Evidence-Based Reviews

Violent behavior in autism spectrum disorder: Is it a fact, or fiction?

Current Psychiatry. 2013 October;12(10):22-25,30,32

References

1. Kanner L. Autistic disturbances of affective contact. Nerv Child. 1943;2:217-250.

2. Diagnostic and statistical manual of mental disorders, 4th ed. Washington, DC: American Psychiatric Association; 2000.

3. Autism and Developmental Disabilities Monitoring Network Surveillance Year 2008 Principal Investigators. Prevalence of autism spectrum disorders--Autism and Developmental Disabilities Monitoring Network, 14 sites, United States, 2008. MMWR Surveill Summ. 2012;61(3):1-19.

4. Asperger H. Die autistichen psychopathen im kindesalter. Arch Psychiatr Nervenkr. 1944;117:76-136.

5. Happe F. Criteria, categories, and continua: autism and related disorders in DSM-5. J Am Acad Child and Adolesc Psychiatry. 2011;50:540-542.

6. Walkup JT, Rubin DH. Social withdrawal and violence. N Engl J Med. 2013;368:399-401.

7. Hippler K, Vidding E, Klicpera C, et al. Brief report: no increase in criminal convictions in Asperger’s original cohort. J Autism Dev Disord. 2010;40:774-780.

8. Siponmaa L, Kristiansson M, Jonson C, et al. Juvenile and young adult mentally disordered offenders: the role of child neuropsychiatric disorders. J Am Acad Psychiatry Law. 2001;29(4):420-426.

9. Matson JL, Shoemaker M. Intellectual disability and its relationship to autism spectrum disorders. Res Dev Disabil. 2009;30(6):1107-1114.

10. Rutter M, Bailey A, Lord C. Social communication questionnaire. Los Angeles, CA: Western Psychological Services; 2003.

11. US Department of Justice. Violent crime. http://www2.fbi.gov/ucr/cius2009/offenses/violent_crime. Published September, 2010. Accessed April 26, 2013.

12. Wing L. Asperger’s syndrome: a clinical account. Psychol Med. 1981;11(1):115-129.

13. Scragg P, Shah A. The prevalence of Asperger’s syndrome in a secure hospital. Br J Psychiatry. 1994;165:67-72.

14. Mouridsen SE, Rich B, Isager T, et al. Pervasive developmental disorders and criminal behaviour: a case control study. Int J Offender Ther Comp Criminol. 2008; 52(2):196-205.

15. Woodbury-Smith MR, Clare ICH, Holland AJ, et al. High functioning autistic spectrum disorders, offending and other law-breaking: findings from a community sample. J Forens Psychiatry Psychol. 2006;17(1):108-120.

16. Simonoff E, Pickles A, Charman T, et al. Psychiatric disorders in children with autism spectrum disorders: prevalence, comorbidity, and associated factors in a population-derived sample. J Am Acad Child Adolesc Psychiatry. 2008;47(8):
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17. Ghaziuddin M. Mental health aspects of autism and Asperger syndrome. London, United Kingdom: Jessica Kingsley Press; 2005.

18. Newman SS, Ghaziuddin M. Violent crime and Asperger syndrome: the role of psychiatric comorbidity. J Autism Dev Disord. 2008;38:1848-1852.

19. Wing L. Asperger’s syndrome: management requires diagnosis. The Journal of Forensic Psychiatry. 1997;8(2):253-257.

Step #2. Screen for comorbid psychiatric and medical disorders, including depression, psychosis, and seizure disorder.

Step #3. Treat any disorders you identify with a combination of medication and behavioral intervention.

Step #4. Carefully examine the circumstances surrounding the offending behavior. Involve forensic services on a case-by-case basis, depending on the type and seriousness of the offending behavior (see Related Resources for information on the role of forensic services). When the crime does not involve serious violence, lengthy incarceration might be unnecessary. Because psychopathy and ASD/AD are not mutually exclusive, persons who commit a heinous crime, such as rape or murder, should be dealt with in accordance with the law.

Need for greater awareness of the complexion of ASD

Patients who have ASD/AD form a heterogeneous group in which the levels of cognitive and communication skills are variable. Those who are low-functioning and who have severe behavioral and adaptive deficits occasionally commit aggressive acts against their caregivers.

Most patients with ASD/AD are neither violent nor criminal. Those who are at the higher end of the spectrum, with relatively preserved communication and intellectual skills, occasionally indulge in criminal behavior—behavior that is nonviolent and results from their inability to read social cues or excessive preoccupations.

Most reports that link criminal violence with ASD are based on isolated case reports or on biased samples that use unreliable diagnostic criteria. In higher-functioning persons with ASD, violent crime is almost always precipitated by a comorbid psychiatric disorder, such as severe depression and psychosis.

In short: There is a need to increase our awareness of the special challenges faced by persons with ASD/AD in the criminal justice system.

aGiven the term pervasive developmental disorders (PDD) in the DSM-IV-TR, the spectrum includes autistic disorder, Asperger’s disorder, and pervasive developmental disorder not otherwise specified.2

Bottom Line

Most people who have an autism spectrum disorder (ASD) do not commit violent crime. When violent crime occurs at the hands of a person with ASD, it is almost always precipitated by a comorbid psychiatric disorder, such as severe depression or psychosis. Treating a person with ASD who has committed a violent crime is multimodal, including forensic services when necessary.

Related Resources

Autism Speaks. No link between autism and violence. www.autismspeaks.org/science/science-news/no-link-between-autism-and-violence.
Haskins BG, Silva JA. Asperger’s disorder and criminal behavior: Forensic-psychiatric considerations. J Am Acad Psychiatry Law. 2006;34(3):374-384.
Newman SS, Ghaziuddin M. Violent crime and Asperger syndrome: the role of psychiatric comorbidity. J Autism Dev Disord. 2008;38:1848-1852.
Wing L. Asperger’s syndrome: a clinical account. Psychol Med. 1981;11(1):115-129.

Disclosure

Dr. Ghaziuddin reports no financial relationship with any company whose products are mentioned in this article or with manufacturers of competing products.