1. Violence risk assessment in AUTISM
By Dr C Thomas (Consultant Forensic Psychiatrist)
A Wright (Trainee Psychologist)
Dr S Gunasekaran (Consultant Forensic Psychiatrist)

2. HCR 20
Why do we use HCR 20?
Where did the factors come from?

3. F1 F2 Correlated Model F3 F4 χ2 = 42.88, p < .000 CFI = .944
TLI = .926
RMSEA = .050
H1. Previous Violence
H2. Young Age 1st Violence
H7. Psychopathy F1
H8. Early Maladjustment
H9. Personality Disorder
H10. Prior Supervision Failure
H3. Relationships Problems F2
H4. Employment Problems
Correlated Model
Dimensions on the HCR-20 (Douglas & Lavoie, 2006)
H5. Substance Use Problems
C1. Lack of Insight
C2. Negative Attitudes F3
C4. Impulsivity
C5. Unresponsive to Treatment
R4. Noncompliance
R1. Plans Lack Feasibility
R2. Exposure to Destabilizers
R3. Lack of Personal Support
R5. Stress F4
F1: Chronic Antisociality
F2: Life Dysfunction
F3: Disagreeableness
F4: Destabilizing Context
Cross-validation N = 2,047

4. ASD People with ASD are over represented in forensic populations
Scragg 1994, Hare 1999, Langstrom et al., 2009

5. Common characteristics
Deficient empathy, Interpersonal Naivety, Sexual Frustration, Immediate confession and Links to preoccupation
Less likely to have an obvious gain
Less likely to involve illicit drugs/alcohol
Less commonly occurred at night
Less able to recognise fear in others
Bowler and Worley (1994), Murrie et al (2002), O’ Brien and Bell (2004), Barry-Walsh & Mullen (2004), Berney (2004), Woodbury-Smith et al (2005)

6. Characteristics of Offences
More common
Less common
Among High functioning:
Threats to kill
Arson
Sexual offending
Criminal damage
Stalking
Acquisitive offences
Drug related offences
Assaults

7. Recommendations based on
Theory
Clinical Experience
Cognitive Theories
Social Theories
ABA Theories
Social Model of Disability
Literature in relation to violence and autism associations
Study on 40 patients with ASD at STAH Notts.
Clinical Experience

8. Literature
Literature concerning violence and aggression within Autistic Spectrum Disorders (ASD) has been criticised as lacking understanding of underlying reasons and risk factors for the relationship.
Prevalence
Prevalence of ASD in secure settings has been reported at 5.3% (Hare, Gould, Mills & Wing, 1999).

9. Risk factors Theory of Mind deficits
In Bjorkly (2008)’s literature review of risk factors for violence in Asperger’s Syndrome, 35% of violence towards others was reportedly attributed to social misinterpretations of the victims’ intentions.
Barry-Walsh and Mullen (2004) suggest that weak central coherence can result in preoccupations and rigidities that may lead to criminal behaviour.
Burdon and Dickens (2009) have noted that impairment in understanding social cues may influence criminal behaviour, in individuals with Asperger’s Syndrome.

10. Risk factors Psychiatric comorbidities
The prediction of comorbidities on violence in ASD has been substantiated by Langstrom, Grann, Ruchkin, Sjostedt and Fazel (2008) who found that comorbid substance use disorders and personality disorders were risk factors for violent offending behaviours in ASD.
Quek, Sofronoff, Sheffield, White and Kelly (2012) found that depression was a significant predictor of anger in young people with ASD.
Richards et al (2012) found that participants with ASD that engaged in SIB have significantly lower mood than those who did not exhibit SIB.
Kerns, Kendall, Zickgraf, Franklin, Miller and Herrinton (2015) found that comorbid anxiety disorders were associated with increased patient-reported self-harm in youths with ASD.

11. Risk factors Sociodemographic factors
Amongst sociodemographic factors investigated by Langstrom, Grann, Ruchkin, Sjostedt and Fazel (2008), it was found that male gender and higher chronological age were associated with engagement in violent crimes.
Kanne and Mazurek (2011) reported various demographic variables that were associated with violence in children with ASD; including lower chronological age and coming from a family with higher income.

12. Risk factors Intellectual functioning and Intelligence Quotient (IQ)
Lower IQ has been found to be associated with aggression in children with ASD (Kanne & Mazurek, 2011).
Sensory processing
In Bjorkly (2008)’s literature review, sensory hypersensitivity was the second largest cause of violence towards others.
Severity of ASD symptoms
The severity of ASD symptoms have been found to be significant predictors of SIB in ASD (Baghdadli et al, 2003; McClintock et al, 2003), though the former research studied a sample of children, limiting generalizability to adults with ASD.

17. Any questions, comments or feedback?