ArticleLiterature Review

What Do We Know About Suicidality in Autism Spectrum Disorders? A Systematic Review

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Abstract

Suicidality is a common and concerning issue across development, and there is a plethora of research on this topic among typically developing children and youth. Very little is known, however, about the nature of suicidality among individuals with autism spectrum disorders (ASDs). The purpose of the current study was to undertake a systematic literature review to assess the current state of the research literature to examine the prevalence of suicidality among individuals with ASD, related demographic and clinical profiles, and associated risk and protective factors. A literature search using key terms related to suicidality and ASD yielded 10 topical studies that were evaluated for the study objectives. Suicidality was present in 10.9–50% of the ASD samples identified in the systematic review. Further, several large-scale studies found that individuals with ASD comprised 7.3–15% of suicidal populations, a substantial subgroup. Risk factors were identified and included peer victimization, behavioral problems, being Black or Hispanic, being male, lower socioeconomic status, and lower level of education. Only one study reported on protective factors, and this is identified as a significant gap in the literature. Several methodological weaknesses were present in the current literature, such as lack of appropriate comparison groups and little to no use of empirically validated measures for ASD diagnosis and suicide assessment. Additional research is necessary to understand better how this unique population experiences and expresses suicidal tendencies. Recommendations for future research are discussed. Autism Res 2014, ●●: ●●–●●. © 2014 International Society for Autism Research, Wiley Periodicals, Inc.

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... Further, we evaluated the full-texts of 86 articles and excluded 60 articles that did not meet all the criteria of this review. Finally, 26 articles meeting all the criteria were included in this umbrella review (see Table 3), including 14 systematic reviews (Arnevik and Helverschou, 2016;Hannon and Taylor, 2013;Hedley and Uljarević, 2018;Kalyva et al., 2016;Menezes et al., 2018;Nickel et al., 2019;Padgett et al., 2010;Richa et al., 2014;Segers and Rawana, 2014;Skokauskas and Gallagher, 2009;Stewart et al., 2006;Vannucchi et al., 2014;Wigham et al., 2017;Zahid and Upthegrove, 2017) and 12 metaanalyses (De Giorgi et al., 2019;Díaz-Román et al., 2018;Elrod and Hood, 2015;Hollocks et al., 2019;Hudson et al., 2019;Lai et al., 2019;Lugo-Marín et al., 2019;Lugo Marín et al., 2018;Morgan et al., 2020;van Steensel et al., 2011;van Steensel and Heeman, 2017;Zheng et al., 2018). ...
... The earliest review included in this umbrella review was published in 2006 (Stewart et al., 2006). Most (n = 17) reviews are published after 2015, whereas only nine reviews were published till 2015 (Elrod and Hood, 2015;Hannon and Taylor, 2013;Padgett et al., 2010;Richa et al., 2014;Segers and Rawana, 2014;Skokauskas and Gallagher, 2009;Stewart et al., 2006;van Steensel et al., 2011;Vannucchi et al., 2014). The number of the searched databases in the included reviews ranged from one to eight, with a median of four. ...
... Among 26 reviews included in this review, 15 reviews reported the origin of the primary study populations. Most reviews included primary studies from the US, UK, Canada, Netherlands, Sweden, Italy, Norway, Germany, Australia, and other countries from North America, Europe, and Oceania whereas nine reviews included at least one country from Asia (Díaz-Román et al., 2018;Elrod and Hood, 2015;Hedley and Uljarević, 2018;Lai et al., 2019;Lugo-Marín et al., 2019;Lugo Marín et al., 2018;Segers and Rawana, 2014;Wigham et al., 2017;Zahid and Upthegrove, 2017). No primary studies were found from Africa, Central America, or Latin America. ...
Article
With ever-increasing prevalence of various mental disorders worldwide, a comprehensive evaluation of the prevalence of co-occurring psychiatric disorders among individuals with autism spectrum disorder (ASD) is needed to strengthen the knowledge base. This umbrella review aims to summarize the current evidence on the prevalence of comorbid psychiatric disorders among people with ASD. A systematic search of 12 major databases and additional sources was conducted. Any systematically conducted narrative, qualitative, or meta-analytic review reporting the prevalence of psychiatric disorders among people with ASD with no age or geographical restriction were included. From a total of 2755 records, 26 articles representing 14 systematic reviews and 12 meta-analyses met the criteria of this review. The synthesized findings reveal a high burden of comorbid psychiatric disorders among people with ASD, including anxiety disorders, depressive disorders, bipolar and mood disorders, schizophrenia spectrum, suicidal behavior disorders, attention-deficit/hyperactivity disorder, disruptive, impulse-control and conduct disorders amongst diverse age groups, with a majority in younger participants. Most studies were conducted in developed nations, with limited evidence from low and middle-income countries. These synthesized findings provide high-quality evidence for clinical and policy-level decision-making from a global overview of the status of comorbid psychiatric disorders among people with ASD.
... Further, we evaluated the full-texts of 86 articles and excluded 60 articles that did not meet all the criteria of this review. Finally, 26 articles meeting all the criteria were included in this umbrella review (see Table 3), including 14 systematic reviews (Arnevik and Helverschou, 2016;Hannon and Taylor, 2013;Hedley and Uljarević, 2018;Kalyva et al., 2016;Menezes et al., 2018;Nickel et al., 2019;Padgett et al., 2010;Richa et al., 2014;Segers and Rawana, 2014;Skokauskas and Gallagher, 2009;Stewart et al., 2006;Vannucchi et al., 2014;Wigham et al., 2017;Zahid and Upthegrove, 2017) and 12 meta-analyses (De Giorgi et al., 2019;Díaz-Román et al., 2018;Elrod and Hood, 2015;Hollocks et al., 2019;Hudson et al., 2019;Lai et al., 2019;Lugo-Marín et al., 2019;Lugo Marín et al., 2018;Morgan et al., 2020;van Steensel et al., 2011;van Steensel and Heeman, 2017;Zheng et al., 2018). ...
... The earliest review included in this umbrella review was published in 2006 (Stewart et al., 2006). Most (n = 17) reviews are published after 2015, whereas only nine reviews were published till 2015 (Elrod and Hood, 2015;Hannon and Taylor, 2013;Padgett et al., 2010;Richa et al., 2014;Segers and Rawana, 2014;Skokauskas and Gallagher, 2009;Stewart et al., 2006;van Steensel et al., 2011;Vannucchi et al., 2014). The number of the searched databases in the included reviews ranged from one to eight, with a median of four. ...
... Among 26 reviews included in this review, 15 reviews reported the origin of the primary study populations. Most reviews included primary studies from the US, UK, Canada, Netherlands, Sweden, Italy, Norway, Germany, Australia, and other countries from North America, Europe, and Oceania whereas nine reviews included at least one country from Asia (Díaz-Román et al., 2018;Elrod and Hood, 2015;Hedley and Uljarević, 2018;Lai et al., 2019;Lugo-Marín et al., 2019;Lugo Marín et al., 2018;Segers and Rawana, 2014;Wigham et al., 2017;Zahid and Upthegrove, 2017). No primary studies were found from Africa, Central America, or Latin America. ...
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p>With ever-increasing prevalence of various mental disorders worldwide, a comprehensive evaluation of the prevalence of co-occurring psychiatric disorders among individuals with autism spectrum disorder (ASD) is needed to strengthen the knowledge base. This umbrella review aims to summarize the current evidence on the prevalence of comorbid psychiatric disorders among people with ASD. A systematic search of 12 major databases and additional sources was conducted. Any systematically conducted narrative, qualitative, or meta-analytic review reporting the prevalence of psychiatric disorders among people with ASD with no age or geographical restriction were included. From a total of 2755 records, 26 articles representing 14 systematic reviews and 12 meta-analyses met the criteria of this review. The synthesized findings reveal a high burden of comorbid psychiatric disorders among people with ASD, including anxiety disorders, depressive disorders, bipolar and mood disorders, schizophrenia spectrum, suicidal behavior disorders, attention-deficit/hyperactivity disorder, disruptive, impulse-control and conduct disorders amongst diverse age groups, with a majority in younger participants. Most studies were conducted in developed nations, with limited evidence from low and middle-income countries. These synthesized findings provide high-quality evidence for clinical and policy-level decision-making from a global overview of the status of comorbid psychiatric disorders among people with ASD.</p
... Individuals with ASD have a high rate of comorbidities, including mental disorders such as attention-deficit hyperactivity disorder, depression, anxiety, and obsessive-compulsive disorder [Gjevik, Eldevik, Fjaeran-Granum, & Sponheim, 2011;Joshi et al., 2010;Leyfer et al., 2006]. Recent studies have indicated that high autistic traits and ASD diagnosis are associated with an increased risk of suicidality [Cassidy et al., 2014;Cassidy, Bradley, Shaw, & Baron-Cohen, 2018;Culpin et al., 2018;Hirvikoski et al., 2016;Mayes, Gorman, Hillwig-Garcia, & Syed, 2013;Paquette-Smith, Weiss, & Lunsky, 2014;Pelton & Cassidy, 2017;Richards et al., 2019;Segers & Rawana, 2014]. For instance, a 2014 review of suicidality in individuals with ASD indicated that the prevalence of suicidal behavior in this group ranges between 10.7 and 50% [Segers & Rawana, 2014]. ...
... Recent studies have indicated that high autistic traits and ASD diagnosis are associated with an increased risk of suicidality [Cassidy et al., 2014;Cassidy, Bradley, Shaw, & Baron-Cohen, 2018;Culpin et al., 2018;Hirvikoski et al., 2016;Mayes, Gorman, Hillwig-Garcia, & Syed, 2013;Paquette-Smith, Weiss, & Lunsky, 2014;Pelton & Cassidy, 2017;Richards et al., 2019;Segers & Rawana, 2014]. For instance, a 2014 review of suicidality in individuals with ASD indicated that the prevalence of suicidal behavior in this group ranges between 10.7 and 50% [Segers & Rawana, 2014]. Although the literature provides no clear definition of "suicidality," the term is typically used to indicate a state in which individuals express some form of suicide ideation or plans or attempt suicide [Silverman, 2016]. ...
... Factors protecting individuals with elevated autistic traits from suicide are poorly understood and researched [Cassidy & Rodgers, 2017;Segers & Rawana, 2014]. In the current study, we explored the protective effects of academic performance and family function in alleviating the risk of suicidality in children with elevated autistic traits; however, our results did not provide evidence supporting these hypotheses. ...
Article
By using a nationally representative school‐based sample (4,816 children aged 8–14 years), we examined the risk of suicidality in children with elevated autistic traits and assessed the mediation of anxiety/depression and moderation effects of family function and academic performance. The Chinese version of the Social Responsiveness Scale (SRS‐C) was used to measure autistic features. Logistic regression models were applied to assess associations between autistic traits and suicidality (suicidal ideation, suicide plans, and suicide attempts) for estimating the mediation effects of anxiety/depression and moderation effects of academic performance and family function after adjustment for control variables. Every 10‐point increase in the SRS‐C score was associated with a 1.3–1.4‐fold increase in suicidality risk. Associations relating to suicide plans and attempts were fully mediated; however, the association with ideation was partially mediated by anxiety/depression. Academic performance and family function did not appear to moderate associations between autistic traits and suicidality. In conclusion, children with elevated autistic traits exhibited increased risk of suicidality, which could be generally attributed to symptoms of anxiety/depression. Because adequate family function and academic performance did not mitigate the link between elevated autistic traits and suicidality, in‐depth exploration into specific protective factors in children with elevated autistic traits is warranted. Lay Summary By using a nationally representative school‐based sample (4,816 children aged 8–14 years), we observed that the risk of suicidality increased in children with elevated autistic traits. This association was generally explained by increased levels of anxiety/depression. Furthermore, better family function and academic performance did not appear to mitigate the link between autistic traits and suicidality.
... In adolescents, from the limited research conducted, findings show those with ASD are also at a greater risk of suicidal behaviours [22]. For example, one clinical study found over one in six young people with ASD contemplated or attempted suicide during childhood, making them 30 times more at risk than typically developing children [23]. ...
