I think part of the confusion I'm having in "digesting" this article is the way the authors seem to move from a "psychological/psychiatric" vocabulary to a "legal" one, just about every other sentence or so. And since I've got what I think is a fair layperson's grasp of both, I suspect I know enough to think myself into confusion....and not out again.
As far as the vocabulary goes, I am embarrassed to admit that I did not know it is typically a "forensic psychiatrist" that would determine competency to stand trial until I tried to make some sense of this article. But the authors also seem to be using the term "forensic" or "forensics" as something akin to a "psychological autopsy," reviewing or meta-reviewing previous work, trying to reach some sort of conclusion, and essentially throwing their hands up in the air and saying more work needs to be done. I guess that's how I've mentally summarized the article, but there were a few poinst that rather stuck in my craw:
1) This is a quote from the article re: Broadmoor Hospital in the UK, which I'm presuming is the sort of facility that would be used to house the "criminally insane" (not sure what the UK analogue is) in the US
Quote:
Homicide occurred at a rate consistent with the special hospitals' base prevalence, sexual offenses were underrepresented (3% versus 9%), and arson was over-represented (16% versus 10%).
Yet, when the authors provide the three case-studies,
2 of the 3 are related to sexual misconduct? Umm, why? If the Broadmoor data is valid in any sense, shouldn't the case studies have reflected this?
2) Since Broadmoor is a psychiatric hospital, I'm presuming the population reviewed was not found competent to go to trial, based upon some condition or other. And only a minority of the population the researchers determined to have ASD had been previously diagnosed as such. Meaning, a very high rate of co-morbidit[y/ies], noted by the authors, but not at all expounded upon. Nor was their even an attempt to justify this tested population as having any bearing at all on the general population on the ASD.
3) Shouldn't they have given a nod somehow or somewhere to the prevalence or lack thereof in the "general" (non-psychiatric) prison population, of, say, a medium security prison? But there's not a syllable on anything close to that. This is especially puzzling since if ASD rates are above average, perhaps these inmates could be helped, or even transferred to a more appropriate setting. And if they're below average? I'm honestly not sure what they'd say then. Maybe return some grant money?
4) Back to co-morbidity...They do mention it numerous times, but never quantify what is most common, and what is rare (except for co-morbidity w/psychotic disorders). The reason I mention this is that the incarceration rate AND recidivism rate for people with ADHD is absolutely horrendous. See:
21% To 45% 0f Prisoners Have ADHD 15 Peer Reviewed Studies Show. Crime & Jail Are Costly, Treatment Is Cheap (link) for a tolerably written article on the topic. Even better, if you can get your hands on a copy, is the book
ADHD in Adults: What the Science Says (google e-bk excerpts). Anyway, if there's a high co-mordity between ASD and ADHD, which we don't know from the article, clearly that would have to be accounted for somehow. And I suspect the same for Borderline Personality Disorder and doubtless others.
Finally, I guess I'm frustrated that they spent so much time building "castles in the air" with Theory of Mind arguments, variant brain functions, and so on, before they really made a case that there's a problem out there for ASD folks in this area. Heaven knows we have enough in other parts of our life.
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"The man who has fed the chicken every day throughout its life at last wrings its neck instead, showing that more refined views as to the uniformity of nature would have been useful to the chicken." ? Bertrand Russell