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The Phenomenology and Clinical Correlates of Suicidal Thoughts and Behaviors in Youth with Autism Spectrum Disorders

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Abstract

This study investigated the phenomenology and clinical correlates of suicidal thoughts and behaviors in youth with ASD (N = 102; range 7–16 years). The presence of suicidal thoughts and behavior was assessed through the Anxiety Disorders Interview Schedule-Child and Parent Versions. Children and parents completed measures of anxiety severity, functional impairment, and behavioral and emotional problems. Approximately 11 % of youth displayed suicidal thoughts and behaviors. Children with autism were more likely to have suicidal thoughts and behaviors whereas children with Asperger’s disorder were less likely. Suicidal thoughts and behaviors were associated with the presence of depression and post-traumatic stress disorder. Overall, results suggest that suicidal thoughts and behaviors are common in youth with ASD, and may be related to depression and trauma.

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References

  • Achenbach, T. M. (2001). Manual for the ASEBA school-age forms and profiles. Burlington: University of Vermont.

    Google Scholar 

  • Achenbach, T. M., Dumenci, L., & Rescorla, L. A. (2003). DSM-oriented and empirically based approaches to constructing scales from the same item pools. Journal of Clinical Child and Adolescent Psychology, 32, 328–340.

    Article  PubMed  Google Scholar 

  • APA. (2000). Diagnostic and statistical manual of mental disorders (DSM-IV-TR). Washington, DC: American Psychiatric Association.

    Google Scholar 

  • Bauminger, N., & Kasari, C. (2000). Loneliness and friendship in high-functioning children with autism. Child Development, 71, 447–456.

    Article  PubMed  Google Scholar 

  • Ben-Sasson, A., Cermak, S. A., Orsmond, G. I., Tager-Flusberg, H., Kadlec, M. B., & Carter, A. S. (2008). Sensory clusters of toddlers with autism spectrum disorders: Differences in affective symptoms. Journal of Child Psychology and Psychiatry, 49, 817–825.

    Article  PubMed  Google Scholar 

  • Ben-Sasson, A., Hen, L., Fluss, R., Cermak, S. A., Engel-Yeger, B., & Gal, E. (2009). A meta-analysis of sensory modulation symptoms in individuals with autism spectrum disorders. Journal of Autism and Developmental Disorders, 39(1), 1–11.

    Article  PubMed  Google Scholar 

  • Bird, H., Andrews, H., Schwab-Stone, M., Goodman, S., Dulcan, M., Richters, J., et al. (1996). Global measures of impairment for epidemiologic and clinical use with children and adolescents. International Journal of Methods in Psychiatric Research, 6, 295–307.

    Article  Google Scholar 

  • Bradley, E. A., & Isaacs, B. J. (2006). Inattention, hyperactivity, and impulsivity in teenagers with intellectual disabilities, with and without autism. Canadian Journal of Psychiatry, 51(9), 598–606.

    Google Scholar 

  • Brereton, A. V., Tonge, B. J., & Einfeld, S. L. (2006). Psychopathology in children and adolescents with autism compared to young people with intellectual disability. Journal of Autism and Developmental Disorders, 36(7), 863–870.

    Article  PubMed  Google Scholar 

  • Bridge, J. A., Goldstein, T. R., & Brent, D. A. (2006). Adolescent suicide and suicidal behavior. Journal of Child Psychology and Psychiatry, 47(3–4), 372–394.

    Article  PubMed  Google Scholar 

  • Brown, G. K., Beck, A. T., Steer, R. A., & Grisham, J. R. (2000). Risk factors for suicide in psychiatric outpatients: A 20-year prospective study. Journal of Consulting and Clinical Psychology, 68(3), 371–377.

    Article  PubMed  Google Scholar 

  • Bryan, C. J., & Rudd, M. D. (2006). Advances in the assessment of suicide risk. Journal of Clinical Psychology, 62, 185–200.

    Article  PubMed  Google Scholar 

  • Cappadocia, M. C., Weiss, J. A., & Pepler, D. (2012). Bullying experiences among children and youth with autism spectrum disorders. Journal of Autism and Developmental Disorders, 42, 266–277.