... suicidal ideation vs. suicide attempt) have been aggregated into binary outcomes. Furthermore, the methodological approaches of these studies, including cross-sectional designs, small, selective and mostly clinical samples, as well as lack of adequate adjustment for possible confounding factors or comparable control groups, [22][23][24][25] further limit the interpretation and generalisability of these findings. ...
... Previous studies have reported an association between ASD and suicidal behaviours in adolescents; however, these have methodological weaknesses such as lack of appropriate comparison groups and have used measures of self-harm assessment such as parent report. These studies have also largely relied on clinical populations [22,23] and therefore have not provided evidence that ASD is a risk factor for self-harm in a general population sample. ...
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Background Individuals with autism spectrum disorder (ASD) are at particularly high risk of suicide and suicide attempts. Presentation to a hospital with self-harm is one of the strongest risk factors for later suicide. We describe the use of a novel data linkage between routinely collected education data and child and adolescent mental health data to examine whether adolescents with ASD are at higher risk than the general population of presenting to emergency care with self-harm. Methods A retrospective cohort study was conducted on the population aged 11–17 resident in four South London boroughs between January 2009 and March 2013, attending state secondary schools, identified in the National Pupil Database (NPD). Exposure data on ASD status were derived from the NPD. We used Cox regression to model time to first self-harm presentation to the Emergency Department (ED). Results One thousand twenty adolescents presented to the ED with self-harm, and 763 matched to the NPD. The sample for analysis included 113,286 adolescents (2.2% with ASD). For boys only, there was an increased risk of self-harm associated with ASD (adjusted hazard ratio 2·79, 95% CI 1·40–5·57, P<0·01). Several other factors including school absence, exclusion from school and having been in foster care were also associated with a higher risk of self-harm. Conclusions This study provides evidence that ASD in boys, and other educational, social and clinical factors, are risk factors for emergency presentation with self-harm in adolescents. These findings are an important step in developing early recognition and prevention programmes.
... Despite the seriousness of suicidality in autistic youth becoming increasingly clear, reasons why are unclear and under-researched (Cassidy, 2020). Efforts to distill knowledge from emerging suicide-autism research have largely focused on autistic adults or lifespan (Hedley & Uljarević, 2018;Richa, Fahed, Khoury, & Mishara, 2014;Segers & Rawana, 2014;Zahid & Upthegrove, 2017), with little focus specifically on autistic youth. ...
... Given the aforementioned issues, it is perhaps unsurprising that much of the existing suicide research has focused more on samples of autistic adults with lifespan considerations (Hedley & Uljarević, 2018;Richa et al., 2014;Segers & Rawana, 2014;Zahid & Upthegrove, 2017). In the adult literature, some studies report that increased risk is associated with psychiatric comorbidities (e.g., depression and anxiety), demographic factors (e.g., belonging to an ethnic minority and having lower socio-economic status), and psychological factors, such as bullying and loneliness (Culpin et al., 2018;Hedley & Uljarević, 2018;Mikami et al., 2009;Richa et al., 2014;Segers & Rawana, 2014). ...
... Given the aforementioned issues, it is perhaps unsurprising that much of the existing suicide research has focused more on samples of autistic adults with lifespan considerations (Hedley & Uljarević, 2018;Richa et al., 2014;Segers & Rawana, 2014;Zahid & Upthegrove, 2017). In the adult literature, some studies report that increased risk is associated with psychiatric comorbidities (e.g., depression and anxiety), demographic factors (e.g., belonging to an ethnic minority and having lower socio-economic status), and psychological factors, such as bullying and loneliness (Culpin et al., 2018;Hedley & Uljarević, 2018;Mikami et al., 2009;Richa et al., 2014;Segers & Rawana, 2014). However, others highlight risk factors that are unique to autism, such as impaired social communication, unmet support needs, and camouflaging (i.e., conscious or unconscious compensatory strategies to hide autistic behaviors in order to try and fit in in social situations; Cassidy et al., 2018; Cook, Hull, Crane, & Mandy, 2021; Lai et al., 2017;Paquette-Smith, Weiss, & Lunsky, 2014). ...
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Suicidality in autistic youth is a major public health issue. This study aimed to determine global prevalence of, and risk/protective factors for suicidality in autistic youth via systematic review and meta-analysis. We systematically searched Embase, PubMed, PsycINFO, Web of Science, and the Cochrane library for studies from inception to November 22nd, 2021. We selected empirical studies reporting on suicide outcomes (i.e., ideation, behaviors, attempts and deaths) in autistic youth (≤25 years). Random effects models were used to estimate the pooled prevalence of suicide outcomes with 95% confidence interval (CI). Heterogeneity was investigated with potential moderators using meta-regression analyses. The final selection included 47 papers, 29 of which were included in meta-analyses and 37 were narratively synthesized (sociodemographic, psychiatric, psychological, other factors, and interventions). The pooled prevalence of suicidal ideation was 25.2% (95% CI 18.2–33.8; i.e., one in four), suicide attempts 8.3% (3.6–18.2), and suicide deaths 0.2% (0.05–0.52). Estimates in self-reports were higher than in parent-reports. Age was a significant but inconsistent moderator on suicide outcomes, but substantial heterogeneity remained. Adverse childhood experiences were strong risk factors for suicidality, while resilience was protective. Participatory suicide risk-assessment, early intervention, and resilience promotion should be primary clinical/research goals.
... Autistic individuals are at elevated risk for suicidal ideation and behavior, and for deaths by suicide. Autistic individuals are up to nine times more likely to experience suicidal ideation and up to six times more likely to attempt suicide than age-and sexmatched controls (Cassidy et al. 2014;Chen et al. 2017;Croen et al. 2015;Segers and Rawana 2014). Populationlevel data from Sweden suggest that autistic individuals were over 7.5 times more likely to die by suicide than matched general-population controls (Hirvikoski et al. 2016). ...
... Clinicians identified a greater proportion of their nonautistic clients at elevated risk for suicide than their autistic clients, and were much more likely to say that an autistic client had no risk for suicide. These findings stand in contrast to recent literature indicating that autistic individuals experience suicidal thoughts and behaviors at higher rates than others even when controlling for co-occurring psychiatric diagnoses (Cassidy et al. 2014;Chen et al. 2017;Croen et al. 2015;Hirvikoski et al. 2016;Kirby et al. 2019;Segers and Rawana 2014). The design of the current study precluded us from verifying the accuracy of these clinicians' estimates of risk and determining whether suicide risk was under-detected in their autistic clients. ...
Article
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Autistic individuals experience elevated risk for suicide ideation, attempts, and deaths. Little is known about how clinicians assess risk or intervene with suicidal autistic individuals. We surveyed 121 clinicians about use of suicide prevention practices with autistic and non-autistic clients. Clinicians reported greater self-efficacy in screening for suicide risk among non-autistic clients (p = 0.01). There were no statistically significant differences in whether they used standardized screening measures or in their reported normative pressure or attitudes towards screening. Clinicians reported similar rates of use of Safety Planning, an evidence-based suicide-prevention strategy, across groups, but greater acceptability for non-autistic clients (p < 0.001). These findings have implications for strategies to increase clinicians’ adoption of these tools for autistic individuals.
... Despite emerging findings that STB are highly prevalent in autistic individuals, with estimates as high as 50% of samples (Segers & Rawana, 2014), and that the incidence of suicide death is three to seven times greater in the autism spectrum disorder (ASD) population than in the general population (Hirvikoski et al., 2016;Kirby et al., 2019;Kõlves et al., 2021), the co-occurrence of ASD and STB, as well as clinical considerations for suicide-related care for autistic 1 youth, have received far less attention. Additionally, research has shown that autistic youth have substantially higher ED utilization rates compared to the general child and adolescent population, particularly for visits related to psychiatric presenting concerns (Beverly et al., 2021;Kalb et al., 2012Kalb et al., , 2019Liu et al., 2017). ...
... These clinicians overwhelmingly identified suicide risk screening and management for autistic youth as important and adaptations to standard suiciderelated practices as necessary for the autistic patient population. However, the majority did not identify ASD as a risk factor for STB, despite recent research indicating that the rates of STB and suicide death are significantly higher in the ASD population than in the general population (Cassidy et al., 2018;Chen et al., 2017;Demirkaya et al., 2016;Horowitz et al., 2018;Kirby et al., 2019;Kõlves et al., 2021;McDonnell et al., 2019;Oliphant et al., 2020;Segers & Rawana, 2014), suggesting that clinicians may have limited knowledge about the co-occurrence of ASD and STB. This is not surprising, as research in this area is emerging (Cassidy & Rodgers, 2017) and autistic individuals are not often included as a high risk group in general suicide resources and trainings. ...
Article
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Suicidal thoughts and behaviors (STB) and emergency department (ED) utilization are prevalent in autistic youth. The current study surveyed clinicians in a pediatric psychiatric ED to examine differences in attitudes on suicide-related care for autistic and non-autistic patient populations. While clinicians rated addressing STB in ASD as important and adaptations to care as necessary, less than half identified ASD as a suicide risk factor and confidence ratings were significantly lower for autistic patients. Previous ASD training predicted confidence and accounted for approximately 25% of the variance in confidence scores. Findings highlight the urgency to develop and disseminate ED clinician training, and address the lack of validated assessment tools, adapted suicide prevention practices, and evidence-based treatments for STB in autistic youth.
... The extant literature has also identified other demographic and clinical factors related to suicidal ideation both in the ASD and general populations. Among the factors most consistently associated with suicidal ideation is a family history of suicidality, as well as the presence and severity of psychiatric comorbidity, in particular depression [5,9,[30][31][32] and, as mentioned previously, anxiety disorders [9,[33][34][35]. Previous studies also suggested a higher severity of social difficulties such as impairment in social communication, poor social relationships and support, and victimization by peers, which are often encountered in ASD, are associated with increased risks of suicidal thoughts both in ASD and typically developing individuals [3,5,[36][37][38]. ...
Article
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Children with autism spectrum disorder (ASD) are at elevated risk of suicidal ideation, particularly those with comorbid anxiety disorders and/or obsessive-compulsive disorder (OCD). We investigated the risk factors associated with suicidal ideation in 166 children with ASD and comorbid anxiety disorders/OCD, and the unique contribution of externalizing behaviors. Suicidal ideation was reported in the child sample by 13% of parents. Controlling for child age, sex, and IQ, perceived loneliness positively predicted the likelihood of suicidal ideation. In addition, externalizing behaviors positively predicted suicidal ideation, controlling for all other factors. Reliance on parental report to detect suicidal ideation in youth with ASD is a limitation of this study. Nonetheless, these findings highlight the importance of assessing and addressing suicidal ideation in children with ASD and comorbid anxiety disorders/OCD, and more importantly in those with elevated externalizing behaviors and perceptions of loneliness.
... Suicide is a leading cause of premature death in autistic people 16 . Therefore, it is crucial to better understand the factors that improve or worsen the well-being of autistic adults and develop prevention strategies for suicide in this population 14,17 . ...
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Mental health problems and suicide are more frequent in autistic adults than general population. Dog ownership can improve human well-being. This study aimed to generate a framework of well-being outcomes for dog-related activities in autistic adults and compare it to the framework generated for a general adult population. Thirty-six autistic dog owners (18–74 years old, 18 males) from diverse UK regions were interviewed and transcripts thematically analysed. 16.7% reported that their dogs prevented them from taking their own lives, mainly due to the dog's affection and the need to care for the animal. Close dog-owner interactions (e.g., cuddling, walking, dog's presence) were the most frequent activities improving emotions/moods and life functioning, whereas routine-like activities (e.g., feeding the animal) particularly enhanced life functioning. Well-being worsening was mainly linked to dog behaviour problems, dog poor health/death and obligations to the dog. Despite some negatives associated with ownership, having a dog could improve the well-being of many autistic adults and assist suicide prevention strategies in this high-risk group. The framework was consistent with that generated previously, indicating its robustness and the potential opportunity to focus on dog-related activities rather than the vague concept of “ownership” when considering the impact of ownership on well-being.
