Intra- & Extra-Familial Child Homicide in Sweden 1992-2012: A Population-Based Study

Previous studies have shown decreasing child homicide rates in many countries - in Sweden mainly due to a drop in filicide-suicides. This study examines the rate of child homicides during 21 years, with the hypothesis that a decline might be attributable to a decrease in the number of depressive filicide offenders (as defined by a proxy measure). 

In addition, numerous characteristics of child homicide are presented. All homicide incidents involving 0-14-year-old victims in Sweden during 1992-2012 (n = 90) were identified in an autopsy database. Data from multiple registries, forensic psychiatric evaluations, police reports, verdicts and other sources were collected. Utilizing Poisson regression, we found a 4% annual decrease in child homicides, in accordance with prior studies, but no marked decrease regarding the depressive-offender proxy. 

Diagnoses from forensic psychiatric evaluations (n = 50) included substance misuse (8%), affective disorders (10%), autism-spectrum disorders (18%), psychotic disorders (28%) and personality disorders (30%). Prior violent offences were more common among offenders in filicides than filicide-suicides (17.8% vs. 6.9%); and about 20% of offenders in each group had previously received psychiatric inpatient care. 

Aggressive methods of filicide predominated among fathers. Highly lethal methods of filicide (firearms, fire) were more commonly followed by same-method suicide than less lethal methods. Interestingly, a third of the extra-familial offenders had an autism-spectrum disorder. 

Based on several findings, e.g., the low rate of substance misuse, the study concludes that non-traditional risk factors for violence must be highlighted by healthcare providers. Also, the occurrence of autism-spectrum disorders in the present study is a novel finding that warrants further investigation.

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By:  Hedlund J1, Masterman T2, Sturup J3.

• 1National Board of Forensic Medicine, Department of Forensic Psychiatry, PO Box 4044, SE-141 04 Huddinge, Sweden; Karolinska Institutet, Department of Clinical Neuroscience, SE-171 77 Stockholm, Sweden. Electronic address: jonatan.hedlund@ki.se.
• 2National Board of Forensic Medicine, Department of Forensic Psychiatry, PO Box 4044, SE-141 04 Huddinge, Sweden; Karolinska Institutet, Department of Clinical Neuroscience, SE-171 77 Stockholm, Sweden.
• 3National Board of Forensic Medicine, Department of Forensic Psychiatry, PO Box 4044, SE-141 04 Huddinge, Sweden; Karolinska Institutet, Department of Clinical Neuroscience, SE-171 77 Stockholm, Sweden; Stockholm University, Department of Criminology, Sweden.
• J Forensic Leg Med. 2016 Jan 25;39:91-99. doi: 10.1016/j.jflm.2016.01.011.  

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Impact of Psychiatric Information on Potential Jurors in Evaluating High-Functioning Autism Spectrum Disorder (hfASD)

During a trial involving an offender with a mental disorder, jurors are often required to evaluate information on the disorder and its characteristics. This evaluation relies on how jurors understand and synthesize psychiatric and other evidence on the disorder and this information's impact on the case, an offender's culpability, and the rendered verdict. The importance of this evaluation is further highlighted when jurors are faced with evaluating a disorder that may be associated with criminal actions of diagnosed offenders, such as high-functioning autism spectrum disorder (hfASD). 

We designed a three-part survey to assess potential jurors' attitudes concerning an offender's diagnosis with hfASD in terms of perceptions and decisions surrounding legal and moral responsibility, personal characteristics of the offender, the introduction of psychiatric and genetic information, and the condition's influence on the facts of the case. A sample of 623 jury-eligible U.S. adults completed the survey. 

We found the majority of participants were influenced by the information provided on hfASD. Most respondents indicated that hfASD diagnosis should generally not affect the legal responsibility of an offender, but many reported the disorder as a mitigating factor when evaluating moral responsibility and legal consequences for criminal actions. Respondents reported favorable and sympathetic perceptions of individuals with autism and associated characteristics but were unsure, even after the presentation of psychiatric information on hfASD, if these disorders should be classified as "mental illness." Further, the majority reported their views were in some way influenced by the fact that hfASD has potential genetic origins.

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By:  Berryessa CM1, Milner LC2, Garrison NA3, Cho MK4.

• 1Stanford Center for Biomedical Ethics Stanford University, and Department of Criminology University of Pennsylvania.
• 2Stanford Center for Biomedical Ethics Stanford University.
• 3Center for Biomedical Ethics and Society Vanderbilt University, and Department of Pediatrics Vanderbilt University Medical Center.
• 4Stanford Center for Biomedical Ethics Stanford University, and Department of Pediatrics Stanford School of Medicine. 

