This is a lay summary of Chapter 19 ‘Neurodiversity Assessment In Forensic Contexts, by Nancy Doyle, Lorraine Hough, Karen Thorne & Tanya Banfield’ – which appears in G.C., Fisher, M.J., & Jones, L.F. (Eds.) (2022). Challenging Bias in Forensic Psychological Assessment and Testing: Theoretical and Practical Approaches to Working with Diverse Populations (1st ed.). Routledge.
Who was this chapter written for?
This Chapter was written for Forensic Psychologists working with neurodivergent people in prisons. Drawing on a proposal by Judy Singer, the authors agree that that there is nothing inherently disabling about ADHD, Autism, Dyslexia, Dyspraxia, and that diversity in the way we think is a natural feature for humans.
Problems with umbrella terms
We noted that the UK Criminal Justice Joint Inspectorate Neurodiversity Review (CJJI, 2021) used Neurodiversity as an umbrella term referring to the group of conditions falling under the category of neurodevelopmental disorders (NDDs). We suggested it is better to use ‘neurominorities’ or ‘neurodivergence’ as umbrella titles, because neurodiversity itself includes everyone. There are more neurominorities in prison than there should be, considering how many there are in the population in general. This means that Forensic Psychologists should be aware that lots of people in their care may be neurodivergent, as the following summary shows:
(CJJI, 2021) | Over 50% of the prison UK population is dyslexic. |
(McNamara, 2012) | Up to 80% of people in a UK prison have some kind of speech, language or communication difficulty. |
(Young et al., 2018) | Approximately one quarter of people in prison in the UK would meet diagnostic criteria for ADHD. |
(CJJI, 2021) | Approximately 5-7% of those meeting Liaison and Diversion services in the UK have Autistic traits, with around 16-19% of those in prison showing signs of Autism. |
(Prison Reform Trust, 2021) | Approximately 34% of people in custody in the UK have a Mild Intellectual Disability (MID) or Borderline Intellectual Functioning (BIF). |
(Prison Reform Trust, 2021) | 49% of women and 23% of men in custody in the UK have been diagnosed with anxiety or depression. |
(Shiroma et al., 2010)
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Estimated brain injuries amongst Criminal Justice System populations vary significantly based on the populations being studied and the assessment method, but analysis of international studies suggests that rates of brain injury in convicted populations is approximately 60%. |
Diagnosis
Many neurodivergent people in prisons do not know that they are neurodivergent, or don’t have a diagnosis. Does this mean that Forensic Psychologists should try to make diagnoses using specialist tests? We explained that neuropsychology is not finding strong evidence for neurominorities as separate diagnoses. In fact, there is more in common across the different conditions than there are features to separate them. Because of this, it is hard to make accurate diagnoses.
We also explained that diagnosis is made difficult because of intersecting identities, such as those in this table, which are affected by biased definitions and tests:
Gender |
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Race and Ethnicity |
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Poverty |
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When we added together the differences for different types of people, and how unreliable testing is, we advised psychologists working in prisons to focus on needs rather than labels. We advised working with different types of testing (see following table) to assess neurodivergent people in prisons.
Tests | Important facts | Strengths | Limitations |
Cognitive ability testing (standardised)
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MUST be validated with data analysis and approved by a peer review publication. | Gives very accurate information about how well a person thinks using different areas of thinking – verbal skills, memory etc | Expensive, takes time. Not always immediately helpful to a person who wants to know what to do next. |
Self-Report questionnaires (standardised)
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Must be validated with data analysis to check how reliable the answers are.
Good ones will also be approved by a peer review publication. |
Makes sense to people taking the tests.
Useful for thinking about what to do next. |
Can be affected by how the person feels on the day. They might answer differently at a different time or on a different day. |
Testing that has not been standardised (whether self-report or ability testing) | These provide information about a person’s experience. | They cannot be used to make predictions about what people might need. |
We then explained what types of help are useful for different challenges, rather than recommending help based on a label.
Challenge | Recommendations for potential strategies and reasonable adjustments |
Executive functions – working memory and processing speed |
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Executive functions – planning, time management and organisation |
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Language – verbal |
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Language – written |
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Motor control and balance |
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Sensory Sensitivity
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Emotional dysregulation |
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We hope that this information helps people working in prisons to make a positive difference for neurodivergent people in prisons.
References
CJJI. (2021). Neurodiversity in the Criminal Justice System: A review of evidence (pp. 1–77). Criminal Justic Joint Inspection.
McNamara, N. (2012). Speech and language therapy within a forensic support service. Journal of Learning Disabilities and Offending Behaviour, 3(2), 111–117. https://doi.org/10.1108/20420921211280097
Prison Reform Trust. (2021). Bromley Briefings Prison Factfile (p. 66). Prison Reform Trust.
Shiroma, E. J., Ferguson, P. L., & Pickelsimer, E. E. (2010). Prevalence of traumatic brain injury in an offender population: A meta-analysis. Journal of Correctional Health Care : The Official Journal of the National Commission on Correctional Health Care, 16(2), 147–159. https://doi.org/10.1177/1078345809356538
Young, S., González, R. A., Fridman, M., Hodgkins, P., Kim, K., & Gudjonsson, G. H. (2018). The economic consequences of attention- deficit hyperactivity disorder in the Scottish prison system. BMC Psychiatry, 18, 1–11. https://doi.org/10.1186/s12888-018-1792-x