Identification and support of autistic individuals within the UK Criminal Justice System: a practical approach based upon professional consensus with input from lived experience

In the International Classification of Diseases, 11th revision (ICD-11) autism is characterised by, ‘Persistent deficits in initiating and sustaining social communication and reciprocal social interactions; Persistent restricted, repetitive, and inflexible patterns of behaviour, interests, or activities; Lifelong excessive and persistent hypersensitivity or hyposensitivity to sensory stimuli or unusual interest in sensory stimuli’ [4] and similarly described by the Diagnostic and Statistical Manual, 5th Edition Text Revision (DSM-5 TR) [5]. Due to diversity in presenting behaviours, autism is a highly heterogenous condition [6]. Estimated prevalence of autism in the general population is between 1 and 2.5% for children and adults [7, 8] and continues to increase as a result of awareness, earlier diagnoses and changes in diagnostic criteria [9, 10]. Reported diagnosis rates are three times higher in biological males than females [10, 11] but the biological male:female ratio is debated due to potential sex differences in detection, referral and assessment. It should be noted that the prevalence rates of autism for those who self-report gender incongruence is much higher. A recent meta-analysis utilising data from 25 studies consisting of 8662 participants identified an autism prevalence rate of 11% in individuals with gender dysphoria/incongruence [12]. Although the core features of autism are reported to remain stable across the lifespan [13], this is not universally accepted [14].

Despite the extensive literature on autism, research exploring autism within the CJS is limited [15, 16]. Barriers to completing high-quality research within the CJS include challenges in obtaining detailed developmental histories necessary for a comprehensive assessment, co-occurring conditions and differential diagnoses, and access to clinical populations in secure settings. Additional ethical considerations arise when attempting to complete research with individuals in secure settings. In response to historical abuse, the UK research regulatory bodies (such as the National Research Ethics Service) focus on protecting those in secure settings as vulnerable participants who have limited capacity for informed consent and whose confidentiality and privacy may not be assured, all whilst being within a restrictive or coercive environment [17]. These factors lead to small sample sizes and varied methodologies resulting in mixed research findings and conclusions that may be limited.

The core features of autism are not inherent risk factors for engaging in offending. Some literature reviews and meta-analyses consisting of a small number of studies indicate that autistic individuals are no more likely to engage in potential criminal offences than the general population [18‐21]. Some research indicates that autistic individuals are less likely to engage in offending. For example, in a Danish follow-up study of 113 individuals (82 males and 31 females; mean age 40.3 years) with a diagnosis of childhood autism, only one was convicted of a criminal offence (0.9%), compared with 18.9% in the control group [22]. It is important to highlight that autistic individuals may be more likely to have contact with the CJS as victims rather than perpetrators of crime [23]. For example, a literature review by Sevlever [24] and colleagues (2013) identified that difficulties recognising the emotions or intentions of others can increase vulnerability in becoming victims of sexual abuse or assault crimes.

For the small subgroup of autistic individuals who do engage in potential criminal offences, it is important to consider how specific characteristics of their autistic profile may have contributed to vulnerabilities in their pathway into offending behaviour. It is imperative to consider this on a case-by-case basis, particularly when a set of environmental circumstances outweighs an individual’s ability to cope [25]. Literature reviews and some small-scale studies have suggested that characteristics associated with autism can be linked to potential criminal offences. For example, social naivety, intense preoccupations and a narrow range of interests, theory of mind (or mentalising) differences (understanding other’s thoughts and beliefs), sensory sensitivities, emotional regulation difficulties, poor impulse control, a tendency to focus on small details and difficulty seeing ‘the bigger picture’ and the co-occurrence of other psychiatric conditions [20, 26‐30]. Autistic individuals may have more difficulty making decisions by weighing up the subjective value of two different options, particularly if there is not a clear right or wrong answer [31]. This may have direct implications as to how autistic individuals navigate challenging social situations. Associated risk factors such as trauma, childhood adverse experiences and bullying are also relevant [30]. Some research has identified that the link between circumscribed interests and potential criminal offences for autistic individuals who experience them is less clear. For example, in a small UK-based case study of 21 autistic offenders (18 men and three women) [32], Woodbury-Smith and colleagues (2010) found that for 15 of the autistic offenders, the content and intensity of their interests were not be linked with their offence.

