Incredibly different or differently credible?

1. Incredibly different or differently credible? Autism .. ? Sue Mulcahy Impact of Autism on Policing

2. Topics • Autism Act 2009 • Government Strategy for Adults with Autism (policing elements) • Vulnerability for Involvement in criminality • Vulnerability in Police Settings • Assessment and Detention • Memory and Recall • Emotion • Communication, Best Evidence, and Special Measures • Police Expectations

3. Autism Act 2009 • Background – sets out to enable adults with autism to; • have more opportunities to lead fulfilling and rewarding lives • know that they can depend on public services to treat them fairly as individuals to enable them to live independently within the community • Autism Act 2009 • Unprecedented as first ever disability specific legislation in UK • Sets out to ensure fair and equal access to public services • Places statutory duty on UK Government to publish its Strategy for Adults with Autism in England • Autism Strategy: ‘Rewarding and Fulfilling Lives’ (DoH, 2010) • to increase and improve understanding of autism amongst police • to improve access to police services and wider criminal justice system • because adults with autism typically fall between two stools - learning disability and mental illness (autism falls within neither category)

4. Quotes from Governmental Strategy “Professionals have a habit of asking with person with [autism] for insight into their own problems – the person struggles to find a reasons and comes up with whatever they can think of at the time.” “People think that autistic people are being rude or arrogant and ban them from cafes, pubs, cinemas, etc. They call the police who also believe the autistic person to be arrogant, rude etc and then arrest them for a public order offence.” ‘Training for frontline staff should focus less on theory of autism and more on giving staff insight into how autism can affect people, drawing directly on the experiences and input of adults with autism and their families’ (Department of Health, 2010)

5. Autism & Criminality • Majority of autism sufferers is law-abiding and not involved in violent activities (Frith, 1991 & Barry-Walker et al, 2004) Suspects • Criminal behaviours are often strange and bizarre to the extreme (Katz et al, 2006) • Intoxication at time of offending and use of knives or guns less common than in other groups (Whaland et al, 2006) • Autism alone is not a risk factor for serious violence; 84% of offenders also have mental health problems (Newman et al, 2008) • Autism psychopathology has been linked to sexual serial killings (Silva et al, 2004) • More easily led, manipulated or coerced into criminal activity by others (Gudjonsson et al, 2004)

6. Reasons for criminal behaviour • Exploitation by others • Interruptions to routines leading to disruptive behaviour • Difficulties understanding social clues • Obsessional tendencies/morbid interests (Howlin, 1997) • Distinction between people and things is less sharp than is normally expected (Tantum, 2000) • Psychological compartmentalisation .... in ways that would be difficult to understand or incomprehensible to most people (Baron-Cohen, 2003)

7. Victimology • Dearth of empirical literature on victimology – e.g. Petersilia’s (2001) review on crime victims with developmental disabilities • Particularly vulnerable to bullying, exploitative crimes, being led into criminality by others without understanding and far more likely to be victims than perpetrators due to social impairment (Howlin, 2007, Tantum, 2008) • Greater time spent on-line(Benford, 2008); may be especially vulnerable to involvement in contemporary criminality involving internet including grooming, fixation, radicalisation, high-tech crime and cyber threat related

8. Recognition - Autism Spectrum Disorder ‘labels’ ICD-10 - Pervasive Developmental Disorders (PDD) Childhood Autism Atypical Autism Asperger’s syndrome PDD – unspecified (World Health Authority, 2007) DSM IV – Axis 1: Mental Disorder (i.e. not* personality disorder) Autistic disorder Asperger’s disorder PDD – not otherwise specified (‘atypical autism’) (American Psychiatric Association, 2000) Other labels in common usage Kanner’s Autism Classic Autism Regressive Autism High Functioning Autism (HFA) (without learning difficulties, i.e. IQ>70)

