1. Prevalence & interventions for people with ASC & offending behaviour
Glynis Murphy, Prof of Clinical Psychology & Disability

2. Outline What does the research literature say?
Prevalence of ‘offending’ in people with Autism spectrum conditions
Interventions for ‘offenders’ with ASC
Conclusions

3. Research literature
Terminology: overlap between offending & challenging behaviour; arbitrariness of arrest, charging & trials
Prevalence – very difficult to investigate. Far more studies in LD than in ASC.
Interventions – beginning to appear, but again far more literature on LD than ASC.

4. Prevalence
Numerous case studies in the research literature describing people with ASC who commit crimes, various kinds from aggression to IT-related
Some high profile cases such as: - Gary McKinnon UK who hacked into US government computers, for evidence of UFOs, causing over $800,000 worth damage - some multiple shootings in USA school/college campuses ?by young men with ASC

5. Why might people with ASC be at more risk of offending than others?
Their increased social naiveté & poorer theory of mind may lead to manipulation by others
A disruption of routines, or over-rigid adherence to rules, might lead them to aggression
A lack of understanding of social situations & poor negotiating skills might lead to aggression
An obsessional interest might lead to them committing an offence in the pursuit of that interest, not recognising the implications of behaviour
Psychiatric co-morbidity raises risk?

6. Why might people with ASC be at Less risk of offending than others?
People with ASC find rules helpful in surviving in the social world, and laws are simply social rules of a particular type
They are more likely to be supervised and supported
They are less likely to be in a gang & led astray by others
Need for systematic review!

7. Systematic literature search
Autism keywords.
Criminal Justice System keywords.
Autis*
ASD
ASC
Asperger
Pervasive Developmental Disorder
1659 papers found, 22 fitted criteria
Criminal Justice System
Prison
Probation
Court
Secure
Forensic
Crim* or Offen*

8. Studies of prevalence
Two very different questions with different purposes
Q1: What percentage of people in parts of the Criminal Justice System have ASC? (if there is no over-representation, expect ~1% in any stage of CJS).
Q1 usually relates to questions about what support to provide to people once they are in the CJS
Q2: What percentage of people with ASC in the community commit offences? Need good control group of people with no ASC for comparison.
Q2 relates more to need for services to prevent people with ASC engaging in behavior that could be termed criminal

9. Percentages of people with ASC in parts of the CJS
Figures obtained depend on methodology (especially sampling) & jurisdiction & diversion
7 studies gave prevalence rates of 3%-27%
5 examined rates of ASC in forensic populations ie those referred for psychiatric evaluation or already in forensic mental health provision
Only 2 looked at unbiased populations cases in juvenile court in Japan - Kumagani & Matsuura 2009) - 3% prevalence rate - 12 prisons Scotland - Robinson et al 2012 – 4%?

10. Percentages of people with ASC in the community who offend
What counted as offending? Convictions vs contacts with justice depts vs self-report
6 studies, of which 5 had a comparison group of non-ASC offenders. All 5 showed those with ASC had LOWER prevalence rates than the non-ASC groups. Best: Brookman Frazee et al 2009; Cheely et al (Confirmed by Lundstrom et al 2014).
Proportionately: Crimes against people higher vs property offences, tda, drugs offences lower

11. those with ASC who offend VS those with ASC who do not
More adverse childhood experiences, including abuse and neglect in offending group
No differences in theory of mind and emotional recognition and executive function between offending and non-offending group & very rare for special interest to be an issue in the crime (Woodbury Smith et al 2005, )
No differences in suggestibility (North et al 2008)
Frequent reports of very high anxiety and confusion once in the CJS (Allen et al 2008)

12. Interventions for people with ASC who offend
Again there are anecdotal reports ++
Systematic review completed – search terms as before, plus intervention/treatment/therapy
1279 papers found, 13 met inclusion criteria
Pharmacological, psychological and other treatments considered
No RCTs or controlled studies found
11 case reports and 4 case series found

13. Intervention packages: CBT
Two main approaches:
Risk, needs, responsivity approach (RNR)
Good Lives approach, with support needed. Not really evaluated yet for people with ID.
Specific interventions trialled for ID:
Anger management
Arson
Sexual offending
General offending packages – TSP; EQUIP

14. Single Case studies
These were essentially qualitative, ie they typically used no pre- and post- treatment measures (apart from offending)
6 of 11 reported reductions in offending, 5 of 11 reported no reductions
2 employed medication plus psychological intervention – one led to reduction in offending
Remainder reported CBT, CAT, reconstructive therapy, psychoeducation, social skills training. Some did not specify!

