Asperger Syndrome & Offending Behaviour

1. Asperger Syndrome & Offending Behaviour Exploring the Links David Allen1,2, Carys Evans1, Andrew Hider3 & Helen Peckett1 1 -Special Projects Team, Bro Morgannwg NHS Trust, 2- University of Glamorgan, 3- Caswell Clinic, Bro Morgannwg NHS Trust,

2. 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

3. 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

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

5. Asperger & Offending • ‘While the majority of persons with Asperger’s syndrome are scrupulously law abiding..a small subset does come into contact with the legal system’ (Murrie et al, 2002) • ‘Although there is little evidence of any significant association between autism and criminal offending, occasional and sometimes lurid publicity has led to suggestions that there may be an excess of violent crime amongst more able people with autism or those diagnosed as having Asperger syndrome ’ (Howlin, 2004)

6. Media Reports (US) • DM –35 year old, obsessed with subway maps, trains, timetables. 18 arrests. First ‘borrowed’ subway train aged 15; recent incidents involved pulling emergency break during rush hour, impersonating transit worker (New York Times, 2001) • RD – 60 year old, heir to multi-million property fortune. Living in disguise as a woman, killed & systematically dismembered neighbour. Implicated in two other disappearances (Telegraph, 2003)

7. Media Reports (UK) • 13 year old (ASD) - killed 85 year old woman in Dorset (Daily Mail, 1994) • TM –shot & killed 18 year old burglar (Norfolk Eastern Daily Press) • SH – assaults against police etc. Experienced periods in prison and detained under MHA. Misdiagnosed as psychotic, depressed (BBC Newsnight) • TM-detained in Rampton following conviction for murder of 9 year old boy who had provoked him (Times, 2000)

8. BG – killer of Jill Dando (Telegraph, 2001) • 12 year old, killed 6 month old baby brother in cot, cut off his left hand. Asked why he had done it: ‘I want to be with my mother’(Telegraph, 2001) • SH – stalked, threaten to hack to death Tina Barrett of S Club 7 (Telegraph, 2003)

9. AC – sent computer virus that caused ‘potentially catastrophic’ crises at port of Houston, Texas (Telegraph, 2003). • PB – diagnosed as schizophrenic, detained in Broadmoor for over 10 years following single act of violence (Telegraph, 2003) • PS – aged 18; murdered 10 year old girl who had teased him while at a party attended by 60 guests (Telegraph, 2004)

10. Popular Media • CSI • The Brief

11. Professional literature: Case studies • Mawson et al (1985) • Baron-Cohen (1988) • Everall & LeCouter (1990) • Tantam (1991) • Chesterman & Rutter (1994) • Kohn et al (1998) • Milton et al (2002)

12. Murrie et al (2002): Analysis of six case histories from forensic settings. Commonalities across cases included:- Deficient empathy- Interpersonal Naivety- Sexual Frustration- Immediate confession- Links to preoccupations • Barrie-Walsh & Mullen (2004): Analysis of five cases. Similar themes raised, especially deficient empathy

13. Studies on rates of offending in Asperger Groups • Tantum (1988):Study of long-term users of mental health services regarded as socially isolate/eccentric. 77% subsequently diagnosed as AS. 3% had been committed to secure hospitals, 44% had committed isolated offences & 23% actual criminal offences (primarily violence against others) • Ghaziuddin, Tsai & Ghaziuddin (1991): reviewed 21 publications, n=132,on people with AS. Only 2.3% had clear history of violent behaviour

14. Scragg & Shah (1994): 1.5% prevalence of AS in Broadmoor (as compared to 0.36% population base rate established by Ehlers & Gillberg, 1993) • Siponmaa et al (2001): 3% of consecutive referrals aged 15-22 to forensic psychiatric service in Stockholm met criteria for AS

15. Hare et al (1999): Study of ASD in three special hospitals in England. 31/1305 had definite ASD (2.4%); 21/31 had AS. • Myers (2004):ASD/LD in secure, forensic other specialist settings in Scotland.6/216 ASD only; 34 ASD & LD.

