Traits of Autism Spectrum Disorder and Co-Occurring Mental Health Problems Among Prisoners

Thursday, May 15, 2014
Atrium Ballroom (Marriott Marquis Atlanta)
H. L. Hayward1, L. Underwood1, J. M. McCarthy2, E. Chaplin3 and D. G. Murphy4, (1)Institute of Psychiatry, King's College London, London, United Kingdom, (2)St. Andrew's Healthcare Nottinghamshire, Mansfield, United Kingdom, (3)Behavioural and Developmental Psychiatry, Clinical Academic Group, Insititute of Psychiatry, King's College London, London, United Kingdom, (4)Department of Forensic and Neurodevelopmental Sciences, Institute of Psychiatry, King's College London, London, United Kingdom

The provision of support for people with autism spectrum disorder (ASD) within the community is improving as a consequence of policy and legislative changes. However, specialist services are not currently provided in prisons.  Also recent initiatives to improve mental health care within the criminal justice system have not considered people with ASD. As a consequence, ASD and associated vulnerabilities including depression, anxiety and suicidality often go unrecognised and unsupported.


This aim of the study was to determine the extent of ASD and co-occurring mental health problems among prisoners.  We tested the hypothesis that ASD traits would be unrecognised by prisons, and would be significantly associated with increased rates of anxiety, depression and suicidality.


ASD traits were measured among 240 prisoners in a resettlement prison in London, UK using the 20-item Autism Quotient (AQ-20). Anxiety, depression and suicidality were assessed using the Mini International Neuropsychiatric Interview (MINI).


There were 39 participants (16%) with an AQ-20 score ≥10; indicating significant autistic traits. 12 prisoners (5%) were above research diagnostic cut off scores for ASD on the ADOS. Only three of these had been previously identified as having ASD. Mental health data were available for 37 ‘high autistic trait’ participants and another 101 prisoners with no/low ASD traits. There was a significant positive association between AQ-20 and suicidality scores (r=.29, p=0.001). Participants with ASD traits had significantly higher suicidality scores (means=15.1 (ASD) vs. 5 (non-ASD), p= 0.001) and chi-square analysis showed that they were more likely to have a high suicidality rating (27% vs. 8 %), p=0.003) than those without ASD traits. Moreover, those with ASD were significantly more likely to be suffering from a current episode of depression (30% vs. 6%, p<0.001) or Generalised Anxiety Disorder (GAD) (27% vs. 11% p=0.019) and there were significant positive associations between AQ-20 and current depression (r=.43, p<0.001) and current GAD symptoms (r=.254, p=0.003).


We identified high levels of unrecognised ASD traits among prisoners.  Our initial data suggests that severity of ASD traits is a risk factor for suicidality and common mental health problems among prisoners. Improvements in prison health care should include improved recognition of ASD, and the detection (and appropriate treatment) of commonly occurring mental health symptoms.

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