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Individuals with diagnoses of autism spectrum disorder (ASD) within criminal justice settings are a highly heterogeneous group. Although studies have examined differences between those with and without ASD in such settings, there has been no examination of differences within the ASD group. The paper aims to discuss these issues.

Drawing on the findings of a service evaluation project, this paper introduces a typology of ASD within forensic mental health and intellectual disability settings.

The eight subtypes that are described draw on clinical variables including psychopathy, psychosis and intensity/frequency of problem behaviours that co-occur with the ASD. The initial assessment of inter-rater reliability on the current version of the typology revealed excellent agreement, multirater Kfree =0.90.

The proposed typology could improve understanding of the relationship between ASD and forensic risk, identify the most appropriate interventions and provide prognostic information about length of stay. Further research to refine and validate the typology is ongoing.

This paper introduces a novel, typology-based approach which aims to better serve people with ASD within criminal justice settings.

The purpose of this paper is to explore the perspectives of healthcare professionals on autism in adult females with intellectual disability (ID), including regarding the gender ratio of autism, the clinical manifestation of autism in females, and the recognition, screening and diagnosis of autism.

The questionnaire was developed following a review of the relevant literature and distributed to professionals within three healthcare trusts as well as members of two clinical research groups. The questionnaire was completed by 80 ID healthcare professionals. Data were aggregated and analysed using Microsoft Excel.

ID healthcare professionals had a lack of recognition of the smaller gender ratio of autism in patients with ID as compared to those without ID. Most respondents reported believing that autism manifests differently in females; with women demonstrating a greater ability to mask their symptoms. A considerable proportion of participants reported feeling less confident in recognising, screening and diagnosing autism in female patients, with many endorsing a wish for additional training in this area.

These findings suggest that ID healthcare professionals are keen to improve their skills in providing services for women with autism. Training programmes at all levels should incorporate the specific needs of women with ASD, and individual professionals and services should actively seek to address these training needs in order to promote best practice and better outcomes for women with autism.

This is the first published questionnaire exploring the perspectives of healthcare professionals regarding autism in adult females with ID.

The diagnosis of psychosis in individuals with autism spectrum disorder (ASD) poses a unique clinical challenge. The presence of intellectual disability (ID) further complicates the diagnostic picture. Reliable and timely diagnosis of psychosis in such individuals minimises the duration of untreated psychotic symptoms and the subsequent impact on the quality of life of the patients concerned. The paper aims to discuss this issue.

The authors present four patients with psychosis, ASD and ID, who have received care within forensic mental health and ID settings. These examples demonstrate the interaction between these conditions, as well as issues pertaining to diagnosis and management.

In all four patients, sustained use of antipsychotic medication was objectively associated with an improvement in psychotic symptoms and quality of life. In instances where autistic phenomena were accentuated upon development of psychosis, such features returned to the baseline levels evident prior to the onset of psychosis.

The discussion and related case examples could improve the understanding of the possibility of psychosis in individuals with ASD and ID, and increase awareness of this diagnostic possibility among healthcare professionals.

This is the first published case series illustrating the challenges of diagnosing psychosis in individuals with ASD and ID.

Elucidating where antisocial or violent behaviour arises within the life course of individuals with intellectual disability (ID) could improve outcomes within this population, through informing services and interventions which prevent behaviours reaching a forensic threshold. The paper aims to discuss this issue.

The Historical Clinical Risk Management-20, Version 3 assessments of a cohort of 84 inpatients within a forensic ID service were analysed for this study, with a particular emphasis on items concerned with the age at which antisocial or violence first emerged.

For most participants, violent or antisocial behaviour was first observed in childhood or adolescence. The study also highlighted a smaller subgroup, whose problems with violence or antisocial behaviour were first observed in adulthood.

The study findings suggest that targeted services in childhood and adolescence may have a role in reducing the offending behaviour and forensic involvement of people with ID. This has implications for the service models provided for children and adolescents with ID with challenging or offending behaviour.

Fiction has the potential to dispel myths and helps improve public understanding and knowledge of the experiences of under-represented groups. Representing the diversity of the population allows individuals to feel included, connected with and understood by society. Whether women and girls with autism spectrum disorder (ASD) are adequately and accurately represented in fictional media is currently unknown. The paper aims to discuss this issue.

Internet and library searches were conducted to identify female characters with ASD in works of fiction. Examples of such works were selected for further discussion based on their accessibility, perceived historical and cultural significance and additional characteristics that made the work particularly meaningful.

The search highlighted a number of female characters with ASD across a range of media, including books, television, film, theatre and video games. Many were written by authors who had a diagnosis of the condition themselves, or other personal experience. Pieces largely portrayed characters with traits that are highly recognised within the academic literature. However, some also appeared to endorse outdated myths and stereotypes. Existing works appear to preferentially portray high functioning autistic women, with limited representation of those whom also have intellectual disability.

This is the first exploration of the depiction of ASD in females within fiction. There is a need for more works of fiction responsibly depicting females with ASD, as this can help reduce stigma, develop public awareness and recognition and increase representation.

