LETTERS
http://www.100md.com
《美国精神病学与法律学报》
We read with great interest the report, "Asperger's Disorder and Murder," by Dr. Schwartz-Watts.1 Her article highlights the increasing psychiatric interest in Asperger's Disorder (AD) and criminality,2–5 and the need to clarify our current knowledge base in this area. To enhance forensic appreciation of this fascinating area, we would like to make the following points.
Recent reviews of AD and its association with violence, written from different perspectives, suggest that an association between AD and violence may exist.2–5 Other important contributions in this area have also appeared during the past two decades.6–7
In addition to the study by Siponmaa and colleagues2 discussed by Dr. Schwartz-Watts, a broad screening survey of an adult forensic population found a prevalence rate of between one and three percent for AD.8 Also, the most comprehensive and technically sound work concerning the epidemiology of Asperger's Disorder provides a prevalence of pervasive developmental disorders other than Autistic Disorder of 0.367% (or 36.7 per 10,000).9 These results, coupled with the work of Siponmaa and colleagues,2 support the idea that both AD cases and individuals with PDD NOS are at elevated risk for violent acts compared with the general population and that the number of individuals who suffer from autism and engage in violent crimes may be substantially higher than 2.5 per 10,000. Dr. Schwartz-Watts makes an important point when she states that there is a need for well-trained psychiatrists to recognize and diagnose PDD spectrum disorders, including AD. As forensic clinicians deepen their investigation into these disorders and violent crime, it will be crucial to identify various risk factors in subgroups of affected persons. For example, a murder may be perpetrated by a person with Asperger's Disorder who has substantial difficulties in appreciating the killing of a victim. His actions may be clarified by taking into account paradigms traditionally used to understand Asperger's Disorder, such as deficits in theory of mind, central coherence or executive dysfunction.10–12 The extreme-male theory of autism may also shed light on the nature of crime in individuals with Asperger's Disorder.12
Dr. Schwartz-Watts mentions diminished capacity statutes as relevant to defendants with AD. We agree. There are many areas relevant to culpability and sentencing that may be affected by a PDD diagnosis. Given the deficits in the ability to read social situations and appreciate the points of view of others in AD, some affected defendants may qualify for criminal responsibility defenses of a psychiatric nature.
Finally, Autism Spectrum Disorders have a high heritability,13 and are thought to have robust underlying neuropsychiatric bases.11,12,14 Therefore, comprehensive forensic psychiatric evaluations in AD may necessitate diagnostic interventions, such as specialized neuropsychological testing and the collection of comprehensive psychiatric family histories, to help clarify the biological nature of cases of AD associated with violence.
References
Schwartz-Watts DM: Asperger's disorder and murder. J Am Acad Psychiatry Law 33:390–3, 2005
Siponmaa L, Kristiansson M, Jonson C, et al: Juvenile and young mentally disordered offenders: the role of child neuropsychiatric disorders. J Am Acad Psychiatry Law 29:420–6, 2001
Murrie DC, Warren JI, Kristiansson M, et al: Asperger's syndrome in forensic settings. Int J Forensic Ment Health 1:59–70, 2002
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, 2002
Tantam D: The challenge of adolescents and adults with Asperger's syndrome. Child Adolesc Psychiatr Clin North Am 12:143–63, 2003
Mawson D, Grounds A, Tantam D: Violence and Asperger's syndrome: a case study. Br J Psychiatry 147:566–9, 1985
Barry-Walsh JB, Mullen PE: Forensic aspects of Asperger's syndrome. J Forensic Psychiatry Psychol 15:96–107, 2004
Scragg P, Shah A: Prevalence of Asperger's syndrome in a secure hospital. Br J Psychiatry 165:679–82, 1994
Chackrabarti S, Frombonne F: Prevalence of developmental disorders in preschool children: confirmation of high prevalence. Am J Psychiatry 162:1133–41, 2005
Frith U: Autism: Explaining the Enigma. Malden, MA: Blackwell, 1989
Ozonoff S, Griffith EM: Neuropsychological function and the external validity of Asperger syndrome, in Asperger Syndrome. Edited by Klin A, Volkmar FR, Sparrow SS. New York: Guilford Press, 2000, pp 72–96
Baron-Cohen S: The Essential Difference: The Truth About the Male and Female Brain. New York: Basic Books, 2003
Santangelo SL, Folstein SE: Autism: a genetic perspective, in Neurodevelopmental Disorders. Edited by Tager-Flusberg H. Cambridge, MA: MIT Press, 1999, pp 431–47
