Abstract
Youth on the autism spectrum who engage in delinquent or violent crimes can be adjudicated to juvenile correctional settings. These settings, which are meant to successfully reintegrate youth back into the community through education, counseling, and skills programs, are often ill-equipped to navigate the unique needs of youth on the autism spectrum. As a result, autistic youth in juvenile correctional settings often do poorly, minimizing the likelihood that successful reintegration occurs. The purpose of this review is to summarize the literature on the prevalence of autistic youth in correctional settings and their needs, as well as the standard of care often afforded to them in these settings. Finally, we will present suggested strategies informed by the literature whereby adjudicated autistic youth are provided services and support that are feasible in a correctional setting and align with autism-informed, evidence-based practices.
Autism spectrum disorder (autism; autism spectrum) is a neurodevelopmental condition characterized by pervasive social communication challenges and restricted, repetitive, and inflexible patterns of behavior, interests, and activities.1 In this article, we have used a mix of person-first (i.e., person on the autism spectrum) and diagnosis-first language (i.e., autistic person) to reflect and be respectful of the wide diversity of identity preferences in the English-speaking autism community2,3 and to align with guidance from the National Institutes of Health.4
Individuals on the autism spectrum can experience co-occurring behavioral and mental health symptoms, which has been noted to place them at risk for being in contact with the criminal justice system (CJS).5 Although there is a small but growing literature base on the prevalence, experiences, and outcomes of youth on the autism spectrum involved in the CJS, research is limited by methodological quality.6,7 A wide range of prevalence exists for autism diagnosis in offending populations (i.e., estimated to be between 0.2 and 62.8%).6 Some existing research suggests that autistic young adults encounter the juvenile CJS during youth at a similar rate as neurotypical young adults, whereas other research indicates that youth on the autism spectrum may be overrepresented in forensic settings.8,–,10
Many argue that traits associated with autism (social communication challenges, restrictive behavior and interests, etc.) can place autistic persons at a disadvantage in the CJS, and some movement has been made within the court system to address and mitigate these potential risks.10,–,13 A federal judge in Nevada, Sunny Bailey, has established an alternative court and diversion program, Detention Alternative for Autistic Youth (DAAY), for autistic individuals to address and mitigate these potential risks.13 The intent of DAAY is to address the disparities autistic youth with CJS involvement face by providing appropriate accommodations, treatment, and therapeutic support in the courtroom, other CJS settings, and the community to reduce the likelihood these youth become incarcerated as adults. As of February 2024, 86 autistic youth have graduated from DAAY with only six returning to court. Because of DAAY’s success, Nevada Senate Bill 411 has been signed into law, enabling other jurisdictions across Nevada to create their own DAAY program.14
Although it is unclear whether autistic youth and young adults are overrepresented or routinely receive harsher penalties in forensic settings, literature supports that autistic youth do commonly encounter the CJS,6 and there is a potential risk of adverse outcomes.10,–,12,15 Therefore, it is important to understand the experiences of youth on the autism spectrum in CJS settings and ensure they have adequate support.
When autistic individuals are incarcerated, they may experience unique challenges, specifically related to social interactions with staff and other delinquent youth who lack understanding of autism, difficulties coping with the unpredictability of the environment, lack of staff knowledge regarding the recognition of autism and appropriate management, and difficulties tolerating loud noises that commonly occur in correctional settings.6,16,–,18 Although several policies and recommendations have been proposed19,20 to ensure that autistic people who encounter the CJS are receiving person-centered and evidence-based care, the current care practices in prisons and jails, including juvenile correctional centers, are considered “autism-unfriendly.”20,–,22 Specifically, strategies currently employed in juvenile forensic settings often emphasize repression-control procedures that can negatively affect any youth (regardless of neurodevelopmental status),23 whereas evidence-based practices that prioritize individualized services and interventions to enhance skills and overall functioning are underemphasized.17,21 Further, there is recognition that autistic individuals are highly vulnerable to social isolation, victimization, and exploitation by other peers in the juvenile system.17,19,20,22 Thus, it is evident that improvements to the current structure of the CJS in the United States are necessary so persons on the autism spectrum are supported.
Related to the dearth of research on autism in juvenile correctional settings, autistic youth presently in these settings continue to experience inadequate care. To begin to improve care of incarcerated youth on the autism spectrum, development of a framework for improved care is needed. The purpose of this article is to provide preliminary recommendations to inform the starting steps to improve care for incarcerated youth on the autism spectrum. Although further research is needed to establish a comprehensive ideal framework, this article is designed to serve as an initial guide by which, once an adolescent with autism is sentenced to a juvenile forensic setting, correctional staff might identify strategies, programs, or systems of care that may lead to more positive outcomes.
