Self-harm, suicidal thoughts common in people with autism

People with autism are more than four times as likely as their typical peers to be admitted to the hospital after harming themselves. And many people with autism frequently entertain thoughts about suicide.

Two sets of researchers presented the unpublished results today at the 2017 International Meeting for Autism Research in San Francisco, California.

A diagnosis of both autism and attention deficit hyperactivity disorder (ADHD) puts people at an even higher risk of hospitalization than autism alone, the first study found.

Researchers examined hospital records from the Stockholm Youth Cohort, which includes 696,612 people from birth to age 27. Among those, 11,663 have an autism diagnosis, and about 300 of them, or 2.6 percent, have been admitted for self-harm at least once.

This study is among the largest to probe the relationship between autism and self-harming behavior. In January, researchers in Colorado published an analysis of the medical records of 8,000 children and showed that one in four children with autism harm themselves. Other research has linked having autism as well as either impulse control or digestive problems to self-injury.

The new study looked at behaviors such as cutting and poisoning and at more potentially lethal acts, such as self-strangulation or jumping from a high location. Having autism puts people at 5.7 times the ordinary risk for these more dangerous forms of self-injury, the researchers found.

“As a clinician, I want my colleagues to bear in mind that patients with autism are supposed to be considered a risk group,” says Isidora Bubak, a psychiatrist at Saint George Hospital in Sweden, who presented the findings. Bubak says several previous studies on self-harm excluded people with autism from analysis.

People who have both autism and ADHD are 8.5 times more likely than their typical peers to harm themselves. Having autism and intellectual disability, by contrast, is not associated with being admitted to the hospital for these behaviors.

Bubak plans to analyze the data for people with autism and depression, and for differences between men and women with autism.

Dark thoughts:

In a separate study, also presented today, researchers in Maine reported that some children with autism who are in specialized hospitals frequently think about suicide.

The researchers found that 23 percent of 107 individuals with autism, ages 10 to 20, had talked ‘very often’ or ‘often’ with their parents about death or suicide. The researchers gleaned the data from a single question asked on a slew of psychological tests given to the participants.

The finding has several limitations, including the small sample size and the fact that it was an incidental result from a larger study. That the answers came from a single question points to a larger problem researchers face when trying to measure suicidal ideation in autism, says lead researcher Matthew Siegel, director for the Center for Autism and Developmental Disorders in South Portland, Maine.

There is no valid screening tool to measure suicide risk for people with autism, says Siegel, who presented the finding. Questions that identify this risk in the general population — such as whether someone is obsessed with horror films — are liable to be interpreted differently by people with autism and may skew the results.

The usual questionnaires may also conflate involuntary behaviors seen in some severely affected individuals — such as repetitively hitting themselves — with suicidal behavior, he says.

A detailed psychiatric interview with a clinician who is able to ferret out these differences is important, Siegel says.

“A lot of work needs to be done to develop sensitive and specific measures,” he says. “When I look at the standard screening measures that are out there for youth or adults and I think about applying these to people with autism, they cause me a fair bit of worry.”

For more reports from the 2017 International Meeting for Autism Research, please click here.