Abstract
People who are diagnosed with Autism Spectrum Disorder (ASD) are at increased risk of suicidal behaviour compared to the general population; recent population-based studies demonstrate a three- to sevenfold increased risk of premature death by suicide. This chapter provides an overview of: (a) the current literature regarding risk and prevalence of suicide behaviour in autism; (b) the role of intellectual disability/intellectual developmental disorder in suicide in autism; (c) correlates, risk and protective factors; (d) dimensional constructs of suicide, including autistic traits; (e) current approaches to suicide assessment, including potential modifications; and (f) suicide prevention and service access. We consider these topics by drawing on state-of-the-art research, the perspective of lived experience, and consideration of the potential impacts of major events such as the coronavirus (COVID-19) pandemic.
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Change history
25 August 2022
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Notes
- 1.
Consistent with the most recent edition of the Publication Manual of the American Psychological Association (2019), and the preferences of individuals with lived experience of autism (Bury et al., 2020), we utilise identity first language.
- 2.
Permission to be identified and quoted in this chapter provided by W.A. via personal communication with author D.H., June 28, 2020.
- 3.
At the time of writing, Max is supported by a multidisciplinary team. Team members have experience with autism and are willing to learn about Max’s needs and wishes for the future. Max has an Assistance Dog and is beginning to venture outside again. Whilst suicide attempts have now stopped, Max continues to experience suicidal ideation to varying degrees.
References
Ajdacic-Gross, V., Weiss, M. G., Ring, M., Hepp, U., Bopp, M., Gutzwiller, F., & Rössler, W. (2008). Methods of suicide: International suicide patterns derived from the WHO mortality database. Bulletin of the World Health Organization, 86, 657–736. https://doi.org/10.2471/BLT.07.043489
Aldao, A., Nolen-Hoeksema, S., & Schweizer, S. (2010). Emotion-regulation strategies across psychopathology: A meta-analytic review. Clinical Psychology Review, 30, 217–237. https://doi.org/10.1016/j.cpr.2009.11.004
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). American Psychiatric Publishing. https://doi.org/10.1176/appi.books.9780890425596
American Psychological Association. (2019). Publication manual of the American Psychological Association (7th ed.). American Psychological Association. https://doi.org/10.1037/0000165-000
Andrea, T., Katharine, D., Nicole, K., Nicole, K., Thomas, O., & Susan, W. (2014). Under-identification of autism spectrum disorder in females: A case series illustrating the unique presentation of this disorder in young women. Scandinavian Journal of Child and Adolescent Psychiatry and Psychology, 2, 66–76. https://doi.org/10.21307/sjcapp-2014-010
Anestis, M. D., Bagge, C. L., Tull, M. T., & Joiner, T. E. (2011). Clarifying the role of emotion dysregulation in the interpersonal-psychological theory of suicidal behavior in an undergraduate sample. Journal of Psychiatric Research, 45, 603–611. https://doi.org/10.1016/j.jpsychires.2010.10.013
Arnevik, E. A., & Helverschou, S. B. (2016). Autism spectrum disorder and co-occurring substance use disorder: A systematic review. Substance Abuse: Research and Treatment, 10, 69–75. https://doi.org/10.4137/SART.S39921
Arnold, S., Uljarebić, M., Hwang, Y. I., Richdale, A. L., Trollor, J. N., & Lawson, L. P. (2019). Brief report; Psychometric properties of the Patient Health Questionnaire-9 (PHQ-9) in autistic adults. Journal of Autism and Developmental Disorders, 50(6), 2217–2225. https://doi.org/10.1007/s10803-019-03947-9
Ballaban-Gil, K., Rapin, I., Tuchman, R., & Shinnar, S. (1996). Longitudinal examination of the behavioral, language, and social changes in a population of adolescents and young adults with autistic disorder. Pediatric Neurology, 15, 217–223. https://doi.org/10.1016/S0887-8994(96)00219-6
Bargiela, S., Steward, R., & Mandy, W. (2016). The experiences of late-diagnosed women with autism spectrum conditions: An investigation of the female autism phenotype. Journal of Autism and Developmental Disorders, 46, 3281–3294. https://doi.org/10.1007/s10803-016-2872-8
Bernert, R. A., & Joiner, T. E. (2007). Sleep disturbances and suicide risk: A review of the literature. Neuropsychiatric Disease and Treatment, 3, 735–743. https://doi.org/10.2147/NDT.S1248
Bernert, R. A., Kim, J. S., Iwata, N. G., & Perlis, M. L. (2015). Sleep disturbances as an evidence-based suicide risk factor. Current Psychiatry Reports, 17, Article e554. https://doi.org/10.1007/s11920-015-0554-4
Bos, D. J., Silverman, M. R., Ajodan, E. L., Martin, C., Silver, B. M., Brouwer, G. J., Di Martino, A., & Jones, R. M. (2019). Rigidity coincides with reduced cognitive control to affective cues in children with autism. Journal of Abnormal Psychology, 128, 431–441. https://doi.org/10.1037/abn0000423
