Abstract
Individuals with autism are at heightened risk for experiencing suicidality compared to those without autism. Despite this, it is unknown what tools are used to assess suicide risk in research and clinical practice among children and youth with autism. This systematic review examined tools commonly used to measure suicidality in children and youth with and without autism spectrum disorder. Four databases were searched. We identified five tools (C-SSRS, PSS, SITBI, SIQ-JR, BSS) commonly used with youth in the general population; however, we did not identify any tools that were commonly used autistic children and youth. Results highlight the lack of available tools utilized to measure suicidality in autistic children and youth. We propose a framework to facilitate research to fill this gap.
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References
Achenbach, T. M. (1991a). Manual for the Youth Self-Report and 1991 profile. Department of Psychiatry, Burlington, VT: University of Vermont.
Achenbach, T. M. (1991b). Manual for the Child Behavior Checklist/4-18 and 1991 Profile. Department of Psychiatry, Burlington, VT: University of Vermont.
Agosti, V., Chen, Y., & Levin, F. R. (2011). Does attention deficit hyperactivity disorder increase the risk of suicide attempts? Journal of Affective Disorders, 133(3), 595–599.
American Psychological Association. (2000). Diagnostic and statistical manual of mental disorders (4th ed.). Washington, DC: Author.
American Psychological Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: American Psychiatric Publishing.
Au-Yeung, S. K., Bradley, L., Robertson, A. E., Shaw, R., Baron-Cohen, S., & Cassidy, S. (2018). Experience of mental health diagnosis and perceived misdiagnosis in autistic, possibly autistic and non-autistic adults. Autism, 23(6), 1508–1518.
Baraskewich, J., & McMorris, C. (2019). Internalizing mental health issues in individuals with neurodevelopmental disorders: Implications for practitioners. Current Developmental Disorders Reports, 6(1), 1–8.
Barzilay, S., Feldman, D., Snir, A., Apter, A., Carli, V., Hoven, C.W., C. Wasserman, Sarchiapone, M., & Wasserman, D. (2015). The interpersonal theory of suicide and adolescent suicidal behaviour. Journal of Affective Disorders, 183, 68–74.
Beck, A. T., Brown, G. K., Steer, R. A., Dahlsgaard, K. K., & Grisham, J. R. (1999). Suicide ideation at its worst point: A predictor of eventual suicide in psychiatric outpatients. Suicide and Life Threatening Behaviour, 29(1), 1–9.
Beck, A. T., Kovacs, M., & Weissman, A. (1979). Assessment of suicidal intention: The Scale for Suicide Ideation. Journal of Consulting and Clinical Psychology, 47, 343–352.
Beck, A., Steer, R., & Ranieri, W. (1988). Scale for Suicidal Ideation: Psychometric properties of a self-report version. Journal of Clinical Psychology, 44, 499–505.
Cassidy, S. A., Bradley, L., Bowen, E., Wigham, S., & Rodgers, J. (2018a). Measurement properties of tools used to assess depression in adults with and without autism spectrum conditions: A systematic review. Autism Research, 11(5), 738–754.
Cassidy, S., Bradley, L., Bowen, E., Wigham, S., & Rodgers, J. (2018b). Measurement properties of tools used to assess suicidality in autistic and general population adults: A systematic review. Clinical Psychology Review, 62, 56–70.
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. The Lancet Psychiatry, 1(2), 142–147.
Cassidy, S., & Rodgers, J. (2017). Understanding and prevention of suicide in autism. The Lancet Psychiatry, 4(6), 11.
Chen, M. H., Pan, T. L., Lan, W. H., Hsu, J. W., Huang, K. L., Su, T. P., et al. (2017). Risk of suicide attempts among adolescents and young adults with autism spectrum disorder: A nationwide longitudinal follow-up study. Journal of Clinical Psychiatry, 78(9), 1174–1179.…
Czyz, E. K., King, C. A., & Bierman, B. J. (2019). Motivational interviewing-enhanced safety planning for adolescents at high suicide risk: A pilot randomized controlled trial. Journal of Clinical Child and Adolescent Psychology, 48(2), 250–262.