Social deficits are central within conceptualisations of autism spectrum disorder (ASD), and separately linked to offending behaviour. Social problem-solving interventions are often used with offenders, but little research has examined the social information processing (SIP) skills of individuals with ASD and a history of criminal offending behaviours. The paper aims to discuss this issue.

This conceptual paper will introduce the SIP model, review SIP research as applied to those with ASD and in forensic populations, and further consider the relevance to the assessment and treatment of offenders with ASD.

Difficulties in all areas of the SIP model are noted in ASD and research suggests these difficulties may be directly linked to behaviour.

It is possible that identifying SIP abilities and deficits could improve the effectiveness of rehabilitation programmes for this group.

This paper reviews the utility of social information models in the offending behaviour of people with ASD.

This paper briefly reviews the literature on smoking and smoking cessation programmes for people with intellectual disability, and describes the baseline audit of such a programme for patients resident in a forensic service. The audit describes the prevalence of smoking, its significant associations and the effect of an intervention programme. In total, 79 patients participated in the audit, 48 of whom were smokers on admission (60.8%). Roughly a third of smokers gave up during their hospital stay (N = 15). Those who did not give up significantly reduced the number of cigarettes they smoked per day. Female smokers appeared less likely to give up than men. Length of stay and treatment with anti‐psychotic medication were not significantly linked to smoking behaviour. A simple smoking cessation programme with an emphasis on health education and nicotine replacement therapies appeared to be effective in cutting down smoking rates and tobacco consumption in this population. One should be cautious about generalising the conclusions to all forensic hospital services for people with intellectual disability, as the audit was limited by the lack of a control group and conducted in a single service.

The aim of the present study is to explore the psychometric properties of the EssenCES measure (patient report) of social climate in a secure service for people with intellectual disabilities.

Patients (37 men, 14 women, Mean age=33.24 years, SD=11.29, age range: 18‐71 years) residing in a secure intellectual disabilities service completed the EssenCES as part of routine clinical practice.

Reliability analysis revealed acceptable reliability for all three subscales (α=0.76‐0.88). In order to consider one aspect of the construct validity of this measure, a predicted group difference regarding the impact of security level on ratings of social climate was investigated. Analysis revealed that social climate ratings were more positive on low secure wards than medium secure wards as measured by the combined EssenCES subscales F(3, 31)=4.71, p=0.008; Λ=0.69; η²=0.31, and the Experienced Safety subscale, F(1, 33)=7.41, p=0.01.

Future research should consider the link between social climate and treatment outcome within forensic secure intellectual disability services.

Results provide preliminary evidence to suggest that the EssenCES subscales (patient report) are reliable in this previously unconsidered population. However the validity of the measure is still unclear and requires further investigation.

Research investigating the experience and management of pain in people with intellectual disabilities has mainly been carried out in community services. The purpose of this baseline audit aims to examine this area in a forensic intellectual disability setting.

A baseline audit of pain management was carried out. Audit standards were derived from recent research, and the performance on each measured. Patients and nurses were interviewed. The audit included 82 patients, of which 64 were interviewed. Twelve nurses were interviewed. Health Action Plans and medication files were accessed for information.

There were interesting differences and similarities in the experience and management of pain between community and forensic intellectual disability patients. Within this sample, most patients were able to communicate their pain, and access appropriate treatment. However, a minority required further support. Nurse decision making about providing pain treatment was affected by fears of manipulation, contributing to addition and disbelieving the patient. Additionally, a number of patients appeared to have insufficient knowledge about how to best manage pain.

Results suggested that a standardised approach to pain management, incorporating policy, staff training, and health promotion and psycho-education for patients, would have benefits for both patients and staff within secure intellectual disability services.

At present, there is little research focusing on pain experience and management in forensic intellectual disability settings.

Patients treated within secure/forensic settings experience numerous barriers to meaningful vocation, including restrictions under the Mental Health Act, which limit community access. The purpose of this paper is to describe the development of Real Work Opportunities, an inclusive and accessible vocational rehabilitation programme within a forensic intellectual disability service. The programme involved setting up employment and interview workshops, interviews, and interview feedback, and job roles within the secure service, to simulate the real work process.

A reflective account of the development and implementation of the Real Work Opportunity programme with a forensic intellectual disability population.

The programme was well received by the patients involved and a high attendance rate was maintained over time despite the demands that were expected. Roles have been advertised for two employment periods and have had two sets of successful candidates. Patients demonstrated skills development throughout the employment process, including general work-based skills, punctuality and time management, managing duties, responsibility, specific role-related skills, interpersonal skills and personal presentation.

Despite limited experience of work prior to admission, many patients were enthusiastic and motivated to work. The initial trial of the programme has been well received by both patients and staff. Future developments will include widening the number and types of opportunity offered by the programme.

This paper describes a vocational rehabilitation programme for a particularly marginalised population, people with intellectual disabilities within a forensic service. The programme proved highly popular with patients, and enabled them to develop transferable employment skills.