Autism Spectrum Disorder in the Criminal Justice System

A Guide to Understanding Suspects, Defendants and Offenders with Autism

Dr Clare S. Allely

• Publisher: Routledge
• Year: 2022
• Print ISBN: 9781032079431
• eBook ISBN: 9781000569803
• Edition: 1
• Topic: Law
• Subtopic: Autism Spectrum Disorders
• Index: Law

This book focuses on autism spectrum disorder (ASD) in the criminal justice system. Rather than being the perpetrators of offending behaviour, individuals with ASD are more likely to be the victims of crime. However, there is nevertheless a small subset of individuals with ASD who do offend, and this book provides an in-depth understanding of how certain features of ASD may provide the context of vulnerability to engaging in a number of types of offending behaviours.

Chapters focus on arson or fire-setting; cybercrime (e.g., hacking); online sexual offending such as the viewing of indecent child imagery; offline sexual offending; violent crime; stalking; terroristic behaviour (including radicalisation and extremism); bestiality or zoophilia; and also extreme violence such as mass shooting and serial homicide. This book also outlines the ways in which a defendant with ASD may present in court and how they may exhibit behaviour which could be misinterpreted and perceived negatively, leading to an unfair trial. Lastly, it discusses the need to identify the impact that ASD can have on the capacity to form the requisite criminal intent and offers appropriate court adaptions to support individuals with ASD during court proceedings.

This book is ideal for criminal defence lawyers and practitioners in psychology, psychiatry, and social work as well as policy makers and reformers.

Chapter 1 What Is Autism Spectrum Disorder (ASD)?

DOI: 10.4324/9781003212195-1

What Is Autism Spectrum Disorder?

Autism spectrum disorders (ASD) are neurodevelopmental disorders characterised by reciprocal social interaction and communication impairments and also restricted repetitive behaviours (Wing, 1997). The fifth edition of the Diagnostic Statistical Manual of Mental Disorders (DSM-5, American Psychiatric Association (APA), 2013) characterises two core areas of impairment in ASD. These are: (1) “persistent deficits in social communication and social interaction” and (2) “restricted, repetitive patterns of behavior, interests, or activities” (APA, 2013). Repetitive behaviours and restricted interests (RBRIs) characterise behaviours that can include repetitive motor movements, sensory reactions, rituals, routines, and restricted interests. During early typical development, RBRIs are common (e.g., Arnott et al., 2010; Leekam et al., 2007). RBRIs have been found to be one of the earliest predictors of ASD displayed in infants who are later diagnosed with ASD (Ozonoff et al., 2008; Wolff et al., 2014). Research suggests that there exist two main subtypes of RBRIs (see Leekam, Prior, & Uljarevic, 2011). One of the subtypes is repetitive sensory and motor (RSM) behaviours which comprise of repetitive motor behaviours and unusual sensory responses (e.g., simple motor stereotypies, excessive smelling or touching of objects). The other subtype is where the individual has an insistence on sameness which includes routines, rigid behaviours and restricted interests (Bishop et al., 2013; Honey, McConachie, Turner, & Rodgers, 2012).

Impairment to these two core domains differs across individuals with respect to symptoms and severity of symptoms. Individuals with ASD exhibit impairments in social behaviour, including impairments in understanding and reading body language, difficulties with identifying and recognising facial expressions and verbal cues, and impaired social interaction abilities; they display an intense focus on routine or specific interests, and are at increased susceptibility to anxious and impulsive behaviours (Mayes, 2003 as cited in Berryessa, 2017). Individuals with ASD exhibit a wide spectrum of abilities and challenges. Changes were made to the criteria for ASD in the DSM-5 (APA, 2013) with the aim of increasing the levels of consistency across diagnosticians. Only one category, autism spectrum disorder, encompasses what was previously four separate disorders: autism disorder, Asperger’s disorder, childhood disintegrative disorder or pervasive developmental disorder – not otherwise specified. The fifth edition criteria include two core domains of impairment:

