Suicide Screening in Neurodevelopmental and Autism Clinics: Early Data and Implications

Background: Children and adults with neurodevelopmental disabilities, including autism spectrum disorder (ASD), are reported to be at increased risk for suicidality. However, no studies have screened for suicidal ideation in this population when presenting to outpatient clinics. In 2015, The Joint Commission, an international healthcare accreditation organization, issued a “Sentinel Event Alert” mandating health care facilities to implement suicide screening in all healthcare settings. This study presents preliminary data on suicide screening in medical outpatient clinics at The Kennedy Krieger Institute, a large university-based center for neurodevelopmental disabilities.

Objectives: (1) To determine the overall rates of past suicidal ideation, prior suicide attempts and current suicidal ideation in individuals presenting to 27 distinct outpatient neurodevelopmental medical clinics (2) To compare rates of suicidality in patients with ASD to patients with other neurodevelopmental conditions.

Methods: All individuals greater than 9 years of age were screened during August and September 2017. There was no upper age limit for screening. Suicide screening instruments included the “Ask Suicide Screening Questions” (ASQ) (ages 9 to 18 years) and the “Ask Suicide-Screening Questions to Everyone in Medical Settings” (ASQ’em) (over age 18 years). Nurses performed the screenings during the initial intake. Patients and caregivers were given the option to opt out of the screening. Patients or their caregivers could respond to the questions. We reviewed results for patients presenting to all clinics. We then compared patients presenting to autism and related disorders clinic with those presenting to the center for development and learning, and neurology and developmental medicine clinics. The latter two clinics collectively see patients with a variety of neurodevelopmental disorders, including ADHD, intellectual disability, learning disabilities, epilepsy and other neurological diagnoses.

Results: A total of 2054 patient visits were eligible for suicide screening. Patients were screened at each visit. A total of 522 (25.4%) of the 2054 eligible patients declined screening. Of those screened in all clinics (1532 distinct visits), 99 (6.5%) screened positive for past or present suicidal ideation or prior attempted suicide, and 1433 (93.5%) were negative screens. In our autism clinic, 317 patients were eligible for screening and 106 (33.4%) declined screening. Among those who were screened (211 patients), 29 (13.7%) had positive screens and 182 (86.3%) negative screens.Of the 555 patients eligible for screening in the center for development and learning, 101 (18.2%) declined screening. Of the patients screened (454 patients), 23 (5.1%) screened positive and 431 (94.9%) screened negative.In the neurology and developmental medicine clinic, 237 patients were eligible for screening of which 72 (30.4%) declined screening. Of the patients screened (165 patients), 9 (5.5%) screened positive and 156 (94.5%) had negative screens.

Conclusions: Individuals with neurodevelopmental disabilities are at risk for suicidal ideation. In our sample, patients with ASD had higher rates of suicidality compared to patients with developmental and neurological conditions. A substantial number of individuals declined screening. Further studies are needed to determine outcomes for patients who screen positive and examine reasons for why screening was declined.