Autism and offending behaviour:

needs and services

Helen Pearce and Thomas Berney

Helen Pearce is based at Abstract

Autism Secure Services, Tees, Purpose – Autism spectrum disorder (ASD) brings out the limitations of the Criminal Justice Service.
Esk and Wear Valleys, NHS The purpose of this paper is to review some of the salient issues and their remedies.
Foundation Trust, Design/methodology/approach – A narrative review based on the literature and the clinical experience
Middlesbrough, UK. of the authors.
Thomas Berney is a Findings – ASD’s hidden disabilities, even without the frequent coexistence of other disorder, derail the
Developmental Psychiatrist standard responses to offending.
based in Sunderland, UK. Practical implications – Management of these individuals as offenders depends on awareness of the
issues, adaptation and the input of a variety of other services, especially health, social care and employment.
Originality/value – Although this is a very active field of work, there is relatively little written about it.
Keywords Criminal justice system, Asperger, Rehabilitation, Autism, Offending behaviour,
Neurodevelopmental
Paper type General review

The nature of the problem

Studies suggest autism spectrum disorder (ASD) to be disproportionately present in offender
populations, whether in secure facilities (prisons and hospitals) or community clinics (Chaplin
et al., 2013; Mouridsen, 2012) although this may be an artefact, the indirect result of associated
problems. A controlled follow up of attendees at an Edinburgh child psychiatry clinic found that it
was only in women that the presence of ASD[1] increased the likelihood of eventual conviction: in
men it was increased for all (Wolff, 2000). The result might explained by ASD’s close association
with attention deficit hyperactivity disorder (ADHD) (Croen et al., 2015) which is linked more
clearly to offending (Young and Thome, 2011). This, however, remains to be explored as a
hierarchical approach to classification meant that a diagnosis of ASD precluded that of ADHD
until relatively recently.

A further complication is that a group of offenders is defined by chance and variable criteria. To
qualify, an individual has to be caught, charged (without diversion from the legal process) and
convicted. The process is likely to differ for anyone seen as unusual, the standard of behaviour
expected, and therefore the threshold for engaging the Criminal Justice Service (CJS), varying
with their circumstances and so creating an (unstated) selection pressure.
Overall, ASD probably does not predispose to offending; if anything, the characteristic respect
for structure and order makes it less likely (Chaplin et al., 2013; King and Murphy, 2014; Maras
Received 17 June 2016 et al., 2015) although our perception is distorted by the publicity arising from the unusual nature
Revised 6 August 2016
Accepted 8 August 2016 of some offences. People with ASD are a very heterogeneous group (Wolff and Barlow, 1979)

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and, even though a rule-governed orthodoxy would seem protective, other characteristics bring
vulnerability:
1. Poor emotional regulation, expressed in a too ready, too intense anxiety or anger, may be a
feature of the wider neurodevelopmental disorder and its accompanying stresses. However,
sensory sensitivity and the impulsivity of coexistent ADHD are more particular to ASD and
can set off emotional arousal which, especially as it reaches the pitch of panic, may be violent.
Where this is directed only towards family or carers, it is likely to be under-reported.
2. Besides developing strategies to avoid stress and de-escalate distress, emotional regulation
can be improved with adapted dialectical behaviour therapy (Hartmann et al., 2012). As
alexithymia is associated with ASD, this may need to be preceded by a programme of
emotional literacy, teaching individuals to identify, label and communicate their feelings.
3. Difficulties with pragmatics, notably in judging the responses of others and the social rules in
a given circumstance, are central to ASD and may explain the desire for a well-ordered life.
For example, Temple Grandin (2005) identified a category of offence, such as sexual
transgression and drug offences, as apparently minor but carrying severe penalties. Calling
these “Sins of the System”, she decided to play safe, choosing total abstinence. Her fear is
well-grounded for it reflects how vague are the margins between seduction and date rape or
the point at which a dedicated suitor finds themselves a stalker; both offences depending on
an understanding of when “no” means “no”.
4. Closely related is a reduced capacity for intuitive empathy, hindering the ability to gauge the
impact of an action (Baron-Cohen, 2011) and possibly contributing to malice, a constant
theme in the accounts of Asperger syndrome (Tantam, 2005). This may be a factor in the
occasional extremes of violence which reach their zenith in senseless or multiple killings (Allely
et al., 2016; Im, 2016) in which ASD recurs as part of a varied and complex psychopathology
(Faccini, 2016).
5. The need here is to teach the basic rules of social engagement and functioning (normally
learned informally) as well as conscious empathy. These are educational tasks and the skills
should be taught routinely at school rather than waiting until an offence reveals the deficit.
6. The ability to think beyond the immediate consequences of an action is often limited (perhaps
evidence of weak central coherence). This can call into question the individual’s capacity to
form the intent to commit that offence. The result of a course of action truly may be unintended
and unforeseen, producing an inadvertent offender (Katz and Zemishlany, 2006). Here, again,
individuals can be taught to take a less impulsive, more thoughtful approach to problems.
7. A focal interest, one of ASD’s diagnostic characteristics, may be pursued so intently and
persistently as to lose sight of society’s constraints, leading the lover to stalk, the keen
collector to steal, and automated searching to accumulate an unwatched diskful of
pornography (Helverschou et al., 2015; Woodbury-Smith et al., 2010). The driving motives
may vary and include the development of a persona, an aid to friendship or an anxiolytic
distraction. Blocking the pursuit of such an interest can be followed by a reactive
intensification, destabilisation of a fragile style of life and further offending.
8. Many with ASD are attuned to computers and the internet which suit focussed, systematic
thinking and structured social relationship. They also offer an easy entrance to hacking,
trolling and online fraud but although one study suggests an association between autism
traits and cyber-deviancy (Seigfried-Spellar et al., 2015) there has been remarkably little
research, leaving the field open to anecdote and speculation (Kibbie, 2012; Ledingham and
Mills, 2015). Again, the motivation is frequently unusual and mixed, perhaps stemming from a
strong sense of social justice (a knight to the rescue) or an obsessive interest, compulsively
followed, with little thought as to the potential outcome, its impact on others, or even that it
might be an offence. Computer gaming may involve a rich fantasy life which, detached by the
use of an avatar, goes beyond the culturally acceptable. For some, a blurred boundary
between fantasy and reality lets them slip into enacting a game or video and, while its removal
may result in a substantial improvement, eventual success requires the individual to cope
with its later reintroduction.