    Article  PubMed  Google Scholar 

  • Carter, R., Silverman, W. K., Allen, A., & Ham, L. (2008). Measures matter: The relative contribution of anxiety and depression to suicidal ideation in clinically referred anxious youth using brief versus full length questionnaires. Depression and Anxiety, 25(8), E27–E35.

    Article  PubMed  Google Scholar 

  • CDC. (2010). Youth risk behavior surveillance-United States. Atlanta: Centers for Disease Control.

    Google Scholar 

  • CDC. (2012). Prevalence of autism spectrum disorders—autism and developmental disabilities monitoring network, 14 Sites, United States, 2008. MMWR Surveill Summ, 61, 1–19.

    Google Scholar 

  • Cottenceau, H., Roux, S., Blanc, R., Lenoir, P., Bonnet-Brilhault, F., & Barthelemy, C. (2012). Quality of life of adolescents with autism spectrum disorders: Comparison to adolescents with diabetes. European Child and Adolescent Psychiatry, 21, 289–296.

    Article  PubMed  Google Scholar 

  • de Bruin, E. I., Ferdinand, R. F., Meester, S., de Nijs, P. F., & Verheij, F. (2007). High rates of psychiatric co-morbidity in PDD-NOS. Journal of Autism and Developmental Disorders, 37, 877–886.

    Article  PubMed  Google Scholar 

  • Eisenmajer, R., Prior, M., Leekam, S., Wing, L., Gould, J., Welham, M., et al. (1996). Comparison of clinical symptoms in autism and Asperger’s disorder. Journal of the American Academy of Child and Adolescent Psychiatry, 35(11), 1523–1531.

    Article  PubMed  Google Scholar 

  • Engel, N. A., Rodrigue, J. R., & Geffken, G. R. (1994). Parent-child agreement on ratings of anxiety in children. Psychological Reports, 75(3 Pt 1), 1251–1260.

    Article  PubMed  Google Scholar 

  • Fenton, W. S. (2000). Depression, suicide, and suicide prevention in schizophrenia. Suicide and Life-Threatening Behavior, 30(1), 34–49.

    PubMed  Google Scholar 

  • Foley Nicpon, M., Doobay, A. F., & Assouline, S. G. (2010). Parent, teacher, and self perceptions of psychosocial functioning in intellectually gifted children and adolescents with autism spectrum disorder. Journal of Autism and Developmental Disorders, 40(8), 1028–1038.

    Article  PubMed  Google Scholar 

  • Gadow, K. D., Devincent, C. J., & Drabick, D. A. (2008). Oppositional defiant disorder as a clinical phenotype in children with autism spectrum disorder. Journal of Autism and Developmental Disorders, 38(7), 1302–1310.

    Article  PubMed  Google Scholar 

  • Gillott, A., Furniss, F., & Walter, A. (2001). Anxiety in high-functioning children with autism. Autism, 5(3), 277–286.

    Article  PubMed  Google Scholar 

  • Hallfors, D. D., Waller, M. W., Ford, C. A., Halpern, C. T., Brodish, P. H., & Iritani, B. (2004). Adolescent depression and suicide risk: Association with sex and drug behavior. American Journal of Preventative Medicine, 27(3), 224–231.

    Google Scholar 

  • Hardan, A., & Sahl, R. (1999). Suicidal behavior in children and adolescents with developmental disorders. Research in Developmental Disabilities, 20, 287–296.

    Article  PubMed  Google Scholar 

  • Hill, R. M., Castellanos, D., & Pettit, J. W. (2011). Suicide-related behaviors and anxiety in children and adolescents: A review. Clinical Psychology Review, 31, 1133–1144.

    Article  PubMed  Google Scholar 

  • Jackson, P., Skirrow, P., & Hare, D. J. (2012). Asperger through the looking glass: An exploratory study of self-understanding in people with Asperger’s syndrome. Journal of Autism and Developmental Disorders, 42, 697–706.

