Screening for Suicide Risk in Children with Autism and Related Disabilities in a Pediatric Autism Center.

Background: Suicide thoughts and behaviors are reported at high rates in people with autism spectrum disorder (ASD). With high rates of suicide in the general population, suicide risk screening has been promoted during medical visits to US health care facilities by The Joint Commission since 2016.

Objectives: Determine suicide risk in children with ASD seen during medical visits using a suicide risk screening instrument at a specialty developmental medical center; and examine clinical characteristics of those with screening-identified suicide risk.

Methods: Suicide risk screening was performed on children ages 8 to 17 years seen for a medical visit at the Center for Autism and Related Disorders at the Kennedy Krieger Institute, a specialty children’s developmental health facility, as part of an institutional quality improvement project over five months. The “Ask Suicide Screening Questions” (ASQ) was completed by nursing staff through child or parent/guardian interview before seeing a physician. Screening results, demographics, and clinical characteristics of those with ASD and identified suicide risk were analyzed, including past and current ideation and attempts, associated mental health diagnoses, therapies, medications, and family history of suicide.

Results: There were 775 children eligible for screening between August 2017 and January 2018. 542 were screened; 30% (233) eligible declined. 58 (10.7%) children demonstrated suicidal risk. Risk was two-fold higher in white children. 48 (8.9%) had confirmed or probable ASD diagnosis (73% male; 71% white; median age 12 years [range 8-17]). Of those with ASD screening at suicide risk, 40 (83%) were child-completed, 8 (17%) by the parent /guardian.

On the ASQ questions, 27 (56%) of the 48 children with ASD wished they were dead in the past few weeks, 16 (33%) thought they or family would be better off if they were dead, 17 (35%) had suicide thoughts within the past week, and 22 (46%) reported trying to kill themselves. Five (6%) were actively suicidal at screening; one was sent to the emergency department. None required hospital admission.

Chart review indicated that 44 (92 %) of the children with ASD who screened at risk had psychiatric comorbidities, with 15 (31%) having one disorder and 29 (60%) two or more. 35 (73%) had a history of ADHD, 28 (58%) anxiety, and 15 (31%) depression. Four (8%) had family history of suicide. They had high rates of mental health treatment (39; 81%), with 35 (73%) receiving psychiatric care and 29 (60%) psychotherapy. 40 children (83% ) were currently treated with psychotropic medication, with 38% (18) taking one and 46% (22) two or more. 21 (44%) received an SSRI, 20 (42%) stimulant, and 12 (25%) antipsychotic medication.

Conclusions: Suicide risk screening in children with ASD at a specialty medical center demonstrates that suicide thoughts and attempts are common. Those with suicide risk have high rates of psychiatric comorbidity and are commonly treated with medication and psychotherapy. Children with ASD seen in specialty centers, particularly those receiving mental health treatments, are at high risk and should be screened for suicidal behavior as part of best clinical practice.