1. Persistent deficits in social communication and social interaction across multiple contexts, as manifested by the following, currently or by history (examples are illustrative, not exhaustive; see text):
   1. Deficits in social-emotional reciprocity, ranging, for example, from abnormal social approach and failure of normal back-and-forth conversation; to reduced sharing of interests, emotions, or affect; to failure to initiate or respond to social interactions.
   2. Deficits in nonverbal communicative behaviours used for social interaction, ranging, for example, from poorly integrated verbal and nonverbal communication; to abnormalities in eye contact and body language or deficits in understanding and use of gestures; to a total lack of facial expressions and nonverbal communication.
   3. Deficits in developing, maintaining, and understanding relationships, ranging, for example, from difficulties adjusting behaviour to suit various social contexts; to difficulties in sharing imaginative play or in making friends; to absence of interest in peers.
   Specify current severity:
   Severity is based on social communication impairments and restricted, repetitive patterns of behavior.
2. Restricted, repetitive patterns of behavior, interests, or activities, as manifested by at least two of the following, currently or by history (examples are illustrative, not exhaustive; see text):
   1. Stereotyped or repetitive motor movements, use of objects, or speech (e.g., simple motor stereotypes, lining up toys or flipping objects, echolalia, idiosyncratic phrases).
   2. Insistence on sameness, inflexible adherence to routines, or ritualized patterns of verbal or nonverbal behavior (e.g., extreme distress at small changes, difficulties with transitions, rigid thinking patterns, greeting rituals, need to take same route or eat same food every day).
   3. Highly restricted, fixated interests that are abnormal in intensity or focus (e.g., strong attachment to or preoccupation with unusual objects, excessively circumscribed or perseverative interests).
   4. Hyper- or hyporeactivity to sensory input or unusual interest in sensory aspects of the environment (e.g., apparent indifference to pain/temperature, adverse response to specific sounds or textures, visual fascination with lights or movement, excessive smelling or touching of objects, fascination with lights or spinning objects).
   Specify current severity:
   Severity is based on social communication impairments and restricted, repetitive patterns of behavior.
3. Symptoms must be present in the early developmental period (but may not become fully manifest until social demands exceed limited capacities, or may be masked by learned strategies in later life).
4. Symptoms cause clinically significant impairment in social, occupational, or other important areas of current functioning.
5. These disturbances are not better explained by intellectual disability (intellectual developmental disorder) or global developmental delay. Intellectual disability and autism spectrum disorder frequently co-occur; to make comorbid diagnoses of autism spectrum disorder and intellectual disability, social communication should be below that expected for general developmental level.

(DSM-5, APA, 2013, pp. 50–51)

Even though they share the same core symptoms, across individuals with ASD there is significant variability in the clinical presentation (Veselinova, 2014). In the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV, APA, 1994), autistic disorder was considered to be one of four categorical diagnoses that comprised of a group of disorders which were referred to as pervasive developmental disorders (PDD). As well as autistic disorder, the PDD group comprised Asperger’s disorder, childhood disintegrative disorder, Rett’s disorder, and pervasive developmental disorder not otherwise specified (APA, 2013). The subtypes of ASD have been removed (e.g., autistic disorder and Asperger’s disorder) in the DSM-5 and there is now just a single category of ASD (Maenner et al., 2014). ASD has an early developmental onset of persistent, typically lifelong symptoms.

To meet the diagnostic criteria for ASD, the DSM-5 (APA, 2013) states that an individual is required to meet four broad criteria which consist of meeting all of the three distinctions of the social communication and interaction (SCI) criteria and also two out of four distinctions of the RBRI criteria. Following the changes to the DSM-5 there are now fewer ways an individual can meet the diagnostic threshold for ASD (Kulage, Smaldone, & Cohn, 2014). There are 11 possible combinations of ASD criteria (McPartland et al., 2012; however, see Huerta, Bishop, Duncan, Hus, & Lord, 2012; Swedo et al., 2012). Etiologically and clinically in terms of presentation, ASD is a heterogeneous disorder.