In 2022, the Indiana Department of Corrections (IDOC) recognized a need to improve care for autistic youth adjudicated to their juvenile forensic settings. The first author (J.C.F.), a regional expert on community-based neuro-affirming interventions, and the fifth author (D.D.), the IDOC Director of Behavioral Health and an expert in therapeutic care within correctional settings, began a collaborative relationship to develop a set of recommendations to implement at a pilot site, the Pendelton Juvenile Correctional Facility (PNJCF). The goal was to enhance access to appropriate support and strategies for staff working with adjudicated autistic youth. Given the limited research and scarcity of experts focused on this topic, evidence-based guidelines were not available. Consequently, the team (including IDOC and PNJCF administrators and staff) codeveloped site-specific support and strategies based on their review of the available literature. The following narrative review provides an outline for the basis of the agreed-upon initial areas for improvements at PNJCF for addressing barriers to care and areas for improvement for autistic juvenile correctional settings.
Barriers to Care
Evidence-based treatments for youth on the autism spectrum stress the importance of motivation and incentive systems based on positive reinforcement, structured and consistent environments with predictable routines, low child-to-adult ratios for instruction, the use of visual support (e.g., activity schedules), familial support and involvement, and environmental modifications to ensure appropriate levels of sensory stimulation depending on an individual youth’s needs.24 There is a lack of research investigating the treatment of youth on the autism spectrum in juvenile correctional settings. Existing knowledge about the common practices used in these settings indicates that autistic youth do not receive the support necessary to thrive. For example, overcrowding is a common difficulty in juvenile CJS,23 which can lead to overstimulation for individuals with autism who report that they find areas with too many people and crowded spaces to be loud, busy, and stressful to navigate.25 Additionally, access to intensive behavioral and therapeutic evidence-based treatment and coordination among previous treatment providers (e.g., behavioral therapists, psychiatrists, psychologists, occupational therapists) may be limited once incarcerated26 because of insufficient staffing levels and time constraints and competing demands of correctional officers, in-house therapeutic staff, and community-based providers. Family involvement is also often impaired when youth are in correctional settings. For all youth in correctional settings, being able to maintain contact with loved ones could be a source of support. Yet, for autistic youth, family involvement has been found to be vital to the development of their self-determination skills,27 successful transition to adulthood,28 and improved outcomes across the lifespan.29 As a result of the disruption in maintaining contact with loved ones and other well known familiar persons, adjudicated autistic teens may struggle to develop the skills necessary to thrive.
The current discipline and care models within juvenile detention settings may be another area that contributes to difficulties for autistic youth. Historically, juvenile correctional facilities have used a punitive model for youth,30 which is counter to the positive behavioral support that is known to be effective for individuals with autism.31 Along these lines, restraints and seclusion are often used as interventions for externalizing behavioral episodes,26 which can lead to adverse psychological, physical, or emotional harm and escalate conflicts.32,33 Data consistently show that, for any youth, regardless of autism status, the use of punitive treatment models, like restraint and seclusion, are contraindicated.34,–,36 Professional organizations23,34,37,–,41 and the 2018 Juvenile Justice Reform Act42 call for the elimination of dangerous practices in the juvenile CJS, including the unreasonable use of restraints and seclusion, and increases in the use of alternative behavioral management techniques. Finally, youth in juvenile CJS settings may move through numerous placements and spend unpredictable amounts of time at each facility.23 For individuals on the autism spectrum who most often do their best with consistency, clear expectations, and routine in their environment,24 transitions to new placements may cause undue stress and anxiety, resulting in behavioral and emotional dysregulation. Additionally, on a day-to-day basis, it may be difficult for juvenile correctional settings to provide the amount of structure and routine needed to help autistic youth thrive. Thus, barriers to care within the juvenile correctional setting may include overwhelming sensory environments, insufficient therapeutic support, disrupted family engagement, punitive disciplinary approaches, and limited structure and predictability.
In addition to the disparity between evidence-based practices for autism and the routine care delivered in juvenile detention settings, a lack of clarification and communication about diagnoses and minimal staff training on the needs of autistic youth serve as barriers to care. A study by Passmore et al.43 found that correctional officers working in juvenile detention settings who were involved in the day-to-day care of autistic youth were rarely informed about their neurodevelopmental disability diagnosis. Further, in instances where a youth was noted to have a neurodevelopmental disability, the diagnosis was most likely based on the officers’ own judgment rather than the findings of a qualified mental health professional (e.g., psychologist or psychiatrist). This finding aligns with previous research by Talbot and Riley44 noting that learning difficulties in adult prisoners were most often identified through staff observation. Consequently, the absence of a systematic approach to arrive at a diagnosis and the subsequent effective communication of autism status to staff involved in the autistic youth’s care pose a significant barrier to providing adequate services within the juvenile justice system.
