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      Autism and the criminal justice system: An analysis of 93 cases

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          Abstract

          We investigate whether autistic people's vulnerability is taken into account at each stage of the criminal justice system (CJS). Defense lawyers from 12 nations were included in the study although the sample was predominantly from the UK. Lawyers completed an online survey regarding one case in which they had defended an autistic client between January 2015 and January 2020; and on one case in which they had defended a nonautistic client charged with a similar offense, to provide a comparison group. Ninety‐three lawyers (85% in the UK) reported on one autistic case, and 53 also reported on one nonautistic case. 75% of autistic clients were not given reasonable adjustments during the process. Only 43% were offered an appropriate adult during police investigations, even though they had an existing diagnosis of autism. 59% of prosecution barristers and 46% of judges said or did something during the trial that made the lawyers concerned that they did not have an adequate understanding of autism. Lawyers were 7.58 times more likely to be concerned about their autistic client's effective participation in court and were 3.83 times more likely to be concerned that their autistic clients would engage in self‐harm, compared with their nonautistic clients. There is a failure to identify and address autistic peoples' disability within the CJS. There is a need for mandatory autism training for police officers and the judiciary, with a focus on identifying autism and understanding the needs of autistic people so that reasonable adjustments are offered in all cases.

          Lay Summary

          This study sought to investigate if the needs of autistic people are being overlooked by the police and other professionals within the CJS. Results show that autistic people are not always given the support they need during police questioning or in court. The experience of being involved with the police may also have a more negative impact on autistic peoples' mental health than that of nonautistic people.

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          Prevalence and Characteristics of Autism Spectrum Disorder Among Children Aged 8 Years — Autism and Developmental Disabilities Monitoring Network, 11 Sites, United States, 2018

          Matthew J Maenner, Kelly Shaw, Amanda V Bakian … (2021)
          Problem/Condition Autism spectrum disorder (ASD). Period Covered 2018. Description of System The Autism and Developmental Disabilities Monitoring (ADDM) Network conducts active surveillance of ASD. This report focuses on the prevalence and characteristics of ASD among children aged 8 years in 2018 whose parents or guardians lived in 11 ADDM Network sites in the United States (Arizona, Arkansas, California, Georgia, Maryland, Minnesota, Missouri, New Jersey, Tennessee, Utah, and Wisconsin). To ascertain ASD among children aged 8 years, ADDM Network staff review and abstract developmental evaluations and records from community medical and educational service providers. In 2018, children met the case definition if their records documented 1) an ASD diagnostic statement in an evaluation (diagnosis), 2) a special education classification of ASD (eligibility), or 3) an ASD International Classification of Diseases (ICD) code. Results For 2018, across all 11 ADDM sites, ASD prevalence per 1,000 children aged 8 years ranged from 16.5 in Missouri to 38.9 in California. The overall ASD prevalence was 23.0 per 1,000 (one in 44) children aged 8 years, and ASD was 4.2 times as prevalent among boys as among girls. Overall ASD prevalence was similar across racial and ethnic groups, except American Indian/Alaska Native children had higher ASD prevalence than non-Hispanic White (White) children (29.0 versus 21.2 per 1,000 children aged 8 years). At multiple sites, Hispanic children had lower ASD prevalence than White children (Arizona, Arkansas, Georgia, and Utah), and non-Hispanic Black (Black) children (Georgia and Minnesota). The associations between ASD prevalence and neighborhood-level median household income varied by site. Among the 5,058 children who met the ASD case definition, 75.8% had a diagnostic statement of ASD in an evaluation, 18.8% had an ASD special education classification or eligibility and no ASD diagnostic statement, and 5.4% had an ASD ICD code only. ASD prevalence per 1,000 children aged 8 years that was based exclusively on documented ASD diagnostic statements was 17.4 overall (range: 11.2 in Maryland to 29.9 in California). The median age of earliest known ASD diagnosis ranged from 36 months in California to 63 months in Minnesota. Among the 3,007 children with ASD and data on cognitive ability, 35.2% were classified as having an intelligence quotient (IQ) score ≤70. The percentages of children with ASD with IQ scores ≤70 were 49.8%, 33.1%, and 29.7% among Black, Hispanic, and White children, respectively. Overall, children with ASD and IQ scores ≤70 had earlier median ages of ASD diagnosis than children with ASD and IQ scores >70 (44 versus 53 months). Interpretation In 2018, one in 44 children aged 8 years was estimated to have ASD, and prevalence and median age of identification varied widely across sites. Whereas overall ASD prevalence was similar by race and ethnicity, at certain sites Hispanic children were less likely to be identified as having ASD than White or Black children. The higher proportion of Black children compared with White and Hispanic children classified as having intellectual disability was consistent with previous findings. Public Health Action The variability in ASD prevalence and community ASD identification practices among children with different racial, ethnic, and geographical characteristics highlights the importance of research into the causes of that variability and strategies to provide equitable access to developmental evaluations and services. These findings also underscore the need for enhanced infrastructure for diagnostic, treatment, and support services to meet the needs of all children.
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            Toward brief “Red Flags” for autism screening: The Short Autism Spectrum Quotient and the Short Quantitative Checklist for Autism in toddlers in 1,000 cases and 3,000 controls [corrected].