Demirkaya, S. K., & Tutkunkardaz, M. D. (2016). Mukaddes NM (2016) Assessment of suicidality in children and adolescents with diagnosis of high functioning autism spectrum disorder in a Turkish clinical sample. Neuropsychiatric Disease and Treatment, 12, 2921–2926.
Dickerson Mayes, S. D., Gorman, A. A., Hillwig-Garcia, J., & Syed, E. (2013). Suicide ideation and attempts in children with autism. Research in Autism Spectrum Disorders, 7(1), 109–119.
Durbin, A., Balogh, R., Lin, E., Wilton, A., & Lunsky, Y. (2018). Emergency department use: Common presenting issues and continuity of care for individuals with and without intellectual and developmental disabilities. Journal on Autism and Other Developmental Disabilities, 48(10), 3542–3550.
Eskin, M. (1995). Suicidal behavior as related to social support and assertive-ness among Swedish and Turkish high school students: A cross-cultural investigation. Journal of Clinical Psychology, 51(2), 158–172.
Francesca-Pedrero, E., Inchausti, F., Perez-Albeniz, A., & Ortuno-Sierra, J. (2018). Validation of the Prodromal Questionnaire-Brief in a representative sample of adolescents: Internal structure, norms, reliability, and links with psychopathology. International Journal of Methods in Psychiatry Research, 27(4), e1740.
Fremouw, W. L., Strunk, J. M., Tyner, E. A., & Musick, H. (2009). Adolescent Suicide Assessment Protocol. West Virginia Suicide Council.
Giddens, J. M., Sheehan, K. H., & Sheehan, D. V. (2014). The Columbia-Suicide Severity Rating Scale: Has the “gold standard” become a liability? Innovations in Clinical Neuroscience, 11(9–10), 66–80.
Glenn, C. R., Lanzillo, E. C., Esposito, E. C., Santee, A. C., Nock, M. K., & Auerbach, R. P. (2016). Examining the course of suicidal and nonsuicidal self-injurious thoughts and behaviours in outpatient and inpatient adolescents. Journal of Abnormal Child Psychology, 45, 971–983.
Glenn, C. R., Millner, A. J., Esposito, E. C., Porter, A. C., & Nock, M. K. (2019). Implicit identification with death predicts suicidal thoughts and behaviour in adolescents. Journal of Clinical Child and Adolescent Psychology, 48(2), 263–272.
Haas, A. P., Eliason, M., Mays, V. M., Mathy, R. M., Cochran, S. D., A’Augelli, A. R., ..., Clayton, P. J. (2011). Suicide and suicide risk in lesbian, gay, bisexual, and transgender populations: Review and recommendations. Journal of Homosexuality, 58(1), 10–51.
Hannon, G., & Taylor, E. P. (2013). Suicidal behaviour in adolescents and young adults with ASD: Findings from a systematic review. Clinical Psychology Review, 33(8), 1197–1204. https://doi.org/10.1016/j.cpr.2013.10.003.
Hirvikoski, T., Mittendorfer-Rutz, E., Boman, M., Larsson, H., Lichtenstein, P., & Bolte, S. (2016). Premature mortality in autism spectrum disorder. British Journal of Psychiatry, 208(3), 232–238.
Horowitz, L. M., Thurm, A., Farmer, C., Mazefsky, C., Lanzillo, E., Bridge, J. A., ..., Siegel, M. (2017). Talking about death or suicide: Prevalence and clinical correlates in youth with autism spectrum disorder in the psychiatric inpatient setting. Journal of Autism and Developmental Disorders, 48(11), 3702–3710.
Horvath, L. O., Balini, M., Ferenczi-Dallos, G., Farkas, L., Gadoros, J., Gyori, D., ..., Balazs, J. (2018). Direct self-injurious behaviour (D-SIB) and life events among vocational school and high school students. International Journal of Environmental Research and Public Health, 15, 1068–1081.
