Social cognition in offenders with autism: A preliminary exploration

1
Social cognition in offenders with autism A
preliminary exploration

• Carol Guinan Assistant Psychologist
• Dr Anne Sheeran Consultant Clinical Forensic
• Psychologist
• Kent Forensic Psychiatry Service

2
Outline

• Methodology
• Theoretical background
• Clinical details
• Analysis
• Implications ?

3
Methodology

• Single case analysis of offenders own account
• Semi-structured interview
• Interpretative Phenomenological Analysis (IPA)
  (see e.g. Smith and Osborn, 2003)
• Insiders perspective using idiographic approach
• Unit of analysis - individuals own account
• Guided by SIP model to examine social cognitive
  deficits e.g. Theory of Mind (ToM)

4
Social cognition offending behaviour

• Social cognition the process of making sense out
  of all aspects of the social world (Kunda, 1999)
• Skilful processing of social cues the basis of
  competent social functioning (Nas et al, 2005)
• Reliable predictor of offending behaviour
  (Farrington, 2001 Ross Fabiano, 1985)

5
ASD and Offending

• Majority of people with Asperger's Syndrome are
  scrupulously law abiding (Howlin,
  2004Tantam,2000Wing, 1997)
• Minority who are in the forensic system a
  highly unique population with specialised needs
  (Murphy, 2003) Certain commonalities may be
  found in those with the disorder charged with
  criminal acts (Murrie et al, 2002)
• Focus neurocognitive abnormalities, yet
  remarkable heterogeneity in presentation ?
  COMPENSATION ??

6
Some characteristics of the hfASD offender

• A sense of self absorption disregard for others
  (Wing, 1997)
• Purely intellectual interest chilling
  detachment from the effects of their crimes on
  victims (Wing, 1997)
• Autistic egocentricism vs. Neurotypical
  egocentricism (Frith, 2004)
• Intention to harm others is rare (Howlin, 2004)
• Involved in more unusual or bizarre offences

7
What types of crime?

• Small scale (N45) study by Woodbury-Smith et al.
  (2005)
• Compared with equivalent control group (n20),
  hfASD offenders (n25) were involved with less
  acquisitive crime
• 5 times less likely to have convictions for drug
  related crime
• More likely to have convictions for violent
  behaviour and criminal damage
• Participants accounts indicated desire for
  revenge in response to perceived victimisation

8
Questions to bear in mind

• How do some with this condition adapt more
  successfully than others?
• Is adequate social information processing a
  protective factor against offending?
• In what ways are the criminogenic needs of this
  population the same/different?
• How can treatment providers intervene at this
  level?

9
Proposed motives

• Wish to have power in inter-personal situations ?
  seemingly malicious behaviour (Tantam, 1999)
• Displaced resentment ? unprovoked assaults
• Exploitation victimisation by more dominant
  peers left to carry the can
• Severe social ignorance ? inappropriate social
  behaviour (Frith,1991)

10

• Murrie et al (2002) Analysis of six case
• histories from forensic settings.
• Commonalities across cases included
• Deficient empathy
• Interpersonal Naivety
• Sexual Frustration
• Immediate confession
• Links to preoccupations

11
Mechanisms

• Hostility arising from negative social
  experiences e.g. rejection bullying
• Lacking regulating effects of empathy
• Co-morbid psychopathology in some e.g.
  delusional/paranoid ideation
• Lacking ability to stand in potential victims
  shoes i.e. Theory of Mind
• ? Consequential thought

12
A heterogeneous condition

• Triad of impairments Limitations in social
  interaction, communication and imagination
  (DSM-IV,1994)
• Core clinical characteristics Deficits in
  empathy, inappropriate social interaction,
  limited capacity to form friendships and poor
  understanding of non verbal communication (Wing,
  1981)
• Combination intensity of characteristics
  availability of support, influence nature of
  behavioural outcomes

13
An alien from outer space

• First hand accounts from successful individuals
  highlight the anxieties stresses experienced
  when attempting to tune into social and
  affective information e.g. gestures, facial
  expression and tone of voice (Williams, 2004)
• Temple Grandin describes her thinking as from
  the vantage point of an observer
• Jim Sinclair like an alien from outer space