Bury, S. M., Jellett, R., Spoor, J. R., & Hedley, D. (2020). “It defines who I am” or “it’s something I have”: What language do [autistic] Australian adults [on the autism spectrum] prefer? Journal of Autism and Developmental Disorders. Advance online publication. https://doi.org/10.1007/s10803-020-04425-3
Butwicka, A., Långström, N., Larsson, H., Lundström, S., Serlachius, E., Almqvist, C., Frisén, L., & Lichtenstein, P. (2017). Increased risk for substance use-related problems in autism spectrum disorders: A population-based cohort study. Journal of Autism and Developmental Disorders, 47, 80–89. https://doi.org/10.1007/s10803-016-2914-2
Cai, R. Y., Richdale, A. L., Dissanayake, C., Trollor, J., & Uljarević, M. (2019). Emotion regulation in autism: Reappraisal and suppression interactions. Autism, 23, 737–749. https://doi.org/10.1177/1362361318774558
Cai, R. Y., Richdale, A. L., Dissanayake, C., & Uljarević, M. (2018). Inter-relationship between emotion regulation, intolerance of uncertainty, anxiety, and depression in youth with autism spectrum disorder. Journal of Autism and Developmental Disorders, 48, 316–325. https://doi.org/10.1007/s10803-017-3318-7
Camm-Crosbie, L., Bradley, L., Shaw, R., Baron-Cohen, S., & Cassidy, S. (2019). “People like me don’t get support”: Autistic adults’ experiences of support and treatment for mental health difficulties, self-injury and suicidality. Autism, 23, 1431–1441. https://doi.org/10.1177/1362361318816053
Carmassi, C., Palagini, L., Caruso, D., Masci, I., Nobili, L., Vita, A., & Dell'Osso, L. (2019). Systematic review of sleep disturbances and circadian sleep desynchronization in autism spectrum disorder: Toward an integrative model of a self-reinforcing loop. Frontiers in Psychiatry, 10, Article e366. https://doi.org/10.3389/fpsyt.2019.00366
Casey, P., Dunn, G., Kelly, B. D., Lehtinen, V., Dalgard, O. S., Dowrick, C., & Ayuso-Mateos, J. L. (2008). The prevalence of suicidal ideation in the general population: Results from the Outcome of Depression International Network (ODIN) study. Social Psychiatry and Psychiatric Epidemiology, 43, 299–304. https://doi.org/10.1007/s00127-008-0313-5
Cassidy, S., Bradley, L., Cogger-Ward, H., & Rodgers, J. (2021). Development and validation of the suicide behaviours questionnaire-Autism spectrum conditions in a community sample of autistic, possibly autistic and non-autistic adults. Molecular Autism, 12, Article e46. https://doi.org/10.1186/s13229-021-00449-3
Cassidy, S., Bradley, L., Cogger-Ward, H., Shaw, R., Bowen, E., Glod, M., Baron-Cohen, S., & Rodgers, J. (2020a). Measurement properties of the suicidal behaviour questionnaire-revised in autistic adults. Journal of Autism and Developmental Disorders, 50, 3477–3488. https://doi.org/10.1007/s10803-020-04431-5
Cassidy, S., Bradley, L., Shaw, R., & Baron-Cohen, S. (2018). Risk markers for suicidality in autistic adults. Molecular Autism, 9, Article e42. https://doi.org/10.1186/s13229-018-0226-4
Cassidy, S., Bradley, P., Robinson, J., Allison, C., McHugh, M., & Baron-Cohen, S. (2014). Suicidal ideation and suicide plans or attempts in adults with Asperger’s syndrome attending a specialist diagnostic clinic: A clinical cohort study. Lancet Psychiatry, 1, 142–147. https://doi.org/10.1016/S2215-0366(14)70248-2
Cassidy, S., Nicolaidis, C., Davies, B., Rosa, S. D. R., Eisenman, D., Onaiwu, M. G., Kapp, S. K., Kripke, C. C., Rodgers, J., & Waisman, T. C. (2020b). An expert discussion on autism in the COVID-19 pandemic. Autism in Adulthood, 2, 106–117. https://doi.org/10.1089/aut.2020.29013.sjc
Centers for Disease Control and Prevention. (2020). Web-based Injury Statistics Query and Reporting System (WISQARS) fatal injury data 1999–2018. Centers for Disease Control and Prevention.
Chisholm, K., Lin, A., Abu-Akel, A., & Wood, S. J. (2015). The association between autism and schizophrenia spectrum disorders: A review of eight alternate models of co-occurrence. Neuroscience and Biobehavioral Reviews, 55, 173–183. https://doi.org/10.1016/j.neubiorev.2015.04.012
Crandall, A., Allsop, Y., & Hanson, C. L. (2018). The longitudinal association between cognitive control capacities, suicidality, and depression during late adolescence and young adulthood. Journal of Adolescence, 65, 167–176. https://doi.org/10.1016/j.adolescence.2018.03.009
Crane, L., Hearst, C., Ashworth, M., Davies, J., & Hill, E. L. (2021). Supporting newly identified or diagnosed autistic adults: An initial evaluation of an autistic-led programme. Journal of Autism and Developmental Disorders, 51, 892–905. https://doi.org/10.1007/s10803-020-04486-4
Cuthbert, B.N., & Insel, T.R. (2013). Toward the future of psychiatric diagnosis: The seven pillars of RDOC. BMC Medicine, 11, Article e126. https://doi.org/10.1186/1741-7015-11-126
de la Vega, D., Giner, L., & Courtet, P. (2018). Suicidality in subjects with anxiety or obsessive-compulsive and related disorders: Recent advances. Current Psychiatry Reports, 20, Article e26. https://doi.org/10.1007/s11920-018-0885-z
Deady, M., Ross, J., & Darke, S. (2015). Suicide Assessment Kit (SAK): A comprehensive assessment and policy development package. National Drug and Alcohol Research Centre.
