With specific reference to intellectual disability, Lindsay, Carson, Holland, O’Brien, Taylor, & Steptoe (2014) compared offence incidence and type in those with and without ASD in 477 offenders with ID. The overall prevalence of ASD in this group was 10%, which is consistent with the prevalence of ASD in the general population of people with ID (Cooper et al. 2007 reported a rate of 7.5%). Those with ASD had similar patterns of offending to those without but they showed a lower prevalence of contact sexual offences and fewer had been previously charged. Lindsay et al. (2014) concluded that there was no persuasive evidence that ASD is a risk factor for offending or for any particular type of offending.
21.7 SUMMARY
There have been significant advances in methods for assessment of offenders with ID. This is especially true in the areas of anger and violence and sexual offending.
Standard assessments for propensities towards anger have been adapted and standardised for populations of offenders with ID. This allows the clinician and researcher to assess the client and have a reasonable confidence in the result. It also allows clinicians to compare individual client assessments with results from larger cohorts of people with ID and compare the result with mainstream populations. This is a significant clinical advance enabling much clearer judgements about an individual client’s violence.
Assessments have also been developed for specific relevant issues related to sex offending. We can now understand more clearly the relationship between sexual knowledge and inappropriate sexual behaviour in clients with ID. There are comprehensive sexual knowledge assessments that have norms on both general populations with ID and offenders with ID. There have also been developments in the assessment of fire interest and social problem solving. There have also been significant advances in the assessment of risk for future violence and future sexual offences.
Corresponding to the developments in the assessment techniques, treatment services and procedures are now fairly well established for both anger/violence and inappropriate sexual behaviour. Approaches such as anger management treatment and cognitive behaviour therapy for sex offenders have been adapted to be suitable for offenders with ID. Detailed descriptions of treatment are now available so that practitioners can implement their own programmes suitable to their own particular settings.
Treatments have been evaluated in research and service settings. The best established treatment approach with a number of controlled evaluations is anger management treatment. There are a large number of evaluations regarding sex offender treatment but they do not reach a similar methodological standard as evaluations of anger treatment for this population at this time.
ESSAY/DISCUSSION QUESTIONS
What are the difficulties in the assessment of risk in offenders with intellectual disability?
Review the evidence for and against the view that intellectual disability and autism spectrum are serious risk factors for offending.
Contrast the evidence on the effectiveness of treatment for violent offenders and sexual offenders.
Describe how you would conduct an assessment for criminogenic factors in offenders with intellectual disability.
Low functioning offenders can be assessed and treated in much the same way as any other offender. Discuss this statement.
ANNOTATED READING LIST
Farrington D. P. (2005). Childhood origin of antisocial behaviour. Clinical Psychology and Psychotherapy, 12, 177–189. Farrington and colleagues have conducted a long series of studies on developmental factors leading to criminal careers and pathways into offending. This paper is one of several summaries this major research project. He outlines risk factors from childhood including troublesome behaviour in childhood, poor housing in childhood, poor parental behaviour at 8 years, having convicted parents and low IQ.
Fazel, S., Xenitidis, K., & Powell, J. (2008). The prevalence of intellectual disabilities among 12,000 prisoners: A systematic review. International Journal of Law and Psychiatry, 31, 369–373. This Cochrane review assesses the quality of evidence in studies on the prevalence of offenders with intellectual disability in prison populations. They conclude that in those studies with good quality experimental designs, the prevalence is between 1% and 2%.
Lindsay, W. R., O’Brien G., Carson, D., Holland, A. J., Taylor, J. T., Wheeler, J. R., Middleton, C., Price, K., Steptoe, L., & Johnston, S. (2010). Pathways into services for offenders with intellectual disabilities. Criminal Justice and Behavior, 37, 678–694. This article introduces a major research project reviewing the differences between referrals to community forensic services and secure services. It reviews offenders with ID referred to generic community services, specialist community forensic services, low/medium secure and maximum secure services.
Lindsay, W. R., Steptoe, L., Wallace, L., Haut, F. & Brewster, E. (2013). An evaluation and 20 year follow up of recidivism in a community intellectual disability service. Criminal Behaviour and Mental Health, 23, 138–49. This article provides a description of a mature community forensic learning disabilities service. They found that sex offenders and other types of offenders were quite separate in the offending history, which reflected current offending. Sex offenders were generally older than other types of offender and were more frequently referred from the criminal justice system. Treatment outcome demonstrated significant amount of harm reduction quantified at around 90%.
Michie, A. M., Lindsay, W. R., Martin, V., & Grieve, A. (2006). A test of counterfeit deviance: A comparison of sexual knowledge in groups of sex offenders with intellectual disability and controls. Sexual Abuse: A Journal of Research and Treatment, 18, 271–279. This study tests the hypothesis known as “counterfeit deviance”, which suggests that men with intellectual disabilities commit sexual offences through a misunderstanding of appropriate behaviour and a lack of sexual knowledge. In two linked studies they found that the opposite was the case and that sexual offenders had a higher level of sexual knowledge than non-offenders. Level of knowledge was significantly correlated with IQ in the non-offenders but showed no relationship with IQ in the sex offender group.
Murphy, G. H., Sinclair N., Hays, S. J., et al. (SOTSEC – ID) (2010) Effectiveness of group cognitive behavioural treatment for men with intellectual disabilities at risk of sexual offending. Journal of Applied Research in Intellectual Disabilities, 23, 537–551. In this large collaborative study, 46 sex offenders with ID were treated for one year using a manualised CBT programme. The men were from community and secure settings and were treated in small groups. As with the previous studies on sex offenders, participants showed improvements on measures of victim empathy, sexual knowledge and cognitive distortions with changes maintaining to six-month follow-up. Only the presence of autism spectrum disorders was related to offending although other studies (see above) have found ASD not to be over-represented in offender populations and not to feature in predictions of offender pathways.
Taylor, J. L., Novaco, R. W., Gillmer, B. T., Robertson, A., & Thorne, I. (2005). Individual cognitive behavioural anger treatment for people with mild-borderline intellectual disabilities and histories of aggression: A controlled trial. British Journal of Clinical Psychology, 44, 367–382. This research group have conducted a number of controlled treatment trials on anger management treatment. The study compares 40 men convicted for violence-related incidents, split equally between an experimental and control group. The treated group showed superior progress over the control group on most measures including the Novaco anger scale and staff ratings. Improvements were maintained to a four-month follow-up.
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