A whistle-Stop Tour of asd



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A Whistle-Stop Tour of ASD

  • A Whistle-Stop Tour of ASD
  • and vulnerability for involvement in criminality
  • Richard Mills
  • Manchester
  • September 2013

”in order to understand a person, you must understand what that person understands”

  • ”in order to understand a person, you must understand what that person understands”
  • Sören Kierkegaard

Take home messages

  • Low rates of offending overall
    • Individuals with ASD more vulnerable of being victims of crime – but Some offences are attributable to ASD
      • Co morbid psychiatric disorders less important than social factors
      • Concern about perceived growth in Cybercrime
      • Screening for this population is difficult
      • Decisions must be nuanced e.g. Capacity (inc mens rea) can only be determined on case-by-case basis
      • Risk assessment to take account of ‘autistic thinking’
      • We need to know more about why they come into contact with the CJS as victims and offenders

About autism

  • Autism :- Present from birth or early life-highly heterogeneous
  • Core features
  • Presence of unusual social development, repetitive and other behaviour –strengths in rote memory
  • Absence of (instinctive) social development
  • and behaviour-impaired reciprocity and self monitoring
      • Environment and relationships
  • Overlapping and other related
  • states; anxiety; learning
  • disabilities , neurological and
  • psychiatric conditions

  • Context
  • the nature of the problem
  • Concern from the autism community
  • vulnerability
  • victims and witnesses
  • Concern from the criminal justice system and allied professionals
  • majority of offenders with ASD not mentally ill or intellectually impaired
  • Media reports
  • often sensational: e.g. Ahsan; Napper; occasionally sympathetic; McKinnon, Palmer
  • most offending ‘low level’

  • Context
  • The nature of the problem…questions
  • Why do people come into contact with the CJS?
  • What is the nature and scale of the problem?
  • What might help?

Context

  • Context
  • Limited research
  • Victims
  • Witnesses
  • Offenders
  • What is the nature scale of the problem?
  • How many victims?- Seven times more likely to be a victim of crime (Kurry et al 1993) - numbers not known
  • How many offenders- over representation in secure settings (Hare et al 1999) but number in prison unknown (PRT 2009)
  • Offender numbers overall and types of offences not known.

Victims of crime

  • Case reports
    • Stephon Watts was autistic- aged 15 he was shot dead by Chigago police for ‘wielding a butter knife’
      • “all the family wanted was help, but they got trouble. We are a law-abiding family and we believed in the police and for this to happen is devastating.” Wayne Watts, Stephon’s uncle
    • Adrian Palmer was autistic – age 21 he was raped, harassed and murdered
      • he was vulnerable and became a target because of his condition, but we weren't given any help” Margaret Palmer, Adrian’s grandmother

Victims of crime

  • NAS survey 2013 - 800 RESPONDENTS
  • ABUSE
    • 81% SAID THEY HAD EXPERIENCED VERBAL ABUSE,
    • 47% REPORTED VICTIMS OF A PHYSICAL ASSAULT.
    • 28% HAD EXPERIENCED EXPLOITATION, THEFT OR FRAUD
    • 28% HAD POSSESSIONS OR PROPERTY DAMAGED
    • 65% HAVE EXPERIENCED HATE CRIME MORE THAN 10 TIMES.
  • 73% DIDN’T REPORT THE CRIME TO POLICE
    • OF THOSE THAT DID, 54% SAID IT WASN’T RECORDED AS A HATE CRIME
    • 40% SAID POLICE DID NOT ACT ON THEIR REPORT
    • 62% DID NOT THINK POLICE HAD TAKEN THEIR DISABILITY INTO ACCOUNT
  • ‘ALARMING NUMBER’ EXPERIENCING BULLYING
    • ONLY 6% HAD NOT EXPERIENCED ANY BULLYING OR ABUSE.
    • 24% HAD BEEN VICTIMS OF CYBER BULLYING 

Victims of crime

  • Case reports
    • ZH was autistic- aged 16 he was restrained in handcuffs and leg irons by police after refusing to get out of a swimming pool
    • Subsequently awarded damages in the High Court.