Dell’Osso, L., Carpita, B., Muti, D., Morelli, V., Salarpi, G., Salerni, A., Scotto, J., Massimetti, G., Gesi, C., Ballerio, M., Signorelli, M. S., Luciano, M., Politi, P., Aguglia, E., Carmassi, C., & Maj, M. (2019). Mood symptoms and suicidality across the autism spectrum. Comprehensive Psychiatry, 91, 34–38. https://doi.org/10.1016/j.comppsych.2019.03.004
den Houting, J. (2020). Stepping out of isolation: Autistic people and COVID-19. Autism in Adulthood, 2, 103–105. https://doi.org/10.1089/aut.2020.29012.jdh
Dodd, P., Doherty, A., & Guerin, S. (2016). A systematic review of suicidality in people with intellectual disabilities. Harvard Review of Psychiatry, 24, 202–213. https://doi.org/10.1097/HRP.0000000000000095
Duvekot, J., van der Ende, J., Verhulst, F. C., Slappendel, G., van Daalen, E., Maras, A., & Greaves-Lord, K. (2017). Factors influencing the probability of a diagnosis of autism spectrum disorder in girls versus boys. Autism, 21, 646–658. https://doi.org/10.1177/1362361316672178
Erlangsen, A., Stenager, E., Conwell, Y., Andersen, P. K., Hawton, K., Benros, M. E., Nordentoft, M., & Stenager, E. (2020). Association between neurological disorders and death by suicide in Denmark. JAMA, 323, 444–454. https://doi.org/10.1001/jama.2019.21834
Esang, M., & Ahmed, S. (2018). A closer look at substance use and suicide. American Journal of Psychiatry Residents’ Journal, 13, 6–8. https://doi.org/10.1176/appi.ajp-rj.2018.130603
Fazakas-DeHoog, L. L., Rnic, K., & Dozois, D. J. A. (2017). A cognitive distortions and deficits model of suicide ideation. Europe’s Journal of Psychology, 13, 178–193. https://doi.org/10.5964/ejop.v13i2.1238
Foley, K., & Trollor, J. (2015). Management of mental ill health in people with autism spectrum disorder. Australian Family Physician, 44, 784–790. https://www.racgp.org.au/afp/2015/november/management-of-mental-ill-health-in-people-with-autism-spectrum-disorder
Fontenelle, L. F., & Miguel, E. C. (2020). The impact of coronavirus (COVID-19) in the diagnosis and treatment of obsessive-compulsive disorder. Depression and Anxiety, 37, 510–511. https://doi.org/10.1002/da.23037
George, R., & Stokes, M. A. (2018a). A quantitative analysis of mental health among sexual and gender minority groups in ASD. Journal of Autism and Developmental Disorders, 48, 2052–2063. https://doi.org/10.1007/s10803-018-3469-1
George, R., & Stokes, M. A. (2018b). Sexual orientation in autism spectrum disorder. Autism Research, 11, 133–141. https://doi.org/10.1002/aur.1892
Geurts, H. M., Verte, S., Oosterlaan, J., Roeyers, H., & Sergeant, J. A. (2004). How specific are executive functioning deficits in attention deficit hyperactivity disorder and autism? Journal of Child Psychology and Psychiatry, 45, 836–854. https://doi.org/10.1111/j.1469-7610.2004.00276.x
Glenn, C. R., Cha, C. B., Kleiman, E. M., & Nock, M. K. (2017). Understanding suicide risk within the Research Domain Criteria (RDoC) framework: Insights, challenges, and future research considerations. Clinical Psychological Science, 5, 568–592. https://doi.org/10.1177/2167702616686854
Glenn, C. R., Kleiman, E. M., Cha, C. B., Deming, C. A., Franklin, J. C., & Nock, M. K. (2018). Understanding suicide risk within the Research Domain Criteria (RDoC) framework: A meta-analytic review. Depression and Anxiety, 35, 65–88. https://doi.org/10.1002/da.22686
Hallett, V., Lecavalier, L., Sukhodolsky, D. G., Cipriano, N., Aman, M. G., McCracken, J. T., McDougle, C. J., Tierney, E., King, B. H., Hollander, E., Sikich, L., Bregman, J., Anagnostou, E., Donnelly, C., Katsovich, L., Dukes, K., Vitiello, B., Gadow, K., & Scahill, L. (2013). Exploring the manifestations of anxiety in children with autism spectrum disorders. Journal of Autism and Developmental Disorders, 43, 2341–2352. https://doi.org/10.1007/s10803-013-1775-1
Hand, B. N., Benevides, T. W., & Carretta, H. J. (2019). Suicidal ideation and self-inflicted injury in Medicare enrolled autistic adults with and without co-occurring intellectual disability. Journal of Autism and Developmental Disorders, 50, 3489–3495. https://doi.org/10.1007/s10803-019-04345-x
Hedley, D., Batterham, P., Bury, S. M., Clapperton, A., Denney, K., Dissanayake, C., Fox, P., Gallagher, E., Hayward, S. M., Robinson, J., Sahin, E., Trollor, J., Uljarević, M., & Stokes, M. A. (2021). The Suicide Ideation Attributes Scale-Modified (SIDAS-M): Development and preliminary validation of a new scale for the measurement of suicidal ideation in autistic people. Manuscript submitted for publication.
