A descriptive study of young people with Autism Spectrum Disorder referred to a Fixated Threat Assessment Centre

Abstract

This study examines a cohort of persons aged 14 to 25 years referred to a threat assessment centre in Australia due to concerns regarding their potential for extremist or other grievance-fuelled violence. It examines the demographic features, clinical comorbidities and threat profile of this cohort and compares cases with and without a diagnosis of Autism Spectrum Disorder (ASD). The findings suggest that young people with ASD are significantly overrepresented, compared to the population rate, with late diagnosis and complex, unmet needs. The services required to mitigate risk were predominantly mainstream disability and mental health programs, not specialised forensic interventions. These exploratory findings have broader implications for improved provision of autism-specific services to prevent this vulnerable group entering the justice system.

Introduction

Fixated threat assessment centres (FTAC) comprised of co-located police and mental health personnel have been established in the United Kingdom, Australia, New Zealand and parts of Europe to identify concerning, and often mentally ill, fixated¹ persons through their inappropriate attentions to dignitaries. They have a preventative focus aimed at improving public health and safety through the facilitation of care for these individuals (Barry-Walsh et al., 2020; Wilson et al., 2021).

The Victorian Fixated Threat Assessment Centre (VFTAC), established in the state of Victoria, Australia, expanded its remit in 2018 to include the identification, assessment and coordination of interventions for individuals who pose a significant threat of lone actor grievance-fuelled violence (VFTAC) more broadly, many of whom have unmet psychosocial needs. LAGFV incorporates cases of lone actor terrorism, hate killings, fatal family violence and massacres in workplace and educational settings, and includes violence against public figures by pathologically fixated individuals. The term LAGFV reflects the fact that similarities exist between those committing violent acts in the context of grievance, in settings and circumstances previously studied separately (Cooper et al., 2022; Pathé & Farnham, 2023).

VFTAC accepts referrals from a range of sources, including law enforcement and correctional organisations, educational institutions and both adult and child/youth mental health services. To warrant VFTAC involvement these ‘persons of interest’ (POI) must have a known or suspected mental disorder or disability. Threat assessments are jointly administered by police and mental health staff using a standardised, evidence-based guidance tool informed by ethically shared police and mental health data. This enables prioritisation of cases according to their level of concern (low, moderate or high). The concern levels employed by VFTAC are defined in Table 1 (see also Pathé & Farnham, 2023; Wilson et al., 2021). Where there is a lack of consensus among bi-disciplinary assessors regarding the concern level, it is VFTAC’s initial practice to defer to the higher concern category until subsequent investigation indicates otherwise.

Table 1.

Concern level definitions.

Concern level	Definition
Low	The initial presentation indicates a low potential for adverse consequences (disruption, distress, escalation or violence), according to the threat assessment guidance tool, the absence of problematic approach behaviours or any stated intention to engage in any. The subject’s interest contains no form of threat or desperation and is generally at a mild nuisance level.
Moderate	The initial presentation indicates a potential for adverse consequences according to the threat assessment guidance tool. The subject has exhibited an unusual interest and displayed this in a manner that suggests that problematic behaviours will continue or escalate, and/or they have made realistic direct or indirect threats towards individuals, organisations or the wider community.
High	The initial presentation indicates the likelihood of adverse consequences according to the threat assessment guidance tool. The identified risk factors indicate a clear capacity and/or intent to cause adverse consequences and/or a clear propensity for violence. This includes cases where intrusive harassment has occurred, or is highly likely to occur.

The threat assessment forms the basis for the development of a management plan, which includes linking cases to appropriate services such as specialist mental health and drug and alcohol agencies. Cases can be closed to VFTAC once intervention has reduced them to a low level of concern, or at a moderate concern level where risk factors are being actively addressed by partner agencies and there is no added value from continuing VFTAC involvement.

