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Undiagnosed Autism in Adults in the CJS

Undiagnosed Autism in Adults in the CJS

A number of studies have been carried out over the last twenty years looking at whether people with autistic spectrum conditions (ASCs) are more or less likely to engage in offending behaviours than the general population. Many of these studies have been prevalence studies, involve calculating what percentage of a sample of offenders has autism, then comparing that to the prevalence of autism in the general population.

However, there is a major flaw in this approach.

Many people either with higher functioning autism or Asperger Syndrome, or those with a co-existing learning disability that might mask their autism, and particularly those born before about 1990, are unlikely to have had a formal diagnosis and many are not even aware that they have autism.

 

Autism diagnosis before 1990s

In people who are now middle-aged, there were few specialist services for children with autism when they were growing up, and only more severely autistic children were likely to be given a diagnosis. Over the last 20 years, access to early diagnosis has greatly increased. However for autistic people born in the 1960’s, 1970’s and 1980’s this often means many go undiagnosed, or receive diagnoses much later in life. It is also often more difficult to disentangle the social and communicative problems associated with ASCs from the more complicated clinical picture in adulthood, especially where there are co-existing learning disabilities.

 

The Implications of the lack of autism assessment in a court case

Autistic Person in CourtIt is therefore important not to rely on pre-exisitng diagnoses, or even a detainee or offender's self-identification. I was recently involved in a case supporting a man who was in Crown Court. Through my work with him I had suspected that he might have undiagnosed autism and his key worker had also assumed that he did have an autism diagnosis until they were informed that he had never been assessed. There was a strong potential this could have implications for his case, as he was very suggestible and likely to plead guilty to things that he had not done (as he had done previously) or to fail to recognise the importance of providing evidence of mitigating circumstances.

When the Judge was informed of this by those of us who had concerns, they were very sceptical about how a man could reach his mid-forties and not receive an assessment or diagnosis. However, when presented with some of the information given here, the judge agreed to take the possibility into account and the outcome of the trial, in this instance, appeared to be fair.

This underscores the importance of people who work in the criminal justice system (and anyone else who might work with people who may be on the spectrum) to have at least an awareness of the nature of the cognitive, emotional and behavioural implications of autistic spectrum conditions. This can include appreciating the need for additional support, such as Appropriate Adults in Police Custody or advocates in court; the ability to procees complex information; suggestibility; and the impact of high stress situations on an autistic persons' ability to cope. Criminal justice practitioners should also be aware of the communication issues that people with autism may experience, both to enable effective communication between all parties involved, and also to ensure that peoples' fluency is not over-estimated and that they understand essential information such as the Police Caution.

This scenario also highlights the importance of adequate assessments for people who may be autistic and may become involved in the criminal justice system. Without this, they may not receive equal and fair treatment if their condition is not recognised and acknowledged, and reasonable adjustments made.

 

Autism and Prison

Autistic Prisoner on Prison LandingIt has previously been identified that prison staff often have unrealistic expectations of individuals with Asperger Syndrome, due to their intelligence levels and verbal fluency. However, level of articulate speech does not always equate to an equal level of verbal comprehension and where an ASC has not been diagnosed, can mask a person's lack of social and communicative ability. Prisoners with ASCs are also recognised as being at substantially higher risk of exploitation from other prisoners.

Whilst for some people with an ASC, prison can be a strange, hostile and frightening place, for some prisoners with an ASC, the routine of prison is very reassuring and in some cases, can lead to quite quick institutionalisation. Whilst delivering learning disability and autism awareness training to prison staff, there were numerous reports of prisoners who 'kept themselves to themselves' and were 'model prisoners' until a minor change in the prison routine such as the cancellation of association or visits, or an enforced cell move caused extreme 'out-of-character' behaviour. Although impossible to say whether autism was a factor in these, it highlights how a lack of diagnosis could mean that self-isolation is perceived as 'good behaviour' and how many challenging behaviours could be avoided if a diagnosis and staff understanding were present.

 

Prison and Probation Offending Behaviour Programs

There are no specially adapted OBPs for people with autism and historically, mixed groups of autistic people and 'neurotypicals' have not worked well without modification and a lot of pre-planning and additional support for the autistic participant before, during and after the group. Cognitive behavioural approaches are usually based on the social and cognitive norms of the general population, rather than people with autism, and may not be very effective. Problems with social interaction can also make participation in group-based OBP unproductive at best and damaging and counter-productive at worst. Again, where a participant is undiagnosed, these can lead to people with autism being labelled as poorly engaged and non-compliant, rather than poorly supported.

Beyond these criminal justice-specific issues, there is overwhelming evidence that people with ASCs experience much higher levels of affective mental health issues, such as anxiety and depression. However, these are predominantly secondary psychological problems that occur as a consequence of late diagnosis or poor support, rather than as a direct result of having autism. Therefore early diagnosis and appropriate support can mitigate the elevated risk of these, and other secondary problems. 

 

 

About Hugh Asher

 

Hugh is an author, practitioner, trainer, researcher and consultant.

He keeps rare breed sheep and cows.

He also shares his house with the world’s largest puppy, called Charlie.

Although he was told from a young age that “Life isn’t fair” he has refused
to give up on his goal to make other people’s lives as happy as he can.

His vision for a better world involves giving people the skills and
confidence to make a positive change to other people’s lives.

To learn more about Hugh and the mission of Soma, click here.​
   

 

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