Autism: Implications for high secure psychiatric care and move towards best practice.

Murphy (2020) looked at adults with autism who live in high-secure psychiatric units. These are locked hospitals for people who pose a serious risk.

The paper is a narrative review. That means the author gathered stories and studies already published, then stitched them together to show what staff need to know.

The review found that adults with autism in these units have needs that differ from other patients. Sensory issues, rigid routines, and communication gaps can spark crises.

Staff who understand autism get better results. When workers use ASD-friendly tools, incidents drop and therapy moves faster.

Allen-Meares et al. (2016) focused on babies and preschoolers with autism. Both papers say the same thing: staff training is the linchpin, whether the client is three or thirty.

Kleinert et al. (2007) listed ways to assess challenging behavior in children. Murphy (2020) echoes that call, but shifts the lens to adults behind locked doors.

Subramaniam et al. (2023) asked direct-care staff in assisted-living how they view attachment behaviors. Their struggle mirrors the secure-unit staff in David’s paper: both groups want to help but lack autism-specific skills.

Goldfarb et al. (2019) warn that simply matching an adult’s special interest to a job is not enough; motivation and self-determination matter too. David adds a forensic twist: in secure care, ignoring those same needs can fuel aggression.

If you work with adults in any locked or supervised setting, treat this review as your briefing note. Ask for autism training that covers sensory breaks, clear instructions, and crisis de-escalation. Push for functional behavior assessments that respect autistic traits rather than punish them. When you write plans, add items that build autonomy and meaningful activity—skills that later ease transition to lower security or community placements.