... 6 Associations have also been found in people with other disabilities including autism spectrum disorders and Huntington disease. 8,9 Suicidal behaviours in the context of the COVID-19 pandemic among PWDs A recent study found that PWDs experienced increased symptoms of depression (56.6% v. 28.7%), substance use (38.8% v. 17.5%) and suicidal ideation (30.8% v. 8.3%) compared with people without disabilities during the COVID-19 pandemic. 10 Two other studies from the UK and USA also found an increased prevalence of suicidal ideation among PWDs compared with those without disabilities during the COVID-19 pandemic (30.1% v. 6.9%, a twofold increase from pre-pandemic estimates, and 20.7% v. 4.1%, respectively). ...
Article
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Background: Evidence from pandemic and pre-pandemic studies conducted globally indicates that people with disabilities (PWDs) have a higher risk for suicidality. However, none of these studies has assessed suicidality among PWDs in Bangladesh. Aims: The purpose of this study was to determine the prevalence of and factors associated with suicidal ideation among PWDs during the COVID-19 pandemic in Bangladesh. Method: Using a snowball sampling technique, a cross-sectional survey was conducted from February to April 2021 among PWDs from six districts in the northern region of Bangladesh. Information related to sociodemographic factors, clinical characteristics, behavioural factors and suicidal ideation was collected. Chi-squared test and logistic regression were used to describe the data and explain the relationship of factors associated with suicidal ideation. Results: The prevalence of COVID-19-related past-year suicidal ideation was 23.9%. The factors associated with suicidal ideation included: age above 35 years, being female, acquiring a disability later in life, lack of sleep and current substance use. In addition, higher education appeared to be a protective factor against suicidal ideation. Conclusions: This study highlighted that PWDs had an increased risk of suicide; that is, one-fourth of them had past-year suicidal ideation. This may have been because of COVID-19-related restrictions and stressors. Thus, the government and policy makers need to pay more attention to developing effective suicide assessment, treatment and management strategies, especially for at-risk groups, to minimise the impact of the COVID-19 outbreak.
... A closer examination of the four Negative Self-Esteem items endorsed more frequently by autistic youth reveals salient cognitive symptoms of depression: items 2 (hopelessness), 7 (guilt), 8 (suicidality), and 24 (feeling unlovable). Suicidal ideation and hopelessness have been reported at higher rates among autistic individuals than peers (Hedley et al., 2018;Hu et al., 2019;Segers & Rawana, 2014), but it appears that beliefs of guilt (item 7) and being unlovable (item 24) may also be prominent factors in the development of depression in ASD. In addition, four Interpersonal Problems items were endorsed more frequently by autistic youth and showed distinct cognitive, emotional, and behavioral symptoms of depression: items 5 (low mood), 19 (loneliness), 21 (peer network), and 25 (peer conflict). ...
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Lay abstract: Depression is more common in autistic adolescents than their neurotypical peers, but the effects of diagnosis and sex on the severity and types of depressive symptoms remain unclear. The study explored diagnostic- and sex-based differences in depressive symptoms in 212 autistic and neurotypical early adolescents. Results show that autism spectrum disorder and female may pose elevated risks, and depressive symptoms related to interpersonal problems and negative self-esteem are more frequent in autism spectrum disorder. Autistic males and females endorsed similar severity and type of depressive symptoms, but unique differences emerged when compared to sex-matched neurotypical peers. Exploratory analyses in a clinical subsample of early adolescents with elevated depressive symptoms (Children's Depression Inventory, Second Edition, Total T-score ⩾60) revealed more endorsement of beliefs of worthlessness in autistic early adolescents. Findings suggest initial intervention targets for treating depression in autistic early adolescents.
... The prevalence of co-occurring attention deficit/hyperactivity disorder (ADHD) among people with autism ranged from 25.7 to 65% (11,14,15), while disruptive, impulse-control, and conduct disorders ranged from 12 to 48% (12,15,16), the prevalence of obsessive-compulsive disorders (OCD) co-occurring in ASD, which ranged from 9 to 22% (8,17,18), the prevalence of suicidal ideation and attempts, which ranged from 10.9 to 66% and 1 to 35%, respectively (12,14,16,19,20). Sleep-wake disorder was 13% (95% CI: 9-17) among 190,963 participants with ASD (15), schizophrenia spectrum, and other psychotic disorders was reported in range from 4 to 67% (11,13,15,16,(21)(22)(23). Five reviews reported the prevalence of mood disorders, which ranged from 4.4 to 37% across ASD samples (11,12,16,22,24). ...
Article
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Autism spectrum disorder (ASD) is a neurodevelopmental disorder with social communication deficits, restricted interests, and repetitive behaviours. In this lifelong condition the core features that cause impairment may also be expanded by behavioural and emotional problems. Individuals with ASD are likely to experience a higher prevalence of common mental disorders compared to the typically developed individuals. This high epidemiological burden of various psychiatric disorders among ASD population encourages further research and improvement in diagnostic practise in ASD and comorbid disorders. In this brief research report of a cross-sectional study, I aimed to estimate the psychiatric comorbidity prevalence and describe their general characteristics in children with ASD in the Autism Centre in Montenegro. The study population consisted of 152 patients who were diagnosed with ASD, 117 male and 35 female, and the mean age (SD) was 8.02 (4.26). In this brief research report prevalence of children with ASD with at least one psychiatric comorbidity was 36.84%. Only one psychiatric comorbidity disorder was reported in 17.16%, two in 9.87%, three in 8.55%, and in 0.66% patients four other psychiatric disorders. Psychiatric disorders present in this population sample were attention deficit hyperactivity disorder (17.76%), conduct disorder (13.10%), disruptive mood dysregulation disorder (9.87%), anxiety disorder and insomnia (7.89%), elimination disorder (3.29%), and depression (1.97%).
... Also, there is limited evidence regarding suicide relating to ASD within the prison population. Estimates of suicidality in general for individuals with ASD range from 10.7 to 50% (Segers & Rawana, 2014). This study showed that those prisoners with autistic traits had higher rates of lifetime attempted suicide up to 65 % indicating that this group is a very high-risk population coming into prison, who will require a more intensive and involved clinical input. ...
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Background Prevalence studies among prisoners have found rates of 1–4% for autism spectrum disorder (ASD) or autistic traits. However, little is known about those prisoners with high levels of autistic traits. Aim This aim of this study was to compare the mental health characteristics of prisoners with autistic traits with neurotypical prisoners not screening positive for neurodevelopmental disorders. Method The study recruited 240 male prisoners from a London prison and screened for autism spectrum disorder using the Autism Quotient (AQ) 20 and 10, and Autism Diagnostic Observation Schedule (ADOS). The Mini International Neuropsychiatric Interview was used to assess for depression, anxiety, self-harm behavior and suicide. Results Screening using the AQ identified 46 prisoners with significant autistic traits, with 12 meeting the diagnostic threshold for ASD using the ADOS. Those screening positive with autistic traits were significantly more likely to have thought about self-harm and suicide in the past month than neurotypical prisoners and have a comorbid mental disorder. They were also significantly more likely to report having attempted suicide during their lifetime compared to neurotypical peers at a rate of 64.9 % compared to 11.6 % for the neurotypical prisoners. Conclusion Prisoners with elevated levels of autistic traits were more likely to report self-harm, suicidal thoughts and were more vulnerable to a range of mental disorders than neurotypical prisoners. There is a need for more evidence on the experience of autistic prisoners to inform how pathways should work to improve health outcomes through increased awareness and access to screening and subsequent diagnosis which currently prisons are currently not set up for.
... Concerning mental health, depression is the most common diagnosis in those who die by suicide [4]. An elevated risk has also been detected among patients with traumatic brain injury [5] autism spectrum disorders [6] or chronic pain [7], and among patients afflicted by post-traumatic stress disorder [8]. ...
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Background Suicide is a serious public health issue and one of the most common causes of death globally. Suicide has long-lasting impact on personal, relational, community and societal levels. Research has shown that patients often seek help in the primary healthcare system preceding a suicide. Studies exploring the experiences of encountering patients at risk for suicide have been performed among various categories of healthcare personnel, such as nurses and psychiatry residents as well as emergency room staff. There is a lack of research regarding primary healthcare rehabilitation staff, despite the fact that physiotherapists are the third largest health profession in the Western hemisphere and often work with patients experiencing mental health symptoms. The aim of this study was to explore the experiences of encountering patients at risk for suicide among physiotherapists working in a primary healthcare rehabilitation setting. Methods Semi-structured interviews were conducted with 13 physiotherapists working in primary healthcare rehabilitation clinics in the Gothenburg area, Sweden. The interviews were recorded on audio and transcribed into written text. A qualitative content analysis was performed on the material collected. Results The analysis of the material revealed an overarching theme, Through barriers and taboos – the physiotherapist finds a way, with five main categories: possibilities for identification, obstacles in meeting suicide, workplace environment matters, where does the patient belong? and education and experience are keys. Conclusions The present study indicates that physiotherapists in the primary healthcare system encounter patients experiencing suicidality, and they expressed a strong desire to care for both the physical and mental wellbeing of the patients. Despite reporting many barriers, the physiotherapists often found a way to form a meaningful therapeutic alliance with the patient and to ask about possible suicidality in their clinical practice. The result suggests that physiotherapists could play a larger role in working with patients experiencing suicidality in a primary healthcare setting and that they could be viewed as possible gatekeepers in identification as well as referral of these patients into other parts of the healthcare system.
... Nevertheless, little evidence from large-scale studies exists regarding an association between ASD and suicidality. [11][12][13][14][15] A recent population-based case-cohort study from Sweden showed an increased risk of suicide and suicide attempt among those with ASD, especially among those without intellectual disability. 16 It has yet to be determined what factors are associated with suicidal behavior in people with ASD and whether they differ from the factors associated with suicidal behavior in the population without ASD. ...
Article
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Importance There is limited evidence supporting an association of autism spectrum disorder (ASD) with suicidality and the risk factors for suicide attempt and suicide among people with ASD. Existing research highlights the need for national cohort studies. Objectives To analyze whether people with ASD have higher rates of suicide attempt and suicide compared with people without ASD using national register data, identify potential risk factors for suicide attempt and suicide among those with ASD, and examine associations with comorbid disorders. Design, Setting, and Participants In this cohort study, nationwide register data from January 1, 1995, to December 31, 2016, were gathered on 6 559 266 individuals in Denmark aged 10 years or older. Statistical analysis was performed from November 20, 2018, to November 21, 2020. Main Outcomes and Measures Rates of suicide attempt and suicide among persons with ASD were compared with rates among persons without ASD, using Poisson regression models to calculate incidence rate ratios adjusted for sex, age, and time period. Results Of the total study population of 6 559 266 individuals, 35 020 individuals (25 718 male [73.4%]; mean [SD] age at diagnosis, 13.4 [9.3] years) received a diagnosis of ASD. A total of 64 109 incidents of suicide attempts (587 [0.9%] among individuals with ASD) and 14 197 suicides (53 [0.4%] among individuals with ASD) were recorded. Persons with ASD had a more than 3-fold higher rate of suicide attempt (adjusted incidence rate ratio [aIRR], 3.19; 95% CI, 2.93-3.46) and suicide (aIRR, 3.75; 95% CI, 2.85-4.92) than those without ASD. For individuals with ASD, the aIRR for suicide attempt among female individuals was 4.41-fold (95% CI, 3.74-5.19) higher compared with male individuals; for individuals without ASD, the aIRR for female individuals was 1.41-fold (95% CI, 1.39-1.43) higher compared with male individuals. Higher rates of suicide attempt were noted across all age groups for those with ASD. Persons with a diagnosis of ASD only had an aIRR of 1.33 (95% CI, 0.99-1.78) for suicide attempt, whereas those with other comorbid disorders had an aIRR of 9.27 (95% CI, 8.51-10.10) for suicide attempt compared with those without any psychiatric disorders. A total of 542 of 587 individuals with ASD (92.3%) who attempted suicide had at least 1 other comorbid condition and 48 of 53 individuals with ASD (90.6%) who died by suicide had at least 1 other comorbid condition. Conclusions and Relevance This nationwide retrospective cohort study found a higher rate of suicide attempt and suicide among persons with ASD. Psychiatric comorbidity was found to be a major risk factor, with more than 90% of those with ASD who attempted or died by suicide having another comorbid condition. Several risk factors are different from the risk factors in the general population, which suggests the need for tailored suicide prevention strategies.
