Prevalence and Clinical Features of Suicidal Ideation in Cognitively Able Children and Adolescents with Autism Spectrum Disorder

Background:  Some of the most prevalent risk factors associated with suicidal behavior include impulsive/aggressive tendencies, social isolation, bullying, anxiety, and depression; all of which are well-documented areas of difficulty for individuals with autism spectrum disorder (ASD). The limited research on this topic in adults with ASD has reported abnormally high rates of suicidal ideation (66%) and suicidal plans/attempts (35%; Cassidy et al., 2014; Paquette-Smith, Weiss, & Lunsky, 2014). In the two studies that have examined this topic in children/adolescents with ASD, elevated rates of suicidal ideation (11-14%) were observed, even at these young ages (Dickerson-Mayes et al., 2013; Storch et al., 2013). As a history of previous suicidal behavior is one of the greatest predictors of suicide attempts, it is of critical importance that additional research investigates the prevalence, predictors, and indicators of suicidal ideation in youth with ASD, so focused efforts can be made to identify those at risk and provide pre-emptive intervention.

Objectives:  The current study investigates prevalence rates and clinical features representing risk factors and/or warning signs for suicidal ideation in youths with ASD.

Methods: Collected as part a larger program of research, the sample for this study was comprised of 34 youth with ASD (28 male, 6 female; M=13.8 years-old) and 30 typical developing (TD) youth controls (15 male, 15 female; M=13.0 years-old). Groups were matched on IQ (DAS-II GCA) and age (Table 1). Suicidal ideation was assessed by parent-report of whether their child “talks about killing self” over the past 6-months, as reported on the CBCL. Clinical features examined as risk factors were assessed by both parent-report (CBCL, MASC-P, SRS-2) and child-report (MASC-C). Data collection is ongoing.

Results: Suicidal ideation was endorsed by parents of six (17.65%) children with ASD, as compared to one (3.33%) child with TD [X²(1)=3.73, p=0.05]. Examining solely the ASD sample, none of the demographic variables (age, gender, ethnicity) were significantly associated with suicidal ideation (0.28<ps<0.53). Stronger cognitive abilities (IQ) were marginally associated with suicidal ideation (r=0.33, p=0.06). Although degree of ASD symptomology severity (SRS-2) was not significantly associated with suicidal ideation (p=0.51), multiple clinical features (assessed by the CBCL and MASC-C/P), associated with aggressive behaviors, internalizing problems, oppositional-defiant problems, feelings of humiliation/rejection, and parent-reports of overall anxiety, were significantly correlated with suicidal ideation (detailed in Table 2).

Conclusions: In line with previous findings, children/adolescents with ASD presented with elevated rates of suicidal ideation as compared to a matched TD sample. The observed relationships between suicidal ideation and clinical features provide information about potential risk factors (keeping problems internalized, increased concerns over being teased and/or viewed negatively by others) and warning signs (aggressive or defiant behaviors, elevated presence of observable symptoms of anxiety) of suicidal ideation in youth with ASD. Such information can provide guidance for future interventions (e.g. developing skills around sharing and communicating problems), and insight for preventative efforts [e.g. encouraging caregivers/teachers/practitioners to recognize the manifestations of problematic behaviors (such as aggression, defiance, anxiety), as potential indicators of underlying emotional issues that may eventually result in suicidal thoughts/behaviors].