Identification and support of autistic individuals within the UK Criminal Justice System: a practical approach based upon professional consensus with input from lived experience.

BACKGROUND: Autism spectrum disorder (hereafter referred to as autism) is characterised by difficulties with (i) social communication, social interaction, and (ii) restricted and repetitive interests and behaviours. Estimates of autism prevalence within the criminal justice system (CJS) vary considerably, but there is evidence to suggest that the condition can be missed or misidentified within this population. Autism has implications for an individual's journey through the CJS, from police questioning and engagement in court proceedings through to risk assessment, formulation, therapeutic approaches, engagement with support services, and long-term social and legal outcomes. METHODS: This consensus based on professional opinion with input from lived experience aims to provide general principles for consideration by United Kingdom (UK) CJS personnel when working with autistic individuals, focusing on autistic offenders and those suspected of offences. Principles may be transferable to countries beyond the UK. Multidisciplinary professionals and two service users were approached for their input to address the effective identification and support strategies for autistic individuals within the CJS. RESULTS: The authors provide a consensus statement including recommendations on the general principles of effective identification, and support strategies for autistic individuals across different levels of the CJS. CONCLUSION: Greater attention needs to be given to this population as they navigate the CJS.

Identification and treatment of individuals with attention-deficit/hyperactivity disorder and substance use disorder: An expert consensus statement.

Attention-deficit/hyperactivity disorder (ADHD) often co-occurs with substance use (SU) and/or substance use disorder (SUD). Individuals with concurrent ADHD and SU/SUD can have complex presentations that may complicate diagnosis and treatment. This can be further complicated by the context in which services are delivered. Also, when working with young people and adults with co-existing ADHD and SU/SUD, there is uncertainty among healthcare practitioners on how best to meet their needs. In February 2022, the United Kingdom ADHD Partnership hosted a meeting attended by multidisciplinary experts to address these issues. Following presentations providing attendees with an overview of the literature, group discussions were held synthesizing research evidence and clinical experience. Topics included: (1) A review of substances and reasons for use/misuse; (2) identification, assessment and treatment of illicit SU/SUD in young people and adults with ADHD presenting in community services; and (3) identification, assessment and treatment of ADHD in adults presenting in SU/SUD community and inpatient services. Dis-cussions highlighted inter-service barriers and fragmentation of care. It was concluded that a multimodal and multi-agency approach is needed. The consensus group generated a table of practice recommendations providing guidance on: identification and assessment; pharmacological and psychological treatment; and multi-agency interventions.

What aspects of vision facilitate haptic processing?

We investigate how vision affects haptic performance when task-relevant visual cues are reduced or excluded. The task was to remember the spatial location of six landmarks that were explored by touch in a tactile map. Here, we use specially designed spectacles that simulate residual peripheral vision, tunnel vision, diffuse light perception, and total blindness. Results for target locations differed, suggesting additional effects from adjacent touch cues. These are discussed. Touch with full vision was most accurate, as expected. Peripheral and tunnel vision, which reduce visuo-spatial cues, differed in error pattern. Both were less accurate than full vision, and significantly more accurate than touch with diffuse light perception, and touch alone. The important finding was that touch with diffuse light perception, which excludes spatial cues, did not differ from touch without vision in performance accuracy, nor in location error pattern. The contrast between spatially relevant versus spatially irrelevant vision provides new, rather decisive, evidence against the hypothesis that vision affects haptic processing even if it does not add task-relevant information. The results support optimal integration theories, and suggest that spatial and non-spatial aspects of vision need explicit distinction in bimodal studies and theories of spatial integration.

Spatial reference and scanning with the left and right hand.

Discrepant findings on performance by the two hands in spatial tasks make it difficult to infer spatial coding unambiguously. We tested the hypotheses (a) that the left hand is consistently better in haptic spatial tasks and (b) that adding spatial reference information produces more accurate coding in spatial tasks, independently task and hand effects. Instructions to use external cues from a surrounding frame as well as body-centred cues for reference produced highly significant increases in accuracy in haptic distance and location experiments. The distance experiments showed no hand differences. A small right-hand advantage with longer positioning movements in the recall of locations was significant when combined with left-hand scanning of the frame, but did not relate to reference conditions. Hand use interacted significantly with the location-versus-distance experiments, but showed no interaction with the spatial reference factor, which was highly significant in both experiments. The finding suggests that modes of coding need to be distinguished from cross-lateral effects of sensory input conditions. The study shows that varying reference information offers a potentially useful behavioural tool for distinguishing spatial coding from input and task conditions independently of hand performance. Methodological, practical, and theoretical implications are discussed.

External and body-centered frames of reference in spatial memory: evidence from touch.

The study reports independent effects of external and body-centered reference cues on spatial coding of an irregular sequence of haptic locations. The aim was to investigate the nature of spatial coding by using a modality that does not provide distal cues routinely. Our method isolates and combines body-centered and external spatial reference cues for irregularly placed locations, scanned along a raised-line route. Disrupting body-centered reference for the locations, by orienting the map differently to the body in the test phase than in the presentation phase, doubled errors in positioning the locations along the route in recall. Adding external reference, by giving instructions to use a surrounding frame for reference when body-centered coding was disrupted, reduced errors to near baseline (no-rotation) levels. Adding external reference cues to intact (not displaced) body-centered reference halved errors, as compared with the baseline. The results are consistent with the hypothesis that accurate spatial coding is determined by the congruence of potential reference cues from diverse sources. The new findings suggest that external and body-centered reference cues have independent additive effects on spatial coding. The sequence of locations had a significant effect in all the reference conditions, suggesting the additional use of fortuitous but distinctive local touch cues on the route. The discussion considers theoretical and practical implications of the results.

The Müller-Lyer illusion in touch and vision: implications for multisensory processes.

In six experiments, we used the Müller-Lyer illusion to investigate factors in the integration of touch, movement, and spatial cues in haptic shape perception, and in the similarity with the visual illusion. Latencies provided evidence against the hypothesis that scanning times explain the haptic illusion. Distinctive fin effects supported the hypothesis that cue distinctiveness contributes to the illusion, but showed also that it depends on modality-specific conditions, and is not the main factor. Allocentric cues from scanning an external frame (EF) did not reduce the haptic illusion. Scanning elicited downward movements and more negative errors for horizontal convergent figures and more positive errors for vertical divergent figures, suggesting a modality-specific movement effect. But the Müller-Lyer illusion was highly significant for both vertical and horizontal figures. By contrast, instructions to use body-centered reference and to ignore the fins reduced the haptic illusion for vertical figures in touch from 12.60% to 1.7%. In vision, without explicit egocentric reference, instructions to ignore fins did not reduce the illusion to near floor level, though external cues were present. But the visual illusion was reduced to the same level as in touch with instructions that included the use of body-centered cues. The new evidence shows that the same instructions reduced the Müller-Lyer illusion almost to zero in both vision and touch. It suggests that the similarity of the illusions is not fortuitous. The results on touch supported the hypothesis that body-centered spatial reference is involved in integrating inputs from touch and movement for accurate haptic shape perception. The finding that explicit egocentric reference had the same effect on vision suggests that it may be a common factor in the integration of disparate inputs from multisensory sources.