Victims of crime

  • ‘Mate crime’
    • Individuals with autism more vulnerable to mate crime defined as :-
      • ‘the exploitation, abuse or theft from any vulnerable person by those they consider to be their friends.  Those that commit such abuse or theft are often referred to as 'fake friends‘.
    • Also implicated in offending behaviour by the autistic person
      • Coerced into offending- seeking approval- intimidated

Witnesses to a crime

  • Witnesses often regarded as unreliable
    • How they present in court
    • Response to questions they may not understand
    • Response to open questions
    • May give literal answers
    • Intimidation
    • Stressed, especially under cross examination
    • “You are quite certain that on the night in question you could clearly see the two accused in vicinity of the café where the alleged offence took place ? “
    • “You say that you saw the defendant and co defendant in the vicinity of the café – Are you quite sure? …You can’t be sure of that can you?... I put it to you that you were in fact mistaken”
    • “Will you tell the court in your own words…….”
    • “do you not consider that to be unusual….?”

What is the scale and nature of offending?

  • Prevalence of ASD in general population 1%
  • Some studies suggest that between 2% and 4% of offenders have an autistic disorder
    • Hare et al 1999: Scraggs and Shah 1994, Soderstrom et al 2004
  • Less able group insignificant in terms of offending- called ‘challenging behaviour’
    • Holland et al 2002

From research: What is the scale and nature of offending?

  • 15-20% of Asperger population reported at ‘increased risk’ (predisposition)
  • Of the offender population
    • Lower reported rates of acquisitive offending
    • Mixed evidence on violent and sexual offences
    • Linkage to certain offences? e.g. computer crime , stalking, arson, harassment
    • 2-4% special hospital population with ASD
    • Prison population ?
    • Soderstrom et al 2004. Allen at al 2008 , Hare et al 1999: McCarthy et al 2013:

  • From research : What is the
  • nature of offending?
  • Full picture unknown but from actual cases of patients detained in secure hospital (n 62) ; Hare et al 1999
  • Deliberate exploitation by others- Accomplice to other crimes; possession of stolen property; Trafficking
  • Violent offences- Homicide and attempted homicide; arson, kidnapping; assault; hostage taking
  • Antisocial offences- Stalking; harassment; computer crime; possession of pornography; threats to kill; hoax calls

  • Risk factors
  • The inter-relationship of social, psychological, autism and other factors
  • Risk factors also relate to predisposition to victimhood

  • Risk factors
  • Vulnerability related to
  • social isolation
  • low self esteem
  • community factors
  • psychological factors including cognitive style- ‘autistic thinking’ – paranoid ideation – propensity for stress
  • other disorders
  • social and ‘private’ events- internal schemas

  • Risk
  • Related to degree of
  • predisposing factors- mainly static
  • precipitating factors- usually dynamic
  • perpetuating factors- both dynamic and static

Cognitive features (‘autistic thinking’) such as :-

  • Cognitive features (‘autistic thinking’) such as :-
    • lack of concern or awareness for outcome; social naivety; misinterpretation of rules;inability to predict response of others (instinctive difficulties of understanding the minds of others and context) (TOM, Executive function , Central coherence, Context blindness) Tantam 2008; Baron Cohen 1988; Vermeulen 2013; Murphy 2013
    • Autism features such as:-
    • Fixations and obsessive interests, repetitive routines, impulsivity. Language and communication problems – literalness –high need for control Wing 1997; Hare et al 1999; Murphy 2013
  • Predisposing factors

Predisposing factors (CONT)

  • Co occurring conditions
    • Sensory processing differences
      • Dunn 2008;Kern 2009
  • Co morbid psychopathology, including ADHD, psychosis, PD ; other neurological disorder;
    • 100 ‘grave’ adult forensic referrals : * 55% other neurodevelopmental disorders and abnormal adult personality development - including psychopathy
      • Ghaziuddin et al 1998; Hare et al 1999; * Soderstrom et al 2004.
  • Problems with agreement and accuracy of diagnosis –autistic behaviours in non autistic populations
      • Palermo 2004, Tantam 1986

Precipitating factors

  • From case reviews
  • Dislocation from routine- unplanned change
  • ‘Autistic thinking’ – pursuit of special interest
  • Perception of slight or ridicule
  • Neurological phenomena
  • ADHD type problems
  • Anxiety/panic/ stress reaction
  • Adverse reaction to sensory stimuli
  • Hare et al 1999, Howlin 2004, Wing 1997, Holland et al 2002, Tantam 1998
  • From case reviews
  • Rigidity- regardless of consequences
  • Suspicious/ paranoid –misunderstanding intentions of others
  • Internal schemas- e.g.
    • Offence hidden - not detected by others- therefore no consequences - therefore no offence
    • Offence carried out in the common good or against stigmatised group or individual - therefore no offence
  • Hare et al 1999, Howlin 2004, Wing 1997, Holland et al 2002, Tantam 1998
  • Freckleton 2013
  • Precipitating factors (cont)