A small number of studies have indicated that characteristics associated with autism may increase the risk of engaging in sexual offences for a small subset of young people [33‐36] and adults [37]. Limited evidence prohibits any concrete conclusions being drawn. However, possible increased rates of sexual offending compared with non-autistic individuals have been linked to certain features of autism, such as differences in sexual development [38‐40] and/or sexual frustration due to difficulties in developing appropriate sexual relationships [35, 41].

It has been suggested that autistic traits (such as circumscribed interests and difficulties with consequential thinking, along with generally higher technical ability) rather than a diagnosis of autism may be associated with cybercrime, such as hacking [42‐46]. Given the core and associated features of autism, there are also potential concerns that some autistic individuals may be more susceptible to radicalisation for several reasons, including cognitive rigidity, hyper-focusing, differences with abstract thinking, information processing and problem solving [47]. However, there is very little evidence available and more research is required.

In summary, the evidence on autism and engaging in potential criminal offences is inconclusive. Retrospective studies relying on pre-existing diagnoses (such as crime registries) may be fallible due to autism being missed or misdiagnosed [48]. Therefore, rates of offending perpetrated by autistic individuals may be underrepresented in the literature. Any link between autism and offending behaviour is likely to arise from an amalgam of individual, environmental and contextual factors.

The prevalence of autism within the CJS and secure settings is unknown [49]. There are a number of explanations for this. For example, Chaplin and McCarthy [50] highlighted that autism is not part of the prison screening process in the UK [50] and there is a lack of suitable, autism-sensitive, assessment tools [25, 51, 52]. Furthermore, incarcerated populations are not static, and individuals move between institutions, creating challenges for assessments and tracking.

Many research studies exploring the prevalence of autism rely on screening questionnaires, such as the Autism Spectrum Quotient (AQ) [53], which has been shown to have poor sensitivity and specificity in clinical populations [54]. There are also limitations when using the AQ in forensic contexts due to the type of questions and nature of institutional settings [55]. Despite debates over the quality of study methodologies [21], some research has found comparable rates of autism in community and forensic populations [56‐58]. However, findings are inconsistent, with some research indicating that autistic young people are more likely to come into contact with the CJS [59]. Although some consider autism to be under-recognised within the CJS [58, 60], others have reported higher rates of autism in youth and adult forensic populations compared with the general population, with rates ranging between − 4 and 4.4% [61, 62].

It is important to consider other possible influences on autistic prevalence rates in forensic settings. For example, some autistic individuals may be less able to deceive others [63, 64]. Additionally, some individuals may not be aware that their behaviour constitutes a criminal offence [65]. Existing research has predominantly focused on biological males, and little is known about the rates of autism in biological females or in specific ethnic minority backgrounds within forensic settings. Research indicates that autistic individuals from ethnic minority backgrounds are less likely to be diagnosed, receive financial benefits, such as Disability Living Allowance, or access appropriate services in the community [66]. This may be reflected within forensic populations, but further research is required.

In both community and forensic populations, it is the norm rather than the exception for other neurodevelopmental and mental health conditions to co-occur with autism [67‐71]. Co-occurring conditions include psychotic disorder, substance use disorders, personality disorder, anxiety, depression, obsessive–compulsive disorder, bipolar disorder, post-traumatic stress disorder, intellectual disability and attention deficit/hyperactivity disorder (ADHD) [48, 72‐80].

Research also indicates that prisoners with elevated levels of autistic traits have increased vulnerability to mental health problems and are more likely to self-report self-harm compared with prisoners without ADHD, intellectual disability or autism [81]. Rates of suicidal ideation and completed suicide are higher than in non-autistic community populations [82, 83]. This may be influenced by a range of factors, such as genetic associations [84], restricted and repetitive behaviours [85], difficulties in communicating their experiences and having access to appropriate services [86, 87], the co-occurrence of low mood [88], sub-optimal self-esteem [89] and efforts to camouflage and conform to societal expectations and minimise stigma [90].

In January 2014, the Criminal Justice Joint Inspection published “A joint inspection of the treatment of offenders with learning disabilities within the criminal justice system” [91, 92] which included neurodevelopmental conditions such as autism. It found that the awareness and support for individuals with such conditions within the police, courts and prison services was insufficient. As a result, autistic individuals can be disadvantaged during their journey though the CJS [93]. Since this time efforts have been made to raise awareness of autism within these institutions, but more is required. The Criminal Justice Joint Inspection (CJJI) made a number of recommendations for improvement. These included, identifying a screening tool for universal use with the CJS, systematic collection of data to determine accurate prevalence rates and needs, the development of a neurodivergent awareness programme for staff, appropriate adjustments for neurodivergent individuals and improved coordination between different CJS agencies [94].

