Violence is Rare in Autism: When It Does Occur, Is It Sometimes Extreme?

A small body of literature has suggested that, rather than being more likely to engage in offending or violent behavior, individuals with autism spectrum disorder (ASD) may actually have an increased risk of being the victim rather than the perpetrator of violence (Sobsey, Wells, Lucardie, & Mansell, 1995 ). There is no evidence that people with ASD are more violent than those without ASD (Im, 2016). There is nevertheless a small subgroup of individuals with ASD who exhibit violent offending behaviours and our previous work has suggested that other factors, such as adverse childhood experiences, might be important in this subgroup (Allely, Minnis, Thompson, Wilson, & Gillberg, 2014 ). Fitzgerald ( 2015 ) highlights that school shootings and mass killings are not uncommonly carried out by individuals with neurodevelopmental disorders, with frequent evidence of warning indicators. The aim of the present review is to investigate this in more detail using the 73 mass shooting events identified by Mother Jones (motherjones.com) in their database for potential ASD features. There are 73 mass shooting events but there are two events where there is a pair of shooters which meant that 75 mass shooter cases were investigated. This exercise tentatively suggests evidence of ASD in six of 75 included cases (8%) which is about eight times higher when compared to the prevalence of ASD found in the general population worldwide (motherjones.com). The 8% figure for individuals with ASD involved mass killings is a conservative estimate. In addition to the six cases which provide the 8% figure, there were 16 other cases with some indication of ASD. Crucially, ASD may influence, but does not cause, an individual to commit extreme violent acts such as a mass shooting episode.

Prenatal exposure to very severe maternal obesity is associated with adverse neuropsychiatric outcomes in children.

BACKGROUND: Prenatal maternal obesity has been linked to adverse childhood neuropsychiatric outcomes, including increased symptoms of attention deficit hyperactivity disorder (ADHD), internalizing and externalizing problems, affective disorders and neurodevelopmental problems but few studies have studied neuropsychiatric outcomes among offspring born to very severely obese women or assessed potential familial confounding by maternal psychological distress. METHOD: We evaluated neuropsychiatric symptoms in 112 children aged 3-5 years whose mothers had participated in a longitudinal study of obesity in pregnancy (50 very severe obesity, BMI ⩾40 kg/m2, obese class III and 62 lean, BMI 18.5-25 kg/m2). The mothers completed the Conners' Hyperactivity Scale, Early Symptomatic Syndrome Eliciting Neurodevelopmental Clinical Examination Questionnaire (ESSENCE-Q), Child's Sleep Habits Questionnaire (CSHQ), Strengths and Difficulties Questionnaire (SDQ), and Child Behavior Checklist (CBCL) to assess child neuropsychiatric symptoms. Covariates included child's sex, age, birthweight, gestational age, socioeconomic deprivation levels, maternal age, parity, smoking status during pregnancy, gestational diabetes and maternal concurrent symptoms of anxiety and depression assessed using State Anxiety of Spielberger State-Trait Anxiety Index (STAI) and General Health Questionnaire (GHQ), respectively. RESULTS: Children exposed to prenatal maternal very severe obesity had significantly higher scores in the Conners' Hyperactivity Scale; ESSENCE-Q; total sleep problems in CSHQ; hyperactivity, conduct problems and total difficulties scales of the SDQ; higher externalizing and total problems, anxious/depressed, aggressive behaviour and other problem syndrome scores and higher DSM-oriented affective, anxiety and ADHD problems in CBCL. Prenatal maternal very severe obesity remained a significant predictor of child neuropsychiatric problems across multiple scales independent of demographic factors, prenatal factors and maternal concurrent symptoms of anxiety and depression. CONCLUSIONS: Prenatal maternal very severe obesity is a strong predictor of increased neuropsychiatric problems in early childhood.

Multi-informant perspective on psychological distress among Ghanaian orphans and vulnerable children within the context of HIV/AIDS.

