The protective scale of the Armidilo-S: The importance of forensic and clinical outcomes.

BACKGROUND: The Armidilo has two scales-the risk scale and the protective scale. Research has been confined to the risk scale which appears to predict future incidents with medium to large effect sizes. There have been no publications on the use of the protective scale. METHODS: The Armidilo was completed on four individuals with IDD who were either moving on from their placement or whose placement was in jeopardy because of new information or altered policies in the organization. The Armidilo was completed in the usual fashion. RESULTS: Risk and protective results show that for each individual, recommendations could be made that ensured the best outcome. For two participants, restrictive placements were avoided because of the data on protective factors. CONCLSIONS: The protective scale can be a powerful support for the clinician's case in offenders with IDD. The protective scale should be completed routinely for clinical evaluation.

An evaluation and 20-year follow-up of a community forensic intellectual disability service.

BACKGROUND: Since the middle of the 20th century, there have been several heterogeneous studies of recidivism by offenders with intellectual disabilities (ID) who have been in specialist mental health services after an index offence. Although some were long term, as befits a chronically needy group, laws and services have changed in that time. It may no longer be appropriate to rely on findings from the 1960s and 1970s. AIMS: To compare mental health presentations and recidivism between male sex offenders, men convicted of other offences and female offenders from a 1986-2008 cohort of offenders referred to specialist forensic ID services in Scotland. METHOD: A 20-year follow-up of an assessment and treatment service for 309 offenders with ID (156 sex offenders, 126 non sexual male offenders and 27 women) was conducted. RESULTS: Sex offenders were more likely to be referred from the courts and had lower anger levels. Women were more likely to be diagnosed with mental illness. There was a split between groups with sex offenders committing few nonsexual offences and the other groups showing few sexual offences. During the study period, 16% of sexual offenders, 43% of male nonsexual offenders and 23% of women committed at least one further offence. Following assessment and treatment there was a 90-95% reduction in offending incidents. CONCLUSIONS: Although recidivism rates are disappointing, harm reduction data suggests that assessment and treatment for offenders with ID can be highly successful in terms of public safety.

Alcohol and its relationship to offence variables in a cohort of offenders with intellectual disability.

BACKGROUND: Alcohol use and misuse may be lower in people with intellectual disability (ID) than in the general population but may be related to offending. METHOD: Alcohol-related crime and history of alcohol use was recorded in 477 participants with ID referred to forensic ID services and related to offending. RESULTS: Level of alcohol-related crime and history of alcohol misuse was lower than in some previous studies at 5.9% and 20.8%, respectively. History of alcohol abuse was associated with alcohol-related offences and theft. Higher rates of alcohol problem history were associated with histories of a number of offences, psychiatric disturbance in adulthood, psychiatric disturbance in childhood, and experiences of childhood adversity. Most effect sizes were weak or moderate. CONCLUSIONS: The convergence of childhood adversity, psychiatric problems in childhood and adulthood, and alcohol abuse is consistent with studies that have found these as risk markers for offending.

Referrals into services for offenders with intellectual disabilities: variables predicting community or secure provision.

BACKGROUND: There is a need for research to promote an understanding among service developers on why people with intellectual disabilities (ID) are referred to offender services in order for them to receive appropriate assessment and treatment. Previous studies investigating referrals into forensic ID services have concentrated on referral sources and administrative variables such as legal status. AIMS: To construct a predictive model for choice of service referral based on a comprehensive range of information about the clientele. METHOD: We conducted a case record study of 336 people referred to community services and 141 to secure provision. We gathered information on referral source, demographics, diagnosis, index behaviour, prior problem behaviours and history of abuse. RESULTS: Comparisons revealed 19 candidate variables which were then entered into multivariate logistic regression. The resulting model retained six variables: community living at time of referral, physical aggression, being charged, referral from tertiary health care, diverse problem behaviour and IQ < 50, which correctly predicted the referral pathway for 85.7% of cases. CONCLUSIONS: An index act of physical aggression and a history of diversity of problem behaviours as predictors against the likelihood of community service referral suggest that professionals have similar concerns about people with ID as they do about their more average offending peers; however, the more severe levels of ID mitigated in favour of community referral, regardless. Offenders with ID tend to be referred within levels of service rather than between them, for example, form tertiary services into generic community services.

Risk assessment in offenders with intellectual disability: a comparison across three levels of security.

In mainstream offender samples, several risk assessments have been evaluated for predictive validity. This study extends this work to male offenders with intellectual disabilities. Participants from high-, medium-, and low-security settings, as well as community settings, were compared on a range of risk assessments. The Violence Risk Appraisal Guide, HCR-20-Historical Scale, the Risk Matrix 2000-C (combined risk), and the Emotional Problems Scales-Internalising discriminated between groups, with participants from high security having higher scores than those in medium security, who had higher scores than those in the community. The Violence Risk Appraisal Guide, all HCR-20 scales, the Short Dynamic Risk Scale, and the Emotional Problems Scales (Internalising and Externalising) showed significant areas under the curve for the prediction of violence. The Static-99 showed a significant area under the curve for the prediction of sexual incidents. The discussion reviews the value of these various scales to intellectual disability services.

Pathways through services for offenders with intellectual disability: a one- and two-year follow-up study.