Kahn, J., Tubiana, A., Chen, R. F., Carli, V., Wasserman, C., Hoven, C., ..., Wasserman, D. (2015). Important variables when screening for students at suicidal risk: Findings from the French cohort of the SEYLE Study. International Journal of Environmental Research and Public Health, 12, 12277–12290.
Kato, K., Mikami, K., Akama, F., Yamada, Y., Maehara, M., Kimoto, K., ..., Matsumoto, H. (2013). Clinical features of suicide attempts in adults with autism spectrum disorders. General Hospital Psychiatry, 35, 50–53.
Kaufman, J., Birmaher, B., Brent, D., Rao, U., Flynn, C., Moreci, P., et al. (1997). Schedule for affective disorders and schizophrenia for school-age children-resent and lifetime version (K-SADS-PL): Initial reliability and validity data. Journal of the American Academy of Child and Adolescent Psychiatry, 36(7), 980–988.…
Keane, E. M., Dick, R. W., Bechtold, D. W., & Manson, S. M. (1996). Predictive and concurrent validity of the Suicidal Ideation Questionnaire among American Indian adolescents. Journal of Abnormal Child Psychology, 24, 735–747.
Keith, J. M., Jamieson, J. P., & Bennetto, L. (2019). The importance of adolescent self-report in autism spectrum disorder: Integration of questionnaire and autonomic measures. Journal of Abnormal Child Psychology, 47(4), 741–754.
Kennard, B. D., Goldstein, T., Foxwell, A. A., McMakin, D. L., Wolfe, K., Biernesser, C., ..., Brent, D. (2018). As Safe as possible (ASAP): A brief app-supported inpatient intervention to prevent postdischarge suicidal behaviour in hospitalized, suicidal adolescents. American Journal of Psychiatry, 179(9), 864–872.
Kovacs, M. (2010). Children’s Depression inventory 2nd Edition (CDI-2). North Tonowanda, NY: Multi-Health Systems, Inc.
Krysinska, K., & Lester, D. (2010). Post-traumatic stress disorder and suicide risk: A systematic review. Archives of Suicide Research, 14(1), 1–23.
Large, M., Sharma, S., Cannon, E., Ryan, C., & Nielssen, O. (2011). Risk factors for suicide within a year of discharge from psychiatric hospital: A systematic meta-analysis. Australian and New Zealand Journal of Psychiatry, 45(8), 619–628.
Lever, A. G., & Geurts, H. M. (2016). Psychiatric co-occurring symptoms and disorders in young, middle-aged, and older adults with autism spectrum disorder. Journal of Autism and Developmental Disorders, 46(6), 1916–1930.
Leyfer, O. T., Folstein, S. E., Bacalman, S., Davis, N. O., Dinh, E., Morgan, J., ..., Lainhart, J. E. (2006). Comorbid psychiatric disorders in children with autism: Interview development and rates of disorders. Journal of Autism and Developmental Disorders, 36, 849–861.
Linehan, M. M., Comtois, K. A., Brown, M. Z., Heard, H. L., & Wagner, A. (2006). Suicide Attempt Self-Injury Interview (SASII): Development, reliability, and validity of a scale to assess suicide attempts and intentional self-injury. Psychological Assessment, 18(3), 303–312.
Malagama, A. S., Tennakoon, S., & Abeyasinghe, D. R. R. (2018). Validation of Adolescent Suicide Assessment Protocol (ASAP-20) to Sri-Lankan adolescents. Asian Journal of Psychiatry, 33(2018), 11–17.
Matson, J. L., & Wilkins, J. (2008). Reliability of the autism spectrum disorders-comorbid for children (ASD-CC). Journal of Developmental and Physical Disabilities, 20(4), 327–336.
Mazefsky, C. A., Kao, J., & Oswald, D. P. (2011). Preliminary evidence suggesting caution in the use of psychiatric self-report measures with adolescents with high-functioning autism spectrum disorders. Research in Autism Spectrum Disorders, 5(1), 164–174.
