Looking for Autism in The Criminal Justice System

1. Looking for Autismin The Criminal Justice System Jim O’Donnell Clinical Autism Specialist Adult Autism Team NHS Greater Glasgow & Clyde

2. Problem Assessment StudyHMP BarlinnieScottish Prison Service – April 2007 Brief was to answer some key questions:- • Were there people in prison with undiagnosed ASD? • Did the prison population have an incidence of ASD which was higher than in the general population? • Was the incidence of ASD in prison a significant concern?

3. Autism Awareness Sessions A number of ASD awareness sessions were offered to a wide range of staff working in the prison. A total of 22 individuals took part from various departments within the prison (Prison Officers, Mental Health & General trained Nurses, Social Workers and Forensic Psychologist). All 22 responded to evaluations.

4. Evaluations 18 of the 22 respondents stated that they would like to attend further ASD training. All 22 stated that they would view the development of a screening tool as being useful.

5. Some Quotes Respondents felt that ASD Awareness Training would allow then to change their practice in the following ways:- “To possibly identify ASD during admission and ensure correct procedures in dealing with it.” “Take more time to try and understand the problems people with ASD may have.” “Will begin to think about people differently if they respond in certain ways to certain questions/instructions.”

6. Development of Screening Tool – Barlinnie Prison • It was felt that Health Staff were the most appropriate to complete screening tools/questionnaires with clients. • There was a smaller unit within the prison that accommodated more vulnerable prisoners, those assessed as ‘at risk’ due to mental health issues, mild learning disability etc.(40) • It was felt that this may be where there was likely to be the greatest prevalence of ASD within the prison. • Adult Autism Team supported a member of the SPS mental health team to develop the skills that enabled her to support screening this population.

7. Screening • It was found that SPS staff did not have the knowledge of the prisoners to complete screening checklists. • Self reporting questionnaires required to be paraphrased and examples given before they could be answered. • ‘Off the shelf’ tools proved difficult. • Reduced literacy skills. • Lack of self evaluation. • ‘Hard man’ image.

8. Screening (Cont) • Self reporting of a detailed personal history, direct observation and results from paraphrased AQ were used to determine the likelihood of the presence of an ASD. • Only those with a significant score in AQ and a supporting developmental history were counted in figures of ‘probable ASD’

9. Results • General Prison population – 7.5% of probable ASD. • High support Unit population – 14.6% of probable ASD. (The incidence of ASD in mainstream society is widely recognised as 1:100.)

10. Why do Criminal Justice Services need to think about this? • People with undiagnosed ASD are currently in the criminal justice system. • ASD is over represented in the criminal justice system. • Hidden communication difficulties both understanding and expressing of both verbal and non verbal language render people with ASD as extremely vulnerable at many stages in the criminal justice system. • Failure to understand the full nature of the behaviour and impact of the environment and others upon this will lead to disadvantage at various stages for the person with ASD in the criminal justice system. • Re-offending is likely to occur unless behaviour is understood in the context of ASD and appropriate supports put in place.

11. Points of vulnerability in Criminal Justice System • Social enquiry report – the possibility of an undiagnosed ASD requires to highlighted and communicated with the PF • 2. Attendance at social enquiry report interview may be difficult due to communication • regarding the appointment and need for change to be tolerated. • 3. Community based disposals may not meet the needs of those with ASD but the nature of these could render attendance impossible. • 4. Children’s reporter may place children ‘out-with parental control’ in residential care. • There is no specific service of this kind for those with ASD. • 5. During police interview a person with ASD may appear to have well developed • communication skills and the fact that they may fail to fully understand the question • and the implications of the questions may not be apparent. The use of appropriate • adults should be utilised where ASD or the possibility of ASD has been identified. • Any others?????

12. Possible Predisposing Factors(Howlin, 2004;Berney, 2004) • Innate lack of empathy can lead to offence that is disproportionately intense/damaging. Individuals often lack insight, deny responsibility, blame others. May be due to inability to see inappropriate behaviour as others do • Innate lack of awareness of outcome allows individuals to embark on actions with unforeseen consequences • Impulsivity, sometimes violent, can be a component of co-morbid ADHD or of anxiety that turns into panic • Social naivety and misinterpretation of relationships can result in exploitation as a stooge

13. Misinterpreting rules, especially social rules, can find individuals unwittingly embroiled in offences such as date rape • Difficulty judging the age of others may lead to illegal relationships, sexual advances to minors etc. • Over-riding obsessions can lead to offences such as stalking or compulsive theft. • Lacking motivation to change, individuals may remain stuck in risky patterns of behaviour

14. Forensic presentations possibly indicative of undiagnosed Asperger Syndrome (Berney, 2004) • Obsessive harassment (stalking) • Inexplicable violence • Computer crime • Offences arising out of misjudged social relationships

15. Why do we need to recognise ASD? 4. Failure to understand the full nature of the behaviour and impact of the environment and others upon this will lead to disadvantage at various stages for the person with ASD in the criminal justice system. 5. Re offending is likely to occur unless behaviour is understood in the context of ASD and appropriate supports put in place

16. What should you look out for? (Remembering that everyone is different and none of these points are diagnostic in themselves) • Odd social interaction – too formal, too informal, body language, interruption, eye gaze etc • Mismatch between cognitive abilities and level of skill in everyday tasks. • Lack of organisation • Clumsy • Honest to a fault

17. The unofficial police. • Insensitive to the emotions of others. • Bullied and sometimes unaffected by this. • Ritualistic and rule bound • Intense interest in a particular subject often with immense level of knowledge

18. Underperformance – Mismatch between academic achievements and occupation. • Unable to progress through career, many changes in job, lack of tolerance for imperfection. • Academic progress arrested at point of transition when structure lessens. • Few ‘real’ friends and often many acquaintances. • Islets of ability or skill sometimes associated with special interest.

19. Sensory differences – food fads, annoyed by sounds others would not notice, sensitivity to being touched, averse to the feelings of some surfaces, fascinated by the touch of some surfaces. • Often get into troublesome situations because of their ill-timed responses. • Great collectors of facts or things, the focus of which can change over time and can sometimes stop due to financial or other constraints. • Fall out easily with others and sometimes seem perplexed as to what went wrong

20. The Adult Autism Team, Yarrow View Centre, 1880 Dumbarton Road, Glasgow. G14 0YA. Telephone 0141 342 3030. James.O’Donnell@ggc.scot.nhs.uk