Previous studies of referrals to FTACs in other jurisdictions in Australia and abroad have revealed high rates of psychosis and major mood disorders (Pathé et al., 2017; Wilson et al., 2021). An audit² of VFTAC’s expanded case remit in 2020 found that rates of referrals of individuals aged 14–25 years had increased over its 2.5 years of operations and that there was an overrepresentation of confirmed or suspected Autism Spectrum Disorder³ (ASD) diagnoses in this cohort relative to the population base rate. This review also highlighted difficulties in securing risk-mitigating interventions for this cohort.

The Diagnostic and Statistical Manual of Mental Disorders 5^th Edition (DSM-5) (American Psychiatric Association, 2013) defines Autism Spectrum Disorder (ASD) as a developmental condition typically identified in early childhood that persists through adolescence and adulthood, with key features, including difficulties with communication, social cues and information processing, as well as restricted, repetitive behaviours and sensory sensitivity. The Australian Bureau of Statistics (ABS, 2019) found that over 200,000 people in Australia have a diagnosis of ASD and more than three quarters of these are male. The ABS reported that the prevalence in Australia varies considerably depending on age, with approximately 3% of young Australians (aged 5–19) found to have a diagnosis of ASD, dropping to 0.1% of those aged 40 and over. The report cited changes to diagnostic criteria, greater community and clinical awareness, changes to disability funding models and adaptation to neurodiversity with age as possible reasons for the variation in rates across the lifespan and the increased rate of diagnosis in young people compared to earlier ABS surveys. It was also noted that research into mortality of those with ASD in Australia has found shorter life expectancies, with mortality rates approximately twice that of the general population (Hwang et al., 2019), which may further contribute to lower population prevalence in older people.

Despite current research indicating that people on the autism spectrum are no more likely to be violent than other members of the community (Im, 2016), there are disproportionate numbers of young people with ASD in forensic populations (Allely, 2022; Cooper et al., 2022; Lewis et al., 2015). It has been postulated that factors contributing to general offending risk in those with ASD could include social naivete, disruption of routines and rigid adherence to rules, poor understanding of social situations and obsessional interests (Howlin et al., 2004). A study by Foster and Young (2021) suggests that young people with autism receive harsher sentences than non-ASD youth who have committed similar offences, and that some features of ASD, such as poor eye contact and limited social skills, may be prejudicial in this regard.

Furthermore, disproportionately higher rates of ASD have been reported among young people identified by security intelligence agencies to be at risk of committing acts of extremist violence and subject to monitoring provisions (Grierson, 2021). Emerging research has examined whether those with ASD have a heightened vulnerability to extremist narratives. For example, a tendency to hyper focus on restricted interests (such as mass killings and bomb-making) and the collection of material related to such interests, rich fantasies, reliance on the digital world and the need for routine may all create vulnerability to narratives that often promise order, stability and rigid rules (Al-Attar, 2019). However, while there have been some high-profile incidents of mass violence involving neurodiverse individuals (Allely et al., 2014), there is a lack of empirical evidence to link ASD to radicalisation (Worthington et al., 2022). Cognitions and behaviours that characterise ASD may present as extremist ideology but have no link to a person’s actual beliefs, values or propensity for violence (Moseley, 2021).

The current study

Our study sought to explore this potential bias in referrals of persons with ASD to an agency concerned with the prevention of grievance-fuelled violence, including violent extremism. It aimed to compare demographic, offending and clinical characteristics, assessed threat levels, service utilisation and required interventions in young persons with ASD accepted by VFTAC with accepted non-ASD youth cases, and examined factors contributing to the problematic behaviours that prompted their referral.

Method

This is a retrospective review of young people (aged 14–25 years) who were referred to VFTAC between March 2018 and June 2023. The sample was then divided into cases with a known or suspected diagnosis of ASD and those without any evidence of ASD. Data related to this sample – including referral source, demographics, offending history, assessed concern levels and mental health conditions and comorbidities – was then extracted from VFTAC’s electronic database, which comprises de-identified data from both Victoria Police and the Victorian Department of Health.