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 9. The individual will have had a social barrier, isolating them from others, from early childhood.
Common to many offences is a desire to develop a closer relationship, ranging from
compliance to a more active control, including maladaptive attempts to develop a sexual
relationship. Here, again, the management is predominantly educational although its
specialist nature may mean that it is delivered by a number of agencies which include not just
education but also health, the CJS and social services. The aim is to help the individual attain
a more normal life with normal relationships that include intimate friends and partners.
While this list identifies some of the major elements contributing to offending, any specific offence
will derive from a complex mix of these. For example, a sexual offence may be the result of the
emotional arousal from a blend of excitement and anxiety, a desire to get a girlfriend, unempathic
egocentricity, a lack of awareness of social rules and a long-standing sense of immunity based on
the tolerance of others (Allely and Creaby-Attwood, 2016; Berney, 2016). Blinded by the
presence of ASD, services risk overlooking other contributory factors, for example past sexual
abuse (Sevlever et al., 2013), psychosis and coexistent dissocial personality disorder. Their
starting point has to be an all-round assessment of the whole person and their background (Royal
College of Psychiatrists, 2014, No. 11275).

Encounters with the CJS

There is published guidance to help members of the CJS to identify and manage ASD in offenders
and although training programmes are becoming more widespread (Debbaudt, 2007; National
Autistic Society, 2011) there is some way to go (Chown, 2010). The challenge is to make people
aware of them and of the importance of involving other agencies, particularly in three situations:
1. The first encounter for someone with ASD is likely to be with the police, possibly called to help
with behaviour which is unusual, withdrawn or violent, often originating in anxiety. Alternatively,
it may be a police investigation which provokes anxiety and possibly panic. Whatever the basis,
the police should seek to understand, calm and resolve a situation (which may include an arrest)
and consider involving other agencies, such as the local mental health team, at an early stage.
2. The next encounter may be a formal interview at the police station. So much of the disability is
hidden and often unsuspected, that it is essential that all involved are sensitive to the possibility
of ASD, aware of its potential difficulties and give thought to enlisting someone with a good
understanding of ASD. Relatively few appropriate adults are familiar with, let alone trained in,
ASD but increasingly there are mental health teams with the remit of working into the CJS whose
involvement at this point can make for early intervention and diversion. They can also contribute
to the interview’s reliability, reducing the risk of subsequent challenge. Important points are:
■ The problems with communication (especially comprehension) are becoming better
known. Less so are the frequent, specific problems with memory; for example, the recall
of events that were emotionally charged, their recall by a participant (as compared to an
observer), or simply being able to tell whether an event had actually happened.
Surprisingly the cognitive interview, designed to aid better recall by witnesses in police
interviews, can make matters worse (Maras and Bowler, 2012). However, much can be
remedied by appropriate interviewing and support (Mattison et al., 2015).
■ ASD is associated with increased compliance (but not with suggestibility) (North et al.,
2008) although misleadingly, an innate rigidity may encourage a dogged obstinacy over
specific points.
■ Anxiety will hinder rather than help an interview and so the setting must take this into
account, perhaps by ensuring an unusual structure and predictability as well as trying to
reduce the effect of sensory distractions.
3. In court, defendants have to meet the Pritchard criteria to be considered fit to plead. Attention
and comprehension, in addition to intellectual ability, are necessary to follow the
proceedings. It may be necessary to appoint an intermediary as well as employing other,
special measures such as visual aids or structuring the proceedings, breaking them into
short, predictable episodes.

PAGE 174 j ADVANCES IN AUTISM j VOL. 2 NO. 4 2016

Whatever the circumstance, there has to be a readiness to suspect the presence of ASD for, of
those with it, only a minority are aware of their diagnosis. It would be helpful to have an effective,
simple screening tool although there are substantial hidden difficulties, particularly in prisons
(Robinson et al., 2012).

