By Jill Del Pozzo

On December 14, 2012 I walked into my client’s preschool, just as I had done every other day as his behavioral therapist for the past two years. On this day, however, I was not greeted with the friendly hellos I had grown accustomed to, but rather, I was bombarded with questions about my four-year-old client and whether I had ever witnessed him “act violently” and if I thought “he posed a risk to other students and staff.” My client has autism spectrum disorder (ASD) and this was the afternoon of the Sandy Hook Elementary school shooting.

This incident, I realized, was the tipping point that brought a theorized association between ASD and violence into the public eye. Media outlets quickly began declaring that the shooter was “odd” and “a loner,” which quickly turned into a “lack of ” and finally, that he was “on the autism spectrum” and was diagnosed with a mental illness “like ’s.” Within a few days, reporters were confidently attributing the shooting to Adam Lanza’s autism.

, also known as pervasive developmental disorders (PDD), are a range of lifelong neurodevelopmental disorders that onset in early . On a spectrum, a diagnosis of ASD includes disorder (AD), pervasive developmental disorder not otherwise specified (PDD-NOS), and Asperger syndrome (AS). It is currently estimated that 1 in 68 US children have ASD, with males outnumbering females five to one. These disorders are characterized by two prominent symptom clusters: (1) significant impairments in social communication and interaction and (2) repetitive patterns of behavior, activities and interests. ASD fall on a continuum, with some individuals showing only mild symptoms and others having symptoms that are severely impairing.

Media reports in the past two decades have covered some high profile criminal cases involving offenders with alleged diagnoses of ASD, such as the Virginia Tech, Newtown, Santa Barbara, and most recently, the Umpqua Community College shootings. News and social media outlets across the nation have attributed the offenders’ violent behavior to ASD. This and the sensational nature of these incidents has given rise to public concerns and led to the perception that persons with ASD are predisposed to violent behavior, generating a speculative association. Not only is this publicity and speculation inaccurate and irresponsible, it is damaging and stigmatizing to those with ASD.

Aside from media reports, most of the published studies on criminal offending and ASD have been conducted in secure settings and hospitals, yielding highly biased population samples which may not be representative of individuals with ASD in the community. In 2006, Woodbury-Smith and colleagues did a community-based study (the only one to date), which suggested that individuals with ASD offend at a similar or lower rate as the general population, not a higher one.

Nevertheless, even if it is rare and only a small subset of individuals with ASD are violent or criminally offend, we need to understand the reasons why. Understanding who is at-risk for violence will help us develop and provide preventative treatments. In a recent op-ed, Andrew Solomon sensibly addressed the issue of in autism, noting that when the two conditions coincide, the red flags should go up. However, another such risk factor that is too often overlooked is a comorbid psychotic disorder. A 2013 article by Wachtel and Shorter noted the presence of psychotic ideation among recent mass murderers. They argue that in some of these cases two associated conditions may be at play, autism and , leading to an increased risk for violence. Most quality research on the subject indicates that rates of violence are increased when people have psychotic symptoms, such as and delusions. (At the same time, most people with a psychotic disorder are not violent, and psychosis accounts for a very small proportion of overall violence in society).

When the term ‘autism’ was first used by Eugen Bleuler at the beginning of the twentieth century, it originally signified a particular disturbance in described as a narrowing of relationships to people and the outside world, one where they live in a world of their own and detach from reality. Yet, in 1943 Leo Kanner distinguished autism from childhood schizophrenia, determining that individuals with schizophrenia withdrew from social relationships while children with autism never developed social relationships to begin with. This distinction identified autism as a distinct neurological condition.

On the other hand, ASD are known to have much , with schizophrenia-type illnesses observed in up to 35% of patients with ASD. This includes having hallucinations, and delusions, leading researchers to propose that ASD might actually be a risk factor for the development of psychosis. The early symptoms of schizophrenia, including social impairments and withdrawal, difficulty communicating and lack of emotion or emotional expression can be indistinguishable from those of ASD. Furthermore, people with ASD often have a strong family history of schizophrenia, and there is some overlap in structural brain changes between the two conditions (e. . grey matter deficits). Therefore, while autism and schizophrenia are distinct disorders, there appears to be some degree of clinical overlap.

Despite this overlap, there is no scientific evidence that autism, by itself, increases the risk of violence. In fact, because of the rigid ways individuals with ASD tend to think and to keep to rules and regulations, studies suggest that people with autism are less likely to engage in criminal behavior of any kind compared with the general population. However, while the risk of violence in non-psychotic ASD individuals appears to be no greater than among the general population, individuals with ASD have an elevated risk of psychosis, which is strongly associated with violence. Therefore, it is possible to identify a person with ASD who is at risk for violence based on psychotic comorbidity, but not based on the ASD itself.

My four-year-old client was not psychotic (few four-year-olds are), and indeed was nothing but smart, sweet, and sensitive. In the three years I worked with him the slightest thing would often hurt his feelings and if any other child were upset, he would comfort them and ask if they were okay. He always followed directions and had many friends he was constantly engaging with, both at school and at aftercare. He talked to and played with everyone in his class and made sure everyone was included in each activity. How could any one of the teachers at his school think a four-year-old was at risk for suddenly becoming violent when he had no prior history, just because of an autism diagnosis? Their flood of questions shocked me and all I could do was stare at them.

Clearly, the popular narrative is that autism raises the risk for violence, and even many educated people have internalized this message. Aside from leading to stigma, it is entirely unhelpful in preventing mass shootings. Of course, it is extremely important to try to prevent these incidents and we need real data-driven ways to do that. This speculative noise about autism is unfair and distracts us from pursuing the real risk factors.