Thread by @alysanmati

Today is crucial day in the Toronto van attack trial. The forensic psychiatrist who has been called Minassian's one chance at a defence is on the virtual stand. As always, follow along here or at the link below which has some background.

thestar.com/news/gta/2020/…

One thing to watch for is what, if anything, Superior Court Justice Anne Molloy will say to Dr. Alexander Westphal after he refused to testify unless she issued an unprecedented ruling. She compared him to a kidnapper demanding a ransom. thestar.com/news/gta/2020/…

Westphal is a forensic psychiatrist specializing in autism spectrum disorder and based at the Yale School of Medicine.

The Crown and judge have no issues with Westphal testifying as an expert in forensic psychiatry. He is swearing his oath to tell the truth on the Bible.

One thing to note before we start. The media hasn't gotten copies of any of the psychiatric reports in this case yet so it's a bit of a challenge to follow along. There is no jury so there is some assumption by the witnesses that the report has been read already.

Westphal is explaining his credentials. He's in the department of law and psychiatry at Yale. He's also linked to the child psychiatry department. He's also a consulting psychiatrist for Connecticut mental health and addictions.

His CV says he specializes in "developmental and learning disorders, particularly autism spectrum disorders" and involvement in the law. He says pretty much his whole career has involved studying autism.

He's written a textbook called "Handbook on Autism and the Law" and has written extensively about autism and the law, autism and violence. Also gave a presentation about autism and the internet (he says he's not an expert in this area, though he's interested in it).

The defence points out that Dr. Westphal is doing some research in Canada, linked to understanding the effects of hate speech, the internet and autism (not sure who the research is affiliated with).

Defence is starting his formal examination-in-chief now. Starts with how Westphal got involved in this case. Westphal says Dr. Bradford was a visiting prof at Yale a few years back. He gave some talks and raised the topic of autism tangentially. Westphal spoke to him afterwards.

On the basis of that, and another meeting at a conference, Bradford introduced Westphal to the defence.

Members of the prosecution team have reached out to Westphal from time to time. Some back and forth on specific questions, about four times. He did his best to answer when he could and provided some material to look at.

Defence asks if Westphal had seen any other expert reports before he did his own. He had not. He didn't want to review them until he'd submitted his report.

Does autism cause anyone to commit any crime whatsoever? No. Does it cause you to care less about right and wrong? No, sometimes the opposite, it can make you care more about it? Does it make you vulnerable? It can.

People with autism are not more likely than gen pop to commit crimes, but more likely than gen pop to be victims of crimes. Are they more likely to commit violent or predatory crimes? No.

Looking at a slide of 22 cases of mass shooting. It lists the name of the mass killer, as per the Mother Jones database, and a link with autism spectrum disorder (most described as tentative links).

The slide is from a study that found mass killers are more likely to have autism spectrum disorder. Westphal points out only 3 of the 22 had a diagnosis and one of the 3 doesn't have a solid diagnosis.

The whole mass killer thing is a "powder keg of a topic." Concerned that it would become fact to say 8 per cent of mass killers have autism. But there is a lot speculation and conjecture about people who have autism.

Points out the autism is a diagnosis not an "odd lifestyle." He says if you look at the list, there would be fewer mass killers with autism than people with autism in the general population. A mass killer is often socially isolated, but that is NOT the same as autism

There is lots of variation among people with autism spectrum disorder. Can't make generalizations about people with autism on the basis of one person's individual actions.

(To clarify he was saying, if you look at confirmed diagnoses on that list the number goes from 22 to 2).

Defence asks if Westphal has heard about the youth case involving J.F. that Dr. Bradford referenced. He is not familiar with it.

Westphal says he is not familiar with any Canadian cases that involve autism and NCR, other than a brief reference in a commentary he did with someone else. He knew about it from a paper he read.

He is referencing a paper written by Tessa Grant et al at Queen's in 2017. It's called "Criminal Responsibility in Autism Spectrum Disorder: a critical review examining empathy and moral reasoning."

Westphal is not an expert in Canadian law (and our test for criminal responsibility) and has not testified in a Canadian court before. Defence asks him what he thinks the key issues are.