14
Rethinking criminogenic needs

• Social anxiety and distress is a direct
  consequence of the core syndrome itselfand the
  development of conduct disorders is a significant
  personal reaction to those stresses (Tantam,2000
  p.47)
• E.g. Perceived victimisation ? long term
  rumination suppression ? displaced aggression
  / unprovoked attacks

15
Social cognition a common deficit

• Hallmark deficit of ASD Detachment from the
  social world
• Popular treatments e.g. RR focus on teaching
  these skills in social cognition in neurotypical
  group
• Social cognitive deficits seen as arising from
  lack of learning opportunity rather than
  intelligence/organic impairment

16
Compensation?

• Neurocognitive impairments are considered to
  underlie the social cognitive deficits in ASD
• Not equipped with normal preferences for social
  stimuli (Hill Frith, 2003)
• Failure to attend to encode salient social cues
  e.g. others facial expressions (Klin et al.,
  2003)
• Misinterpretation of whole social situation
  ? inappropriate behaviour
• Can style of processing social information
  mediate adaptability ??

17
Social Information Processing (SIP)

• We are cognitive misers (Gannon et al, 2005).
• Schemas guide us in predicting, explaining and
  understanding our social world (Mann Beech,
  2003)
• Schemas cognitive shortcuts that automatically
  bias our attention to information that fits with
  what we know and selectively filters out
  information that doesnt make sense
• Can lead to biased attribution behaviour

18
SIP (cont.)

• Rely on information in long-term memory
• Expectancies processes of judgement, rather
  than intelligence, influence propensity to offend
  (Blackburn, 2003)
• Theories are generated and tested throughout
  childhood, and pervade unless disproved no
  longer explain social behaviour (Drake et al,
  2001)
• Individuals adopt socially in/appropriate
  scripts, resulting in a pattern of pro- or
  anti-social behaviour (Dodge Crick, 1990).

19
SIP Aggressive Behaviour

• Aggressive boys encode less relevant information
  (Matthys et al., 1999)
• Generate more aggressive responses judge these
  responses less negatively than non-aggressive
  boys (Matthys et al., 1999)
• Attribute more hostile intentions experience
  less guilt (Orobio de Castro et al.,2003)

20
SIP Aggression

• Motivated by revenge, getting even and the
  pursuit of dominance over others rather than
  affiliation with others (Orobio de Castro et
  al.,2005)
• This link not yet established in the adult
  offending literature
• Longitudinal research indicates this pervades
  into adulthood (e.g Farrington, 1998)

21
SIP Empathy

• callous with low empathy. They are relatively
  poor at role taking and perspective taking and
  may misinterpret other peoples intentions
  cognitive element . This lack of awareness or
  sensitivity to others thoughts and feelings
  affective element impairs their abilityto
  appreciate the effects of their behaviour on
  other people. this refers to neurotypical
  offenders
• Farrington (1998, p.257)

22
Theory of Mind

• Difficulty processing complex emotion (Hill et
  el, 2004)
• Difficulty experiencing empathy (Gillberg, 1992)
• Preference for external events rather than inner
  experiences compared to neurotypicals
  (Gillberg, 1992)
• Poor ToM linked with delusion formation
• Development of coping abilities in some a
  mediating effect of SIP style on ToM development
  ??

23
ToM delusion formation

• Identified in people with Aspergers Syndrome
  (Clarke et al., 1999 Tantam, 1991)
• Link between anxiety and self consciousness with
  delusions (Abell Hare, 2005).
• Private self consciousness - a reliable predictor
  Blackshaw et al., 2001)
• Heightened self-awareness to exclusion of others
  feelings, due to difficulty and stresses
  experienced reading others minds ? paranoia
  (Frith, 2004)

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Clinical Details

• Male, single, early 40s
• One previous minor conviction (fined)
• Graduate, with previously successful career in IT
  in UK/Europe
• High status hobby
• Twin brother ? ASD two other siblings
• Convicted for offences of harassment custodial
  sentence imposed
• Transferred suicidal behaviour in prison.
  Described this as exit strategy (from his
  predicament). Serious suicide attempt in
  hospital.
• Diagnosed with ASD following admission. Also has
  diagnosis of delusional disorder (related
  directly to offences)
• Current treatment little or no change in
  presentation has received both pharmacological
  and psychological interventions

25
Results

• Self as isolationist
• Persecuted and powerless
• Consistent with existing findings linked with
• ToM impairments e.g.
• Poor empathy
• Difficulty taking others perspectives
• Egocentricism
• Also a delusional aspect

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Theme 1 Self as isolationist

• I prefer not to have the interaction its too
  much like hard work.
• relationships are too much, too much
  troublewouldnt want a relationship you have
  to put yourself out and make a fool out of
  yourself.

