Thread by @alysanmati

Okay Alek Minassian's trial is underway today. On the stand is Dr. Rebecca Chauhan, a forensic psychiatrist at St. Joseph’s Hospital, specializing in child and adolescent psychiatry. She's testified before about criminal responsibility, but she's not here for that purpose.

She did an assessment of Minassian from a child and adolescent psychiatric perspective (I'm sure this will become clearer as we go). She is now explaining autism spectrum disorder, a life-long developmental disorder.

In general there would be deficits in social interaction. Would often be symptoms like problems with speech, eye contact, lack of interest in or lack of peer relationships, difficulty understanding and predicting reactions of others aka "mindblindness"

This was more than the defence wanted to get into at the moment, he's just establishing Dr. Chauhan's areas of expertise so she can be qualified as an expert by the court.

Dr. Chauhan is going through her expertise in autism which she has studied and which is sometimes part of her clinical practice at McMaster Children's Hospital, where she is a child psychiatrist.

Dr. Chauhan got involved in this case via Dr. John Bradford, one of the defence forensic psychiatrists who assessed Minassian. She was tasked with looking at Minassian's autism diagnosis which was made under the old DSM-4 criteria.

He thought it would be wise to get a second opinion from her. She notes that her primary focus is not autism, though it is part of her expertise. She has been formally recognized by the court as an expert witness.

She says looking at someone at age 25 is different from seeing them in childhood, important to look back at that for a neuro-developmental disorder diagnosis. She used a tool known as the ADI (Autism Diagnosis Interview) which involved speaking to his parents, brother

It's very common "gold standard" diagnostic tool for autism. It has a lot of questions getting at many different things and at the end there is an "algorithm" that produces a score. But it doesn't make the diagnosis, a doctor does.

She's explaining how the ADI scoring process works. We can't see the document in question.

There are lots of different categories but the focus is early in development of the child.

Based on the tool, the criteria for autism was met.

Now talking about the ADOS-2 (Autism Diagnostic Observation Schedule) which involves observing the person doing tasks and answering questions. Because Minassian has fluent speech he did module 4. Another gold standard tool used to diagnose autism.

She saw Minassian three times, and did the "semi-structured" interview with him on one of those occasions. She explains that she accidentally first used an old ADOS scoring sheet, though she did the interview with the ADOS-2 manual. Some small differences between the two.

She said it "all balanced out" and there was no impact on the results at the end of the day.

Minassian's lawyer is now asking about the ADOS-2 assessment she did. What is the difference between autism and autism spectrum disorder boxes on the form? The latter can involve fewer symptoms and under DSM-4 might have been diagnosed with Asperger's Syndrome.

The autism category would be the more severe symptoms.

Defence asks about "high-functioning autism." She says it can mean fewer symptoms but usually means intelligence is not affected, and is average or above average.

She notes autism can co-occur with intellectual disorders (about 40 per cent).

Minassian's scores are above the cut-off for autism. Dr. Chauhan says there was more evidence of symptoms when he was younger.

Back after a break. Both the Crown and defence forensic psychiatrists are observing the testimony. The Crown's expert, Dr. Scott Woodside, recently testified in another high-profile NCR case in New Brunswick (which I know from following @HadeelBIbrahim)
cbc.ca/news/canada/ne…

Dr. Chauhan is explaining the different severity levels of autism spectrum disorder per the DSM-5. Minassian is not at level 3 which is "requiring substantial support." Talking about Level 1 and Level 2 now.

Dr. Chauhan is explaining the difference between "requiring support" and "requiring substantial support." Minassian falls into both categories at different times.

When she saw him in 2018, she determined that in restricted and repetitive behaviour he would be Level 1 (requiring support) and in social communication between Level 1 and Level 2.

She is now explaining another criteria known as "adaptive functioning" as in how can they handle the day to day things they need to do, practical skills like banking and grocery shopping, social skills, communication. How much in daily life are you being impacted?

Dr. Chauhan says she doesn't really opine on severity of autism as part of her work. Never used a standardized tool for that purpose.

Dr. Chauhan met with Minassian in 2018 and asked him about what happened in this particular case, defence said.

She agrees, it was part of the interview.

Defence asked if he seemed like he was holding anything back

She said he was "forthright" more than would be expected and that it seemed like he wanted to talk about it.

He didn't elaborate on things. Didn't give lots of description, just facts.

Defence asks about Minassian demeanor.

Chauhan: Affect was "flat", and he made intense eye contact that was unnerving. Even when describing other people's emotions his affect was flat. He spoke in a monotone.

She did an interview that was about 90 minutes for the ADOS-2. Defence asks if anything he did was unusual.

Chauhan say he had notable difficulties in the social interaction part. Talked about emotions like "putting pieces together." In stark contrast to severity of the offence

Chauhan said she had him read two books, to interpret what was going to happen next. He gave excessive detail and focused on extraneous detail. The stories are amusing, but he showed no emotion or enjoyment from them.

