Suicidality and Youth with Autism or other Intellectual or Developmental Disabilities

Autism Spectrum Disorder (ASD) is a condition that affects an individual's neurodevelopment throughout their life. This condition influences how a person perceives and interacts with others, leading to difficulties in communication and social interaction. In addition, it involves exhibiting repetitive and limited patterns of behavior. The spectrum aspect of ASD signifies the broad range of symptoms and severity that can manifest in individuals.

When evaluating autistic individuals in crisis for suicide risk, it is important to account for their inherent autistic characteristics and behaviors. These factors have the potential to affect the accuracy of an assessment that was originally designed for neurotypical individuals. Therefore, extra considerations must be taken into account to ensure an appropriate evaluation of suicide risk in autistic individuals during times of crisis.

Autistic individuals possess individual strengths and weaknesses across the autism spectrum, and they should be acknowledged accordingly. Missing warning signs of suicide in autistic individuals may lead to tragic outcomes. On the other hand, intervening in a crisis without a full understanding of the autistic person's experience can be distressing and detrimental. Therefore, it is essential to approach such situations with great care and consideration, which is the driving force behind the development of this toolkit.

Warning Signs

  • Anxiety, agitation, unable to sleep or sleeping all the time:
    Autistic individuals often struggle with anxiety throughout their lives, and sleep issues are a common occurrence. Therefore, any significant changes in sleep or anxiety levels should be carefully examined to determine the underlying cause.

  • Feeling trapped - like there’s no way out:
    Autistic individuals frequently experience cognitive inflexibility, which limits their options when feeling stuck in negative thought patterns or adverse circumstances. During a crisis situation, autistic individuals may experience a regression of skills such as problem-solving and flexible thinking, which can impact their ability to regulate emotions and manage their sensory difficulties.

  • Increased substance (alcohol or drug) use:
    The available literature on substance use in autistic individuals is limited, and the findings from the studies conducted so far suggest that substance use in the autistic community is lower compared to the general population. However, it remains unclear whether this is due to the scarcity of research on the topic or if it is genuinely reflective of the lower prevalence of substance use in this population.

  • No reason for living; no sense of purpose in life:
    The expression of a lack of purpose in life by an autistic individual may have a different connotation due to their social isolation and may even lead to suicidal ideation. It's crucial to consider statements like "I don’t belong to this world," "I’ve never fit into this world," "I wish I were anywhere but here," and "I wish I could leave here and be in a place I belong, and it’s not on this earth." The assessor must be mindful of the context and the underlying meaning behind these expressions. Such statements may reflect the reality of an autistic individual's life who feels a lack of cultural and social belonging. Many autistic individuals struggle with feeling different and not fitting in, which can lead them to voice a desire to be elsewhere.

  • Hopelessness:
    Autistic individuals may express feeling hopeless, but this may not necessarily be an emotion. Rather, it could be an expression of their truth. It is important to investigate what the individual means by this statement to better understand their emotional state.

  • Withdrawal from friends, family, and society:

    Withdrawal from friends, family, and society may be a coping mechanism for autistic individuals, necessary for their self-care and well-being. Reframing the situation or helping them perceive what happened in a different way may help improve their mood, as these mood changes may be the beginning of a meltdown, an intense response to overwhelming situations.

  • Giving away prized possessions or seeking long-term care for pets:

    Autistic individuals may form emotional connections with their possessions or pets, making giving them away a warning sign of a potential crisis.

  • Rage, uncontrolled anger, seeking revenge:

    Autistic meltdowns can occur, even in adulthood. Meltdowns are an overloaded sympathetic nervous system and must run their course. It is essential to keep the individual safe until the meltdown subsides.

  • Acting recklessly or engaging in risky activities, seemingly without thinking:

    What may seem like reckless or risky behavior without thought may be the result of overthinking, perseverating, deep thinking, or not understanding the situation or the risks involved. It is crucial to investigate the reasons behind the behavior to determine if the individual is in a suicidal crisis.

  • Dramatic mood changes: Autistic individuals may experience dramatic mood changes due to overwhelming emotions, sensory difficulties, and/or change. The individual is likely to be able to reason with someone who is helping them, but it is important to be aware of the possibility of a meltdown and take steps to prevent it.

Autistic Individuals in Crisis Might Express:

  • Sensory difficulties- such as with sight, sound, smell, touch 

  • May present with emotions opposite of being in a crisis - like laughter 

  • Difficulty identifying or verbalizing emotions 

  • May not know how to cope with or what to do with - emotions Literal thinking and understanding 

  • Has experienced countless misunderstandings/miscommunications 

  • Shares difficulty or inability to make friends and sustain relationships 

  • Feels disconnected and isolated from society 

  • Perseveration- ruminates on thoughts, situations, or circumstances 

  • Unusual patterns of speech such as odd pitch, tone, pace, or robotic 

  • Verbal or text response time will vary according to processing speed 

  • May use echolalia - repeating words, sounds, and responses 

When Screening for Suicidality:

  • Ask clear, direct questions -use fewer words and be straight to the point

  • Allow extra time to process thoughts and formulate words

  • Help shift the thoughts - ask about any interests or passions

  • Avoid using metaphors, social nuances, allegories, or slang

  • Speak using logical words - not emotional words

  • Explain positive coping skills and how they are helpful

  • Facilitate a safety plan - help make connections to people or resources