The data was transferred to SPSS version 29.0.1.0 for analysis. A descriptive analysis was conducted to characterise the sample. Differences between groups (young people with and without ASD) were examined using Chi-square tests or, where more than 20% of comparison groups fewer less than 5, Fishers exact test was used. A Wilcoxin Signed Rank test and Mann-Whitney U tests were conducted to assess differences in related scores and outcomes. Where group sizes contained fewer than 10 participants, no statistical analysis was performed. Where multiple tests were conducted, Holms sequential correction was applied to the value of p to control for familywise type 1 error.

Case identification

All referrals accepted by VFTAC must meet the criteria for pathological fixation, pathological grievance and/or extremist themes and include ‘mental disorder’, as defined in Table 2.

Table 2.

Summary of acceptance criteria for VFTAC.

Criteria	Criteria description
Pathological fixation	Meets the definition for pathological fixation (obsessive preoccupation with a person, place or cause pursued to an extreme or irrational degree) and is targeting a public figure.
Pathological grievance	The individual harbours an intense hatred, perceived injustice or resentment towards a workplace or former workplace, educational institution or other organisation, a specific individual, race, religion, cultural group or gender, family members, other minority groups or wider society, and the grievance poses a serious threat to the individual, public safety and/or public welfare.
Extremist themes	There is radicalisation, suspected radicalisation or references to terrorist themes involving any extremist ideology, where ‘extremist’ is a collective term for individuals who have come to the attention of authorities through their ideological language and behavioursa
Mental disorder	There is known or suspected mental disorder, including major mental illness, personality disorder, psychiatric syndromes secondary to brain injury or medical conditions, and diagnosed or suspected autism spectrum disorder.

^aSome individuals who threaten or engage in lone actor grievance-fuelled violence espouse extremist ideologies that are masking what is actually an act driven by a highly personal grievance (Clemmow et al., 2020). Also, some mentally ill people incorporate extremist themes in their delusional belief system, and those with disabilities such as ASD may be drawn to extremist forums but are not violent extremists. VFTAC has a legitimate interest in these cases and a role in facilitating relevant interventions, given such individuals confound counter-terrorism operations and place themselves at risk in armed environments.

For those young persons who met VFTAC’s threshold for acceptance, mental health information was extracted from Victoria’s state-wide mental health database. This mental health information comprised psychiatric diagnoses, dates and duration of involvement with any Victorian public mental health services and details of any mental health treatment orders or admissions to psychiatric inpatient units within Victoria. The presence of ASD was based on the diagnoses recorded during prior episodes of treatment, the diagnosis at the time of referral to VFTAC, or diagnoses assigned during VFTAC’s case management and intervention. In regards to the latter, a diagnosis of ASD was typically assigned during the young person’s involvement with VFTAC and linkage to, and assessment by, either a child and adolescent mental health service or a youth forensic mental health service.

Results

Sample characteristics

A total of 52 young people were referred to, and subsequently accepted by, VFTAC during the study period. The majority of these were male (n = 49, 94.2%) with an average age of 20 years at the time of referral to the service (M = 19.6, SD = 3.6). Over half the young people referred had a confirmed or suspected diagnosis of ASD (n = 28, 53.8%). Detailed participant characteristics are set out in Table 3.

Table 3.

Participant characteristics.

	n (%)
Gender
Male	49 (94.2)
Female	3 (5.8)
Referral source
Victoria Police	36 (69.2)
Counter terrorism command-security investigation unit	7 (13.5)
Local police	21 (40.3)
Sex offences and child abuse investigation team	1 (1.9)
Countering Violent Extremism (CVE)a	1 (3.8)
Victoria police (other)	5 (9.6)
Mental health service	8 (15.4)
Education department/service	4 (7.7)
Other (e.g. Youth service)	4 (7.7)
Referral pathways
Extremist themes	27 (51.9)
Pathological grievance	25 (48.1)
Psychiatric diagnosis (at closure of case with VFTAC)
Autism Spectrum Disorder (ASD)	28 (53.8)
Schizophrenia	6 (11.5)
Mood disorder (depression, anxiety, PTSD, bipolar)	8 (15.4)
First episode psychosis	2 (3.8)
No diagnosis/unknown	2 (3.8)
Other (e.g. Personality disorder)	6 (11.5)

^aCountering Violent Extremism programs in Australia provide a range of community supports to individuals who are engaging in behaviours that suggest they are radicalised or radicalising (Harris-Hogan, 2020).