    Article  PubMed  Google Scholar 

  • Javdani, S., Sadeh, N., & Verona, E. (2011). Suicidality as a function of impulsivity, callous-unemotional traits, and depressive symptoms in youth. Journal of Abnormal Psychology, 120, 400–413.

    Article  PubMed  Google Scholar 

  • Johnson, S. A., Filliter, J. H., & Murphy, R. R. (2009). Discrepancies between self- and parent-perceptions of autistic traits and empathy in high functioning children and adolescents on the autism spectrum. Journal of Autism and Developmental Disorders, 39(12), 1706–1714.

    Article  PubMed  Google Scholar 

  • Kingery, J. N., Ginsburg, G. S., & Burstein, M. (2009). Factor structure and psychometric properties of the multidimensional anxiety scale for children in an African American adolescent sample. Child Psychiatry and Human Development, 40(2), 287–300.

    Article  PubMed  Google Scholar 

  • Lecavalier, L., Gadow, K. D., DeVincent, C. J., Houts, C., & Edwards, M. C. (2009). Deconstructing the PDD clinical phenotype: Internal validity of the DSM-IV. Journal of Child Psychology and Psychiatry, 50(10), 1246–1254.

    Article  PubMed  Google Scholar 

  • Lee, M. T., Wong, B. P., Chow, B. W., & McBride-Chang, C. (2006). Predictors of suicide ideation and depression in Hong Kong adolescents: Perceptions of academic and family climates. Suicide and Life-Threatening Behavior, 36(1), 82–96.

    Article  PubMed  Google Scholar 

  • Lewin, A. B., Bergman, R. L., Peris, T. S., Chang, S., McCracken, J. T., & Piacentini, J. (2010). Correlates of insight among youth with obsessive-compulsive disorder. Journal of Child Psychology and Psychiatry, 51(5), 603–611.

    Article  PubMed  Google Scholar 

  • Leyfer, O. T., Folstein, S. E., Bacalman, S., Davis, N. O., Dinh, E., Morgan, J., et al. (2006). Comorbid psychiatric disorders in children with autism: Interview development and rates of disorders. Journal of Autism and Developmental Disorders, 36, 849–861.

    Article  PubMed  Google Scholar 

  • Lord, C., Rutter, M., DiLavore, P. C., & Risi, S. (1999). Autism diagnostic observation schedule. Los Angeles: Western Psychological Services.

    Google Scholar 

  • Magnuson, K. M., & Constantino, J. N. (2011). Characterization of depression in children with autism spectrum disorders. Journal of Developmental and Behavioral Pediatrics, 32, 332–340.

    Google Scholar 

  • March, J. (1998). Manual for the multidimensional anxiety scale for children. Toronto: Multi-Health Systems Inc.

    Google Scholar 

  • March, J., Silva, S., Petrycki, S., Curry, J., Wells, K., Fairbank, J., et al. (2004). Fluoxetine, cognitive-behavioral therapy, and their combination for adolescents with depression: Treatment for adolescents with depression study (TADS) randomized controlled trial. JAMA, 292(7), 807–820.

    Article  PubMed  Google Scholar 

  • Marshall, R. D., Olfson, M., Hellman, F., Blanco, C., Guardino, M., & Struening, E. L. (2001). Comorbidity, impairment, and suicidality in subthreshold PTSD. American Journal of Psychiatry, 158(9), 1467–1473.

    Article  PubMed  Google Scholar 

  • Mattila, M. L., Hurtig, T., Haapsamo, H., Jussila, K., Kuusikko-Gauffin, S., Kielinen, M., et al. (2010). Comorbid psychiatric disorders associated with Asperger syndrome/high-functioning autism: A community- and clinic-based study. Journal of Autism and Developmental Disorders, 40, 1080–1093.

    Article  PubMed  Google Scholar 

  • Mazza, J. J. (2000). The relationship between posttraumatic stress symptomatology and suicidal behavior in school-based adolescents. Suicide and Life-Threatening Behavior, 30(2), 91–103.

