Sunday, December 30, 2012

WebMD OpEd "Asperger's and Violence: Experts Weigh In"

Once again people who want to be at the top of search engines are passing off speculation as "expertise." Now WebMD is taking its turn.

As a mother with Asperger's syndrome, who knows many adults and children on the autism spectrum (and probably knows many more Autistic adults than your forensic specialist) I am highly concerned by your article here: Please consider removing this article, as it does not belong on a site that claims to have health and medical *information* as its basis.

The centerpiece of the article is a "professional" (Kristiansson) who engages in armchair diagnosis of the Connecticut shooter and then applies it to potentially all individuals on the autism spectrum. She said when she heard about the Connecticut shooting, her first thought was that the shooter might have had Asperger’s. It does not take an expert to come up with a hunch that the shooter had Asperger’s, what with all the media hype about Asperger’s. It would be surprising if anyone, "expert" or not, didn't think of Asperger's any time someone committed a crime.  In our current climate, in almost every case of a shooting, some media person speculates that the shooter was on the autism spectrum, such as the TV personality who said the Aurora shooter was Autistic. Anyone who watches TV can start diagnosing the person, as did your expert, even before any facts about the shooting are known.

Kristiansson says: “That was just my diagnosis,” <> “This offender behavior that he has presented is quite typical of a subject with ... autistic traits.” I would like to point out to WbMD that a diagnosis is actually a specific process undertaken by an expert to determine whether or not a person has any particular health condition. A diagnosis is not a gut feeling or a guess one makes upon hearing about a crime having been committed.

Another statement that is problematic is: “A 2008 review found that 84% of violent offenders with autism also had co-existing psychiatric disorders at the time they committed the crime. “This comment does not clarify whether or not Asperger’s had anything at all to do with the fact that the person was violent, given that they had other mental health conditions (which also may or may not have had anything to do with the crime). It does not say whether the violent offenders committed pre-planned crimes, as did the CT shooter, or whether the offenses were reactive violence. It also does not give any picture of what the mental health conditions (psychiatric disorders) were. And, 84% of how many people? How many offenders total in this literature review? This “information” is not enough to assert that people with Asperger’s are more violent than the general population, to commit intentional violence.

Let us not forget that our entire culture in the United States tends to have a fascination with weapons. Not just people with Asperger's. Look at the huge rise in gun sales after the shootings when people ran out and bought weapons, thinking there might be some sort of ban. I will bet most of those people did NOT have Asperger syndrome. Yes, some people with Asperger's have an interest in weapons. So do many more people who are not anywhere near the autism spectrum. Several other things Kristiansen sound also like guesswork, such as” When people with Asperger’s become fixated on weapons, it can lead to violence, she says." Unless an interest in weapons is shown to be THE CAUSE of violence in Autistic people, this is more passing off hypothesis as truth. When *anyone* becomes fixated on weapons, it is reasonable to assume that violence might be an outcome. I have not noticed many Autistic people seeking revenge, although I am certain some might, just like many non-autistic people also seek revenge. Revenge-seeking is not limited to the autism spectrum.

A backlash is happening against Autistic people and your article is helping perpetuate it. If the article contains FACTS, it might be useful but what it does is scapegoat people like myself who have Asperger's syndrome. Indeed, as has happened lately, someone known to have Asperger’s reached into their coat pocket for a grocery list and was tackled by security guards. Instances of bullying have occurred in the schools. Facebook hate groups have sprung up. Please do not add to the atmosphere of alarm and speculation about Asperger Syndrome and autism by perpetuating myths.

This story was written by someone who does not have any expertise in autism and "reviewed" by someone else who does not have any expertise in autism:

Brenda Goodman, MA, is a freelance health and science writer <>. She has a master’s degree in science and environmental reporting from New York University.


Laura J. Martin, MD, MPH, is a medical editor for WebMD who is responsible for reviewing WebMD news and feature stories to ensure their medical accuracy. She has many years of experience in the practice of both inpatient and outpatient internal medicine. She has served as a medical educator in the fields of general internal medicine, palliative care, and medical ethics.

Really. Medical ethics? Sigh. 


Paula C. Durbin-Westby said...

If other people would like to write to WebMd, please use their contact page at the bottom of each page. I could use some assistance in countering the many little articles that spring up here and there. It's like putting out brush fires. Thank you!

Paula C. Durbin-Westby said...

Thank you to Kate Mia for pointing out the article to me.

Amy Caraballo said...

This disgusts me. Couldn't find the dirt they needed so they found someone in another country to blame autism??? Her comments are ludicrous. How in anyone's name can you speculate about the motives of a dead person and conclude that autism played a part. I feel like a broken record.

Kate Mia said...

You're welcome Paula. Now that I re-read the article, I think the most potentially inaccurate statement was the broad categorical statement made by the author of the article from Web MD that a diagnosis of asperger's or autism may explain some aspects of seemingly unfathomable acts. There is nothing the "experts" say in the article that supports that statement, quoted here:

"In those isolated instances, forensic psychiatrists tell WebMD, a diagnosis of Asperger’s or autism may help explain some aspects of seemingly unfathomable acts."

In fact, the same variable, substance abuse, that has been has been identified as a risk factor for violent crime associated with schizophrenia and psychosis, is the risk factor associated with Aspergrer's and psychosis in the two research studies published in 2009, on these issues of concern. Furthermore, the substance abuse variable, as a risk factor for criminal violence, is identified at similar levels of risk in the general population in both sources of research linked and quoted below.

Substance abuse is associated with the disease of addiction, and is considered a completely separate diagnosis in the DSMIV-TR, with any diagnosis of an autism spectrum disorder.

"Schizophrenia and other psychoses are associated with violence and violent offending, particularly homicide. However, most of the excess risk appears to be mediated by substance abuse comorbidity. The risk in these patients with comorbidity is similar to that for substance abuse without psychosis. Public health strategies for violence reduction could consider focusing on the primary and secondary prevention of substance abuse. Please see later in the article for Editors' Summary. "

"Violent individuals with ASD are more often male and diagnosed with Asperger syndrome rather than autistic disorder. Furthermore, comorbid psychotic and substance use disorders are associated with violent offending. We conclude that violent offending in ASD is related to similar co-occurring psychopathology as previously found among violent individuals without ASD. Although this study does not answer whether ASDs are associated with increased risk of violent offending compared with the general population, careful risk assessment and management may be indicated for some individuals with Asperger syndrome."

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