Characteristics of referrals and admissions to a medium secure ASD unit

Date08 September 2014
Publication Date08 September 2014
AuthorTherese O' Donoghue,John Shine,Olufunto Orimalade
SubjectHealth & social care,Learning & intellectual disabilities,Offending behaviour
Characteristics of referrals and admissions
to a medium secure ASD unit
Therese O’Donoghue, John Shine and Olufunto Orimalade
Dr Therese O’Donoghue is an
Assistant Psychologist, based
at Department of Psychology,
St Andrew’s Healthcare,
Northampton, UK.
John Shine is based at
Department of Psychology,
St Andrew’s Healthcare,
Northampton, UK.
Dr Olufunto Orimalade is a
Consultant Forensic
Psychiatrist, based at
Community-Services, Alberta
Health Services, Edmonton,
Purpose – The purpose of this paper is to present preliminary data on a cohort of patients referred to a
specialist forensic medium-secure autism spectrum disorder (ASD) service during its first two years of
opening and to identify variables associated with admission to the service.
Design/methodology/approach – Data on all referrals to the service (n ¼40) was obtained from clinical
files on demographics, offending history, psychiatric history and levels of therapeutic engagement. The
sample was divided into two groups: referred and admitted (n ¼23) and referred and not admitted (n¼17).
Statistical analysis compared the two groups on all variables.
Findings – Totally, 94 per cent of all individuals assessed had a diagnosis of autism, however, structured
diagnostictools for ASD were usedin a small minority of cases.About half the sample hada learning disability,
almost four-fifths had at least one additional mental disorder and almostthree-quarters had a history of prior
supervisionfailure or non-compliance withtreatment. The sample had a widerange of previous offences. No
significant differences were found betweenthe groups on any of the variables includedin the study.
Research limitations/implications – The present study presents a starting point to follow up in terms of
response to treatment and characteristics associated with treatment outcome.
Practical implications – The sample had a wide range of clinical and risk-related needs. Both groups
shared many similarities.
Originality/value – This highlights the need for comprehensive assessmentlooking at risk-related needs so
that individuals are referred to an optimal treatment pathway.
Keywords Referrals, Risk, Challenging behaviour, ASD, Medium secure, Specialist service
Paper type Research paper
Autism spectrum disorder (ASD)
ASD is characterised by deficits in communication, social interaction and the presence of
stereotypic behaviours, resistance to change or restricted interests. Individuals with ASD also
experience difficulties with cognitive and behavioural flexibility, altered sensory sensitivity,
sensory processing difficulties and emotional regulation difficulties (National Institute for Health
and Care Excellence (NICE) Clinical Guidelines; CG142, 2012). The mean worldwide
prevalence is 0.62-0.70 per cent (Fombonne et al., 2009; Lai et al., 2014).
For the purposes of this study, the term “ASD” will be used as a descriptor for the range of
conditions that commonly represent the triad of impairment in ASD, i.e. impairments in social
interaction, social communication and social imagination. The term ASD therefore includes the
following autistic disorders: pervasive developmental disorder (ICD-10 and DSM-IV); childhood
autism (ICD-10); autistic disorder (DSM-IV); atypical autism (ICD-10) and Asperger’s syndrome
(ICD-10 and DSM-IV); ASD (DSM-V).
Offending and challenging behaviour in ASD
In the early case studies of autism, Dr Hans Asperger (1944), noted a propensity towards violence of
some of the children he studied. However, a case review of 177 cases originally diagnosed by
PAGE 138
VOL. 5 NO. 3 2014, pp. 138-146, CEmerald Group Publishing Limited, ISSN 2050-8824 DOI 10.1108/JIDOB-06-2014-0008

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