Aetiology of ASD

The aetiology of ASD is complex and remains largely unknown. However, it is likely the result of the interactive effects of genetic and environmental risk factors (Lai et al., 2014; Schaefer 2016; Tchaconas & Adesman 2013). ASD is a highly heritable neurodevelopmental disorder (Risch et al., 2014). Between 10% and 35% of ASD cases have a known major risk factor or identified aetiology. This means that the cause of ASD remains unknown in the majority of cases (Coleman & Gillberg, 2012). There are a number of potential factors which are being investigated such as specific genetic, metabolic, infectious, and environmental factors (Muhle, Trentacoste, & Rapin, 2004). An interesting hypothesis is that ASD is a “whole body disorder”, which involves metabolic pathways that are expressed across the whole body (Schengrund, Ali-Rahmani, & Ramer, 2012). The “extreme male brain” theory of ASD (Baron-Cohen, 2002) has generated hypotheses about the role of elevated fetal sex steroids (e.g., testosterone) in the development of ASD. However, it does not explain the contribution of other factors such as sex chromosome effects or the involvement of other steroid hormones proximal to testosterone in biosynthesis pathways including vitamin D, estradiol, cortisol, and progesterone. So, although most research to date has focused on fetal testosterone and ASD, it may be that the actions of testosterone coupled with other precursor steroid hormones within the same biosynthesis pathway may all contribute to fetal development of ASD (Baron-Cohen et al., 2015). Gillberg and colleagues (2017) reviewed studies which linked some of the steroid hormones, specifically vitamin D, with levels of cholesterol. The steroid hormones reviewed included testosterone, estrogens, cortisol, and vitamin D. All of these steroid hormones have studies which suggest their link with ASD. Therefore, it is possible that there may be a cholesterol steroid hormone pathway underlying the development of ASD. There may be links between “steroid metabolism” and findings of steroid abnormalities of various kinds (cortisol, testosterone, estrogens, vitamin D) in ASD (Gillberg et al., 2017).

Prevalence of ASD in the General Population

The prevalence of ASD in children in the United States is 1 in 69 (Christensen et al., 2018). In the United Kingdom, the estimates are higher at 1 in 59 (Russell et al., 2014). Prevalence estimates are typically derived from western, higher-developed nations (e.g., Randall et al., 2016) which are often higher than those prevalence estimates derived from low-income countries (Elsabbagh et al., 2012). Approximately four males are diagnosed with ASD for every female (e.g., Fombonne, 2009). It remains unclear exactly what are the reasons for this male-to-female imbalance (Adamou, Johnson, & Alty, 2018). Across all age groups, males are more commonly diagnosed with ASD than females (Fombonne, 2009; Russell et al., 2011). Entire population estimates would suggest about three males receive an ASD diagnosis for every female based on gold-standard assessments. In clinical samples who have already received a diagnosis of ASD, the ratio has been found to be even higher at over four males to each female (Loomes et al., 2017). The ratio is closer to 2:1 in individuals with an intellectual disability (Yeargin-Allsopp et al., 2003). It has been argued that there may be something inherent in being female that potentially “protects” them from the likelihood of developing ASD (Robinson et al., 2013). It has also been suggested that diagnostic biases and variation in the way females with ASD may present have led to a high level of failures to identify the presence of ASD in some females compared to males (Dworzynski et al., 2012; Russell et al., 2011).

Research has also indicated that the sex ratio decreases as the symptom severity of ASD increases (e.g., Werling & Geschwind, 2013; Werling, 2016). Epidemiological studies have found that the ratio becomes about 2:1 towards the lower-functioning end of the autism spectrum (which also includes individuals with a co-morbid intellectual disability) (Fombonne, 2009; Mattila et al., 2011). Research indicates that the gender ratio may increase to about 6:1 in those in the higher-functioning end of the spectrum (individuals whose intellectual functioning is ...

Table of contents

• Cover
• Endorsements
• Half-Title
• Title
• Copyright
• Dedication
• Contents
• Preface
• 1 What Is Autism Spectrum Disorder (ASD)?
• 2 ASD and Offending Behaviour: Why It Is Important to Recognise How ASD Symptomology Can Provide the Context of Vulnerability for Engaging in Offending and Important Considerations When Interviewed by Police and Other Criminal Justice Professionals
• 3 Risk Assessment: ASD and Issues with Current Standardised Risk Assessment
• 4 Prevalence of ASD in Forensic Settings
• 5 Psychiatric Co-Morbidity in ASD
• 6 ASD in the Courtroom: Why It Is Important to Recognise This Disorder in Defendants
• 7 ASD and Arson
• 8 ASD and Sexual Offences (Offline and Online)
• 9 ASD and Cybercrime
• 10 ASD and Violent Offending
• 11 ASD and Radicalisation and Extremism
• 12 ASD and Extreme Violence
• 13 ASD and Stalking
• 14 ASD in the Prison Environment
• 15 Conclusions and Recommendations
• Recommended Further Reading
• Index