learning disabilities and offending behaviour

7/28/2019 Learning Disabilities and Offending Behaviour

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Learning Disabilities and

Offending Behaviour Dr Harry Wood,

Consultant Clinical Psychologist,Yorkshire Centre for Forensic Psychiatry

[email protected]



Visits?



Rewind (1)…

• Public Health Warning: – Some people may find the issues we discuss

to be upsetting or they may touch on their own personal issues. we talk about cases thatare emotionally challenging. If this happensfeel free to leave at anytime; we would behappy to talk through things during the breakor afterwards



Rewind (2)…



Mental Health Act, 1983, Amended2007: You can be detained if…

• You have a Mental Disorder = mental illness,arrested or incomplete development of mind,psychopathic disorder and/or any other disorder or disability of mind

• The mental disorder is of such a nature or degree as to warrant the provision of medicaltreatment

• There is substantial risk of you causing seriousharm to yourself or others and it is necessary for the protection of yourself or others that medicaltreatment is provided



Agenda

• Introduction to learning disability, includingstories and some „issues

• Where do people with learning disabilitiesnormally get help?

• Offending behaviour

• Some photographs



A recent case (1)



What do you think?

• Raise both hands if you think that this manshould be prosecuted

• Raise one hand if you think he should belet off, perhaps with a warning

• Leave your hands down if you think thathe was the victim



“Mental Retardation” A: Significant sub-average intellectual functioning: an IQ of

approximately 70 or below on an individuallyadministered IQ test.

B: Concurrent deficits or impairments in present adaptivefunctioning (the person s effectiveness in meeting thestandards expected for his/her age by his/her culturalgroup) in at least two of the following areas:communication, self-care, home living,social/interpersonal skills, use of community resources,self-direction, functional academic skills, work, leisure,

health and safety.C: The onset is before age 18-years.DSM-IV: American Psychiatric Association (1994)



Mental Health Act, 1983

• “Mental impairment” means a state of arrested or incomplete development of mind (not amounting to severe mentalimpairment) which includes significantimpairment of intelligence and socialfunctioning and is associated with

abnormally aggressive or seriouslyirresponsible conduct on the part of thepart of the person concerned.



Mental Health Act, 1983

• “Severe mental impairment” means a stateof arrested or incomplete development of mind which includes severe impairment of intelligence and social functioning and isassociated with abnormally aggressive or seriously irresponsible conduct on the part

of the part of the person concerned.



Degree of Severity

• Borderline: IQ level 70 to 80• Mild: IQ level 50-55 to 70

• Moderate: IQ level 35-40 to 50-55• Severe: IQ level 20-25 to 35-40• Profound: IQ level below 20 or 25



British Psychological Society

• IQ, measured on a recognisedpsychometric test of intelligence, less than70

• Significant impairment in adaptivefunctioning

• Problems began before the age of 18



A recent case (2)



What do you think?






Causes of Learning Disability

• Genetic, e.g. Down s syndrome, Fragile Xsyndrome

• Problems during pregnancy, e.g. foetalalcohol syndrome, maternal illness

• Problems at birth, e.g. anoxia, prematuredelivery

• Brain injury during first 18-years of life• Severe deprivation• Treatment leading to role/identity?



Prevalence

• IQ Assessment: bottom 2.5% of the IQdistribution

• 1.35 million people in England and Wales• Referral to Learning disability services =

1%• Community services = focus upon dual

diagnosis, i.e. individuals with additionalproblems, including mental healthdifficulties, challenging behaviour, autism



Learning Disability and OffendingBehaviour

• “There is no investigator who denies the fearfulrole of mental deficiency in the production of vice, crime and delinquency… Not all criminals

are feeble-minded but all feeble-minded are atleast potential criminals…” Terman, 1911 • Goddard, 1921: 50% of people in prisons were

“mentally defective” • Sutherland, 1937: 50% of delinquents residing in

prison were “feeble minded”



Trends in „care of people withlearning disability

• „Asylum • 1834: poor laws and „feeble -mindedness

• Institutionalised care• „normalisation • Care in the community



Effects of increasing communitypresence

• Mid-1970 s: most hospitals for PLD had„back wards

• Lund (1990): Doubling of sexual offenceswhen 1983 compared to 1973 (91offenders with LD, Denmark)



Criminal Behaviour and PLD

• Relationship between IQ and offending is„robust (Taylor and Lindsay, 2010)

• People in lower IQ groups have greater rates of offending

• Even when SES is controlled for • BUT: most studies consider IQ s between

80 -120• When IQ s <70 included the relationship is

less straightforward



Prevalence of Offending by PLD

• Do PLD commit more crime?• Is the nature and frequency of offending

by PLD different?• Methodological issues:

– Location of studies = sampling bias – Inclusion criteria, including IQ s 70 to 80 – Identification of LD



Learning Disability in the PoliceStation

• Gudjonsson et al. (1993): between 5% and9% of individuals in police station havelearning disability

• Detection?• Police and Criminal Evidence Act (PACE)

and Appropriate Adults



Learning Disability in the Courts

• Hayes (1993, 1996); 14% of individualsassessed in court in Australia met criteriafor learning disability

