Characteristics of male autistic spectrum patients in low security: are they different from non‐autistic low secure patients?

Abstract

Purpose -The purpose of this paper is to describe the characteristics of adult male autistic spectrum disorder (ASD) patients admitted to low secure services and to compare them with non-ASD patients. Design/methodology/approach -Case-control study of admissions to two ASD units and one non-ASD unit at a tertiary referral centre. Subjects were compared on demographic, personal, clinical and offending behaviour variables. Findings -In total, 51 ASD and 43 controls were studied. Median age at diagnosis of ASD was 21 years (range 6-56). The ASD group were younger (median age 27 vs 33 years) and more likely to be single than controls. Their age at first contact with psychiatric services was lower and proportionally more were admitted from prison and courts. Almost three-quarters had psychiatric comorbidity, most commonly schizophrenia, but unlike controls, personality disorder and drug and alcohol disorders were uncommon. Lifetime sexually inappropriate behaviour and physical violence were less common, as was non-compliance with medication. However, 78 per cent had a lifetime history of physical violence and a third had a conviction for GBH or homicide. Offending behaviour was sometimes atypical in nature and some had convictions for unusual offences such as harassment and stalking.Research limitations/implications -The age difference between cases and controls is likely to have confounded the results. Findings cannot be generalised to the NHS. Originality/value -This group of ASD patients in low security differed in several important respects from their non-ASD counterparts, which highlights their differing treatment needs, strengths and weaknesses.

Autism spectrum disorder traits among prisoners

“…In a Swedish study of young offenders referred for forensic assessment: 15% had ASD with further 12% having probable ASD (Siponmaa et al, 2001), a US study in a maximum secure prison found that 4.4% of participants had significant ASD traits (Fazio et al, 2012) and Hare and colleagues (1999) found an ASD rate of 2.4% in three high secure hospitals in England while a study in the Scottish prison service found a rate of just 0.93% (Robinson et al 2012). Haw et al (2013) looked at the characteristics of male patients in a low secure setting with ASD. Compared with those without ASD, they were more likely to be single, at a younger age at their first contact with psychiatric services and 73% had a psychiatric diagnosis (most commonly schizophrenia) but personality disorders and substance abuse were less common.Studies of ASD among forensic populations have produced mixed results (Sabet et al, 2015).…”

A systematic PRISMA review of individuals with autism spectrum disorder in secure psychiatric care: prevalence, treatment, risk assessment and other clinical considerations

“…Only three studies explored any type of characteristics of patients with ASD detained in secure psychiatric hospitals (Murphy, 2003;Haw, Radley, & Cooke, 2013;Murphy, 2014).…”

“…In Haw and colleagues' study, there was no significant difference between the controls and the patients with ASD in terms of history of antisocial behaviour before the age of 18 years, age of first conviction and having served a custodial sentence. Patients with ASD did, however, have less prior convictions compared to the controls but this could be because of the age difference between the two groups (Haw et al, 2013).…”

“…Only three studies were identified which explored any type of characteristics of patients with ASD detained in secure psychiatric hospitals (Murphy, 2003;Haw, Radley, & Cooke, 2013;Murphy, 2014). Noting that there is a dearth of research and understanding of the characteristics of patients with ASD in secure care and how they compare to those from non-ASD populations, Haw, Radley and Cooke (2013), investigated the characteristics of male forensic patients with ASD in low-secure care and compared them to patients without ASD.…”

“…Noting that there is a dearth of research and understanding of the characteristics of patients with ASD in secure care and how they compare to those from non-ASD populations, Haw, Radley and Cooke (2013), investigated the characteristics of male forensic patients with ASD in low-secure care and compared them to patients without ASD. Specifically, they used two ASD units (one in Northampton and the other in Birmingham) and one non-ASD unit at a tertiary referral centre.…”