... 16,17 Suicidality among autistic individuals is a prevalent and concerning issue. Two recent systematic reviews found that suicidality was present in 11%-66% of autistic samples, 18,19 rates that are substantially higher than those found in the general population. The mortality rate by suicide is also higher for autistic individuals when compared with the general population controls matched on gender and age (0.31% vs. 0.04%). ...
Article
Many autistic adults experience poor mental health. Research has consistently shown that cultivating self-compassion is a promising approach to strengthening resilience in nonautistic adults. Self-compassion is a trainable skill that is associated with several mental health benefits, such as higher levels of happiness and well-being as well as lower symptoms of depression and anxiety. However, no studies to date have explored self-compassion in autistic individuals. We suggest that self-compassion may be a relevant target in mental health interventions for autistic adults without severe or profound intellectual disability. Self-compassion may improve mental health in autistic adults through directly modifying emotions (as an emotion regulation strategy) or its interactions with emotion regulation processes. Existing approaches to cultivating self-compassion include identifying and practicing self-compassionate behaviors, using self-compassionate thought records, and practicing self-compassion meditations. Before self-compassion approaches are implemented by autistic adults, it will be necessary to evaluate their role and effectiveness in mental health through carefully designed studies. We suggest that researchers should first study the relationship between self-compassion and mental health outcomes in autistic adults. Once researchers have established the connection, we can then begin to study self-compassion-based interventions for autistic adults. Relevant clinical considerations include identifying the autistic groups that self-compassion practices are suitable for, determining how autistic adults with and without mental health conditions can effectively practice self-compassion (on their own and with the support of clinicians), and evaluating existing self-compassion tools or designing new tools. It is also relevant for future research to identify the enablers and barriers to using self-compassion in autistic adults.
... We also examined the risk for intentional selfharm by combining suicide and suicide attempt and other intentional self-harm into one variable, even though we are aware that mixed outcome measures (e.g. combination of suicide attempts and suicide) are not recommended (Segers and Rawana 2014). Also in this analysis we observed the same result, i.e., the association was explained by comorbid psychiatric disorders. ...
Article
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To examine the risk for premature mortality and intentional self-harm in autism spectrum disorders (ASD). Based on a national birth cohort. Children born in 1987–2005, diagnosed with ASD by 2007 (n = 4695) were matched with four non-ASD subjects (n = 18,450) and followed until 2015 for mortality and intentional self-harm. The risk among ASD subjects was elevated only for natural cause of death. The risk for intentional self-harm was increased in the unadjusted analyses, but decreased to non-significant after adjusting for comorbid psychiatric disorders. ASD subjects are at increased risk for premature mortality due to natural causes of death. While ASD subjects die of suicide and present with more self-harm, the association is explained by comorbid psychiatric disorders.
... studies have reported high rates of self-harming behaviour including suicidal attempt, ideation and completion in this population (Davignon et al., 2018;Hedley et al., 2018;Segers & Rawana, 2014). Depression and selfharming behaviour do not only have a negative impact on the quality of life of individuals with ASD but are also important risk factors for suicidal death, a leading cause of premature mortality in this population (Hirvikoski et al., 2016). ...
Article
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Lay abstract: Children with autism spectrum disorder are at increased risk of depression and self-harming behaviours. The question of whether timing of diagnosis of autism spectrum disorder is associated with these consequences in adolescence has not yet been studied. This exploratory study aimed to explore the association between depression and self-harming behaviour in adolescence and the parent-reported timing of diagnosis for autism spectrum disorder using a large population-based cohort in the United Kingdom. Most of the children with autism spectrum disorder in our study had within-typical-range cognitive ability. We found a linear association between timing of autism spectrum disorder diagnosis and depression and self-harming behaviour in adolescence; later diagnosis of autism spectrum disorder, particularly diagnosis in adolescence, was associated with the increased risk of self-reported depressive symptoms and self-harming behaviour in adolescence among children with autism spectrum disorder. Our findings, albeit observational, suggest that interventions targeting the earlier diagnosis of autism spectrum disorder and approaches to improve person-environment fit may help prevent secondary mental health problems in this population, particularly among those without cognitive delays and those diagnosed late. Further studies replicating across a wider intellectual spectrum and clarifying the underlying mechanism are warranted.
... While mental health concerns such as depression and anxiety are associated with suicide risk both generally and in autism (Cassidy et al. 2014;Hedley et al. 2018b), links between mental health concerns, non-suicidal self-injury, and suicidal thoughts and behaviors in autism are not straightforward (Hannon and Taylor 2013;Hedley and Uljarević 2018;Maddox et al. 2017;Richa et al. 2014;Segers and Rawana 2014). One emerging factor that requires further study is that rates of suicide are more uniform between males and females in autism (Hirvikoski et al. 2016;Kirby et al. 2019), in contrast to non-autism populations where men die by suicide more frequently than women. ...
Chapter
The presence of anxiety in individuals with autism has been recognized since the original description by Leo Kanner (1943), who noted that a number of children from his original sample experienced anxiety in response to particular objects and situations and also in response to sensory stimuli such as loud sounds or mechanical noises. Kanner remarked that children with autism displayed an “anxiously obsessive desire for the maintenance of sameness” (p. 245) and further speculated that some of the core autism features might be, at least in part, driven by high levels of anxiety. Almost 50 years ago, Rutter (1970) first reported depressive symptoms in a follow-up of an adolescent with autism. Despite these early descriptions and clear indications of pervasiveness and clinical impact, anxiety and depression have become a focus of autism research only in the past 20 years.
... ASD is estimated to effect 2 to 4% of the population [May, Sciberras, Brignell, & Williams, 2017]. Some individuals with ASD may display symptoms of a disruptive and/or challenging nature, which can include behaviors such as meltdowns, physical aggression, and violence toward others, non-suicidal self-injurious behaviors such as headbanging [McClintock, Hall, & Oliver, 2003] and suicidal behaviors at greater rates than neurotypical individuals [Segers & Rawana, 2014]. ...
Article
Parenting a child with autism spectrum disorder (ASD) is associated with high levels of stress. Several studies have conceptualized this as a traumatic stress response to challenging child behaviors such as self‐harm, suicidal ideation, and physical aggression toward caregivers. In the present study, we explored the relevance of a trauma‐based diagnostic framework to a sample of 30 mothers (M age = 42.97, SD = 5.82) of children with ASD (M age = 12.43, SD = 3.15). Participants were interviewed using the Clinician‐Administered PTSD Scale for DSM‐5 (CAPS‐5) for post‐traumatic stress disorder (PTSD) and an abbreviated Mini International Neuropsychiatric Interview to assess for comorbidity. Three participants were excluded as they met criteria for PTSD from a traumatic event unrelated to their parenting experience. Of the remaining 27 participants, 6 (22.2%) met criteria for PTSD in the context of traumatic parenting experiences. Descriptions of traumatic events experienced are summarized. Results suggest that, for some parents, challenging child behaviors such as physical violence toward the caregiver from the child, self‐injurious behaviors, and suicidal behaviors function as traumatic stressors as per Criterion A of PTSD (American Psychiatric Association [2013]. Diagnostic and statistical manual of mental disorders [DSM‐5]. Arlington, VA). This has implications for health professionals engaged with parents of children with ASD, who should consider the possibility of PTSD when challenging behaviors of a potentially traumatic nature are present. Autism Res 2020. © 2020 International Society for Autism Research, Wiley Periodicals, Inc. Lay Summary This study found that some challenging behaviors exhibited by children with autism spectrum disorder can be traumatic for parents and lead to the development of post‐traumatic stress disorder. Some of these behaviors included self‐harming behaviors like head banging, expressing suicidal urges, and becoming physically aggressive toward parents during meltdowns.
... Surgical intervention may be refused for unexpected reasons and careful exploration may be required to address concerns Orthopaedic surgeons and chronic pain specialists Ehlers-Danlos or hypermobility syndromes are increasingly recognised as associated with autism. Therefore, joint problems such as dislocations and chronic pain commonly occur Emergency department Autistic people are three times more likely to present to the emergency department, have increased admissions into hospital and are more likely to die post admission (Vohra et al, 2016) Psychiatry Between 7.3 and 15% of patients admitted following a suicide attempt may be autistic (Segers and Rawana, 2014). This is not something that would usually be considered by intensive care or medical teams, for example when someone is admitted following an overdose Copyright © CWP NHS Foundation Trust (2020). ...
Article
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The accompanying article set out why it is important to identify autistic people and the negative consequences of not recognising or understanding autism, including more severe illness and premature death. This article sets out what clinicians can do to help reduce those negative consequences by making ‘reasonable adjustments’ in any healthcare service in which they work.
... Table 1, a large part of our sample has a primary diagnosis of developmental and autism spectrum disorders. Though NSSI is associated with several psychiatric disorders (Nock et al., 2006;Segers & Rawana, 2014), it is possible that individuals with autism spectrum disorder engaging in NSSI (Moses, 2018) may find the internet-based design especially appealing due to the structured learning approach and a therapeutic communication form based on writing as is the case with this internet-based treatment of ERITA. This aspect calls for further investigation. ...
Article
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Non‐suicidal self‐injury (NSSI) is common in adolescents receiving psychiatric treatment and is a significant risk factor for suicidal behavior. There are few randomised clinical trials assessing interventions for NSSI in youth, and knowledge about internet‐delivered interventions is limited. We assessed the feasibility of Internet based Emotion Regulation Individual Therapy for Adolescents (ERITA) in psychiatric outpatients aged 13–17 years who engaged in NSSI. A randomised clinical feasibility trial with a parallel group design. Non‐suicidal self‐injury engaging patients were recruited from Child and Adolescent Mental Health Outpatient Services in the Capital Region of Denmark from May to October 2020. ERITA was provided as add‐on to treatment as usual (TAU). ERITA is a therapist‐guided, internet‐based program of emotion regulation and skills training involving a parent. The control intervention was TAU. Feasibility outcomes were the proportion who completed follow‐up interviews at end of intervention; proportion of eligible patients who participated in the trial; proportion of participants completing ERITA. We further investigated relevant exploratory outcomes, including adverse risk‐related events. We included 30 adolescent participants, 15 in each group (ERITA vs. Treatment as usual). 90% (95% CI, 72%–97%) of the participants completed post‐treatment interviews; 54% (95% CI, 40%–67%) of the eligible participants were included and randomised; and 87% (95% CI, 58%–98%) of the participants completed at least six out of 11 ERITA modules. We identified no difference for the primary exploratory clinical outcome of NSSI between the two groups. There are few randomised clinical trials assessing interventions for NSSI in youth, and knowledge about internet‐delivered interventions is limited. Based on our results we conclude that a large‐scale trial seems feasible and warranted. Internet based intervention for non‐suicidal self‐injury (ERITA) is tested in Child and Adolescent Mental Health Services in Denmark and found feasible warranting for further investigation in a large‐scale trial.
... In the 1990s, dialectical behaviour therapy (DBT) emerged as a rehabilitative technique for suicidal behaviour and borderline personality disorder. But researches have found similar suicidal ideation in ASD patients (Hedley and Uljarević 2018;Segers and Rawana 2014). Hedley and Uljarević (2018) have found that 25% of the total (N ¼ 76) adults with ASD had clinical range of depression and 20% had suicidal ideation. ...