27
His view

• Difficulties with dynamic social interaction
• Effortful a likely source of anxiety
• Elective
• Great inhibitions about putting myself forward
• Yet maintains he is confident in most
  situations

28
Functionality of isolation

• Protective function minimise opportunities to
  fail expose personal vulnerabilities
• Incongruence between self actual and self ideal
  representations ? his only option is external
  attribution i.e. blame others
• Delusion formation a maladaptive strategy to
  regulate self esteem (Bentall Kindermann, 1998)
  

29
Implications of isolation

• Minimising opportunities to learn pro-social
  skills
• Negative core beliefs are maintained, cannot
  disprove them
• No expression of desire to learn coping skills
• However, isolation not absolute. Sought a social
  outlet, i.e. his victim

30
Profound social ignorance

• Keeping in contact with each other 6 monthly
  friendship
• Perspective taking problems
• It came round to the six months where I tried to
  contact her She just blanked meAt the time I
  was confused because I didnt know what was
• going onso I absolutely pursued her to find
  out why

31
Friendship as harassment

• Absolute pursuit perceived as harassment by ex
  colleague
• He was unable to accept this view (letter)
• Gutted upset at loss of primary social
  outlet
• Sudden realisation of social cognitive deficits?
• Denial of these deficits
• Supposed to guess ? anger

32
His view

• I was very annoyed the way she handled it. It
  wasnt so much she
• dumped usit was the way she done itshe wasnt
  going to say anything
• to us and I was supposed to guess. That made me
  really angryI didnt
• have a clue what was going on...

33
Interpretation

• Able to sustain friendship on his own terms
  only
• Crucial dynamic element non existent
• Demonstrates his perspective taking problems
• ? imaginative ability to read between the lines
• Satisfactory only when able to predict the course
  outcome of relationship
• How can this be rationalised ? external
  attribution easier than admitting to own
  difficulties, while maintaining his self concept

34
Theme 2Persecuted Powerless

• I just wanted the attacks on me to stop, after I
  had been turned down by the police, they told me
  it was such a trivial matter not to bother themI
  resorted to doing something to them.

35
His reality

• He is a victim of harassment via regime of
  nuisance phone calls and razor blades
• Not taken seriously by police or BT
• Revocation of rights to high status hobby ?
  resentment sadness
• Last resort threaten arson against regulating
  organisation
• Retaliation as self defence therefore justified
• Core belief Do unto others as they do unto you
• Self as victim and protagonist

36
Interpretation

• Lifelong social exclusion, rejection, bullying ?
  attends to schema congruent information
• Existing core beliefs are based on tried and
  tested theories bias his judgement formation
• Focus attention on information to confirm
  negative beliefs ? paranoid/persecutory type
  delusions (Wells Matthews,1994)

37
Interpretation

• Tangible retributive philosophy
• Vengeful desire to cause physical injury, rather
  than emotional distress to his victims
• Autistic egocentrism (Frith, 2004) or autistic
  malice (Asperger, 1944) ?
• Intention here to cause physical injury
• Do unto others rather than more explicit
  emotional distress motivation

38
Limitations of this study

• Integrity of data is reliant on the information
  provided by interviewee
• Interviewing skills of researcher
• Accuracy? / Motives?
• Findings not generalisable
• However, case study design is ideal to examine
  subjective experiences and social cognitions
  which appear to be so variable

39
Treatment implications?

• Co-morbidity of anxiety and related
  psychopathologies evident in offenders with
  Aspergers Syndrome (Tantam, 2000)
• Emphasis on improving emotional awareness,
  emotion regulation and anxiety management as
  primary criminogenic need (Bolton, 2006 Wood,
  unpublished)
• Traditional CBT treatments for offenders may not
  be appropriate

40
Improving intervention

• Multi-modal rather than a one-size-fits-all
• Heterogeneity must incorporate individuals
  experiences, coping skills emotional resources
• Potential for modified CBT strategies,
  incorporating emotion awareness and regulation
  strategies (Hare, 1997)
• Adapt current ASD interventions - e.g. Social
  Stories and 5 point scale frameworks for
  offender population with ASD?