Assessing and Managing Suicide Risk in Autistic Youth: Findings from a Clinician Survey in a Pediatric Psychiatric Emergency Setting

Cervantes, Paige E.; Li, Annie; Sullivan, Katherine; Seag, Dana E M; Baroni, Argelinda; Horwitz, Sarah McCue

doi:10.1007/s10803-022-05448-8

Cited by 7 publications

(11 citation statements)

References 45 publications

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“…Because ED clinicians are not often specialized in the evaluation of neurodevelopmental and psychiatric diagnoses, ASD, ID, and suicidal ideation and intentional self-inflicted injury diagnoses coded at ED visits likely represent underestimations of true prevalence. This may be particularly true for suicidal ideation and self-harm at visits by autistic youth and youth with ID, as clinicians may be less confident assessing and managing suicide risk in these groups (Cervantes, Li, et al, 2022; Jager-Hyman et al, 2020) and validated instruments to screen for suicide risk in autistic youth and youth with ID do not yet exist (Howe et al, 2020; Ludi et al, 2012). Next, as discussed, a minority of ED visits in the ASD group include visits by youth with both ASD and ID diagnoses (~9%), which is less than would be expected based on data from the ADDM Network and may point to under-identification, suggesting that maintaining these visits in the sample would be a cautious approach to analyses.…”

Section: Discussionmentioning

confidence: 99%

Suicidal ideation and intentional self-inflicted injury in autism spectrum disorder and intellectual disability: An examination of trends in youth emergency department visits in the United States from 2006 to 2014

Cervantes

Brown

Horwitz

2022

Autism

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Substantial efforts have been dedicated to understanding, assessing, and managing suicide risk in youth broadly. However, little attention has been focused specifically on autistic youth and youth with intellectual disability. Because emergency departments are an essential point of suicide-related care, we used the National Emergency Department Sample databases to explore differences in prevalence of U.S. emergency department visits with a suicidal ideation or intentional self-inflicted injury ICD-9 diagnostic code by autistic youth, youth with intellectual disability, and youth without these diagnoses (i.e. the comparison group). Emergency department visits with a suicidal ideation or intentional self-inflicted injury diagnosis were more prevalent in autistic youth (5.1%) and youth with intellectual disability (6.6%) than in the comparison group (1.2%). Similar results were found when examining visits with a suicidal ideation diagnosis and with an intentional self-inflicted injury diagnosis separately. Prevalence of these emergency department visits increased more from 2006 to 2014 in autistic youth and in youth with intellectual disability than in the comparison group and were correlated with common and distinct sociodemographic and clinical factors across groups. Results suggest autistic youth and youth with intellectual disability may be uniquely vulnerable to suicide risk, highlighting the urgency of addressing suicidality and self-harm in these groups, particularly within emergency department settings. 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.

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Section: Discussionmentioning

confidence: 99%

Suicidal ideation and intentional self-inflicted injury in autism spectrum disorder and intellectual disability: An examination of trends in youth emergency department visits in the United States from 2006 to 2014

Cervantes

Brown

Horwitz

2022

Autism

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“…Because a goal of this project was to build a referral list for emergency department clinicians, as part of a larger effort to enhance universal youth suicide risk screening and management in several emergency department settings, this lack of service availability has serious implications for their care. Clinicians that serve autistic youth in psychiatric crisis within emergency departments are often left with no or very limited options for referral at discharge (Cervantes et al, 2022). Because it is well documented that barriers to accessing outpatient services increase the probability of recurring MH crises in the future, this lack of MH service availability for autistic youth is a substantial issue.…”

Section: Discussionmentioning

confidence: 99%

Mental health service availability for autistic youth in New York City: An examination of the developmental disability and mental health service systems