• Mixed rural/urban settings-caution recultural differences re aboriginal people



Learning Disability in Prison

• Coid (1988) 5.1% of prisoners on remand were known to LDservices (does not account for un-detected LD)

• MacEachron (1979) Literature review. Range of 2.6% to 39.6% (!!!!)• 20-30% of offenders have learning difficulties or learning disabilities

that interfere with their ability to cope within the criminal Justicesystem (Loucks, 2007)• 7% of prisoners have an IQ of less than 70 and a further 25% have

an IQ of less than 80 (Mottram, 2007)• Crocker et al (2007) Remand prisoners in Montreal: 19% probable

LD, 30% in borderline range

• Holland and Persson (2010): using WAIS 1.3%• 23% of young prisoners under the age of 18 have an IQ of less than70 (Harrington and Bailey et al, 2005)



Who are the LD offenders?(O Brien et al, 2010)

• 477 adults in 3 regions in UK referred to servicesdue to antisocial/offending behaviour

• 75% male

• 68% IQ between 55 and 80• 50% diagnosed psychiatric condition in

adulthood

• 35% childhood abuse/neglect• >80% physical/verbal aggression• 30% sexual offences



Learning Disability in SecureHospital

• Difficulties in identification:

Not always diagnosed as having alearning disability!

Not all patients on a learningdisability service have learningdisability!



Learning disability in high securehospital (Taylor et al., 1998)

All patients classified under mentalimpairment:

• 14% homicide• 63% other violent offences• 10% sexual offences

• 13% arson/property damage



An unscientific snap-shot view• 20 medium secure beds• IQ s between 60 and 85(!!) • Additional mental illness = 19/20 (mostly psychosis)• Violence = 11, including 1 murder, 1 violent abduction

and 1 set of unprovoked violent assaults against women• Sex = 5, 3 against children, 1 repeat, „indecent exposer,

and 1 rape• Arson = 4, 3 in hospital premises

• Formal convictions = 17/20• Restriction orders = 12/20



Mental Illness and risk

• Increased risk• People with mental health problems at increased

risk of any offending:

2.5 times for men5 times for women

• People with mental health problems at increased

risk of violent offending:4.5 times for men

27 (!!!!) times for women



Mental illness and learningdisability: Mood disorders

• Aggression “common” in 40% LD withdepression

• 12% referrals to sex offender treatment grouphad mood disorder

• Hypomania associated with public order offences, theft and assault

• Tend to have lower IQ scores than non-mood

disordered LD offenders• Less likely to re-offend, but not for sexualoffences



Substance misuse and learningdisabilities

• 90% of offenders misuse substances• Less prevalent in LD, but remains high

• Newton Lodge population = 6/20

Neuro psychiatric conditions and



Neuro-psychiatric conditions andlearning disabilities:

Autism/Aspergers• 5% to 10% of people with autism havemild LD

• Lack of empathy inherent in autism (Wing,

1982)• More likely to be misled by others,

aggression due to disruptions to daily

routine, lack of understanding of socialcues, violence resulting from obsessions(Howlin, 1997)



Autistic Spectrum Disorder • Must meet criteria 1, 2, and 3:

• 1. Clin ica l ly s ign i f ican t , pe r s i s ten t d e f ic i t s in soc ia l co mm unica t ion and in teract ions , as manifes t by a l l o f the fo l low ing : – a. Marked deficits in nonverbal and verbal communication used for social

interaction:

– b. Lack of social reciprocity; – c. Failure to develop and maintain peer relationships appropriate todevelopmental level

• 2. Restr ic ted , repet it ive p at terns of behaviou r, in teres ts , and act iv i t ies ,as manifes ted by a t leas t TWO of the fo l low ing : – a. Stereotyped motor or verbal behaviours, or unusual sensory behaviours

– b. Excessive adherence to routines and ritualized patterns of behaviour – c. Restricted, fixated interests

• 3. Symptoms must be present in early childhood (but may not becomefully manifest until social demands exceed limited capacities)



What do you think?






What do you think?

• Did your views change during the courseof the afternoon?

• If so, why?• Think about the importance of formulation

and individual understanding



How do you assess intelligence?

• Context: who wants to know and why?• What do they want to know?• Is this assessment necessary? Ethical?• What other factors might affect

performance?



Assessment of Intelligence

• The Wechsler Tests:WAIS-IV (Wechsler Adult Intelligence Test)

WISC (Wechsler Intelligence Scale for Children)

WASI (Wechsler Abbreviated Scale of Intelligence)

WTAR (Wechsler Test of Adult Reading)



Intelligence

• Full Scale intelligence (FSIQ)• Verbal Comprehension Score• Perceptual Organisation Score• Working Memory Score• Performance Speed Score



WAIS-IV

• 10 basic sub-tests• 5 Verbal tests (Vocabulary, Similarity,

Arithmetic, Digit span, Information)• 5 performance tests (Visual Puzzles, Digit

Symbol coding, Block design, Matrixreasoning, symbol search)



Key reference

• Lindsay, Taylor and Sturmey (editors),2004, Offenders with developmentaldisabilities , Wiley

learning disabilities and offending behaviour

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