Hedley, D., & Uljarević, M. (2018). Systematic review of suicide in autism spectrum disorder: Current trends and implications. Current Developmental Disorders Reports, 5, 65–76. https://doi.org/10.1007/s40474-018-0133-6
Hedley, D., Uljarević, M., Cai, R. Y., Bury, S. M., Stokes, M. A., & Evans, D. W. (2021b). Domains of the autism spectrum disorder phenotype, cognitive control, and rumination as transdiagnostic predictors of DSM-5 suicide risk. PLoS ONE, 16, Article e0245562. https://doi.org/10.1371/journal.pone.0245562
Hedley, D., Uljarević, M., Foley, K. R., Richdale, A., & Trollor, J. (2018). Risk and protective factors underlying suicidal ideation in autism spectrum disorder. Depression and Anxiety, 35, 648–657. https://doi.org/10.1002/da.22759
Hirvikoski, T., Mittendorfer-Rutz, E., Boman, M., Larsson, H., Lichtenstein, P., & Bölte, S. (2016). Premature mortality in autism spectrum disorder. British Journal of Psychiatry, 208, 232–238. https://doi.org/10.1192/bjp.bp.114.160192
Hochard, K. D., Pendrous, R., Mari, T., & Flynn, S. (2020). Examining the relationship between autism traits and sleep duration as predictors of suicidality. Journal of Autism and Developmental Disorders, 50, 3575–3584. https://doi.org/10.1007/s10803-020-04405-7
Hollocks, M. J., Pickles, A., Howlin, P., & Simonoff, E. (2016). Dual cognitive and biological correlates of anxiety in autism spectrum disorders. Journal of Autism and Developmental Disorders, 46, 3295–3307. https://doi.org/10.1007/s10803-016-2878-2
Hor, K., & Taylor, M. (2010). Suicide and schizophrenia: A systematic review of rates and risk factors. Journal of Psychopharmacology, 24, 81–90. https://doi.org/10.1177/1359786810385490
Hudson, C. C., Hall, L., & Harkness, K. L. (2018). Prevalence of depressive disorders in individuals with autism spectrum disorder: A meta-analysis. Journal of Abnormal Child Psychology, 47, 165–175. https://doi.org/10.1007/s10802-018-0402-1
Jackson, L., Keville, S., & Ludlow, A. K. (2020). Mothers’ experiences of accessing mental health care for their child with an autism spectrum disorder. Journal of Child and Family Studies, 29, 534–545. https://doi.org/10.1007/s10826-019-01662-8
Joiner, T. E. (2005). Why people die by suicide. Harvard University Press.
Joiner, T. E., Brown, J. S., & Wingate, L. R. (2005). The psychology and neurobiology of suicidal behavior. Annual Review of Psychology, 56, 287–314. https://doi.org/10.1146/annurev.psych.56.091103.070320
Jokiranta-Olkoniemi, E., Gyllenberg, D., Sucksdorff, D., Suominen, A., Kronström, K., Chudal, R., & Sourander, A. (2021). Risk for premature mortality and intentional self-harm in autism spectrum disorders. Journal of Autism and Developmental Disorders, 51, 3098–3108. https://doi.org/10.1007/s10803-020-04768-x
Kanwar, A., Malik, S., Prokop, L. J., Sim, L. A., Feldstein, D., Wang, Z., & Murad, M. H. (2013). The association between anxiety disorders and suicidal behaviors: A systematic review and meta-analysis. Depression and Anxiety, 30, 917–929. https://doi.org/10.1002/da.22074
Karalunas, S. L., Hawkey, E., Gustafsson, H., Miller, M., Langhorst, M., Cordova, M., Fair, D., & Nigg, J. T. (2018). Overlapping and distinct cognitive impairments in attention-deficit/hyperactivity and autism spectrum disorder without intellectual disability. Journal of Abnormal Child Psychology, 46, 1705–1716. https://doi.org/10.1007/s10802-017-0394-2
Kerns, C. M., Kendall, P. C., Berry, L., Souders, M. C., Franklin, M. E., Schultz, R. T., Miller, J., & Herrington, J. (2014). Traditional and atypical presentations of anxiety in youth with autism spectrum disorder. Journal of Autism and Developmental Disorders, 44, 2851–2861. https://doi.org/10.1007/s10803-014-2141-7
Kessler, R. C., Berglund, P., Borges, G., Nock, M., & Wang, P. S. (2005). Trends in suicide ideation, plans, gestures, and attempts in the United States, 1990–1992 to 2001–2003. JAMA, 293, 2487–2495. https://doi.org/10.1001/jama.293.20.2487
King, T. L., Milner, A., Aitken, Z., Karahalios, A., Emerson, E., & Kavanagh, A. M. (2019). Mental health of adolescents: Variations by borderline intellectual functioning and disability. European Child and Adolescent Psychiatry, 28, 1231–1240. https://doi.org/10.1007/s00787-019-01278-9
Kirby, A. V., Bakian, A. V., Zhang, Y., Bilder, D. A., Keeshin, B. R., & Coon, H. (2019). A 20-year study of suicide death in a statewide autism population. Autism Research, 12, 658–666. https://doi.org/10.1002/aur.2076
Kõlves, K., Fitzgerald, C., Nordentoft, M., Wood, S. J., & Erlangsen, A. (2021). Assessment of suicidal behaviors among individuals with autism spectrum disorder in Denmark. JAMA Network Open, 4, Article e2033565. https://doi.org/10.1001/jamanetworkopen.2020.33565
Lai, M.-C., Kassee, C., Besney, R., Bonato, S., Hull, L., Mandy, W., Szatmari, P., & Ameis, S. H. (2019). Prevalence of co-occurring mental health diagnoses in the autism population: A systematic review and meta-analysis. The Lancet Psychiatry, 6, 819–829. https://doi.org/10.1016/S2215-0366(19)30289-5