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Template to Perpetrate: An Update on Violence in Autism Spectrum Disorder

Introduction

For the past two decades, researchers have been using various approaches to investigate the relationship, if any, between autism spectrum disorder (ASD) and violence. The need to clarify that relationship was reinforced by the tragic mass shooting at Sandy Hook Elementary School in Newtown, Connecticut, in December 2012 by an individual diagnosed with Asperger’s syndrome. The purpose of this article is (1) to provide an updated review of the literature on the association between ASD and violence, and (2) to examine implications for treating, and for preventing violence by, individuals with ASD.

Method

A review of all published literature regarding ASD and violence from 1943 to 2014 was conducted using electronic and paper searches.

Results

Although some case reports have suggested an increased violence risk in individuals with ASD compared to the general population, prevalence studies have provided no conclusive evidence to support this suggestion. Among individuals with ASD, however, generative (e.g., comorbid psychopathology, social-cognition deficits, emotion-regulation problems) and associational (e.g., younger age, Asperger’s syndrome diagnosis, repetitive behavior) risk factors have been identified or proposed for violent behavior.

Conclusions

While no conclusive evidence indicates that individuals with ASD are more violent than those without ASD, specific generative and associational risk factors may increase violence risk among individuals with ASD. Further research would help to clarify or confirm these findings, suggest potential directions for evaluation, treatment, and prevention, and potentially provide compelling empirical support for forensic testimony regarding defendants with ASD charged with violent crimes.

Full article at:   http://goo.gl/ZzmyDM

By:  David S. Im, MD

From the University of Michigan Medical School and Center for Forensic Psychiatry, Saline, MI.

Correspondence: David S. Im, MD, 8303 Platt Rd., Saline, MI 48176. Email: vog.nagihcim@dmi

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Parental Awareness of Sexual Experience in Adolescent Boys with Autism Spectrum Disorder

Parent report and adolescent self-report data on lifetime sexual experience in adolescents with ASD were compared in 43 parent-adolescent dyads. Parents tended to underestimate the lifetime sexual experience of their sons, particularly solo sexual experiences such as masturbation and experience with orgasm. Parental underestimation and unawareness of adolescents’ sexual experience may influence communication and education about sex and sexuality in families. These findings have implications for the interpretation of earlier research, based on parent and caregiver reports, on sexuality in adolescents with ASD.

...Parent-adolescent agreement about sexual experiences was higher with respect to romantic relationships and partnered sexual experiences than solo sexual experiences. The majority of the boys with ASD in this study had been in a romantic relationship, and most parents were aware of this; nevertheless about a third of parents underestimated their sons’ partnered sexual experience. The underestimation of sexual experience of their sons’ might reflect limited discussion of sexual experiences between adolescents and parents. It is also possible that assumptions about their sons’ lack of sexual experience temper parents’ inclination to discuss partnered sexual behaviours with their sons. The taboo on discussing romantic relationships is possibly less strong than the taboo on talking about the sexual aspects of relationships. The higher level of agreement about partnered sexual experience might also be explained by the generally lower frequencies of partnered experiences. Given parental underestimation, the probability of agreement on the absence of a behaviour is higher in the case of low-frequency behaviours (Mollborn and Everett 2010). It would be interesting to examine parent-adolescent agreement on the partnered sexual experiences of older boys with ASD as it is possible that a higher proportion of them will have had partnered sexual experiences.

The number of boys who reported having forced someone else to do sexual things or having been forced to do sexual things themselves was low. Slightly more parents stated that they did not know if their son had coerced someone into sexual behaviour than reported that they did not know if their son had been victimised sexually. This finding should be interpreted with care, given the exploratory nature of this study; however parents could have doubted about the possibility that their sons coerced others to sexual behaviours...

Agreement on sexual experience between boys with ASD and their parents (N = 43 dyads)

Relational or sexual behaviour	Adolescent report		Parental report						Parental awarenessa
			Agreement on occurrence		Agreement on non-occurrence		Do not know
	n	%	n	%	n	%	n	%	n	%
Masturbation	41	95.3	22	53.6	1	50	19	44.2	23	53.5
Orgasm	38	88.4	19	50	1	100	22	51.2	20	46.5
Relationship	32	74.4	28	87.5	10	91	1	2.3	38	88.4
French kissing	26	60.5	20	76.9	12	71	7	16.3	32	74.4
Petting above clothes	24	55.8	16	66.6	12	63	11	25.6	28	65.1
Penile/vaginal intercourse	12	27.9	8	66.7	22	71	12	27.9	30	69.8
Making love to a boy	1	2.3	0	0	39	93	3	7	39	90.7
Forcing someone else to do sexual things	2	4.7	1	50	35	85	7	16.3	36	83.7
Being forced to do sexual things	3	7	1	33.3	37	92	1	2.3	38	88.4

aParents correctly aware of the presence or absence of sexual behaviour

Full article at:   http://goo.gl/nWdOMu

By:  J. Dewinter, R. Vermeiren, I. Vanwesenbeeck, and Ch. Van Nieuwenhuizen

Tranzo, Scientific Centre for Care and Welfare, Tilburg University, PO Box 90153 (T618), 5000 LE Tilburg, The Netherlands

