Characteristics of male autistic spectrum patients in low security: are they different from non‐autistic low secure patients?

Date01 January 2013
Publication Date01 January 2013
AuthorCamilla Haw,Jane Radley,Louise Cooke
SubjectEducation,Health & social care,Sociology
Characteristics of male autistic spectrum
patients in low security: are they different
from non-autistic low secure patients?
Camilla Haw, Jane Radley and Louise Cooke
Camilla Haw is a Consultant
Psychiatrist at the Men’s
Service, St Andrew’s
Healthcare, Northampton, UK
and Professor of Mental Health
Care at the University
of Northampton,
Northampton, UK.
Jane Radley is a Consultant in
Learning Disability Psychiatry
at the Men’s Service,
St Andrew’s Healthcare,
Northampton, UK.
Louise Cooke is a Specialty
Doctor at St Andrew’s
Healthcare, Birmingham, UK.
Purpose – The purpose of this paper is to describe the characteristics of adult male autistic spectrum
disorder (ASD) patients admitted to low secure services and to compare them with non-ASD patients.
Design/methodology/approach – Case-control study of admissions to two ASD units and one non-ASD
unit at a tertiary referral centre. Subjects were compared on demographic, personal, clinical and offending
behaviour variables.
Findings – In total, 51 ASD and 43 controls were studied. Median age at diagnosis of ASD was 21 years
(range 6-56). The ASD group were younger (median age 27 vs 33 years) and more likely to be single than
controls. Their age at first contact with psychiatric services was lower and proportionally more were
admitted from prison and courts. Almost three-quarters had psychiatric comorbidity, most commonly
schizophrenia, but unlike controls, personality disorder and drug and alcohol disorders were uncommon.
Lifetime sexually inappropriate behaviour and physical violence were less common, as was non-compliance
with medication. However,78 per cent had a lifetime history of physical violence and a third had a conviction
for GBH or homicide. Offending behaviour was sometimes atypical in nature and some had convictions for
unusual offences such as harassment and stalking.
Research limitations/implications – The age difference between cases and controls is likely to have
confounded the results. Findings cannot be generalised to the NHS.
Originality/value – This group of ASD patients in low security differed in several important respects from
their non-ASD counterparts, which highlights their differing treatment needs, strengths and weaknesses.
Keywords Intellectual disabilities, Offending behaviour, Institutional care, Autism,Asperger, Inpatients,
Forensic psychiatry
Paper type Research paper
Autistic spectrum disorders (ASD) comprise a group of pervasive developmental disorders of
varying severity and form characterised by impairment in social interaction, communication and
behaviour/imagination, the so-called “triad of impairments” described by Lorna Wing (1981). In
Asperger’s syndrome the qualitative impairment in social interaction and repetitive stereotyped
behaviours typical of autism are seen but subjects have normal intellectual ability and syntactical
speech. Although autism, atypical autism and Asperger’s syndrome are classified separately in
ICD-10 (World Health Organisation, 1992), they are now thought not to be qualitatively distinct
entities and instead the term ASD has been widely adopted to describe them (and is to be
adopted in DSM-V and ICD-11). In the past the diagnosis of ASD hasbeen a clinical one, based
on developmental history, mental state and behaviour. The recent NICE Guidance on the
assessment and diagnosis of adults with ASD (2012) recommends that a comprehensive
assessment for ASD should include the use of formal assessment tools, such as the Autism
VOL. 4 NO. 1/2 2013, pp. 24-32, CEmerald Group Publishing Limited,ISSN 2050-8824 DOI 10.1108/JIDOB-03-2013-0006

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