The pathways through services for offenders with intellectual disability were reviewed. Participants were 197 offenders with intellectual disability accepted into three types of community and three types of secure forensic intellectual disability services. They were first compared with 280 participants referred but not accepted into services and were then followed-up for 2 years to review pathways through services. Those accepted into services had a higher charge rate than did those who were referred (46% and 25%, respectively). The greatest diversity in pathway was seen in participants in community forensic intellectual disability and inpatient services. Individuals in secure settings showed the least diversity over time, and, similarly, a relatively high percentage of those accepted into generic community services remained in these services.

The Ward and Hudson pathways model of the sexual offense process applied to offenders with intellectual disability.

The offense pathways model of Ward and Hudson has had a significant impact on work with sex offenders. Researchers have hypothesised that offenders with intellectual disability (ID) will show a predominantly avoidant and passive pathway. The present study classifies 62 sex offenders with ID according to the four self-regulation pathways. Allocation to pathways is highly reliable and, against prediction, most participants are allocated to approach pathways. Explicit/active offenders have a higher rate of contact offenses and a lower rate of reoffending. Automatic/passive offenders have a lower average IQ. There are no significant differences between groups on victim choice, previous offenses, or assessment of cognitive distortions. The results suggest that treatment may improve understanding of society's laws, promote self-regulation, and reduce recidivism for explicit/active offenders.

Internal consistency and factor structure of personality disorders in a forensic intellectual disability sample.

BACKGROUND: The publication of the DSM-III (American Psychiatric Association (APA), 1980) prompted a significant increase in interest and research on personality disorder (PD), and the concept has subsequently been incorporated into mental health legislation in the developed world. Despite this, such research on people with intellectual disability (ID) has been sporadic, with widely varying results. The present study addresses a number of criticisms directed at previous research. METHOD: DSM-IV (APA, 2000) diagnoses of PD were made on 164 participants with ID on the basis of four independent sources of classification. RESULTS: Reliability data for each PD was acceptable and alpha was .74 or above, with the exception of schizotypal PD (.63). Exploratory and confirmatory factor analyses were conducted, with the former revealing a 4-factor solution accounting for 58.9% of the variance, and a 2-factor solution accounting for 37.2% of the variance emerging for the latter. The factors were orthogonal, and we called the first factor "avoidant/rumination/inhibited" and the second factor "acting out". DISCUSSION: We review these findings in relation to previous research on PD and alternative frameworks for the understanding of personality. We hypothesise consistencies between these findings and previous work on personality and ID. A number of drawbacks to the research are discussed, including a caution on the pejorative nature of a diagnosis of PD in an already devalued population.

Quality of life and relationships in sex offenders with intellectual disability.

BACKGROUND: Hayes (1991) and Day (1994) have developed hypotheses about the importance of social and developmental variables in the aetiology of sexual offences in offenders with intellectual disability. The present study is the first of its kind to investigate the perceived quality of life and relationships of sex offenders in comparison to an appropriate control group. METHOD: A group of 28 sex offenders with intellectual disability (ID) were compared with 28 members of a control group of individuals with ID. All participants completed the Significant Others Scale (SOS) which assesses self-perceptions of potential and ideal support from significant others in the individual's life, and the Life Experience Checklist (LEC) which assesses experiences and opportunities across 5 living domains: home, leisure, freedom, relationships and opportunities. RESULTS: There were no differences between the groups on age and IQ. On the SOS there were no differences between the groups on the number of times each significant other was reported. Actual and ideal levels of support from both mother and father were lower for sex offenders than the control group. On the LEC, sex offenders reported lower scores on the relationships and leisure sections. CONCLUSIONS: Poorer relationships and little indication of any wish to change that state of affairs suggests lower levels of integration and identification with society for sex offenders compared with the control group.

A comparison of offenders with intellectual disability across three levels of security.

BACKGROUND: A number of authors have described, with disparate results, the prevalence of people with intellectual disability and their characteristics, in a range of offender cohorts defined by service use. These have included high security, a range of criminal justice services and community services. There is a need for research comparing cohorts of offenders with intellectual disabilities across different settings. AIM AND HYPOTHESIS: To conduct such a comparison and test the hypothesis that severity of characteristics measured will be highest in highest levels of residential security. METHOD: A clinical-record-based comparison a offenders with intellectual disability in high security (n = 73), medium/low security (n = 70), and a community service (n = 69). RESULTS: Groups were similar in age and tested IQ levels. Early psychiatric service contact had been more likely in the lower security groups. In line with the hypothesis, more complex presentations, in particular comorbid personality disorder, was more likely in the highest security group. Both fatal and non-fatal interpersonal violence convictions were significantly related to group, with more in the high security group sustaining a conviction both at the index offence and prior to that. Over 50% of all groups had at least one conviction for a sexual offence. A regression model accounting for 78% of the variance was made up largely of disposal variables (Mental Health Act status and probation) and indications of antisocial traits (criminal damage, lifetime conviction for murder and ICD-10 personality disorder classification). CONCLUSIONS AND IMPLICATIONS FOR PRACTICE: The authors show that context of sampling affects most relationships between intellectual disability (ID) and offending when the methods for measuring ID are held constant. The results also present several questions on the relationship between risk, services available in an area and referral to higher security.