Autism Spectrum Disorder and Sex Offense

Difficulty with social communication
People with autism have difficulty using and understanding verbal and non-verbal language, such as gestures, facial expressions and tone of voice, as well as jokes and sarcasm. Some people with the condition might not speak or have fairly limited speech. They may understand what people say to them but prefer to use alternative forms of communication, such as sign language.

Difficulty with social interaction
People with autism have difficulty recognizing and understanding people’s feelings and managing their own. They may, for example, stand too close to another person, prefer to be alone, behave inappropriately and may not seek comfort from other people. This can make it hard for them to make friends.

Difficulty with social imagination
Those with autism have difficulty understanding and predicting other people’s intentions and behavior, and imagining situations that are outside their own routine. This can mean they carry out a narrow, repetitive range of activities. A lack of social imagination should not be confused with lack of imagination. Many people with autism are very creative.

NHS Choices. (n.d.).  Autism in Adults. Retrieved from http://www.nhs.uk/Livewell/Autism/Pages/Diagnosisinadults.aspx

ASD and Sexuality
Individuals with autism spectrum disorders generally undergo normal physical development and emergence of secondary sex characteristics at puberty, but the emotional changes and increasing sexual urges that accompany adolescence may be delayed or prolonged.  A substantial proportion of individuals with autism, 10-30%, experience increased behavioral problems during adolescence, especially those with mental retardation (Eaves & Ho, 1996).  Inappropriate sexual behaviors are often an area of concern because the sexual drives that emerge in adolescence are not accompanied by the socialization and understanding of social norms governing acceptable sexual behaviors that a typical peer will gain. Because individuals with ASD are not generally involved in peer groups, they are excluded from the valuable learning opportunities that shape people’s sexual behaviors.  Understanding the issues surrounding the sexuality of persons with autism and how to teach healthy, socially-appropriate socio-sexual behavior becomes increasingly important as they have more opportunities for inclusion in educational and community settings.  Identification rates of autism are increasing and most children with autism attend public schools regardless of their level of functioning (Eaves & Ho, 1996).

Previous public perception of the sexuality of individuals with autism has been found to be largely negative and according to current data, largely inaccurate.  In the past, such individuals were regarded as unaware of their sexuality, as uninterested in intimacy, and as using relationships only to satisfy their own needs.  Early research suggested that persons with autism had no drive for intercourse (DeMyer, 1979) and that few had sexual problems (Dewey & Everard, 1974).  However, current research indicates a high rate of sexual behavior among this population and highlights that the general social impairments typical of the autism spectrum do not necessarily mean that individuals with these disorders have no interest in developing some kind of intimate relations with others (Haracopos, 1995; Haracopos & Pedersen, 1992; Hellemans, Colson, Verbraeken, Vemeiren, & Deboutte, 2007; Kontstantareas & Lunsky, 1997; Ray et al., 2004; Ruble & Dalrymple, 1993; Stokes & Kaur, 2005; Van Bourgondien, Reichle, & Palmer, 1997).  In reality, adults with autism do not appear to experience any less sexual interest than do adults with developmental disabilities (Kontstantareas & Lunsky, 1997; Ousley & Mesibov, 1991).

Most individuals with ASD, approximately 75%, display some kind of sexual behavior and most masturbate (Haracopos & Pedersen, 1992; Hellemans et al., 2007; Van Bourgondien et al, 1997).  Many seek out physical contact with others (Hellemans et al., 2007).  In a study of 81 Danish adults with autism living in group homes, 74% demonstrated sexual behavior including masturbation and sexual behavior with others (Haracopos & Pedersen, 1992).  Masturbation was more common in males than females, while females showed more sexual behaviors towards others.  In this study, 10% of the subjects expressed a strong desire to have a romantic relationship, yet, none had established what the authors considered a typical “reciprocal and intimate relationship.”  The study also found that 35% of the residents expressed a sexual interest in both sexes and 9% showed an interest in same sex individuals.  Van Bourgondien and colleagues (1997) surveyed the parents of 89 individuals with both autism and some degree of mental retardation and found that 34% engaged in physical behavior with another individual such as handholding, hugging, kissing, touching, and attempted intercourse.  This behavior was three times more likely in nonverbal individuals.  This study also found that those persons who had not received sex education were more likely to masturbate while those who had were more likely to engage in person-oriented behaviors.  Interestingly, Ousley and Mesibov (1991) indicated that men with autism were more likely to report sexual frustration than women with autism.