Precipitating factors (cont)

  • From case reviews
  • Experience of bullying
  • Hostility to family member
  • Pursuit of special interest … political ‘causes
  • Exploited - following lead of stronger personality
  • Escape from stress or demands
  • Lack of awareness of wrongdoing
  • Intellectual interest in the crime and its effects
  • Absence of victim empathy
  • Wing 1997 cited in Hare 1999, Hare et al 1999; Tantam 2008; Berney 2004, Freckleton 2013
  • From case reviews
  • Vulnerability not addressed
  • Offence not detected
  • No action taken on offence
  • Untreated residual anxiety
  • Co morbid psychiatric or neurological disorder
  • Continued exposure to setting conditions – e.g. bullying, obsession/special interest –social isolation
  • Autistic features – e.g. compulsions- ‘autistic thinking’
  • Perpetuating (maintaining) factors

‘Autistic thinking’

      • Context blindness
      • Problems in instinctive understanding of other minds
      • Rigidity – ‘black and white’
      • Focus on detail
      • Literal - rule bound
      • Poor intuition- self monitoring-organisation
      • Not confined to autism – part of the spectrum of human behaviour – in autism - just more so
    • Vermeulen 2010 Baron Cohen 1994 Frith 1992, Wing 1996

Other cognitive factors

  • Problems associated with:
  • 1. Theory of mind: knowledge others have their own thoughts different to ones own-
  • Yes – but not all- unable to identify nature thoughts in others-intent-understand emotional states of others
  • 2. Central coherence: – good on detail but not big picture
  • Yes- but not all
  • 3. Executive function problems: making sense of different and diverse sources of information –self organisation and monitoring-
  • Yes – but not all
  • 4. ‘Context blindness’: understanding the shifting social context for ones actions and the actions of others –including how own behaviour seen by others - problems with written and unwritten rules
  • Yes -in most
  • Vermeulen 2013, Baron Cohen et al 1997; Lerner et al 2012

Other difficulties?

  • Specific language and communication problems
  • Literal; concrete; pedantic; rule bound
  • Related problems
  • Anxiety- stress
  • Impulsivity
  • Sensory differences
  • Behaviour seen as ‘unusual or odd’ in public

Case example: Ivan

  • Ivan 18 years
    • Ivan is a tall, handsome, African man. He does not speak . He travels independently to and from college from his home using the Tube
    • Ivan travels at times when the Tube is crowded but this particular evening he has been to a social event at college.
    • When he enters the carriage is empty apart from an elderly lady. Ivan sits next to her
    • What happened next?

The social ‘instinct’ and autism

  • The social ‘instinct’ and autism
  • How to confuse people further ….

‘Social instinct’ in autism

  • Happy face looks like this
  • Sad face looks like this
  • Angry face looks like this

Attributing thoughts and intentions to others

  • No absolute meaning for social encounters between human beings
  • All such encounters need context to be meaningful
  • A major problem in autism is an inability to judge shifting or different contexts
  • Vermeulen 2013

Attributing thoughts and intentions to others Context blindness

  • Stimulus
  • Response
  • Girl smiles
  • “thinks”.. girl romantically
  • interested
  • Context
  • Supermarket
  • checkout
  • Problem!

Attributing thoughts and intentions to others Context blindness

  • Stimulus
  • Response
  • Girl smiles
  • “thinks”.. girl romantically
  • interested
  • Context
  • nightclub
  • Problem?
  • Acknowledgements: Peter Vermuelen

Attributing thoughts and intentions to others Context blindness

  • Stimulus
  • Response
  • Mother “thanks for coming in late
  • I have missed my T.V. programme as I now have to get your supper”
  • Son “good- can I have steak ? ” (Pleased at being thanked )
  • Context
  • Sarcasm
  • Confused
  • - angry
  • Mother “no chance buster – its beans on toast for you”
  • Acknowledgements: Francesca Happe and Peter Vermuelen
  • Living and working with able autism and Asperger syndrome ;
  • Margaret Dewey (With grateful thanks to Margaret Dewey and Uta Frith)
  • The Informal Test of Social Know-How
  • Rate the following behaviours how you think others will see them;
  • A. Fairly normal in that situation
  • B. Rather strange in that situation
  • C. Very eccentric in that situation
  • D. Shocking behaviour in that situation
  • The impact of impairments in
  • instinctive social behaviour (‘intuition’)