GGzE Centre for Child and Adolescent Psychiatry, PO Box 909 (DP1104), 5600 AX Eindhoven, The Netherlands

Department of Child and Adolescent Psychiatry, Curium-LUMC, PO Box 15, 2300 AA Oegstgeest, Leiden, The Netherlands

VU Medical Centre Amsterdam, PO Box 303, 1115 ZG Duivendrecht, The Netherlands

Interdisciplinary Social Science, Utrecht University, PO Box 80140, 3508 TC Utrecht, The Netherlands

Rutgers WPF, PO Box 9022, 3506 GA Utrecht, The Netherlands

J. Dewinter, Phone: (0031)402613700, Email: eb.neprewtna@retniwed.neorej.

  

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Different Brain Responses During Empathy in Autism Spectrum Disorders vs Conduct Disorder & Callous-Unemotional Traits

BACKGROUND:

Deficits in empathy are reported in autism spectrum disorders (ASD) and also underlie antisocial behavior of individuals with conduct disorder and callous-unemotional traits (CD/CU+). Many studies suggest that individuals with ASD are typically impaired in cognitive aspects of empathy, and individuals with CD/CU+ typically in affective aspects. In the current study, we compared the neural correlates of cognitive and affective aspects of empathy between youth with ASD and youth with CD/CU+.

METHODS:

Functional magnetic resonance imaging (fMRI) was used to assess boys with ASD (N = 23), boys with CD/CU+ (N = 23), and typically developing (TD) boys (N = 33), aged 15-19 years. Angry and fearful faces were presented and participants were asked to either infer the emotional state from the face (other-task; emotion recognition) or to judge their own emotional response to the face (self-task; emotional resonance).

RESULTS:

During emotion recognition, boys with ASD showed reduced responses compared to the other groups in the ventromedial prefrontal cortex (vmPFC). During emotional resonance, the CD/CU+ and ASD groups showed reduced amygdala responses compared to the TD controls, boys with ASD showed reduced responses in bilateral hippocampus, and the CD/CU+ boys showed reduced responses in the inferior frontal gyrus (IFG) and anterior insula (AI).

CONCLUSION:

Results suggest differential abnormal brain responses associated with specific aspects of empathic functioning in ASD and CD/CU+. Decreased amygdala responses in ASD and CD/CU+ might point to impaired emotion processing in both disorders, whereas reduced vmPFC responses suggest problems in processing cognitive aspects of empathy in ASD. Reduced IFG/AI responses, finally, suggest decreased emotional resonance in CD/CU+.

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By:  Klapwijk ET1,2, Aghajani M1,2, Colins OF1,2, Marijnissen GM3, Popma A4,5, van Lang ND1,2, van der Wee NJ2,6, Vermeiren RR1,2,4.

• 1Department of Child and Adolescent Psychiatry, Curium - Leiden University Medical Center, Leiden, The Netherlands.
• 2Leiden Institute for Brain and Cognition (LIBC), Leiden, The Netherlands.
• 3Centrum Autisme Rivierduinen, Leiden, The Netherlands.
• 4Department of Child and Adolescent Psychiatry, VU University Medical Center, Amsterdam, The Netherlands.
• 5Institute of Criminal Law & Criminology, Faculty of Law, Leiden University, Leiden, The Netherlands.
• 6Department of Psychiatry, Leiden University Medical Center, Leiden, The Netherlands. 

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Trajectories of Internalizing & Externalizing Symptoms among Adults with Autism Spectrum Disorders

Individuals with autism spectrum disorder (ASD) experience higher rates of psychopathology than their typically developing peers or peers with other intellectual or developmental disabilities. Little is known about the developmental course of psychiatric symptoms such as internalizing and externalizing behaviors in this population. 

Individual characteristics and aspects of the family environment may explain variability in outcomes for adults with ASD. The present study extends our current understanding of psychopathology among individuals with ASD by examining group-based trajectories of internalizing and externalizing symptoms in adulthood. Overall, the results showed that symptoms became less severe over time. Distinct patterns of change in psychopathology were observed and associated with differential profiles of psychotropic medication use, comorbid mental health diagnoses, and residential placement. The likelihood of following each developmental trajectory was estimated based on characteristics of the adults with ASD (gender, adaptive behavior, and autistic symptoms) and maternal expressed emotion (criticism and warmth). 