Although this consensus focuses on autistic individuals who have committed potential criminal offences, it is important to note that some autistic individuals may have contact with the CJS as suspects, victims and/or witnesses. In a study of 35 Canadian autistic adults (aged 18–65) recruited from communities across Canada, 80% reported at least one lifetime interaction with police as either a suspect, victim, witness or in the context of a mental health crisis. Furthermore, 39% reported four to nine interactions with police and 14% reported 10 or more interactions [95]. In a large US sample of 920 autistic individuals (83.1% males and 67.2% white), Rava and colleagues (2017) [59] found that by 21 years of age, approximately 20% of autistic young people had interacted with law enforcement officers. In a prospective Canadian study, which followed a sample of 284 autistic adolescents and adults over a 12- to 18-month period in the community, approximately 16% had some form of police involvement during the study period [96].

Police officers have reported dissatisfaction in their management of interactions with autistic individuals. For example, Crane and colleagues [97] surveyed 394 police officers (ranging from constables to superintendents) from England and Wales. Approximately half (52%) of the police officers did not feel knowledgeable about autism and 29% reported feeling poorly equipped to manage effectively. Overall, only 42% reported feeling “satisfied” with how they worked with the autistic individuals. Autistic individuals also reported their dissatisfaction during police interactions.

The extant literature highlights difficulties at the police interview stage due differences in how autistic individuals remember and report their experiences during this socially and cognitively demanding context [98]. To date, most research has focused on autistic witnesses. However, in a recent study, Bagnall and colleagues (2023) interviewed autistic mock suspects about a novel virtual burglary scenario. Innocent (truth telling) autistic mock suspects reported fewer details that would support their innocence than non-autistic mock suspects. They also self-reported greater difficulty in understanding interview questions, had higher anxiety and perceived the interview as less supportive than non-autistic participants [99]. Similar findings were reported in a small Australian study of 32 university students (20 males and 12 females; 20–64 years) with diagnoses of autism or Asperger syndrome [100]. In the study, autistic and non-autistic adults were asked to listen to scenarios where the police believed erroneously that they had been involved in crime. Each scenario included critical information that could extricate them if the participant recognised the significance of this information and informed the police. Compared with non-autistic adults, autistic adults performed markedly worse on perspective-taking measures and the extrication task. These findings indicate that if the police erroneously suspect criminal involvement, autistic adults may have more difficulty in allaying police suspicions and extricating themselves from the focus of investigations than non-autistic peers.

The Police and Criminal Evidence Act 1984, Code C Revised [101] details that young people and vulnerable adults should be provided with an appropriate adult to safeguard their rights, entitlements and welfare. Although this legislation exists, it may not be applied appropriately and is dependent on the recognition of the vulnerability [102]. Whilst it is widely recognised that professional training about autism and managing autistic individuals’ distress whilst in police custody is important, concerns have been raised about availability of this training for police officers [103‐107]. In England and Wales, police receive a 2-h mental health training programme, which includes only a subsection related to autism. As such, policy reform and improved training for police officers has been recommended to reduce distress and miscarriages of justice for autistic individuals [103].

Vulnerability in autistic individuals may be overlooked due to good expressive language skills and intellectual capability. These skills may mask difficulties in understanding, processing and responding to questions and demands during police interviews or interrogations [108]. Some autistic individuals may have difficulty understanding both the verbal and written caution that is prescribed upon arrest [109]. Understanding the police caution is integral to allow an individual the opportunity to protect their legal interests. A failure in understanding their rights may increase the risk of self-incrimination.

Due to difficulties managing the demands of police questioning, differences in receptive language ability, and additional sensory and emotional (such as anxiety) stressors during interviews, the behaviour of autistic individuals could be misinterpreted as deceitful, less credible, non-compliant, challenging or disrespectful [110‐112], particularly if they have been wrongly accused or are unaware as to why they are being questioned. For other autistic individuals, misinterpretation may be due to qualitative differences in verbal and non-verbal communication, processing and/or memory difficulties, reduced cognitive flexibility, tangential thinking, Theory of Mind (mentalising) differences, repetitive movements, unusual preoccupations and perseverative interests [63].