Research by Stokes and Kaur (2005) found that many high functioning autistic (HFA) individuals indicated a desire for social contact and sexual relations, but that their social disabilities may prevent the development of appropriate relationships.  This study found that compared to their typical peers, adolescents with HFA displayed poorer social behaviors, had fewer privacy related behaviors, and had less knowledge of privacy issues and sex education.  In addition, their parents reported more concerns about their children’s sexual behavior.

The average fifteen year old with HFA displayed the sexual behavior characteristic of typical ten-year-olds.  However, more recent research has found that high-functioning individuals show normal, age-appropriate behaviors even though appropriate social skills were not present (Hellemans et al., 2007).

Parents of children with autism typically express concerns about their children’s developing sexual behavior.  For example, in Ruble and Dalyrymple’s (1993) survey of 100 parents of children with ASD, 75% of the parents feared that their children’s common behaviors may be misinterpreted by others as sexually deviant.  Inappropriate fixations and obsessions have also become a concern based on case reports of stalking, frottage, fondling, paraphilias, compulsive masturbation, and sexual assault, although such reports are quite rare (Ray et al., 2004; Realmuto & Ruble, 1999; Williams et al., 1996).

There is also a great deal of concern regarding the high risk of sexual victimization for this population.  As many as 16 to 25% of persons with autism have been sexually abused (Koller, 2000; Mandell, Walrath, Manteuffel, Sgro, & Pinto-Martin, 2005).  Their intrinsic social and communication impairments, as well as their lack of exposure to appropriate peer interactions, may leave these youth at risk for misinterpretation of social cues and sexual behaviors of predators.  In addition, victims of sexual abuse were more likely to display serious consequences such as engaging in sexual acting-out, self-injurious or suicidal behavior, and running away and they were more likely to be hospitalized in a psychiatric institution (Mandell et al., 2005).

Although adolescents with ASD may lack the social abilities and communication skills to develop appropriate friendships and intimate relationships, their typical physiological development may lead to a desire for sexual intimacy, even in the face of social rejection.  The lack of knowledge of appropriate social norms can lead to conflicts between the fulfillment of their sexual needs and socially acceptable sexual behavior.  It is the high frequency of inappropriate public behaviors that has raised concern for many parents and service providers.

Ruble and Dalrymple (1993) report that approximately 65% of individuals with autism touch themselves in public, 23% masturbate in public, and 28% remove their clothing in public.  Others studies have indicated that as many as 52% of individuals with autism masturbate in public and 90% display sexual behaviors that are directed towards strangers or other inappropriate individuals such as caregivers or service providers (Haracopos & Pedersen, 1992).  Some researchers have posited that this behavior may be due to impairment in social awareness and social judgment or to the predisposition toward self-stimulatory behavior, while others have suggested that it may be due to the lack of socially appropriate outlets (Realmuto & Ruble, 1999).

Such displays may jeopardize the community integration of individuals with ASD and placements in least restrictive environments.  Hellemans et al.  (2007) reported that nearly a third of their sample required intervention in the area of sexual behaviors and emphasized the importance of sex education.

In summary, research indicates a high degree of interest in intimate relationships and a high frequency of sexual behaviors among individuals with ASD (Haracopos & Pedersen, 1992; Hellemans et al., 2007; Van Bourgondien et al, 1997).  It is apparent that the social impairments characteristic of these disorders does not negate sexuality and its accompanying desires or behaviors.  There is a great need to understand the sexuality of these individuals and how better to serve them in areas related to this domain as this area is largely overlooked in research and practice.  Much of the present literature is limited by small samples and a focus on institutionalized populations.  Moreover, the participants generally had presented with a wide range of cognitive abilities, making it difficult to distinguish between the impact of ASD and mental retardation (Hellemans et al., 2007).  Future research is needed that examines more diverse samples, including adolescents with various levels of cognitive functioning and communication skills who are attending public or specialized schools.  There is also a need to understand what constitutes appropriate sexuality education for these individuals and their families so that their basic needs and rights are respected, and that maladaptive behaviors can be prevented and corrected.