            Carrie Allison, Bonnie Auyeung, Simon Baron-Cohen (2012)
            Frontline health professionals need a "red flag" tool to aid their decision making about whether to make a referral for a full diagnostic assessment for an autism spectrum condition (ASC) in children and adults. The aim was to identify 10 items on the Autism Spectrum Quotient (AQ) (Adult, Adolescent, and Child versions) and on the Quantitative Checklist for Autism in Toddlers (Q-CHAT) with good test accuracy. A case sample of more than 1,000 individuals with ASC (449 adults, 162 adolescents, 432 children and 126 toddlers) and a control sample of 3,000 controls (838 adults, 475 adolescents, 940 children, and 754 toddlers) with no ASC diagnosis participated. Case participants were recruited from the Autism Research Centre's database of volunteers. The control samples were recruited through a variety of sources. Participants completed full-length versions of the measures. The 10 best items were selected on each instrument to produce short versions. At a cut-point of 6 on the AQ-10 adult, sensitivity was 0.88, specificity was 0.91, and positive predictive value (PPV) was 0.85. At a cut-point of 6 on the AQ-10 adolescent, sensitivity was 0.93, specificity was 0.95, and PPV was 0.86. At a cut-point of 6 on the AQ-10 child, sensitivity was 0.95, specificity was 0.97, and PPV was 0.94. At a cut-point of 3 on the Q-CHAT-10, sensitivity was 0.91, specificity was 0.89, and PPV was 0.58. Internal consistency was >0.85 on all measures. The short measures have potential to aid referral decision making for specialist assessment and should be further evaluated.
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              Identifying the lost generation of adults with autism spectrum conditions.

              Meng-Chuan Lai, Simon Baron-Cohen (2015)
              Autism spectrum conditions comprise a set of early-onset neurodevelopmental syndromes with a prevalence of 1% across all ages. First diagnosis in adulthood has finally become recognised as an important clinical issue due to the increasing awareness of autism, broadening of diagnostic criteria, and the introduction of the spectrum concept. Thus, the idea of a lost generation of people who were previously excluded from a diagnosis of classic autism has arisen. Making a first diagnosis of autism spectrum conditions in adults can be challenging for practical reasons (eg, no person to provide a developmental history), developmental reasons (eg, the acquisition of learnt or camouflaging strategies), and clinical reasons (eg, high frequency of co-occurring disorders). The diagnostic process includes referral, screening, interviews with informants and patients, and functional assessments. In delineating differential diagnoses, true comorbidities, and overlapping behaviour with other psychiatric diagnoses, particular attention should be paid to anxiety, depression, obsessive-compulsive disorder, psychosis, personality disorders, and other neurodevelopmental disorders. Possible misdiagnosis, especially in women, should be explored. The creation of supportive, accepting, and autism-friendly social and physical environments is important and requires a coordinated effort across agencies and needs support from government policies.
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                Author and article information