    PubMed  Google Scholar 

  • Mikami, K., Inomata, S., Hayakawa, N., Ohnishi, Y., Enseki, Y., Ohya A., et al. (2009). Frequency and clinical features of pervasive developmental disorder in adolescent suicide attempts. General Hospital Psychiatry, 31,163–166.

    Article  PubMed  Google Scholar 

  • Mosconi, M. W., Kay, M., D’Cruz, A. M., Seidenfeld, A., Guter, S., Stanford, L. D., et al. (2009). Impaired inhibitory control is associated with higher-order repetitive behaviors in autism spectrum disorders. Psychological Medicine, 39(9), 1559–1566.

    Article  PubMed  Google Scholar 

  • Muris, P., Steerneman, P., Merckelbach, H., Holdrinet, I., & Meesters, C. (1998). Comorbid anxiety symptoms in children with pervasive developmental disorders. Journal of Anxiety Disorders, 12, 387–393.

    Article  PubMed  Google Scholar 

  • Pelkonen, M., & Marttunen, M. (2003). Child and adolescent suicide: Epidemiology, risk factors, and approaches to prevention. Paediatric Drugs, 5(4), 243–265.

    PubMed  Google Scholar 

  • Posner, K., Oquendo, M. A., Gould, M., Stanley, B., & Davies, M. (2007). Columbia classification algorithm of suicide assessment (C-CASA): Classification of suicidal events in the FDA’s pediatric suicidal risk analysis of antidepressants. American Journal of Psychiatry, 164(7), 1035–1043.

    Article  PubMed  Google Scholar 

  • Raja, M., Azzoni, A., & Frustaci A. (2011). Autism spectrum disorders and suicidality. Clinical Practice, Epidemiology and Mental Health, 30, 97–105.

    Article  Google Scholar 

  • Reaven, J., Blakeley-Smith, A., Culhane-Shelburne, K., & Hepburn, S. (2012). Group cognitive behavior therapy for children with high-functioning autism spectrum disorders and anxiety: A randomized trial. Journal of Child Psychology and Psychiatry, 53, 410–419.

    Article  PubMed  Google Scholar 

  • Reinherz, H. Z., Giaconia, R. M., Silverman, A. B., Friedman, A., Pakiz, B., Frost, A. K., et al. (1995). Early psychosocial risks for adolescent suicidal ideation and attempts. Journal of the American Academy of Child and Adolescent Psychiatry, 34(5), 599–611.

    Article  PubMed  Google Scholar 

  • Reynolds, W. (1987). Suicidal ideation questionnaire-junior. Odessa, FL: Psychological Assessment Resources, Inc.

    Google Scholar 

  • Rotheram-Fuller, E., Kasari, C., Chamberlain, B., & Locke, J. (2010). Social involvement of children with autism spectrum disorders in elementary school classrooms. Journal of Child Psychology and Psychiatry, 51, 1227–1234.

    Article  PubMed  Google Scholar 

  • RUPP. (2002). The pediatric anxiety rating scale: Development and psychometric properties. Journal of the American Academy of Child and Adolescent Psychiatry, 41, 1061–1069.

    Article  Google Scholar 

  • Rutter, M., LeCouteur, A., & Lord, C. (2003). Autism diagnostic interview, revised. Los Angeles, CA: Western Psychological Services.

    Google Scholar 

  • Sareen, J., Houlahan, T., Cox, B. J., & Asmundson, G. J. (2005). Anxiety disorders associated with suicidal ideation and suicide attempts in the National Comorbidity Survey. Journal of Nervous and Mental Disease, 193(7), 450–454.

    Article  PubMed  Google Scholar 

  • Schlomer, G. L., Bauman, S., & Card, N. A. (2010). Best practices for missing data management in counseling psychology. Journal of Counseling Psychology, 57, 1–10.

    Article  PubMed  Google Scholar 

  • Shaffer, D., & Pfeffer, C. R. (2001). Practice parameter for the assessment and treatment of children and adolescents with suicidal behavior. Journal of the American Academy of Child and Adolescent Psychiatry, 40(Supplement), S24–S51.

