Autism Spectrum Disorder and Criminal Responsibility in the Italian Forensic Context - Multicenter Study for Italian Validation of the Forensic Autism Risk Assessment Scale.

The study is a multicenter, observational project aimed at translating, culturally adapting, and validating the Forensic Autism Risk Assessment Scale (FARAS-IT) for use in the Italian criminal responsibility context. It focuses on adults with Autism Spectrum Disorder (ASD) or well-founded clinical suspicion of ASD who are involved in different forensic and clinical settings, with the overarching goal of improving the structured assessment of vulnerability, risk, and protective factors relevant to criminal responsibility and judicial decision-making.

The research is designed as a non-randomized, cross-sectional, comparative cohort study with prospective enrollment of all eligible participants over a 12-month observation period (T0), with standardized data collection at the time of clinical-forensic or clinical evaluation. Participants are recruited in three Italian regions (Campania, Apulia, and Tuscany) from a range of contexts that reflect different degrees of involvement with the criminal justice and mental health systems, ensuring a heterogeneous and representative sample.

Three groups are included: Group A consists of perpetrators of criminal offenses managed in forensic psychiatric pathways and subject to detentive or non-detentive security measures (e.g., REMS, forensic residential and intermediate facilities, probation with therapeutic prescriptions); Group B includes perpetrators of offenses who are considered criminally responsible and are managed in correctional facilities or external criminal execution settings without a psychiatric treatment pathway; Group C comprises psychiatric patients with ASD who have never committed criminally relevant acts and are followed in community mental health services or non-forensic residential or semi-residential facilities. This tripartite structure allows the study to distinguish between factors associated with ASD per se and those specifically related to criminal behavior and forensic management.

The primary objective is to assess the psychometric properties of FARAS-IT, including internal consistency, reliability, convergent and discriminant validity, and its clinical-forensic utility across these settings. Secondary objectives include: clinically and forensically characterizing adults with ASD in different judicial and health contexts; exploring the associations between FARAS profiles, indicators of criminal responsibility, expert findings, and judicial outcomes; identifying under-diagnosed ASD among perpetrators not in psychiatric care; and evaluating the incremental contribution of FARAS-IT beyond traditional risk and functioning instruments such as HCR-20, SAPROF, DUNDRUM, and WHODAS 2.0.

FARAS-IT is administered to subjects with a diagnosis or well-founded suspicion of ASD and covers seven domains of autistic functioning that are particularly relevant for forensic formulations (e.g., social communication, cognitive rigidity, cognitive empathy, adaptability, sensory sensitivity, emotional regulation, and risk awareness). Data are gathered through clinical interviews, behavioral observation, and analysis of clinical and, where available, forensic documentation, and are integrated-when applicable-into existing forensic information systems such as the SMOP registry for patients in forensic psychiatric circuits.