In the elevator

  • Charlie 23 had been out of work for several months. On this day his hopes were high because he was on his way to apply for a job that seemed just right for him.
  • As he rode up in the elevator a stranger said pleasantly “nice day isn't it” [ ]
  • Just then Charlie happened to see his reflection in a mirror near the elevator buttons. His hair was sticking up and he had no comb with him.
  • He turned to the friendly stranger and said
  • “may I borrow your comb please?” [ ]
  • A. Fairly normal in that situation
  • B. Rather strange in that situation
  • C. Very eccentric in that situation
  • D. Shocking behaviour in that situation

In the park

  • Keith age 27 was a file clerk who worked in an office in the city. At noon he took lunch to a small park and sat on a bench to eat it.
  • Often he tore part of a sandwich to bits,
  • scattering it on the ground for the pigeons [ ]
  • One day a baby carriage was parked next to his bench with a crying baby in it. A woman was swinging an older child nearby but did not hear because the swing was squeaking. Keith had learnt that babies sometimes cry because a nappy pin had come undone.
  • Rather than bother the mother Keith quickly checked the baby to see if he could feel an open pin [ ]
  • A. Fairly normal in that situation
  • B. Rather strange in that situation
  • C. Very eccentric in that situation
  • D. Shocking behaviour in that situation

In the supermarket

  • The supermarket where Robert regularly shopped had a sign
  • that said “BARE FEET PROHIBITED BY LAW” One day while shopping,
  • Robert saw a pretty girl, around his age enter the supermarket.
  • She was wearing a long skirt but no shoes. [ ]
  • Robert wanted to warn her but was afraid to approach her as strange
  • things tended to happen when he talked to girls
  • Finally he decided to follow close behind her with his cart shielding
  • her feet from the store manager [ ]
  • She eventually arrived at the checkout that said 10 items or less.
  • She had 12 items in her basket [ ]
  • The girl then turned to Robert and said,
  • “I don’t know why you're following me but if you don’t go away I will call
  • the police” [ ]
  • A. Fairly normal in that situation
  • B. Rather strange in that situation
  • C. Very eccentric in that situation
  • D. Shocking behaviour in that situation

What might help ?

  • Anticipate
    • Understand autistic thinking
      • ‘mind /context blindness’ and related problems-
    • Identify predisposing precipitating and perpetuating risk factors
      • with a view to early intervention- don’t ignore vulnerabilities, minor indiscretions or warnings!
    • Reduce social isolation
      • Create opportunities for social participation

What might help ?

  • Respond
    • Assertive outreach
    • Detection and diversion strategies e.g.
      • Autism Alert Cards?
      • How to ‘screen’ at different levels –is it possible ? Good sensitivity but poor specificity of screening
      • Appropriate Adult schemes
    • Teach strategies and context based - not just ‘social’ skills
    • Evidence-based training for specific CJS personnel particularly the police – judges- probation officers
    • Study offender populations–what sort of disorders -offences?
    • Adapt offender treatment programmes

What might help ?

  • Respond
  • Court-appointed intermediary
    • works with a witness and any person asking questions during an interview or trial.
    • may help the witness to understand the questions -make sure that their responses are understood by the people asking the questions
  • Video-recorded statements
  • Communication aids – inc written questions?
  • Live TV links allowing the witness to give evidence from outside the court.

What might help ?