Chauhan said the interview is "semi-structured" and observational. It does involve asking questions about things like loneliness. There was a puzzle task where he had to ask for half the pieces but he didn't until she prompted him.

Another part of the test was being given objects to create story. His story was very concrete, not much imagination or creative. Not to the level you'd expect for his intellectual functioning.

Chauhan said he responded to questions when asked, often one word. No expressed shared interest or back-and-forth, just her asking questions.

He had an understanding of basic emotions, used "body symptoms" like feeling hot when angry.

He's learned to predict emotional responses based on cues, but when it came to his parents for example, it was superficial when it came to how they'd be feeling about his killing people.

He described his mother has having a strange smile and his father looking downcast and shocked, she said.

She has said Minassian had average intellectual functioning. Would expect more than just simplistic factual descriptions of emotions. When it came to why his parents would be upset, it was very limited.

Chauhan said he did suffer from some "mindblindness" -- struggled with grasping the internal world of other people or their intention. It was in marked contrast to his intellectual functioning.

Mindblindness is "struggling to understand another person has a different internal world from your own" and struggling to understand the intentions of other people. It's a deficit that is linked to social interaction. He lacked this for more complex situations.

Not everyone with autism will have mindblindness and it can be experienced at different levels.

Defence: How does it affect moral reasoning

With this deficit there is a focus on the seriousness of an outcome rather than whether a person's intention was benign or malevolent, she says.

Now talking about another aspect of autism, which can involve an intense focus on topics for high-functioning people. Like knowing every street name in a city or every weapon used in WW1. Defence asks if she recalls a dance video (Minassian's dad said he was obsessed with it)

Defence: Was copying the dance video hyper-focus?
Dr. Chauhan: Could be, could also be a ritual.

Taking another ten-minute break.

Gonna go through some of the things Minassian said to Dr. Chauhan now about why he did what he did.

Dr. Chauhan said Minassian said he stumbled across Elliot Rodger's manifesto in 2016 while looking up spree killers. He was skipping classes to attend work, was failing out

Minassian said he read the manifesto and watched video. He identified with Rodger, his difficulty socializing with peers and struggling with women. Saw parallels between them.

Chauhan said he told her he would pretend to be afraid of girls, but wanted to talk to them. In high school said he put on off-putting goofy voice to try and keep people away. Negative attention was better than no attention. Wanted to try to make people laugh.

He said girls changed when they were around 12/13. A girl laughed at him in middle school was challenging for him, and adopted this off-putting behaviour. He later asked out a woman in a library who had her head in a book. She politely declined. He took it as rejection.

Back to Elliot Rodger now. Minassian said both had autism, struggled with women and loneliness. Chauhan said she looked up and glanced at the manifesto. Minassian didn't seem to be able to see the differences between him and Rodger, only the similarities.

She said Minassian was fantasizing about mass murders, would look up primary school, secondary school and general mass murders. It was a ritual he did when things felt hopeless, but things got better when he started college, he said. He found the military harder than he thought

Chauhan has not seen Minassian's post-arrest statement. The defence tells her he mentioned in it being rejected at a Halloween party in 2013. Chauhan said he said nothing about that to her and didn't mention he'd told police that.

Defence asks if Minassian said he had an interest in Elliot Rodger prior to 2016 when she said he told her he stumbled on the manifesto. Chauhan said no, though he talked about other mass murders.

(Minassian told police he communicated w Rodger which would be prior to 2014)

Chauhan: In the three months after the military he was seeing lots of similarities between himself and Rodger. He was "obsessed" he said. This was around December 2017 and in his final term of college he was feeling isolated and was nervous at starting work, and failing socially.

He said he was re-reading the manifesto over and over. He talked about lack of a girlfriend was always on his mind. Fantasized about shooting people. Talked about "shock value" and that no one would expect this from him bc he had "low self-confidence."

He though the people who though he was "nothing" would think "Oh Alek Minassian managed to kill a lot of people." He wanted to get a gun but thought it would be too hard. The date he picked was after his finals. He said he "really wanted to do it and thought he would die."

He also, as motivators, cited the manifesto, other school shootings and wanting attention. She'd asked why he finished school then, and he said because he'd started it and should finish.

He said he wanted to die by a gunshot wound by police, and was certain that police would kill him if he acted out violently though there was a risk he would not die.

He recalled he drove into the crowd and he realized he was hitting "random people. He said he was "wishing for more female victims" and young, attractive females in particular. He wanted to die so he wouldn't go to prison.

He told her that if people google his name they would see what he did. "He managed to get attention and feels happy and 'worth it.'" He told her he tried to die by suicide in jail, but was unsuccessful and didn't think he'd be successful so might as well behave.

She said this information was delivered all "devoid of emotion."

Defence: Does he understand the devastation he caused?

She said he "intellectually" knows people would be upset by what he did. Doesn't think he appreciates the magnitude of this highly violent offence.

Chauhan: He showed no remorse. He was happy that he got attention. May not have gone exactly as he wanted it to, but in general he said it was "worth it."