Offending behaviours and concerns

Table 4 describes the history of criminal offences in the sample of young people at the time of referral to VFTAC. Although fewer criminal convictions were observed among young people with ASD than among young people without (n = 1 v n = 5, respectively), group sizes were too small to reach statistical significance. In addition, despite one third of cases having a history of violent behaviour (n = 17, 32.7%) only a minority had been convicted of a violent offence (n = 4, 7.7%). Five subjects had multiple convictions for a criminal offence (n = 4, 9.6%; range = 2–3 offences). There was no significant difference in the history of violent behaviour of young people with ASD compared to their non-ASD counterparts (z = −1.265, p > .05).

Table 4.

Criminal offences of total sample (ASD and non-ASD groups).

	Total sample (N = 52)	ASD group (N = 28)	Non-ASD group (N = 24)
	n (%)	n (%)	n (%)
Any criminal history (excluding pending or withdrawn convictions)	6 (11.5)	1 (3.6)	5 (20.8)
Convicted for a violent offence	4 (7.7)	1 (3.6)	3 (12.5)
Convicted for a property offence	4 (7.7)	1 (3.6)	3 (12.5)
Convicted for verbal assault	2 (3.8)	1 (3.6)	1 (4.2)
Convicted for other offence	5 (9.6)	1 (3.6)	4 (16.7)

Threat themes

Table 5 outlines the threat themes identified among the young people referred to VFTAC. For example, a young person may be expressing right-wing beliefs (political) or espousing views that justify violence in the name of a particular religion (religious). Although numbers were too small for statistical comparison, threat themes of violent interests (n = 20, 60.9%) and school shooting (n = 12, 34.3%) were most commonly observed in both the ASD and non-ASD group.

Table 5.

Threat theme for total sample (ASD and non-ASD groups).

Theme of threat/concern	ASD Group (N = 28)	Non-ASD Group (N = 24)
	n (%)	n (%)
Violent interests (general)	10 (35.7)	10 (41.7)
School shooting	7 (25.0)	5 (20.8)
Political	5 (17.9)	2 (8.3)
Threats to police	2 (7.1)	0
Family violence	2 (7.1)	0
Religious	2 (7.1)	7 (29.2)

Risk and responsivity issues

Table 6 outlines the identified risk and responsivity issues at the time of referral observed across the total sample, with young people often experiencing a range of difficulties. Family disruptions, trauma/stress/loss, education/employment problems and exposure to offline threats were most commonly identified. Relative to their counterparts, the ASD cohort was more likely to express strong fantasies, χ²(1, N = 52) = 5.82, p = .016, adjusted α = .004, and report being bullied, χ²(1, N = 52) = 6.98, p = .015, adjusted α = .004, and isolated, χ²(1, N = 52) = 7.45, p = .006, adjusted α = .004, while being less likely to report substance abuse, χ²(1, N = 52) = 6.60, p = .022, adjusted α = .005. However, these differences were not statistically significant following adjustment of the p value. No further differences in risk and responsivity issues were statically significant between groups either before or after adjustment of the p value.

Table 6.

Risk and Responsivity issues identified upon referral to VFTAC^a.