  • Respond
  • Implement what is already there!
  • Ministry of Justice Research Series 8/10 Court
  • Experience of adults with mental health conditions,
  • Learning disabilities and limited mental capacity
  • McLeod et al 2010
  • In the Courts
  • Awareness of courts
    • Identification of court users
  • Experience of court of those with vulnerabilities
    • Support representation and information
  • Process of attending court
    • Arrival -the court room -giving evidence
  • The ‘after-court’ process
    • Receiving verdict journey home, awaiting outcome
  • Overview of policies, services and practices
    • To support and protect-support justice

Take home messages

  • Low rates of offending overall
    • Individuals with ASD more vulnerable of being victims of crime – but Some offences are attributable to ASD
      • Co morbid psychiatric disorders less important than social factors
      • Concern about perceived growth in Cybercrime
      • Screening for this population is difficult
      • Decisions must be nuanced e.g. Capacity (inc mens rea) can only be determined on case-by-case basis
      • Risk assessment to take account of ‘autistic thinking’
      • We need to know more about why they come into contact with the CJS as victims and offenders

”in order to understand a person, you must understand what that person understands”

  • ”in order to understand a person, you must understand what that person understands”
  • Sören Kierkegaard

Thank you Contact: richard.mills@nas.org.uk websites www.researchautism.net www.nas.org.uk

Selected bibliography

  • Allen D; Evans C; Hider A; Hawkins S; Peckett H and Morgan H: Offending Behaviour in Adults with Asperger Syndrome Journal of Autism and Developmental Disorders; Vol. 38/ April 2008; Springer;Netherlands: 2008
  • Archer N and Hurley E A ; A justice system failing the autistic community. Journal of Intellectual Disabilities and Offending Behaviour Vol. 4 No ½ 2013
  • Asperger H. 'Autistic Psychopathy' in childhood. (trans. U. Frith) In: Frith U. Autism and Asperger Syndrome. Cambridge: Cambridge University Press; 1944/1992. p. 37-62.  
  • Baron-Cohen S: An assessment of violence in a young man with Asperger's syndrome. J Child Psychol Psychiatry 29:351–60, 1988
  • Baron-Cohen S: Mindblindness: An Essay on Autism and Theory of Mind. Cambridge, MA: MIT Press, 1995

Selected bibliography

  • Baron-Cohen S, Ring H, Wheelwright S, et al: Social intelligence in the normal and autistic brain: an fMRI study. Eur J Neurosci 11:1891–999, 1999
  • Barry-Walsh JB, Mullen PE: Forensic aspects of Asperger's Syndrome. J Forensic Psychiatry Psychol 15:96–107, 2004
  • Everall IP, LeCouteur A: Firesetting in an adolescent boy with Asperger's Syndrome. Br J Psychiatry, 157:284–7, 1990
  • Fombonne E: Epidemiological surveys of autism and other pervasive developmental disorders: an update. J Aut Dev Disord 33:365–82, 2003
  • Freckleton I, Autism Spectrum Disorder : Forensic Issues and Challenges for Mental Health Professionals and Courts. Journal of Applied Research in Intellectual Disabilities 2013, 26, 420-434
  • Ghazziudin M, Tsai I, Ghazziudin N: Violence in Asperger's Syndrome: a critique. J Aut Devel Disord 21:349–54, 1991

Selected bibliography

  • Gillberg IC, Gillberg C: Asperger syndrome—some epidemiological considerations: a research note. J Child Psychol Psychiatry 30:631–8, 1989
  • Gillberg CL: Autism and autistic-like conditions: subclass among disorders of empathy. J Child Psychol Psychiatry 30:813–37, 1992
  • Gillberg C. Offending behaviour in adults with Asperger syndrome". J Autism Dev Disord 38 (4): 748–58. doi: 10 ... -
  • Hall I, Bernal J: Asperger's syndrome and violence. Br J Psychiatry 166:262–8, 1995
  • Hare DJ, Gould J, Mills R, et al: A preliminary study of individuals with autistic spectrum disorders in three special hospitals in England 1999 NAS

Selected bibliography

  • Hare RD: Without conscience: the disturbing world of the psychopaths among us. New York: The Guilford Press, 1993
  • Holland, T, Clare, I and Mukhopadhyay, T (2002) Prevalence of 'Criminal Offending' by Men and Women with Intellectual Disability and the Characteristics of 'Offenders': Implications for research and service development, Journal of Intellectual Disability Research, 46, supplement 1, May, pp 6 - 20
  • Howlin P: Outcome in life for more able individuals with autism or Asperger syndrome. Autism 4:63–83, 2000
  • Lerner D Haque O.,Northrup J.,Lawer L Bursztajn H., Emerging Perspectives on Adolescents and Young Adults with High-Functioning Autism Spectrum Disorders, Violence, and Criminal Law . Journal Am Acad Psychiatry Law 40: 177-90, 2012
  • Mawson D, Grounds A, Tantam D: Violence and Asperger's syndrome: a case study. Br J Psychiatry 147:566–9, 1985
  • Langstrom N, Gran M, Ruckin V, Siostedt G and Fazel, S: Risk Factors for Violent Offending in Autism Spectrum Disorder: A National Study of Hospitalized Individuals; Journal of Interpersonal Violence Aug 2008 (epub)