BACKGROUND: There is little knowledge about the psychosocial distress of children affected by human immunodeficiency virus infection and acquired immune deficiency syndrome (HIV/AIDS) in Ghana, to aid the planning of services. This study investigated mental health problems among children affected by HIV/AIDS, compared with control groups of children orphaned by other causes, and non-orphans. METHOD: The study employed a cross-sectional survey that interviewed 291 children and their caregivers. Both children and caregivers completed the Strengths and Difficulties Questionnaire that measured children's psychosocial wellbeing. Verbal autopsy was used to identify whether children lost one or both parents from AIDS. RESULTS: The results indicated that controlling for relevant sociodemographic factors, both children's self-reports and caregivers' reports indicate that both children living with HIV/AIDS-infected caregivers and children orphaned by AIDS were at heightened risk for mental health problems than both children orphaned by other causes and non-orphans. The findings further indicated that a significant proportion of orphaned and vulnerable children exhibited symptoms for depression and other psychiatric disorders (approximately 63%) compared with 7% among the non-orphaned group. Caregivers gave higher ratings for children on externalizing problems and lower on internalizing problems, and vice versa when the children's self-reports were analysed. CONCLUSIONS: The findings suggest that both children and their informants have diverse yet complementary perspectives on psychological outcomes. The study discusses the theoretical and practical implications of these findings and urgently calls for necessary intervention programmes that target all children affected by HIV/AIDS to effectively alleviate psychological distress and enhance the mental health of these children.

Autism in Glasgow: cumulative incidence and the effects of referral age, deprivation and geographical location.

BACKGROUND: Referrals to the Greater Glasgow Community Autism Team (CAT) made before the child's sixth birthday were analysed to obtain an estimation of the proportion of children in Greater Glasgow with childhood autism and investigate whether there were any variations in diagnosis rates, or in age at referral and diagnosis, depending on deprivation or geographical location. METHODS: An analysis was made of the database recording referrals to Greater Glasgow CAT, between 2004 and 2007 inclusive, of children referred by age 6 years, comprising 584 cases. Cumulative incidence was calculated for childhood autism. Ages at referral and diagnosis were also analysed. RESULTS: For this subset of children, there were 246 diagnosed cases of childhood autism, a cumulative incidence from 2004 until 2007 of 11.1 per year per 10,000 children aged 0-6 years. Of children with an eventual diagnosis of autism by age 6, 72% were referred by the age of 4 years. Deprivation was found to have an association with referral and diagnostic rates, with higher rates seen in the most deprived. There was geographical variation in the cumulative incidence of autism. CONCLUSION: Given that the populations were not known to differ in any manner that would lead to a true variation, the geographical variation in the cumulative incidence of autism in children up to 6 years in Greater Glasgow observed in this study is likely to represent differences in the care pathway between areas. Such differences may also explain the observed association with deprivation. Reasons for the variation are being explored.

Disruptive behaviour disorders: a systematic review of environmental antenatal and early years risk factors.

Disruptive behaviour disorders (DBDs), including attention-deficit/hyperactivity disorder (ADHD), oppositional defiant disorder (ODD) and conduct disorder (CD) are chronic disorders with significant overlap in aetiology and presentation. An integrative examination of environmental risk factors is lacking. Six literature searches of web-based bibliographic databases were completed to identify literature on DBDs in general and five disorders in particular: CD, ODD, ADHD, deficits of attention, motor control and perception, and reactive attachment disorder. Searches were filtered to focus on studies including diagnostic assessment, focussing on environmental risk and protective factors in the first 4 years of life. The database searches generated 9806 papers of which 47 were reviewed after filters had been applied. The evidence suggests links between a number of early life risk factors and DBDs, including prenatal cigarette smoking and alcohol use, prenatal viral illness, maternal stress and anxiety, low birthweight, peri-partum and early neonatal complications, parental stress and parenting styles in infancy, early deprivation, adoption and separation. Despite the understanding that there is sharing of risk factors between the DBDs, there has been a disproportionate focus on the role of certain risk factors at the expense of others and the field is weakened by difficulties in controlling for all potential confounding variables.