Book
This book talks about the multidimensional biological etiology of Alzheimer’s disease and autism spectrum disorder which leads to distinctive ways of perception, thinking and learning in affected individuals. It provides a deeper emphasis on the need for early diagnosis, continuous assessment of patients and the proper educational methods and environment required towards enabling people affected with these disorders capable of evolving and learning. This book explores alternative solutions for autism spectrum disorder based on the theory of brain plasticity, the relationship between the gut microbiota and the central nervous system along with genetic factors and toxic metal exposures which are responsible for the oxidative damage resulting in a decreased ability of the patients to use objects or response to auditory stimuli. It also identifies and provides the latest research towards dealing with memory loss, which is the first sign of cognitive impairment followed by behavioral disturbances. These symptoms are associated with a rigorous neuronal decline and the appearance of two brain lesions, senile plaques and neurofibrillary tangles, which are mainly composed of Aβ and hyper phosphorylated tau protein respectively. This book also provides the latest research towards reducing autism disorder severity such as targeting the disease with symptomatic treatments such as cholinesterase inhibitors, NMDA receptor antagonist, β-secretase and γ-secretase inhibitors, α-secretase stimulators, tau inhibitors, immunotherapy, nutraceuticals, and nano drugs. This book will not only be a good resource for professors and lecturers teaching in the area of neuroscience, medicine, biochemistry, neuroinformatics, and nanotechnology, etc. but also for professionals working in the field of occupational therapy and geriatric clinics and rehabilitation.
... In the 1990s, dialectical behaviour therapy (DBT) emerged as a rehabilitative technique for suicidal behaviour and borderline personality disorder. But researches have found similar suicidal ideation in ASD patients (Hedley and Uljarević 2018;Segers and Rawana 2014). Hedley and Uljarević (2018) have found that 25% of the total (N ¼ 76) adults with ASD had clinical range of depression and 20% had suicidal ideation. ...
... While there are several review papers on suicide among autistic individuals, these papers have focused only on adolescents and young adults (Hannon & Taylor, 2013;O'Halloran, Coey, & Wilson, 2022), or have included all ages Richa, Fahed, Khoury, & Mishara, 2014;Segers & Rawana, 2014;Zahid & Upthegrove, 2017). Among a youth sample, the recent review by O'Halloran et al. (2022) found that roughly a quarter of autistic youth experienced suicidal ideation and one in ten had a history of suicide attempts, with bullying and other adverse childhood experiences found to be considerable risk factors. ...
Article
Autistic adults are a high-risk population for suicidal thoughts and behaviors (STBs). Accordingly, this systematic review aims to review the prevalence of STBs among autistic adults, review the risk and protective factors for STBs in autistic adults, and formulate a disorder-specific conceptualization of risk in this population. We systematically searched PsycINFO and Google Scholar for all studies published prior to March 28th, 2022. We included empirical articles focused on autistic adults, ages 18 years and older, reporting on suicide-related outcomes. In total, 45 peer-reviewed empirical articles were included in the current systematic review. The most frequently studied factors in relation to suicide risk among autistic adults were interpersonal constructs (42.4% of total studies looking at risk/protective factors) and depressive symptoms (36.4% of total studies looking at risk/protective factors). We conclude by summarize two key content areas: exploring social and interpersonal constructs and better understanding the role of depressive symptoms in autism. As researchers continue to explore STBs among autistic adults, it will be necessary to addressing the overreliance on autistic symptoms instead of autism diagnoses, measurement issues of STBs, and a need for treatment adaptations.
... Risk factors for suicidal thoughts or behaviors in ASD include male gender, Black or Hispanic self-identity, history of peer victimization, behavioral problems, lower socioeconomic status, and lower educational attainment [24]. Risk markers for suicidality shared with the general population including recurrent self-injurious behaviors, unstable employment, and mental health problems occur in a significantly greater proportion of autistic individuals. ...
Article
Full-text available
Autism spectrum disorder (ASD) is a lifelong neurodevelopmental condition typically diagnosed in childhood. The prevalence and impact of co-occurring behavioral and psychiatric disorders in individuals with ASD are substantial. A growing body of research reveals evidence of the frequent association between ASD, behavioral disturbances, suicidality, ADHD, mood disorders, anxiety disorders, OCD, catatonia, and psychosis including schizophrenia. In clinical practice, symptoms of many disorders that commonly emerge in the context of ASD have considerable overlap with core features of ASD, which adds to the diagnostic challenge. There are a growing number of evidence-based treatments and interventions for autism-related challenges as well as for the treatment of behavioral and psychiatric disorders in autistic individuals. Although most data regarding therapeutic options for ASD has focused on the pediatric population, there is an increasing emphasis on the development of interventions and services that are effective in ASD over the lifespan.
... Psychosocial risk factors in Autistic youth are well-documented. Segers and Rawana (2014) in a review of the literature, identified that suicidal behaviors have been identified within approximately 11%-50% of samples of children and adults with prevalence increasing with age. Hedley et al. (2018) found that nearly half of their sample of youth with ASD had clinically significant levels of depression and over one-third experienced suicidal ideation. ...
Article
Literature has discussed the intersectionality between autism and transgender and gender diverse (TGD) identities. Research has also identified the importance of protective factors, which are experiences that enhance positive outcomes in the face of potentially negative experiences. This exploratory quantitative survey study seeks to identify school and community-based protective factors that relate to psychological well-being and life satisfaction among 31 TGD Autistic youths between the ages of 13 to 17. The authors utilized adapted and full-forms of validated measures including the KID-SCREEN 27, Brief Multidimensional Students’ Life Satisfaction Survey Peabody Treatment Progress Battery, Adolescent Resilience Questionnaire, Perceived Coronavirus Threat Questionnaire, and Autism-Spectrum Quotient. Results suggest that community connectedness, school support, family availability, and self-identification of sexual orientation as queer were identified as protective factors. Implications for research and practice are discussed.
... This specifically included major depressive episodes, generalized anxiety disorder, social phobia, and antisocial personality disorder. There have been a number of systematic reviews (Hannon & Taylor, 2013;Richa et al., 2014;Segers & Rawana, 2014;Zahid & Upthegrove, 2017; see also Hedley & Uljarevic, 2018) suggesting that when compared with the general population, there is a very apparent overrepresentation of suicidal ideation, behavior, and deaths among individuals with ASD. Kõlves et al. (2021) have also found that psychiatric comorbidity is a significant risk factor, with more than 90% of those with ASD who attempted or died by suicide having another co-occurring condition. ...
Article
Julian Assange is an Australian national and the founder of WikiLeaks, a nonprofit organization that publishes news leaks and classified information provided by anonymous whistle-blowers. In May 2019, a United States federal grand jury returned an 18-count criminal indictment against Assange. If convicted, Assange could face up to 10 years of incarceration for each Espionage Act (1917) charge and up to 5 years for conspiracy to access a government computer network. Due to Assange’s current physical location in the United Kingdom, the United States has requested extradition. However, to date, there has been limited scholarly discussion of the relationship between Assange’s autism spectrum disorder (ASD) diagnosis and his potential extradition and lengthy pretrial or postconviction imprisonment in the United States. This article explores the psychiatric submissions from Assange and the United States in light of available evidence on ASD and the risk of suicide among people who are imprisoned. The analysis will focus on common misperceptions about ASD, the particularly detrimental impacts of the prison environment on individuals with ASD, the varying opinions of Assange’s ASD diagnosis, and the importance of considering Assange’s risk of suicide in the context of ASD. From a human rights and individual fairness perspective, a complete understanding of the significance of these issues which does not minimize a diagnosis of ASD is paramount for Assange and any future case with similar elements.
... While this focus on addressing child and adolescent suicide broadly is important, youth who might be particularly vulnerable to suicidality, such as autistic youth and youth with intellectual disability (ID), have received much less attention. A recent body of literature suggests that suicidal ideation and self-harm are more prevalent (Cassidy et al., 2018;Cassidy & Rodgers, 2017;Chen et al., 2017;Demirkaya et al., 2016;Horowitz, Thurm, et al., 2018;Kõlves et al., 2021;McDonnell et al., 2020;Oliphant et al., 2020;Segers & Rawana, 2014) and the incidence of suicide death is higher (Hirvikoski et al., 2016;Kirby et al., 2019;Kõlves et al., 2021) in the autism spectrum disorder (ASD) population than in the general population. Further, once erroneously thought to be protected from suicide because of an inability to comprehend the concept, it is now recognized that individuals with ID experience suicidality (Dodd et al., 2016;Ludi et al., 2012;Merrick et al., 2005;Mollison et al., 2014). ...
Article
Lay abstract: Youth suicide is a major problem in the United States and globally, but little is known about suicide risk in autistic youth and youth with intellectual disability specifically. Using data from the National Emergency Department Sample, which is the largest database of emergency department visits in the United States, we found that emergency department visits with a suicidal ideation or intentional self-inflicted injury diagnosis were more common in autistic youth and youth with intellectual disability than in youth without these diagnoses (i.e. the comparison group). This was true when examining both suicidal ideation diagnoses and intentional self-inflicted injury diagnoses at emergency department visits. In addition, the number of emergency department visits with a suicidal ideation or intentional self-inflicted injury diagnosis increased more from 2006 to 2014 in autistic youth and youth with intellectual disability compared with the comparison group. We also found both similarities and differences when examining factors, such as age, sex, and co-occurring mental health conditions, related to emergency department visits with a suicidal ideation or intentional self-inflicted injury diagnosis across groups that may be helpful for understanding suicide risk. It is urgent that we improve our understanding, assessment, and treatment of suicidality and self-harm in these groups through more research and clinical efforts.
... In the 1990s, dialectical behaviour therapy (DBT) emerged as a rehabilitative technique for suicidal behaviour and borderline personality disorder. But researches have found similar suicidal ideation in ASD patients (Hedley and Uljarević 2018;Segers and Rawana 2014). Hedley and Uljarević (2018) have found that 25% of the total (N ¼ 76) adults with ASD had clinical range of depression and 20% had suicidal ideation. ...
Chapter
Psychotic illness is a major health burden at the present world. Common psychotic disorders like autism spectrum disorders and schizophrenia frequently share clinical manifestations caused by brain dysfunction. However, there is a clear distinction between early- and late-onset psychotic illnesses. Despite appreciable advancement in identifying the genetic risk factors for most psychiatric illnesses, it is still unknown how these genetic variants interact with epigenetic risk factors and environmental factors that predispose risk for these clinically distinct disorders. In this chapter, we tried to trace the clinical features of psychotic illnesses and the relationship between these disorders with genetic insight. Furthermore, we reviewed the common therapeutic targets for these conditions. From the discussion, it is clear that psychotic illnesses share a genetic overlap and the therapeutic target of these abnormalities relies on the same pipeline. Therefore, prospects will be to develop more specific therapies for treating psychotic illnesses.
... In the 1990s, dialectical behaviour therapy (DBT) emerged as a rehabilitative technique for suicidal behaviour and borderline personality disorder. But researches have found similar suicidal ideation in ASD patients (Hedley and Uljarević 2018;Segers and Rawana 2014). Hedley and Uljarević (2018) have found that 25% of the total (N ¼ 76) adults with ASD had clinical range of depression and 20% had suicidal ideation. ...
Chapter
Alzheimer’s disease (AD) is a degenerative brain disease that is the leading cause of dementia among the human population. AD is characterized by accumulating amyloid plaques which are insoluble deposits of a 4 kDa peptide of ~40–42 amino acids in length, known as amyloid-β (Aβ). The imbalance between Aβ generation and clearance in the brain leads to the progression of AD. AD pathology is characterized by the deposition of oligomeric and fibrillar forms of amyloid-β (Aβ) in the neuropil and cerebral vessel walls. Neurofibrillary tangles are composed mainly of hyperphosphorylated tau and neurodegeneration. Polyphenols are the most abundant antioxidants in the diet. More than 8000 naturally occurring polyphenols exist. Numerous studies have indicated that high consumption of fruits and vegetables rich in flavonoids and other polyphenols reduces the risk/incidence of age-related neurodegenerative disorders, highlighting the importance of these polyphenols as neuroprotective agents. Due to polyphenols’ ability to influence and modulate multiple targets in the cascade of the pathogenesis of neurodegenerative diseases, they are considered a candidate with a promising result against neurodegeneration, halting the progression of the disease. There is now substantial evidence indicating that oxidative damage to the brain is an early AD pathogenesis event. Oxidative stress and damage to brain macromolecules are vital processes in neurodegenerative diseases. The antioxidant properties of many polyphenols are purported to provide neuroprotection. There are pieces of evidence that some of the polyphenols can easily cross the blood-brain barrier (BBB). This chapter will provide deeper insights into various polyphenols that play a pivotal role in AD and shed light on the roles of these in the context of AD therapeutics.