Selected bibliography

  • Ministry of Justice. Court experience of adults with mental health conditions, learning disabilities and limited mental capacity : July 2010
  • Ministry of Justice Research Series 8/10 Ministry of Justice (2011) Vulnerable and intimidated witnesses: a police service guide. London: Ministry of Justice.
  • Mullen PE, Pathe M, Purcell R: Stalkers and Their Victims. Cambridge, UK: Cambridge University Press, 2004 Palermo MT: Pervasive developmental disorders, psychiatric comorbidities, and the law. Int J Offend Ther Comp Criminol 48:40–8, 2004
  • Murphy D. Risk Assessment of offenders with an autism spectrum disorder. Journal Of Intellectual Disabilities and Offending Behaviour Vol. 4 1/2 2013 33-41
  • Murrie DC, Warren JI, Kristiansson M, et al: Asperger's syndrome in forensic settings. Int J Forensic Ment Health 1:59–70, 2002
  • National Autistic Society- Hate crime survey 2013 www.autism.org
  • Ousley Y, Mesibov GB: Sexual attitudes and knowledge of high-functioning adolescents and adults with autism. J Aut Devel Disord 21:471–81, 1991
  • Scragg P, Shah A: Prevalence of Asperger's Syndrome in a secure hospital. Br J Psychiatry 165:679–82, 1994
  • Shedler J, Westen D: Refining personality disorder diagnosis: integrating science and practice. Am J Psychiatry 161:1350–65, 2004

Selected bibliography

  • Silva JA, Leong GB, Smith R, et al: Analysis of serial homicide in the case of Joel Rifkin using the neuropsychiatric developmental model. Am J Forensic Psychiatry 26:25–55, 2005
  • Silva JA, Leong GB, Ferrari MM: A neuropsychiatric developmental model of serial homicidal behavior. Behav Sci Law 22:787–99, 2004
  • Silva JA, Ferrari MM, Leong GB: The case of Jeffrey Dahmer: sexual serial homicide from a neuropsychiatric developmental perspective. J Forensic Sci 47:1347–59, 2000
  • Silva JA, Ferrari MM, Leong GB: Asperger's disorder and the origins of the Unabomber. Am J Forensic Psychiatry 24:5–43, 2003
  • Silva JA, Leong GB, Ferrari MM: Paraphilic psychopathology in a case of autism spectrum disorder. Am J Forensic Psychiatry 24:5–20, 2003

Selected bibliography

  • Soderstrom H, Sjodin AK, Carlstedt A, Forsman A Adult psychopathic personality with childhood-onset hyperactivity and conduct disorder: a central problem constellation in forensic psychiatry. Psychiatry Research. 121(3):271-80, 2004
  • Stokes M, Newton N: Autistic spectrum disorders and stalking. Autism 8:337–9, 2004
  • Sverd J: Psychiatric disorders in individuals with pervasive developmental disorders. J Psychiatr Pract 9:111–27, 2003
  • Talbot J. Know one Knows ; Prison Reform Trust 2008
  • Tantam D: The challenge of adolescents and adults with Asperger's syndrome. Child Adolesc Psychiatr Clin North Am 12:143–63, 2003
  • Tantam D: Adolescence and adulthood of individuals with Asperger Syndrome, in Asperger Syndrome. Edited by Klin A, Volkmar FR, Sparrow SS. New York: Guilford Press, 2000, pp 367–99

Selected bibliography

  • Vermeulen P Autism as Context Blindness. AAPC 2013
  • Wing L: Asperger's syndrome: a clinical account. Psychol Med 11:115–29, 1981
  • Wing L, Gould J: Severe impairments of social interaction and associated abnormalities in children: epidemiology and classification. J Aut Devel Disord 9:11–29, 1979
  • Wolff S, McGuire RJ: Schizoid personality in girls: a follow up study—what are the links with Asperger's Syndrome? J Child Psychol Psychiatry 36:793–817, 1995
  • Wolff S: Loners: The Life Path of Unusual Children. New York: Routledge, 1995


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