Stephen White, Ph.D. & Kristine Kienlen, Psy.D.
Winter 2015 Newsletter
Is the presence of autism a red flag for violence risk? Are individuals with autism a subgroup of violent perpetrators? Media reports of sensational mass murders have contributed to the public’s perception of a causal link between autism and violence. The perpetrators of the mass murders at Sandy Hook Elementary School in 2012, Isla Vista-Santa Barbara in 2014, and most recently at Umpqua Community College in Oregon, were all described as having features of autism. Researchers and autism advocates point out that neither accumulated case experience or research supports a direct link between autism per se and violence. However, threat assessors and teams should be aware the issue is not so simple or clear cut. Certain features of autism may contribute to or interact with other risk factors for violence, usually affective or impulsive in nature, but not always. As usual, targeted violence risk is complex – no one “condition” or circumstance accounts for it. Understanding some facts about autism, and autism and violence, will also prevent unjustified stigmatizing of this group of individuals which represents about 1% of the general population.
Autism Spectrum Disorder (ASD) encompasses neurodevelopmental disorders previously referred to as Autism, Asperger’s Disorder, and Pervasive Developmental Disorder. These are not mental illnesses in the usual sense of the term. The phenomenon was first recognized in the 1940’s with increasing interest and research in recent years. ASD is typically identified in early childhood and is manifested by pervasive deficits in social communication and social interaction as well as restricted and repetitive patterns of behavior, interests, or activities. Behaviors may include social awkwardness, peculiar body movements, and lack of eye contact. Due to their cognitive deficits individuals with ASD have difficulty understanding what others are thinking or feeling. Because of this some may be seen as self-centered and “lacking empathy,” and misperceived as psychopathic, manipulative or sadistic. The condition persists over the life span and causes significant impairments in social and occupational functioning. Problems with cognition and communication vary from mild to severe. ASD may be missed or misdiagnosed, especially in higher functioning, more intelligent individuals.
In adult workplace or college contexts these individuals are often described as, “just odd.” Managers requesting assessment help may offer such observations as, “He’s not really mentally ill, or ‘crazy’, but he’s inappropriate and ‘doesn’t get it’ socially. He can lose his temper, or say things that alarm people and not realize the impact he is having on others. He’s either callous or clueless – It’s hard to tell.” Although elementary and secondary schools have caught on to ASD in the last ten years and the need to provide these students multi-pronged assistance, employers are less familiar with the phenomenon and have different objectives.
A summary of pertinent research: ASD and violence
- Most individuals with this disability are neither violent nor criminal. There is disagreement about whether they are over-represented or not in the criminal justice system.1,2
- Methodological problems are quite apparent in the limited research available, for example small or biased samples not generally representing the general population, and inconsistent methods for diagnosing ASD. Results must be interpreted cautiously and much more study is necessary.3,4
- A key finding and perhaps the most significant from a risk assessment perspective is that co-morbid psychiatric conditions (e.g., mood disorders, psychosis, personality disorders, and obsessive disorders) are usually present when individuals with ASD commit serious crimes such as homicide, assault, sexual assault, stalking, and arson. Compounding this is that individuals with ASD have an elevated risk for other psychopathologies.5
- A “one-two vulnerability punch” for violence risk may occur in persons with ASD and co-morbid psychosis: The content of psychotic ideation may include lethal violence, but if the individual also has ASD he may be quicker to act on the psychotic thoughts and impulses.6
- Likewise, it is possible that comorbid psychopathy in a very small number of individuals with ASD leads to a “double hit” – an additional or compounding impairment of empathic response.7 We speculate this may be the case, or part of what is a very complex case, in the Sandy Hook mass murders.
