Autism Spectrum Disorder in a judicial context, summary,
as well as experience in clinical practice over the last few decades.
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Our knowledge of autism and Asperger’s syndrome, what we today refer to as autism spectrum disorders, has grown considerably. We began to find people with autism and Asperger’s syndrome in contexts, where in the past we had not noticed them. From professionals’ viewpoint, we do not think this was because people with autism spectrum disorders were suddenly being noticed in other contexts, but because we had not seen these people's behavior as a result of the hidden difficulties of an autistic nature.
(By Hejlskov Jørgensen, psychologist, PsykologCompagniet, and technical consultant, Knowledge Center for Autism, and Lennart Pedersen, neuropsykolog psykologfaglig and leader, the Center for autism.)
In recent years professionals began to focus on autism spectrum disorders in different groups of people, as well as other conditions in adults with additional psychiatric diagnoses and different criminal behavior.
Twenty or thirty years ago autism was linked first with mental retardation and epilepsy but in recent years, in particular, we became aware of a wide range of other psychological disorders, which can be seen in people with autism/Asperger’s syndrome (hyperkinetic syndrome or ADHD, OCD, Tourette’s syndrome. At the same time we also became aware of an increased risk of psychotic episodes or depression particularly among young people and adults with autism/Asperger’s syndrome.
This has led to greater attention to possible misdiagnosis or missed diagnoses where knowledge of autism/Asperger’s Syndrome was not particularly known. Today, many young people and adults have been in contact with the psychiatric system, medical centers or psychiatric units for explanation of a possible autism spectrum diagnosis.
In professional circles in recent years, it has come to our attention that there may be an increased risk to persons with autism spectrum disorders and that they could be at odds with the law, or actually commit criminal acts.
The first articles on the relationship between autism and crime were presentations of individual case studies where the focus was on violent behavior (Baron-Cohen, S (1988), Mawson; Tantam, 1985) and pyromaniac fireman (Everall; Lecouteur, 1990).
In the last five years there has been more systematic research with a view to shedding light on the existence of autism spectrum disorders among criminals. Siponmaa. et al. (2001) found in a retrospective study of 126 criminals, who had undergone a psychiatric study that 15% had "clear autism spectrum disorders", and with a further 12% there was "a high probability" they also had such a diagnosis.
A minor study undertaken by Scragg; Shah (1994), which examined patients in the secure hospital at Broadmoor in England, found that 1.5 % of the patients had a clear autism diagnosis, while a further 1.7% was less clear. It could not be ruled out that the big difference in the occurrence of autism diagnoses in the two studies was based on differences in diagnostic criteria. The Scragg; Shah study used a narrower definition of autism, with the bulk (12%) in Siponmaa. et al. This studied subject was the broad and less well-defined diagnosis of PDD-NOS. In Siponmaa et al there were no subjects who met the criteria for a diagnosis of infantile autism, while 3% met the criteria for Aspergers syndrome. In both studies the results were considered to be only a fraction of earlier diagnoses of autism spectrum.
It is important to point out in this context it is only criminals with a particular behavior, who give rise to suspicions of mental illness, and are then referred to psychiatric inquiry. The 15% as Siponmaa et al found in their study, does not mean that a similarly large number of young people who commit crime will also meet the criteria for autism spectrum diagnosis.
The research, which is available in this area, is mainly about people with autism disorders, who have committed a crime and are sentenced. Only then will they be evaluated and diagnosed. We know that a small percentage of people with autism spectrum disorders, who actually commit criminal acts, will perhaps not be convicted or discovered. If we are to judge from the past research written on the subject (individual case studies, and systematic studies) and our own clinical practice, the problem seems not to be immediately so great
There have been several studies trying to shed light on a possible difference in the nature of criminal behaviour, in people with autism spectrum disorder and that of other people. O'Brien, Bell (quoted in O'Brien, 2002) found as follows:
*Criminals with autism rarely succeed in their criminal behavior, either economically or in any other way.
*There is rarely alcohol or drugs introduced into the picture.
*Criminals with autism perform extremely rare criminal acts of the night. Howlin (1997)is of the opinion that the cause of criminal behavior on the part of people with autism differs clearly in background to any second crime, and identifies four factors:
* People with autism can, because of naivety, be overtaken by other crimes. Aggressive behavior can have its background in breaches of routines and agreements.
* Antisocial behavior can have its roots in the inadequate ability for social emotion; they find it hard to put themselves in the victim's position.
* People with autism can develop criminal behavior in the context of their symptoms, for example excessive interest in another human being (a celebrity).
