Should police officers be provided with condition-specific training in autism? NPAA Head of Policy Adam O’Loughlin considers the arguments for and against

One of things the NPAA is regularly challenged on is why autism should benefit from condition-specific training to frontline police officers. With that in mind a few weeks ago, a lady called Paula McGowan launched a petition online asking for a Parliamentary debate to discuss the merits of providing all police officers with mandatory training on autism and learning difficulties. This follows on from her successful campaign aimed at ensuring that all NHS staff receive training on the same conditions, prompted by the loss of her son Oliver at Southmead Hospital in Bristol.

Reaction to being asked to provide condition-specific training is met by The College of Policing with resistance, and the reasons for this are well-thought-out and well-argued. They tend to go along these lines:

1. Police officers are not medical professionals
2. There are so many conditions that police officers ‘need’ to know about that if we trained all our staff to the levels advocates want, we’d spend all our time training and none of our time doing police work
3. It’s doesn’t actually matter what condition a person has – just do a balanced combination of what the public want and what the officers say they need, in context to ensure people’s safety and fundamental rights

These are all perfectly reasonable, and therefore it stands to reason that we need to have some robust arguments as to why we are doing it. I think it’s worth starting with some clarity about what autism is, and more importantly, what it isn’t. The reason is that autism means different things to different people.

First things first, then: autism is NOT a mental health condition. It is generally accepted that autism is a neurodevelopmental condition. Following on from that some autistic people view themselves as being disabled, others view themselves as simply having a differently wired brain. Many more have comorbid conditions such as dyslexia and dyspraxia, as well as mental illnesses such as depression and anxiety – which isn’t that much of a surprise considering many autistic people suffer from significant amounts of social exclusion. What almost all autistic people have in common however is that we don’t refer to ourselves as mentally disordered. And this is ironic, as legally at least that’s exactly what we are. It states it in the Mental Health Act. What that means in practice is that it is possible for someone on the autistic spectrum to meet the criteria in the Act for detention, even if the autism is not associated with abnormally aggressive or seriously irresponsible behaviour. Now that’s scary enough, but what it also means is that given the powers and responsibilities police officers are conferred with, we absolutely have to be aware of this. And right now most police officers aren’t.

What of the next point, that autism is just one of a number of conditions that interested parties advocate for? It’s a perfectly reasonable perspective. And in order to answer it, it’s helpful to consider whether there are other professional bodies or pieces of legislation that treat autism as a special case. As it happens there are, and ironically one of those is the Mental Health Act. Glance at the table of contents of the Codes of Practice and you’ll see that autism has its own chapter, under the heading “additional considerations for specific patients”. So clearly Mental Health legislators considered that autism was deserving of special consideration.

If that wasn’t enough, then there’s also the fact that autism is the only condition to have its own Act of Parliament; the Autism Act. The first reaction we normally get when we mention it is that many people are surprised that it exists at all. But in this case the facts are quite clear: The Act remains the first and so far the only condition-specific legislation of its type in England. This demonstrates the importance Parliament has attached to ensuring that the needs of people with autism are met. If Parliament consider autism to be important enough to warrant its own legislation, then surely it follows that policing should follow suit by treating it with similar seriousness. Here’s what the Act says about training:

“We recommend that other providers of public services, such as providers of services to support people into employment, police, probation and the criminal justice system look to follow the guidance to help improve the delivery of the services they provide to adults with autism: for example ensuring that staff who provide services to adults with autism have received autism awareness training would clearly be of value across all public services.”

And that’s not all. There’s also this:

“When people with autism come into contact with the criminal justice system it is often up to them, or their carer, to explain what having autism means. In some cases, it can positively change the way that police or courts view a situation. Police, probation services, courts and prisons should be supported so that they are aware of the communication challenges experienced by people with autism. NHS bodies, Foundation Trusts and local authorities should work with the criminal justice system to achieve this.”

And finally, this:

“Local Authorities, NHS bodies and NHS Foundation Trusts should seek to engage with local police forces, criminal justice agencies and prisons to the training on autism that is available in the local area and consider undertaking some joint training with police forces and criminal justice services working with people with autism.”

