Another Complication of Asperger's: Prison?

A Virginia case involving an adolescent with Asperger’s who faces a 10-year prison sentence for assault raises questions about whether society can protect the impaired. What strategies can psychiatrists give patients to help them control their aggression?

It is difficult to grasp the complexities of this case. A statement from the Stafford County, Va., sheriff’s office says that the adolescent was charged with several counts, including one count of "knowingly disarming a police officer in performance of his official duties," after assaulting the officer last year in the parking lot of a high school.

According to the statement, a call came into the county’s sheriff’s office one morning last May saying that a "suspicious male," possibly in possession of a gun, was sitting on the grass outside a library, which was directly across from an elementary school. When police units arrived on the scene, they were unable to find the young man. At 20 minutes into the search, the statement says, a school resource officer saw the young man coming out of the woods behind the high school. When the officer asked for identification, the teenager reportedly "proceeded to attack and assault the deputy for no apparent reason."

After other officers arrived on the scene, the teenager was taken into custody, and the officer was transported to a hospital with a head laceration, cuts, abrasions, and a broken ankle. The officer reportedly had to retire because of his injuries. A gun was never found.

The young man, who is black and had been diagnosed with Asperger’s disorder and "pervasive developmental disorder – not otherwise specified," according to his mother’s blog, eventually was found guilty of assaulting a law enforcement officer. A jury recommended that he serve a 10.5-year sentence; as of this writing, he is scheduled to be sentenced on May 19.

This is one of those heart-wrenching cases that make us wish that the general public had a better understanding of mental illness, particularly disorders such as Asperger’s. Why would a person with a disability receive such a harsh sentence? Why did the officer fail to recognize that the young man was disturbed? What role did race play in the way the incident unfolded?

Press reports say that the young man’s mother is distraught and that she has received a great deal of support from the community to try to get her son freed. But the symbols of man’s inhumanity to man are emblazoned all over this case.

Asperger’s syndrome is characterized by occasional aggressive outbursts; poor social skills; failure to develop peer relationships; abnormal, nonverbal communication; and numerous other nuances. The failure to develop social skills would make a child in school an easy person to victimize. Children and adolescents with special needs are among the groups that are at great risk of being bullied, according to a paper published recently by Robin M. Kowalski, Ph.D., (Res. Autism Spectr. Disord. 2011 [doi:10.1016/jrasd.2011.01.007]). However, sorting through these issues is particularly challenging when it comes to young people with autism spectrum disorders, because often they are bullies themselves.

In fact, Dr. Kowalski found that – because these young people are able to use all kinds of electronic devices – they are both cyberbullied and cyberbullies. Of course, all kinds of bullying involve an imbalance of power. The failure of some people with Asperger’s to read social cues is critical. "Children with Asperger’s ... often fail to pick up on social cues that would allow for fluent social interactions, often lack verbal fluency, are frequently overly sensitive to particular auditory or tactile sensations, and are unyielding in their need for a routine, characteristics that make them likely candidates for bullying by others who see them as odd and different," she wrote. These patients "frequently behave in aggressive ways, which increases the probability that they might perpetrate bullying behaviors."

Asperger’s is difficult to treat, but some strategies have been identified that address some of the problematic behaviors these patients exhibit. For example, according to researchers in Virginia, a mindfulness-based strategy can help adolescents with Asperger’s shift their focus from the negative emotion triggered by the aggressive behavior to a neutral stimulus: the soles of their feet (Res. Autism Spectr. Disord. 2011;5:1103-9).

The study was very small – just three adolescent boys with Asperger’s participated. All had been on new-generation antipsychotics at least one time before enrolling in the study. All three showed minimal aggressive behaviors at school, but their parents found that they were unable to manage their aggressive behaviors at home or during community outings.

The boys’ mothers were trained to use the technique, called Soles of the Feet (SoF), 1 month before the beginning of baseline. For the first 5 days of the intervention, the researchers reported, each mother taught her son to use the procedure in daily 15-minute sessions. In some cases, the patients remained aggression free for 4 years.

In the SoF meditation, which is very concrete, the participant with severe mental limitations follows a series of steps that essentially wipe out his feelings of aggression. The person meditating is asked to divert attention from an emotionally arousing thought, event, or situation to a neutral part of the body. The individual is able to stop, focus his mind on his body, calm down, be in the present moment, and then make an informed choice about how to react to the thought, event, or situation that has triggered an arousal response.

I found the description of the SoF meditation interesting therapeutically, because the strategy builds on the idea that the Asperger’s syndrome patient has the ability to make choices. This technique also seems like a refinement of ideas advanced by my good friend Aaron (Tim) Beck, developer of cognitive-behavioral therapy (CBT).