Autism Spectrum Disorder and Sexually Offensive Behaviors
In their excellent study Schöttle, et al (2017) offer important insights regarding ASD and sexuality/sexual behavior.Research finds a high degree of interest in intimate relationships and a high frequency of sexual behaviors among individuals with ASD.  It is apparent that the social impairments characteristic of these disorders do not negate sexuality and its accompanying desires or behaviors.  Some of their observations include the following.

• Inappropriate sexual behaviors are often an area of concern for individuals managing ASD because the sexual drives that emerge in adolescence are not accompanied by the socialization and understanding of social norms governing acceptable sexual behaviors that a typical peer will gain.
• Current research indicates a high rate of sexual behavior among this population and highlights that the general social impairments typical of the autism spectrum do not necessarily mean that individuals with these disorders have no interest in developing some kind of intimate relations with others.
• Many with ASD express a strong desire to have a romantic relationship yet have difficulty in establishing what is considered to be a typical “reciprocal and intimate relationship.”
• Many high functioning ASD individuals indicate a desire for social contact and sexual relations, but their social disabilities may prevent the development of appropriate relationships.
• Although adolescents with ASD may lack the social abilities and communication skills to develop appropriate friendships and intimate relationships, their typical physiological development may lead to a desire for sexual intimacy, even in the face of social rejection.The lack of knowledge of appropriate social norms can lead to conflicts between the fulfillment of their sexual needs and socially acceptable sexual behavior.
• Nearly a third of people with ASD require intervention in the area of sexual behaviors.

Schottle, Danielle, et al. Dialogues in Clinical Neuroscience. December 2017. 19(4): 381-393

Creaby-Attwood and Allely (2017) have written an important paper regarding ASD, sex offending and the courts.  They note;

• “. . . when the jury is unaware of the facts surrounding a defendant’s ASD it fails to offer the safeguards that should be afforded. Sexualised behaviour can be misconceived and misinterpreted in light of the legal requirements for conviction.” (p.78)
• “. . . deficiency in social awareness and interpersonal skills, . . . may therefore increase the risk of an accused that has an ASD to behave in a sexual manner. This in turn could lead a jury to believe beyond reasonable doubt that he has fulfilled all of the requirements of a sexual charge. The jury considering here the honest and reasonable belief of the defendant at the time of the sexual activity; behaviour that if witnessed in someone neuro-typical may very well, . . . led to a different outcome.” (p.78)
• “We conclude that sexual behaviour in a defendant with an ASD often does not sit with the criminal definitions within the relevant statute. There will undoubtedly be defendants with an ASD who will understand their sexual behaviour is wrong, recognising fantasy thoughts linked with criminogenic behaviour, who will be rightfully convicted. However, Creaby-Attwood and Ince (2016) found that “medical diagnosis is now sitting as an uncomfortable bed-fellow with criminal law and sentencing in such cases.” (p.78)

A psycho-legal perspective on sexual offending in individuals with autism spectrum disorder.
Creaby-Attwood, C.S. Allely. International Journal of Law and Psychiatry, 2017. 55, 72-80.

Research Abstracts

MMPI-2 Personality Profiles of High-Functioning Adults with Autism Spectrum Disorders
Sally Ozonoff, Nicanor Garcia, Elaine Clark
Assessment, Vol 12(1), Mar, 2005. pp. 86-95.
Abstract
The Minnesota Multiphasic Personality Inventory-Second Edition was administered to 20 adults with autism spectrum disorders (ASD) who fell in the average to above average range of intelligence and 24 age-, intelligence-, and gender-matched college students. Large group differences, with the ASD group scoring higher, were found on the L validity scale, Clinical Scales 2 (D) and 0 (Si), Content scale Social Discomfort (SOD), Supplementary scale Repression (R), and Personality Psychopathology Five (PSY-5) scale INTR (Introversion). The proportion of ASD adults scoring in the clinical range on these scales was between 25% and 35%. High scores on these scales are consistent with the clinical picture of Asperger syndrome and high-functioning autism in adulthood. Future directions and implications for identifying adults in need of a specialized autism assessment are discussed.

