Review
Current status of research on autism spectrum disorders and offending

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Abstract

An emerging literature on autism spectrum disorders (ASD) and offending has highlighted that these disorders are at times associated with criminal behaviour. Ghaziuddin et al. (1991) reviewed the published literature on this topic from 1944 to 1990 and concluded that there was no clear link between Asperger syndrome (AS) and violent crime. They suggested that people with AS hardly were more likely to commit violent crime than the rest of the population. The present review provides an update on the issues in the earlier review mentioned and presents new issues that have emerged in the past two decades. Currently, there is still no body of evidence to suppose that people with ASD are more prone to commit offences than anyone else. However, a small number of serious crimes can be linked to the core features of ASD. Co-morbid psychiatric disorders are important risk factors for offending in people with ASD. Studies of referred samples have suggested considerable differences in offending among subgroups of people with ASD. Offending has rarely been reported in childhood autism, but is more common in atypical autism (AA) and AS. Literature suggests that people with ASD are potentially overrepresented within the criminal justice system, and that failure to detect ASD among offenders is not uncommon. Insofar as people with AA and AS have offended, it has typically been connected with arson and sexual abuse. But due to lack of valid community based studies of offending relating to people with ASD, these findings must be interpreted with caution.

Highlights

► There has been increasing awareness on the co-occurrence of autism spectrum disorders (ASD) and offending. ► This paper provides a review on the available research on offending for persons on the autism spectrum. ► Currently there is no body of evidence to suppose that people with ASD are more prone to committing offences that anyone else. ► People working in custodial settings should have an awareness of the potential overrepresentation and underdiagnosis of individuals in offender populations.

Introduction

In the last decades, evidence showing a possible link between offending and mental illness has increased (Marzuk, 1996). Most studies have examined rates of offending among the mentally disordered or rates of mental illness among persons committing criminal acts.

In the International Classification of Mental and Behavioural Disorders (ICD-10) (WHO, 1992) pervasive developmental disorders (PDD) or autism spectrum disorders (ASD) include childhood autism (CA), atypical autism (AA), and Asperger syndrome (AS) as the main subtypes of ASD. In the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) (APA, 1994) the corresponding categories of PDD are autistic disorder, AS, and pervasive developmental disorder not otherwise specified (PDD-NOS). The DSM-IV criteria for ASD include the same core triad of impairments as listed in the ICD-10. These are impairments in social interaction and communication together with the presence of stereotyped patterns of behaviour and interests affecting a person's capacity for understanding other people, intuiting their feelings, and establishing reciprocal relationships. ASD frequently occurs along with other mental impairments, such as learning disability (Baird et al., 2006), seizure disorders (Amiet et al., 2008), and attention deficit hyperactivity disorder (ADHD) (Leyfer et al., 2006).

The term ASD does not appear in ICD or DSM, but is now widely accepted in both research and lay literature. The concept of the autism spectrum is useful clinically because of the dramatic variation in symptomatology both within and among each of the diagnostic categories, ranging from relatively mild to very severe symptoms in each of the three areas of impairment that characterize ASD. It has been suggested that at least one person in a hundred in the population may have an ASD (Baird et al., 2006).

Several authors have proposed that the core features of ASD (abnormal development of social interaction and communication, and a restricted repertoire of activity and interest) may expose those on the spectrum to commit offending. However, this does not mean that having ASD enhances the likelihood of acting criminally per se.

Howlin (2004) and several other authors have framed the individual offences in terms of the specific cognitive and social impairments associated with having an ASD. An issue that also needs to be taken into account when weighing the person's responsibility for criminal behaviour and his or her ability to stand trial (Katz & Zemishlany, 2006), and when planning management and care within the custodial system (Murphy, 2010). Other people may lead individuals with ASD into criminal acts because of their social naivety (Murrie, Warren, Kristiansson, & Dietz, 2002). Criminal behaviour may be related to a lack of understanding or misinterpretation of social cues (Haskins and Silva, 2006, Murrie et al., 2002, Palermo, 2004). Haskins and Silva (2006) provide a good illustration of this by describing a middle-aged substitute teacher with PDD-NOS who was accused of touching numerous adolescent female students. This resulted in his being charged with several incidents of child abuse. Violent behaviour may arise from disruption of routines or stress from change in daily circumstances (Baron-Cohen, 1988, Mawson et al., 1985). Finally, offending may also arise from obsessions or circumscribed special interests (Barry-Walsh and Mullen, 2004, Chen et al., 2003, Silva et al., 2002) even though these interests do not usually translate directly into offending (Woodbury-Smith et al., 2010). However, in some of the published cases the relationship appears rather direct. For example, Barry-Walsh and Mullen (2004), Everall and LeCouteur (1990), and Woodbury-Smith et al. (2010) all describe individuals whose convictions for arson were preceded by an interest in fire.