These studies raise numerous questions for those of us in psychiatry. We are seeing a remarkable growth in the number of children diagnosed with Asperger’s syndrome, and it is now estimated that 10,000 children have autism and/or Asperger’s. This is a significant number. We know that there has been an expediential growth in the number of children diagnosed with autism, and I suspect we will see more Asperger’s syndrome as time goes by. We also should expect to find a great many adults with Asperger’s syndrome who have suffered with it their entire lives. That means that we can no longer make an assessment of mental retardation in every patient who lacks social skills. Asperger’s syndrome patients have the capacity to reason, learn, and think. However, we are woefully ignorant of their cognitive capabilities and skills. Finally, psychiatrists and other physicians have to learn more about autism and Asperger’s syndrome in order to keep up with the times.

The Virginia case raises several questions for us about the criminal justice system and how it responds to people with behaviors that are not understood. We’ll never know what exactly happened that day in Stafford County. But we do know that one of the problems with illnesses related to autism is that "even innocent behaviors can come off as malicious" ("Is Sitting While Autistic a Crime?" Newsweek, July 8, 2010). Cynics like to say that the largest mental hospital in America is the Los Angeles County Jail, where the cost of incarceration is close to $40,000 per patient. We have to get those in need of mental health care who are housed in our jails into treatment settings, where they can get the attention and medication that they need.

As humanists and caring physicians, we in psychiatry must educate the public about how mental illness works. This tragic case is a good example of our failure to do so in the law-enforcement community. We have to protect those whose conditions make it either tough or impossible for them to protect themselves.

Dr. Fink is a psychiatrist and consultant in Bala Cynwyd, Pa., and professor of psychiatry at Temple University in Philadelphia. He has no conflicts of interest to disclose.

A Virginia case involving an adolescent with Asperger’s who faces a 10-year prison sentence for assault raises questions about whether society can protect the impaired. What strategies can psychiatrists give patients to help them control their aggression?

It is difficult to grasp the complexities of this case. A statement from the Stafford County, Va., sheriff’s office says that the adolescent was charged with several counts, including one count of "knowingly disarming a police officer in performance of his official duties," after assaulting the officer last year in the parking lot of a high school.

According to the statement, a call came into the county’s sheriff’s office one morning last May saying that a "suspicious male," possibly in possession of a gun, was sitting on the grass outside a library, which was directly across from an elementary school. When police units arrived on the scene, they were unable to find the young man. At 20 minutes into the search, the statement says, a school resource officer saw the young man coming out of the woods behind the high school. When the officer asked for identification, the teenager reportedly "proceeded to attack and assault the deputy for no apparent reason."

After other officers arrived on the scene, the teenager was taken into custody, and the officer was transported to a hospital with a head laceration, cuts, abrasions, and a broken ankle. The officer reportedly had to retire because of his injuries. A gun was never found.

The young man, who is black and had been diagnosed with Asperger’s disorder and "pervasive developmental disorder – not otherwise specified," according to his mother’s blog, eventually was found guilty of assaulting a law enforcement officer. A jury recommended that he serve a 10.5-year sentence; as of this writing, he is scheduled to be sentenced on May 19.

This is one of those heart-wrenching cases that make us wish that the general public had a better understanding of mental illness, particularly disorders such as Asperger’s. Why would a person with a disability receive such a harsh sentence? Why did the officer fail to recognize that the young man was disturbed? What role did race play in the way the incident unfolded?

Press reports say that the young man’s mother is distraught and that she has received a great deal of support from the community to try to get her son freed. But the symbols of man’s inhumanity to man are emblazoned all over this case.

Asperger’s syndrome is characterized by occasional aggressive outbursts; poor social skills; failure to develop peer relationships; abnormal, nonverbal communication; and numerous other nuances. The failure to develop social skills would make a child in school an easy person to victimize. Children and adolescents with special needs are among the groups that are at great risk of being bullied, according to a paper published recently by Robin M. Kowalski, Ph.D., (Res. Autism Spectr. Disord. 2011 [doi:10.1016/jrasd.2011.01.007]). However, sorting through these issues is particularly challenging when it comes to young people with autism spectrum disorders, because often they are bullies themselves.

In fact, Dr. Kowalski found that – because these young people are able to use all kinds of electronic devices – they are both cyberbullied and cyberbullies. Of course, all kinds of bullying involve an imbalance of power. The failure of some people with Asperger’s to read social cues is critical. "Children with Asperger’s ... often fail to pick up on social cues that would allow for fluent social interactions, often lack verbal fluency, are frequently overly sensitive to particular auditory or tactile sensations, and are unyielding in their need for a routine, characteristics that make them likely candidates for bullying by others who see them as odd and different," she wrote. These patients "frequently behave in aggressive ways, which increases the probability that they might perpetrate bullying behaviors."

