An exploration of pathways to emotional outbursts and violence in autistic adults

Platt, Martha (2023). An exploration of pathways to emotional outbursts and violence in autistic adults. University of Birmingham. Foren.Clin.Psy.D.

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Abstract

Autistic people experience considerable interpersonal and intrapersonal challenges across their lifespan. These difficulties include being misunderstood resulting in increased stigma and judgement from others. Autistic people are overly represented in the criminal justice system (CJS). Autistic people in the CJS are intrinsically misunderstood and can experience poor treatment from their first contact with the CJS through to the care they experience if they are detained within forensic or mental health services. This thesis aims to explore the risk factors that are associated with violent behaviour in autistic adults, and following this, the triggers that autistic adults have experienced in an inpatient setting, resulting in increased emotional outbursts whilst being detained in a mental health hospital.

The systematic literature review identified research between 2014 and 2022 that aimed to ascertain risk factors associated with autistic adults and violent behaviour. Data were extracted from these research papers and results indicated two broad categories: co-occurring psychiatric diagnoses and individual risk factors. The individual risk factors posited were further broken down into two categories: those associated with the autism diagnostic criteria, and factors that were not explicitly related with the diagnosis of autism.

Following this, an empirical research study is presented whereby autistic adults in a secure mental health hospital were interviewed to identify specific triggers in their current environment that resulted in increased emotional outbursts. Autistic adults were identified by their multidisciplinary teams (MDT) as having experienced emotional outbursts in the setting, and being appropriate for engaging in the research. Participants then volunteered to engage in a semi-structured interview that was specifically designed for the purpose of this study. Data were analysed using reflexive thematic analysis and posited three overarching themes: having a lack of personal agency, not living in a therapeutic environment, and not feeling cared for.

Overall, the present thesis aimed to facilitate further understanding of the aetiology of both violent behaviours and emotional outbursts in the context of the CJS. Through further understanding of these behaviours, clinical recommendations have been made to provide additional support for autistic service users and their teams to ensure meaningful and appropriate interventions and care provision. In addition, the current thesis explores the barriers to change in secure services and comments on why services may not be currently facilitating recommendations posited by previous research.

Type of Work:

Thesis (Doctorates > Foren.Clin.Psy.D.)

Award Type:

Doctorates > Foren.Clin.Psy.D.

Supervisor(s):