One of the most challenging calls I receive from parents is when there is concern about self-harm and/or suicidal thoughts among my autistic patients. Trying to distinguish between "lashing out" during a less regulated emotional outburst and actual intent to self-harm requires a complex interplay of close communication with the family and other clinicians on the care team, as well as frequent assessment of the child. Even when face to face with an autistic child who has expressed thoughts of self-harm, differences in social communication (one of the hallmarks of an autism spectrum disorder) can still make it very difficult to evaluate a child’s risk.
Until recently, there was limited understanding of the true risk of suicide and self-harm among autistic individuals. Symptoms of self-harm sometimes may have been misinterpreted as an autistic behavior, and the emotional complexity of some autistic individuals may have been underestimated. However, studies in the past couple of years have started to build our understanding that autistic individuals are, in fact, at higher risk of becoming injured or completing suicide compared to non-autistic individuals.
Recent studies found that when compared to non-autistic individuals, autistic individuals are at higher risk of attempting suicide, of being hospitalized as a result of a suicide attempted, and of completing suicide. Risk factors for suicide include common autism-associated conditions, such as depression, anxiety, and attention-deficit hyperactivity disorder (ADHD). Age of diagnosis was also recently found to be a potential risk factor. Females on the autism spectrum are also at particularly higher risk, when compared to males on the spectrum and non-autistic females. A large study found that autistic women with ADHD had 10 times the odds of attempting suicide (compared to 5 times the odds among autistic men with ADHD). The presence of an intellectual disability also was associated with increased odds of suicidal attempts, hospitalizations, and death from suicide.
Less is known about the risk of suicide and self-harm behaviors among autistic youth. One recent systematic review found that autistic children and adolescents have a higher risk for self-harm or suicidal behaviors, though prevalence rates varied. Another study found that parents reported suicidal ideation among their children on the spectrum using a general behavior rating scale in nearly 10% of cases, and suicidal and/or self-harm behaviors in nearly 15% of cases. A similar prevalence of suicidal ideation was found among autistic children when families completed a suicide-specific screening tool.
More research is needed to further characterize the prevalence and risk of suicide and self-harm among autistic children and teens. Only then can we start to understand whether current evidence-based prevention strategies and treatments designed for the general youth population need to be tailored to best meet the needs of autistic youth.
For more information:
- If you, or someone you know, are in crisis, call the National Suicide Prevention Lifeline at 1-800-273-TALK (8255).
- If you, or someone you know, are in crisis, access Crisis Text Line: Text "Home" to 741741 for free, 24-hour support.
- This month’s special issue of Journal of Autism and Developmental Disorders includes several recent studies focusing on the prevalence of, risk factors for, and screening tools to assess suicidal and self-harm behaviors among autistic children and adolescents.
- Click here to read more about the link between autism and suicide risk from the Interactive Autism Network.
- SPARK (Simons Powering Autism Research) offers some resources for diagnosing and managing depression in autistic individuals.
- Learn more about the Center for Violence Prevention's suicide prevention programs.
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