16. Present study aimed to identify: • Number of adults with Asperger Syndrome and offending behaviour within defined catchment area • Characteristic patterns of offending • Disposal patterns within CJS & MH systems • Support services received

17. Procedure • Conducted in area served by 7 LHBs in South Wales • General population 1.2 million1 • Contacted all relevant services within area • Identify numbers of people with Asperger served and numbers with offending behaviour 1 Predicted prevalence of Adults with Asperger in Locality (Based on average 43 cases /10,000) 3,932 (Averaged from rates in Ehlers & Gilberg, 1993; Kadesjo et al, 1999; Chakrabarti & Fonbonne, 2001(all child studies)

18. Three-stage interview process (I. Personal Characteristics II. Nature of offending-informant III. Service user views) • 98 services contacted (mental health, learning disability, forensic, probation, prisons) • 235 staff surveyed • Information sheet & consent form sent direct to potential participants • Could consent to all stages or just informant stages

19. Results • Total of 126 people identified • 33 were identified as having offended • 10 lived independently, 9 in secure forensic settings, 3 in prison, 8 in mental health facilities, 2 in specialist ASD services, and 1 in service for pwld • 16 gave informed consent

20. Participants • Mean age 34.8 years (range ) • All male • 15/16 single • 13/16 met at least 4/6 diagnostic criteria on the ASDI (Gillberg et al, 2001) • Mean age first offence 25.8 years (range 10-61)

21. Variety of additional diagnoses (LD & schizophrenia most common) • History of behavioural problems common (88% verbal aggression, 75% physical aggression, 69% destructiveness, 69% inappropriate sexual behaviour, 38% substance abuse, 38% over-activity) • Most frequent services: psychiatry (69%), clinical psychology (56%), social work (38%); 50% receiving anti-psychotics, 33% antidepressants.

22. Nature of offending Mean no. of offences=3 (range 1-7)

23. Example offences • Violent assault on couple following social rejection • Put hidden camera in step daughter’s room to monitor self-harm & under-age sexual activity • Stalking & indecent assault • Sent knife with red substance on it to consultant psychiatrist. Petrol bombs found in home • Arson • Murder

24. Predisposing factors

25. Precipitating Factors

26. Disposal

27. The Experience: Being arrested • ‘The whole time between arrest and getting settled in prison was traumatic’ • ‘There was a loud banging on the door..my mother said it was the police…I obviously knew what it was about…I admitted it straight away’ • ‘To be honest with you, the police down the station were absolutely great. They kept my cell door open, they kept the yard open so that I could just go out for a cigarette whenever I wanted. It was great down there’

28. Being interviewed • ‘Particularly difficult…they were very long’ • ‘The whole experience was really confusing ‘cos I didn’t know what was going to happen next’ • ‘I felt the police trying to pressure me into a conviction…trying to get me charged with something’ • ‘It was awful because in my mind I can’t take too many things in at once’ • ‘My appropriate adult reassured me and he was caring’

29. In court • ‘Pressure…plenty of pressure..but I just blanked it really...I don’t do emotion, I don’t do emotion at all. Smiling is few and far between’ • ‘The judge just seemed to disregard the reports…she’d obviously made up her mind’ • ‘It didn’t help me the first time in that there was a photographer there trying to take pictures of me’ • ‘My barrister didn’t have much time to look into to it…I was only diagnosed the week before’

30. In prison • ‘It’s been awful too be honest..’ • ‘I’m just convinced that something bad will happen to me here’ • ‘People speak to like you’re a piece of crap’ • ‘ I’ve grown in confidence since attending prison’ • ‘Being moved to a smaller wing with less people on it (was good)’ • ‘I became settled and then they moved me…upset my equilibrium’ • ‘It’s just been a bad experience’

31. Mental health disposal • ‘Being there was better than being in prison…I felt safer in there and I could cope better’ • ‘Staff are fantastic, they’re helpful, they’re courteous…they’re well trained’ • ‘The psychiatrists diagnosed me with Asperger’s…but no one really explained to me what it is. I still don’t understand it to be honest’.

32. Room for improvement • ‘Just improving general awareness’ • ‘…then they could understand me more’ • ‘Some kind of person just explaining what was going to happen would have been really helpful’ • ‘More things to do’ • ‘Eventually I got a therapist & that helped..since I’ve been seeing her things have got a bit easier’

33. Discussion points • Adult sample • Sampling frame Overall prevalence of offending very low (0.84%?) • …but quite high (26%) amongst those in touch with specialist MH/LD services? • Causality? • Moderator variables (Woodbury-Smith et al, 2005)? • Future research