Lai, M.-C., Lombardo, M. V., Auyeung, B., Chakrabarti, B., & Baron-Cohen, S. (2015). Sex/gender differences and autism: Setting the scene for future research. Journal of the American Academy of Child and Adolescent Psychiatry, 54, 11–24. https://doi.org/10.1016/j.jaac.2014.10.003
Lake, J.K., Perry, A., & Lunsky, Y. (2014). Mental health services for individuals with high functioning autism spectrum disorder. Autism Research and Treatment, 2014, Article e502420. https://doi.org/10.1155/2014/502420
Lau, W.K.W., Leung, M.-K., & Lau, B.W.M. (2019). Resting-state abnormalities in autism spectrum disorders: A meta-analysis. Scientific Reports, 9, Article e3892. https://doi.org/10.1038/s41598-019-40427-7
Lever, A. G., & Geurts, H. M. (2016). Psychiatric co-occurring symptoms and disorders in young, mintellectual and developmental disabilityle-aged, and older adults with autism spectrum disorder. Journal of Autism and Developmental Disorders, 46, 1916–1930. https://doi.org/10.1007/s10803-016-2722-8
Lovato, N., Lack, L., & Kennaway, D. J. (2016). Comparing and contrasting therapeutic effects of cognitive-behavior therapy for older adults suffering from insomnia with short and long objective sleep duration. Sleep Medicine, 22, 4–12. https://doi.org/10.1016/j.sleep.2016.04.001
Ludi, E., Ballard, E. D., Greenbaum, R., Pao, M., Bridge, J., Reynolds, W., & Horowitz, L. (2012). Suicide risk in youth with intellectual disabilities: The challenges of screening. Journal of Developmental and Behavioral Pediatrics, 33, 431–440. https://doi.org/10.1097/DBP.0b013e3182599295
Lugo-Marín, J., Magán-Maganto, M., Rivero-Santana, A., Cuellar-Pompa, L., Alviani, M., Jenaro-Rio, C., Díez, E., & Canal-Bedia, R. (2019). Prevalence of psychiatric disorders in adults with autism spectrum disorder: A systematic review and meta-analysis. Research in Autism Spectrum Disorders, 59, 22–33. https://doi.org/10.1016/j.rintellectual and developmental disability.2003.06.004
Lunsky, Y. (2004). Suicidality in a clinical and community sample of adults with mental retardation. Research in Developmental Disabilities, 25, 231–243. https://doi.org/
Lunsky, Y., Raina, P., & Burge, P. (2012). Suicidality among adults with intellectual disability. Journal of Affective Disorders, 140, 292–295. https://doi.org/10.1016/j.jad.2012.03.013
Lunsky, Y., Tint, A., Weiss, J. A., Palucka, A., & Bradley, E. (2018). A review of emergency department visits made by youth and adults with autism spectrum disorder from the parent perspective. Advances in Autism, 4, 10–18. https://doi.org/10.1108/AIA-08-2017-0019
Maddox, B. B., Trubanova, A., & White, S. W. (2017). Untended wounds: Non-suicidal self-injury in adults with autism spectrum disorder. Autism, 21, 412–422. https://doi.org/10.1177/1362361316644731
Maenner, M. J., Shaw, K. A., Baio, J., Washington, A., Patrick, M., DiRienzo, M., Christensen, D. L., Wiggins, L. D., Pettygrove, S., Andrews, J. G., Lopez, M., Hudson, A., Baroud, T., Schwenk, Y., White, T., Rosenberg, C. R., Lee, L-C., Harrington, R. A., Huston, M., … Dietz, P. M. (2020). Prevalence of autism spectrum disorder among children aged 8 Years: Autism and developmental disabilities monitoring network, 11 sites, United States, 2016. MMWR Surveillance Summaries, 69, 1–12. https://doi.org/10.15585/mmwr.ss6904a1
Maisel, M. E., Stephenson, K. G., South, M., Rodgers, J., Freeston, M. H., & Gaigg, S. B. (2016). Modeling the cognitive mechanisms linking autism symptoms and anxiety in adults. Journal of Abnormal Psychology, 125, 692–703. https://doi.org/10.1037/abn0000168
Malik, S., Kanwar, A., Sim, L.A., Prokop, L.J., Wang, Z., Benkhadra, K., & Murad, M.H. (2014). The association between sleep disturbances and suicidal behaviors in patients with psychiatric diagnoses: A systematic review and meta-analysis. Systematic Reviews, 3, Article e18. https://doi.org/10.1186/2046-4053-3-18
Maple, M., Wayland, S., Pearce, T., & Hua, P. (2018). Services and programs for suicide prevention: An evidence check rapid review. SAX Institute. https://www.saxinstitute.org.au/publications/programs-services-suicide-prevention
Marrus, N., Veenstra-Vanderweele, J., Hellings, J. A., Stigler, K. A., Szymanski, L., King, B. H., Carlisle, L. L., Cook, E. H., & Pruett, J. R., Jr. (2014). Training of child and adolescent psychiatry fellows in autism and intellectual disability. Autism, 18, 471–475. https://doi.org/10.1177/1362361313477247
Masi, A., DeMayo, M. M., Glozier, N., & Guastella, A. J. (2017). An overview of autism spectrum disorder, heterogeneity and treatment options. Neuroscience Bulletin, 33, 183–193. https://doi.org/10.1007/s12264-017-0100-y
Mazurek, M. O. (2014). Loneliness, friendship, and well-being in adults with autism spectrum disorders. Autism, 18, 223–232. https://doi.org/10.1177/1362361312474121
Mazzone, L., Postorino, V., Siracusano, M., Riccioni, A., & Curatolo, P. (2018). The relationship between sleep problems, neurobiological alterations, core symptoms of autism spectrum disorder, and psychiatric comorbidities. Journal of Clinical Medicine, 7, Article e102. https://doi.org/10.3390/jcm7050102
