What researchers want families to know about autistic kids and suicide

No matter how varied the experiences of children and adolescents on the autism spectrum, one sobering fact remains true: autistic youth more likely to think about suicide and die from itAnd at an earlier agethan their neurotypical peers.

The Times spent months interviewing autistic advocates, families, doctors and researchers to understand the factors behind this crisis and changes that could better support youth and their families.

Solutions are still in their infancy, but autism researchers and advocates are working to develop screening tools, safety plans and treatments based on the unique strengths and differences of the autistic brain.

A critical first step is to educate parents, pediatricians, and other community professionals about the unique risks and challenges faced by autistic youth and why embracing neurodiversity can help reduce the number of young lives lost too soon.

Here are some key takeaways:

Youth with autism are more likely to experience suicidal thoughts and mental health problems than children without autism.

Suicide is leading cause of death in the USA for children aged 10 to 18 years. The risk is higher for teenagers and children with autism. One Meta-analysis 2023 found that about 10% of children and adolescents with autism attempted suicide, more than twice the rate of their non-autistic peers.

In 2023, about 20% of high school students in the United States reported suicidal ideation. According to the Centers for Disease Control and Prevention. When the Kennedy Krieger Institute in Baltimore asked teachers of 900 autistic children Between the ages of 8 and 17, if children thought about killing themselves, 35% said yes. Almost one in five said their child had made a plan.

Children on any autism spectrum are also much more likely to be diagnosed with mental disorders than their allistic or non-autistic peers.

A 2021 study a survey of more than 42,000 caregivers of children ages 3 to 17 found that 78% of children with autism had at least one comorbid psychiatric condition, compared with 14% of children without autism. Contributing factors include the stress of living in a world that is sensory suppressive or socially impenetrable.

Autistic children without intellectual disabilities may be at greater risk.

Diagnostic definition of autism evolved over the years and now includes children who cope by “masking”: consciously or unconsciously suppressing autistic traits in order to fit in at school or in a social environment. Children with masking tendencies are often diagnosed with autism much later in childhood or even adulthood.

Many children wearing masks can participate in normal activities or activities. But constantly deciphering and imitating social responses is cognitively and emotionally exhausting. Masking is highly correlated for depression, anxiety and suicide.

“Masking is actually a risk factor for suicide for autistic people and has a negative impact on mental health,” said Lisa Morgan, the organization's founder. Autism and Suicide Prevention Working Groupwho herself suffers from autism.

Research has shown that autistic people with higher IQs both I'm probably disguised and are more likely to suffer from anxiety and other mental illnesses.

IN one study 2023 According to the University of Iowa, autistic children with an IQ of 120 or higher were nearly six times more likely to have thoughts of suicide than autistic children with an average IQ. For non-autistic children, the opposite was true: higher cognitive ability was associated with a reduced risk of suicide.

Crisis warning signs often look different in autistic children, and mental health interventions designed for neurotypical youth may not be as effective for them.

Most mental health interventions begin with the clinician verbally asking a deceptively simple question: “What are you feeling?”

But up to 80% of autistic children have alexithymiaor difficulty identifying and describing one's own internal emotional state. For this reason, “it makes sense that all interventions developed for neurotypical youth will likely not be equally applicable to autistic youth,” said Jessica Schwartzman, director of the Neurodiversity Empowerment Training and Research Laboratory at Children's Hospital Los Angeles and assistant professor of pediatrics at the Keck School of Medicine of the University of Southern California.

A working group of neurodiverse researchers has identified warning signs of crisis specific to autistic people, including a marked decrease in verbal communication abilities.

“It's often thought that someone might be very anxious or very emotionally distressed when they talk about wanting to die,” said Danielle Rubinow, assistant professor and director of the program in child and adolescent anxiety and mood disorders at the University of North Carolina at Chapel Hill. “An autistic person might not do that. They might say it really matter-of-factly, or they might have a really hard time articulating it.”

Questioning suicide can save a life.

Exists common misconception that questions about suicide can plant the idea in a child's mind and lead to further harm. If anything, the researchers say, it's a protective effect.

“Ask clearly, directly and in a format that is most comfortable for the child,” Schwartzman said. For example, some autistic children may prefer texting or writing to direct oral conversation.

Researchers are looking for inexpensive ways to adapt existing treatments to better serve children with autism and educate the medical community about the need for their use.

Experts are currently working on changes to standard verification tool that service providers use to identify suicidal ideation, and Stanley-Brown Security Planwhere patients list coping strategies and contacts on a one-page sheet that can be easily accessed in the event of a crisis. Research is currently being conducted into the effectiveness of versions adapted for autistic people.

Changes in the way service providers interact with children with autism may also make a difference. Sensory overload can be destabilizing, and a child with autism may initially need a quiet place with dim lighting to calm down, as well as extra time to process and formulate answers to questions.

The most effective way to reduce the depression, anxiety and mental harm caused by masking is to ensure that children with autism get the support they need and don't feel like they have to change everything about themselves to fit in, advocates and doctors say.

“Suicide prevention for autistic people accepts them for who they are, when they can be who they are without masking,” Morgan said.

If you or someone you know is experiencing suicidal thoughts, help is available. Call 988 to connect with qualified mental health counselors or text “HOME” to 741741 in the US and Canada to reach the Crisis Text Line.

This article was published with support from the Christy Hammam National Endowment for Health Journalism at USC Annenberg.