                Contributors
                Rachel Slavny‐Cross:
                ORCID: https://orcid.org/0000-0003-4648-6619
                rjms2@medschl.cam.ac.uk
                Journal
                Journal ID (nlm-ta): Autism Res
                Journal ID (iso-abbrev): Autism Res
                Journal ID (doi): 10.1002/(ISSN)1939-3806
                Journal ID (publisher-id): AUR
                Title: Autism Research
                Publisher: John Wiley & Sons, Inc. (Hoboken, USA )
                ISSN (Print): 1939-3792
                ISSN (Electronic): 1939-3806
                Publication date (Electronic): 14 March 2022
                Publication date (Print): May 2022
                Volume: 15
                Issue: 5 ( doiID: 10.1002/aur.v15.5 )
                Pages: 904-914
                Affiliations
                [ 1 ] Autism Research Centre, Department of Psychiatry University of Cambridge Cambridge UK
                [ 2 ] Psychology and Language Sciences University College London London UK
                Author notes
                [*] [* ] Correspondence

                Rachel Slavny‐Cross, Autism Research Centre, University of Cambridge, Douglas House, 18b Trumpington Road, Cambridge, CB2 8AH, UK.

                Email: rjms2@ 123456medschl.cam.ac.uk

                Author information
                https://orcid.org/0000-0003-4648-6619
                https://orcid.org/0000-0003-2272-2090
                https://orcid.org/0000-0002-0720-4511
                https://orcid.org/0000-0001-9217-2544
                Article
                Publisher ID: AUR2690
                DOI: 10.1002/aur.2690
                PMC ID: 9314022
                PubMed ID: 35289115
                SO-VID: ca8d115e-1869-4a69-a7c3-1b884009267c
                Copyright © © 2022 The Authors. Autism Research published by International Society for Autism Research and Wiley Periodicals LLC.
                License:

                This is an open access article under the terms of the http://creativecommons.org/licenses/by/4.0/ License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.

                History
                Date revision received : 08 February 2022
                Date received : 05 July 2021
                Date accepted : 09 February 2022
                Page count
                Figures: 0, Tables: 4, Pages: 11, Words: 8997
                Funding
                Funded by: Autism Centre of Excellence (ACE)
                Award ID: RG93227
                Funded by: SBC was also supported by Wellcome Trust
                Award ID: 214322\Z\18\Z
                Funded by: the Innovative Medicines Initiative 2 Joint Undertaking
                Award ID: 777394 for the project AIMS‐2‐TRIALS
                Funded by: European Union's Horizon 2020 research and innovation programme
                Funded by: EFPIA , doi 10.13039/100013322;
                Funded by: AUTISM SPEAKS , doi 10.13039/100000073;
                Funded by: Autistica , doi 10.13039/100011706;
                Funded by: SFARI , doi 10.13039/100014370;
                Funded by: Templeton World Charitable Fund
                Funded by: MRC , doi 10.13039/501100000265;
                Funded by: NIHR Cambridge Biomedical Research Centre , doi 10.13039/501100018956;
                Funded by: National Institute for Health Research (NIHR) Applied Research Collaboration East of England
                Categories
                Subject: Research Article
                Subject: PSYCHOLOGY
                Subject: Research Articles
                Custom metadata
                source-schema-version-number 2.0
                cover-date May 2022
                details-of-publishers-convertor Converter:WILEY_ML3GV2_TO_JATSPMC version:6.1.7 mode:remove_FC converted:25.07.2022

                Keywords: autism,criminal justice,mitigation,offending,reasonable adjustments
                Data availability:
                Keywords: autism, criminal justice, mitigation, offending, reasonable adjustments

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