Autism and Convictions for Violent Crimes: Population-Based Cohort Study in Sweden
Autism and Convictions for Violent Crimes: Population-Based Cohort Study in Sweden
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DOI：
10.1016/j.jaac.2017.03.011
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发表时间：
2017-06-01
影响因子：
13.3
通讯作者：
Rai, Dheeraj
中科院分区：
文献类型：
--
作者：
Heeramun, Ragini;Magnusson, Cecilia;Rai, Dheeraj
目的：最近的系统综述强调自闭症和暴力犯罪之间的关系仍然不清楚，但一些案例已经得到了广泛的媒体审查。我们调查了自闭症是否与暴力犯罪的定罪有关，并研究了相关的风险和保护因素。方法：我们分析了斯德哥尔摩青年队列的数据，这是斯德哥尔摩县一个以人口为基础的记录链接队列，包括295,734名15至27岁的个体。在这些人中，有5739人被诊断为自闭症。主要的结果衡量标准是根据瑞典国家犯罪登记册确定的暴力犯罪定罪。结果：患有自闭症的个体，特别是那些没有智力障碍的个体，最初似乎有更高的暴力犯罪风险（调整后的相对风险= 1.39,95% CI = 1.23-1.58）。然而，考虑到同时发生的注意缺陷/多动障碍（ADHD）或品行障碍后，这些关联明显减弱（校正相对风险= 0.85,95% CI = 0.75-0.97）。在自闭症患者中，男性性别和精神状况是暴力犯罪的最强预测因素，此外还有父母的犯罪史、精神病史和社会经济特征。有证据表明，自闭症的延迟诊断与更大的暴力犯罪风险有关。更好的学习成绩和智力缺陷似乎起到了保护作用。结论：最初观察到的自闭症与暴力犯罪在人群水平上的关联可以用ADHD和品行障碍的共病来解释。更好地理解和管理自闭症患者的共病精神病理，可能有助于对自闭症患者的冒犯行为采取预防措施。
Objective: Recent systematic reviews have highlighted that the relationship between autism and violent offending is still unclear, but some cases have received extensive media scrutiny. We investigated whether autism is associated with convictions for violent crimes, and studied the associated risk and protective factors.Method: We analyzed data from the Stockholm Youth Cohort, a total population-based record-linkage cohort in Stockholm County comprising 295,734 individuals followed up between 15 and 27 years of age. Of these, 5,739 individuals had a recorded autism diagnosis. The main outcome measure was a conviction for violent crimes identified using the Swedish National Crime Register.Results: Individuals with autism, particularly those without intellectual disability, initially appeared to have a higher risk of violent offending (adjusted relative risk = 1.39, 95% CI = 1.23-1.58). However, these associations markedly attenuated after co-occurring attention-deficit/hyperactivity disorder (ADHD) or conduct disorder were taken into account (adjusted relative risk = 0.85, 95% CI = 0.75-0.97). Among individuals with autism, male sex and psychiatric conditions were the strongest predictors of violent criminality, along with parental criminal and psychiatric history and socioeconomic characteristics. There was some evidence that a delayed diagnosis of autism was associated with a greater risk of violent crime. Better school performance and intellectual disability appeared to be protective.Conclusion: An initially observed association between autism and violent crimes at a population level was explained by comorbidity with ADHD and conduct disorder. Better understanding and management of comorbid psychopathology in autism may potentially help preventive action against offending behaviors in people with autism.