Assessment and management of risk in autism
| Published date | 16 November 2012 |
| Date | 16 November 2012 |
| Pages | 314-320 |
| DOI | https://doi.org/10.1108/20441281211285964 |
| Author | Santhana Gunasekaran |
| Subject Matter | Education,Health & social care |
Assessment and management of risk in
autism
Santhana Gunasekaran
Abstract
Purpose – This paper aims to describe the issues in risk assessment and management of autism
spectrum disorders in secure hospital settings with reference to best practice guidance.
Design/methodology/approach – The author undertook a review of the current literature on risk
management in autism spectrum disorders and has drawn on clinical experience to highlight key issues.
Findings – Risk assessment and management needs to be tailored to individuals. Characteristics of
offences differ compared to other mental disorders. Underlying factors for offending differ from other
mental disorders and may be misinterpreted.
Practical implications – Risk assessment in autism spectrum disorders should take into account
individual characteristics and be informed by specialist assessments. Management should be based on
a formulation informed by assessments and by recognising individual characteristics.
Originality/value – The paper highlights important issues in risk assessment and management of
patients with autism spectrum disorders particularly in secure hospital settings.
Keywords Autism spectrum disorder, Best practice, Risk assessment,Risk management, Offending,
Asperger’s syndrome, Characteristics, Prevalence
Paper type General review
Introduction
Within secure hospital settings, it is author’sexperience that there is an increasing number of
individuals identified with autism spectrum disorders. Risk assessment and management
are keys to the rehabilitation of individuals in secure settings with a history of violent
behaviour. The practice of risk assessment and management is well established for those
with mental illnesses such as schizophrenia in secure hospitals and in community settings.
However, risk assessment and management in autism is a poorly researched area with little
evidence base for the treatment of those who come into contact with the services with
offending behaviour.Gunasekaran and Chaplin (2012) describe the prevalence of offending
and characteristics of offences from available evidence elsewhere in this issue. This article
discusses the risk assessment and management practices.
Use of risk assessment tools
Department of Health (DOH) (2007) issued best practice guidelines in managing risk which
states that where suitable risk assessment tools are available, risk management should be
based on assessment using a structured clinical judgement approach. Risk assessments
can be considered in two categories, with actuarial risk assessments looking at historical
factors and structured clinical assessments (also known as structured clinical judgments)
incorporating clinical factors which are usually dynamic at least in the short to medium term.
Clinical or dynamic factors usually include the presence of symptoms, compliance with
medication, level of insight and the nature of acute symptoms that may change frequently in
short to medium term.
PAGE 314
j
ADVANCES IN MENTALHEALTH AND INTELLECTUAL DISABILITIES
j
VOL. 6 NO. 6 2012, pp. 314-320, QEmerald Group Publishing Limited, ISSN 2044-1282 DOI 10.1108/20441281211285964
Santhana Gunasekaran is a
Consultant Forensic
Psychiatrist based at
St Andrew’s Healthcare,
Nottinghamshire, UK.
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