Treatment of Individuals with Autism Spectrum Disorders who Display Sexual Offending Behaviours.

Most individuals with autism spectrum disorders (ASD) do not display criminal behaviours, and a penchant for adherence to rules may in fact act as a protective factor against breaking the law in those with ASD . It has however been suggested that the cognitive and behavioural features of ASD such as atypical communication and social interaction styles, difficulties with theory of mind and empathy, inflexibility of thought and repetitive interests, have the potential to leave an individual vulnerable to committing offences, including sexual crimes.

The Autism Act (2009) and later changes in social policy have led to increased recognition and support for autistic offenders, both in the community and those detained at her Majesty's pleasure or under the Mental Health Act. This includes the need for evidenced-based treatment and as such, research has continued to speculate over the presence of ASD in sexual offenders and any potential impact of the clinical features on positive treatment outcomes. It has thus been suggested that the cognitive and behavioural profile referred to above may result in barriers to treatment, particularly in programmes for sexual offending. Sexual offending treatment is typically delivered in groups and includes therapeutic objectives to increase victim empathy and address cognitive distortions to reduce 'pro-offence thinking styles' and attitudes conducive to offending. While many have supposed the ASD phenotype as challenging within treatment programmes, this has not been subjected to rigorous empirical investigation, with autistic offenders frequently being studied within intellectual disability or neurotypical samples rather than as a distinct population. Three studies have therefore been undertaken to begin to address this gap in the evidence based regarding sexual offending treatment for individuals with ASD.

It is widely acknowledged that many adult sexual offenders displayed inappropriate or abusive sexual behaviours during childhood and adolescence, with many missed opportunities for intervention. This pattern also appears to be present in adult autistic sexual offenders, therefore an online prevalence survey (Chapter Five) was undertaken to identify children and young people with ASD who display risky sexual behaviours within services across the UK, and explore current assessment and treatment provisions. Response rate to the survey was low however the data attained illustrated inconsistency in practice across services for both assessment and treatment, with little use of tools or measures adapted specifically for intellectual or developmental disability.

A second study (Chapter Six) provided empirical evidence for sexual offending treatment for individuals with ASD. This was done through interviews with thirteen men with ASD who had completed an adapted sex offender treatment programme and twelve clinicians who facilitated said treatment programmes. The study recorded the collective views and experiences of service users and group facilitators, exploring whether they felt treatment was helpful in reducing risk of re-offending. The findings provided some support for existing propositions regarding the features of ASD and their potential impact on positive treatment outcomes. However, they also illustrated that adapted group sexual offending treatment groups can be beneficial to men with ASD despite potential social or communication difficulties. Challenges remain in shifting cognitive distortions and increasing theory of mind, with changes in affective empathy being a particular caveat in treatment.

To explore empathy in a non-forensic sample (due to challenges in accessing a youth forensic sample) , a final study piloted an adapted empathy course for adolescents with intellectual and developmental disabilities (Chapter Seven). This study examined empathy amongst autistic adolescents, particularly in relation to those with ASD who display challenging or offending behaviours and those who do not, and to those without ASD. A six-week empathy course was run with sixteen students (mean=17.3yrs; SD=11.42). Measures of empathy were taken at (i) baseline, (ii) following a six-week control period, and (iii) after completion of the empathy course. Whilst the measures did not yield any significant increases in empathy, qualitative data from staff and students highlighted improvements in social skills, including increased understanding and awareness of the thoughts and feelings of others. This study illustrated that a short empathy course can be of benefit to adolescents with and without ASD, however for those with more complex needs further input is required to impact behaviour change.

These three studies contribute to the developing body of literature on sexual offending treatment for autistic offenders, providing empirical support to some of the existing suggestions in the literature. The findings from the three studies illustrate the need for appropriate and effective treatment for autistic sexual offenders, and that there are benefits to completing an adapted sex offender treatment programme. Many of these benefits are implicit and relate to improvements in identity, self-esteem and quality of life, with reduction of risk stemming from external or indirect treatment outcomes (e.g. development of external management strategies such as staffing levels, or increased monitoring opportunities) rather than internal change (e.g. shift in cognitive distortions or increases in victim empathy). The empathy profile seen in autistic sexual offenders was echoed in a non-forensic sample of autistic adolescents and further investigation is required into the role of empathy in the development pro-social behaviours and risk of sexual offending.