Research indicates that individuals with ADHD (a neurodevelopmental condition with genetic, biological and behavioural features that partially overlap with autism) show more vulnerabilities during police questioning [113]. Although they are no more susceptible to interrogative suggestibility, research suggests that they are more likely to give “don’t know” responses than individuals without ADHD [114, 115]. ADHD has also been associated with higher rates of false confessions due to weakened resilience under police pressure and unhelpful attempts to end that pressure [116, 117]. By contrast there is relatively little research into suggestibility, compliance and false confessions in autistic individuals (e.g. [108, 118, 119]). The extant evidence to date suggests that autistic adults are no more suggestible than non-autistic adults (i.e., they are just as—but no more—likely to incorporate leading suggestions into their recollection of events), but they may be more compliant to (knowingly) ‘go along’ with interviewer requests and suggestions. For example, in a small UK study of 26 autistic adults (19 males and seven females; mean age 26.5 years) Chandler and colleagues [120] found that autistic individuals were more acquiescent to interviewer requests to give more of their time for free than non-autistic adults. They also scored significantly higher on the self-reported Gudjonsson Compliance scale, indicating that autistic individuals may be more likely to try and ‘please’ others by saying what they think the other individual wants to hear, irrespective of whether it is a true or accurate account of reality [120]. Similarly to those with ADHD, autistic individuals may also wish to remove themselves from the challenging situation.

Over the past 10 years, an accumulating body of experimental research indicates that standard police interviewing techniques can be ineffective in supporting autistic individuals to recall their testimony [121‐123]. However, the introduction of Registered Intermediaries offers a platform for appropriate adaptations to be made during investigative interviews with autistic victims and witnesses. For instance, a Registered Intermediary can conduct a communication assessment, provide bespoke recommendations for questioning and facilitate communication during the interview process (see [124]). Currently, the Registered Intermediary Scheme in England and Wales (as outlined in the Youth Justice and Criminal Evidence Act, 1999) [125] does not apply to police suspects. Rather, the accused is specifically excluded from this provision. If autistic individuals lack appropriate support and have negative experiences during initial contact with the CJS, this may have immediate and long-term consequences for future engagement.

Following police contact, autistic suspects may move further through the CJS. They may face high levels of distress in the context of an interrogative interview or courtroom proceedings [108]. From the authors’ current experiences, the sensory aspects of the courtroom (such as lighting and noise) can cause significant sensory overload and distress for autistic individuals which may lead to negative experiences and/or difficulties with engagement. It is possible that these reactions to sensory overload are misinterpreted by jurors, the judge or prosecutor as indications of guilt or deliberate acts of antisocial behaviour (see [111, 126‐130]).

Judges and juries often lack appropriate lived experience, knowledge and awareness of how autistic characteristics impact on offending behaviour, including criminal intent, behavioural control and false perceptions about potential for violence and aggression [130‐132]. Legal professionals tasked with supporting their clients may also lack appropriate knowledge [133]. As a result, concerns have been raised as to whether the needs of autistic individuals are being met during criminal trials [130, 134‐137] and whether juries may form inaccurate views of defendants [138, 139].

Currently, the special measures legislation in England and Wales applies solely to victims or witnesses, not suspects or defendants. These include a range of measures to support victims or witnesses, such as giving evidence from behind a screen, via video link or in private, removal of wigs and gowns by judges and barristers, intermediaries and aids to communication. Nevertheless, the courts have the power to appoint an Intermediary (referred to as ‘Court Appointed Intermediary’) if this is deemed necessary for a defendant. In this instance, an individual with suspected social communication difficulties would benefit from a comprehensive assessment prior to trial, and special measures applied where appropriate. Recommendations for interviewing vulnerable defendants and general principles for planning to question vulnerable individuals and those with social and communication needs are outlined in the Advocates Gateway Toolkits (www.​theadvocatesgate​way.​org). Broadening legislation to support the needs of autistic suspects and defendants would improve and facilitate the process. In the meantime, advocates can seek reasonable adaptations in the court’s inherent discretion as an issue of procedural fairness. Some research suggests that a more holistic ‘trauma-informed’ approach to courts would be preferable to measures for specific categories of stakeholder [140, 141]. A trauma-informed approach acknowledges the rates and impact of trauma, seeks to understand trauma and its influence upon individuals, how it is experienced and responded to and attempts to create a ‘safe’ environment, minimising the risk of re-traumatisation. A trauma-informed approach recognises that many mental health ‘symptoms’ in survivors are actually psychological, biological and behavioural response to repeated or chronic trauma and represent intuitive coping efforts to manage traumatic distress [142]. A trauma-informed approach would involve treating everyone with dignity and respect, providing a non-judgmental approach, being mindful of how language is used and positions of power and control and making environmental adaptations. For autistic people, there is a need to consider the causes of trauma, for example the impact of sensory differences and underlying causes in the environment and a need to acknowledge and address the overlap between trauma and neurodivergence.