    Google Scholar 

  • Shah, A. (2007). The relationship between suicide rates and age: An analysis of multinational data from the World Health Organization. International Psychogeriatrics, 19(6), 1141–1152.

    PubMed  Google Scholar 

  • Shattuck, P. T., Narendorf, S. C., Cooper, B., Sterzing, P. R., Wagner, M., & Taylor, J. L. (2012). Postsecondary education and employment among youth with an autism spectrum disorder. Pediatrics, 129, 1042–1049.

    Article  PubMed  Google Scholar 

  • Shtayermman O. (2007). Peer victimization in adolescents and young adults diagnosed with Asperger’s Syndrome: A link to depressive symptomatology, anxiety symptomatology and suicidal ideation. Issues in Comprehensive Pediatric Nursing, 30, 87–107.

    Article  PubMed  Google Scholar 

  • Silverman, W. K., & Albano, A. M. (1996). The anxiety disorders interview schedule for DSM-IV-child and parent versions San Antonio. TX: Graywinds Publications.

    Google Scholar 

  • Silverman, W. K., Saavedra, L. M., & Pina, A. A. (2001). Test-retest reliability of anxiety symptoms and diagnoses with the anxiety disorders interview schedule for DSM-IV: Child and parent versions. Journal of the American Academy of Child and Adolescent Psychiatry, 40(8), 937–944.

    Article  PubMed  Google Scholar 

  • Simonoff, E., Jones, C. R., Pickles, A., Happe, F., Baird, G., & Charman, T. (2012). Severe mood problems in adolescents with autism spectrum disorder. Journal of Child Psychology and Psychiatry, 53(11), 1157–1166.

    Article  PubMed  Google Scholar 

  • Smith, J. M., Alloy, L. B., & Abramson, L. Y. (2006). Cognitive vulnerability to depression, rumination, hopelessness, and suicidal ideation: Multiple pathways to self-injurious thinking. Suicide and Life-Threatening Behavior, 36(4), 443–454.

    Article  PubMed  Google Scholar 

  • Sofronoff, K., Dark, E., & Stone, V. (2011). Social vulnerability and bullying in children with Asperger syndrome. Autism, 15, 355–372.

    Article  PubMed  Google Scholar 

  • Storch, E. A., Arnold, E. B., Jones, A. M., Ale, C. M., Wood, J. J., Ehrenreich-May, J., et al. (2012a). The role of co-occurring disruptive behavior in the clinical presentation of children and adolescents with anxiety in the context of autism spectrum disorders. Child Psychiatry and Human Development, 43, 855–883.

    Article  PubMed  Google Scholar 

  • Storch, E. A., Arnold, E. B., Lewin, A., Nadeau, J., Jones, A. M., de Nadai, A. S., et al. (2013). The effect of cognitive-behavioral therapy versus treatment as usual for anxiety in children with Autism Spectrum Disorders: A randomized, controlled trial. Journal of the American Academy of Child and Adolescent Psychiatry, 52(2), 132–142.

    Google Scholar 

  • Storch, E. A., Ehrenreich May, J., Wood, J. J., Jones, A. M., de Nadai, A. S., Lewin, A., et al. (2012b). Multiple informant agreement on the anxiety disorders interview schedule in youth with autism spectrum disorders. Journal of Child and Adolescent Psychopharmacology, 22, 292–299.

    Article  PubMed  Google Scholar 

  • Storch, E. A., Wood, J. J., Ehrenreich-May, J., Jones, A. M., Park, J. M., Lewin, A., et al. (2012c). Convergent and discriminant validity and reliability of the pediatric anxiety rating scale in youth with autism spectrum disorders. Journal of Autism and Developmental Disorders, 42, 2374–2382.

    Article  PubMed  Google Scholar 

  • Strang, J. F., Kenworthy, L., Daniolos, P., Case, L., Wills, M. C., Martin, A., et al. (2012). Depression and anxiety symptoms in children and adolescents with autism spectrum disorders without intellectual disability. Research in Autism Spectrum Disorders, 6(1), 406–412.

