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Authors: Chia-Heng Lin, M.D.^1,2;, Cheng-Hsien Sung, M.D.^3;Chia-Hsiang Chan, M.D., MSc^4,5;,Yu-Sheng Lin^2* 

1. Department of Child and Adolescent Psychiatry, Bali Psychiatric Center, Ministry of Health and Welfare, New Taipei City, Taiwan;
2. Graduate School of Criminology, National Taipei University, New Taipei City, Taiwan;
3. Department of Child and Adolescent Psychiatry, Taoyuan Psychiatric Center, Ministry of Health and Welfare, Taoyuan County, Taiwan;
4. Department of General Psychiatry, Taoyuan Psychiatric Center, Ministry of Health and Welfare, Taoyuan County, Taiwan;
5. Department of Psychology, Chung Yuan Christian University, Chung-Li, Taiwan

Abstract:

Adolescents and young adults with autism spectrum disorder often face interpersonal and learning challenges that are poorly understood by the public. Understanding how these individuals lose control to the point of engaging in violence and crafting effective interventions require further exploration of the medical and criminal justice systems. Investigating several challenging cases, we illustrate commonalities among the young offenders, including comorbidities, addictive behaviors, family histories, and adverse childhood experiences. All these reviewed cases have undergone medical assessment, with some incarcerated and others remaining free.

Keywords: incarceration, addiction, autism spectrum disorder, offenders, young people.

INTRODUCTION
Autism spectrum disorder (ASD), per the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (American Psychiatric Association, 2013), is primarily characterized by poor social and emotional reciprocity, impairment in nonverbal communication and social interactions, and repetitive and restricted behavioral patterns or interests beginning in early development. Links between ASD and violent behavior are controversial for various reasons, including psychiatric comorbidity, challenges in interpreting social cues or rigid thought patterns, and exposure to unfriendly environments and mistreatment (Del Pozzo et al., 2018; Im, 2016b; Mouridsen, 2012). Psychiatric comorbidity among criminal offenders with ASD is estimated to be 78.9% (van Buitenen et al., 2021), including schizophrenia spectrum disorders (31.7%) and substance use disorders (39.8%). Over 50% of patients with ASD have a comorbid diagnosis of attention-deficit/hyperactivity disorder (ADHD) (Lee and Ousley, 2006), and >70% exhibit intellectual disability (Buck et al., 2014). Both are linked to aggression in incarcerated populations (Fazel et al., 2008; Retz et al., 2004). Individuals with ASD may misinterpret nonverbal cues and have impaired abstract thinking and time sequencing (Wing, 1981). A small proportion of ASD individuals may develop circumscribed interests in violence-related materials, potentially leading to violent threats toward others owing to misattributed personal frustrations (Allely et al., 2017). Patients with ASD often have a naïve and limited understanding of interpersonal relationships, leading to progressive social isolation and feelings of loneliness. Some may attempt to develop close relationships in misguided ways (Murrie et al., 2002), and they are at a higher risk of being bullied (Cappadocia et al., 2012). American household survey studies show that youth with ASD tend to experience adverse childhood experiences (ACEs), often attributed to co-occurring behavioral and emotional disturbances (Kerns and Lee, 2015). ACEs in individuals with ASD may be associated with violent behaviors (Allely et al., 2017). In East Asian countries, despite increasing public awareness of ASD, there is little understanding of intermittent aggression in ASD and rare clinical analytical reports on the risk factors associated with criminal offenders with ASD. We present five cases of criminal offenders with ASD who received medical evaluations drawn from facility medical records.

Citation:

Yu-Sheng Lin. Youth Violent Offenders with Autism Spectrum Disorder. Journal of Psychiatry Research 2024.