Autism and Suicide: Strategies to Dovetail Emerging Evidence in Child and Adolescent Suicide Risk Assessments

Abstract Background: This narrative review provides readers with a greater awareness of the increasing prevalence of diagnosed autism spectrum disorder (ASD) in psychiatric clinical settings and the high risk that ASD and autistic traits in the population place the affected individuals at heightened risk for suicidality and suicide. Methods: It represents a comprehensive, systematic literature review. supplemented with reverse citations to assure updated information. By title and abstract 456 articles were identified 456 and 71 articles met the inclusion criteria. Out of those, 50 articles were used for initial review and 15 were added later, manually or through reverse citations. Results: Results indicate that associated suicidal thoughts and behaviors (STB) with ASD, many concomitants comorbid mental health conditions ASD, and suicide risk factors that overlap with ASD symptoms are not clearly understood. Higher rates of STB and suicide have been identified across the age spectrum with ASD/high autistic traits compared to those from the general population in age/sex-matched comparison groups. Increased risk of STB in higher functioning ASD is emphasized. Interpersonal conflict and depression are significant risk factors as are comorbid borderline personality, bipolar disorder, anxiety, and obsessive-compulsive disorders. Conclusions: Multiple diagnostic challenges are considered that support the need for more focused research in this area, better, more ASD-related screening instruments that address the unique features of ASD-related psychopathology, and improved training for clinicians in screening and preventive efforts for enhanced competence and greater comfort in dealing with STB in those with autistic traits and ASD.