	Total	ASD group (N = 28)	Non-ASD group (N = 24)
	n (%)	%	%
Expression of strong fantasies	20 (38.5)	75.0	25.0
Research weapons	17 (32.7)	70.6	29.4
History of suicidal ideation	29 (55.8)	51.7	48.3
Family disruption/strained relationships	37 (71.2)	45.9	54.1
Weapon possessions	13 (25)	46.2	53.8
Exposure to threats offline	31 (59.6)	51.6	48.4
Interest in previous attackers	10 (19.2)	80.0	20.0
Exposure to threats online	15 (28.8)	73.3	26.7
Victim of bullying	16 (30.8)	81.3	18.8
Socially isolated	30 (57.7)	70.0	30.0
Education/employment problems	31 (59.6)	61.3	38.7
Trauma/stress/loss	44 (84.6)	54.5	45.5
Substance abuse	13 (25.0)	23.1	76.9
Engaged in family violence	16 (30.8)	62.5	37.5
Exposure to violence (offline)	31 (59.6)	48.4	51.6
Exposure to violence (online)	12 (23.1)	75.0	25.0
History of leakage	24 (46.2)	50.0	50.0
Affinity with weaponsb	9 (17.3)	44.4	55.6
Soldier mentalityb	5 (9.6)	20.0	80.0

^aDefinitions for these items are available from the corresponding author.

^bCells were too small for robust analysis and therefore no test was conducted on these items.

As detailed in Table 7, at the time of referral to the service, over one third of young people were assessed to be of a high concern, with significant reduction in assessed concern level at the point of closure to VFTAC (z = −5.72, p < .001). At acceptance, there was no significant difference observed in concern levels between young people with an ASD diagnosis and those without, χ² = .923, p > .05, nor was any significant difference observed at the point of closure to VFTAC, χ² = 1.62, p > .05.

Table 7.

Assessed concern level at acceptance and closure to VFTAC.

Concern level	ASD group	Non-ASD group	Total
	n (%)	n (%)	n (%)
At referral
Low	1 (3.6)	1 (4.2)	2 (3.8)
Moderate	14 (50.0)	15 (62.5)	29 (55.8)
High	13 (46.4)	8 (33.3)	21 (40.4)
At closure
Low	15 (53.6)	17 (70.8)	31 (59.6)
Moderate	13 (46.4)	7 (29.2)	21 (40.4)
High	0	0	0

VFTAC interventions

Table 8 describes the interventions and service linkages provided by VFTAC as part of the case management process. This includes Specialist Mental Health Enhancement Services, which are Victorian Government-funded public mental health service teams that provide a range of services based on the identified needs of the VFTAC case including any gaps in their support services (both clinical and non-clinical). Young people with ASD were significantly more likely to have direct contact with VFTAC clinicians, χ²(1, 52) = 11.14, p < .001, adjusted α = .017, as well as referral to the National Disability Insurance Scheme (2019) for further support services, χ²(1, 52) = 5.85, p = .016, adjusted α = .025. No further differences between groups were observed.

Table 8.

VFTAC Interventions and service linkages.

	ASD group (N = 28)	Non-ASD group (N = 24)
	n (%)	n (%)
Linked with National Disability Insurance Scheme	20 (71.4)	6 (25.0)
Linked with area mental health service	21 (75.0)	13 (54.2)
Linked with children’s hospital	4 (14.3)	1 (4.2)
Linked with child/adolescent mental health service	11 (39.3)	6 (25.0)
Linked with forensic youth mental health service	11 (39.3)	4 (16.7)
Direct contact with VFTAC	15 (53.6)	5 (20.8)
Linked with specialist mental health enhancement services	14 (50.0)	13 (54.2)
Referred to Countering Violent Extremism	3 (10.7)	2 (8.3)
Countering Violent Extremism already engaged	2 (7.1)	0
Liaised with school	10 (38.5)a	7 (50.0)b

^aThis item was not applicable for n = 10 cases in the ASD group due to them being beyond school age. ^bThis item was not applicable for n = 2 cases in the Non-ASD group due to them being beyond school age.

Among the ASD group (n = 28) – nearly half (n = 12, 42.9%) – received a diagnosis of childhood autism during their involvement with VFTAC. These cases were identified at the time of referral to VFTAC as presenting with characteristics consistent with a diagnosis of childhood autism; however, no formal diagnosis had been confirmed. Diagnostic confirmation of ASD was then obtained as a result of referral to, and assessment by, either a child and adolescent mental health service or youth forensic mental health service. Table 9 gives an overview of the service interventions provided to this cohort as a consequence of their referral to VFTAC. On average, young people who were diagnosed with ASD during VFTAC’s involvement were linked to at least one additional MH service/intervention (M = 3.83, SD = 2.2) when compared to young people diagnosed prior to VFTAC involvement (M = 2.67, SD = 2.1).