With regard to competency, research indicates that compared to non-autistic individuals, autistic individuals have a poorer understanding of the courtroom process which underscores the importance of appropriate support and the implementation of special measures when required (for further information see: [109, 143]. Judges consider on a case-by-case basis, whether a diagnosis of autism may negate the essential criminal elements which are required when establishing a defendant’s criminal liability or criminal responsibility. When determining criminal responsibility, two components are required, namely, (1) That the person committed the act (“actus reus”, Latin for ‘guilty act’), (2) That they had criminal intent, or intent to cause harm (“mens rea”, Latin for ‘guilty mind’). For some autistic defendants, responsibility and culpability for criminal conduct may be diminished. Berryessa [130] recommends that judges consider whether an autism diagnosis affects and negates the ability of a defendant to formulate the appropriate state of mind to commit certain criminal acts (“mens rea”). This is particularly important in cases involving specific intent crimes [130]. Specific intent crimes are crimes in which the role of the prosecution is to prove that the defendant had the desire to commit a specific crime to in order to achieve a certain outcome. The core features of autism might alter a defendant’s specific intent by undermining their capacity to form the requisite intent to harm with reference to criminal responsibility and the ability to control or project the full consequences of their actions [130, 144, 145]. Many autistic individuals are able to engage in thoughtful deliberation prior to acting. However, when some autistic individuals are in a context which is stressful, confusing or overwhelming their behavioural response may be perceived by others as aggressive ([27] as cited in [144]). These differences or difficulties in perspective taking underscore the importance of considering a defendant’s autism diagnosis when determining criminal responsibility [26, 146]—at least on a case-by-case basis.

There is a lack of research into autistic individuals being accused of complicity crimes (not acting as a principal offender but playing a role in a plan or as an accessory). It may be important to consider how an autistic individual perceives and/or understands the essential plan and their intent in the furtherance of someone else’s crime. Recent cases in England and Wales have highlighted a reluctance by courts to recognise autism as relevant to state of mind.¹ In the absence of clear research, there is a risk of an assumption of complicity. In practice, the onus is on the defendant’s legal team to instruct experts to assess the individual and determine their understanding of the offence.

Conviction may result in incarceration in either prison or a secure hospital. Some research has indicated that in these settings, autistic individuals are more vulnerable to social isolation, bullying, exploitation, sexual victimisation and difficulties developing and maintaining relationships [147‐149]. Communication differences can make it difficult for autistic individuals to convey their experiences to their support systems. This may impact on their support systems’ ability to meet their needs [150‐152]. There is a bidirectional responsibility for both to be aware of communication differences in order to minimise misinterpretations and misunderstandings, and to maximise support. This may be more challenging for autistic individuals with a co-occurring intellectual disability, additional adaptions and support may be required to facilitate effective communication. It is important to consider that secure environments themselves, including the structure and routines provided in prisons or secure hospitals, can be supportive for some autistic individuals [152‐154], but challenging for others [151, 152].

Adapting to new environments, such as police stations, courtrooms and secure units can be particularly distressing for autistic individuals. Autistic individuals of all ages face several challenges when entering secure environments, including interacting with other prisoners, adapting to prison routines, and managing relational aggression [155]. Coupled with qualitative differences in social communication and difficulties in communicating their internal experiences and needs, autistic individuals may experience greater distress than their non-autistic peers. Minor adaptations (in accordance with secure institutions security protocols) can be made to accommodate some of these difficulties [156]. For example, for autistic individuals with hypersensitivity to noise, providing noise cancelling headphones or access to low-stimulating retreat areas may be beneficial for their overall wellbeing.