Westphal references the Grant paper. He notes that psychopathy is totally different from autism even though there are empathy issues in both.

"Autism is as varied as humanity," Westphal says again, in response to a question about generalization. There are observations about common behaviour in the diagnostics criteria but it encompasses a wide range of things.

Another caution about making generalizations from this specific case, and testimony about Minassian specifically.

When autism can cause intersections with the law, it's usually to do with lack of social insight. He references a movie called Adam. Or pursuing hyper-focused interests. One man obsessed with driving buses kept stealing them and as a result has spent a long time in jail.

Defence: What is autism? It's a neuro-developmental condition that is strongly heritable. It is often in the genetic code that controls how we think and behave. It can run in families.

Westphal says neuro-developmental means there are brain differences that are visible in imaging. But it's also developmental -- not like you can have a stroke and get autism. It's in place right from the beginning and manifests in developmental stages as a kid grows up.

You see signs in social interaction, communication, conversations. Also evident in non-verbal communication, body language. Plays out in a disability in maintaining personal and romantic relationships. Other thing is restricted, repetitive behaviors.

Can be something to do with motor skills, can be lining up toys in specific ways. It alters function in day to day living.

Westphal says it does start early in life. Parents will note that the baby doesn't make eye contact. Development of language can be delayed or develop differently. There can be rigid patterns of behaviour even in very young kids.

Westphal notes that it does manifest differently, but in general typical people develop expertise in other people and if you focus on other things development happens quite differently.

We are looking at a rainbow wheel listing the multiple dimensions of autism, including language, motor skills, perception, executive function, sensory filter. He points out that intellectual function is not even on it.

He points out that the autism spectrum is not a linear spectrum, it's more complicated than that.

Defence asks about Minassian's history and relevance to his manifestation of autism spectrum disorder. Looking at slides made by Westphal now.

Westphal says family history is important. His closest degree of family included depression, Tourette's and ADHD, and in second degree includes depression, mood swings, OCD, dementia. No known history of developmental disorders, seizures, schizophrenia or intellectual disability.

Now looking at Minassian's birth history. Westphal explains that there was no in utero exposure to anything like alcohol (no fetal alcohol syndrome for example). He was born several weeks post-partum, which is linked to higher chances of autism. No one knows why this is though.

No issues around his birth. In his infancy he had "early eye contact problems" which is a fundamental part of learning social communication. He didn't initiate social interaction i.e. didn't play with other kids.

He would repeatedly bang his head against the wall, his parents would have to intervene. He had some fine motor skill issues. His speech was delayed, only a few words at the age of three. He went to speech therapy.

He had difficulty following directions, not attentive to language. Was in "lala-land" according to his parents.

Westphal says it's important to track social development because so many concepts we are discussing in the trial and about Minassian as an adult are built on pieces like early eye contact.

He played repetitively not imaginatively. But he walked on time, toilet trained by age three -- was developing normally in some ways. This is not unusual for kids with autism.

Taking the morning break for ten minutes.

Moving onto Minassian at the early school age. He needed help getting dressed throughout his childhood. Also need prompts to use the toilet. One thing he did, which is common with autism, is "bolting." He did it in kindergarten class.

He was advanced in his math skill set. Would ask questions over and over again, sometimes surreal questions like "What would happen if we traded kneecaps." Would also echo things said when not appropriate in conversation (echolalia).

Avoided conversations, was awkward. His parents started to teach him to do things like make eye contact around this time.

Defence asks if some factors are more important than others, if it's cumulative?

Westphal says its cumulative, he showed some classical autism behaviours. Paying particular attention to social interaction.

His speech was monotonous, not emotional. Had a "blankness" in his facial expressions. He would do some repetitive things, like wearing green. He had trouble giving context like not pointing to something he was talking about.

He had trouble understanding body language and implied meaning of expressions. He was "quite involved in his own world."

He was resistant to change, not really a "go with the flow" person. At 5 he was diagnosed with pervasive developmental disorder (a form of autism in the DSM-4). Its a "looser diagnosis" given where there isn't formal diagnostic testing or some puzzling other behaviours.