McCall, W. V., Benca, R. M., Rosenquist, P. B., Youssef, N. A., McCloud, L., Newman, J. C., Case, D., Rumble, M. E., Szabo, S. T., Phillips, M., & Krystal, A. D. (2019). Reducing suicidal ideation through insomnia treatment (REST-IT): A randomized clinical trial. American Journal of Psychiatry, 176, 957–965. https://doi.org/10.1176/appi.ajp.2019.19030267
Moseley, R.L., Gregory, N.J., Smith, P., Allison, C., & Baron-Cohen, S. (2020). Links between self-injury and suicidality in autism. Molecular Autism, 11, Article e14. https://doi.org/10.1186/s13229-020-0319-8
Nicolaidis, C., Raymaker, D. M., McDonald, K. E., Lund, E. M., Leotti, S., Kapp, S. K., Katz, M., Beers, L. M., Kripke, C., Maslak, J., Hunter, M., & Zhen, K. Y. (2020). Creating accessible survey instruments for use with autistic adults and people with intellectual disability: Lessons learned and recommendations. Autism in Adulthood, 2, 61–76. https://doi.org/10.1089/aut.2019.0074
O’Connor, R. C., & Portzky, G. (2018). Looking to the future: A synthesis of new developments and challenges in suicide research and prevention. Frontiers in Psychology, 9, 2139–2139. https://doi.org/10.3389/fpsyg.2018.02139
Office of the Surgeon General and the National Action Alliance for Suicide Prevention. (2012). National strategy for suicide prevention: Goals and objectives for action. US Department of Health and Human Services. https://www.ncbi.nlm.nih.gov/books/n/surgnssp/pdf
Olfson, M., Wall, M., Wang, S., Crystal, S., Gerhard, T., & Blanco, C. (2017). Suicide following deliberate self-harm. American Journal of Psychiatry, 174, 765–774. https://doi.org/10.1176/appi.ajp.2017.16111288
Oliveras-Rentas, R. E., Kenworthy, L., Roberson, R. B., 3rd., Martin, A., & Wallace, G. L. (2012). WISC-IV profile in high-functioning autism spectrum disorders: Impaired processing speed is associated with increased autism communication symptoms and decreased adaptive communication abilities. Journal of Autism and Developmental Disorders, 42, 655–664. https://doi.org/10.1007/s10803-011-1289-7
Osman, A., Bagge, C. L., Gutierrez, P. M., Konick, L. C., Kopper, B. A., & Barrios, F. X. (2001). The Suicidal Behaviors Questionnaire-Revised (SBQ-R): Validation with clinical and nonclinical samples. Assessment, 8, 443–454. https://doi.org/10.1177/107319110100800409
Patja, K., Iivanainen, M., Raitasuo, S., & Lönnqvist, J. (2001). Suicide mortality in mental retardation: A 35-year follow-up study. Acta Psychiatrica Scandinavica, 103, 307–311. https://doi.org/10.1034/j.1600-0447.2001.00019.x
Pelton, M. K., & Cassidy, S. A. (2017). Are autistic traits associated with suicidality? A test of the interpersonal-psychological theory of suicide in a non-clinical young adult sample. Autism Research, 10, 1891–1904. https://doi.org/10.1002/aur.1828
Pelton, M. K., Crawford, H., Robertson, A. E., Rodgers, J., Baron-Cohen, S., & Cassidy, S. (2020). A measurement invariance analysis of the Interpersonal Needs Questionnaire and Acquired Capability for Suicide Scale in autistic and non-autistic adults. Autism in Adulthood, 2, 193–203. https://doi.org/10.1089/aut.2019.0055
Pinder-Amaker, S. (2014). Identifying the unmet needs of college students on the autism spectrum. Harvard Review of Psychiatry, 22, 125–137. https://doi.org/10.1097/HRP.0000000000000032
Poorolajal, J., Haghtalab, T., Farhadi, M., & Darvishi, N. (2016). Substance use disorder and risk of suicidal ideation, suicide attempt and suicide death: A meta-analysis. Journal of Public Health, 38, 282–291. https://doi.org/10.1093/pubmed/fdv148
Productivity Commission. (2019). Mental health, draft report. Australian Government. https://www.pc.gov.au/inquiries/completed/mental-health/draft
Rabiee, A., Samadi, S. A., Vasaghi-Gharamaleki, B., Hosseini, S., Seyedin, S., Keyhani, M., Mahmoodizadeh, A., & Kermani, F.R. (2019). The cognitive profile of people with high-functioning autism spectrum disorders. Behavioral Sciences, 9, Article e20. https://doi.org/10.3390/bs9020020
Rai, D., Culpin, I., Heuvelman, H., Magnusson, C. M. K., Carpenter, P., Jones, H. J., Hannah, J., Emond, A. M., Zammit, S., Golding, J., & Pearson, R. M. (2018a). Association of autistic traits with depression from childhood to age 18 years. JAMA Psychiatry, 75, 835–843. https://doi.org/10.1001/jamapsychiatry.2018.1323
Rai, D., Heuvelman, H., Dalman, C., Culpin, I., Lundberg, M., Carpenter, P., & Magnusson, C. (2018b). Association between autism spectrum disorders with or without intellectual disability and depression in young adulthood. JAMA Network Open, 1, Article e181465. https://doi.org/10.1001/jamanetworkopen.2018.1465
Reichow, B., Steiner, A. M., & Volkmar, F. (2013). Cochrane review: Social skills groups for people aged 6 to 21 with autism spectrum disorders (ASD). Evidence-Based Child Health: A Cochrane Review Journal, 8, 266–315. https://doi.org/10.1002/ebch.1903
Reiss, S., Levitan, G. W., & Szyszko, J. (1982). Emotional disturbance and mental retardation: Diagnostic overshadowing. American Journal of Mental Deficiency, 86, 567–574.