On the other hand, because of the rigid way in which many people with ASD tend to keep to rules and regulations, they may well be more law-abiding than the population in general (Howlin, 2004). Moreover, the protected or supervised environments of many of these individuals may also prevent them from offending.

Research dealing with ASD and offending is important because it alerts us to a group of people whose pattern of disability means that they have special needs and may be particularly vulnerable. Therefore, it is important as early as possible to identify individuals with “violent” interests, i.e., fire setting (Woodbury-Smith et al., 2010), or sexually abusive behaviour (Ray, Marks, & Bray-Garretson, 2004), in order to provide treatment and support. Arson is a crime with an enormous impact. Worldwide, it leads to major financial damage, serious injury, or even death (Haskins & Silva, 2006).

Moreover, inaccurate or sensational reports may lead to unnecessary anxiety on the part of parents and to stigmatization of people with ASD (Howlin, 2004). In particular, individuals with an ASD who commit violent offences may attract a great deal of media interest, especially those involving homicide.

Mawson et al. (1985) were the first to report in detail on the co-occurrence of AS and violent crime. They described a 44-year-old man who had a long history of violent behaviour that led to frequent admissions to psychiatric hospitals and long-term detention in Broadmoor Hospital, a high security special psychiatric hospital in the UK. Subsequently, Baron-Cohen (1988) described the assessment of violence in a 21-year-old man with AS with a history of recurrent violence towards his 71-year-old girlfriend and others. Within the context of a social-cognitive model of ASD, Baron-Cohen hypothesized that underlying the offender's violence was an inability to appreciate the mental states of his victims. Baron-Cohen conducted a psychometric assessment and a series of semi-structured interviews with the offender. The qualitative data gathered added some credence to the hypothesis and revealed that feelings and behaviours associated with the clinical features of AS were the antecedents to the offender's violence. In line with Mawson et al. (1985), Baron-Cohen considered it possible that a co-occurrence between AS and violent behaviour is perhaps more common within the secure estate than has been recognized.

To test this hypothesis Ghaziuddin, Tsai, and Ghaziuddin (1991) reviewed 21 publications published between 1944 and 1990 dealing with people diagnosed with AS to estimate the rate of violence among the individuals. They found that out of a total sample of 132 cases described, only three (2.3%) had a clear history of violent behaviour. Using less conservative criteria for the publications reviewed, they found violence in 11 of 197 cases (5.6%) and concluded that there was no clear association between AS and violent crime. They suggested that people with AS were no more likely to commit violent crime than the rest of the population. Altogether, Ghaziuddin et al. (1991) are critical of the existing literature and emphasize that research thus far had failed to consider that seizure disorders might occasionally be associated with violence.

The current article provides an update on the issues in that earlier review and presents new issues that have emerged in the past two decades.

Section snippets

Prevalence of offending

Researchers have used different strategies to study a possible association between ASD and offending. As Ghaziuddin (2005) points out, the first strategy focuses on studying the prevalence of offending behaviour among people with ASD who received treatment in a psychiatric care system. The second strategy studied the prevalence of ASD among people who committed crime and thus got in contact with the criminal justice system. In the third strategy offending behaviour in community samples is

Risk factors and offending

Are there innate disabilities/vulnerabilities that make it more likely that a person with ASD will offend? So far only a couple of studies have investigated this issue empirically. Knowing the answer to this question will aid the development of preventive programs.

Types of offending behaviour

Due to the lack of valid epidemiologic studies of offending in individuals with ASD, the types of offending in individuals with ASD are not known, and referral bias must be considered when reviewing the relationship between types of offending and ASD. Nevertheless, studies of single cases and referred samples provide indication of the types of offending which may be found in people with ASD.

In the community based study of Woodbury-Smith et al. (2006) two out of twenty-five people (8%) with a

Management of individuals with ASD in custodial settings

A number of people with ASD are involved in the Criminal Justice System as either victims, witnesses, or offenders, and one of the most important issues about ASD and the criminal justice system is the training of first responders regarding ASD. In line with this the National Autistic Society, UK, has issued a number of recommendations for people with ASD who are involved in the Criminal Justice System as either victims, witnesses, or offenders (The National Autistic Society, 2008a, The

Conclusions

As in the Ghaziuddin et al. (1991) review available findings still indicate that people with ASD are not more prone to committing offences than anyone else, but so far no good studies of whole populations of adults with ASD are available. Such studies would be useful to provide a picture of the magnitude of the problem at the population level and to guide the decisions of policy makers and administrators on service planning and development. Furthermore, it is essential to individuals diagnosed

Acknowledgement

I am grateful to Mrs. Lise Landmark for linguistic revision of this paper.

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