Table 9.

VFTAC Initiated service interventions provided to young people with suspected ASD.

	Pre-VFTAC n (%)	Post VFTAC n (%)
Linked with disability services	4 (33.3)	5 (41.7)
Linked with adult mental health service	8 (66.7)	9 (75.0)
Linked with children’s hospital	2 (16.7)	3 (25.0)
Linked with child/adolescent Mental health service	5 (41.7)	5 (41.7)
Linked with youth forensic mental health service	5 (41.7)	7 (58.3)
Linked with specialist mental Health enhancement service	5 (41.7)	7 (58.3)

Discussion

This study supports earlier observations that young people with autism are overrepresented among referrals to specialised threat assessment services, with over half of VFTAC’s cases aged 14–25 years being on the autism spectrum. In almost half of this group ASD was undiagnosed at the time of referral but subsequently confirmed following VTAC’s referral of the case for specialist evaluation. This group with fixated behaviours, who were undiagnosed at referral but were subsequently found to have ASD, is sufficiently large to suggest to the authors that in a proportion of the young people referred to VFTAC, features of ASD may have been misinterpreted as pathological grievance or expression of an extremist ideology. For example, in one case an intense preoccupation with historical facts about Nazi Germany was misinterpreted by the referrer as right-wing extremism, but on assessment by VFTAC found to be a restricted interest, associated with an undiagnosed ASD.

However, this finding also lends support to earlier observations that ASD-related psychosocial disability can worsen with delayed diagnosis (Lupindo et al., 2022), with serious implications for the individual, their carers and other agencies. On average, at the point of VFTAC’s disengagement, persons of interest with ASD were linked with more mental health or disability services and/or interventions relative to the non-ASD cases. The high base rate of service requirement suggested complexity across this entire younger cohort, particularly for those with ASD, which correlates with Australian research showing that delayed diagnosis is associated with higher comorbidity across the neurodiversity spectrum (Knott et al., 2024).

The concern level across the study period reduced or stabilised, with no young cases in either cohort rated as of high concern at the time of separation from VFTAC, although reduction to a moderate or low level of concern is a pre-requisite for closure to VFTAC. At the time of writing none of these cases had progressed to criminal sanctions. This finding supports the continued focus on psychosocial and mental health support as the mainstay of intervention for this group.

In this small sample, there were no statistically significant differences in prior criminal convictions between the ASD and non-ASD cohorts. Consistent with past studies, the ASD cohort reported less substance abuse than their non-ASD counterparts.

There were no significant differences between young people with ASD and those who did not qualify for this diagnosis in the assessed concern levels (low, moderate or high) at the point of acceptance or closure to VFTAC. Similarly, violent interests and school shooting were the most commonly observed themes underlying the behaviours of concern for young people accepted by VFTAC, regardless of ASD status.

Limitations

This study has several important limitations. The small sample size limited the statistical power and significance of the findings. Certainly, in some areas particular themes or trends were observed, many of which were consistent with existing research in ASD and forensic populations, but no causal links could be established, and conclusions regarding between-group differences were limited.

While VFTAC interrogated mental health and police holdings to determine whether a young person had a confirmed diagnosis of ASD either prior to or at the time of referral to VFTAC, in some cases it was not possible to access all relevant assessment information or reports to establish a formal diagnosis of ASD. That is, information extracted from the Victorian state-wide mental health database is limited to a person’s diagnoses and the timing and provider of the service, and thus on occasion we relied upon uncorroborated statements that the ASD diagnosis was determined through appropriate recognised assessment processes in line with the Diagnostic and Statistical Manual of Mental Disorders 5^th edition (DSM-5) (American Psychiatric Association, 2013).

