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Research ArticleRegular Articles

Assessing the Risk of Inpatient Violence in Autism Spectrum Disorder

Alessandra Girardi, Ella Hancock-Johnson, Carlo Thomas and Paul M. Wallang
Journal of the American Academy of Psychiatry and the Law Online December 2019, 47 (4) 427-436; DOI: https://doi.org/10.29158/JAAPL.003864-19
Alessandra Girardi
Dr. Girardi is a Research Manager, and Ms. Hancock-Johnson is a Research Assistant, Research Centre, St Andrew's Healthcare, Northampton, United Kingdom. Dr. Thomas is Consultant Forensic Psychiatrist, and Dr. Wallang is Clinical Director and Consultant Forensic Psychiatrist, St Andrew's Healthcare, Northampton, United Kingdom.
MSc, PhD
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Ella Hancock-Johnson
Dr. Girardi is a Research Manager, and Ms. Hancock-Johnson is a Research Assistant, Research Centre, St Andrew's Healthcare, Northampton, United Kingdom. Dr. Thomas is Consultant Forensic Psychiatrist, and Dr. Wallang is Clinical Director and Consultant Forensic Psychiatrist, St Andrew's Healthcare, Northampton, United Kingdom.
MSc
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Carlo Thomas
Dr. Girardi is a Research Manager, and Ms. Hancock-Johnson is a Research Assistant, Research Centre, St Andrew's Healthcare, Northampton, United Kingdom. Dr. Thomas is Consultant Forensic Psychiatrist, and Dr. Wallang is Clinical Director and Consultant Forensic Psychiatrist, St Andrew's Healthcare, Northampton, United Kingdom.
MRCPsych, MSc, PGCert
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Paul M. Wallang
Dr. Girardi is a Research Manager, and Ms. Hancock-Johnson is a Research Assistant, Research Centre, St Andrew's Healthcare, Northampton, United Kingdom. Dr. Thomas is Consultant Forensic Psychiatrist, and Dr. Wallang is Clinical Director and Consultant Forensic Psychiatrist, St Andrew's Healthcare, Northampton, United Kingdom.
MB, ChB, MRCPsych
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Article Figures & Data

Tables

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    Table 1

    Patient Characteristics and Mental Health Section

    Non-violentViolent
    N (%)12 (42.9)16 (57.2)
    Age at admission (mean, SD)30.5 (10.6)33.2 (11.4)
    Physical aggression, N (%)-14 (50.0)
    Verbal aggression, N (%)-11 (39.3)
    Comorbidities N (%)
        Psychotic disorders4 (33.3)7 (43.8)
        Affective disorders2 (16.7)1 (6.2)
        Neurotic, stress related, somatoform2 (16.7)4 (25.0)
        Personality disorders4 (33.3)1 (6.2)
        Mental retardation1 (8.3)2 (12.5)
        Hyperkinetic disorder1 (8.3)-
    Section at admission N (%)*
        3 (admission for treatment)1 (8.3)8 (50.0)
        37 (hospital order)3 (25.0)-
        37/41 (hospital order with restriction)5 (41.7)5 (31.3)
        47 notional s37 (transfer to hospital)1 (8.3)-
        47/49 (transfer to hospital of prisoners with restriction order)2 (16.7)-
        48/49 (transfer to hospital of prisoners on remand)-1 (6.2)
        CPIA5 (Criminal Procedure Insanity)-2 (12.5)
    • ↵* Sections of the Mental Health Act (1983).

    • View popup
    Table 2

    HCR-20v3 Scores and Group Comparison for Overall Violence

    Non-violent Mdn (range)Violent Mdn (range)Mann-Whitney Ur
    Historical16.8 (12–20)16.6 (10–20)U = 94.5, z = −.07.01
    Clinical6.0 (3–9)7.0 (4–10)U = 59.5, z = −1.74.32
    Risk management8.0 (2–9)8.5 (5–10)U = 70.5, z = −1.21.22
    Total score30.1 (20–35)30.5 (23–38)U = 77.5, z = −.86.16
    Future violence1.0 (0–2)1.0 (0–2)U = 49.0, z = −.40.08
    Serious harm1.0 (0–2)1.0 (0–2)U = 48.0, z = −.31.06
    Imminent violence0.0 (0–1)1.0 (0–2)U = 10.0, z = −2.37*.60
    • Mdn = median; Future violence N: non-violent = 9; violent = 12; Serious harm N: non-violent = 8; violent =13; Imminent violence N: non-violent = 6; violent = 10; r = effect size.

    • ↵* p < .05.