Now it's all called autism spectrum disorder. Defence asks if there is significance to a medical diagnosis and the age it was made.

His presentation is very consistent with autism, Westphal said. Some other people like Adam Lanza got a diagnosis later, more complex, other things going on. But Minassian doesn't have other disorders. Suggests he had some significant impairments early on.

Adam Lanza was the Sandy Hook elementary school shooter.

Defence asks if Minassian had signs of struggling with cognitive abilities. Westphal said there was no IQ testing, didn't seem there was worry about his intellectual development.

Westphal noted that Minassian didn't show signs of aggression towards others (towards himself there was head-banging). But there is a "striking absence" of aggression given the reasons we are here.

Westphal noted that he did show some aggression with toy figures but hard to know what this means -- lots of boy kids play aggressively with figurines and not an indication it was part of a continuum.

Defence asks if Adam Lanza had a history of aggression, Westphal said he is not familiar enough to know.

Now getting into school age behaviours. He didn't seek out kids to play with, but did play with familiar kids. Not much excitement over anything except what he was interested in like Mr. Bean (he mimicked him and recited his lines).

Defence asks about the significance of Mr. Bean. Westphal says this is a "cool question." Mr. Bean doesn't say much but has a "hyper-emotive" face. It's like a cartoon. Maybe that broke through to Minassian at that age, unlike more subtle things.

Notably, he didn't like praise and didn't like to be singled out. This is relevant given that Minassian's stated motivation includes noteriety and attention.

He doesn't like reflections (especially reflections of reflections) and auditory echoes.

In high school he was in special needs classroom and had a social circle through that. He became isolated though, didn't want to be associated with a disability -- this is common. He was uncomfortable around girls. Would say things like "don't hurt me, don't hurt me."

He didn't smile, lacked intuitive social responses. He was taught to reply "good" when neighbours asked how he was. Also had "empathy problems." Points to the anecdote about when his brother needed to go the hospital and Minassian didn't want to stop playing his video game.

Minassian didn't seem concerned about the situation. (Minassian's dad told this story, noting that they were surprised because Minassian loved his brother).

Westphal addresses this -- Minassian and his older brother are close and love each other. He just didn't empathize with him in that context. It's a "striking disconnect," Westphal said.

Minassian would "latch onto missions." Would focus on something until he achieved his goal or lost interest. Started to show "complex tics" involving multiple parts of his body. These are common in autism.

His social communication. The way he spoke could confuse listeners, didn't give the auditory cues needed to follow. Trouble with drawing inferences. He would do negative attention-seeking behaviour. Would make Wookie noises on demand as part of a pattern of trying to fit in.

Academically, he had a mix of grades. Dad said he helped him with assignments which could explain some of the variation in his performance. Re inferences -- he was cause and effect oriented. Part of how differently his brain developed.

Defence asks about the latching onto missions. Is that hyper-focus? Westphal notes the other psychiatrist talked about overvalued ideas. He says these things are muddy and run into each other. People can behave in ways destructive to themselves from an overvalued idea.

Going to get into more of this later.

The thing about hyper-focus and over-valued ideas etc, I mean.

Minassian took medication for his tics which suggests they were quite strong. He stopped the meds at the end of high school. He also had a tic-like behaviour where he'd spit in his hands repeatedly.

Going into adulthood now. Westphal says Minassian once got in trouble for "humping a tree." Some kids had dared him to do it. There was a "fall guy" dynamic and he's eager to please, but they are just mocking him. Does think this happened throughout his older childhood.

Westphal said Minassian has brought up his isolation and being picked on, bullied. So it's important in that context, he said in response to a defence q about the significance of this.

In adulthood he didn't like change (barring a few sudden things). He couldn't speak to female servers.

"I think it's wonderful he graduated from college," but he did take seven years to do it. It was difficult, extended process. He made some abrupt, unrealistic changes.

He suddenly wanted to be a chemistry major despite no history in chemistry. Also like how he wanted to join the military but he couldn't swim.

