Suicidal Ideation and Behaviors in Children, Youth, and Young Adults with Autism Spectrum Disorder (ASD): Rates & Outcomes Based on Parent-Report of 996 Individuals with ASD

Background: Individuals with autism spectrum disorder (ASD) have a higher risk of mental health conditions than individuals without ASD. Recently, there have been growing concerns that individuals with ASD may also have an elevated risk of suicidal thoughts and behaviors, however little is known on this topic, especially in relation to children and adolescents.

Objectives: To determine the rates of suicidal ideation and behaviors in children, youth, and young adults with ASD.

Methods: 996 parent participants in the Interactive Autism Network (IAN)— a large, validated and verified, internet-mediated research registry— completed the Mental Health and Suicidal Behaviors Questionnaire (MHSBQ). The MHSBQ is a proxy-report questionnaire, for parents of verbal children and dependent young adults (≤25) with ASD, which collects information regarding comorbid mental health conditions, medications, service use, family history, and history of suicidal thoughts and behaviors.

Results: The rates of suicidal ideation and behaviors for children and young adults with ASD were reported at higher rates than their typically-developing siblings and the general population. 9.1% of parents reported that their child had a plan or tried to end his or her life. Additionally, 11.5% of parents reported that their child expressed active ideation, or thoughts of wanting to end his/her life (without acting on it), and an additional 21.0% expressed only passive ideation, or thoughts of wanting to die. Significantly higher rates of many comorbid mental health conditions were reported for individuals who experienced suicidal ideation or behaviors, compared to those who did not. Notable conditions include ADHD, anxiety, PTSD, and mood disorders (all p<0.001). Likewise, individuals who experienced suicidal ideation or behaviors (grouped together) were prescribed a significantly greater mean number of behavioral medications than those who did not experience any ideation or behaviors, p<0.001. There were also increases in lifetime service use for treating “emotional, behavioral, or mood related problems,” as individuals progressed from passive ideation, to active ideation, or to plans or attempts, with statistically significant differences in service use between those who experienced ideation or behaviors, and those who did not (p<0.001). 8 years or younger was the most commonly reported age of onset for both passive ideation (28.7%), and active ideation (33.9%). Parents whose children tried to end their lives reported the onset of these suicidal behaviors as young as 5, ranging to 19 years old. Of those who tried to end their lives (n=35), 68.6% only tried one time, whereas nearly a third tried twice or more. The reported methods included suffocation (42.9%), poison (28.6%), motor vehicle accidents (20.0%), cuts/stabs (14.3%), falls/jumps (8.6%), and electrocution (5.7%).

Conclusions: Nearly half of those surveyed reported that their child or young adult with ASD had experienced suicidal ideation or behaviors, which indicates an alarmingly high potential for loss of life among this population. Since these behaviors are significantly coupled with comorbid mental health conditions and service use, this study points to the need for more available screenings and mental health services for children, youth, and young adults with ASD.