Maternal criticism and warmth were identified as key risk and protective factors, respectively, with important implications for future research and intervention for individuals with ASD.

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By:  Woodman AC1, Mailick MR2, Greenberg JS2.

• 1University of Massachusetts-Amherst.
• 2University of Wisconsin-Madison. 

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Callous–Unemotional Traits in Adolescents with Autism Spectrum Disorder

People with callous–unemotional traits and also those with autism spectrum disorder (ASD) display sociocognitive difficulties. However, the frequency and neurocognitive correlates of callous–unemotional traits within individuals with ASD are unknown.

Aims:  To determine the prevalence of callous–unemotional traits in individuals with ASD and test their association with behavioural and cognitive measures.

Parents of 92 adolescents with ASD completed the Antisocial Processes Screening Device (APSD) for callous–unemotional traits. Adolescents participated in tasks of emotion recognition, theory of mind and cognitive flexibility.

In total 51% (n = 47) scored above a cut-off expected to identify the top 6% on the APSD. Of these 17% (n = 8) had concurrent conduct problems. Regression analyses found callous–unemotional traits were associated with specific impairment in fear recognition but not with theory of mind or cognitive flexibility.

Adolescents with ASD show high rates of callous–unemotional traits but, unlike in the general population, these are not strongly associated with conduct problems. The relationship of callous–unemotional traits to impairments in fear recognition suggests similar affective difficulties as in individuals with callous–unemotional traits without ASD.

Full article at: http://goo.gl/lEfzDH

By:  Virginia Carter Leno, Tony Charman, Andrew Pickles, Catherine R. G. Jones, Gillian Baird, Francesca Happé, and Emily Simonoff

Virginia Carter Leno, BSc, MSc, Department of Child and Adolescent Psychiatry, King's College London, Institute of Psychiatry, Psychology & Neuroscience, London; Tony Charman, PhD, Department of Psychology, King's College London, Institute of Psychiatry, Psychology & Neuroscience, London; Andrew Pickles, PhD, Department of Biostatistics, King's College London, Institute of Psychiatry, Psychology & Neuroscience, London; Catherine R. G. Jones, PhD, School of Psychology, Cardiff University, Cardiff; Gillian Baird, FRCPCH, Guy's & St Thomas' NHS Foundation Trust, Newcomen Centre, London; Francesca Happé, PhD, MRC SDGP Centre, King's College London, Institute of Psychiatry, Psychology & Neuroscience, London; Emily Simonoff, MD, FRCPsych, Department of Child and Adolescent Psychiatry, King's College London, Institute of Psychiatry, Psychology & Neuroscience and NIHR Biomedical Research Centre for Mental Health, London, UK

Correspondence: Virginia Carter Leno, Department of Child and Adolescent Psychiatry, Institute of Psychiatry, Psychology & Neuroscience, King's College London, 16 De Crespigny Park, London SE5 8AF. Email: ku.ca.lck@onel_retrac.m.ainigriv

 

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Violent Fantasies in Young Men with Autism Spectrum Disorders: Dangerous or Miserable Misfits? Duty to Protect Whom?

Predictability of dangerousness in association with mental disorders remains elusive, outside of a few relatively well-established risk factors for the prognostication of violence, such as male sex, the presence of a psychotic disorder, and comorbid substance abuse. 

In clinical practice, inquiry into the presence of aggressive or violent ideation, in the form of ideas of homicide or suicide, is part of a standard mental status examination. Nonetheless, fantasy life, when it concerns harm toward others, may not be as reliable an indicator of imminent danger as it may be in the case of self-harm. Five cases of young Italian men with Asperger syndrome and recurrent and extremely violent femicide fantasies are presented. 

While there is no direct correlation between autism spectrum conditions and violence, as other humans, persons with an autistic condition are capable of committing crimes, including homicide. All five had in common a number of characteristics and behaviors felt to be pathoplastic: All had been bullied, all had been romantically rejected, all were long-standing First Person Shooter (FPS) game players, and all were avid violent pornography consumers. 

The potential for an actual neurocognitive impact of violent video games, well documented in the literature, and its combination with personal life history and chronic habituation following long-standing violent pornography use is discussed in the context of social and emotional vulnerabilities. 

While aggressive fantasies cannot and should not be underestimated, in countries where duty to protect legislation does not exist, a clinical approach is imperative, as, incidentally, should be anywhere.

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By: Palermo MT1, Bogaerts S2.

• 1Medical College of Wisconsin, Milwaukee, USA The Law and Behavior Foundation, Amsterdam, The Netherlands mt.palermo@lawandbehavior.org.
• 2Tilburg University, The Netherlands.  

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