Beyond the challenges related to accurate diagnosis and effective communication of autism status, there exists a lack of training on evidence-based care for individuals with neurodevelopmental disabilities within the CJS setting. It has been noted that juvenile correctional officers report that their primary source of information about specific disorders (e.g., autism, attention deficit hyperactivity disorder, and intellectual disability) is most often from personal experience rather than from formal workforce education and training.43 This is consistent with past research demonstrating that workforce education and training is not the primary route through which criminal justice professionals received information about neurodevelopmental disabilities.45,–,48 The absence of adequate training on evidence-based care for individuals on the autism spectrum can result in misinterpretation of behaviors, unintentional escalation of behavioral and emotional difficulties, and counterproductive interventions.49
Staff in juvenile detention facilities are consistently interested in training opportunities and additional knowledge that can help manage the care of incarcerated youth with neurodevelopmental disabilities.44,45,48 This desire to learn more should be commended and indicates that there is a need for effective trainings and interventions to be developed and implemented.
CJS Improvements for Autistic Youth
Although it is important to identify the various barriers that autistic youth experience while adjudicated to juvenile correctional settings, it is equally imperative to consider strategies to address these obstacles. Broadly speaking, many of the obstacles experienced by incarcerated youth with autism fall under three main themes: environment, programming, and staff training and interaction. Of note, many of the suggestions offered below have the potential to result in an improved experience for all individuals in the CJS, including youth who are not on the autism spectrum. But these suggestions are particularly important to address for autistic youth who are at risk of worse outcomes compared with neurotypical peers.10,–,12,15
Environment
Youth on the autism spectrum may exhibit abnormal responses to stimuli, resulting in a hyper- or hypo-response to sensory input.1 Thus, creating a sensory-friendly environment could facilitate a calm, cooperative environment for autistic youth to engage with staff and their peers. This might mean making private or shared living accommodations visually pleasing through paint colors or adding murals. Given the harsh nature of fluorescent lighting that can be aversive for autistic youth with visual hypersensitivity, having varying levels of dimmability for lighting allows for attenuated visual input and may be preferred.50 Noise attenuation devices, such as sound-reducing headphones, ligature-free white-noise machines, or nontoxic earplugs, may be beneficial for youth who may become overstimulated or anxious in noisy settings.51 Individuals on the autism spectrum often have altered sensory-motor awareness,52 resulting in unique needs for moving their body in or around their environment. As a result, providing alternative seating options that allow for movement may help with accessing sensory input while in an enclosed area or when staying seated. Providing access to larger or open areas, both indoors and outdoors, for gross motor movement can also address kinesthetic input needs.50,52 Finally, allowing free access to safe “fidget items” (i.e., nontoxic, wipeable or washable, without sharp edges, and without parts that can be easily broken) can allow for an additional method of self-soothing and relaxation. These items have been shown to increase focus, emotional regulation, and ability to tolerate challenging sensory situations in youth with autism and other neurodevelopmental disabilities.53
Establishing peer relationships can be difficult given the challenges faced by autistic youth in interpreting social cues.1 Furthermore, youth with autism are more prone to being taken advantage of than their neurotypical counterparts.16 To address these concerns, private sleeping rooms could be considered. Private sleeping rooms would provide a safe, therapeutic area for rest during the night. Private rooms could allow youth on the autism spectrum space to calm and recenter themselves away from stressors during the day, without being placed in seclusion. If behaviors have escalated beyond an individual’s ability to self-regulate, providing access to safe spaces or rooms with limited furnishings or padded surfaces may significantly reduce risk of injury from self-harming behaviors. Youth should be able to access and leave these safer spaces independently to promote proactive self-regulation and problem-solving skills versus using these spaces as punishment for engaging in negative behavior.