- Some evidence supports the clinical notion that ASD-related social functioning deficits, life events, mood disturbances and poor emotional coping skills contribute to offending by individuals with ASD.8 A history of neglect or physical abuse in childhood is correlated with later criminal behavior by individuals with high-functioning ASD. 9
- In research and systematic reviews that included mass or serial murderers, the majority of them with autism had also experienced other historical or psychosocial risk factors, such as sexual or physical abuse – underscoring that risk for serious targeted violence involves both distal and proximate risk factors.10
Lerner, Haque, Northrup, Lawer, and Bursztajn (2012) explained that persons with high-functioning ASD have three deficits that may contribute to criminal behavior:11
1) Theory of Mind refers to one’s ability to understand the mental state of others, to interpret social intentions and subtle social nuances. Individuals with ASD may become confused and overwhelmed, especially under duress, by social information they cannot process, and may not recognize the emotional impact of their actions on others.
2) Emotional Regulation is the ability to quickly and appropriately inhibit the expression of strong emotions. In persons with ASD this may be manifested by poor impulse control, aggression, and negative peer interactions.
3) Moral Reasoning is a social-cognitive process by which one judges an action to be worthy of praise or blame. Moral reasoning may be viewed as a fundamental and specific capability encompassing normative evaluations of one’s own actions and the actions of others in light of their behaviors and mental states. Persons with ASD have more difficulty understanding and predicting the behaviors, beliefs, and intentions of others.
As an example of deficits in theory of mind and emotional dysregulation, a student with ASD being taunted on the school bus may react aggressively due to his inability to manage such “over-stimulating” and negative social interactions. Caregivers, family members, and teachers may be more at risk of becoming the target of such reactive aggression or violence when the individual is frustrated and unable to cope with changes in routine. But these are not cold, planned attacks.
Three Case Scenarios:
A more complex array of features is involved in targeted, intended violence. Consider three scenarios revealing the assessment issues for threat teams: The first, a case of our own, involved a college student, very gifted and obsessively focused (a feature of ASD) on his engineering studies. He had shown some interest in a female student in his residence hall, and one day spontaneously started talking to her about a recent murder at another school. He described it in detail, non-stop and with animation until she anxiously exited the hallway, feeling “cornered” by him. Already generally perceived as “strange”, she reported him, concerned that he was a “deranged stalker.” His attempt to connect with her totally failed. When formally evaluated he was judged as posing no risk for predatory violence. Nor did he have malicious intent otherwise. His interest in murder was thoroughly explored and determined to not be about pre-attack phenomena on a pathway to violence. However, his developmental deficits were apparent: an inability to “read” and understand social cues and nuances, a capacity taken for granted by most others. He didn’t realize when he should not bring up his interest in murder. He might fall into the category of the “incompetent suitor” on the Stalking Risk Profile assessment guide12 – usually harmless but causing genuine concern and requiring limit setting. Legal consequences could follow if the behaviors persist. When given feedback these individuals may be confused, feel frustrated, hurt, or remorseful. Their genuine social naïveté may be apparent to evaluators. In this case the student received ongoing psycho-education and coaching about proper conduct so as to minimize the risk of impulsive outbursts if rebuffed and frustrated, and to reduce the likelihood of others reacting negatively. His progress and conduct continued to be appropriately monitored. A comprehensive risk assessment and explanation to campus officials avoided his being perceived and treated as a potential homicidal stalker.
The second scenario is a more recent case in the media and very troubling. On April 29, 2014, a school murder plot was thwarted in Waseca, Minnesota when suspicion led police to search the storage unit of 17-year-old John LaDue. In the unit and in his home they found an arsenal of bombs, bomb-making materials, and guns and ammunition.13 LaDue readily provided investigators the details of his elaborate plot to carry out in the coming weeks which included killing his family, setting a fire in a remote area as a diversion for first responders, and then setting off pressure cooker bombs at the local high school. He would then shoot the school resource officer and students. This is a characteristic of an offender with ASD as opposed to a psychopathic subject – they do not attempt, when apprehended, to deny or conceal their criminal activity. Being literal-minded they tend to answer questions directly and honestly rather than hiding, denying or dismissing their deeds. Although we do not have first-hand information about LaDue, his behavior appears to be an example of ASD-related excessive, ritualistic interest. Since his fixation was on violence and was carrying him away, the situation was very serious. The possible outcome would be no less destructive than the act of the more typically encountered shooter who has malicious intent and is seeking notoriety and/or revenge.