Developmental theory and developmental deficits: the treatment of sex offenders with Asperger’s Syndrome.
Bolton, Winifred.
Sex, mind, and emotion: Innovation in Psychological Theory and Practice. Hiller, Janice, (Ed); Wood, Heather, (Ed); Bolton, Winfred, (Ed); pp. 41-61; London, England: Karnac Books; 2006.
Abstract:
In this chapter, I describe my observations and experiences in individual and group therapy with a small group of six young men that led me to theorize that the core deficit in Asperger’s Syndrome is a failure in non-verbal communication, specifically the interpretation of facial expression, and that this deficit gives rise developmentally to the abnormalities in social interaction, cognition, speech, and use of language, which are the defining features of the syndrome. I argue that an appreciation of the central importance of non-verbal communication to the development of symbolic thinking, the capacity to reflect on the content of one’s own mind, to ‘read’ others’ minds and thereby to connect with them, capacities that are absent in Asperger’s, significantly extends our understanding of normal social and emotional development. I also wish to suggest that our understanding of Asperger’s syndrome has been strongly affected by the fact that both theory and diagnosis have developed on the basis of observations of children. This has led to a failure to account for some features, specifically poor emotion regulation, because in the normal individual the capacity to regulate emotion is acquired in the course of development. Its absence, therefore, may not be apparent until adulthood. I would argue that poor emotion regulation is a core feature of Asperger’s syndrome, and is clearly apparent in the adult. I believe that this difficulty is also evidenced in poor management of sexual arousal, which, together with the currently recognized difficulties in social interaction, make problems of sexuality and sexual relationship inevitable. A truly developmental theory then is required to understand sex offending in adult men with Asperger’s syndrome.

Addressing the sexuality and sex education of individuals with autism spectrum disorders.  Sullivan, A., Caterino, L.
Education & Treatment of Children, Vol 31(3), Aug, 2008. pp. 381-394.
Abstract:
This paper addresses the need for sexuality education for individuals with autism spectrum disorders.  It provides a brief overview of autism and Asperger’s Syndrome as well as a summary of the existing literature regarding the sexuality of this population.  The existing research suggests that there is a high frequency of sexual behaviors among individuals with these disorders.  A number of these behaviors may become problematic for caregivers and service providers because they violate societal norms regarding appropriate interpersonal behavior and may jeopardize the inclusion of this group in educational and community settings.  The existing sex education programs for individuals with ASD are reviewed, highlighting the major components of programs tailored to this population.

From pp. 381-382

“However, more recent literature indicates that most adolescents and adults with these disorders engage in sexual behaviors and many desire intimate relations with others (Haracopos & Pedersen, 1992; Kontstantareas & Lunsky, 1997; Ray, Marks & Bray-Garretson, 2004; Ruble & Dalrymple, 1993; Stokes & Kaur, 2005; Van Bourgondien, Reichle, & Palmer, 1997). Unfortunately, parents continue to report substantial concern regarding negative public perceptions of such behaviors and the subsequent treatment of their children (Realmuto & Ruble, 1999; Ruble & Dalrymple, 1993) and case studies have drawn attention to deviant sexual behaviors (e.g., public masturbation, fetishism, compulsive sexual behaviors, etc.) among this population (Ray et al., 2004; Realmuto & Ruble, 1999; Williams, Allard & Sears, 1996).  Additionally, as the population of individuals with varying degrees of autism continues to grow, this will likely become even more of an issue in the near future.” 