Some variables in our database were excluded from analysis. For security reasons we were unable to report certain information from security intelligence agencies and aspects of police methodology. In addition, while only a minority of VFTAC cases were managed or likely to be managed within the private mental health sector in Victoria, information regarding the young person’s prior involvement with such services was often difficult to confirm. Therefore the analysis was restricted to the young person’s documented involvement with public health and support services within Victoria.

Future directions

This review focuses on a cohort of young people who met the threshold for intervention by a joint police–mental health agency in Victoria, Australia, concerned with the prevention of lone-actor grievance-fuelled violence. The referral period overlapped with the COVID-19 pandemic, which resulted in prolonged lockdowns in Victoria (Le Grand, 2022). The impact of these pandemic restrictions on the mental health and wellbeing of young people in Australia has been well documented (e.g. Butterworth et al., 2022; Li et al., 2022) as has, to a lesser extent, the effects of COVID-19 on young people’s susceptibility to violent extremism and radicalisation (Batool, 2022; Lowe, 2021). However, the impact of enforced social isolation and increased reliance on online communication in young people with pre-existing vulnerabilities, such as social naivete and impaired critical consciousness, particularly with respect to online radicalisation and extremist narratives, is less well known and warrants further investigation.

Future research in this area could achieve larger sample sizes through combining FTAC data from multiple jurisdictions or from similar agencies such as programs for Countering or Preventing Violent Extremism (CVE; PVE). Further research of this nature will help inform the appropriateness of current threat assessment approaches, interventions and case management strategies for young persons with ASD who are entering security intelligence settings, and will ultimately prevent both criminalisation and potential harm to these individuals in the counter-terrorism space. While it is likely that some people diagnosed with ASD are a legitimate concern for counter-terrorism operations, this study suggests that many would be better served by enhanced early access to services for neurodiverse individuals.

Conclusion

To our knowledge this is the first study to examine Autism Spectrum Disorder among referrals to a threat assessment service dealing with lone actor grievance-fuelled violence. In Victoria, Australia, and, anecdotally, in comparable jurisdictions, the overrepresentation of ASD among individuals who appear to pose a threat of LAGFV is an increasingly common observation.

In Australia support pathways for individuals with ASD who are no longer eligible for paediatric or child mental health services are not well-defined or adequately resourced. In this cohort of concerning young people with ASD referred to VFTAC there were substantial needs across the disability and mental health spheres. As evidenced by the number of specialist service linkages this cohort required, sourcing and co-ordinating appropriate multidisciplinary care would pose a major challenge for general medical or family practitioners, but this is usually where the responsibility lies. An intermediary level of service, with better access to diagnostic and co-ordinated intervention services for young people on the autism spectrum who present with complex mental health and disability needs, may facilitate intervention for this group before reaching the threshold of forensic involvement.

Funding Statement

This work was supported by the Victorian Fixated Threat Assessment Centre, jointly managed by the Victorian Department of Health and Victoria Police. There are no additional funding sources or grants to declare.

Ethical standards

Declaration of conflicts of interest

Meredith Gray has declared no conflicts of interest.

Jennifer McCarthy has declared no conflicts of interest.

Daveen Mawren has declared no conflicts of interest.

Steven Cooper has declared no conflicts of interest.

Carolyn Simms has declared no conflicts of interest.

Michele Pathé has declared no conflicts of interest.

Disclosure of benefit or interest statement

None of the authors have any financial benefit or interest that has arisen from the direct applications of this research.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the Victoria Police Human Research Ethics Committee and with the 1964 Declaration of Helsinki and its later amendments or comparable ethical standards. Prior to commencement of the project, ethics approval was granted by the Victorian Police Human Research Ethics Committee and by the Forensicare Operational Research Committee.

Informed consent

Informed consent was not obtained from all individual participants included in the study. The study was an analysis of de-identified health and court records, it was not an in vivo experiment with human participants. It was also not feasible to obtain consent as the whereabouts of individuals was not generally known, and the numbers involved were too large to track down. We obtained a waiver of consent by the Victoria Police Human Research Ethics Committee.