Autistic spectrum disorder and offending behaviour – a brief review of the literature

Prevalence of mental disorders in defendants at criminal court

BACKGROUND

Psychiatric morbidity in prisons and police custody is well established, but little is known about individuals attending criminal court. There is international concern that vulnerable defendants are not identified, undermining their right to a fair trial.

AIMS

To explore the prevalence of a wide range of mental disorders in criminal defendants and estimate the proportion likely to be unfit to plead.

METHOD

We employed two-stage screening methodology to estimate the prevalence of mental illness, neurodevelopmental disorders and unfitness to plead, in 3322 criminal defendants in South London. Sampling was stratified according to whether defendants attended court from the community or custody. Face-to-face interviews, using diagnostic instruments and assessments of fitness to plead, were administered (n = 503). Post-stratification probability weighting provided estimates of the overall prevalence of mental disorders and unfitness to plead.

RESULTS

Mental disorder was more common in those attending court from custody, with 48.5% having at least one psychiatric diagnosis compared with 20.3% from the community. Suicidality was frequently reported (weighted prevalence 71.2%; 95% CI 64.2-77.3). Only 16.7% of participants from custody and 4.6% from the community were referred to the liaison and diversion team; 2.1% (1.1-4.0) of defendants were estimated to be unfit to plead, with a further 3.2% (1.9-5.3) deemed 'borderline unfit'.

CONCLUSIONS

The prevalence of mental illness and neurodevelopmental disorders in defendants is high. Many are at risk of being unfit to plead and require additional support at court, yet are not identified by existing services. Our evidence challenges policy makers and healthcare providers to ensure that vulnerable defendants are adequately supported at court.

Criminal justice system interactions among young adults with and without autism: A national birth cohort study in New Zealand

While sensationalist headlines and highly publicised criminal cases have led many to believe there is a link between autism and criminal behaviour, extant literature presents an unresolved debate. We sought to address this issue by examining the prevalence of criminal justice system interactions among young adults with and without autism, and by assessing whether offence types differ between these groups. This was a national birth cohort study using linked health and criminal justice system data. Cox proportional hazard models were employed to compare criminal justice system interactions between young adults with and without autism, controlling for important socio-demographic characteristics. Data were acquired for 1197 people with autism and 147,879 without autism. Young adults with autism had significantly lower rates of being proceeded against by police, charged in court, and convicted in court compared to those without autism. However, those charged with an offence were significantly more likely to be charged with serious and violent offences, offences against the person and against property. Our findings indicate that, although young people with autism were not over-represented in the criminal justice system, disparities in offence types and incarceration rates among those charged with an offence suggest the importance of identification and appropriate response to autism within the criminal justice system.

Brief Report: Sentencing Outcomes for Offenders on the Autism Spectrum

Although people diagnosed with autism spectrum disorder (ASD) are not more likely to commit crimes, they are overrepresented in the criminal justice system as reported by Howlin (Autism and Asperger syndrome: Preparing for adulthood, Routledge, 2004). This may, in part, be due to unfavourable interactions with the criminal judiciary. Evidence suggests the autistic population are perceived unfavourably in adjudicative proceedings resulting in harsher penalties. The present study explores whether ASD offenders (ASD-O) receive longer sentences compared to national sentencing data. Sentencing data from the Australian Bureau of Statistics (ABS) were used to compare ASD-O with similar offences. ASD-O attracted longer sentences across all offence classifications. Inferential analyses indicated sexual assault sentences were significantly higher in the ASD-O sample. No significant differences were found for murder, manslaughter, and assault.

The health of adolescents in detention: a global scoping review

Adolescents detained within the criminal justice system are affected by complex health problems, health-risk behaviours, and high rates of premature death. We did a global synthesis of the evidence regarding the health of this population. We searched Embase, PsycINFO, Education Resources Information Center, PubMed, Web of Science, CINCH, Global Health, the Cochrane Database of Systematic Reviews, the Campbell Library, the National Criminal Justice Reference System Abstract Database, and Google Scholar for peer-reviewed journal articles, including reviews, that reported the prevalence of at least one health outcome (physical, mental, sexual, infectious, and neurocognitive) in adolescents (aged <20 years) in detention, and were published between Jan 1, 1980, and June 30, 2018. The reference lists of published review articles were scrutinised for additional relevant publications. Two reviewers independently screened titles and abstracts, and three reviewed full texts of relevant articles. The protocol for this Review was registered with PROSPERO (CRD42016041392). 245 articles (204 primary research articles and 41 reviews) were included, with most primary research (183 [90%]) done in high-income countries. A high lifetime prevalence of health problems, risks, and conditions was reported in detained adolescents, including mental disorders (0-95%), substance use disorders (22-96%), self-harm (12-65%), neurodevelopmental disabilities (2-47%), infectious diseases (0-34%), and sexual and reproductive conditions (pregnant by age 19 years 20-37%; abnormal cervical screening test result 16%). Various physical and mental health problems and health-risk behaviours are more common among adolescents in detention than among their peers who have not been detained. As the social and structural drivers of poor health overlap somewhat with factors associated with exposure to the criminal justice system, strategies to address these factors could help to reduce both rates of adolescent detention and adolescent health inequalities. Improving the detection of mental and physical disorders, providing appropriate interventions during detention, and optimising transitional health care after release from detention could improve the health outcomes of these vulnerable young people.

Health determinants of adolescent criminalisation

Several conditions related to health and development in adolescence can increase the risk that a young person will be exposed to the criminal justice system. Such determinants include neurodevelopmental disability, poor mental health, trauma, and experiences of maltreatment. Furthermore, the risk of exposure to the criminal justice system seems to be amplified by social marginalisation and inequality, such that young people are made susceptible to criminal behaviour and criminalisation by a combination of health difficulties and social disadvantages. This Review presents evidence on the health determinants of criminalisation among adolescents, providing a persuasive case for policy and practice reform, including for investment in approaches to prevent criminalisation on the basis of health and developmental difficulties, and to better address related needs once within a criminal justice system.