LaDue had videotapes of himself practicing igniting his homemade explosives by various locations in town including outside of an elementary school playground, a church, and a shooting range. He stated this activity “released pressure. It was very uncommon and illegal. I was happy I’d done it…sometimes proud.”14 When LaDue was asked why he would kill his family, he genuinely replied, “They did nothing wrong. I just wanted as many victims as possible.” LaDue had been fixated on violence and studied mass killers in the U.S. dating to 1920, rating them on intensity of crimes. He wanted to plan the attack around the anniversary of the Columbine High School shooting and had purchased a black duster jacket so he could dress like Eric Harris, one of the Columbine shooters.15 To end his plot LaDue wanted to be killed by the SWAT team. When asked why he planned the murders, LaDue told counselors, “I figured it would be very exciting and enjoyable. I certainly like watching it and I figured it would be better doing it.”16 He told police he believed he was mentally ill and asked when he would see a psychiatrist. Court-appointed psychologists opined that LaDue had ASD with a rare late onset, in the absence of any comorbid disorder. They noted that beginning in 2013 he had become fixated on violent images of death, spending about five hours a week watching videos of murders, autopsies, war and gruesome scenes. He said he had no remorse for his plot, and showed no concern for the impact on others his actions would have. Profoundly lacking in good judgment – or moral reasoning – LaDue wanted to identify with school shooters and follow their “script,” but seemingly in the absence of strong grievances, depression or frank psychosis. Yet he was not just someone fascinated with violence. He apparently did harbor some ill feelings: He wrote about five specific students he wanted to target, two for talking too much in class and one for calling him “queer” on the bus. He also told police, “I had fun entertaining the thought of actually, like, injuring and maiming people, and, like, showing people that I am dominant over them.” These suggest revenge and sadism. Seeking notoriety is suggested by his wanting to have at least 40 victims so that he would kill more than previous mass murderers. This too is more typical of the motives of school shooters, ASD influence or not.
After being certified as an adult and pleading guilty to one felony count of Possession of Explosives/Incendiary Device by Person Under 18 years of age, LaDue was sentenced to 10 years probation with a condition that he participate in treatment for persons with ASD and issues with violence in a secure facility.
As a third scenario, contrast LaDue with the Sandy Hook shooter, Adam Lanza. As presented in the comprehensive investigative report by the Connecticut Office of the Child Advocate, his long-standing ASD was well documented in his medical and educational records, as well as a history of anxiety and obsessive compulsive disorder.17 Lanza had long been obsessed with violence, alarming some teachers early on with his gory essays about war. An evaluation by the Yale Child Study Center when he was 16 expressed great concern for his future and urged treatment, but little was done. Among his activities he eventually created a meticulous spreadsheet more than 7 feet long, detailing past mass murders and attempted murders that he wished to surpass in number of victims. He became more and more isolated, in the end only communicating with his mother by email in the home where they both lived, not allowing her to enter his room. Although he increasingly “deteriorated”, the report states it “does not suggest the presence of psychosis.” However, he is also described as suspicious, and extreme isolation can lead to paranoia, another and important risk factor for targeted violence. Although observations of him growing up varied – he was bullied, he was not; he was social, he was withdrawn – his lack of cooperation and rigidity stand out as the years went on. His stories were about killing or hurting children, and with a chilling tone of felt cruelty. Was there a “double hit” of psychopathic callousness as well? – or even a “triple hit” – ASD, paranoia, and psychopathy? We can only speculate, but we don’t think that knowing Lanza was on the autism spectrum is an adequate explanation per se for his motives and actions. Fortunately, his case is extremely rare, and reveals how the determinants of violence risk can be very complex. The case also gives testimony to how contextual factors can be the ultimate contributors to risk – the enabling of his withdrawal and all its sequelae, no treatment or active monitoring by any agencies, information remaining in silos, and most astonishing – allowing the possession of firearms for a very disturbed young man who relished violence. No thwarted attack this time.
Here are takeaways and what to look for, for threat assessment team members, whether clinicians or not. Some are based on the recommendations of Ghaziuddin (2013).18
- Look for ASD core symptoms of social communication deficits and restricted interests.