Reynolds, A. M., Soke, G. N., Sabourin, K. R., Hepburn, S., Katz, T., Wiggins, L. D., Schieve, L. A., & Levy, S. E. (2019). Sleep problems in 2- to 5-year-olds with autism spectrum disorder and other developmental delays. Pediatrics, 143, Article e20180492. https://doi.org/10.1542/peds.2018-0492
Ribeiro, J. D., Witte, T. K., Van Orden, K. A., Selby, E. A., Gordon, K. H., Bender, T. W., & Joiner, T. E., Jr. (2014). Fearlessness about death: The psychometric properties and construct validity of the revision to the acquired capability for suicide scale. Psychological Assessment, 26, 115–126. https://doi.org/10.1037/a0034858
Rodriguez-Seijas, C., Gadow, K. D., Rosen, T. E., Kim, H., Lerner, M. D., & Eaton, N. R. (2020). A transdiagnostic model of psychiatric symptom co-occurrence and autism spectrum disorder. Autism Research, 13, 579–590. https://doi.org/10.1002/aur.2228
Roth, G. A., Abate, D., Abate, K. H., Abay, S. M., Abbafati, C., Abbasi, N., Abbastabar, H., Abd-Allah, F., Abdela, J., Abdelalim, A., Abdollahpour, I., Abdulkader, R. S., Abebe, H. T., Abebe, M., Abebe, Z., Abejie, A. N., Abera, S. F., Abil, O. Z., Abraha, H. N., & Murray, C. J. L. (2018). Global, regional, and national age-sex-specific mortality for 282 causes of death in 195 countries and territories, 1980: A systematic analysis for the Global Burden of Disease Study 2017. The Lancet, 392, 1736–1788. https://doi.org/10.1016/S0140-6736(18)32203-7
Ruzich, E., Allison, C., Smith, P., Watson, P., Auyeung, B., Ring, H., & Baron-Cohen, S. (2015). Measuring autistic traits in the general population: A systematic review of the Autism-Spectrum Quotient (AQ) in a nonclinical population sample of 6,900 typical adult males and females. Molecular Autism, 6, Article e2. https://doi.org/10.1186/2040-2392-6-2
Ruzzo, E. K., & Geschwind, D. H. (2016). Schizophrenia genetics complements its mechanistic understanding. Nature Neuroscience, 19, 523–525. https://doi.org/10.1038/nn.4277
Samson, A. C., Phillips, J. M., Parker, K. J., Shah, S., Gross, J. J., & Hardan, A. Y. (2014). Emotion dysregulation and the core features of autism spectrum disorder. Journal of Autism and Developmental Disorders, 44, 1766–1772. https://doi.org/10.1007/s10803-013-2022-5
Sanchez-Gistau, V., Baeza, I., Arango, C., González-Pinto, A., de la Serna, E., Parellada, M., Graell, M., Paya, B., Llorente, C., & Castro-Fornieles, J. (2013). Predictors of suicide attempt in early-onset, first-episode psychoses: A longitudinal 24-month follow-up study. The Journal of Clinical Psychiatry, 74, 59–66. https://doi.org/10.4088/JCP.12m07632
Sedgewick, F., Leppanen, J., & Tchanturia, K. (2021). Gender differences in mental health prevalence in autism. Advances in Autism, 7, 208–224. https://doi.org/10.1108/aia-01-2020-0007
Smith, J. M., Alloy, L. B., & Abramson, L. Y. (2006). Cognitive vulnerability to depression, rumination, hopelessness, and suicidal ideation: Multiple pathways to self-injurious thinking. Suicide and Life-Threatening Behavior, 36, 443–454. https://doi.org/10.1521/suli.2006.36.4.443
Stagg, S. D., & Belcher, H. (2019). Living with autism without knowing: Receiving a diagnosis in later life. Health Psychology and Behavioral Medicine, 7, 348–361. https://doi.org/10.1080/21642850.2019.1684920
Stanley, I. H., Day, T. N., Gallyer, A. J., Shelef, L., Kalla, C., Gutierrez, P. M., & Joiner, T. E. (2021). Autism-related traits and suicide risk among active duty U.S. military service members. Psychological Services, 18, 377–388. https://doi.org/10.1037/ser0000418
Steenfeldt-Kristensen, C., Jones, C. A., & Richards, C. (2020). The prevalence of self-injurious behaviour in autism: A meta-analytic study. Journal of Autism and Developmental Disorders, 50, 3857–3873. https://doi.org/10.1007/s10803-020-04443-1
Strauss, G. P., Nuñez, A., Ahmed, A. O., Barchard, K. A., Granholm, E., Kirkpatrick, B., Gold, J. M., & Allen, D. N. (2018). The latent structure of negative symptoms in schizophrenia. JAMA Psychiatry, 75, 1271–1279. https://doi.org/10.1001/jamapsychiatry.2018.2475
Uljarević, M., Hedley, D., Cai, R.-Y., Hardan, A. Y., & South, M. (2020a). Anxiety and depression from adolescence to old age in autism spectrum disorder. In F. R. Volkmar (Ed.), Encyclopedia of Autism Spectrum Disorders. Springer. https://doi.org/10.1007/978-1-4614-6435-8_102432-1
Uljarević, M., Hedley, D., Foley, K. R., Magiati, I., Cai, R. Y., Dissanayake, C., Richdale, A., & Trollor, J. (2020b). Anxiety and depression from adolescence to old age in autism spectrum disorder. Journal of Autism and Developmental Disorders, 50, 3155–3165. https://doi.org/10.1007/s10803-019-04084-z