It could be argued that the prison environment is challenging and difficult for every prisoner, irrespective of diagnosis. However, for a subgroup of autistic individuals, secure environments can be particularly distressing. To date, the National Autistic Society (NAS) has accredited five prisons that have made adaptations to their environment and approach: HMYOI Feltham, HMP Parc; HMP Whatton, HMP Wakefield and HMP Peterborough. Adaptations were required to cover all aspects of prison life, including education, mental health, primary care and the prison itself. Where physical adaptations are not operationally viable or safe, autistic individuals may benefit from additional information, such as details about specific routines and behavioural expectations and safe methods of soothing, such as providing sensory resources or facilities. For many autistic individuals, ensuring that the environment and routine remains as predictable as possible may assist in minimising situational stress.

As highlighted by Newman, Cashin and Graham [151], there is increasing recognition that autistic adults in prison are more vulnerable to bullying, social isolation, sexual victimisation; exploitation or confrontations with other prisoners and to experiencing ‘meltdowns’ and ‘shutdowns’ [93, 147, 148, 157‐159]. They are also more likely to be socially isolated compared with non-autistic prisoners [147]. This is unsurprising given the wealth of literature which has found that autistic individuals are more vulnerable to manipulation and bullying in the general population. Van Roekel and colleagues [149] suggest that autistic adolescents may be at a greater risk for being victimised due to difficulties in developing and maintaining social interactions and relationships; difficulties in understanding the behaviour and intentions of others [160] as well as communication differences and difficulties and stereotyped behaviour/interests that may not adhere to peer norms [161]. In turn, safety issues have raised controversies about whether autistic individuals should be extradited to face trial in other jurisdictions [162, 163].

Some autistic individuals may be allocated to special population units (e.g. vulnerable prisoner units) in an attempt to provide protection from bullying and victimisation from other prisoners [164]. For other autistic individuals, segregation or separation units may come to act as forms of behaviour management [151, 164]. However, autistic individuals may find it particularly difficult to communicate with staff about negative experiences of bullying, resulting in them not receiving access to necessary support [159]. A small Norwegian qualitative study (eight males and one female) carried out by Helverschou and colleagues [154] found that autistic individuals in forensic services did not feel confident with non-autistic prisoners, and also reported feeling different from them. One autistic individual described a preference to spend his time alone due to being teased and receiving negative comments from other prisoners.

Due to the heterogeneity of autism, and the fact that some autistic individuals may find the routine and structure of secure units quite regulating, it is not possible to provide recommendations for specific environmental adaptations. However, it is important that adaptations are considered, monitored and reviewed regularly. It is recognised that there may be limitations due to service resources, but support could be considered on a case-by-case basis, as needs differ for each autistic individual. Lewis and colleagues provide a clear framework for prisons to systematically work towards addressing needs for autistic individuals [159]. These standards are also in line with the NAS’s accreditation process.

Non-pharmacological support is typically delivered across disciplines such as psychology, occupational therapy, speech and language therapy, education, nursing, social work and psychiatry. Characteristics commonly associated with autism (such as cognitive inflexibility, difficulties working in groups and differences in empathy) can present challenges to effective engagement and positive outcomes for non-pharmacological support and risk reduction programmes [165‐167]. From the authors’ knowledge and experiences, access to appropriate psychosocial support varies greatly between services. ‘Alexithymia’ refers to difficulties experiencing, identifying and expressing emotions [156, 168, 169]. Research indicates that 40 to 65% of autistic individuals are alexithymic (e.g. [168, 170]), which is likely to contribute to and/or exacerbate core socio-emotional difficulties in autism. Alexithymia may impact on the accessibility and effectiveness of standardised programmes (for example, when individuals are encouraged to identify, address and self-regulate unhelpful or intense emotions related to their offending).

There are no pharmacological interventions for the core features of autism. In cases of extreme aggression against the self or others, the National Institute for Health and Care Excellence (NICE) guidelines recommend anti-psychotic medication [171, 172]. However, it should be noted that the purpose of such medications is to manage behavioural difficulties rather than treating core features of autism. Medication may be prescribed for co-occurring conditions such as anxiety, depression, psychosis and ADHD, and indeed this may be central to risk reduction and rehabilitation in some autistic individuals with an offending history [48, 68].

To the authors’ knowledge, there have been no empirical studies investigating the rates of reoffending or extensions to the length of stay for autistic individuals in secure settings. This gap in our knowledge places significant limitations on our ability to define and determine the effectiveness of targeted support and current care strategies for this potentially vulnerable population.