His short tenure with the military does show some insight by him. He has never had a romantic relationship, closest he got was getting a phone number from a girl and she never texted back, Westphal said.

He was awkward, especially in unstructured situations. He was "quite fluid" in their conversations but when things weren't about the central topic he was less able.

He was taught by his parents to make contact so now he makes "intense eye contact." It's "poorly modulated."

On lunch till 1:20 p.m.

We are back and looking at a slide intended to explain how someone with autism develops differently from someone who doesn't have autism.

Westphal notes he's been saying Minassian's eye contact is different, which is one of many things that indicate his autism but is also a "window into his brain." There is a "stunning beautiful" literature about this.

sorry, "stunningly beautiful"

There is a clip from Who's Afraid of Virginia Woolf in the slide, involving a complex social situation. People without autism can figure out what is going on based on eye tracking. Viewers without autism were looking at totally different things, and missed lots of social info

Here is the study being referred to: medicine.yale.edu/news/yale-medi…

Viewers with high-functioning autism, if they were looking at social aspects, they looked at mouths rather than the eyes, Westphal said.

The clip in question has a man getting increasingly angry in the background. Viewers without autism looked back and forth between the main couple and that man based on eye cues. Viewers with autism didn't look at the man in the background.

We are looking at images of a brain on a slide called "the social brain." Different sections of the brain are highlighted for different things: social perception, emotion and motivation, behavioural adaptations, social attribution

Now looking at another slide with two diverging arrows, one for experts on people and one for experts on things. The slide captures the oversimplified idea there are diverging developmental trajectories

Westphal talks again about complex it is to learn about how to understand people and social interactions. As the film study shows, it can lead to perceiving different stories.

The defence is now going to go into talking theory of mind, which Westphal says is built on what we've already heard about. It is a "hyper-complex" field and this is only a brief overview.

Theory of mind might be part of a route to not criminally responsible, we've heard from Dr. Bradford.

It is the ability to understand what other people are thinking and feeling in a social situation. The slide said it means understanding other people have their own thoughts and desires, and then intuiting the mental motivations behind their behaviour and thereby predict behaviour

We are going to watch a short video clip which Westphal will explain afterwards.

Basically the idea is that you watch a clip of some shapes moving. Someone without autism will provide a social narrative (one triangle bullying the other) and someone with autism will provide a very literal interpretation of triangles moving around the screen.

Defence asks Westphal to define empathy.

he says the popular way of thinking about is understanding someone suffering or goodwill between people. That's kind of the scientific definition which is to "understand and resonate with the emotional and mind-state of other people."

It doesn't mean you have the same mind-state as someone else, but that you can have emotions that are resonant with the state of another person. He gives the example of seeing someone get robbed. The victim might be afraid. You might be angry. That's empathy.

So Minassian did a test called the Empathy Quotient. It's a 60 question self-report. Minassian got 22. Scores at or above 30 are normal.

(I should say Westphal had Minassian do the EQ test). Minassian's score was well below the cut-off. It's consistent with autism and strongly suggests he has problems with experiencing and processing stimuli that should provoke empathy.

Westphal says there is a difference between "understanding" and "resonating/sharing." Understanding means cognitive empathy and resonating means emotional or affective empathy

Or not so much means as is linked to

Westphal says kids with Down Syndrome are extremely emotionally empathetic but don't know when to have those emotions (lacking cognitive empathy).

Psychopaths on the other hand can have cognitive empathy, and can understand how people feel and then manipulate them. "They don't give a shit," Westphal almost says, narrowly avoiding the swear.

Empathy is usually a combination of both understanding and resonating with the mental states of others.

Westphal draws a distinction between being able to understand the mental state of others and not share it (allowing manipulation) and the other, which is usually the case with autism, that you fail to understand the mental state of someone else....

which undermines the ability to affiliate with or share the emotional state of someone else and undermines the ability to manipulate others.

This is a more clear explanation of the difference between the empathy deficit of a psychopath and the empathy deficit of an autistic person.

We took a quick break for the registrar to explain how to zoom in on slides. We are taking the afternoon break and the judge is gonna get some one-on-one instruction.