Asperger’s is difficult to treat, but some strategies have been identified that address some of the problematic behaviors these patients exhibit. For example, according to researchers in Virginia, a mindfulness-based strategy can help adolescents with Asperger’s shift their focus from the negative emotion triggered by the aggressive behavior to a neutral stimulus: the soles of their feet (Res. Autism Spectr. Disord. 2011;5:1103-9).

The study was very small – just three adolescent boys with Asperger’s participated. All had been on new-generation antipsychotics at least one time before enrolling in the study. All three showed minimal aggressive behaviors at school, but their parents found that they were unable to manage their aggressive behaviors at home or during community outings.

The boys’ mothers were trained to use the technique, called Soles of the Feet (SoF), 1 month before the beginning of baseline. For the first 5 days of the intervention, the researchers reported, each mother taught her son to use the procedure in daily 15-minute sessions. In some cases, the patients remained aggression free for 4 years.

In the SoF meditation, which is very concrete, the participant with severe mental limitations follows a series of steps that essentially wipe out his feelings of aggression. The person meditating is asked to divert attention from an emotionally arousing thought, event, or situation to a neutral part of the body. The individual is able to stop, focus his mind on his body, calm down, be in the present moment, and then make an informed choice about how to react to the thought, event, or situation that has triggered an arousal response.

I found the description of the SoF meditation interesting therapeutically, because the strategy builds on the idea that the Asperger’s syndrome patient has the ability to make choices. This technique also seems like a refinement of ideas advanced by my good friend Aaron (Tim) Beck, developer of cognitive-behavioral therapy (CBT).

These studies raise numerous questions for those of us in psychiatry. We are seeing a remarkable growth in the number of children diagnosed with Asperger’s syndrome, and it is now estimated that 10,000 children have autism and/or Asperger’s. This is a significant number. We know that there has been an expediential growth in the number of children diagnosed with autism, and I suspect we will see more Asperger’s syndrome as time goes by. We also should expect to find a great many adults with Asperger’s syndrome who have suffered with it their entire lives. That means that we can no longer make an assessment of mental retardation in every patient who lacks social skills. Asperger’s syndrome patients have the capacity to reason, learn, and think. However, we are woefully ignorant of their cognitive capabilities and skills. Finally, psychiatrists and other physicians have to learn more about autism and Asperger’s syndrome in order to keep up with the times.

The Virginia case raises several questions for us about the criminal justice system and how it responds to people with behaviors that are not understood. We’ll never know what exactly happened that day in Stafford County. But we do know that one of the problems with illnesses related to autism is that "even innocent behaviors can come off as malicious" ("Is Sitting While Autistic a Crime?" Newsweek, July 8, 2010). Cynics like to say that the largest mental hospital in America is the Los Angeles County Jail, where the cost of incarceration is close to $40,000 per patient. We have to get those in need of mental health care who are housed in our jails into treatment settings, where they can get the attention and medication that they need.

As humanists and caring physicians, we in psychiatry must educate the public about how mental illness works. This tragic case is a good example of our failure to do so in the law-enforcement community. We have to protect those whose conditions make it either tough or impossible for them to protect themselves.

Dr. Fink is a psychiatrist and consultant in Bala Cynwyd, Pa., and professor of psychiatry at Temple University in Philadelphia. He has no conflicts of interest to disclose.

A Virginia case involving an adolescent with Asperger’s who faces a 10-year prison sentence for assault raises questions about whether society can protect the impaired. What strategies can psychiatrists give patients to help them control their aggression?

It is difficult to grasp the complexities of this case. A statement from the Stafford County, Va., sheriff’s office says that the adolescent was charged with several counts, including one count of "knowingly disarming a police officer in performance of his official duties," after assaulting the officer last year in the parking lot of a high school.

According to the statement, a call came into the county’s sheriff’s office one morning last May saying that a "suspicious male," possibly in possession of a gun, was sitting on the grass outside a library, which was directly across from an elementary school. When police units arrived on the scene, they were unable to find the young man. At 20 minutes into the search, the statement says, a school resource officer saw the young man coming out of the woods behind the high school. When the officer asked for identification, the teenager reportedly "proceeded to attack and assault the deputy for no apparent reason."

After other officers arrived on the scene, the teenager was taken into custody, and the officer was transported to a hospital with a head laceration, cuts, abrasions, and a broken ankle. The officer reportedly had to retire because of his injuries. A gun was never found.

The young man, who is black and had been diagnosed with Asperger’s disorder and "pervasive developmental disorder – not otherwise specified," according to his mother’s blog, eventually was found guilty of assaulting a law enforcement officer. A jury recommended that he serve a 10.5-year sentence; as of this writing, he is scheduled to be sentenced on May 19.

This is one of those heart-wrenching cases that make us wish that the general public had a better understanding of mental illness, particularly disorders such as Asperger’s. Why would a person with a disability receive such a harsh sentence? Why did the officer fail to recognize that the young man was disturbed? What role did race play in the way the incident unfolded?