Autism spectrum disorder symptoms in juvenile suspects of sex offenses.
‘t Hart-Kerkhoffs, Lisette A., et. al.
The Journal of Clinical Psychiatry, Vol 70(2), Feb, 2009. pp. 266-272.
Abstract:
Objective: To investigate autism spectrum disorder (ASD) symptoms in juvenile suspects of sex offenses. Method: A group of 175 juvenile suspected sex offenders (all males, mean ± SD age = 14.9 ± 1.4 years) was compared with a matched healthy control group (N = 500, mean ± SD age = 14.0 ± 1.4 years) and a group of children with DSM-IV-diagnosed ASD (N =114, mean ± SD age = 14.2 ± 1.9 years) with respect to autistic symptoms as measured by means of a standardized questionnaire, the Children’s Social Behavior Questionnaire. Furthermore, specific subgroups of sexual offenders, i.e., child molesters, solo peer offenders, and group offenders, were compared with regard to levels of ASD symptoms. The study was conducted from May 2003 to December 2006.
Results: Significantly higher levels of ASD symptoms were found in juvenile sex offenders than in healthy controls, while levels were lower than in the ASD group (F = 148.259, p < .05). Solo peer offenders and child molesters scored higher on several subscales as well as on core autistic symptoms than group offenders (F = 5.127, p<.05).
Conclusions: Levels of ASD symptoms are higher in juvenile suspects of sex offenses as compared to the healthy population, which argues for considering specific diagnostic assessment in this population, especially in solo offenders and child molesters.

Sexual behavior in male adolescents and young adults with autism spectrum disorder and borderline/mild mental retardation.
Hellemans, H., Roeyers, H., Lepale, W., Dewaele, T., and Deboutte, D.
Sexuality and Disability, Vol 28(2), June, 2010. pp. 93-104.
Abstract:
Group home caregivers of 20 institutionalized, male adolescents and young adults with Autistic Disorder (AD) and Borderline/Mild Mental Retardation (MR) and of 19 institutionalized, male adolescents and young adults with Borderline/Mild MR, without AD were interviewed with the Interview Sexuality Autism-Revised (ISA-R). Overall the individuals with AD were not significantly less sexually active than the individuals with MR. Masturbation was common in both groups. Individuals with MR had significantly more experience with relationships. No difference was found in the presence of inappropriate behavior. No difference was found in sexual orientation. Some deviant sexual behaviors (stereotyped sexual interests; sensory fascinations with a sexual connotation; paraphilia) were present in the group with AD, but not in the group with MR. A difference seemed to exist in the nature of sexual problems in the individuals with AD and MR, problems in individuals with AD being more related to an obsessive quality of the sexual behavior.

Self-assessed sexuality in young adults with High-Functioning Autism
Prianka Mehzabin, Mark A. Stokes
Research in Autism Spectrum Disorders, Vol 5, Issue 1, January-March 2011, pp. 614-621
Abstract
The literature has revealed that autistic persons of all ages show an interest in sexuality and relationships, but the poor social and communication skills found among those with autism hinders the experience of this. Unfortunately, most research to date in this domain has relied exclusively upon parental or caregiver reports. Thus there remains a need for research to be undertaken in this area based on direct reports from autistic individuals. We hypothesised that compared to Typically Developing (TD) persons, persons with High-Functioning Autism (HFA) would reveal lesser levels of sexual experience, lower levels of sexual and social behaviour, and less understanding of privacy on various subscales of the Sexualised Behaviour Scale. The results of this present study supported the hypothesis on all scales except Privacy and Sexualised Behaviour. Overall, compared to TD individuals, HFA individuals engaged in fewer social behaviours, had less sex education and fewer sexual experiences, had more pronounced concerns for the future, and showed similar levels of privacy knowledge and public sexualised behaviour. These findings suggest a need for specialised sex education programs for autistic populations; further, since social behaviour was significantly lower for autistic individuals and future concerns were higher, this suggests that sex education programs need to incorporate education about social rules to enhance social communication and understanding.