... In the 1990s, dialectical behaviour therapy (DBT) emerged as a rehabilitative technique for suicidal behaviour and borderline personality disorder. But researches have found similar suicidal ideation in ASD patients (Hedley and Uljarević 2018;Segers and Rawana 2014). Hedley and Uljarević (2018) have found that 25% of the total (N ¼ 76) adults with ASD had clinical range of depression and 20% had suicidal ideation. ...
Chapter
Full-text available
Neurodegenerative diseases are becoming more common in the people of old age. Numerous complications have occurred in the treatment of neurodegenerative diseases, some of which are multi-systemic in nature. Since the structure, efflux pumps, and expression of the blood-brain barrier’s (BBB) metabolism are limited, traditional drug delivery systems are ineffective for treating neurodegenerative disorders. Nanotechnology has the potential to significantly improve neurodegenerative disease treatment by bioengineered systems that interact with biological systems on a molecular level. This chapter discusses the applications of nanoparticles in the treatment of Alzheimer’s disease.
... 19% met criteria for MDD, and of this sample, 37% had associated psychotic symptoms and/or suicidality (Fig. 1). The high rate of depression may be attributed to ASD-related social issues, such as peer victimization [22], social difficulties [23,24], impaired ability to emotionally adapt to perceived social failures [25], greater loneliness [26], poorer quality of life [27] and lack of friendships [28] compared to neurotypical peers. Additionally, autistic individuals may engage in greater use of maladaptive forms of emotional regulation, such as rumination and shutting down (e.g. ...
Article
Full-text available
Background Autistic adolescents have greater predisposition to depression and suicidality than neurotypical adolescents. Early detection is essential for timely treatment. The Patient Health Questionnaire 9-item (PHQ-9) is a brief screen for depression. The study examines the validity of the PHQ-9 for detecting major depressive disorder (MDD) in autistic youths. Methods English speaking youths aged 10–18 years, with DSM-IV/DSM-5/ICD-10 diagnosis of Autism Spectrum Disorder (ASD), and their parents presenting to a child psychiatric service were invited to participate between May 2018 to August 2020. Participants completed the respective self- and parent-rated PHQ-9 independently. MDD was verified using the MINI-Kid (Mini-International Neuropsychiatric Interview, Kid version). Results One hundred one youth, mean (SD) age 14.6 (2.3), were enrolled. 27 (27%) met criteria for current MDD. Mean total PHQ-9 scores, percentage ratings for severity of symptoms of depression, functional impairment, dysthymia and suicidality were compared. Areas under the ROC curve and statistically optimal cutoffs were determined. Parents rated depressive symptoms severity lower than their children. The PHQ-9 displayed low sensitivity with high false negative rates at conventional, adjusted and proposed cutoffs. Conclusions Future studies should improve on the validity and reliability of existing depression screening tools, or develop more appropriate screening methods of depression, for autistic youths.
Chapter
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Since 1943, when Kanner introduced the term “Autism,” there has been much progress to identify the nature of impairment in autism spectrum disorder (ASD) among adults and children. Currently, it is classified as a neurodevelopment disorder marked by impaired social cognition, altered sensory stimulation and language deficiency with or without impaired IQ. Despite having clear diagnostic criteria, the heterogeneity in cognitive, language and intellectual abilities across type and ages perplexes the clinical picture of ASD and needs clinical expertise for diagnosis. This chapter outlines the nature of ASD and types of impairment broadly classified in the area of cognition, speech and language, intelligence impairment and executive dysfunctioning. Furthermore, the chapter highlights a range of rehabilitative technique for person with ASD, namely, dialectical behaviour therapy (DBT), cognitive behaviour therapy (CBT), pivotal response treatment (PRT), sensory motor training, parent-mediated intervention (PMT), speech therapy, music therapy and sensory integration therapy. This chapter has also highlighted the current scholarly debate about ASD and DLD (developmental language disorder) categorically different or on the same continuum.
Article
Adults diagnosed with Autism spectrum disorder (ASD) are at high risk of experiencing suicidality compared with other clinical groups. Recently, near-infrared spectroscopy (NIRS) studies have investigated the association between frontotemporal functional abnormalities and suicidality in patients with mood disorders. However, whether these prefrontal hemodynamic responses are associated with suicide vulnerability in individuals with ASD remains unclear. Here, we used 24-channel NIRS to examine the characteristics of prefrontal hemodynamic responses during a verbal fluency task in 20 adults with ASD and in age-, sex-, and intelligence quotient-matched healthy controls. In addition, we used Spearman's correlation analysis to identify the relationship between the time-course of prefrontal hemodynamic activation and the current suicide risk in patients with ASD. We found no significant differences between the verbal fluency task-induced prefrontal hemodynamic responses in the ASD vs. control group. However, we found a significant positive correlation between the current suicide risk score and the time-course of prefrontal hemodynamic activation in the ASD group. Thus, the 24-channel NIRS system appears to be useful in assessing suicide risk in individuals with ASD.
Article
Suicide-related behaviors are over-represented among youth with autism spectrum disorder (ASD). A more thorough understanding of the connections between ASD and suicide-related behaviors may help to identify potential avenues for prevention efforts and can inform clinical care for youth with ASD. This manuscript presents a conceptualization of suicide risk among youth with ASD based on the Interpersonal Theory of Suicide, in order to spur discussion and future research. This manuscript also provides preliminary clinical recommendations for improving suicide prevention efforts among youth with ASD based on hypothesized risk and protective factors.
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Resumo As altas taxas de ideações, tentativas e mortes por suicídio entre a comunidade de pessoas autistas é um tema que vem sendo investigado com frequência e profundidade. No interior de determinado segmento da ciência, que instrumentaliza a lógica neoliberal de gestão do sofrimento, se faz destacar o fenômeno do suicídio no âmbito do autismo, na mesma medida em que o lugar reservado ao sujeito autista se torna ausente de sua prática discursiva. Nesse contexto, este trabalho buscou produzir um levantamento bibliográfico sobre o tema em questão, com o objetivo de evidenciar as principais linhas de força atuantes nesta dimensão específica de sofrimento em pessoas autistas. Quando o enfoque da análise recaiu sobre as formas de expressão desses sujeitos em sofrimento, tornou-se incontornável assumir que o ato suicida faz ressaltar as marcas do ser, da falta-a-ser e da angústia frente ao real - atributos de uma experiência singular de sofrimento que o discurso da ciência tenta eliminar.
Poster
Ludwig’s angina (LA) is a rare severe diffuse cellulitis of the submandibular, submental and sublingual spaces of the neck, which can potentially be lethal. It commonly arises from an untreated dental infection, and it is characterised by its rapid ability to spread to surrounding tissues. Complications can result in acute airway obstruction, which is why pre-operative assessment is key in determining the presence of a difficult airway. We present a 42-year-old woman, who arrived in the emergency department with acute airway obstruction. She reported that she was afraid to visit the doctor to look at her dental abscess due to her fear of contracting COVID-19. After 1 week, it had become a very extensive neck abscess, with computed tomography showing invasion of deep-neck structures with significant distortion of the tracheal wall. The treatment required was to secure the airway and drain the abscess. There were two options to secure the airway: awake fibreoptic intubation or tracheostomy under local or inhalational anaesthesia. After discussion with the surgeon, we chose to go ahead with awake fibreoptic intubation, with the surgeon scrubbed and ready to secure the airway surgically. The airway was anaesthetised with a 4% lidocaine nebuliser and the patient was given oxygen along with intravenous dexmedetomidine and glycopyrrolate. Upon starting the awake intubation, there were too many secretions to visualise the vocal cords or airway, and after 20 min of struggle, we decided to switch to inhalational anaesthesia with sevoflurane. The patient started to desaturate and the airway was further obstructed. A tracheostomy was performed by the surgeon and the airway successfully secured. Afterward, the abscess was successfully drained and the patient was brought to the intensive care unit. After 3 days the tracheostomy was removed and the patient was discharged to the surgical floor and sent home a few days later uneventfully. Airway management is the first step in managing LA, as airway obstruction is the primary reason for death. A thorough pre-operative clinical assessment is important as it can identify features that could pose a risk for a difficult airway and allow for a quick decision on airway management. The anaesthetist must choose the safest option available given the clinical picture, the urgency to secure the airway, while preparations for an emergency surgical airway should be made available.
Thesis
This study explored resilience factors as identified by autistic adults with authentic lived experience. Historically, Autism Spectrum Disorder (ASD) has been diagnosed using deficit models and criteria designed by outsiders with little input from the autism community. While risk of adversity is often high for those with ASD, scant research exists looking at the strengths, adaptive skills, and environmental factors contributing to the resilience of people with ASD. Autistic adults were interviewed (N = 10) to assess which internal and external risks and protections participants deemed important to their resilience. Responses were coded, analyzed, and compared to existing resilience data from the literature. Results indicated a high overlap (87.5%) of risk and protection factors between existing literature and interview results. However, many novel risks and protections were shared by participants, and autistics likely need unique and individualized systems of support to nurture their development of resilience. Implications for the field of resilience research are presented, and new methods to assess the capacity of systems to foster autistic resilience are discussed.
Article
To assess the rates of dentition checks during emergency intubations, a series of covert observations of emergency intubations, followed by a survey of intubators were performed over a 1-month period in December 2019
Article
Objective: Self-harm among young autistic individuals is a clinical challenge, and the risk of premature death by suicide is strongly increased in this group. Using the advantage of total-population and family-based data we investigated whether autism per se is a risk factor for self-harm independently of psychiatric comorbidities and how it differs from self-harm in non-autistic individuals. Methods: We used The Stockholm Youth Cohort, a total-population register study, including all residents in Stockholm County aged 0-17 years between 2001-2011.Study participants were followed from age 10 to 27 for hospital admissions due to self -harm. We used modified Poisson regression to calculate relative risks (RR) using robust standard error to derive 95 % confidence intervals (CI). Results: In all, 410,732 individuals were included in the cohort (9,070 with a diagnosis of autism). Autistic individuals had a fivefold increased adjusted relative risk of self-harm (RR 5.0 [95 % CI 4.4-5.6]). The risk increase was more pronounced for autism without intellectual disability and particularly high for self-cutting 10.2 [7.1-14.7] and more violent methods 8.9, [5.2-15.4]. The association between autism and self-harm was independent of, but clearly exacerbated by comorbid psychiatric conditions. It was of similar magnitude as risks linked to these conditions per se, and not explained by shared familial factors. Conclusion: Self-harm severe enough to present to medical services is as common in autistic youth as in those with depression or ADHD. Potentially more lethal methods are more likely to be used of autistic self-harmers.