Press reports say that the young man’s mother is distraught and that she has received a great deal of support from the community to try to get her son freed. But the symbols of man’s inhumanity to man are emblazoned all over this case.

Asperger’s syndrome is characterized by occasional aggressive outbursts; poor social skills; failure to develop peer relationships; abnormal, nonverbal communication; and numerous other nuances. The failure to develop social skills would make a child in school an easy person to victimize. Children and adolescents with special needs are among the groups that are at great risk of being bullied, according to a paper published recently by Robin M. Kowalski, Ph.D., (Res. Autism Spectr. Disord. 2011 [doi:10.1016/jrasd.2011.01.007]). However, sorting through these issues is particularly challenging when it comes to young people with autism spectrum disorders, because often they are bullies themselves.

In fact, Dr. Kowalski found that – because these young people are able to use all kinds of electronic devices – they are both cyberbullied and cyberbullies. Of course, all kinds of bullying involve an imbalance of power. The failure of some people with Asperger’s to read social cues is critical. "Children with Asperger’s ... often fail to pick up on social cues that would allow for fluent social interactions, often lack verbal fluency, are frequently overly sensitive to particular auditory or tactile sensations, and are unyielding in their need for a routine, characteristics that make them likely candidates for bullying by others who see them as odd and different," she wrote. These patients "frequently behave in aggressive ways, which increases the probability that they might perpetrate bullying behaviors."

Asperger’s is difficult to treat, but some strategies have been identified that address some of the problematic behaviors these patients exhibit. For example, according to researchers in Virginia, a mindfulness-based strategy can help adolescents with Asperger’s shift their focus from the negative emotion triggered by the aggressive behavior to a neutral stimulus: the soles of their feet (Res. Autism Spectr. Disord. 2011;5:1103-9).

The study was very small – just three adolescent boys with Asperger’s participated. All had been on new-generation antipsychotics at least one time before enrolling in the study. All three showed minimal aggressive behaviors at school, but their parents found that they were unable to manage their aggressive behaviors at home or during community outings.

The boys’ mothers were trained to use the technique, called Soles of the Feet (SoF), 1 month before the beginning of baseline. For the first 5 days of the intervention, the researchers reported, each mother taught her son to use the procedure in daily 15-minute sessions. In some cases, the patients remained aggression free for 4 years.

In the SoF meditation, which is very concrete, the participant with severe mental limitations follows a series of steps that essentially wipe out his feelings of aggression. The person meditating is asked to divert attention from an emotionally arousing thought, event, or situation to a neutral part of the body. The individual is able to stop, focus his mind on his body, calm down, be in the present moment, and then make an informed choice about how to react to the thought, event, or situation that has triggered an arousal response.

I found the description of the SoF meditation interesting therapeutically, because the strategy builds on the idea that the Asperger’s syndrome patient has the ability to make choices. This technique also seems like a refinement of ideas advanced by my good friend Aaron (Tim) Beck, developer of cognitive-behavioral therapy (CBT).

These studies raise numerous questions for those of us in psychiatry. We are seeing a remarkable growth in the number of children diagnosed with Asperger’s syndrome, and it is now estimated that 10,000 children have autism and/or Asperger’s. This is a significant number. We know that there has been an expediential growth in the number of children diagnosed with autism, and I suspect we will see more Asperger’s syndrome as time goes by. We also should expect to find a great many adults with Asperger’s syndrome who have suffered with it their entire lives. That means that we can no longer make an assessment of mental retardation in every patient who lacks social skills. Asperger’s syndrome patients have the capacity to reason, learn, and think. However, we are woefully ignorant of their cognitive capabilities and skills. Finally, psychiatrists and other physicians have to learn more about autism and Asperger’s syndrome in order to keep up with the times.

The Virginia case raises several questions for us about the criminal justice system and how it responds to people with behaviors that are not understood. We’ll never know what exactly happened that day in Stafford County. But we do know that one of the problems with illnesses related to autism is that "even innocent behaviors can come off as malicious" ("Is Sitting While Autistic a Crime?" Newsweek, July 8, 2010). Cynics like to say that the largest mental hospital in America is the Los Angeles County Jail, where the cost of incarceration is close to $40,000 per patient. We have to get those in need of mental health care who are housed in our jails into treatment settings, where they can get the attention and medication that they need.

As humanists and caring physicians, we in psychiatry must educate the public about how mental illness works. This tragic case is a good example of our failure to do so in the law-enforcement community. We have to protect those whose conditions make it either tough or impossible for them to protect themselves.

Dr. Fink is a psychiatrist and consultant in Bala Cynwyd, Pa., and professor of psychiatry at Temple University in Philadelphia. He has no conflicts of interest to disclose.