The Interaction Is the Work: Rehabilitating Risk in a Forensic Patient with Autism Spectrum Disorder and Learning Disability

  • Sushie Dobbinson
Part of the The Language of Mental Health book series (TLMH)


In this chapter, interactions between four clinicians and a man who has autism spectrum disorder (ASD) and a learning disability, and who is detained on a Forensic Learning Disability ward in a secure psychiatric hospital, are analysed. The context of engaging patients who have not themselves initiated the rehabilitative process is explored, since this has a bearing on the nature of the interactions. Dobbinson demonstrates how the four clinicians each approach talk with Malcolm, the service user, according to their own styles of working, although all orientate to a variety of common interactional issues. Reflections from two clinicians illustrate the variety of perspectives which inform different clinicians’ practice. Nevertheless, Dobbinson ultimately stresses the importance of good communication and consistency of approaches within clinical teams when working with ASD patients.


  1. Bottema-Beutel, K., Louick, R., & White, R. (2015). Repetition, response mobilization, and face: Analysis of interactions with a 19-year-old with Asperger syndrome. Journal of Communication Disorders, 58, 179–193.CrossRefPubMedGoogle Scholar
  2. Button, G., & Casey, N. (1984). Generating topic: The use of topic initial elicitors. In J. M. Atkinson & J. Heritage (Eds.), Structures of social action: Studies in conversation analysis (pp. 167–190). Cambridge: Cambridge University Press.Google Scholar
  3. Department of Health. (2007). Mental Health Act. London: HMSO.Google Scholar
  4. Dobbinson, S. (2016). Conversations with adults with features of autism spectrum disorders in secure forensic care. In M. O’Reilly & J. Lester (Eds.), The Palgrave handbook of adult mental health. Basingstoke: Palgrave Macmillan.Google Scholar
  5. Frith, U. (1989). Autism: Explaining the enigma. Cambridge: Blackwell.Google Scholar
  6. Goffman, E. (1974). Frame analysis. New York: Harper & Row.Google Scholar
  7. Gray, C. (1994). Comic strip conversations: Illustrated interactions that teach conversation skills to students with autism and related disorders. Arlington, TX: Future Horizons.Google Scholar
  8. Johnstone, S. (2005). Epidemiology of offending in learning disability. In T. Riding & C. Swann (Eds.), The handbook of forensic learning disabilities (pp. 15–30). Oxford: Radcliffe Publishing.Google Scholar
  9. Norrick, N. R. (1987). Functions of repetition in conversation. Text and Talk, 7(3), 245–264.Google Scholar
  10. Pagliai, V. (2012). Non-alignment in footing, intentionality and dissent in talk about immigrants in Italy. Language and Communication, 32, 277–292.CrossRefGoogle Scholar
  11. Prochaska, J. O. (1999). How do people change, and how can we change many more people? In M. A. Hubble, B. L. Duncan, & S. D. Miller (Eds.), The heart and soul of change: What works in therapy (pp. 227–255). Washington, DC: APA.CrossRefGoogle Scholar
  12. Rogers, C. A. (2007). The necessary and sufficient conditions of personality change. Psychotherapy: Theory, Research, Practice, Training, 44(3), 240–248.CrossRefGoogle Scholar
  13. Sacks, H., Schegloff, E., & Jefferson, G. (1974). A simplest systematics for the organization of turn-taking in conversation. Language, 50, 696735.CrossRefGoogle Scholar
  14. Sellars, C. (2011). Risk assessment in people with learning disabilities (2nd ed.). Oxford: BPS Blackwell.Google Scholar
  15. Tannen, D., & Wallat, C. (1987). Interactive frames and knowledge schemas in interaction: Examples from a medical examination/interview. Social Psychological Quarterly, 50(2), 205–216.CrossRefGoogle Scholar
  16. Vanegas, S. B., & Davidson, D. (2015). Investigating distinct and related contributions of central coherence, executive dysfunction and systematizing theories to the cognitive profiles of children with Autism Spectrum Disorders and typically developing children. Research in Autism Spectrum Disorders, 11, 77–92.CrossRefGoogle Scholar

Recommended Reading

  1. Muskett, T., Perkins, M., Clegg, J., & Body, R. (2010). Inflexibility as an interactional phenomenon: Using conversation analysis to re-examine a symptom of autism. Clinical Linguistics and Phonetics, 24(1), 1–16.CrossRefPubMedGoogle Scholar
  2. Robinson, J. D., & Heritage, J. (2014). Intervening with conversation analysis: The case of medicine. Research on Language and Social Interaction, 47(3), 201–218.CrossRefGoogle Scholar
  3. Sterponi, L., de Kirby, K., & Shankey, J. (2014). Rethinking language in autism. Autism. doi: 10.1177/1362361314537125

Copyright information

© The Author(s) 2017

Authors and Affiliations

  • Sushie Dobbinson
    • 1
  1. 1.Humber Mental Health NHS Foundation TrustHullUK

Personalised recommendations