Establishing an environment focused on utilizing strengths-based and trauma-informed practices is imperative for all youth in the juvenile correctional setting,23 including youth with autism.30 Being able to capitalize on their skills, interests, and abilities can be a way to more frequently align with an autistic youth who may struggle to form positive relationships with peers and adult staff because of social communication difficulties associated with the condition and because of their history, which may involve trauma, neglect, or negative interactions with law enforcement or health care professionals. All youth in juvenile correctional settings (regardless of autism status) should have medical screening upon admission and as needed if new concerns arise. For youth on the autism spectrum, specific screening for medical problems noted to commonly occur in these individuals (e.g., seizures, constipation, sleep disturbance)54 is important to ensure adequate accommodations are provided. Further, noting or assessing for mental health symptoms (e.g., anxiety, mood, irritability, impulsivity, inattentiveness) is necessary given the increased risk of co-occurring psychiatric disorders in autistic youth.5 Including multiple methods of assessment (e.g., self- or caregiver report, record review, observation, diagnostic instruments developed for or adapted to use with autistic youth) will be important to guard against mis- or underdiagnosis. In instances where there is an identified co-occurring psychiatric disorder, using evidence-based psychopharmacology guided by licensed mental health prescribers (e.g., board certified child psychiatrists, psychiatric nurse practitioners) will be necessary.55
Programming
Youth on the autism spectrum more often excel when provided with clear, consistent directions and structure.24 Specifically, it would be beneficial to provide easily understandable schedules using visual aids, because neurodivergent youth commonly have executive functioning challenges and processing difficulties, particularly in response to verbal instructions.55,–,57 These schedules may include pictures or text-based representations of daily routines. To facilitate smooth transitions between activities, research has shown that autistic youth do best when positive behavior support strategies are used, including providing clear transition cues, alternating tasks (type, preference level), choices, and advance preparation for changes.58
The use of positive behavior support strategies, including positive reinforcement, has been shown to be effective therapeutic tools for youth on the autism spectrum.31 Rather than focusing on negative behaviors, positively reinforcing desired behaviors can be beneficial. Providing developmentally appropriate, clear, and consistent expectations may also aid language processing, which is a noted difficulty for those on the autism spectrum.59 Autistic youth often benefit from more frequent and individualized reinforcement that considers their specific interests,60 which may differ from neurotypical peers. Although tailored programs are helpful, creating opportunities for integration with neurotypical peers can foster social connections and lessen stigma.
Programming for youth on the autism spectrum should preferentially be organized by a licensed mental health professional (e.g., licensed clinical psychologist or clinical social worker) with advanced training in autism or with a strong background in applied behavior analysis and other relevant evidence-based practices. Mental health professionals with training in evidence-based psychotherapies for youth can be a viable option, particularly when experienced autism treatment providers are unavailable. This is particularly true if the professionals demonstrate a commitment to autism-focused continuing education, utilize a strengths-based therapeutic approach, actively collaborate with autistic youth to establish actionable goals that enhance quality of life and self-determination, consult with autism-focused experts in their area, and thoughtfully integrate the individual’s needs and interests into treatment planning.61,62 In general, individualized or group-based programs should be informed by a positive behavior support framework31 and focused on increasing adaptive skills and emotional regulation, while concurrently minimizing or mitigating behaviors or mental health symptoms that hinder the youth’s success. Ideally, comprehensive programming would encompass various domains, including emotion identification and regulation, distress tolerance, sexual health, healthy relationship education, self-advocacy, functional communication, problem-solving, self-care or activities of daily living, and vocational training.
As youth approach discharge and reentry into their community, specialized transition programming may need to be considered depending on the individual’s needs. Caregiver training may be indicated to facilitate a smoother transition home. Engaging in care coordination with community providers can ensure continued service provision. For optimal outcomes, strategies that have been effective should be communicated in advance to all relevant parties involved in the youth’s ongoing care within the community, including parents and caregivers, school personnel and teachers, and health care providers. In cases where proactive transition planning is not feasible, caregivers should be provided with contact information for relevant community mental health care services in the youth’s home area. A typed treatment summary that includes effective therapeutic and educational strategies can also support this transitional phase. The treatment summary should be shared with the individual’s school, so that any beneficial therapies or educational strategies can be incorporated into an individualized education program (IEP)63 or 504 plan.64
Staff Interaction and Training
Emotional dysregulation and interfering or unsafe behaviors, such as self-injury and aggression, commonly occur in autistic youth. Additionally, being in unfamiliar settings can cause anxiety in children and adolescents on the autism spectrum, which may be expressed through an increase in disruptive or aggressive behavior.65 As a result of the increased risk of behavioral and emotion regulation difficulties, specialized autism inpatient psychiatric units typically maintain higher staff ratios compared with the general psychiatric units.66 The presence of additional staff is crucial to ensure efficient and safe utilization of appropriate aid and de-escalation techniques. Similarly, juvenile CJS facilities, because of rules and regulations that may not align with the autistic youth’s needs, may exacerbate the risk of behavioral outbursts.45,67 As a result, juvenile correctional settings should consider maintaining a higher staff-to-youth ratio when youth on the autism spectrum are under their care. The availability of extra staff within milieu settings could aid in interventions such as de-escalation, coaching youth in learned problem-solving skills and coping strategies, and facilitating activities and positive peer interaction.
