lower in people with ASD than in the general population."

This is welcomed research. It reiterates what many people have already known/suspected, in that the label 'autism' for many is not typically associated with intentional delinquency or offending behaviour. As Rutten et al note: "many people with ASD have an overactive sense of right and wrong and are usually conscientious and unwilling to break the law." I should also point out that a diagnosis of autism is not however necessarily some kind of 'shield' when it comes to offending behaviour (see here and see here for a more recent example) or indeed, potential 'vulnerability' to becoming involved in specific offences (see here). But serious 'intentional' delinquency is not the norm; even that is, in the context of something like greater likelihood of contact with law enforcement agencies (see here).

There are still lessons to learn in this area of research and practice. Certain 'over-represented' comorbidity appearing alongside autism is still something to potentially consider [2] as per other findings (see here and see here). I say that without 'trying to pass the [diagnostic] buck'. Bearing in mind also how wide the autism spectrum is, specific diagnoses on the spectrum might also require further study as per the authors comments: "The prevalence of ASD diagnoses, particularly Asperger’s syndrome, in forensic settings is remarkable because it is much higher than the prevalence of ASD diagnoses in the general population." At this point I'll also refer you once again to the comprehensive review paper by Tom Berney [3] that mentions some of the potential how-and-whys of offending in the specific context of Asperger syndrome, again minus any sweeping generalisations. Recent media attention on previously undiagnosed Asperger syndrome in a prison context also makes for important and relevant reading too (see here) particularly where substance abuse is prominently mentioned (see here).

I would however question one rather sweeping statement made by Rutten and colleagues: "It is important to diagnose ASD carefully and to differentiate autism symptoms such as a lack of empathy from psychopathic traits". Lack of empathy and autism? Hmm, sounds a bit old hat to me...

I will again close with the point made that for the majority of people on the autism spectrum, the label is much more likely to be associated with law abiding rather than law breaking.

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[1] Rutten AX. et al. Autism in adult and juvenile delinquents: a literature review. Child and Adolescent Psychiatry and Mental Health. 2017; 11: 45.

[2] Newman SS. & Ghaziuddin M. Violent crime in Asperger syndrome: the role of psychiatric comorbidity. J Autism Dev Disord. 2008 Nov;38(10):1848-52.

[3] Berney T. Asperger syndrome from childhood into adulthood. Advances in Psychiatric Treatment. 2004. 10; 341-351.

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ADHD and law enforcement contact: not a straight-forward relationship

Several times on this blog I've talked about how a diagnosis of attention-deficit hyperactivity disorder (ADHD) seems to place the recipient at quite a bit of excess risk for various unfavourable outcomes (see here). I've tried hard not to make too many sweeping generalisations on this issue; mindful that behind every statistic in every peer-reviewed bit of science there are real people and real lives. But the data is becoming quite compelling on this matter...

The paper by Mark van der Maas and colleagues [1] makes an important contribution to the idea that the relationship between a diagnosis of ADHD and contact with law enforcement 'systems' is perhaps not as straight-forward as many might believe. Concluding that: "The observed connection between ADHD and criminality may be better understood through their shared relationships with indicators of poor social bonds", researchers suggest that social factors may very well come into play.

OK, based on a sample of over 5300 adults "representative of the general population of Ontario, Canada" researchers asked participants about their "self-reported arrest on criminal charges" history alongside examining ADHD-linked symptoms via the Adult Self Report Scale (ASRS-v1.1). They also interviewed/questioned about various social bonds - household size, education level, drug and substance abuse, etc.

They observed that: "screening positive for ADHD was twice as likely... and past use of medications for ADHD three times as likely... to be associated with ever having been arrested." But... when statistical modelling took into account the data on social bonds, things started to get a little more fuzzy. So: "In the best fitting statistical model, ever having been arrested was not associated with ADHD, but it was significantly associated with indicators of strong and weak social bonds." So things like anti-social behaviour, not progressing well in educational terms and substance use (abuse) might have some important influences on contact with law enforcement agencies. A shocker, I know.

I do have to point out a few important things about this research before anyone gets too immersed in the idea that ADHD is completely off the hook. First was the reliance on self-report when it comes to both ADHD signs and symptoms and also arrest record. The ASRS might very well be a nice rough-and-ready measure of ADHD symptoms but it is no substitute for a thorough assessment for a diagnosis of ADHD. Similarly, people may not always be completely truthful when it comes to their arrest record under several circumstances including research conditions...