Murrie et al (2002) also describes the Howlin (1997) mentioned naivety as a cause of crime in individuals with autism spectrum disorders. In addition, they take the view that sexual frustration experienced by a person with autism spectrum disorders because of their inadequate skills attracting sexual partners; in combination with an inadequate understanding of their victim's experience of a sexual assault can result in sexual violence (conducted primarily by men).
They also pointed out that some people with autism have a tendency to confess immediately to crimes committed if they are confronted with evidence, possibly because of an inadequate understanding of the consequences of a confession, or because of naive honesty.
Through research, looking at criminal behavior as a direct consequence of autism spectrum disorders, Barry-Walsh Mullen (2004), describes a number of cases, where the common thread is the criminal’s lack of ability to anticipate the consequences of his/her actions, and to act in a social context. He also describes the behaviours connected with a pyromaniac fireman appearing in other men with Asperger’s syndrome.
There are also descriptions of crime as a direct consequence of vested interests. For example interests in murder (Silva et al 2002), or from persecution and persecution of people, which we are particularly interested in investigating (Barry-Walsh, Mullen, 2004).
We have in our clinical work met some people with autism spectrum disorders who have been on the edge of the law or have directly been convicted of a crime. It is difficult to generalize from clinical work, but we have chosen to describe three different young people, who, because of their autism have come into contact with the law.
Michael is 24 years old. He was looked after at home, and was in regular kindergarten for one year, until at seven years old he started a special school. Michael had a delayed development and was characterized by hyperactive behavior in childhood. He moved when he was 12 years old into an institution associated with school. He was diagnosed with (AS) autism, when he was about 13 years old, and will continue his schooling at a special school for children with autism.
When he was 21 years old he moved to an adult institution for persons with autism. An assessment with CARS (Childhood Autism Rating Scale) describes Michael with (AS) a moderate to severe degree of autism, which manifests in the form of resistance to change in the daily routine, divergent interests and the use of objects, soma-motor mannerisms, different reactions to auditory stimuli and different verbal communication. His verbal communication is characterized by echolalia. His spontaneous communication consists of two or three word phrases. His daily skills are characterized by an exceptionally uneven profile, where Michael in many areas is very self-reliant (dining, dress code, functions), while in other areas he is in need of intensive support, such as socializing with others, and management of his own money.
Michael has since 7 years of age been marked by an obsession. He brings beads, the kind that is used in kindergartens, including rocks and in garbage. Over the years his obsessions will be even greater. At first when Michael was enrolled in the nearby childcare facilities, he was unaffected by the other children and adults, instead entering, and looking for gems. He also entered private homes to search for gems.
The behaviours escalate to happening at night. He does not just go into childcare facilities and private homes where there is immediate access, but breaks in to gain access.
At the beginning the institution is ill equipped to find Michael when he disappears into the local environment. The local citizens are familiar with the institution but despite those local contacts often being ill equipped they usually find him. When police are involved in looking for Michael, or are told of a stranger's intrusion or presence on private property, they act.
There are reports of situations where Michael has been threatening, when people have been attempting to stop him in his endeavor. The situation for Michael culminates when the police arrest him after an incident on the S-train tracks, where he, searching for stones, had been a danger to himself and train movements. His behaviour has never led to legal action against him. Michael has never stolen valuable objects, even though he has been looking for gems in private homes, and he has often been able to deliver them back to their rightful owners.
His behavior has also been so obviously different or deviant, which everyone understands that he was not a danger to others, even though he has created fear through his actions and behavior. Redress through targeted educational work, involving a total restructuring of his daily life and with the use of additional staff resources, will be able to get Michael's obsession under control.
Kim was adopted by Danish parents when he was three years old. He was adopted along with his little brother since birth. Kim lived his first three years in an orphanage in Korea. On arrival in Denmark his parents noticed that he was very difficult to have contact with; he seemed very uncomfortable, and did not seek security among them. In childhood Kim showed signs of poor social skills and found it hard to endure deviations from everyday life. When he was in his early teens at home, he spent a lot of time on his computer and he had no close friends. His parents state they were concerned early, mainly because of the huge differences between Kim and his brother, as his brother did better socially. His parents were also concerned about the fact that Kim was able to laugh at the news or scenes in movies, where there were many emotions in play. Kim said that he laughed, because people in the games had so much fun, when they displayed emotions.
When Kim was 15 years old, he was arrested for his sexual behavior. He was arrested on the street after having been recognized by a girl that he had violated. The police in his hometown had, for a time, been looking in the mall for a boy of Asian appearance, who had touched young women's breasts in Kim’s home town.