Article
Objectives Higher prevalence of suicidality has been reported in individuals with ASD. This study aimed to (1) Estimate the prevalence of suicidal ideation (SI) in epidemiologically-ascertained, population-based, samples of children with ASD or Autism Spectrum Screening Questionnaire (ASSQ) Screen Positivity (ASP); (2) Determine whether ASD/ASP is an independent risk factor for SI, controlling for known SI risk factors; and, (3) Develop an explanatory model for SI in children with ASD/ASP. Methods Participants came from three epidemiologically-ascertained samples of school-aged Korean children (n = 14,423; 3,702; 4,837). ASSQ ≥ 14 was the cutoff for ASP. A subsample (n = 86) was confirmed to have ASD. SI was based on parents’ endorsement of items on the Behavioral Assessment System for Children-2-Parent Report Scale-Children. Logistic regressions were used to assess associations between SI and ASD/ASP, controlling for demographics, peer victimization, behavior problems, and depression. To develop an explanatory model for SI within ASD/ASP, the associations between SI and child characteristics (comorbid conditions, ASD symptoms, IQ, adaptive function) were tested. Results SI was higher in children with ASD (14%) and ASP (16.6–27.4%) than ASSQ Screen Negative (ASN) peers (3.4–6.9%). ASD/ASP was strongly predictive of SI (ORs: 2.87–5.67), after controlling for known SI risk factors compared to ASN. Within the ASD and ASP groups, anxiety was the strongest predictor of SI. Conclusions SI prevalence was higher in non-clinical samples of children with ASD and ASP, relative to ASN peers. These results underscore the need for routine screening for SI in children with ASD and social difficulties, particularly those with high anxiety. • Highlights • Population-based, epidemiologically-ascertained, school-aged children • ASD and ASP are independent risk factors for SI in school-aged children • Anxiety is an independent risk factor for SI in children with ASD or ASP
Article
Background Adults on the autism spectrum are at high risk for co-occurring conditions and poor health outcomes, yet they often experience significant unmet healthcare needs. A better understanding of potential gaps and barriers is essential for improving the healthcare system. This mixed-methods study was conducted to better understand the healthcare needs and experiences of adults on the autism spectrum from the perspective of parents and caregivers. Method Twenty-four caregivers of adults on the autism spectrum (21 mothers, 2 fathers, 1 non-parent caregiver) completed surveys and participated in one of seven focus group interviews to share their perspectives regarding healthcare needs, experiences, and suggestions for improvement. Results Survey responses indicated general satisfaction with primary care; however, in-depth qualitative data analyses revealed four primary themes and 10 subthemes. The first theme focused on barriers to healthcare access and included insurance coverage, geographic distance, waitlists, and provider shortages. Caregivers also expressed dissatisfaction with healthcare quality (Theme 2), particularly a lack of provider knowledge resulting in inadequate treatment. Participants also emphasized the need for comprehensive and coordinated healthcare services (Theme 3), and described pressure on parents to advocate and coordinate care. Finally, caregivers stressed the importance of person-centered care (Theme 4), particularly the need for accommodations and rapport for adults on the spectrum. Conclusions These results indicate that the nature and quality of current healthcare services may not be adequate to meet the needs of adults on the autism spectrum. The suggestions provided by caregivers should be used to inform strategies for healthcare improvement.
Chapter
Offending in people with intellectual disability (ID) and/or autism spectrum disorder (ASD) is poorly understood. The evidence suggests that people with ID and/or ASD may be overrepresented in the criminal justice system and their presence is associated with an increased likelihood of future recidivism and custodial or more restrictive or punitive sentencing. The detection of offenders with ID and/or ASD has not been a priority across the criminal justice system which has concentrated on identifying offenders with severe mental illness. There is a growing evidence based on interventions such as risk assessment tools for people with ID but less so for those with ASD. Specific offence-related interventions such as sex offending treatment programmes that have shown promise and have been adopted into clinical practice. However, the treatment and management of offending behaviours in people with ID and/or ASD is complex. Targets for treatment to reduce future risk can include communication, anger, poor assertiveness, poor self-esteem, social isolation and frustration. A lack of treatment outcome studies means there is little evidence of the effectiveness of interventions aimed at preventing future offending although there has been support for CBT and some other psychological interventions. Deficits in ability, understanding and functioning associated with ID and ASD often mean lifelong involvement from multiple agencies for those who have contact with the criminal justice system, although in many places these are rarely provided for this group.
Article
Background Depressive symptoms are prevalent in autistic individuals. However, there is a limited understanding of what is known about depression in autistic children and adolescents. The aim of this scoping review is to examine the themes and the quality of studies on depressive symptoms in young autistic people. Method A search was conducted on the electronic databases PubMed and PsycINFO examining the themes and quality of the studies. Participant demographics and instruments used were also reviewed. Results Fifty-five studies met inclusion criteria. Four major themes emerged across the reviewed studies: 1) Prevalence and clinical presentation, 2) Associated features, 3) Intervention, 4) Psychometric properties. Thirty-one of the 55 studies (56%) were rated as Strong, 11 studies (20%) rated as Adequate, and 13 studies (24%) as Weak. Most studies were conducted on adolescents with IQ > 70. A variety of instruments were used to assess depressive symptoms. Conclusions Most studies have been conducted in the past decade. Clinical presentation and the associated features were the most studied themes. Very little is known on intervention targeting depression or studies examining psychometric properties of instruments in young autistic people. Further studies are needed to address the gap in research in the following area: 1) Validation of instruments used, 2) Symptoms in those with intellectual disability, 3) Longitudinal studies exploring the course of depression over time, 4) Correlates of depressive symptoms, and 5) Intervention specifically targeting depressive symptoms in ASD.
Poster
Carcinoid tumours are a subtype of neuroendocrine tumour, which typically begin in the digestive tract with the capability of producing bioactive substances such as serotonin, histamine and kinins. Perioperative anaesthetic management is required due to the possibility of carcinoid crisis (diarrhoea, flushing and hypotension). We present the case of a 64-year-old male patient with acute abdomen, who was indicated for colonoscopy and laparoscopy for a biopsy after a mass was seen on computed tomography, which confirmed carcinoid tumour in the small intestine. The patient was scheduled for an emergency laparotomy and was anaesthetised with propofol, rocuronium and fentanyl under rapid sequence induction, with his blood pressure significantly dropping shortly after. The patient received bolus high doses of phenylephrine and was put on infusion; however, his blood pressure could not be maintained. We administered bolus octreotide and a vasopressin infusion intra-operatively, and a good response was observed. Following the surgery, the patient was extubated uneventfully and transferred to the post-anaesthetic care unit to wean off from the phenylephrine and octreotide infusion. Carcinoid tumours can be a challenge for anaesthetists due to their clinical unpredictability. The goal of perioperative management is to prevent carcinoid crises and, additionally, these patients typically have a delayed emergence from anaesthesia as a result of high serotonin levels, hence requiring postoperative monitoring. This case highlights the need to use phenylephrine and vasopressin with octreotide in patients undergoing anaesthesia with carcinoid tumours, as there is a need to forgo many vasopressors and ionotropic drugs (adrenaline, noradrenaline, ephedrine, etc.), as well as other drugs used during anaesthesia such as succinylcholine and thiopental, to prevent carcinoid crises.
Article
Self‐Harm Significantly Higher in Populations with ADHD, Anxiety, ASD, Depression, and Eating Disorders. I appreciated your recent paper on the large and well‐matched studies on nonfatal self‐harm and suicide among adolescents in the UK Clinical Practice Research Datalink (Cybulski et al. 2021). This large study involved 56,008 self‐harm cases and 1,399,356 controls aged 10–19 years and reported that many diagnoses were associated with significantly higher rates of self‐harm. Compared to controls, the risk of self‐harm was significantly higher in attention‐deficit/hyperactivity disorder (ADHD) (OR 3.3, 95% CI 3.1–3.4), anxiety disorder (OR 3.8, 95% CI 3.7–3.9), autism spectrum disorder (ASD) (OR 2.4, 95% CI 2.3–2.6), depression (OR 7.9, 95% CI 7.8–8.2), and eating disorders (OR 3.1, 95% CI 3.0–3.2) (Cybulski et al. 2021).
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A young man with Asperger syndrome who presented with severe depression and self-injurious behaviour was treated with Ig sessions of cognitive-behavioural therapy. A decrease in the levels of measured depression and self-injury were found following the therapy. It remained unclear exactly which elements of the intervention brought about the improvements. The use of cognitive-behavioural treatments with people with Asperger syndrome is discussed.
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Self-injury is a frequent and serious problem for individuals with autism and developmental disabilities. This paper summarizes the clinical and empirical evidence pertaining to self-injury, and highlights valid theories and treatment options. Unlike most reviews of self-injury, the present one pays particular attention to the impact that research has made within the field of autism treatment. The importance of prospective large-scale research is stressed to support the development of treatments that should alleviate or even prevent the primary causes of self-injurious behaviour. This review aims to impart readers with an unambiguous conceptualization of self-injury and hopes to stimulate further research within the field.
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A preponderance of males with autism spectrum disorders (ASD) has been evident since the initial writings on the topic. This male predominance has consistently emerged in all ASD research to date in epidemiological as well as clinical populations. Despite this long recognized gender disparity in ASD, surprisingly there is a paucity of research addressing gender as it relates to core ASD symptom presentation. Gender differences may manifest with regard to symptom domains, severity, breadth, and so forth. The present review will discuss background (e.g., history, prevalence), assessment issues, gender differences in typically developing individuals in domains relevant to ASD, an in depth review of the literature base on the nature and etiology of gender differences in ASD, as well as future research directions and implications.
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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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The purpose of this paper was to integrate literature on positive psychology and adolescent well-being to provide a cohesive platform for future research and discussion. It is aimed at researchers, and mental health and educational professionals who are interested in the empirical evidence behind using positive psychology interventions with adolescents. The positive psychology concepts reviewed are: the authentic happiness theory, flow, hope, coaching, gratitude, kindness, and strengths-based interventions. Although positive psychology is only in its infancy, and more research in adolescent populations is needed, support for positive psychology interventions in fostering adolescent mental health is steadily accumulating.
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The purpose of this study was to examine the level of suicidal ideation and comorbid disorders (major depressive disorder, generalized anxiety disorder) among adolescents and young adults with diagnosed Asperger's syndrome (AS). A cross-sectional study using a self-administrated mail questionnaire and a Web-based questionnaire were used. Two samples were selected for this study. The first sample used snowball sampling, starting with parents of adolescents and young adults with diagnosed AS who participated in a qualitative study conducted in 2002. The second sample consisted of a volunteer sample of parents who visited Web sites for parents and individuals with diagnosed autism spectrum disorder. The sample included 10 adolescents and young adults with diagnosed AS. Fifty percent of the sample had a clinically significant level of suicidal ideation, 20% met criteria for a diagnosis of major depressive disorder, and 30% met criteria for generalized anxiety disorder.
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The Reynolds Adolescent Depression Scale (RADS) was first published in 1987 and since then has become one of the most used self-report measures of depression in adolescents. In 2002, the second edition of the RADS was published (RADS-2; Reynolds, 2002), which included the development of four empirically derived subscales that reliably evaluate meaningful components of depression in adolescents; extension of the age range to include 11- to 20-year-olds; a new standardization sample of 3,300 adolescents; standard scores (T scores) to assist in interpretation and comparisons across subscales; a new empirically derived clinical cutoff score; a quick scoring carbonless test protocol; and an expanded test manual with extensive psychometric information and interpretive procedures. Keywords: depression; adolescents; self-report
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Object: The first aim of this study was to find out whether Autism Spectrum Disorder (ASD) co-occurs with Borderline personality disorder (BPD). Secondly, we wanted to compare BPD-patients with and without ASD on a number of important clinical measures such as suicide attempts, self-harm, inpatient days, symptom burden, and describe characteristic features in patients with comorbid ASD and BPD. Method: Consecutively referred female patients with SCID-II-verified BPD were assessed for autistic traits. All patients were extensively investigated with interviews, neuropsychological testing and self-rating questionnaires and medical records were reviewed. Among the instruments used in the structured assessment procedure for all patients were measurement for self-image (SASB) and global functioning (GAF). Results: Six (15 %) of 41 patients with SCID-II-verified BPD fulfilled criteria for ASD. ASD patients had significantly more frequent suicide attempts. They also had significantly lower global functioning (GAF median 30 versus 44). The two groups did not differ in number of comorbid Axis I and II disorders with the exception of substance abuse which was more common in patients without ASD. Patients with ASD were found to have a more negative self-image in SASB. Conclusions: Comorbid ASD and BPD might indicate a group at high risk for suicide. Absence of substance abuse and pronounced negative self-image should lead to a clinical suspicion that Autism spectrum disorder might be present. These findings need to be replicated. There is a need for more studies in this complex patient group that challenges our capacity in therapeutic work. Limitations: The referral procedure of severely ill patients and the small number make it hard to generalize these findings to all patients with BPD.