    • View popup
    Table 3

    HCR-20v3 Scores and Group Comparison for Physical Aggression

    Non-violent Mdn (range)Violent Mdn (range)Mann-Whitney Ur
    Historical15.8 (10–20)17.0 (11–20)U = 76.5, z = −.99.19
    Clinical6.0 (3–9)7.5 (5–10)U = 53.0, z = −2.10*.40
    Risk management8.0 (2–9)8.5 (5–10)U = 69.5, z = −1.34.25
    Total score29.1 (20–35)32.1 (24–38)U = 57.5, z = −1.86.35
    Future violence1.0 (0–2)1.0 (0–2)U = 42.0, z = −1.03.22
    Serious harm0.0 (0–2)1.0 (0–2)U = 51.0, z = −.23.05
    Imminent violence0.0 (0–1)1.0 (0–2)U = 7.0, z = −2.84**.71
    • Mdn = median; Future violence N: non-violent = 10; violent = 11; Serious harm N: non-violent = 9; violent =12; Imminent violence N: non-violent = 7; violent = 9; r = effect size.

    • ↵* p < .05.

    • ↵** p < .01.

    • View popup
    Table 4

    HCR-20v3 Scores and Group Comparison for Verbal Aggression

    Non-violent Mdn (range)Violent Mdn (range)Mann-Whitney Ur
    Historical17.0 (12;20)16.2 (10;20)U = 84.5, z = −.43.08
    Clinical6.0 (3–10)8.0 (4–9)U = 63.0, z = −1.50.28
    Risk management8.0 (2–10)9.0 (5–10)U = 61.5, z = −1.54.30
    Total score30.0 (20–37)33.2 (23–38)U = 79.0, z = −.68.13
    Future violence1.0 (0–2)1.0 (0–2)U = 40.5, z = −.93.20
    Serious harm1.0 (0–2)1.0 (0–2)U = 54.0, z = −.00.00
    Imminent violence0.0 (0–2)1.0 (0–2)U = 17.5, z = −1.49.37
    • Mdn = median; Future violence N: non-violent = 13; violent = 8; Serious harm N: non-violent = 12; violent =9; Imminent violence N: non-violent = 10; violent = 6; r = effect size.

    • View popup
    Table 5

    ROC-AUC Results for Overall Violence

    First Three-Month PeriodSecond Three-Month Period
    AUCCI 95%AUCCI 95%
    Historical.42.19–.64.57.36–.80
    Clinical.66.45–.86.74*.54–.94
    Risk management.48.26–.70.76*.59–.94
    Total score.48.25–.71.75*.56–.94
    Future violence.61.37–.86.61.37–.86
    Serious harm.45.17–.72.52.24–.80
    Imminent violence.84*.64–1.0.84*.64–1.0
    • AUC: area under the curve; CI: confidence interval.

    • ↵* p < .05.

    • View popup
    Table 6

    ROC-AUC Results for Physical Aggression

    First Three-Month PeriodSecond Three-Month Period
    AUCCI 95%AUCCI 95%
    Historical.54.32–.77.64.44–.85
    Clinical.71.51–.91.80**.62–.97
    Risk management.50.27–.72.77*.59–.95
    Total score.60.38–.82.82**.65–.98
    Future violence.70.47–.92.61.37–.86
    Serious harm.51.24–.78.52.24–.80
    Imminent violence.92**.78–1.0.84*.64–1.0
    • AUC: area under the curve; CI: confidence interval.

    • ↵* p < 05.

    • ↵** p < .01.

    • View popup
    Table 7

    ROC-AUC Results for Verbal Aggression

    First Three-Month PeriodSecond Three-Month Period
    AUCCI 95%AUCCI 95%
    Historical.40.07–.71.44.20–.69
    Clinical.52.26–.78.64.40–.88
    Risk management.52.25–.78.72.52–.92
    Total score.42.11–.72.60.34–.87
    Future violence.52.19–.86.63.39–.88
    Serious harm.37.11–.61.56.30–.81
    Imminent violence.66.34–.98.81.58–1.0
    • AUC: area under the curve; CI: confidence interval.

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Journal of the American Academy of Psychiatry and the Law Online: 47 (4)
Journal of the American Academy of Psychiatry and the Law Online
Vol. 47, Issue 4
1 Dec 2019
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Assessing the Risk of Inpatient Violence in Autism Spectrum Disorder
Alessandra Girardi, Ella Hancock-Johnson, Carlo Thomas, Paul M. Wallang
Journal of the American Academy of Psychiatry and the Law Online Dec 2019, 47 (4) 427-436; DOI: 10.29158/JAAPL.003864-19

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Assessing the Risk of Inpatient Violence in Autism Spectrum Disorder
Alessandra Girardi, Ella Hancock-Johnson, Carlo Thomas, Paul M. Wallang
Journal of the American Academy of Psychiatry and the Law Online Dec 2019, 47 (4) 427-436; DOI: 10.29158/JAAPL.003864-19
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