When children receive a diagnosis of Autism Spectrum Disorder (ASD) or Intellectual Disability (ID) they are often prescribed a plethora of services that aim to target communication skills, adaptive functioning, and daily living skills. Although it is common practice to target problem behaviors and teach emotional regulation, comorbid conditions such as anxiety and depression are often overlooked. Some people even believe that those who are diagnosed with ASD or ID are incapable of perceiving anxious or depressive thoughts that could lead to self-harm.
The Need To Pay Attention
A study by Mayes et al., (2012) found that suicidal ideation for children with an ASD diagnosis age 1 to 16 years were 28% higher than of children without a diagnosis. Suicidal ideation was identified to be significantly higher for black or Hispanic males with a lower socio-economic status. A compilation of multiple studies found that people on the autism spectrum have a 1 to 35% prevalence rate for suicidal attempts, and 11 to 66% for suicidal ideation (Hedley & Uljarević, 2018). We also know that individuals diagnosed with ID experience higher exposure to depression and other risk factors for suicide when compared to the general population (Wark et al., 2018). Knowing these risk factors should compel us to look beyond adaptive functioning and pay attention to anxiety, depression, and other private event behaviors in these children.
The Biodyne Model’s Three Stage Process of Suicide (Cummings & Cummings, 2012)
Ideation – During this stage, the person is thinking about suicide however, the fear of suicide is still greater than the motivation to enact it. They may be expressing thoughts of death through their writings, artistic expressions, and activities of choice.
Planning – During this stage, the person is beginning to formulate a plan for suicide. There are noticeable sings such as worsening depression, or behavioral changes such as withdrawal from physically touching others. They may stop expressing pain to others even if they are observed to be in pain.
Auto-pilot – During this stage, the person has made the decision to enact on their plans. This decision becomes repressed and therefore put on “auto-pilot”. This stage could be difficult to identify as the person may act “normal” in a way that has not been observed in a while. They appear to have their depression suddenly disappear because they are no longer grappling with the decision to die. This stage can be easily missed as others will be relieved that the person suddenly “got better”. It is extremely critical to disrupt people who are on auto-pilot as they typically attempt suicide within 48 hours.
How Does This Apply To Individuals Diagnosed With ASD and ID?
Children diagnosed with ASD or ID often experience impairments in expressive communication thus, making it difficult to identify the stages of suicide. If they do not use vocal communication, they often communicate in their own unique ways such as, sign language, picture communication systems, augmentative and alternative devices, or perhaps they are not able to functionally communicate yet. Doing our part in paying attention means we are listening to their unique voices. This includes observing non-vocal cues and looking at changes in their behaviors like changes in sleep pattern, appetite, interactions with others, facial expressions, and energy levels. We should also ensure that they are learning important self-regulation skills including, identifying emotions, expressing emotions, mindfulness, and coping skills. Teaching them Healthy Relationships at a young age is also crucial in their ability to identify personal boundaries, promote safe interactions, and ultimately prevent interactions that could lead to adverse experiences that may increase risk factors for suicidal ideation.
Call To Action
As I mentioned above, children with ASD and ID often receive multiple services. All providers along with family members should work as the child’s trusted team. We need to stay informed and advocate for improved screening tools that can accommodate the ASD and ID population. We cannot continue to overlook suicide risk in this vulnerable population.
If you’re thinking about suicide, are worried about a friend or loved one, or would like emotional support, the Lifeline network is available 24/7 across the United States.
Cummings, N. A. & Cummings, J. L. (2012). Refocused psychotherapy as the first line intervention in behavioral health. New York, NY: Routledge.
Hedley, D., & Uljarević, M. (2018). Systematic Review of Suicide in Autism Spectrum Disorder: Current Trends and Implications. Current Developmental Disorders Reports, 5(1), 65–76. https://doi.org/10.1007/s40474-018-0133-6
Mayes, S. D., Gorman, A. A., Hillwig-Garcia, J., & Syed, E. (2012, August 25). Suicide ideation and attempts in children with autism. Research in Autism Spectrum Disorders. https://www.sciencedirect.com/science/article/abs/pii/S1750946712000931.
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 : JIDR, 62(1), 1–9. https://doi.org/10.1111/jir.12442