15. Case series (men with ID/ASC)
All had pre- and post- treatment measures
Classified as case series as no control groups
3 concerned SOTSEC-ID (for men with harmful sexual behaviour) & one concerned EQUIP (for general offending groups)
SOTSEC-ID showed increases in sexual knowledge, victim empathy, & reductions in cognitive distortions, for men with & without ASC. Re-offence rates higher for ASC.
EQUIP: promising pilot study

16. SOTSEC-ID Group cognitive-behavioural therapy
Measures: included Lindsay’s QACSO, plus sexual knowledge & empathy measures
Treatment lasts for one year or more (one session per week)
Modules: - sex education & relationships - the cognitive model - empathy training - the 4-stage model of sexual offending - relapse prevention

17. SOTSEC-ID (n=109)

18. EQUIP (Langdon et al 2013)
Adapted from Equipping Youth to Help One Another Programme (Gibbs et al, 1984)
Based on moral reasoning; intensive (4 sessions /week for 12 weeks); n=7 in pilot study
Mutual help sessions (group helps solve a problem) & equipment sessions (anger management, social skills training, decision-making training)
Moral reasoning, cognitive distortions, problem solving & anger all improved

19. Anger management: Group studies with controls
Anger management – CBT of around 15 X 2hr sessions
Self-report of reduced anger reliably found Benson et al 1986, in USA; Rose et al, 2000, Taylor et al, 2002, Willner et al 2002; Lindsay et al, 2004; Taylor et al 2005; Rose et al 2005; Willner & Tomlinson 2007, all in UK.
Newest study: RCT, n=180 – train the trainers approach in community sample; limited effects (Willner et al 2013, in UK)
Self-report of anger vs records of aggressive incidents
How many had ASC?

20. Arson
Successful single case, man with ID – broadly CBT; offence free for 10+ yrs (Clare al. 1992)
Group CBT, no controls, for 8 men & 6 women, all with ID - scores on FIRS, FAS little change; anger & GAS improved (Taylor et al 2004 & Taylor et al 2006)
Fire Intervention Programme for Prisoners (FIPP) – CBT & Good Lives approach. Controlled study in prison promising for non-ID, but not tested properly yet for ID or ASC (Gannon 2012)
How many have ASC in previous studies?

21. Adapted - Thinking Skills Programme
Thinking Skills Programme runs in UK prisons; people with IQ<80 excluded
We adapted TSP for people with ID – longer, simpler, more pictorial material (Oakes et al 2015)
3 modules: self-control, problem-solving, positive relationships (10, 5, 6 sessions), plus 3 x 1:1
Own offence chain; emotions, thoughts, actions; red flag situations; planning; consequences; red/ green flag people
3 prison trial for 24 men: improved locus of control & problem solving (n=23)
How many had ASC?

22. What do the Service Users think?
Very few studies ask people with ASC what they think of treatment. These asked people with IDD/ASC:
Taylor et al (2004): reported 83% enjoyed anger management sessions; 67% said they felt they had changed for the better; 83% felt less angry
Murphy et al (2004): reported most men could say why referred for sex offender treatment; what they learned; what best & worst things were; very positive on whole (2 other studies not yet published)
Macdonald et al (2003): qualitative study of 9 people involved in psychoanalytical groups; valued group but found it painful; not aware of own progress

23. Conclusions Prevalence needs no further study?
Vulnerabilities need some further study; protections do!
Treatment needs much further study: RCTs, cost-benefit analysis, etc
Support needs further study: how best to do it; cost-benefit analysis
We know very little about women with ASC in the CJS
We know very little about adolescents with ASC in CJS

24. References
King, C. & Murphy, G.H. (2014) A systematic review of people with Autism Spectrum Disorder and the Criminal Justice System. Journal of Autism and Developmental Disorders, 44.
Lundstrom et al (2014) Childhood Neurodevel-opmental Disorders and Violent Criminality: A Sibling Control Study, Journal of Autism and Developmental Disorders,44,
Melvin, C., Langdon, P.E. & Murphy, G.H. (in press) Treatment Effectiveness for Offenders with Autism Spectrum Conditions: A Systematic Review. Psychology Crime and Law.

25. Thank you for listening! Questions? g.h.murphy@kent.ac.uk