9. Autism Spectrum Disorder*Characterised by qualitative impairments in reciprocal social interaction and communication, and a restricted, stereotyped or repetitive pattern of interests and behaviour persisting from early developmental periodIntellectual ability can fall across spectrumDelay/deviance in language development can be marked or mild (North et al, 2008) Without speech With speech*

10. Prevalence - adults in private households* in England • 1% adult population (1.8% M, 0.2% F) • 8% males in social housing & 4.5% all single males • 7.5% males with learning difficulties and 4.3% males in IQ range 70-85 • Correlated negatively with IQ in males (Health & Social Care Information Centre, Social Care Statistics, 2009) • > 50% autistic population have 1Q within or above normal range (Rice, 2009; Kawamura, 2008) Prevalence in secure settings • High functioning males over-represented in secure hospitals • Prevalence in prisons and in police detention unclear (North et al, 2008) • 15%* most serious violence linked to individuals with autism, 63% of whom had committed arson (Siponmaa, 2001) Phenotype & trait like prevalence • Significant Autistic Traits below diagnostic threshold • Increased incidence in families with 1+ member with diagnosis of ASD(Piven, 1997)

11. Diversity within Autism Spectrum Albert Einstein Robert Napper - Green Chain Murders Charles Darwin Nicky Reilly (aka Mohammed Alim) - Exeter Bomber H G Wells Gary Ridgeway - Green River Killings Thomas Jefferson Barry George – principle suspect Jill Dando (fixation) murder Isaac Newton Gary McKinnon – US Computer Hacker Ajit Singh-Mahal – 12 year old boy killed by mother And 500,000 others (in UK)

12. Assessment • Autism is mental disorder as defined under Mental Health Act 1983i.e. Not learning difficulty or mental illness • Multiple diagnoses and overlapping conditions common • Epilepsy, anxiety, stress and depression • ASDs lifelong conditions – crisis may be catalyst for diagnosis • Commonly undiagnosed or misdiagnosed in adults • Diagnosed via developmental history - symptoms must be present in childhood (but may not become fully manifest until social demands exceed limited capacities) (American Psychological Association, 2010) • Many generalist psychiatrists regard themselves as unqualified to conduct assessments on people on autism spectrum

13. Sensory Difficulties & Environmental Factors • Sensation and attention difficulties most commonly in over-focusing (Liss et al, 2006) • Tend not to be able to attend to looking and listening simultaneously (Bonnet et al, 2008) • Superior visual and auditory discrimination (O’Riordan, 2006) • Repetitive behaviours associated with low functioning group and ruminating with high functioning group (Carcani-Rathwell, 2006)

14. South Yorkshire Police Custody Initiative Sensory Difficulties – Potential Difficulties • Strong smells • Magnified acoustics • Poorly ventilated • Little natural light • UV fluorescent lights (pulse) • Walls and surfaces baron – hard • Functional but intimidating (PS Andy Hunt*, S. Yorks Police, National Autistic Society 2010)

15. S. Yorks Police Approach • Alternative interventions – PACE 9 – immediate rebail, community interventions • Enhanced review with strict time limits • Ensuring Appropriate adults always available • Constant supervision to prevent self-injuries* • Use of visual information wherever possible • No jargon, sarcasm or irony • Instructions clear and simple • Use of National Autistic Society ‘autism-at-a-glance’ cards • Vulnerable tags and family intervention “Happy to share experience with other forces” PS Andy Hunt

16. Emotion • Difficulty regulating emotion • Fluctuate between ‘flat’ and heightened emotions • Tend not to identify with more complex emotions • Have difficulty expressing own emotions in real time and anticipating emotional response of self and others • Difficulty in recalling emotions and memories of emotional experiences • Emotional understanding lags behind intellectual understanding which can result in confusion • May not understand impact of criminality, whether as suspect or victim, at time of incident, for long time after incident or possibly not ever

