Suicide attempts or ideation were a problem in 43% of autistic children compared with 14% of depressed nonautistic children and 0.5% of children with neither depression nor autism, in a prospective study of 1,012 children.

Mothers of the children rated 165 items on the Pediatric Behavior Scale from "not at all a problem" to "very often a problem." Suicide ideation and attempts were considered a problem if they occurred anywhere from sometimes to very often.

"Because suicide ideation and attempts in autism are significantly higher than the norm, all children with autism should be screened for suicide ideation or attempts," Angela A. Gorman, Ph.D., said at a poster presentation at the annual meeting of the American Academy of Child and Adolescent Psychiatry.

Among the 179 autistic children, 77% of those with suicide ideation or attempts were depressed, but only 28% of those with depression had suicide ideation or attempts. Among autistic children without depression, 95% had no suicide ideation or attempts, reported Dr. Gorman, a clinical psychologist in the department of psychiatry at Pennsylvania State College of Medicine, Hershey, and her associates.

The autistic children ranged in age from 1 to 16 years; 68% had high-function autism (defined as an IQ of 80 or higher), and the rest had low-functioning autism. The 35 nonautistic children with depression ranged in age from 8 to 16 years, and the 186 typical children were 6-12 years old.

Males comprised 84% of the autistic group, 26% of the nonautistic depressed group, and 44% of the typical group. The proportions of parents whose occupations were professional or managerial (indicating higher socioeconomic status) were 37% in the autistic group, 51% in the nonautistic with depression, and 51% in the typical group. The study cohort came mainly from rural, central Pennsylvania, where white children made up 92% of the autistic group, 94% of the nonautistic with depression, and 78% of the typical group.

The study assessed numerous variables to identify multiple risk factors in children with autism. Suicide ideation or attempts were more common in autistic males (15%) than females (7%); children with nonprofessional parents (16%), compared with those with professional parents (10%); black or Hispanic children (28%), compared with white or Asian children (13%); and in youths aged 10-16 years (32%), compared with those aged 1-9 years (10%).

Rates of suicide ideation or attempts increased with the number of risk factors, with rates of 11%-71% in children with two to four of these demographic risk factors (male sex, lower socioeconomic status, black or Hispanic race/ethnicity, and older age), Dr. Morgan reported.

Higher rates of suicide ideation or attempts also were seen in autistic children whose mothers reported that the child had been teased (19%) than in those who were not teased, in those who were depressed (26%), compared with nondepressed (5%), and in those with behavior problems (24%), compared with children without behavior problems (7%).

Rates of suicide ideation or attempts increased from 6% to 46% in autistic children with one to three of these comorbidity risk factors (teasing, depression, or behavior problems).

Screening for suicidality is especially important for children with these demographic and comorbidity risk factors, because the children’s risk might be reduced by interventions focused on teasing, mood, behavior problems, depression, and adversities related to race or socioeconomic status, Dr. Morgan said.

Factors that were not associated with suicide ideation and attempts in autistic children included IQ, the severity of autism, attention deficit, hyperactivity, psychosis, eating disturbances, or excessive sleep.

The study "reminds us that there’s the issue of ‘diagnostic overshadowing’ that can occur with patients – kids and adults – who are on the autism spectrum," she said. "We have to remember that these individuals also suffer from other disorders" and that symptoms of depression, suicidal ideation, and suicide behaviors should not be overlooked.

Because the study relied on parental reports, it provides a better understanding of how children with autism are perceived by their parents, but more research is needed to discern whether the children truly were considering and attempting to kill themselves or whether some of these were attempts by the autistic children to communicate something else.

"It’s important to screen more thoroughly when we have patients on the autism spectrum and make sure that we’re really understanding what’s going on with them," she said.

The investigators hope to expand their research to include other clinical sites, especially more urban sites, with a greater diversity of children.

Previous studies have shown depressed mood in 54% of children with high-functioning autism and 42% of children with low-functioning autism, she said. The current study appears to be the first to investigate suicidal ideation and attempts in autistic children.

Dr. Gorman reported having no financial disclosures.

s.boschert@elsevier.com

On Twitter @sherryboschert

Higher suicidality seen in autistic children