Moving on again, it’s not just Parliament, and it’s not just recommendations. As part of the Autism Strategy, each Local Authority is required by Public Health England to complete a bi-annual Self-Assessment Return (SAF) to demonstrate compliance with the Act. And it will come as no surprise to learn that there is a specific question about the very topic currently up for discussion. It’s actually question 23, and it looks like this:

Criminal justice services: Do staff in the local police service engage in autism awareness training?

Any police forces out there fancy replying: “No, because the College of Policing don’t think it’s a good idea?” No, us neither.

So we think it’s safe to say that the mandate is there. In fact, we don’t think it could be much clearer. The Mental Health Act treats autism as a special case, there’s a specific Act of Parliament that recommends that police forces should engage with partners to undertake training, and a mandatory self-assessment to inform the Department of Health as to progress.

That’s the why, and we think the case is made. ∎

Follow Adam O’Loughlin on Twitter at @autisticcop

Why do so many ADHD children fail at school and fall foul of the criminal justice system?

by Kaj Bartlett
NPAA ADHD Lead & Sussex Police Deputy Coordinator

Attention Deficit and Hyperactivity Disorder (ADHD) is a neurodevelopmental condition affecting five percent of the UK population. Indications are that it is underdiagnosed. Lack of societal awareness of the condition means that many believe it only affects young boys and they grow out of it during the transition to adulthood. This is a myth. ADHD affects all ages, both genders and across all social classes.

There are many symptoms which affect someone living with ADHD, and like autism, not everyone experiences the condition in the same way. It is now known that there are three sub-types of ADHD: inattentive, hyperactive and combined type. There are screening tools which help signpost if someone has ADHD; however diagnosis is ultimately based on a psychiatric assessment of behavioural traits according to the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM5). lt is classed as a ‘hidden disability’, because many of the challenges faced by a person who lives with ADHD aren’t always obvious. There are many positive aspects of living with ADHD, however the purist medical concept of the condition defines it through a ‘double whammy’ of being a deficit and a disorder. Most often it is the negative behavioural traits which are exhibited and observed, which are impatience, impulsivity, hyperactivity, significant emotional dysregulation, and poor executive functioning skills. ADHD is not a behavioural disorder: neuroscience now proves that it is a difference in brain function for those who live with it.

ADHD, like autism, cannot be cured; however there are psychological, behavioural, educational and pharmacological interventions which can transform lives. There is a genetic basis for ADHD being passed down the generations, although there is currently no definitive genomic variance conclusion which determines a predisposition for ADHD. Symptoms present differently in women and girls than they do in men and boys.

ADHD can be comorbid with many other conditions including anxiety and depression, and neurodiverse conditions such as dyslexia, dyspraxia and autism. lt is more often that not the comorbid condition will be the one which is identified first, as they are often easier to diagnose. Whilst treatment steps to manage those other conditions will help, a syndrome mix including ADHD will still mean the individual will struggle in life in many ways. Self-medicating can also take the form of substance and alcohol misuse. Adults living with ADHD are 78 percent more likely to be addicted to tobacco and 58 percent more likely to use illegal drugs than those without ADHD. Even food and purchasing addictions are more prevalent. 38 percent of young adults with unmanaged ADHD have been pregnant or have caused an unwanted pregnancy.

Taking that back a step further, children with neurodiverse conditions and in particular ADHD, will inevitably cause problems in the classroom. They will behave differently to their peer group, because they have a different learning style which is not catered for in schools. ADHD is first often seen through disruptive, challenging behaviour in schools, where there can be a prevalence of fighting, defiance and aggression, and damage being caused. lt can also present in more subtle ways and the individual will be the class chatterbox or clown. Usual ways of managing behaviour do not and will never work to moderate and alter the behaviour of those who live with ADHD. Undiagnosed and unsupported children living with ADHD are losing the opportunity for learning as their behaviour in school becomes the only focus, leading to sanctions and a hundred fold increased likelihood of permanent exclusion. Child and adolescent ADHD is widely, and incorrectly believed to be caused by poor parenting, poor diet, too much screen use and lack of self-control. Society expects individuals to exhibit certain levels of self-control, commensurate with the age of the individual. ADHD affects the neurodevelopmental abilities and pathways needed to acquire those skills in life. Challenging, aggressive behaviour arises through deficits of skill, not will. Unmet educational needs leads to criminality and longer term recidivism.

