What researchers want families to know about autistic kids and suicide
As diverse as the experiences of children and adolescents on the autism spectrum are, one sobering fact is true: young people with autism are more likely to think about suicide and dieAnd at earlier agesthan their neurotypical peers.
The Times spent months interviewing autism advocates, families, doctors and researchers to understand the factors driving this crisis and what changes could better support young people and their families.
Solutions are still in their infancy, but autism researchers and advocates are working to develop screening tools, safety plans and therapies based on the unique strengths and differences of an autistic brain.
A crucial first step is to educate parents, pediatricians and other professionals in the community about the unique risks and challenges faced by young people with autism, and why considering neurodiversity could help reduce the number of young lives lost too soon.
Here are some key findings:
Young people with autism are more likely to suffer from suicidal thoughts and mental health problems than children without autism.
Suicide is a main cause of death in the United States for children ages 10 to 18. For adolescents and children with autism, the risk is higher. A Meta-analysis 2023 found that about 10% of autistic children and adolescents had attempted suicide, a rate more than twice that of their non-autistic peers.
About 20% of American high school students reported suicidal thoughts in 2023, according to the Centers for Disease Control and Prevention. When the Kennedy Krieger Institute in Baltimore asked caregivers of 900 autistic children ages 8 to 17 whether the children had thought about ending their lives, 35 percent said yes. Nearly one in five people said their child had made a plan.
Children across the autism spectrum are much more likely to also receive a diagnosis with mental health problems than their allistic or non-autistic peers.
A Study 2021 of more than 42,000 caregivers of children aged 3 to 17 found that 78% of autistic children had at least one co-occurring psychiatric problem, compared to 14% of non-autistic children. Contributing factors include the stress of living in a sensory overwhelming or socially impenetrable world.
Autistic children without intellectual disabilities may be at greater risk.
The diagnostic definition of autism has 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 social environments. For children with a propensity for masking, autism is often diagnosed much later in childhood or even adulthood.
Many masked children can participate in classes or regular activities. But constantly deciphering and imitating social responses is cognitively and emotionally draining. Masking is strongly correlated with depression, anxiety and suicide.
“Masking is actually a risk factor for suicide for autistic people, and it has a negative effect on mental health,” said Lisa Morgan, founder of the association. Autism and Suicide Prevention Task Forceherself autistic.
Research has shown that autistic people with higher IQs are both more likely to mask and more likely to suffer from anxiety and other mental health problems.
In a 2023 studyAutistic children with an IQ of 120 or higher were nearly six times more likely to have suicidal thoughts than autistic children with average IQs. For non-autistic children, the opposite was true: higher cognitive abilities were associated with lower risk of suicide.
Warning signs of a seizure often look different in children with autism, and mental health interventions designed for neurotypical youth may not be as effective for them.
Most mental health interventions begin with a provider verbally asking a deceptively simple question: How do you feel?
But up to 80% of autistic children suffer from alexithymiaor difficulty identifying and describing one’s own internal emotional state. For this reason, “it makes sense that not all interventions designed for a neurotypical young person are likely to translate the same way to a young person with autism,” said Jessica Schwartzman, director of the Empowering Neurodiversity Training and Research Lab at Children’s Hospital Los Angeles and assistant professor of pediatrics at the Keck School of Medicine of USC.
A working group of neurodiverse researchers identified warning signs of crisis specific to autistic people, including a notable decline in verbal communication skills.
“We often think that a person can be very agitated or show a lot of emotional distress when they talk about wanting to die,” said Danielle Roubinov, associate professor and director of the Child and Adolescent Anxiety and Mood Disorders Program at the University of North Carolina at Chapel Hill. “An autistic person might not do that. They might say it in a very matter-of-fact way, or they might have a lot of trouble articulating it.”
Asking questions about suicide could save a life.
There is a common misconception that asking questions about suicide could implant the idea in a child’s head and lead to further harm. On the contrary, according to researchers, it is protective.
Ask clearly, directly and in the format the child is most comfortable with, Schwartzman said. Some autistic children may prefer a written text or letter, for example, rather than a direct verbal conversation.
Researchers are looking for inexpensive ways to adapt existing therapies to better serve children with autism and to educate the medical community about the need to use them.
Experts are currently working on modifications to be made standard screening tool that providers use to identify suicidal tendencies, as well as Stanley-Brown Safety Planwhere patients list coping strategies and contacts on a one-page sheet that is easily accessible in the event of a crisis. Studies on the effectiveness of versions adapted for autistic people are underway.
Changes in how providers interact with children with autism can also make a difference. Sensory overwhelm can be unsettling, and an autistic child may initially need a quiet place with dim lighting to calm down, and more time to process and formulate answers to questions.
The most effective way to reduce depression, anxiety and mental damage caused by masking is to ensure that autistic children get the support they need, advocates and clinicians say, and that they don’t feel like they have to change everything about themselves to fit in.
“Suicide prevention among autistic people is acceptance for who they are, the ability to be who they are without a mask,” Morgan said.
If you or someone you know is having suicidal thoughts, help is available. Call 988 to connect with trained mental health counselors or text “HOME” to 741741 in the United States and Canada to reach the crisis text line.
This article was reported with support from the Kristy Hammam Fund for Health Journalism of the USC Annenberg Center for Health Journalism National Fellowship.
