20 th Annual Forensic Rights and Treatment Conference November 27, 2012

1. Autism, Adolescence -Sexuality – and the Criminal Justice SystemAddressing needs soonerrather than later Sutton BAS 11-27-2012

2. 20th Annual Forensic Rights and Treatment ConferenceNovember 27, 2012 Lawrence R. Sutton, Ph.D.Bureau of Autism Services lasutton@pa.gov Sutton BAS 11-27-2012

3. Things to consider as the First Responder Sutton BAS 11-27-2012

4. Introduction and Statement of Need Some of the individuals that I will be speaking about, and their companions are individuals who have learned about sex by being subjected to sexual relations (sexual assault) as children themselves, often times by loved ones or by people whom they would associate as being importantauthority figures in their lives when they were younger and despite the fact that the sex may have hurt them at the time, in a concrete and matter-of-fact way this is something that someone does to someone else in a matter of fact fashion to meet their sexual needs. Sutton BAS 11-27-2012

5. Agenda • State of the field • Ways to help including First Responders, training of criminal justice personnel, educators • Attempts to respond – difficult climate…. • Emerging best practice methods to address concerns • Identifying Individuals With Autism in a State Facility for Adolescents Adjudicated as Sexual Offenders: A Pilot Study Sutton BAS 11-27-2012

6. Is one who Sexually Harms anothera Sexual offender

7. In a Concrete Sense, Are these Sex Offenders • Bill and his Mom (how the police responded) • Child pornography and the FBI • Jason and victory on the ball field • George making friends • Fixation on specialized interests Bobby and the ‘Thought Police” • But in some cases, Rick and not knowing what to do next… Sutton BAS 11-27-2012

8. Bill and His Mom • Who Bill is – 6’,5” 356 pounds • Problem at transition program • 302 three days later • Outcome Sutton BAS 11-27-2012

9. Executive Dysfunction and traps • One photo and FBI involvement, but… • Can you have an IQ of 135 and be considered ‘incompetent’? • 2+2=4 but does 3+1 also =4?? • Understanding what you’ve done and seeing the bigger picture, is it possible? • Slamming the door and thinking all is now ok - Sutton BAS 11-27-2012

10. Celebrating a victory • Many are taught by family Sutton BAS 11-27-2012

11. The thought police • The case of Bobby and the bully’s • Lined up trains • Collected match box cars • Collected skate boards • Read about serial murders • Being bullied • Guidance Counselor’s offer of help (was it?) • Psychiatric evaluation • Sex offender treatment (despite no charge) • Clinical depression and intervention Sutton BAS 11-27-2012

12. Pennsylvania’s Juvenile Justice Centersand the disabled • Are the disabled in these juvenile jails? • In 2004 I was told ‘no’ as I met a young man with Asperger’s…this is what led to my work • Are there individuals with Intellectual disabilities in the system • How is trauma assessed, or is it? • These are some of the specifics outlined in my YDC work. Sutton BAS 11-27-2012

13. Pennsylvania’s Juvenile Justice Centersand the disabled • Are ‘best practices’ best for all adolescents? • NCYDC ASOP was (and maybe still is) the best for adolescent sexual offending treatment in the eastern US, but are there limitations for those with IDD? • Trauma – some good literature for some disorder, no literature for how to treat – in or outside of criminal justice – for IDD • MAYSI – supplement for Intellectual and other developmental disorders needed. • What might Diversion look like? Sutton BAS 11-27-2012

14. Who are in the YDC’s Sutton BAS 11-27-2012

15. Juvenile Justice Centers and Special needs • Assessment for Mental Health and Drug and alcohol use/abuse • But no clear assessment for Developmental disabilities – autism and/or intellectual disabilities • No clear assessment for prior sexualized trauma of residents Sutton BAS 11-27-2012

16. Juvenile Justice Centers in PennsylvaniaAt the time of this investigation (2005) • 3 Large Centers containing 9 independent programs • 2 Forestry Camps • 2 Specialty programs • One female program • Act 21 (ages 21 and over) Sutton BAS 11-27-2012

17. Juvenile Justice Centers in Pennsylvania • Adjudicated Youth from ages 11 years to 20 years • Treatment offered for: • Mental health • Drug and alcohol abuse/dependence • Sexual offending Sutton BAS 11-27-2012

18. Juvenile Justice Centers in Pennsylvania • All centered contained schools on site • Two psychiatrists in the State • No licensed doctoral level psychologist • Some Certified Addictions Counselors Sutton BAS 11-27-2012

19. Therapeutic Environment • Double razor wire in the entrances • Located in remote areas of the State without direct bus routes (making it difficult for regular visiting of family or concerned others) • Heavy metal doors, stools and beds • Introduction to ‘best friends’ Sutton BAS 11-27-2012

20. Who are the kids house there? (Is everyone who sexually offends another, a sex offender??)

21. Those At Risk • * Self-harm • * Depression and Bipolar Disorders • * Autism Spectrum • * Trauma • * Addictions • * Other Developmental Disorders Sutton BAS 11-27-2012

22. Autism(defined) • Noted Developmental delays in: • Developmental History by age 3 or so (most important) • Language • Social • Behavior and Sensory Sutton BAS 11-27-2012

23. New Castle Adolescent Sexual Offenders Program (NCYDC ASOP) • 46-54 Bed Units (5 cottages) • “0” diagnosed “Autistic” in 2004 • ‘Best Practice’ - Rehabilitation Program for adolescent sexual offenders in existence for over 15 years • Rehab program uses traditional lecture format and includes traditional group methods for instruction (review of offenses, fantasy journals…) ((is this a problem?)) Sutton BAS 11-27-2012

24. NCYDC ASOP Project • January –May 2007 • One staff and three doctoral students – Duquesne University School Psychology • Assessment to define limits and scope of the presence and prevalence autism and other disorders • Treatment was provided in a limited sense Sutton BAS 11-27-2012

25. NCYDC ASOP • Testing for: • Autism, Mental Status Examination and ASDS • Trauma – Childhood Trauma Questionnaire • IQ using WAIS, WISC, UNIT and WRAT • Auditory Processing using WJ • Mood/Personality – BDI, BHI, BASC, CBCL, • Sex Offender J-SOAP Sutton BAS 11-27-2012

26. Where to Go • Diversion Project – BAS, BJJS, OMHSAS 2007-2008 • The need for a different treatmentapproach – lessons learned from NCYDC • Admission assessments to pair with MAYSI to look for Autism and IDD (CARS II and BRIEF) • Behavioral approaches to shape in replacement behaviors • Groupings/housing with others who have IDD • Limited group therapies • Loaded individual therapy and peer-peer therapy Sutton BAS 11-27-2012

27. Where to Go • Training • First Responders • Court officials including DA and Public Defenders • Alternatives including Diversion • Re-visiting BAS RFI’s • Systems working in harmony • First responders • BAS ASERT Center project with EMS (Dr. John McGonigle WPIC) • Indiana County ARC • Washington County Project Sutton BAS 11-27-2012

28. Where to goModules to recoverysupport of novel – Emerging best practice programming Sutton BAS 11-27-2012

29. Where to goModules to recovery • More Research defining “emerging best practices” for: • Identification – Duquesne’s current initiatives • The treatment those Developmentally Disabled People who offend • To Divert them from Criminal Justice settings into settings where they can learn alternatives to their offending behaviors. Sutton BAS 11-27-2012

30. Summary and Questions Sutton BAS 11-27-2012