Understanding and meeting the needs of autistic individuals within the CJS is essential for their care, public protection and for professionals working in forensic clinical practice. In order to develop understanding, it is important to examine and synthesise what is currently known, and to generate a professional consensus with input from lived experience on good practice when working with autistic individuals within the CJS. Given the variability of individual needs and service provisions, it is beyond the scope of this paper to provide specific recommendations. However, this paper provides general recommendations across different levels of the UK CJS.

There is a growing recognition that current standardised risk assessments, such as the Historical-Clinical-Risk Management-20, Version 2 [243] and Version 3 [244] have limited use with autistic individuals [25, 51, 245‐247] given they are normed on the general population.

Inappropriate assessments may lead to professionals either over- or under-estimating an autistic individual’s level of risk (e.g. [187, 246, 248]). There are additional complexities in assessing risk for autistic individuals, including inherent social communication differences, variation in presentations and co-occurring conditions, which may affect autistic individuals differently [51, 52, 247]. Therefore, it is recommended that structured risk assessment tools such as Version 3 of the HCR-20 [244] and the Risk of Sexual Violence Protocol Version 2 (RSVP-V2) [249] should also provide an adjunct individual formulation. Given the limitations of current risk assessments for autistic individuals, we suggest that the tools applied are carefully considered and assessments are conducted by professionals with specialist training in autism.

To date, no risk assessment tools have been validated for use with autistic individuals. However, the Framework for the Assessment of Risk and Protection in Offenders on the Autistic Spectrum (FARAS) [198] can be a useful clinical tool. The author clearly indicates that the FARAS must not be used to replace standardised risk assessments, but as an adjunct to and to supplement standardised risk assessments to address the autism-related functions of areas of risk and protection. It is recommended that professionals either familiarise themselves with the tool or undertake specific FARAS training before use. It should only be used by those who have completed training in formal risk assessment. The FARAS is organised in seven sections based on features of autism that relate to risk factors and protective factors in offending behaviour and offers guidance on how each facet can be considered during the interview. The information obtained from the FARAS should be integrated into the formulation of risk and protection, and may inform support and risk management strategies.

An autism-appropriate risk assessment should include consideration of co-occurring mental health conditions, social awareness, cognitive and socio-emotional intelligence, vulnerability to exploitation or sexual victimisation, stereotyped behaviours, unusual or atypical preoccupations and self-harm and/or suicidality. An individualised review of protective factors should also be considered, such as the impact of the immediate environment, given the difficulties some individuals may have managing changes in their environment and sensory differences (see Gunasekaran, 2012) [51].

Evidence suggests that differences in social cognition account for a substantial amount of social communication difficulties for autistic individuals [250]. Social cognition is associated with the perception, processing and interpretation of social interactions. Differences in explicit and implicit social cognition may inform our understanding of an individual’s risk. The Dewey Story Test [251] requires individuals to judge eight sample social situations and determine how they would respond. It can inform our understanding of how an individual is seeing the world, including complex social relationships. This may need to be considered differently depending on whether the accused individual is alleged to be a principal or complicit offender.

When communicating risk assessment findings to autistic individuals, conclusions should be presented clearly and concisely. The individual’s presentation and social communication during the risk assessment may inform clinical thinking about the context of their autistic functioning and the most appropriate, effective way to provide feedback. For example, a detailed, matter-of-fact offence account which appears to lack social and emotional sensitivity may reflect the individual’s detailed and literal cognitive and communication style, differences in Theory of Mind (mentalising) and qualitative differences in non-verbal communication.

Due to the heterogeneity within autism, a ‘one-size-fits-all’ approach cannot be utilised. Following an autism diagnosis, a review of the individual’s strengths and differences should inform support strategies that are appropriate for their specific profile of needs.

For convicted individuals with an existing autism diagnosis, it is important that there is continuity of care as they transition from community services to forensic services. It cannot be assumed that individuals who were diagnosed with autism in the community have received adequate psychoeducation or support, particularly as many out-patient diagnostic services discharge individuals once the assessment process has been completed. Therefore, it may be helpful to consider a review of strengths and differences before tailoring management, assessment and rehabilitation approaches.