We are back. Westphal is explaining the two different kinds of empathy and how they related to autism. Autism is characterized by problems with cognitive empathy (theory of mind) and not normally affective empathy (resonating).

Westphal notes there is lots of variation among people with autism. Some autistic people have deep affective empathy, sometimes more than typical people.

Pyschopaths have intact theory of mind but problems with affective empathy, he says.

Now Westphal is talking about the testing they did with Minassian, which is done to confirm diagnostic things. He worked with a psychologist, Dr. Rachel Loftin, for those tests. She specializes in autism as well.

People with autism process information in many different ways. One of the characteristic styles is a hyper-reliance on verbal ability (something you see in people diagnosed with Asperger's). Minassian would over or under estimate the amount of info needed to answer the question.

Or he'd provide answers that were overly detailed and that was focused on less crucial aspects. (The tester would determine what is less crucial).

We are looking at a slide about the Autism Diagnostic Inventory, Revised (we heard about this from another expert earlier this trial). Basically its a standardized interview to cover all the bases of developmental history.

It's done with another test, the ADOS-2, to get the full picture. He was trained to do both to make an autism diagnosis.

The Crown expert team did not do either of these tests, is that surprising? Westphal said no, it requires specialized expertise in autism.

Minassian met the classification for autism on all three domains: language/communication, reciprocal social interaction, repetitive behaviours/interests.

However the ADI-R is mostly to get a really thorough history.

They also gave Minassian the "Wechsler Adult Intelligence Scale" test to measure intellectual ability. His processing was average, sverbal comprehension was superior. The "magnitude of difference" was highly unusual. Really good verbal skills, being articulate can hide disability

The difference is seen in autism spectrum disorder. Would be seen with Asperger's -- higher verbal ability, lower processing. The opposite would be "high-functioning autism." They'd have the same score.

There are four domains tested in the Wechsler test. Verbal comprehension, perceptual reasoning, working memory and processing speed.

We took a break and now we are back. Still talking about the intellectual ability test.

Minassian got a 121 on verbal comprehension (if I understand correctly the average is 100). He is in the 92nd percentile for this one. He got a 98 on perceptual reasoning, 102 in working memory.

Minassian is watching all of this from a room at the Toronto South Detention Centre. Unsurprisingly based on the evidence we don't see much reaction from him even as deeply personal things about him are revealed. He does appear to be paying attention.

Now Westphal is defining executive function. It includes the ability to organize information, working memory, impulse control. Think of the skills required of someone who does executive organizing.

Minassian tested average on a test of executive function.

There has been some testing done for depression and anxiety. Part of the "complex pile of information." But didn't meet criteria for depression or mania (nothing manic about him ever).

Minassian reported himself as average in social awareness (he had moderate concerns about social responsiveness but his parents had severe concerns).

Now seeing the results of the ADOS-2 test. He was found to be in the "autism range" rather than the "autism spectrum range" so it was on the higher side. Poor emotional insight, overly formal, awkward speed, failure to notice and respond to social cues were all noted.

*awkward speech

An additional test was done because he had poor problem-solving. He was presented with a problem with no clear solution to see if he'd ask for clarification or assistance. He just sat quietly and said nothing.

Westphal says one of Minassian's problem-solving styles is to rapidly come to and answer and rush through it without getting a missing piece of info or what he needs.

Now talking about the Vineland Adaptive Behaviour Scales which is where the rubber of intelligence meets the road, Westphal said. Basically looks at day to day function. His daily living skills and communication were moderately low, socialization was low.

The Crown experts didn't do this test. Defence asks if the results have been helpful to Westphal. He says you can see Minassian as a college grad, who tried to join the military or someone who struggled with college and the military.

He's smart but how does it translate to daily life -- there is a disconnect for him between IQ and the adaptive test. Shows a lack of reality-based thinking about his place in his world.

Taking another break for ten minutes now. We haven't yet gotten into what this all means for the actual actions -- running down pedestrians in a van -- at the centre of this trial.

Molloy notes that Minassian's diagnosis of autism is not contentious -- the issue is how it manifests and how it affects things like empathy and emotion.