Kim confessed to the offense, but said he did not know it was wrong. He told me later that his father had urged him to get a girlfriend, but he did not know how to go about finding a girlfriend. He therefore tried it his way. Kim was arrested, went to court, and was diagnosed with Asperger’s syndrome, and so the indictment was dropped. Kim's criminal behavior can be seen as a direct consequence of his autism; he was unable to understand social relations and did his best to navigate in a field he did not understand.
Anders is a 15-year-old boy. He showed early signs of difficulties with social communication and had only a few friends in the course of his childhood. Anders had, for many years, been very interested in crime and has spent a lot of time watching TV-series over and over again.
When Anders was 14 years old, he began to take an interest in football team memorabilia and was a spectator at football matches. The summer, in which Anders was 15 years old, he wanted to have an item coveted by many youngsters, but could not afford one. He therefore took his pocketknife and robbed his local farm; a shop he visited several times a week. Anders was not masked and was immediately recognized. When he left the store with his adored object he was captured and held by two male customers. He was then arrested and held in custody until police arrived.
Anders says he had not imagined he would be caught, and that he did not understand why the other customers ran after him. He believes he had not done anything to them. Anders confessed to the robbery immediately after the arrest.
While in custody, Anders was given a psychological study, which showed that he was normal intelligence but had clear autistic features. It was after discussions with his parents that the diagnosis was atypical autism. Anders is serving at the moment in an institution.
We now know with certainty people with autism spectrum disorders, have a greater risk of developing criminal behavior than other people. The major of their difficulties is in the interpretation and understanding of the social world, difficulties with language and communicating with others. This is likely to increase the risk that people with autism will come into conflict with the law, perhaps without knowledge or understanding.
In diagnosing childhood Asperger’s syndrome and autism, most children are diagnosed on the basis of early symptoms, which often affords them and their family specialized support and treatment which may compensate for these difficulties. It may be presumed that children identified early in life and helped over many years, are not in a particularly high risk of developing criminal behavior. This is supported in the research among other things, by Ghaziuddin, Tsai & Ghaziuddin (1991), who found that violent behavior is not more common among people with Aspergers syndrome than in others.
This is not the case for the group of most normal intelligence young people and adults with autism or Asperger’s syndrome, who will not be identified in childhood. They are left to cope by themselves and are likely to be involved in crime either because of selecting the wrong social environment, and the difficulty of regulating sexuality in a socially acceptable form, or a characteristic behaviour that can have serious implications in the form of criminal behavior.
All of our case studies reflect difficulties associated with autism spectrum disorders, which will have serious consequences for the individual. The factors that may be specific to the crime, as experienced by people with autism spectrum disorders, are: rapid confessions, theft because of special interests, inadequate understanding of victims experience and inadequate capacity to deal with the other sex.
Even if the present research, and our clinical experiences in day to day visits only seems to point to a limited presence of crime among persons with autism spectrum disorders, we believe that there is a need for an increased awareness of the link between autism spectrum disorder, co-morbid conditions, mental illness and criminal behavior. We are experiencing in the last few years, an increased attention from psychiatric literature where young people’s criminal behaviors need further explanation, which in several cases, is undiagnosed autism spectrum disorder.
The background for further reference to psychiatric studies can be undertaken by the judicial system or the secured services. The experiences of these young people are of being different from other young people, but also that it can be difficult for them to understand the background for their criminal acts. Crime may in such cases help to ensure the young person's difficulties are identified in a number of cases, however, it means the price of deprivation of liberty. It also means that the insured institutions and prison service should have knowledge of autism spectrum disorders, and that, in the treatment of criminals, should be able to use methods designed for people with autism.
We also believe there is need to reverse the education system, among children and young people who have been diagnosed, and who already receive specialized support and treatment, also including awareness of the difficulties and dangers that may be associated with possible future criminal behavior. It is believed today, that young people are increasingly trained to be able to be included in a general social life, to cope with their own housing, education and jobs. It makes greater demands on them to understand and be able to settle in life, also when they may be directly or indirectly involved in criminal acts, or where their own particular interests control them in a direction that can create difficulties for them in relation to property and personal integrity.
There are many young people with autism who will also, via the Internet, in the context of a large group of people be victimized, but also perhaps put themselves in situations where they will no longer be able to understand and consider the consequences of their own actions.
The increase of people with autism spectrum is seen in the psychiatric field and may be the result of increased attention from the investigating authorities. It can also be the result of the knowledge of autism, which we have seen in the last ten years, since the diagnoses of Asperger’s syndrome and PPD-NOS was part of the official diagnostic system, ICD-10.
It looks at the present research, where the majority of psychiatric cases are presented as Asperger’s syndrome. This should lead to putting more focus on finding people with autism spectrum disorders early, for them to receive the correct support, to be implemented so that crime can be prevented.
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