Disposal
The court has to take into account the aims of the CJS (to deter, punish and rehabilitate the
offender and to protect the public). Besides more standard disposals (ranging from community
programmes to imprisonment) it might consider placements with other agencies, such as health
(whether in hospital or the community) and social care.
Risk assessment, central to any plan, has to be individual and, while standard instruments are not
immediately suitable to ASD (Murphy, 2013), they can be adapted to be the basis of an interview.
The past history is key to this and it should include the trajectory of the offending, identifying both
the occasional serious offence as well as the more minor infringements which might show the
individual’s life to be stuck in a repetitive rut.

Management in the community

In England, Transforming Care[2] should mean that more people are to be managed in the
community, subject to various constraints as well as to treatments which are often indistinct from
social care. Where these are imposed (i.e. without consent), there has to be formal, legal
authorisation to protect both the individuals and the people caring for them. In hospital, this
authority is provided by the Mental Health Act (1983) but there is no real equivalent in the
community where even the courts cannot authorise staff to detain or restrain individuals.
However, this is only one aspect of a wide range of supervision extending from regular mentoring
(to forestall an accidental drift back into offending) through to round-the-clock supervision. While
the latter may be accepted by those for whom the alternative is institutional detention, it is legally
questionable whether anyone can accept a self-imposed imprisonment.
The viability of any community programme will depend on its public perception as being relatively
safe. This requires an effective programme of risk assessment and good inter-service
collaboration which can be formalised in England and Wales by invoking the Multi Agency Public
Protection Arrangements.
The presence of ASD can mean that the elements of their management have to be taken in
turn rather than concurrently, each phase building on an earlier achievement to develop a
sequence of:
1. teaching habilitate skills that address the specific deficits that ASD has brought to that
individual;
2. remediation of the psychological difficulties typical of ASD; and
3. offender programs adapted to the specific needs of that individual and their ASD.
What may pose a greater problem is identifying a specialty that has sufficient expertise to manage
the issues that come with ASD: services familiar with ASD, those that provide for children and
adolescents and people with an intellectual disability, are understandably reluctant to take on an
adult of normal intellectual ability while adult mental health and forensic services are only
beginning to discover the neurodevelopmental disorders (Royal College of Psychiatrists, 2014).

Management in hospital
A placement should be determined by the individual’s needs rather than their label as, for
example, the stress of a general psychiatric ward and inexperienced staff can amplify the mental
illness of someone with ASD. A service needs the appropriate staff and setting to tease out the
significance of someone’s symptomatology, manage the ASD and implement treatments as well
as to identify what else remains at the end of this process.

VOL. 2 NO. 4 2016 j ADVANCES IN AUTISM j PAGE 175

 There are those with ASD whose severe environmental sensitivity needs unusual structure and
predictability; something that might only be found in a secure environment even though they are
unlikely to abscond. Then, should their innate fragility be destabilised by the usual discharge path
through a chain of step-down placements, they may need to move directly to their specialist
community placement.

Future research
This is explored in a relatively recent paper which identifies a number of the methodological
difficulties, particularly that of identifying ASD in the absence of a developmental history and in
settings which may mask the symptomatology (Woodbury-Smith and Dein, 2014).

A recent review of inpatient progress found that the presence of ASD did not of itself determine
the outcome. It concluded that attention needed to be directed towards defining predictive
subtypes (Esan et al., 2015) and two dichotomies would appear to repay exploration:
1. the extent to which the presence or absence of ADHD, in conjunction with ASD, is a
significant determinant of offending behaviour; and

2. whether there is a useful distinction to be made between those who have a history of diverse
offences (possibly associated with poorer social skills and peer group influence) from those
whose offences are more classically “autistic”.

Conclusions
ASD has such a varied presentation and is associated with so many disabilities and disorders that
it is difficult to generalise about it, a difficulty which is multiplied by the heterogeneity of offending.
At a clinical level, each individual must be seen in their own right. Usually unrecognised, ASD has a
major effect on the way the individual experiences and responds to the world and its rules. The
law, which has grasped the concept of intellectual disability, now has to accommodate other
mental concepts such as differences in thinking style, communication, memory and the way the
world is experienced and perceived. These are dimensional characteristics which clinicians have
to translate into descriptive categories for them to be accommodated by the legal process (which
involves determining the threshold for abnormality). In a field founded on concepts, this much
criticised process of translation is an important driver of their clinical and legal evolution.

Notes
1. The Edinburgh studies were of children with schizoid personality, now indistinguishable from the ASD
defined by DSM 5.

2. The Transforming Care programme followed the discovery of abuse of adults by the staff of
Winterbourne View. The subsequent report highlighted the inappropriate and prolonged placement of
people with intellectual disability and/or autism in hospital. The programme aims to ensure timely
discharge, an avoidance of unnecessary admission and the development of community provision
(NHS England, 2015).

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Corresponding author
Thomas Berney can be contacted at: [email protected]

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