Extreme violence in a man with an autistic spectrum disorder: assessment and treatment within high-security psychiatric care

Abstract

Autistic spectrum disorders (ASD) are lifelong neurodevelopmental disorders characterised by significant impairments in social communication, social interaction and in different dimensions of imagination such as with perspective taking. Individuals with an ASD who commit violent offences typically present as a challenge to clinicians and struggle within conventional forensic psychiatric services. A case study is described of a young man with an ASD convicted of manslaughter and admitted to high-security psychiatric care (HSPC). His detailed psychological assessment is described, along with an offence formulation and subsequent psychological interventions within HSPC. Additional issues relating to mental capacity, risk assessment and future management are highlighted. A final discussion is given towards some general issues relating to the role of HSPC in the assessment and management of individuals with an ASD who commit serious offences.