Second is the concept of cause-and-effect. As easy as it is to say that ADHD was not itself linked to arrest record(s), it is important not to interpret the findings to say that there is 'no connection' between ADHD and 'having been arrested'. Minus sweeping generalisations, facets of ADHD - such as impulsivity and inattention - can and do perhaps account for some of the heightened risk for various types of offending behaviour [2]. It's fine to say that these facets of ADHD might be exacerbated under conditions of substance use/abuse for example, but one could easily then ask whether ADHD might have actually been involved in facilitating such substance use/abuse in the first place. Certainly, there is (peer-reviewed) evidence that a diagnosis of ADHD - if left untreated - may very well impact on educational outcomes for example [3] which could be one of several factors in determining other life choices.

The idea however that ADHD as a sole risk factor for adverse outcomes such as law enforcement contact does not exist in some sort of social vacuum is an important one to come from data such as that presented by van der Maas et al. It is perhaps the issue of 'vulnerability' that comes to the forefront, and how an ADHD diagnosis should perhaps be explored with that tenet in mind...

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[1] van der Maas M. et al. Examining the effect of social bonds on the relationship between ADHD and past arrest in a representative sample of adults. Crim Behav Ment Health. 2017 Jul 5.

[2] Berryessa CM. Attention, reward, and inhibition: symptomatic features of ADHD and issues for offenders in the criminal justice system. Atten Defic Hyperact Disord. 2017 Mar;9(1):5-10.

[3] Lu Y. et al. Association Between Medication Use and Performance on Higher Education Entrance Tests in Individuals With Attention-Deficit/Hyperactivity Disorder. JAMA Psychiatry. 2017 Jun 28.

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Analysing police involvement in the context of autism

"About 1 in 6 people with autism interacted with police over 18 months" went one of the media headlines covering the study published by Ami Tint and colleagues [1] looking at the hows-and-whys of police involvement in a cohort of nearly 300 young people and adults diagnosed with an autism spectrum disorder (ASD).

Researchers observed that some 16% of their cohort had some contact with law enforcement agencies but only a very small proportion actually resulted in any criminal charges being brought. Perhaps reassuringly, and despite 'aggressive behaviours' being cited as "the primary concern necessitating police involvement", most interactions between person and law enforcement were not especially adverse or particularly unpleasant for those on the spectrum. To quote: "Most parents reported being satisfied to very satisfied with their children’s police encounters."

But that's not to say that such encounters ended well for everyone, as talk about 1 in 5 police interactions involving physical restraint are also detailed and highlight the need for further research in this area. I might also add that symptom severity (I assume also referring to the presence of learning or intellectual disability alongside autism) was not a great indicator of police interaction or not according to the study.

Trawling through the quite small peer-reviewed research base in this area, there are some interesting points raised when it comes to awareness and training of police and other first responders [2] in respect of autism. Research here in Blighty has similarly highlighted gaps in police training [3] that may have been contributory to less positive satisfaction ratings when it came to interaction with people with autism. I draw back however from blanket blaming police for such statistics; they often have a very difficult job to do already, irrespective of whether diagnostic labels or other factor(s) are part and parcel of the situation(s) they are faced with.

So aside from greater training for law enforcement agencies and other first responders, what can be done to ensure that interactions with those on the autism spectrum are more positive? Some people have talked about setting up registries to guide police and related services where autism might be a factor in encounters. I can see the logic in such discussions, particularly in the context of another important issue to the autism spectrum - wandering or elopement - and ensuring that police have important knowledge about such an issue (see here). But with such registries come risks; risks of stigmatisation and also to personal liberties too. Some of the same issues relevant to the use of disclosure cards and autism come to the forefront (see here).

Perhaps a better arrangement would be a greater focus on community policing for example, where community Bobbies know their neighbourhood and it's residents and are able to apply that local knowledge as and when required. Appreciating that in these days of continued austerity, community policing numbers have suffered, perhaps a move back to neighbourhood policing is an important way of making police contact with those on the autism spectrum and no doubt various other groups that little more easier for all concerned?

Music to close, and the Beastie Boys meet Sesame Street?

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[1] Tint A. et al. Correlates of Police Involvement Among Adolescents and Adults with Autism Spectrum Disorder. J Autism Dev Disord. 2017. June 13.

[2] Kelly E. & Hassett-Walker C. The training of New Jersey emergency service first responders in autism awareness. Police Pract Res. 2016;17(6):543-554.

[3] Crane L. et al. Experiences of Autism Spectrum Disorder and Policing in England and Wales: Surveying Police and the Autism Community. J Autism Dev Disord. 2016 Jun;46(6):2028-41.

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