Forensic rehabilitation in Asperger syndrome: a case report

Abstract

PurposePeople with Asperger syndrome are at increased risk of co‐morbid mental health problems. The core features underlying autism are likely to play an important role in offending behaviour amongst this population. Forensic rehabilitation includes a multidisciplinary approach and combination of therapeutic interventions. However there is limited evidence in the literature of what constitutes effective treatment within this setting, and how the process of rehabilitation is experienced by patients. The purpose of this paper is to describe a case of Asperger syndrome with co‐morbid psychosis and offending behaviour and the process of forensic rehabilitation.Design/methodology/approachThe authors briefly review the literature related to Asperger syndrome, offending in this population and co‐morbidity. The authors then describe and reflect on a case of a young man with Asperger syndrome, sexual offending and the process of forensic rehabilitation, and offer an insight from the patient's perspective.FindingsCo‐morbid mental illness, when detected early, can be successfully managed with limited additional disability. The process of forensic rehabilitation includes a multidisciplinary approach. Therapeutic interventions specifically aimed at addressing core features of autism, risk and offence‐related factors are effective in promoting recovery amongst those with autism and offending behaviour.Originality/valueThe paper highlights how core features of autism can lead to offending behaviour, the importance of early recognition and treatment of co‐morbidity, and the process of forensic rehabilitation and recovery. Also included are quotes from the patient's perspective on what it is like to have Asperger syndrome, and what has been the key learning from the rehabilitation process.

Treatment effectiveness for offenders with autism spectrum conditions: a systematic review

“…Social and communication difficulties were also a common theme across the case studies (Faccini, 2014;Griffin-Shelley, 2010;Kelbrick & Radley, 2013;Kohn et al, 1998;Murphy, 2010a;Radley & Shaherbano, 2011). These difficulties were identified particularly in relation to theory of mind and social perspective taking and appeared to be a key factor in the offending, supporting suggestions made in existing literature regarding the potential influence of ASCs characteristics in offending (Dein & Woodbury-Smith, 2010;Howlin, 2004).…”

“…For some, effectiveness was directly referenced to reductions in offending behaviours (in frequency or severity) e.g. Griffin-Shelley (2010), Kelbrick & Radley (2013) and Kohn et al (1998). Reductions were linked to clinical judgement and observations of improvement, with specific details rarely given i.e.…”

“…Some were specific, referring to a particular approach i.e. As well as specific offender treatment, Radley and Shaherbano (2011) and Kelbrick and Radley (2013) also had a wider treatment programme available including psycho-education, occupational therapy and social skills training. Supplementary therapies were also mentioned in a number of the other reports, which did not appear to reduce offending behaviour (Milton et al, 2002;Murphy, 2010a).…”

Experiences of prison inmates with autism spectrum disorders and the knowledge and understanding of the spectrum amongst prison staff: a review

“…For instance, "Mind Reading", an interactive guide to emotions, which has been shown to significantly increase the ability of adults with AS to recognise a range of complex emotions and also mental states in just 10-15 weeks of engagement (Golan and Baron-Cohen, 2006). There have also been recent attempts to formulate treatments within forensic psychiatric services which are specific to the needs of individuals with ASDs (Kelbrick and Radley, 2013;Langdon et al, 2013) given that generic programmes will not be as effective as more specialised interventions (Browning and Caulfield, 2011). However, these new formulated treatments need further evaluation using larger samples (Woodbury- Smith and Dein, 2014).…”

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

“…Regarding therapy, Kelbrick and Radley (2013) investigate psychotherapeutic approaches in adults with ASD. Additionally, more research is required looking at patients with ASD in secure forensic settings to determine which approaches and types of interventions are most effective in improving outcomes and the patient factors which are linked to good prognosis (Haw, Radley, & Cooke, 2013;Murphy, 2010).…”