- Get a good history, especially childhood neglect/abuse and early problems relating to peers.
- Assess for co-morbid psychiatric disorders, manifested by psychotic or obsessive thinking, with violent content or not, and recommend treatment for them where possible and appropriate.
- Distinguish between aggressive, impulsive behavior and more serious, intentional violence risk, whatever the combined risk factors for the latter. This is a given in our assessments of targeted violence risk.
- Stressors such as bullying, problems with dating, and school pressure are triggers for aggression or violence, regardless of the level of seriousness of a case.
- Planning and operational preparations for serious violence are usually motivated by conscious grievances, a desire for revenge or notoriety, and/or violent delusions. Unfortunately – in very rare cases – they could instead be based predominantly in a naïve understanding of the implications of one’s actions and driven by intense fixations, likely influenced by absorption in social media and video games.
- Psychopathic or anti-social traits or psychotic delusions are gasoline on a fire in someone with ASD characteristics whose obsessional interest is violence, assassins, or weapons.
- ASD is commonly missed or misunderstood. Where necessary, provide education and understanding among caretakers, managers, and officials of this important disability, whether “simple” or complex scenarios.
- Finally, as emphasized by Maras, Mulcahy, and Crane (2015), studies that examine all the various factors that lead some individuals with ASD to engage in criminal (or violent) behavior would be the most useful research, rather than studies of whether ASD individuals in general are more likely to commit offenses than the general population.
[2 Lerner, Matthew D., Omar Sultan Haque, Eli C. Northrup, Lindsay Lawer, and Harold J. Bursztajn. “Emerging perspectives on adolescents and young adults with high-functioning autism spectrum disorders, violence, and criminal law.” Journal of the American Academy of Psychiatry and the Law Online 40, no. 2 (2012): 177-190.
3 King, Claire, and Glynis H. Murphy. “A systematic review of people with autism spectrum disorder and the criminal justice system.” Journal of Autism and Developmental Disorders 44, no. 11 (2014): 2717-2733.
4 Allely, C. S., Minnis, H., Thompson, L., Wilson, P., & Gillberg, C. “Neurodevelopmental and psychosocial risk factors in serial killers and mass murderers.” Aggression and Violent Behavior 19, no. 3 (2014): 288-301.
7 Rogers, J., Viding, E., Blair, R. J., Frith, U., & Happe, F. “Autism spectrum disorder and psychopathy: shared cognitive underpinnings or double hit?.” Psychological Medicine 36, no. 12 (2006): 1789-1798.
8 Allen, D., Evans, C., Hider, A., Hawkins, S., Peckett, H. & Morgan, H. “Offending behaviour in adults with Asperger syndrome.” Journal Of Autism And Developmental Disorders 38, no. 4 (2008): 748-758.
9 Kawakami, C., Ohnishi, M., Sugiyama, T., Somekl, F., Nakamura, K., & Tsujii, M. (2012). The risk factors for criminal behavior in high-functioning autism spectrum disorders (HFASDs): A comparison of childhood adversities between individuals with HFASDs who exhibit criminal behaviour and those with HFASD and no criminal histories. Research in Autism Spectrum Disorders, 6, 949–957.
12 MacKenzie, R., McEwan, T., Pathe, M., James, D., Ogloff, J., & Mullen, P. Stalking risk profile: Guidelines for the assessment and management of stalkers. Stalk Inc. and the Centre for Forensic Behavioural Science, Monash University, 2009.
13 Drash, W., “The massacre that didn’t happen.” CNN. November 3, 2015, retrieved on December 3, 2015. http://www.cnn.com/2015/11/03/us/minnesota-foiled-school-massacre-john-ladue/
14 Feshir, R. “Teen charged in school plot to be tried as an adult.” Minnesota Public Radio News. August 21, 2015, retrieved on December 3, 2015. Retrieved from http://www.mprnews.org/story/2015/08/21/ladue
17 “Shooting at Sandy Hook Elementary School: Report of the Office of the Child Advocate.” Office of the Child Advocate State of Connecticut. November 21, 2014. Retrieved from http://schoolshooters.info/sites/default/files/sandyhook11212014_0.pdf