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Predictors of Suicidal Thoughts in Children with Autism Spectrum Disorder and Anxiety or Obsessive-Compulsive Disorder: The Unique Contribution of Externalizing Behaviors

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Abstract

Children with autism spectrum disorder (ASD) are at elevated risk of suicidal ideation, particularly those with comorbid anxiety disorders and/or obsessive-compulsive disorder (OCD). We investigated the risk factors associated with suicidal ideation in 166 children with ASD and comorbid anxiety disorders/OCD, and the unique contribution of externalizing behaviors. Suicidal ideation was reported in the child sample by 13% of parents. Controlling for child age, sex, and IQ, perceived loneliness positively predicted the likelihood of suicidal ideation. In addition, externalizing behaviors positively predicted suicidal ideation, controlling for all other factors. Reliance on parental report to detect suicidal ideation in youth with ASD is a limitation of this study. Nonetheless, these findings highlight the importance of assessing and addressing suicidal ideation in children with ASD and comorbid anxiety disorders/OCD, and more importantly in those with elevated externalizing behaviors and perceptions of loneliness.

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Acknowledgements

We acknowledge the contributions to the overall study of the following people: Adam Lewin, Ph.D., Jane Mutch, Ph.D., Tanya Murphy, M.D., Carly Johnco, Ph.D., Robert Selles, Ph.D., Monica Wu, Ph.D. Given their roles, Dr. Storch (Editor) and Dr. Saxena (Associate editor) had no involvement in the peer-review of this article and has no access to information regarding its peer-review.

Funding

Data included in this paper were supported in part by grants to the fourth, fifth, and last authors (R01HD080098-01A1, R01HD080097-01A1, and R01HD080096-01A1) from the National Institutes of Health (NIH). The opinions expressed in this manuscript are those of the authors and do not reflect those of NIH.

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Authors and Affiliations

  1. Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, 1977 Butler Blvd, Suite 4-400, Houston, TX, USA

    Valérie La Buissonnière Ariza, Sophie C. Schneider, Sandra L. Cepeda, Kirti Saxena & Eric A. Storch

  2. Department of Education, UCLA, 405 Hilgard Avenue, Los Angeles, CA, 90095-1521, USA

    Jeffrey J. Wood

  3. Department of Psychiatry, UCLA, 405 Hilgard Avenue, Los Angeles, CA, 90095-1521, USA

    Jeffrey J. Wood & Karen S. Wood

  4. Department of Psychology, Temple University, 1701 N 13th St, Philadelphia, PA, 19122, USA

    Philip C. Kendall

  5. School of Aging Studies, College of Behavioral and Community Sciences, University of South Florida, 4202 E Fowler Ave, Tampa, FL, 3362, USA

    Brent J. Small

  6. Department of Psychology, University of British Columbia, 2136 West Mall, Vancouver, BC, V6T 1Z4, Canada

    Connor Kerns

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  1. Valérie La Buissonnière Ariza
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  10. Eric A. Storch
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Correspondence to Valérie La Buissonnière Ariza or Eric A. Storch.

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Conflict of interest

Dr. La Buissonnière-Ariza has received a postdoctoral research scholarship from the Canadian Institutes of Health Research. Dr. Storch has received royalties from Elsevier Publications, Springer Publications, American Psychological Association, Oxford, Kingsley, Wiley, Inc, and Lawrence Erlbaum. He has received research funding from National Institutes of Health, Texas Higher Education Coordinating Board, Red Cross, Rebuild TX, Misophonia Research Fund, and Greater Houston Community Foundation. Dr. Kendall has received royalties from Elsevier Publications, Guilford Publications, Workbook Publishing, and from translation of his treatment materials. He has received research funding from National Institute of Health and the Macarthur Foundation. Dr. Kerns has received research funding support from NICHD (HD K23087472) and Autism Science Foundation, which support the use of the ADIS/ASA in the trial. She receives royalties for an edited book on anxiety and autism published by Academic Press. In addition, she has received honoraria and consulting fees for training other researchers on the Autism Spectrum Addendum. Dr. Schneider has received research funding from the Texas Higher Education Coordinating Board, Red Cross, and Misophonia Research Fund.

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All procedures performed in the study were in accordance with the ethical standards as laid down in the 1964 Declaration of Helsinki and its later amendments or comparable standards.

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Informed consent was obtained from all individual participants included in the study.

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This study was approved by the Los Angeles general institutional review board, University of California, University of South Florida institutional review board, and Temple University’s Human Research Protection Program.

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La Buissonnière Ariza, V., Schneider, S.C., Cepeda, S.L. et al. Predictors of Suicidal Thoughts in Children with Autism Spectrum Disorder and Anxiety or Obsessive-Compulsive Disorder: The Unique Contribution of Externalizing Behaviors. Child Psychiatry Hum Dev 53, 223–236 (2022). https://doi.org/10.1007/s10578-020-01114-1

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