McCauley, E., Berk, M. S., Asarnow, J. R., Adrian, M., Cohen, J., Korslund, K., ..., Linehan, M. M. (2018). Efficacy of dialectical behaviour therapy for adolescents at high risk for suicide: A randomized clinical trial. JAMA Psychiatry, 75(8), 776–785.
Miranda, R., Ortin, A., Scott, M., & Shaffer, D. (2014). Characteristics of suicidal ideation that predict the transition to future suicide attempts in adolescents. J Child Psychology and Psychiatry, 55, 1288–1296.
Muehlenkamp, J. J., & Gutierrez, P. M. (2004). An investigation of differences between self-injurious behaviour and suicide attempts in a sample of adolescents. Suicide and Life-Threatening Behaviour, 34(1), 12–23.
Nock, M. K., Holmberg, E. B., Photos, V. I., & Michel, B. D. (2007). Self-Injurious Thoughts and Behaviors Interview: Development, reliability, and validity in an adolescent sample. Psychological Assessment, 19(3), 309–317.
Orbach, L., Milstein, L., Har-Even, D., Apter, A., Tyano, S., & Elizur, A. (1991). A multi-attitude suicide tendency scale for adolescents. Psychological Assessment, 3, 398–404.
Ordaz, S. J., Goyer, M. S., Ho, T. C., Singh, M. K., & Gotlib, I. H. (2018). Network basis of suicidal ideation in depressed adolescents. Journal of Affective Disorders, 226, 92–99.
Paykel, E. S., Myers, J. K., Lindenthal, J. J., & Tanner, J. (1974). Suicidal findings in the general population: A prevalence study. The British Journal of Psychiatry, 124(582), 460–469.
Penn, J. V., Esposito, C. L., Schaeffer, L. E., Pritz, G. K., & Spirito, A. (2003). Suicide attempts and self-mutilative behaviour in a juvenile correctional facility. Journal of the American Academy of Child and Adolescent Child Psychiatry, 42(7), 762–769.
Pfeffer, C. R. (1986). The suicidal child. New York: Guilford.
Pinto, A., McCoy, K. J. M., & Whisman, M. A. (1997). Suicidal ideation in adolescents: Psychometric properties of the Suicidal Ideation Questionnaire in a Clinical Sample. Psychological Assessment, 9, 63–66.
Posner, K., Brown, G. K., Stanley, B., Brent, D. A., Yershova, K. V., Oquendo, M. A., ..., Mann, J. J. (2011). The Columbia-Suicide Severity Rating Scale: Validity and internal consistency findings from three multisite studies with adolescents and adults. American Journal of Psychiatry, 168, 1266–1277.
Prinstein, M. J., & Nock, M. K. (2003). Parents under-report children’s suicide ideation and attempts. Evidence Based Mental Health, 6(1), 12.
Reaven, J., & Wainer, A. L. (2015). Children and adolescents with ASD and co-occurring psychiatric conditions: Current trends in intervention. In R. M. Hodapp & D. J. Fidler (Eds.), International review of research in developmental disabilities (pp. 45–90). New York: Academic.
Reynolds, W. M. (1988). SIQ. Psychological Assessment Resources, Odessa, FL: Suicidal Ideation Questionnaire.
Reynolds, W. M., & Mazza, J. J. (1999). Assessment of suicidal ideation in inner-city children and young adolescents: Reliability and validity of the Suicidal Ideation Questionnaire-JR. School Psychology Review, 28(1), 17–30.
Rodgers, J., Wigham, S., McConachie, H., Freeston, M., Honey, E., & Parr, J. R. (2016). Development of the anxiety scale for children with autism spectrum disorder (ASC–ASD). Autism Research, 9(11), 1205–1215.
Roos, L., Sareen, J., & Bolton, J. M. (2013). Suicide risk assessment tools, predictive validity findings and utility today: Time for a revamp? Neuropsychiatry, 3(5), 483–495.
Rudd, M. D., Dahm, P. F., & Rajab, M. H. (1993). Diagnostic comorbidity in persons with suicidal ideation and behaviour. American Journal of Psychiatry, 150, 928–934.
