Autism Spectrum Disorders in Prisoners
by Wendy Hoke
A recent study published in Advances in Autism tested whether members of the prison population were at risk for higher rates of Autism Spectrum Disorder (ASD). The authors used the hypothesis that ASD traits among prisoners would, “continuously [be] distributed among prisoners; be unrecognized by prison staff; and predict whether a prisoner met diagnostic criteria for ASD.”
The study took place in London, and 240 male prisoners took part. The investigators measured ASD traits using the 20-item Autism Quotient (AQ-20), and more diagnostic assessment was conducted using the Autism Diagnostic Observation Schedule. The results were compared with data on ASD from a Psychiatric Morbidity Survey from 2007.
The investigators found that 39 participants had an AQ-20 score equal to 10, which indicates significant autistic traits. However, the distribution of such traits across the participants indicated normal rates of ASD, similar to those found in a population-based sample from the United Kingdom.
Until this investigation, very few previous studies had sought to establish ASD traits among the prison population in relation to the population at large. What this study accomplished is significant; the study found high levels of unrecognized autism traits in the participants, which pointed out the potential need for special assessment of neuro-developmental disorders for people within the criminal justice system.
ASD Rates Among Prisoners
The investigators also explored the percentage of individuals with ASD among the general prison population versus those identified by staff as having behaviors that indicated autistic traits. The rates of ASD in the study resulted in 10 percent screening positive, and 2 percent met the diagnostic criteria. The prison had a capacity of 798, and approximately 33 new prisoners arrived weekly. Based on those statistics, the investigators estimated that 34 individuals with ASD traits will pass through that particular prison in any given year. The estimates also suggested that 16 prisoners with ASD will be incarcerated at the prison on any given day.
The mean AQ-20 score was 6.06. This result was compared and contrasted to the results of a study conducted in 2007, the Adult Psychiatric Morbidity Survey, produced by the National Centre for Social Research and University of Leicester in England. In that survey, 2618 men between the ages of 20 and 72 completed the AQ-20, and the mean score was 6.25. The investigators concluded that, considering the statistical deviation, the difference between the study scores was not statistically significant. Thus, the prison population had AQ-20 scores that were distributed normally.
However, the investigators also looked into the self- or staff-referral rates and suggested that based on those rates alone, the percentage of recognized traits would be close to just 1 percent for ASD and just 0.3 percent for meeting diagnostic criteria. Of the prisoners who were referred as participants in the study, 85 percent had been incarcerated for at least four weeks prior to the referral. This suggested a delay in the identification of potential neuro-developmental problems. Those participants that had been referred to the investigation scored much higher on the AQ-20 than the mean: 9.06. The investigators suggested that the prisoners with much more subtle traits of ASD may not be recognized without the implementation of standardized testing. The actual percentage of participants who were recruited to take the test was 52 percent screening positive for ASD and 16 percent that met diagnostic criteria.
In the study, out of the 11 of the prisoners who met the ASD diagnostic criteria, six had received specialist intervention programs through school, three were recognized by their communities as having ASD, and only two were recognized by the prison as having ASD. In fact, three of those participants had no indication of ever receiving an ASD or autism diagnosis at all.
The investigators made several significant conclusions based on their findings. They suggested that improvements in screening methods in the prison system would better identify individuals with co-occurring behavioral or mental health difficulties. Their recommendations included adding a training program designed to meet the needs of a variety of prison staff levels. For instance, training the staff that handles discipline could differ distinctly from the training provided for intake coordinators. The training programs could cover issues such as how individuals with autism or ASD can present differently and provide examples of behaviors that might indicate the need for an assessment. Programs could also include training as how to best support those individuals and develop relationships with them.
The result would, hopefully, be an improvement in making reasonable adjustments surrounding the sensory, communication and social needs of prisoners with ASD. The investigators also suggested the need to better recognize ASD prior to any individual every entering the criminal justice system, such as in schools and by physicians. At the same time, simply identifying an individual with ASD leaves much to be desired. Identification must be followed up with interventions by professionals who promote diversion and liaison. This could be accomplished by a new pathway for individuals with ASD in the criminal justice system by encouraging partnerships between healthcare and social welfare providers and the criminal justice system. The investigators further suggested updates to policies and practices for those with mental illness and learning disabilities to improve support and reduce the risk of recidivism.