Medical Examiner

Don’t Be Afraid of People With Autism

They are not cold-blooded killers.

Boy throwing a temper tantrum.
Yes, autistic children can engage in dangerous behavior. But the autistic population has a lower rate of criminal activity than that of neurotypicals.

Photo by Agnieszka Ciura/Hemera/Thinkstock.

It first showed up in my Facebook feed early Saturday morning, and then I saw it everywhere—in my email inbox, my texts, all over the internet:  Asperger’s … Asperger’s … Did you hear???? … Asperger’s. Twenty-year-old Adam Lanza, who had killed 26 people at Sandy Hook Elementary School the day before, was allegedly on the autism spectrum. Advocates rushed to respond; many groups, including Autism Speaks, GRASP (the Global and Regional Asperger Syndrome Partnership) and Autism Rights Watch issued statements expressing sympathy for the victims while reminding a spooked public not to “scapegoat” the disorder or further “stigmatize … autistic persons and their families.”

Although Lanza’s diagnosis has yet to be confirmed, he is only the latest mass murderer whose autism-spectrum status has been speculated about, including Colorado movie shooter James Holmes and Anders Behring Breivik, the Norwegian who killed 77 people in 2011. Even serial killer Jeffrey Dahmer and Unabomber Ted Kaczynski have been retroactively labeled autistic, with the same diagnosis-happy fervor that has caused other activists to claim Albert Einstein and Thomas Edison as members of the Asperger’s nation. But the legitimacy of these diagnoses is less interesting than the question they imply: Did autism make them do it?

As president of EASI Foundation: Ending Aggression and Self-Injury in the Developmentally Disabled, I work with many families struggling to manage their autistic children’s dangerous behaviors. There was a time when my own son Jonah, now 13, was prone to such violent rages that I feared I might end up like Trudy Steuernagel, who was bludgeoned in 2009 by her 19-year-old autistic son Sky Walker, or Linda Foley, who was also beaten to death by her 18-year-old stepson, Henry Cozad. But I was never afraid Jonah would massacre 20 kids with a semi-automatic rifle. 

Researchers distinguish between two types of aggression: affective and predatory. Affective aggression is the most common; it occurs when an individual reacts to stimuli in the environment—or, as was the case for my son, internal neuropsychiatric events. These are short but very emotional episodes, accompanied by the increased heart rate and flushed skin of autonomic system arousal. The vast majority of violent crimes committed by individuals with an autism spectrum diagnosis fall in this category, and the details reveal a marked lack of premeditation. A 2006 Swedish study comparing autistic murderers with those who had been diagnosed with antisocial personality disorder found that more than 70 percent of antisocial killers used a weapon, whereas only 25 percent of the autistic killers did—and, I should note, this group was very small, consisting of eight autistic individuals who had been convicted of homicide or manslaughter in Sweden from 1996 to 2001, compared with 27 who had been diagnosed with anti-social personality disorder. As many autism advocates have pointed out over this past weekend, the autistic population has a lower rate of criminal activity than that of neurotypicals; in all likelihood this is because those who are prone to the most violent rages—like Sky Walker and Henry Cozad—are identified at a very young age. In the best-case scenario, they respond, as Jonah did, to psychiatric intervention. But this population is notoriously difficult to treat. Many end up in residential treatment facilities.

Predatory aggression is very different. Cool, detached, and controlled, it is primarily a cognitive experience of planning and execution. When Adam Lanza donned black fatigues and a military vest, drove to Sandy Hook Elementary School with three of his mother’s guns, and ruthlessly gunned down everyone he found—this was an example of predatory aggression that is generally not seen in the autistic population.

Still, this distinction doesn’t explain why so many autistics are prone to aggression of any kind. Studies have found that up to a staggering 30 percent suffer from aggressive and/or self-injurious behaviors of varying degrees. But it turns out this might not have much to do with autism at all—the primary impairments of which, according to the Diagnostic and Statistical Manual of Mental Disorders, involve socialization and communication, not violence. The violence has and more to do with psychiatric conditions that many people on the spectrum suffer from. One 2008 study by scientists at King’s College London found that 70 percent of their young autistic subjects had at least one co-morbid disorder, such as childhood anxiety disorder, depressive disorder, oppositional defiant and conduct disorder, or ADHD. Forty-one percent had two or more co-morbid disorders.

It is this combination of developmental delay and psychiatric disorders that pops up again and again in the literature on autism and violent crime. A 2008 review by Stewart S. Newman and Mohammad Ghaziuddin reported that “an overwhelming number of violent cases had co-existing psychiatric disorders at the time of committing the offence”—84 percent, to be precise. And Newman and Ghaziuddin couldn’t rule out personality disorders, such as anti-social personality disorder, in the remaining subjects. They conclude, “co-existing mental disorders raise the risk of offending behavior in this group, as it does in the general population.” This academic paper echoes the practical experience of those working with autistic youth; Roma Vasa, child psychiatrist in Kennedy Krieger Institute’s Center for Autism & Related Disorders, states that children with Asperger’s “usually only exhibit intense anger if they have additional psychiatric disorders.” Even then, “their anger does not typically result in these types of massive violent attacks [like the Sandy Hook shooting].”

It’s no surprise to find the real culprit is mental illness, not autism. As Katherine S. Newman, author of the 2004 book Rampage: The Social Roots of School Shootings observed in a CNN editorial Monday morning, school shooters such as Adam Lanza “are almost always mentally or emotionally ill.” Still, there is a lesson for those of us who care for a person on the autism spectrum: We need to watch for those secondary psychiatric disorders our loved ones are vulnerable to. Often, parents and clinicians assume that patients are anxious or depressed or manic or aggressive because of their autism, when in fact those symptoms may have a different etiology. It isn’t easy to tease them apart, especially in lower-functioning individuals who can’t articulate their feelings well. But it was only once my son was diagnosed with bipolar disorder and treated accordingly that the frequent, unpredictable, and intense rages that characterized his childhood finally subsided.

Going forward, we may or may not find out more about Adam Lanza’s alleged Asperger’s diagnosis. But his social awkwardness, his genius IQ, his ability to build a computer from parts—these are all red herrings, reasons why autistic individuals are more likely to be victims of crime. These factors are not even remotely relevant explanations of why Lanza committed this crime. And every time we conflate his developmental disorder with whatever psychiatric or personality disorders he may also have suffered from, we harm the entire autism community.