Academic research has estimated 30 to 40 percent of those incarcerated within the prison system have ADHD. There is a soon to be published piece of academic evidence which reinforces the importance of addressing the critical public health issue of ADHD for people living in detention, through (i) systematically offering initial screening and diagnosis to all individuals entering detention, and (ii) delivering treatment, monitoring and care for ADHD during and after detention. These strategies are believed to reduce recidivism and reincarceration, as well as violence in detention settings, in addition to improving the health and wellbeing of people living in detention.

Stripping that back a layer, another academic research paper concluded that 25 percent of those entering police custody during the study, met the strict assessment criteria to gain an ADHD diagnosis. A further conclusion was that these individuals also needed the most support and care whilst in custody and were the most challenging for custody staff. In these prison and police studies, the vast majority of individuals who fitted the assessment criteria for a diagnosis of ADHD were actually unware that they lived with the condition, meaning they have had no possible opportunity for diagnosis and treatment help. From a policing perspective, those living with ADHD are much more likely to commit impulsive crimes often where a loss of self-control is evident, rather than a pre-planned criminal enterprise. This will be seen in offences such as anti-social behaviour and shoplifting, and opportunist acquisitive crime, public disorder, violent behaviour and criminal damage offences. Driving offences such as speeding and failing to stop for police also feature; driving performance can be affected by ADHD through inattention, impulsiveness and hyperactivity. Seeking risk-taking activities can be a form of self-medicating for unmanaged ADHD to increase the dopamine activity in the frontal lobes of the brain, this being an aspect of the neurochemistry behind ADHD.

The College of Policing Authorised Professional Practice on Detention and Custody covers the risk assessment of police custody detainees. Currently there is no specific reference to adult ADHD, and only a one line reference to it in the Children and Young Persons section of that guidance. Vulnerability is increased through the presence of ADHD, however this vulnerability is not being recognised. In my experience, there is no specific training for our custody officers, nor the wider policing family about ADHD and how to best support and manage those who live with it. Lack of awareness and unconscious bias leads us to focus on the offending and not what could be underpinning it. Our untrained behaviours can and do often lead to compounding the problem as we increase the likelihood of emotional dysregulation, leading to non­compliance from the subject. This often leads to violent behaviour.

ADHD is not an excuse for poor behaviour at any age, yet the negative aspects of its presence leads to poorer social outcomes in life and hidden vulnerability for many. An individual’s social environment does not cause ADHD, yet poor social environment and adverse childhood experiences can exacerbate behavioural symptoms. The neurodevelopmental basis of ADHD creates those skills deficits through biology. Neuroplasticity means ADHD biology can be managed and changed with the right approaches. ∎

Follow Kaj Bartlett on Twitter at @ADHD_InspKaj

Are we approaching workplace stress the wrong way?

by John Nelson
Chair, National Police Autism Association

The last couple of years have seen an increased recognition of the importance of staff welfare within policing. As a service, we are now far more aware of the effects of stress: in years gone by, an officer struggling with the after-effects of a fatality or other traumatic incident might be offered nothing more than a stiff drink in the bar after work; today, Forces offer trauma risk management (TRiM) and access to counselling as standard. The launch of the Oscar Kilo wellbeing portal in 2017 and the Police Federation’s successful ‘Protect the Protectors’ campaign reflect a more enlightened approach to wellbeing within the emergency services.

The focus on dealing with traumatic events tends to overlook another source of stress, and one that particularly affects staff with a neurodiverse condition such as autism, ADHD or dyslexia: day-to-day wellbeing. As a support group, we are often contacted by officers and staff who, for one reason or another, are not having a happy time at work; these reasons usually boil down to basic needs not being met. Despite our improved understanding of wellbeing, the police service is still something of a ‘one size fits all’ culture: as a warranted officer, you’re expected to work anywhere, in any core role, and perform to the same high standard. (Police staff are typically limited to their chosen role but may still be subject to widely varying working environments.) This approach doesn’t always work for everyone, and it especially doesn’t work for staff with hidden conditions and disabilities.