    Article  PubMed  Google Scholar 

  • van Roekel, E., Scholte, R. H., & Didden, R. (2010). Bullying among adolescents with autism spectrum disorders: Prevalence and perception. Journal of Autism and Developmental Disorders, 40, 63–73.

    Article  PubMed  Google Scholar 

  • van Steensel, F. J., Bogels, S. M., & Perrin, S. (2011). Anxiety disorders in children and adolescents with autistic spectrum disorders: A meta-analysis. Clinical Child and Family Psychology Review, 14, 302–317.

    Article  PubMed  Google Scholar 

  • Weissman, M. M., Wolk, S., Wickramaratne, P., Goldstein, R. B., Adams, P., Greenwald, S., et al. (1999). Children with prepubertal-onset major depressive disorder and anxiety grown up. Archives of General Psychiatry, 56(9), 794–801.

    Article  PubMed  Google Scholar 

  • White, S. W., Oswald, D., Ollendick, T., & Scahill, L. (2009). Anxiety in children and adolescents with autism spectrum disorders. Clinical Psychology Review, 29(3), 216–229.

    Article  PubMed  Google Scholar 

  • White, S. W., Schry, A. R., & Maddox, B. B. (2012). The assessment of anxiety in high-functioning adolescents with autism spectrum disorder. Journal of Autism and Developmental Disorders, 42, 1138–1145.

    Article  PubMed  Google Scholar 

  • Wood, J. J., Drahota, A., Sze, K., Har, K., Chiu, A., & Langer, D. A. (2009). Cognitive behavioral therapy for anxiety in children with autism spectrum disorders: A randomized, controlled trial. Journal of Child Psychology and Psychiatry, 50, 224–234.

    Article  PubMed  Google Scholar 

  • Wood, J. J., & Gadow, K. D. (2010). Exploring the nature and function of anxiety in youth with autism spectrum disorders. Clinical Psychology: Research and Practice, 17, 281–292.

    Article  Google Scholar 

  • Wood, J. J., Piacentini, J. C., Bergman, R. L., McCracken, J., & Barrios, V. (2002). Concurrent validity of the anxiety disorders section of the anxiety disorders interview schedule for DSM-IV: Child and parent versions. Journal of Clinical Child and Adolescent Psychology, 31(3), 335–342.

    PubMed  Google Scholar 

  • Wunderlich, U., Bronisch, T., Wittchen, H. U., & Carter, R. (2001). Gender differences in adolescents and young adults with suicidal behaviour. Acta Psychiatrica Scandinavica, 104(5), 332–339.

    Article  PubMed  Google Scholar 

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Acknowledgments

The contributions of Lindsay Brauer, Robert Selles, Dr. Jeffrey Wood, and Danielle Ung are acknowledged. This paper was supported by grants to the first author from the National Institute of Child Health and Human Development (5R34HD065274-02), All Children’s Hospital Research Foundation and the University of South Florida Office of Research and Innovation Established Researcher Grant Program.

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  1. Department of Pediatrics, Rothman Center for Neuropsychiatry, University of South Florida, 880 6th Street South, 4th Floor Suite 460, Box 7523, St. Petersburg, FL, 33701, USA

    Eric A. Storch, Josh Nadeau, Adam B. Lewin, Elysse B. Arnold, P. Jane Mutch, Anna M. Jones & Tanya K. Murphy

  2. Department of Psychiatry and Neuroscience, University of South Florida, St. Petersburg, FL, USA

    Eric A. Storch, Adam B. Lewin & Tanya K. Murphy

  3. Department of Disability and Psychoeducational Studies, University of Arizona, Tucson, AZ, USA

    Michael L. Sulkowski

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  1. Eric A. Storch
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Correspondence to Eric A. Storch.

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Storch, E.A., Sulkowski, M.L., Nadeau, J. et al. The Phenomenology and Clinical Correlates of Suicidal Thoughts and Behaviors in Youth with Autism Spectrum Disorders. J Autism Dev Disord 43, 2450–2459 (2013). https://doi.org/10.1007/s10803-013-1795-x

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