Back on the Vineland test. The slide we're looking at notes Minassian's level of socialization is equivalent to that of a young child. These low scores for daily living skills, communication and socialization are not unusual for someone with autism spectrum disorder.

(So says the slide). Again, haven't seen the full report (sigh) so we don't have the full context.

The test is designed to see how skills work in daily life. His written communication skills are about the age of an 18-year-old compared to much lower levels for his oral communications skills

Re socialization (his lowest scoring area). The area covers interpersonal relationships - friendships, relationships. He notes that to have autism means to have a clinically significant impairment in some part of function. Not just awkwardness.

Overall he scored between the age equivalent of two years old (for interpersonal relationships) and eight years old in this area.

Minassian has yawned a few times now and is stretching. Court running to about 5 p.m. today.

Looking at a slide that highlights the disconnect between Minassian's high IQ and low adaptive function. The slide said it shows his intellectual capacity is higher than his real world function.

Westphal says that it would be a misrepresentation to define autism on a linear spectrum of high to low function because there are so many dimensions and they are all so variable.

Seeing some examples using pie charts with different sized slices to show how autism can vary from person to person.

Defence is now asking about malingering (basically, is he faking it). Crown made point that malingering tests are not lie detectors in the context of we don't know when Minassian being truthful.

Westphal says the malingering test is useful because it helps establish whether someone is trying get a diagnosis for secondary gain. It covers lots of different questions, but the theme is to do with suggestibility.

Idea is to get people to give out symptoms that are not their own.

Westphal says Minassian was "shockingly frank" in his intereviews and he'd have been shocked for the test to have found him malingering.

Defence asks about the difference between malingering and suggestibility. Westphal said in this context it means whether they'd take take the bait when symptoms are suggested.

Does this test help a diagnosis? It doesn't give anything other than validation of the overall diagnostic picture, Westphal said. The test is not specific to autism.

Now talking about the psychopathy checklist. Minassian's score of 13 was well below the cutoff for psychopathy, so removes the idea that he did this out of a callous disregard for other people.

Westphal said again there is a distinction between the empathy deficit of a psychopath and of someone with autism. Not the same thing.

According to the slide, Minassian had a "shallow affect" and lack of remorse" which are consistent with psychopathy but lacked other characteristics including superficial charm, manipulative behaviour. Some of his scores could be explained by his autism.

Westphal said some of the affective aspects in the test are tied to empathy. His overarching point is that Minassian doesn't come near psychopathy and the aspects can be explained through his empathy deficits, inability to understand impact on the world around him.

Defence asks what Minassian scored on pathological lying. He got the highest score, Westphal said. Its more complex though. He has lied, tho not someone really accurately described by the term pathological. But he has lied multiple times so wanted to err on side of higher score.

Justice Molloy observes that the high score on pathological lying surprises her, given Minassian's overall history. She asks if he would have scored on other things in the lifestyle section which includes impulsivity, lack of realistic goals.

Westphal said impulsivity and irresponsibility don't really capture what's going on with Minassian. He's the opposite of impulsive. Also not really irresponsible. Stimulation seeking would be speeding or gambling, doesn't really describe him either.

Westphal scored Minassian the max on grandiose self worth because of his stated motivation re noteriety. Doesn't think he's conning or manipulative at all.

Scored him the max on lack or remorse or guilt. Cannot begin to explain how significant that in in the context of the severity of what he did.

Westphal notes Minassian did have tantrums as a child consistent with autism, wouldn't class it as poor behaviour control. Did give him the max on early behavioural problems though the test is more about juvenile delinquency stuff.

Gave him a zero on lack of realistic goals. This seems at odds with him joining the military and a few other things. Found overall his insight into his future to be reasonable. Could have given him more points on this one, he admits.

Just to reiterate what Justice Molloy said before, no one in this trial is arguing Minassian is a psychopath.

Westphal says he doesn't think Minassian feels any "emotional responsibility" for what he did, which seems shocking to say.

Okay, we've finished for the day. Back tomorrow at 10 a.m.