Heterogeneity within Autism Spectrum Disorder in Forensic Mental Health: The Introduction of Typologies

Purpose: Individuals with diagnoses of Autism Spectrum Disorder (ASD) within criminal justice settings are a highly heterogeneous group. Although studies have examined differences between those with and without ASD in such settings, there has been no examination of differences within the ASD group. Design/methodology/approach: Drawing on the findings of a service evaluation project, this paper introduces a typology of ASD within forensic mental health and learning disability settings. Findings: The eight sub-types that are described draw on clinical variables including psychopathy, psychosis and intensity/ frequency of problem behaviours that co-occur with the ASD. The initial assessment of inter rater reliability on the current version of the typology revealed excellent agreement, multirater Kfree = .90. Practical implications: The proposed typology could improve understanding of the relationship between ASD and forensic risk, identify the most appropriate interventions and provide prognostic information about length of stay. Further research to refine and validate the typology is ongoing. Originality/value: This paper introduces a novel, typology based approach which aims to better serve people with ASD within criminal justice settings

A Phenomenological Approach to Diagnosing Psychosis in Autism Spectrum Disorder and Intellectual Disability: A Case Series

Purpose: The diagnosis of psychosis in individuals with autism spectrum disorder poses a unique clinical challenge. The presence of intellectual disability further complicates the diagnostic picture. Reliable and timely diagnosis of psychosis in such individuals minimizes the duration of untreated psychotic symptoms and the subsequent impact on the quality of life of the patients concerned. Design/methodology/approach: The authors present four patients with psychosis, autism spectrum disorder and intellectual disability, who have received care within forensic mental health and intellectual disability settings. These examples demonstrate the interaction between these conditions, as well as issues pertaining to diagnosis and management. Findings: In all four patients, sustained use of antipsychotic medication was objectively associated with an improvement in psychotic symptoms and quality of life. In instances where autistic phenomena were accentuated upon development of psychosis, such features returned to the baseline levels evident prior to the onset of psychosis. Practical implications: The discussion and related case examples could improve understanding of the possibility of psychosis in individuals with autism spectrum disorder and intellectual disability, and increase awareness of this diagnostic possibility among healthcare professionals. Originality/value: This is the first published case series illustrating the challenges of diagnosing psychosis in individuals with autism spectrum disorder and intellectual disability