Children with an autism spectrum disorder may be at greater risk for contemplating suicide or attempting suicide than children without autism, according to Penn State College of Medicine researchers.
"We were looking at suicidal ideation and suicide attempts among children with autism versus those that didn't have autism," said Angela Gorman, assistant professor of child psychiatry, Penn State College of Medicine. "What we found is that there were some risk factors that were much more greatly associated with suicidal ideation and suicide attempts than others."
The research is the first large-scale, broad age and IQ range study that uses data provided by parents to analyze the rates of suicide contemplation and attempts in children with autism.
Gorman, along with Professor of Psychiatry Susan Dickerson Mayes, Assistant Professor Jolene Hillwig-Garcia and Associate Professor Ehsan Syed, analyzed data provided by parents of 791 children with autism, 186 typical children and 35 non-autistic depressed children between 1 and 16 years of age. The researchers looked at achievement and cognitive ability, as well as various demographic variables. The four most significant demographic variables were Black or Hispanic, 10 years old or older, socioeconomic status and male. The results were published in the January issue of Research in Autism Spectrum Disorders.
The researchers found that the percentage of children with autism rated by their parents as sometimes to very often contemplating or attempting suicide was 28 times greater than that of typical children, though three times less than that of depressed non-autistic children. The four demographic variables were significant risk factors, as well.
"That was probably the most important piece of the study," said Gorman. "If you fell into any of those categories and were rated to be autistic by a parent, the more categories you were a part of increased your chances for experiencing suicidal ideation or attempts."
The frequency of suicidal contemplation in children with autism was twice as common in males, although gender differences were insignificant for suicide attempts. Autistic children with a parent in a professional or managerial position demonstrated a 10 percent rate of suicidal contemplation or attempts versus 16 percent for children whose parents worked in other occupations. Black and Hispanic children had a 33 percent and 24 percent rate of suicide contemplation and attempts respectively versus whites at 13 percent and Asians at zero percent. Also, suicide contemplation and attempts were three times greater in children 10 years of age or older versus younger children.
According to Gorman, the majority of children, 71 percent, who had all four demographic factors had contemplated or attempted suicide. However, suicide contemplation and attempts were absent in 94 percent of children with autism without any of the four significant demographic risk factors.
The researchers also looked at the psychological and behavioral problems that were the most predictive of children who contemplated or attempted suicide and found that depression and behavior problems were highly associated with suicide contemplation and attempts, as were children who were teased or bullied.
"Out of those kids, almost half of them had suicidal ideation of attempts," said Gorman. "That was pretty significant."
Depression was the strongest single predictor of suicide contemplation or attempts in children with autism. Seventy-seven percent of children with autism who were considered by their parents to be depressed had suicide contemplation or attempts. Contemplation and attempts were absent in all autistic children who were not impulsive, 97 percent of those who did not have mood dysregulation, 95 percent of those who were not depressed and 93 percent of those who did not have behavior problems. Therefore, children with autism who do not have mood or behavioral problems and do not fall into certain demographic categories are very unlikely to have suicide contemplation or attempts, according to the study.
The researchers were surprised to find that cognitive ability or IQ did not have much effect on whether or not children with autism experienced suicide contemplation or attempts, so both low functioning autistic children and higher functioning autistic children had similar results.
According to Gorman, the researchers would now like to replicate the study with the addition of developing a "screening tool that can help us better rule out some of these issues and partition out some of these factors."
This may include other predictors such as previous attempts, negative life events, family history of suicide, and biological and neurochemical variables. They may also replicate the study with a larger and more diverse minority representation and a broader socioeconomic status range.
In the meantime, Gorman suggests parents of autistic children pay close attention to what is normal for their child in terms of behavior and emotions versus what is abnormal, develop early communication and social skills and, depending on cognitive ability, seek early intervention programs, therapists, and psychologists that can help build upon the protective factors that the patient has, such as supportive family and community and potentially high IQ.
- Susan Dickerson Mayes, Angela A. Gorman, Jolene Hillwig-Garcia, Ehsan Syed. Suicide ideation and attempts in children with autism. Research in Autism Spectrum Disorders, 2013; 7 (1): 109 DOI: 10.1016/j.rasd.2012.07.009
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