Having dedicated staff with autism experience and training is important in maintaining a safe environment. Beyond this, having appropriately trained staff reduces the risk of burnout, thereby decreasing the rate of turnover. Having inconsistent staffing (whether related to high turnover or scheduling) results in lags in consistent use of therapeutic strategies and disrupts the daily routine, which can lead to increased emotion regulation difficulties in youth with autism.68,69 Having a consistent group of staff could also promote building therapeutic bonds between staff and the autistic youth, thereby increasing engagement and cohesion in skill-building activities, particularly those provided in groups. With regards to training, at a minimum, staff should be educated on the core characteristics of autism, including its diagnostic features, factors of the disorder that may make interaction with staff more difficult, strategies to build rapport with autistic youth, autism-informed behavioral teaching or therapeutic strategies, and trauma-informed de-escalation strategies. Additional periodic training to reinforce content or introduce new behavior management or therapeutic strategies would be beneficial.
Educating staff on specific triggers and needs of the youth they support allows for more individualized care. When an autistic youth arrives, staff should complete a “staffing summary sheet” (see Figs. 1 and 2 for two examples being used at PNJCF) with the assistance of the youth or prior caregivers. This document should include essential information, such as the youth’s confirmed diagnoses (as appropriate); how the youth best communicates and best understands others’ speech; preferred activities; dietary needs or restrictions; effective occupational, learning, and sensory-based support; and behaviors of concern, if applicable. For autistic youth who engage in interfering or unsafe externalizing behavior, the sheet should outline known triggers, signs of distress, de-escalation strategies, crisis plans, expectations, and accommodations. This form can be updated over time and shared with staff who are involved in the youth’s direct care and support.
Figure 1. Example of a staffing summary sheet. DOC, Department of Correction.
Figure 2. Example of a brief staffing summary sheet. DOC, Department of Correction.
Conclusions
Individuals on the autism spectrum may be overrepresented in the CJS despite similar rates of offense compared with neurotypical peers.8,–,10 This is particularly true for youth on the autism spectrum. Despite the increased risk of autistic individuals encountering the CJS, the standard practices in juvenile correctional settings are not designed to help youth on the autism spectrum thrive.30 Several barriers exist in the standard juvenile correctional setting, including an overcrowded and overstimulating environment, limited access to evidence-based behavioral and therapeutic treatments, inadequate staffing levels, and lack of training and understanding among staff regarding autism and effective care practices.19,20,30,67
It is important to recognize obstacles to providing adequate autism care in juvenile correctional settings and make attempts to address barriers so that autistic youth can achieve better outcomes. It should be noted that many of the recommended strategies for youth on the autism spectrum are also beneficial for the broader population of incarcerated youth, meaning that training staff on these approaches is a worthwhile and potentially cost-effective investment. Areas that should be targeted for change include making environmental modifications, increasing access to programming that aligns with evidence-based autism practices, and ensuring appropriate staff ratios and training, as is summarized in Table 1. We acknowledge that there is a significant lack of available research on this topic. Our goal is to initiate discussion regarding the existence of these barriers and begin to consider how we, as a community, may begin to address them. Therefore, we recognize that the list of suggested strategies is not exhaustive, and additional research is required. Furthermore, it is important that future research acknowledges the ethics and challenges associated with the incarceration of autistic youth as well as noncarceral rehabilitation alternatives.
Areas Important to Address to Increase Autism-Specific Care in Juvenile Correctional Settings
Acknowledgments
We would like to thank the staff at the Pendelton Juvenile Correctional Facility in Pendelton, Indiana and the Indiana Department of Corrections for recognizing the need for improving access to neuro-affirming care for teens with autism in their care.
We would like to thank Tiffany Neal, PhD and Angelica Cogliano, Esq. for their thoughtful suggestions and reflections on a previous version of this manuscript.
Footnotes
This project received support from the Indiana Clinical and Translational Sciences Institute, which is funded in part by Award Number UM1TR004402 from the National Institutes of Health, National Center for Advancing Translational Sciences, Clinical and Translational Sciences Award. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.
Disclosures of financial or other potential conflicts of interest: None.
- © 2025 American Academy of Psychiatry and the Law