Uljarević, M., Richdale, A. L., McConachie, H., Hedley, D., Cai, R. Y., Merrick, H., Parr, J. R., & Le Couteur, A. (2018). The hospital anxiety and depression scale: Factor structure and psychometric properties in older adolescents and young adults with autism spectrum disorder. Autism Research, 11, 258–269. https://doi.org/10.1002/aur.1872
Upthegrove, R., Abu-Akel, A., Chisholm, K., Lin, A., Zahid, S., Pelton, M., Apperly, I., Hansen, P. C., & Wood, S. J. (2018). Autism and psychosis: Clinical implications for depression and suicide. Schizophrenia Research, 195, 80–85. https://doi.org/10.1016/j.schres.2017.08.028
van Orden, K. A., Cukrowicz, K. C., Witte, T. K., & Joiner, T. E. (2012). Thwarted belongingness and perceived burdensomeness: Construct validity and psychometric properties of the Interpersonal Needs Questionnaire. Psychological Assessment, 24, 197–215. https://doi.org/10.1037/a0025358
van Spijker, B. A. J., Batterham, P. J., Calear, A. L., Farrer, L., Christensen, H., Reynolds, J., & Kerkhof, A. J. F. M. (2014). The Suicidal Ideation Attributes Scale (SIDAS): Community-based validation study of a new scale for the measurement of suicidal ideation. Suicide and Life-Threatening Behavior, 44, 408–419. https://doi.org/10.1111/sltb.12084
van Steensel, F. J., Bogels, S. M., & Perrin, S. (2011). Anxiety disorders in children and adolescents with autistic spectrum disorders: A meta-analysis. Clinical Child and Family Psychology Review, 14, 302–317. https://doi.org/10.1007/s10567-011-0097-0
Vanbergeijk, E., Klin, A., & Volkmar, F. (2008). Supporting more able students on the autism spectrum: College and beyond. Journal of Autism and Developmental Disorders, 38, 1359–1370. https://doi.org/10.1007/s10803-007-0524-8
Vogan, V., Lake, J. K., Tint, A., Weiss, J. A., & Lunsky, Y. (2017). Tracking health care service use and the experiences of adults with autism spectrum disorder without intellectual disability: A longitudinal study of service rates, barriers and satisfaction. Disability and Health Journal, 10, 264–270. https://doi.org/10.1016/j.dhjo.2016.11.002
Wark, S., McKay, K., Ryan, P., & Müller, A. (2018). Suicide amongst people with intellectual disability: An Australian online study of disability support staff experiences and perceptions. Journal of Intellectual Disability Research, 62, 1–9. https://doi.org/10.1111/jir.12442
Weinheimer, L. A. (2018). A mixed method exploration of suicidality in clients with intellectual disability. (Doctor of Psychology). University of Toronto, Canada. https://hdl.handle.net/1807/91979
Wigham, S., Rodgers, J., South, M., McConachie, H., & Freeston, M. (2015). The interplay between sensory processing abnormalities, intolerance of uncertainty, anxiety and restricted and repetitive behaviours in autism spectrum disorder. Journal of Autism and Developmental Disorders, 45, 943–952. https://doi.org/10.1007/s10803-014-2248-x
Wood, J. J., Kendall, P. C., Wood, K. S., Kerns, C. M., Seltzer, M., Small, B. J., Lewin, A. B., & Storch, E. A. (2020). Cognitive behavioral treatments for anxiety in children with autism spectrum disorder: A randomized clinical trial. JAMA Psychiatry, 77, 474–483. https://doi.org/10.1001/jamapsychiatry.2019.4160
Acknowledgements
We would like to thank Will Attwood and Lachlan Dummigan for their insights which helped shape the writing of this chapter, and Melissa Dummigan for reading and commenting on a draft version. We would especially like to thank the contributors of the case studies and quotes presented in this chapter for so freely sharing their very personal stories. D.H. and S.M.H. contributed equally to the writing of this chapter.
Funding
The writing of this chapter was supported by a Suicide Prevention Australia National Suicide Prevention Research Fellowship awarded to D.H. M.U. is supported by the Australian Research Council Discovery Early Career Researcher Award (DE180100632). D.H. also receives research funding to examine suicide prevention in autism from Untapped Holdings Pty Ltd.
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Hedley, D., Hayward, S.M., Clarke, A., Uljarević, M., Stokes, M.A. (2022). Suicide and Autism: A Lifespan Perspective. In: Stancliffe, R.J., Wiese, M.Y., McCallion, P., McCarron, M. (eds) End of Life and People with Intellectual and Developmental Disability. Palgrave Macmillan, Cham. https://doi.org/10.1007/978-3-030-98697-1_3
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