17. Communication, Attention & Physical Responses • Difficulties in turn-taking and recall within conversation • Use ‘I’ and ‘Me’ less than most people and difficulties in organising thoughts in terms of time (Colle et al, 2008)– leads to difficulties in distinguishing between what is and isn’t relevant. (Colle et al, 2008) • Literal interpretation of meanings and rigid thinking (Frith, 2001) • Difficulties in shifting and sustaining attention (Bonnet et al, 2008) • Involuntary facial expressions affected and associated often accompanied with involuntary sound productions • Recognising emotion in facial expressions, especially fear, is suggested as a potential factor in sustained violence (Baron-Cohen et al, 2007)

18. Memory & Recall • Difficulties in working memory; long term memory unaffected but complexity affects recall; short term memory unaffected • Recall events involving themselves less well than events performed by peers (Bowler et al, 1997) • Experience of social situations different (Gras-Vincendon et al, 2008) and recall tends to feature less social elements than for most people (Gaigg et al, 2008) • Understanding of language is unaffected, even though may not use speech, as is immediate memory. Recall of faces, social scenes and dynamic spatial awareness affected (Williams et al, 2005) • Superior performance in tasks relying on detection and graphic reproduction of visual elements (Caron et al, 2004) Short term memory intact Working memory impaired Long term memory, whilst intact, negatively impacted by complexity of material to be recalled

19. Vulnerability at Investigative Interview • HF individuals may not be recognised as vulnerable by police by virtue of apparent competent use of language and presenting as intellectually capable. However may face difficulty with demands of police interview (North et al, 2008) • Free recall elicits less information, especially gist in AS group, but no difference in amount of additional information obtained using general and specific questions. More reliant on questioning to facilitate recall (McCrory et al, 2007) • Significantly less accurate when interviewed using CI but no difference when interviewed using SI (Maras, 2010) • Suggestibility level no different in AS group as a whole but scores vary more than for general population • Compliance significantly greater in AS group (North et al, 2008)

20. Achieving Best Evidence • Special measures likely to achieve best evidence irrespective of level of functioning • Quiet interview room and calm approach critical • Allow plenty of time • Single interview unlikely to result in best evidence • Preparation – seek advice from appropriate adult, intermediary or NAS helpline • CI found not to be helpful • SI preferable • Frequent summarising and checking of understanding by interviewer and interviewee • Avoid making inferences at all costs • Avoid open questions and make more use of direct questions • Use of diagrams advisable • May volunteer ongoing trickle of new or additional evidence after interview

21. CI found not to be helpful - SI preferable • Avoid open questions and make more use of direct questions • Allow lots of thinking time • Encourage to say if ‘cannot remember’ or ‘do not know’ (beware over-compliance) • Frequent summarising and checking of understanding by interviewer and interviewee • Avoid making inferences • Use of diagrams recommended • May volunteer ongoing trickle of new or additional evidence after interview

22. Manage Expectations • Don’t underestimate potential for misunderstandings even if person appears articulate and intelligent • Assume requirement to check understanding frequently during and between interviews • Remember that conforming to social norms is difficult for those on the autism spectrum • Remember sophisticated coping strategies are common and can mask true extent of communication difficulties • Don’t assume apparent contradictions are result of dishonesty • Be tolerant if person appears more upset than might ordinarily be expected • Bear in mind this group highly susceptibility to mental health problems, easily damaged, difficult to treat and, following upsets, tend to have extraordinary long recovery times

23. Resources National Autistic Society Helpline: 0808 800 4104 (open Monday to Friday, 10-1600) Available at: Autism:http://www.autism.org.uk/working-with/criminal-justice.aspx Autism Alert Cards and Autism ‘at-a-glance cards’ Autism: a guide for criminal justice professionals (ACPO endorsed) And At: http://www.autism.org.uk/Living-with-autism/Adults-with-autism-or- Asperger-syndrome/Self-advocacy.aspx - Self-advocacy booklet for adults (including advice for criminal justice professionals)

24. Questions? s.mulcahy@liv.ac.uk Understanding autism will assist me in my work ... all officers need to be aware of this