26 March 2024

Neurodiversity, neurodisability and the needs of young adults

Young adults
A young Black woman wearing a denim shirt looks thoughtfully out a window

The 2021 Criminal Justice Joint Inspectorate report ‘Neurodiversity in the Criminal Justice System’ highlighted that the prevalence of neurodiversity is much higher than has previously been reported. Encountering the criminal justice system is incredibly stressful and worrying, especially for young adults who require additional support. That’s why we recently spoke to Professor Huw Williams and PhD Researcher Hope Kent from The University of Exeter about their work in this area and how the current system can be improved.

Assessments in police custody

Young adults can present with various needs, including acquired brain injury (ABI), neurodiversity, ADHD, autism, as well as language and communication issues. Huw recognises that this can be daunting for professionals.

“How do we bring in a system for people to better recognise the signs and signals of neurodisability? We don’t want frontline staff to be overwhelmed by the complexity of the information but to be better equipped in the interaction with the person and think about how to support them because they’re vulnerable.”

32% of under 18s interviewed in the secure estate have a learning disability1 (compared to about 4% of the general population). Unfortunately, similar data related to young adults aged 18 to 25 is not documented. However, we can safely assume that a significant number of young adults are coming into custody with additional needs.

That makes the screening process crucial. If young adults are properly assessed at this first point of contact with the justice system, their charges can be mitigated, and they can be diverted into local support systems. Particularly for those aged 18-25, proper screening could be the difference between being supported by an Appropriate Adult in police custody or not.

“We have supported various projects to help police to screen for brain trauma. Hope and I did some work with Devon and Cornwall Police, specifically with their Pathfinder diversion program. The team fed back that they saw the need to pick up on mild brain injury more effectively so that staff could be more mindful of how it affects people and make appropriate adjustments – which could be simple, like issuing regular reminders for appointments.”

As police forces operate independently, it’s challenging for best practice approaches, like this project in Devon and Cornwall, to be shared widely. Instead, there are often pockets of good practice.

Risk versus vulnerability

Earlier this year, Hope was working on a research project exploring the impact of the PACE safeguards on the detention and questioning of children in custody2. She requested custody record data from the 43 territorial police forces in England and Wales. One of the factors examined in the project was the quality of information police forces were recording about the vulnerability of children appearing in custody.

She explains: “We heard back from 12 forces who could provide us with electronic datasets – eight of which were of high enough quality to include in our analysis. The vulnerability flags that police forces use varied hugely across the 12 forces and were generally collected under the heading of ‘person warning flags’. The number of electronically recorded ‘person warning flags’ ranged from 3 in some forces, to 12 in others. They also ranged significantly – including ‘Mental Health’, ‘Mental Disorder’, ‘Suicidal’, ‘Escaper’, ‘Drugs’, ‘Contagious’, amongst others.

“Flags for things that might make a child or young person particularly vulnerable in police custody, such as a mental health condition, are collected along the same lines as flags for their management in custody, such as ‘escaper’.”

“It’s clear that the vulnerability flags are not fit for purpose, and the consistent electronic recording of more detailed information would enable proper enforcement of safeguards for children and young people who need them.”

A unified approach to screening

The picture that starts to emerge is one where people’s vulnerability is viewed through a lens of risk, rather than a supportive lens that seeks to identify appropriate support or interventions. Hope believes that a more joined-up approach will help improve the situation.

“In South Wales, there are people working in police custody who understand this problem and have put screening in place, but there needs to be top-down management of what the forces are expected to collect.

“The quality of the data that police forces can easily access electronically was poor. The police forces don’t have to electronically report this data back to the home office and, without this requirement to report on people’s vulnerability, it’s incredibly hard to understand what’s going on ‘on the ground’ in custody suites.

“Asking for quality, routine data collection would make sure police forces ask questions about vulnerability in a much more consistent way.”

Effective identification of brain injury and neurodiversity

Huw Williams and Hope Kent are currently working on a research project with Thames Valley Police force. Huw and Hope were tasked with reviewing how neurodevelopmental issues and trauma may increase a young adult’s likelihood of coming into contact with the criminal justice system.

The aim is to be able to effectively identify experiences in someone’s background that may be indicative of a brain injury, and to help the police to divert people into appropriate rehabilitation services.

“We’re working with Thames Valley to work out what’s appropriate to screen for too because there’s lots of issues when children are involved as the courts can use information gained during the screening process against young women,” Hope explains.

“Police sometimes aren’t the best agency to have very sensitive information about people, but they’re often the ‘first responders’ in situations like domestic violence. So, we have to ask, what actually should go on record, what should be screened for, what the police should know about to support that person, and whether a functional assessment of what that person might be struggling with is better than having a brain injury on record?”

Functional assessments versus diagnostic assessments

Hope has also worked with Professor Amanda Kirby who created the Do-IT Profiler screening tool – a holistic assessment that considers an individual’s whole experience.

“Amanda was getting frustrated with diverse needs like autism and ADHD not being picked up and assessed properly. Do-IT Profiler operates in schools, universities, workplaces, but also in the prison system.

“They’ve worked collaboratively with prisons to design assessments that give staff the information they need to be able to support someone in education and also in their reintegration into the community.

“Do-IT is designed to be very holistic – they conduct whole person assessments. They collect somebody’s education history. Were they ever in care? Who did they live with before they came to prison? Are they struggling with homelessness, substance use, medical problems? Have they ever been diagnosed with the neurodisability?”

This innovative tool also incorporates a variety of functional assessments to better understand what support a young adult might require.

“The tools include both self-reporting and cognitive assessments – to help prison officers understand whether an individual has the skills they need to be able to go to probation appointments, for example. Do we know if they can read a bus timetable? It then produces a report for the prison that says this person might struggle with their memory, for example, and here are some simple techniques you could use to help them.”

What’s unique about this tool is the focus on function over diagnosis. This means prison staff don’t have to be experts in multiple conditions to understand what support a young adult might need.

International approaches to young adults and neurodiversity

Huw has also been looking at how criminal justice systems in other countries are supporting young neurodiverse adults.

“There are some really nice examples in the US of having social workers involved in policing, so instead of going down the arrest route, you’d be going down the support route. In New Zealand, there’s been shifts in the system so that, up to the age of 25, you are much more likely to be assessed for a neurodisability to see what support you need. So instead of going into the prison system, you’re given a community order.

“60 or 70% of police work is supporting people who are vulnerable, but this is the wrong place for people to end up. A shift in what policing does is really important, a move towards a trauma-informed supportive stance.

“But you need a system in place for that to happen, and for the police to have confidence in this approach, and local stakeholders and crime commissioners to have a stake in that and see the purpose in that.”

Bringing all the partners to the table

It’s clear that a joined-up approach – involving local health and social care partners – is needed across the criminal justice system to ensure that young neurodiverse adults are properly assessed, given appropriate support, and diverted away from crime.

“We need better systems with all the stakeholders engaged and sharing information. Rather than escalate things down the criminal justice route, you can have a more supportive response.

“What we’re calling for would be adoption of a youth justice system, in the sense that you know the young person who’s in the system is the product of what’s happened to them in early life – including adverse childhood experiences – and the responses from education, health, and social care systems. The point of the justice system should be to alert us to what support they need. But the current system doesn’t do that.”

  1. http://psychology.exeter.ac.uk/documents/Nobody_made_the_connection_Neurodevelopment%20Report_OCC_October2012.pdf ↩︎
  2. https://www.nuffieldfoundation.org/wp-content/uploads/2021/07/Kemp-Examining-the-impact-of-PACE-on-the-detention-and-questioning-of-child-suspects.pdf ↩︎