Defence: Did he know it was against the law to kill someone
Chauhan said he absolutely knew.

Minassian is fidgeting a little bit more than usual and moving his arms but can't really make anything of his reactions to all of this.

Chauhan: People with autism are by no means amoral. They learn from those around them right and wrong. There is often a strict adherence to rules and more rigidity around them. Sometimes they focus overly on outcome of act being right or wrong rather than intention.

Chauhan says people with autism, if they show enough deficit, we intervene to help them gain skills in a more formal manner. It can come off like training or stilted.

Chauhan: People with autism can determine right from wrong and make moral decisions but it can be less sophisticated. In a complex or nuanced situation or a quick one, it can be overwhelming. Planning and problem-solving can be affected.

Chauhan observed no sign of psychosis or history of psychosis. If someone is acutely psychotic there are symptoms could be accounted for by another disorder, she said, so it would need to be ruled out.

Chauhan said her assessment took place in a "seclusion suite" anteroom at a hospital. Not the ideal space for an interview, she said.

The interview took place a week after he tried to die by suicide in jail.

Chauhan said while he observed him he seemed content to be on his own in his room and was muttering under his breath. He appeared to be checking his belongings repeatedly. Kind of like a ritual, no real purpose.

Defence asks her to comment on the two suicide attempts made by Minassian. She said people with autism can also have depression and anxiety, and there can be stress from a world that is "unforgiving" to people with autism.

Minassian's desire to be killed by police seemed like a plan that can't really be separated from the planned mass killing., she said.

Defence asks about Minassian's insight into his diagnosis. Did he understand it?

Chauhan: Not really. He understood he'd been diagnosed but couldn't explain what autism is or the symptoms he struggled. Don't know if it's bc no one told him or he didn't pick up on it.

Chauhan concluded that his descriptions of other people and relationships and emotions were at a superficial level, and he struggled to understand the perspectives of other people. Likely a reflection of impairment in theory of mind.

Chauhan said he said his ability to understand the emotional experiences of others was poor and he used facial expressions,t one to try and figure it out. Minassian, due to his intellectual function, was able to learn to put these pieces together and appear like he understands.

We are taking another ten minute break.

Defence: Is it significant he was diagnosed at age 5?
Chauhan: Yes -- typically higher severity of symptoms present at early age, especially with regard for language.

Defence: In terms of social interactions, can you express Minassian's functioning equivalent to an age?

Chauhan: That's what adaptive function tries to get at. Generally would say his biggest deficit is social skills.

Chauhan said Minassian was really fixed on what Rodger did and that they are the same and the outcome of notoriety -- an outcome he said he wanted for himself. No emotion attached to it. They are connected on facts rather than an emotional state or even anger.

Minassian doesn't describe feeling angry or jilted, but that "I won't be able" to do things like have a girlfriend or get a job. Doesn't blame other people, focused on what he can't do.

Chauhan associates Minassian's obsession with Rodger as likely part of or informed by his autism spectrum diagnosis. Not to say it couldn't be for another reason but could be linked to his past tendency for hyper-focus.

Chauhan says there wasn't much focus on the why Minassian did what he did other than notoriety. Nothing in their interaction showed he had a desire for the limelight but wanted to succeed socially and this notoriety was how.

Chauhan notes that her comments about his capacity for moral reasoning re mindblindness are not to do with the legal test for moral wrongfulness (she's not here to testify about that).

That he was obsessed with the Rodger manifesto, re-reading it and researching it, suggests he was hyper-fixated on it and could have been "indoctrinated" by the manifesto, she concluded in his report. He lacks an appreciation for how his actions affect others

She said he had "rigidity" or a ritual approach to his plan to act violently and die. He didn't understand why it was odd to finish his courses if that was his plan.

She also concludes that he is a high risk for suicide, given his focus on carrying out plans.

Defence asks if, in non-medical terms, Minassian has autism or "autism-light"?

Chauhan said the term autism-light is quite offensive given that it is a recognized disorder, would not use the term. Doesn't answer the question.

And that wraps up the examination-in-chief.
We are doing a little bit of cross now.
Crown prosecutor John Rinaldi says today is the first we are hearing from Dr. Chauhan of mindblindness or theory of mind. Not in her report or notes.

She said she's trying to clarify what she means by moral reasoning and that she isn't talking about the legal test.

The Crown says he's just pointing out that she's never mentioned mindblindness or theory of mind before in this case.

She agrees.

Crown is asking what Dr. Chauhan knew going into her interview with Minassian and if she knew he was apparently afraid of women. Points out she is a woman. She said she did ask and he said it was fine.

Done for the day, back at 10 am tomorrow for the rest of cross. I'll have a story up on today's evidence later this evening.

It's extremely rare for autism spectrum disorder alone to be the basis of a not criminally responsible defence, especially in an extraordinarily violent case. Here is what the some in autism community think about what they've heard so far, w @nadineyousif_ thestar.com/news/gta/2020/…