A majority of adults with an Autism Spectrum Disorder (ASD) do not commit criminal acts. Those adults with an ASD who do commit criminal acts represent about 1.5% of all individuals with an ASD (Ghazziudin & Ghazziudin 1991) to 2.3% of all individuals with an ASD in special forensic hospitals in the United Kingdom (Scragg & Shah, 1994) These adults with an ASD are considered to have autism-based deficits (Baren-Cohen, 1995; Howling, 1997; O’Brien, 2002) or psychopathology (Palermo, 2004) that contribute to the commission of the criminal acts. Also, Eriksonian Psychosocial deficits have been suggested as another set of factors that mediate the connection between an ASD and criminality (Faccini, 2014). This article presents the developmental framework of “reconstructive therapy” and discusses its need in regard to therapy with adults with a high functioning ASD and criminal acts.
Adults with an ASD face the same stressors and challenges of resolving the most basic of human developmental milestones. Not only do adults with an ASD try to positively negotiate psychosocial tasks, as identified by Gilson 1987, but also need to resolve essential Eriksonian Psychosocial stages to develop a substantial quality of life. Gilson (1987) identified 14 psychosocial milestones that an individual with an Intellectual Disability or an ASD may encounter as they age. In encountering these “milestones” the person would undergo experiences that would stress their abilities and own self-concept. Essential psychosocial milestones, as defined by Gilson (1987) encompass the following: an individual’s symptoms first being diagnosed as consistent with an Intellectual Disability (ID) or ASD, dealing with the birth of siblings, commencing school, dealing with adolescence, puberty, sexuality, and having one’s sibling’s development and accomplishments surpass one’s own. Additionally, finishing one’s schooling and education, coping with an out-of-home-placement, the aging of one’s parents, possible loss of staff/friends/peers, and the development of medical illness and even mental illness are also identified as stressors. Other stressors that a person with an ID or ASD may encounter includes a higher risk of one’s own victimization, social stigma, possible trauma and even the substantial stress of congregate living.
Many will notice that the developmental milestones identified by Gilson (1987) are also those that many of us must negotiate throughout our lives. However, there are another set of developmental tasks, as identified by Erik Erikson, that are as basic to the developmental of a coherent sense of self, and a fundamentally satisfying life. These developmental stages are identified as the development of a sense of self-value, autonomy, pride, identity, intimacy etc. According to Dr. Jerome Schulte (personal communication, 2007), the developer of reconstructive therapy, “within each phase of therapy, the individual is presented with contradictory ‘forces’ that pull at the person. The goal is to withstand, negotiate and personally resolve these contradictory forces towards personal growth.” A positive resolution of these stages would contribute to a sense of positive self-worth, trust in oneself to manage one’s life as well as trust of others and that goodness in one’s life can last. In addition to these tasks are also those involving taking initiative in engaging in activities that add meaning to one’s life, developing pride in one’s accomplishments, a coherent identity, and a capacity for closeness and intimacy with others. However, their substantial negative resolution contributes to a deficient sense of self-value such as a sense of worthlessness, an ongoing sense of doubt in not being able to be oneself, exert self-control, and make important decisions for oneself. Furthermore, one can be nagged by a sense of guilt over inappropriate actions or the lack of relevant actions and left with a sense of inferiority that one cannot direct one’s life towards the fulfillment of one’s goals, or a good life. It may be at this point in one’s development, that a person may resort to manipulation and the control of others, via possible criminal means, to try to resolve these developmental tasks.
The relevance of the resolution of these Eriksonian stage deficits was already exemplified in the case of Mr. “M” who presented with an ASD, psychopathology and psychosocial developmental deficits and terroristic threats (Faccini, 2014); these three factors were presented as contributing to criminal behavior, as opposed to earlier research indicating autism-based deficits or psychopathology. Mr. “M” presented with problems with theory of mind (that others could have thoughts and a feelings different from oneself), high systematization (organizing and counting of newspaper articles, etc.), and an average amount of empathy. In addition, he also evidenced compulsive cleanliness rituals and an unresolved trauma with underlying exaggerated fears of the world being dangerous. Also, he had a substantial number of significantly negatively resolved Eriksonian developmental stages. The negative resolution of these stages left him regarding himself as worthless, with a constant fear that others would see him as inadequate and powerless to control his life and make important decisions for himself. Primarily, the only area of his life where he felt “alive,” important and equal to others was when he engaged in uttering terroristic threats. Basically, after about three years in reconstructive therapy, Mr. “M” was able to develop a sense that he was as good as others and had self-value, a sense of initiative with tasks that were important to him, a sense of pride in his capabilities, and developed a sense of positive identity in helping others and advocating for himself and other. A certain degree of autonomy was addressed, but he was taught to rely more on his social support circle than to just stand on his own, especially when making important life decisions. In addition, when skill building was needed in therapy it could be easily incorporated into the reconstructive therapy framework. In fact, this may be an important concept that is either a coherent identity or these psychosocial stages need to be positively resolved before skill building approaches can be effective. This may especially be the case with individuals with a high functioning ASD who have also committed lifelong criminal acts.
In conclusion, the positive resolution of Eriksonian psychosocial stages towards self-value, autonomy, initiative, pride, identity and intimacy are as relevant to persons with autism as they are to everyone. This is especially relevant when an adult with autism evidences the negative resolution of these stages and/or when they start engaging in inappropriate or even criminal acts, via manipulation and control strategies as a means of trying to reconcile these same stages. In this way, reconstructive therapy can develop an essential personal base so that more cognitive-behavioral interventions and skills can be “embedded” into a coherent identity for the person with autism and criminal acts. To date, reconstructive therapy has been applied to a handful of cases with positive outcomes.
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