Critchley HD, Daly EM, Bullmore ET, et al: The functional neuroanatomy of social behavior: changes in cerebral blood flow when people with autistic disorder process facial expressions. Brain 123:2203–12, 2000(J. Arturo Silva, MD ；Barb)
Recent reviews of AD and its association with violence, written from different perspectives, suggest that an association between AD and violence may exist.2–5 Other important contributions in this area have also appeared during the past two decades.6–7
In addition to the study by Siponmaa and colleagues2 discussed by Dr. Schwartz-Watts, a broad screening survey of an adult forensic population found a prevalence rate of between one and three percent for AD.8 Also, the most comprehensive and technically sound work concerning the epidemiology of Asperger's Disorder provides a prevalence of pervasive developmental disorders other than Autistic Disorder of 0.367% (or 36.7 per 10,000).9 These results, coupled with the work of Siponmaa and colleagues,2 support the idea that both AD cases and individuals with PDD NOS are at elevated risk for violent acts compared with the general population and that the number of individuals who suffer from autism and engage in violent crimes may be substantially higher than 2.5 per 10,000. Dr. Schwartz-Watts makes an important point when she states that there is a need for well-trained psychiatrists to recognize and diagnose PDD spectrum disorders, including AD. As forensic clinicians deepen their investigation into these disorders and violent crime, it will be crucial to identify various risk factors in subgroups of affected persons. For example, a murder may be perpetrated by a person with Asperger's Disorder who has substantial difficulties in appreciating the killing of a victim. His actions may be clarified by taking into account paradigms traditionally used to understand Asperger's Disorder, such as deficits in theory of mind, central coherence or executive dysfunction.10–12 The extreme-male theory of autism may also shed light on the nature of crime in individuals with Asperger's Disorder.12
Dr. Schwartz-Watts mentions diminished capacity statutes as relevant to defendants with AD. We agree. There are many areas relevant to culpability and sentencing that may be affected by a PDD diagnosis. Given the deficits in the ability to read social situations and appreciate the points of view of others in AD, some affected defendants may qualify for criminal responsibility defenses of a psychiatric nature.
Finally, Autism Spectrum Disorders have a high heritability,13 and are thought to have robust underlying neuropsychiatric bases.11,12,14 Therefore, comprehensive forensic psychiatric evaluations in AD may necessitate diagnostic interventions, such as specialized neuropsychological testing and the collection of comprehensive psychiatric family histories, to help clarify the biological nature of cases of AD associated with violence.
References
Schwartz-Watts DM: Asperger's disorder and murder. J Am Acad Psychiatry Law 33:390–3, 2005
Siponmaa L, Kristiansson M, Jonson C, et al: Juvenile and young mentally disordered offenders: the role of child neuropsychiatric disorders. J Am Acad Psychiatry Law 29:420–6, 2001
Murrie DC, Warren JI, Kristiansson M, et al: Asperger's syndrome in forensic settings. Int J Forensic Ment Health 1:59–70, 2002
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, 2002
Tantam D: The challenge of adolescents and adults with Asperger's syndrome. Child Adolesc Psychiatr Clin North Am 12:143–63, 2003
Mawson D, Grounds A, Tantam D: Violence and Asperger's syndrome: a case study. Br J Psychiatry 147:566–9, 1985
Barry-Walsh JB, Mullen PE: Forensic aspects of Asperger's syndrome. J Forensic Psychiatry Psychol 15:96–107, 2004
Scragg P, Shah A: Prevalence of Asperger's syndrome in a secure hospital. Br J Psychiatry 165:679–82, 1994
Chackrabarti S, Frombonne F: Prevalence of developmental disorders in preschool children: confirmation of high prevalence. Am J Psychiatry 162:1133–41, 2005
Frith U: Autism: Explaining the Enigma. Malden, MA: Blackwell, 1989
Ozonoff S, Griffith EM: Neuropsychological function and the external validity of Asperger syndrome, in Asperger Syndrome. Edited by Klin A, Volkmar FR, Sparrow SS. New York: Guilford Press, 2000, pp 72–96
Baron-Cohen S: The Essential Difference: The Truth About the Male and Female Brain. New York: Basic Books, 2003
Santangelo SL, Folstein SE: Autism: a genetic perspective, in Neurodevelopmental Disorders. Edited by Tager-Flusberg H. Cambridge, MA: MIT Press, 1999, pp 431–47
Critchley HD, Daly EM, Bullmore ET, et al: The functional neuroanatomy of social behavior: changes in cerebral blood flow when people with autistic disorder process facial expressions. Brain 123:2203–12, 2000(J. Arturo Silva, MD ；Barb)