Access to appropriate support for autistic individuals relies on available resources, including appropriately trained clinical staff. This may vary between different facets of the CJS, which is not surprising given that recommendations for support typically follow the identification of impairment or difficulties (such as a conviction for an offence). In line with government guidelines, some programmes within secure services and probation settings are accredited by the Correctional Services Accreditation and Advice Panel (CSAAP) and their delivery must adhere to specific standards. Some programmes are flexible enough to allow for specific adaptations to ensure individual responsivity. However, when the autistic individual’s risk, needs and responsivity cannot be addressed through accredited programmes, individualised alternative support may be considered.

Rehabilitation is much broader than specific psychosocial support and includes all aspects of the individual’s day-to-day living. In this respect, autism awareness training may be helpful for all those involved in the individual’s care and support, including professionals making decisions about the individual’s case. This includes solicitors, prison officers, educators, clinicians, probation and The Parole Board. Based on our knowledge and experience, this level of awareness is not universal across the CJS.

Overall, evidence for the effectiveness of support for autism is inconsistent. This may contribute to the apprehension or concern with which some autistic individuals may approach recommended support. Possible exceptions include those associated with supported employment [252] and more recently those concerning mentoring or life-coaching [253].

In 2000, the Department of Health assumed responsibility for healthcare provision within Her Majesty’s Prison Service, with full administrative control completed in 2006. Since this time, several improvements have been reported, including improved healthcare services in prison, increased engagement of service users ‘voice’ in service development and improved continuity of care for people as they transition from prison to the community [298]. In addition, prison and probation services are required to provide a level of social care and support equal to that of people living in the community [299].

Regarding the management of young and adult autistic individuals within the CJS, we recommend that a ‘shared record’ of the individual’s needs is communicated to all agencies involved throughout their journey within the CJS. Some potential challenges for professionals working with autistic individuals are identified in Table 3.

Based on individual needs, custodial alternatives could be considered along with joint working with local community forensic teams. In such cases, appropriate support could be made available. This may require collaborative work between secure services and community services, including the sharing of knowledge, experience, tools and education. In addition, courts will require information about the evaluation of the effectiveness of such support.

Local multiagency strategic planning groups could be developed between autism and criminal justice services. Representatives who have received specialist training from each service (such as police and prison health care staff) could follow the individual throughout their CJS journey [300]. These individuals and groups need to be fully integrated into the care plan to ensure effectiveness.

Individuals with mental health needs receive a Care Programme Approach [301, 302] within secure units. A CPA is a package of care that covers a range of domains (such as risk and support strategies) and requires the input from a multidisciplinary team. A CPA care co-ordinator is allocated to prepare and manage the individual’s care plan and review it at least once a year [303]. Other jurisdictions within the UK may have similar processes, such as Care and Treatment Planning, in Wales. For autistic individuals with co-occurring mental health needs and receiving CPAs, we encourage these to be reviewed at least every 6 months, and/or in advance of a significant change (such as release), and/or in response to a significant incident (such as being the victim or perpetrator of violence). The absence of structured support such as CPAs could disadvantage or limit progression. In addition, autistic individuals with co-occurring mental health needs would benefit from regular psychiatric reviews to identify, monitor and manage their mental health needs.

Given that major transitions may be challenging for autistic individuals [304, 305], attention could be given to all transitions from initial contact with the CJS to integration back into the community. A critical time intervention approach [306] in which a designated individual meets with the individual prior to their release and manages their care plan in the community could be considered. This could include liaising with relevant local services and their general practitioner.

It may be beneficial to refer autistic individuals to locality Forensic Outreach Liaison Services (FOLS) within England, and other jurisdictions may have similar services (e.g. Supporting Offenders with Learning Difficulties (SOLD) in Scotland). These are multidisciplinary NHS services working with autistic individuals and/or those with intellectual disability in the CJS, including those who have been released. Where identified needs are linked to autism and/or intellectual disability, FOLS can provide direct intervention and support. The Forensic Intellectual and Neurodevelopmental Disabilities (FIND) services that form part of FOLS can provide risk assessment reports tailored to the needs of autistic individuals. FIND services offer an experienced multidisciplinary team approach (including psychiatry, psychology, nursing and social work) to complete access assessments and care pathway monitoring for those transitioning into and out of secure services. FIND services can also offer individuals and services assessment advice, training and information when transitioning out of secure care. Depending on the individual’s needs, this can be extended for a short period in their new placement.