Sexual abuse and offending in autism spectrum disorders.
Sevlever, Melina, Roth, Matthew E., Gillis, Jennifer M.
Sexuality and Disability, Vol 31(2), June 2013. pp. 189-200.
Abstract:
Individuals with autism spectrum disorders (ASD) may be disproportionately at risk of experiencing sexual abuse and victimization. Moreover, limited research suggests some individuals with ASD may be more likely to engage in sexual offending behavior. The present review addresses both sexual abuse and offending within the ASD population. The literature review was conducted utilizing PsycINFO and the Education Resources Information Center. Characteristics of the ASD population and how they relate to both victimization and offending are assessed. Additionally, a brief review of sexual education for this population is presented. (PsycINFO Database Record (c) 2016 APA, all rights reserved)

Violence and sexual offending behavior in people with autism spectrum disorder who have undergone a psychiatric forensic examination.
Søndenaa, Erik. St., et al.
Psychological Reports, (August 2014). 115(1): 32-43.
Abstract:
The increased awareness of Autism Spectrum Disorders (ASD) over the last few decades as well as the potential association between ASD and off ending behaviors has spurred a need for increased research in this area. In order to explore any possible relationship between ASD and violent or sexual crime the present study examines all forensic examination reports over a 10-yr. period in Norway where the charged persons were diagnosed with ASD and charged with either a violent (N = 21) or a sexual (N = 12) offense. Differences between these two groups regarding previous contact with child welfare and confessions to the offense were found. There was also a tendency toward more severe mental health problems and less intellectual problems among the violent offenders than the sexual offenders.

Autism spectrum disorder and sexual offending: Responsivity in forensic interventions.
Higgs, Tamsin, Carter, Adam J.
Aggression and Violent Behavior, Vol 22, May 2015. pp. 112-119.
Abstract:
Research concerned with autism spectrum disorder (ASD) and criminality has grown in recent years. While having ASD does not increase risk of sexual offending behavior, an association has been recognized between ASD and sexually abusive behaviors. Despite this association, inadequacies in much of the criminal justice system to respond to the needs of this client group have been raised. A proportion of those people within the criminal justice system convicted of sexual offenses will have ASD. Given that group based interventions require participants to carry out introspection, sharing personal information and interacting in a group, all activities that an individual with ASD will invariably find challenging, efforts need to be made to develop interventions to work responsively, safely, appropriately and effectively with this client group to reduce risk of sexual recidivism. This review sets out to consider research on ASD and sexual offending in order to make practical recommendations on working responsively to raise the possibility of therapeutic interventions being effective when engaging with this client group. The status of research on ASD both generally, as far as the scope of this review allows, and in relation to offending is discussed and practical guidance is offered.

Sexual Offending and Autism Spectrum Disorders
Allely, C. S., & Creaby-Attwood, A.
Journal of Intellectual Disabilities and Offending Behaviour
Publication date: 14 March 2016
Abstract
Purpose – Studies have found innate vulnerabilities which potentially may increase the risk of an individual with autism spectrum disorders (ASD) finding themselves involved with the criminal justice system as a result of being charged with a sexual offence. The purpose of the present review is to evaluate the literature which has explored sexual offending in individuals with ASD.
Design/methodology/approach – A systematic PRISMA review (PRISMA, Preferred Reporting Items for Systematic Reviews and Meta-Analyses) was conducted using internet-based bibliographic databases (PsycINFO, MEDLINE, Psychology and Behavioral Sciences Collection and PsycARTICLES) in order to access studies which investigated to any degree the association between ASD and sexual offending. Findings – Only a small number of case reports (N = 7) on sexual offending in individuals with ASD and a small number of prevalence studies (N = 7) were identified.
Research Implications – Research is urgently required to identify the specific requirements and needs of sexual offenders with ASD in order to inform an appropriate treatment strategy for successful outcomes. Originality/value – Relatively few studies and reviews have investigated the area of ASD and sexual offending specifically.