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Self-harm and suicide are major public health problems in adolescents, with rates of self-harm being high in the teenage years and suicide being the second most common cause of death in young people worldwide. Important contributors to self-harm and suicide include genetic vulnerability and psychiatric, psychological, familial, social, and cultural factors. The effects of media and contagion are also important, with the internet having an important contemporary role. Prevention of self-harm and suicide needs both universal measures aimed at young people in general and targeted initiatives focused on high-risk groups. There is little evidence of effectiveness of either psychosocial or pharmacological treatment, with particular controversy surrounding the usefulness of antidepressants. Restriction of access to means for suicide is important. Major challenges include the development of greater understanding of the factors that contribute to self-harm and suicide in young people, especially mechanisms underlying contagion and the effect of new media. The identification of successful prevention initiatives aimed at young people and those at especially high risk, and the establishment of effective treatments for those who self-harm, are paramount needs.
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The Autism Diagnostic Observation Schedule—Generic (ADOS-G) is a semistructured, standardized assessment of social interaction, communication, play, and imaginative use of materials for individuals suspected of having autism spectrum disorders. The observational schedule consists of four 30-minute modules, each designed to be administered to different individuals according to their level of expressive language. Psychometric data are presented for 223 children and adults with Autistic Disorder (autism), Pervasive Developmental Disorder Not Otherwise Specified (PDDNOS) or nonspectrum diagnoses. Within each module, diagnostic groups were equivalent on expressive language level. Results indicate substantial interrater and test—retest reliability for individual items, excellent interrater reliability within domains and excellent internal consistency. Comparisons of means indicated consistent differentiation of autism and PDDNOS from nonspectrum individuals, with some, but less consistent, differentiation of autism from PDDNOS. A priori operationalization of DSM-IV/ICD-10 criteria, factor analyses, and ROC curves were used to generate diagnostic algorithms with thresholds set for autism and broader autism spectrum/PDD. Algorithm sensitivities and specificities for autism and PDDNOS relative to nonspectrum disorders were excellent, with moderate differentiation of autism from PDDNOS.
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The Child Neurology Society and American Academy of Neurology recently proposed to formulate Practice Parameters for the Diagnosis and Evaluation of Autism for their memberships. This endeavor was expanded to include representatives from nine professional organizations and four parent organizations, with liaisons from the National Institutes of Health. This document was written by this multidisciplinary Consensus Panel after systematic analysis of over 2,500 relevant scientific articles in the literature. The Panel concluded that appropriate diagnosis of autism requires a dual-level approach: (a) routine developmental surveillance, and (b) diagnosis and evaluation of autism. Specific detailed recommendations for each level have been established in this document, which are intended to improve the rate of early suspicion and diagnosis of, and therefore early intervention for, autism.
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Currently there are no brief, self-administered instruments for measuring the degree to which an adult with normal intelligence has the traits associated with the autistic spectrum. In this paper, we report on a new instrument to assess this: the Autism-Spectrum Quotient (AQ). Individuals score in the range 0–50. Four groups of subjects were assessed: Group 1: 58 adults with Asperger syndrome (AS) or high-functioning autism (HFA); Group 2: 174 randomly selected controls. Group 3: 840 students in Cambridge University; and Group 4: 16 winners of the UK Mathematics Olympiad. The adults with AS/HFA had a mean AQ score of 35.8 (SD = 6.5), significantly higher than Group 2 controls (M = 16.4, SD = 6.3). 80% of the adults with AS/HFA scored 32+, versus 2% of controls. Among the controls, men scored slightly but significantly higher than women. No women scored extremely highly (AQ score 34+) whereas 4% of men did so. Twice as many men (40%) as women (21%) scored at intermediate levels (AQ score 20+). Among the AS/HFA group, male and female scores did not differ significantly. The students in Cambridge University did not differ from the randomly selected control group, but scientists (including mathematicians) scored significantly higher than both humanities and social sciences students, confirming an earlier study that autistic conditions are associated with scientific skills. Within the sciences, mathematicians scored highest. This was replicated in Group 4, the Mathematics Olympiad winners scoring significantly higher than the male Cambridge humanities students. 6% of the student sample scored 327plus; on the AQ. On interview, 11 out of 11 of these met three or more DSM-IV criteria for AS/HFA, and all were studying sciences/mathematics, and 7 of the 11 met threshold on these criteria. Test—retest and interrater reliability of the AQ was good. The AQ is thus a valuable instrument for rapidly quantifying where any given individual is situated on the continuum from autism to normality. Its potential for screening for autism spectrum conditions in adults of normal intelligence remains to be fully explored.
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Limited information is available about the occurrence of depression in children with autism and other pervasive developmental disorders (PDD). Although depression has been described in autistic children, questions about its validity have often been raised. One approach to address this issue is to investigate family histories of those autistic children diagnosed with clinical depression. Based on data available in nonautistic children, autistic children with depression would be expected to show an increased family history of depression. Since studies of this nature have not been attempted in autistic children, we compared the family history of 13 autistic/PDD children with depression (11 male; 2 female; M full-scale IQ 86.2, SD 24.2; M age 10.4 years, SD 2.2) with 10 autistic/PDD children without a history of current or previous depression (9 male; 1 female; M full-scale IQ 67, SD 12.9; M age 10.5 years, SD 1.6). Diagnosis of depression was based on the DSM-III-R criteria and confirmed independently by two psychiatrists. Ten (77%) of the depressed children had a positive family history of depression compared to 3 (30%) of the nondepressed group, t(21) = –2.4; p = .02. These findings lend support to the validity of depression as a distinct condition in some children with autism/PDD and suggest that, as in the normal population, autistic children who suffer from depression are more likely to have a family history of depression.
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In 2001, the Autism Spectrum Disorders-Canadian-American Research Consortium (ASD-CARC) launched a program of research on autism spectrum disorders (ASD). As part of that undertaking, and in response to concerns about the growing proportion of children diagnosed with ASD, the National Epidemiologic Database for the Study of Autism in Canada (NEDSAC; www.nedsac.ca) was created as a multi-site ASD surveillance program. Government departments, clinicians and researchers collaborated to establish regional teams to collect information on children with ASD in British Columbia, Calgary (Alberta), Manitoba, southeastern Ontario, Prince Edward Island, and Newfoundland and Labrador. NEDSAC provides estimates of the prevalence of ASD in Canadian children and a profile of those who are affected, and allows researchers to monitor trends in age at diagnosis. These data can help the health, education and social services sectors with planning and allocation of resources.
Chapter
The Checklist for Autism Spectrum Disorder (CASD) is a quick and valid instrument for screening for and diagnosing children with autism across the entire autism spectrum, regardless of age, IQ, or autism severity. The CASD is for children 1–16 years of age and is completed and scored by clinicians or parents in 15 min. The 30 CASD symptoms are scored as present or absent based on lifetime occurrence. The CASD is normed and standardized on 2,469 children with autism, other clinical disorders, and typical development (Mayes SD. Checklist for autism spectrum disorder. Chicago: Stoelting; 2012). Children with high-functioning autism and low-functioning autism earn CASD total scores at or above the autism cutoff of 15. In contrast, children with typical development, attention deficit hyperactivity disorder, anxiety disorder, depression, oppositional-defiant disorder, language disorder, learning disability, mental retardation, cerebral palsy, traumatic brain injury, and hearing impairment have CASD scores below 15. In the United States national standardization study conducted by the Stoelting Company, the CASD completed by clinicians differentiated children with and without autism with 99.5 % accuracy.
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The Krug Asperger's Disorder Index (KADI) is an individually administrated, norm referenced screening instrument that provides useful information for determining the diagnosis of Asperger's Disorder.
Article
Purpose – The paper aims to provide an overview of the current situation with diagnosis and assessment in autism spectrum disorders (ASD). Design/methodology/approach – The paper is a review of literature combined with personal observation of practice. Findings – Diagnosis cannot be determined by any one tool. It is a clinical judgement. A solo experienced clinician can make a diagnosis. Wider assessment is needed post diagnosis and needs a team. Practical implications – Specialist multidisciplinary teams to assess people with ASD should be set up for adults as well as for children. Originality/value – The paper is of value to those who are designing and providing diagnostic and assessment services. It provides a new review, covering a wider area.
Article
Frequency of suicide ideation and attempts in 791 children with autism (1–16 years), 35 nonautistic depressed children, and 186 typical children and risk factors in autism were determined. Percent of children with autism for whom suicide ideation or attempts was rated as sometimes to very often a problem by mothers (14%) was 28 times greater than that for typical children (0.5%) but less than for depressed children (43%). For children with autism, four demographic variables (age 10 or older, Black or Hispanic, lower SES, and male) were significant risk factors of suicide ideation or attempts. The majority of children (71%) who had all four demographic risk factors had ideation or attempts. Comorbid psychological problems most highly predictive of ideation or attempts were depression, behavior problems, and teased. Almost half of children with these problems had suicide ideation or attempts. All children with autism should be screened for suicide ideation or attempts because ideation and attempts in autism are significantly higher than the norm and are present across the spectrum. This is especially important for children who have the demographic and comorbid risk factors, many of which can be targeted for intervention to reduce and prevent suicide ideation and attempts.
Article
In recent years, increased attention has been paid to the development and application of the strengths perspective and positive youth development. This paper develops youth promotion practice as a convergence of a strengths perspective and youth development principles. Historical and contemporary contexts of a problem-focused perspective in social work with adolescents are reviewed and a critique developed with emphasis on the evolution of strengths-focused practices. The importance and possibility of combining the strengths perspective and youth development toward youth promotion practice are addressed. Youth promotion is defined as a process of enhancing youth strengths and resources to promote positive outcomes and help young people be healthy adults. Complementary aspects of the two perspectives are expected to support and supplement the strengths and weaknesses of each perspective in synergistic ways. Several advantages of youth promotion practice are discussed as well as its implications for improved social work practices with adolescents.
Article
Significant progress has been made over the past two decades in the development of screening and diagnostic instruments for autism spectrum disorders (ASD). This article reviews this progress, including recent innovations, focussing on those instruments for which the strongest research data on validity exists, and then turns to addressing issues arising from their use in clinical settings. Research studies have evaluated the ability of screens to prospectively identify cases of ASD in population-based and clinically-referred samples, as well as the accuracy of diagnostic instruments to map onto 'gold standard' clinical best estimate diagnosis. However, extension of the findings to clinical services must be done with caution, with a full understanding that instrument properties are sample-specific. Furthermore, we are limited by the lack of a true test for ASD, which remains a behaviourally-defined disorder. In addition screening and diagnostic instruments help clinicians least in the cases where they are most in want of direction, since their accuracy will always be lower for marginal cases. Instruments help clinicians to collect detailed, structured information and increase accuracy and reliability of referral for in-depth assessment and recommendations for support, but further research is needed to refine their effective use in clinical settings.
Article
Objective: The objective of this study was to investigate the frequency and clinical features of suicide attempts in adults with autism spectrum disorders (ASDs). Methods: We enrolled 587 consecutive patients aged 18 or over who attempted suicide and were hospitalized for inpatient treatment. Psychiatric diagnoses, suicide attempt frequency and clinical features were compared between ASD and non-ASD patients. Results: Forty-three (7.3%) of the 587 subjects who attempted suicide had ASDs. The incidence of patients with mood disorders was significantly lower (Fisher's Exact Test, P=.043) and that of those with an adjustment disorder was significantly higher (Fisher's Exact Test, P<.001) in the ASD group than in the non-ASD group. The average length of stay at both the hospital and intensive care unit in the ASD group was longer than that in the non-ASD group (z=-2.031, P=.042; z=-2.322, P=.020, respectively). Conclusions: ASDs should always be a consideration when dealing with suicide attempts in adults at the emergency room.