Schauder, K. B., Mash, L. E., Bryant, L. K., & Cascio, C. J. (2015). Interoceptive ability and body awareness in autism spectrum disorder. Journal of Experimental Child Psychology, 131, 193–200. https://doi.org/10.1016/j.jecp.2014.11.002.
Segers, M., & Rawana, J. (2014). What do we know about suicidality in autism spectrum disorders? A systematic review. Autism Research, 7(4), 507–521.
Sharpley, C. F., Bitsika, V., Andronicos, N. M., & Agnew, L. L. (2016). Further evidence of HPA-axis dysregulation and its correlation with depression in autism spectrum disorder: Data from girls. Physiology and Behaviour, 16, 110–117.
Sheehan, D. V., Sheehan, K. H., Shytle, R. D., Janavs, J., Bannon, Y., Rogers, J. E., ..., Wilkinson, B. (2010). Reliability and validity of the Mini International Neuropsychiatric Interview for Children and Adolescents (MINI-KID). Journal of Clinical Psychiatry, 71, 313–326.
Shtayermman, O. (2008). Suicidal ideation and comorbid disorders in adolescents and young adults diagnosed with Asperger’s syndrome: A population at risk. Journal of Human Behaviour in the Social Environment, 18(3), 301–328.
Srinath, S., Jacob, P., Sharma, E., & Gautam, A. (2019). Clinical practice guidelines for assessment of children and adolescents. Indian Journal of Psychiatry, 61(Suppl 2), 158–175. https://doi.org/10.4103/psychiatry.IndianJPsychiatry_580_18.
Steer, R. A., Kumar, F., & Beck, A. T. (1993). Self-reported suicidal ideation in adolescent psychiatric inpatients. Journal of Consulting and Clinical Psychology, 61, 1096–1099.
Stewart, J. G., Esposito, E. C., Glenn, C. R., Gilman, S. E., Pidgeon, B., Gold, J., et al. (2017). Adolescent self-injurers: Comparing non-ideators, suicide ideators, and suicide attempters. Journal of Psychiatric Research, 84, 105–112.
Teplin, L. A., Stokes, M. L., McCoy, K. P., Abram, K. M., & Byck, G. R. (2017). Suicidal ideation and behaviour in youth in the juvenile justice system: A review of the literature. Journal of Correctional Health Care, 21(3), 222–242.
US Food and Drug Administration. (2012). Guidance for industry: Suicidality: Prospective assessment of occurrence in clinical trials, draft guidance. Rockville, MD: US Department of Health and Human Services.
Vergara, G. A., Stewart, J. G., Cosby, E. A., Lincoln, S. H., & Auerbach, R. P. (2019). Non-suicidal self-injury and suicide in depressed adolescents: Impact of peer victimization and bullying. Journal of Affective Disorders, 245, 744–749.
White, S. E., McMorris, C. A., Weiss, J., & Lunsky, Y. (2012). The experience of crisis in families of individuals with autism spectrum disorder across the lifespan. Journal of Child and Family Studies, 21, 457–465.
Wigham, S., & McConachie, H. (2014). Systematic review of the properties of tools used to measure outcomes in anxiety intervention studies for children with autism spectrum disorders. PLoS ONE, 9(1), e85268.
World Health Organization. (2018). International statistical classification of diseases and related health problems (11th Revision). https://icd.who.int/browse11/l-m/en.
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Special thanks to Panth Shah and Hangsel Sanguino for their help in preparation of this manuscript.
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All authors contributed to the study conception and design. The literature search and data extraction was completed by SJH and KH. The first draft of the manuscript was written by SJH, KH CAM, and JB. SC edited and commented on the manuscript. All authors read and approved the final manuscript.
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Howe, S.J., Hewitt, K., Baraskewich, J. et al. Suicidality Among Children and Youth With and Without Autism Spectrum Disorder: A Systematic Review of Existing Risk Assessment Tools. J Autism Dev Disord 50, 3462–3476 (2020). https://doi.org/10.1007/s10803-020-04394-7
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DOI: https://doi.org/10.1007/s10803-020-04394-7