Screening for autism spectrum disorders and an examination of social cognition in prisoners

Prisoners have high rates of physical and mental morbidity and of re-offending. There have been concerns that autism spectrum disorders (ASDs) may be overrepresented and under-diagnosed in this population. The aims of this study were to examine the effectiveness of an instrument which was developed to screen for ASDs in prisons and to establish whether male Scottish prisoners differ from community controls with respect to facial emotion recognition, as measured by behavioural testing, and differ on a neural basis while performing complex social judgements, as measured using functional magnetic resonance imaging (fMRI). A total of 2458 prisoners (approximately 40% of the convicted prison population) were examined using the screening tool, of whom a further 127 were interviewed in depth and were assessed for facial emotion recognition ability. FMRI was used to examine haemodynamic changes in a small sample of liberated prisoners (9) during a social judgement (approachability) versus control (gender judgments) task. The screening tool had poor sensitivity (28.6%) and specificity (75.6%) and was not effective or useful in screening for ASDs in this population. Significant deficits in negative facial emotion recognition were found in the prisoner group in comparison with age- and sex-matched community controls. Region of interest analysis of fMRI data in the bilateral amygdala revealed significantly greater activation in the left amygdala in ex-prisoners versus controls during the social judgement task. The identification of these abnormalities in facial emotion recognition and social judgement are in keeping with current literature on antisocial populations. They may offer the opportunity for development of interventions aimed at reducing re-offending in the future.