Take the station report writing room, for example – the place where officers start and finish each shift and get case files and paperwork done. With the move to larger police stations, officers are now likely to find themselves working in open-plan offices – sharing facilities with 20 or 30 colleagues at a time is not uncommon. Open-plan offices tend to be noisy – whilst some people might find a certain amount of background noise invigorating and most are are able to block out distractions, staff with sensory sensitivities typical of autism spectrum conditions may find constant background noise and interruptions intolerable and a significant barrier to performance. A supervisor may be sympathetic and willing to consider a reasonable adjustment such as a change of location or finding an officer a quiet room to work in; however all too often such accommodations can be seen as a nuisance (“Everyone else manages, why can’t you?”) or refused outright. What happens next varies, but is never good: if the officer’s performance dips below the minimum, performance management measures may be implemented; this is usually the point at which the officer takes sick leave suffering from stress and we are approached for help. Insisting on reasonable adjustments can sometimes lead to a stand-off between the officer, Occupational Health and local management, the latter being under no obligation to follow recommendations made by healthcare professionals. Even if line managers are willing to accommodate a change in working environment, such accommodations are sometimes made grudgingly, which will negatively impact on the officer’s career development. Or the officer may struggle on, managing to keep their performance above the minimum but coming into work unhappy and resentful every day – hardly a good place to be, and with obvious negative effects on resilience and long-term health.

Another factor which is arguably true for everyone, and especially to neurodiverse staff, is of square pegs not fitting into round holes. People with neurodiverse conditions tend to excel in certain roles and environments and struggle with others – for instance, an officer on the autism spectrum may thrive in a neighbourhoods role, where the focus is on solo working and long-term problem-solving; an officer with ADHD on the other hand may find the constant stimulation of a response role a better fit. Unfortunately there is no pathway for such career preferences to be accommodated, outside of recognised specialisations such as CID; if an officer is unlucky enough to find themselves in the ‘wrong hole’, the only way out may be through requesting a move as a reasonable adjustment, which may only be granted as a means of getting the officer back to work from sick leave. Some managers are more accommodating than others, but this is hardly ideal – our position is that this vital facet of wellbeing should not be a spin of the roulette wheel.

Along with culture, a barrier to wellbeing is austerity – with officers at all ranks being expected to achieve more with less, it is all to easy to view an officer who struggles as a ‘problem child’ (a term that unfortunately is still bandied about in policing circles). Managing resources, performance and sickness tends to fall to local District Commanders – these mid-level managers spend a good deal of time juggling team numbers on their office whiteboards, and with staffing levels constantly at minimum or below minimum, it’s easy to see why an officer requesting a transfer to different location or role would not be seen favourably as a potential high performer. The ‘immoveable object’ behind all of this is the Equality Act: employment law does not recognise that providing reasonable adjustments to disabled staff may ‘upset the numbers’ or be too costly. The ultimate result of getting this wrong is the Force being taken to an employment tribunal – a failure for everyone involved, regardless of outcome.

It’s hard to talk about the importance of wellbeing without looking at what can happen if it’s neglected, but I would like to focus on the positives. Neurodiverse officers and staff who overcome the odds to find their niche can be capable of great things – take for example Detective Inspector Warren Hines, Chief Inspector Nigel Colston and Inspector Kaj Bartlett, senior officers who have forged careers around their strengths arising from autism and ADHD. One of the most satisfying aspects of my role as NPAA Chair is being able to point potential neurodivergent officers to the Media Centre page on our website, where they be can be inspired to turn what many view as a negative into a positive.

I’m often asked what changes I would like to see in the future. An important change for our members would be for officers of all ranks to understand the importance of day-to-day wellbeing rather than just managing trauma, and to recognise that a small expenditure on effort, time and money can make a big difference in getting the best from our staff and giving our best to the public. ∎