Cervantes

Conlon

Seag

et al. 2022

Autism

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Psychiatric conditions are common in autism; however, a multitude of barriers exist in accessing community-based mental health care for autistic youth. Perhaps the first and most formidable barrier is identifying a provider that offers mental health treatment to autistic youth within the many service systems involved in supporting the autism community. These systems typically function independently of one another, contributing to the complexity of accessing services. To identify gaps caused by New York’s multisystem care model for autistic youth, and as part of a larger quality improvement initiative to advance suicide risk management in several New York City emergency departments, we conducted a telephone survey to identify outpatient mental health service availability for autistic youth with depressive symptoms or suicidal thoughts or behaviors in New York City across the state’s mental health and developmental disability systems. Results demonstrated that while a greater proportion of clinics in the mental health system compared with agencies in the developmental disability system offered outpatient mental health services to autistic youth (47.1% vs 25.0%), there is remarkably limited service availability overall. Efforts to reduce these care inequities through policy reform and improving workforce capacity are urgently needed. Lay abstract Autistic children and adolescents experience high rates of co-occurring mental health conditions, including depression and suicidality, which are frequently identified by stakeholders as treatment priorities. Unfortunately, accessing community-based mental health care is often difficult for autistic youth and their families. The first obstacle families confront is finding a provider that offers mental health treatment to autistic youth within the many service systems involved in supporting the autism community. The mental health and developmental disability systems are two of the most commonly accessed, and previous work has shown there is often confusion over which of these systems is responsible for providing mental health care to autistic individuals. In this study, we conducted a telephone survey to determine the availability of outpatient mental health services for autistic youth with depressive symptoms or suicidal thoughts or behaviors in New York City across the state’s mental health and developmental disability systems. Results showed that while a greater percentage of clinics in the mental health system compared with in the developmental disability system offered outpatient mental health services to autistic youth (47.1% vs 25.0%), many more did not offer care to autistic youth and there were very few options overall. Therefore, it is important that changes to policy are made to increase the availability of services and that mental health care providers’ knowledge and confidence in working with autistic youth are improved.

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“…This highlights the need for clinical training to develop speci c validated tools for the SRA of individuals with ASD, adaptations, and training in suicidal prevention practices. Of particular importance, those with previous ASD training indicated being more comfortable in managing STB for this population (Cervantes et al, 2022) it is critical to the formulation and treatment planning to make the correct diagnosis so that ASD strategies can be factored into the formulation and treatment plan.…”

Section: Diagnostic Challengesmentioning

confidence: 99%

“…Clinical research studies are in process to determine the e cacy and psychometric properties of the NIMH-developed Ask Suicide-Screening Questions (ASQ) for youth with ASD and Neurodevelopmental Disorders in order to assure the ability to determine the risk for hurting or killing himself or herself this vulnerable population served by the NIMH. (Ask Suicide-Screening Questions (ASQ) Toolkit, n.d.)Hesitancy among clinicians(Cervantes et al, 2022) has been documented in their use diagnostic screening tools themselves or their overreliance on evidence-based assessment, e.g., ADOS-2 which has long wait times delaying diagnosis, particularly in rural and underserved areas (M..…”

mentioning

confidence: 99%

Autism and Suicide: Strategies to Dovetail Emerging Evidence in Child and Adolescent Suicide Risk Assessments

Gupta,

Petti

2023

Preprint

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Background: This narrative review provides readers with a greater awareness of the increasing prevalence of diagnosed autism spectrum disorder (ASD) in psychiatric clinical settings and the high risk that ASD and autistic traits in the population place the affected individuals at heightened risk for suicidality and suicide. Methods: It represents a comprehensive, systematic literature review. supplemented with reverse citations to assure updated information. By title and abstract 456 articles were identified 456 and 71 articles met the inclusion criteria. Out of those, 50 articles were used for initial review and 15 were added later, manually or through reverse citations. Results: Results indicate that associated suicidal thoughts and behaviors (STB) with ASD, many concomitants comorbid mental health conditions ASD, and suicide risk factors that overlap with ASD symptoms are not clearly understood. Higher rates of STB and suicide have been identified across the age spectrum with ASD/high autistic traits compared to those from the general population in age/sex-matched comparison groups. Increased risk of STB in higher functioning ASD is emphasized. Interpersonal conflict and depression are significant risk factors as are comorbid borderline personality, bipolar disorder, anxiety, and obsessive-compulsive disorders. Conclusions: Multiple diagnostic challenges are considered that support the need for more focused research in this area, better, more ASD-related screening instruments that address the unique features of ASD-related psychopathology, and improved training for clinicians in screening and preventive efforts for enhanced competence and greater comfort in dealing with STB in those with autistic traits and ASD.

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Assessing and Managing Suicide Risk in Autistic Youth: Findings from a Clinician Survey in a Pediatric Psychiatric Emergency Setting

Cited by 7 publications

References 45 publications

Suicidal ideation and intentional self-inflicted injury in autism spectrum disorder and intellectual disability: An examination of trends in youth emergency department visits in the United States from 2006 to 2014

Suicidal ideation and intentional self-inflicted injury in autism spectrum disorder and intellectual disability: An examination of trends in youth emergency department visits in the United States from 2006 to 2014

Mental health service availability for autistic youth in New York City: An examination of the developmental disability and mental health service systems

Autism and Suicide: Strategies to Dovetail Emerging Evidence in Child and Adolescent Suicide Risk Assessments

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