Aspects of sexuality in adolescents and adults diagnosed with autism spectrum disorders in childhood.
Fernandes, Lucrecia Cabral, et al.
Journal of Autism and Developmental Disorders, Vol 46(9), Sep, 2016. pp. 3155-3165.
Abstract:
The literature concerning sexuality in autism spectrum disorders (ASDs) is limited regarding inappropriate sexual behaviours and paraphilias and its relation to age, verbal ability, symptom severity, intellectual ability, or adaptive functioning. A cohort of 184 adolescents and young adults (ages 15–39 years) with ASD diagnosed in childhood, including both low and high functioning individuals, was examined. The large majority were found to have a sexual interest and showed interest towards the opposite sex. Inappropriate sexual behaviours and paraphilias were reported for about a fourth of the individuals. No relationships were found between inappropriate sexual behaviours and any of the background variables listed above. However, associations were found between paraphilias and ASD symptom severity, intellectual ability, and adaptive functioning.

Autism, sexual offending, and the criminal justice system
Melanie Clark Mogavero
Journal of Intellectual Disabilities and Offending Behaviour (2016), Vol. 7 Iss 3 pp. 116 – 126
Abstract:
Purpose – There has been growing concern among stakeholders about individuals with autism spectrum disorders (ASD) and sex offending as research supports an indirect association. The purpose of this paper is threefold: first, bring more awareness of the sexuality and deviant/criminal sexual behavior among those with ASD to stakeholders in the criminal justice system (CJS); second, demonstrate that much of the deviant or sexual offending behavior exhibited among those with ASD is often a manifestation of their ASD symptoms and not malice; and third, demonstrate the necessity to address specific needs of individuals with ASD who enter the CJS due to criminal sexual behavior.
Design/methodology/approach – This paper provides an overview of the ASD symptomology, including the diagnostic changes, a review of the literature on ASD and sexuality, which includes deviant sexual behavior and sexual offending.
Findings – The author linked examples of deviant or sexual behavior in the research literature to the ASD symptomology and described how the symptomology explains such behavior.
Originality/value – Sexual offending among those with ASD has received little research outside the mental health field. This review is of particular importance to those in the CJS unfamiliar with ASD, as they should handle them differently with regard to formal interviewing, measures of competency, capacity, and sentencing.

A psycho-legal perspective on sexual offending in individuals with autism spectrum disorder.
Creaby-Attwood, A., Allely, C. S.
International Journal of Law and Psychiatry, Vol 55, Nov-Dec, 2017. pp. 72-80.
Abstract:
It is important to consider whether there are innate vulnerabilities that increase the risk of an individual with an autistic spectrum disorder (ASD), predominantly those defendants with a diagnosis of Asperger’s Syndrome, being charged and convicted of a sexual offence. The significance of such can be readily seen in recent English case law, with judgments on appeal finding convictions unsafe where there have been a number of failings in the Judge’s summing up. In this article, we will consider the gravity of Judges omitting to highlight a defendant’s diagnosis of autism spectrum disorder and the necessity of detailed explanations to jury members regarding the condition and its effect upon thoughts and behaviour. Consideration will be specifically given to the necessity to prove sexual motivation in such offences and the judicial direction required in relation to whether the appellant’s actions had been sexually motivated. Recognition of the social impairments inherent in ASDs are vital to this work and we shall consider whether the difficulty with the capacity to develop appropriate, consenting sexual relationships as a result of impaired social cognition may be one of the factors which increases the risk of sexual offending in individuals with ASD (Higgs & Carter, 2015).

Assessing autism spectrum disorder in intellectually able adults with the personality assessment inventory: Normative data and a novel supplemental indicator.
Harrison, Kimberly B., et al.
Journal of Autism and Developmental Disorders, Mar 13, 2020.
Abstract:
Differential diagnosis of autism spectrum disorder (ASD) among intellectually-able adults often presents a clinical challenge, particularly when individuals present in crisis without diagnostic history. The Personality Assessment Inventory (PAI) is a multiscale personality and psychopathology instrument utilized across clinical settings, but to date there are no published normative data for use of the PAI with adults with ASD. This study provides normative PAI data for adults diagnosed with ASD, with effect size comparisons to the PAI clinical standardization sample and an inpatient sample. Additionally, a discriminant function was developed and cross-validated for identification of ASD-like symptomatology in a clinical population, which demonstrates promise as a screening tool to aid in the identification of individuals in need of specialized ASD assessment.