Forty-four juvenile thieves revisited: from Bowlby to reactive attachment disorder.

BACKGROUND: John Bowlby's work on attachment has had a major influence on practice in child and adolescent psychiatry and developed from observations Bowlby made in his clinical work. In a published case series of work with juvenile offenders, he provided a case description of the differing sets of problems that drove his interest. Clinical features described in a subgroup of these offenders, the 'affectionless psychopaths', might be recognized now as reactive attachment disorder (RAD). METHODS: We scrutinized Bowlby's case series '44 Juvenile Thieves' and compared the aetiology and clinical features of a subgroup of these children with the other 74 cases described by Bowlby. We selected one typical case as an exemplar and provide an edited version here. We then present one composite case from a recent study of RAD and provide a comparison with typically developing children. RESULTS: Of the Bowlby cases, 86% had experienced early prolonged separation from their primary caregivers and had experienced multiple care placements. In total, 10% of clinical comparisons had been similarly separated. In our recent sample, 66% of children experienced separation from primary caregivers compared with none of the comparison group. A similar proportion of our sample of children with RAD had been removed from home as a result of neglect or had experienced other forms of maltreatment. CONCLUSIONS: Bowlby beleived that a main aetiological factor in the development of difficulties was the experience of separation. We suspect that a main aetiological factor in both his and our cases is the experience of maltreatment. We suggest that RAD arises from a complex interplay of genetic and environmental triggers.

Should we aspire to screen preschool children for conduct disorder?

Life-course persistent conduct disorder is a major public health problem with implications for individual health and for society at large. Recent evidence has shown that treatment can be cost-effective, and early symptom detection is improving. We weigh the evidence for and against the introduction of population screening for conduct disorder in early childhood using Wilson and Jungner's criteria.

The Strengths and Difficulties Questionnaire: a pilot study of a new computer version of the self-report scale.

A computer-based version of the self-report Strengths and Difficulties Questionnaire (SDQ) was developed with colourful graphics illustrating each question. One hundred and two children referred to child and adolescent mental health services were recruited and randomly allocated to complete either the new computer-based version or the paper original. A further 112 children from local schools were recruited and completed the computer-based version of the scale. All children who took part in the study were aged between 8 and 15 years. The paper version of the SDQ is recommended for use in children aged 11 and over and, in this age group, the computer-based questionnaire was able to discriminate between the clinical and community sample (ROC = 0.761, 95 % CI 0.676-0.846). Comparison of the paper-based SDQ and computer-based SDQ within the clinic sample found trends towards better test-retest reliability, inter-rater reliability and significantly better user satisfaction in the computer version compared to the paper-based version. The computer-based SDQ has the added advantage of results being automatically added to a spreadsheet out of view from the user reducing the chance of operator error in coding and entering the data. These preliminary results suggest that the computer-based version of the SDQ may represent a further improvement on the paper SDQ. All versions of the SDQ, including the computer-based version, can be downloaded from the Strengths and Difficulties website address www.sdqinfo.com.

Mental health and foster carer training.

AIMS: To evaluate the impact of training foster carers on children's emotional and behavioural functioning. METHODS: In a randomised controlled trial in 17 Scottish local council areas, with immediate and nine month follow up, 182 children and their foster families were randomly allocated to either standard services alone or standard services plus extra training for foster carers on communication and attachment. Main outcome measures were child psychopathology, attachment disorder, self esteem, and cost of foster care. RESULTS: Over 60% of children had measurable psychopathology at baseline. The training was perceived as beneficial by participants. Scores for parent reported psychopathology and attachment disorders decreased by around 5%, self esteem increased by 2%, and costs by 22% in the intervention group. Results were non-significant. CONCLUSIONS: Despite being well received by foster carers, the training was not sufficient to make a useful impact on the high level of psychopathology. This group may warrant more intensive interventions.