Suicidality Among Children and Youth With and Without Autism Spectrum Disorder: A Systematic Review of Existing Risk Assessment Tools

Howe, Stephanie J.; Hewitt, Kim; Baraskewich, Jessica; Cassidy, Sarah; McMorris, Carly A.

doi:10.1007/s10803-020-04394-7

Cited by 41 publications

(32 citation statements)

References 66 publications

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“…Given that autistic and possibly autistic people are at high risk of suicidality, it is crucial that appropriate and valid assessment tools are available to accurately identify suicidal thoughts and behaviours in these groups. However, systematic reviews have shown that no suicidality assessment tool has yet been validated for autistic people [16][17]. A suicidality assessment tool developed for non-autistic people -the Suicide Behaviours Questionnaire -Revised [18] -was identi ed as a promising candidate tool to adapt for autistic people, given the moderate to strong evidence in support of a range of measurement properties when used in general population research [16].…”

Section: Introductionmentioning

confidence: 99%

Development and Validation of the Suicide Behaviours Questionnaire – Autism Spectrum Conditions in Autistic, Possibly Autistic and Non-Autistic Adults.

Cassidy

Bradley

Cogger-Ward

et al. 2020

Preprint

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Background: Autistic people and those with high autistic traits are at high risk of experiencing suicidality. Yet, there are no suicidality assessment tools developed or validated for these groups.Methods: A widely used and validated suicidality assessment tool developed for the general population (SBQ-R), was adapted using feedback from autistic adults. The adapted tool was refined through 9 interviews, and an online survey with 251 autistic adults, to establish clarity and relevance of the items. Subsequently, 308 autistic, 113 possibly autistic, and 268 non-autistic adults completed the adapted tool online, alongside self-report measures of autistic traits (AQ), camouflaging autistic traits (CAT-Q), depression (PHQ-9), anxiety (ASA-A), thwarted belongingness and perceived burdensomeness (INQ-15), lifetime non-suicidal self-injury, and the original version of the suicidality assessment tool (SBQ-R). Analyses explored the appropriateness and measurement properties of the adapted tool between the groups.Results: There was evidence in support of content validity, structural validity, internal consistency, convergent and divergent validity, test retest validity, sensitivity and specificity (for distinguishing those with or without lifetime experience of suicide attempt), and hypothesis testing of the adapted tool (SBQ-ASC) in each group. The structure of the SBQ-ASC was equivalent between autistic and possibly autistic adults, regardless of gender, or use of visual aids to help quantify abstract rating scales.Limitations: The samples involved in the development and validation of the adapted tool were largely female, and largely diagnosed as autistic in adulthood, which is not representative of the wider autistic population. The SBQ-ASC has been developed for use in research and is not recommended to assess risk of future suicide attempts and/or self-harm.Conclusions: The SBQ-ASC is a brief self-report suicidality assessment tool, developed and validated with and for autistic adults, without co-occurring intellectual disability. The SBQ-ASC is appropriate for use in research to identify suicidal thoughts and behaviours in autistic and possibly autistic people, and model associations with risk and protective factors.

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Section: Introductionmentioning

confidence: 99%

Development and Validation of the Suicide Behaviours Questionnaire – Autism Spectrum Conditions in Autistic, Possibly Autistic and Non-Autistic Adults.

Cassidy

Bradley

Cogger-Ward

et al. 2020

Preprint

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“…These results corroborate previous findings of preadolescent youth with ASD being at an increased risk for suicidality. 54,55 One study shows that youth with ASD are 28 times more likely to endorse suicidal thoughts or behaviors than their unaffected peers. 56 This strong link between risk of suicidality and elevated autistic traits could be explained by specific behavioral attributes of both phenotypes, such as poor socialization and problem-solving skill, or increased levels of anxiety.…”

Section: Discussionmentioning

confidence: 99%

Genome-wide Polygenic Scores for Multiple Psychiatric and Common Traits Identify Preadolescent Youth with Risk for Suicide

Joo¹,

Moon²,

Wang³

et al. 2020

Preprint

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Suicide is a leading cause of death in youth worldwide, but identifying which youth are at high risk for suicide remains challenging. We constructed genome-wide polygenic scores (GPSs) from 24 psychiatric disorders and common traits from 8,212 US preadolescent children ages 9 to 10 and investigated their associations and predictive utility with suicidality (suicidal ideation and attempt). We identified three GPSs significantly associated with youth suicidality: ADHD (P=2.83x10-4; odds ratio=1.12), general happiness with a belief that life is meaningful (P=1.30x10-3; odds ratio=0.89) and autism spectrum disorder (ASD) (P=1.81x10-3; odds ratio=1.14). We also found a significant gene-by-environment interaction such that the GPS of ASD in the context of early life stress substantially increased suicidal ideation (P=1.39x10-2, odds ratio=1.11). Machine learning models showed, in predicting suicidal ideation, a receiver operators characteristics-area under the curve (ROC-AUC) of 0.72, and, in suicidal attempts, a ROC-AUC of 0.765. By providing the first quantitative account of the polygenic and environmental factors of suicidality in a large, representative population of preadolescent youth, this study shows the potential utility of the GPSs in investigating youth suicidality for early screening, intervention, and prevention.

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“…These results corroborate previous findings of children with ASD being at an increased risk for suicidality. 43,44 One study shows that children with ASD are 28 times more likely to exhibit suicidal thoughts or behaviors than that of typical counterparts. 45 This strong link between risk of suicidality and elevated autistic traits could be explained by specific behavioral attributes of both phenotypes, such as poor socialization and problem-solving skill, or increased levels of anxiety.…”

Section: Discussionmentioning

confidence: 99%

Genome-Wide Polygenic Scores for Common Traits and Psychiatric Disorders Identify Young Children with Risk for Suicides

Joo

Moon

Wang

et al. 2020

Preprint

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BackgroundSuicide is the leading cause of death in youth worldwide.1 Identifying children with high risk for suicide remains challenging.2 Here we test the extents to which genome-wide polygenic scores (GPS) for common traits and psychiatric disorders are linked to the risk for suicide in young children.MethodsWe constructed GPSs of 24 traits and psychiatric disorders broadly related to suicidality from 8,212 US children with ages of 9 to 10 from the Adolescent Brain Cognitive Development study. We performed multiple logistic regression to test the association between childhood suicidality, defined as suicidal ideation or suicidal attempt, and the GPSs. Machine learning techniques were used to test the predictive utility of the GPSs and other phenotypic outcomes on suicide and suicidal behaviors in the youth.OutcomesWe identified three GPSs significantly associated with childhood suicidality: Attention deficit hyperactivity disorder (ADHD) (P = 2.83×10−4; odds ratio (OR) = 1.12, FDR correction), general happiness with belief that own life is meaningful (P = 1.30×10−3; OR = 0.89) and autism spectrum disorder (ASD) (P = 1.81×10−3; OR = 1.14). Furthermore, the ASD GPS showed significant interaction with ELS such that a greater polygenic score in the presence of a greater ELS has even greater likelihood of suicidality (with active suicidal ideation, P = 1.39×10−2, OR = 1.11). In machine learning predictions, the cross validated and optimized model showed an ROC-AUC of 0.72 and accuracy of 0.756 for the hold-out set of overall suicidal ideation prediction, and showed an ROC-AUC of 0.765 and accuracy of 0.750 for the hold-out set of suicidal attempts.InterpretationOur results show that childhood suicidality is linked to the GPSs for psychiatric disorders, ADHD and ASD, and for a common trait, general happiness, respectively; and that GPSs for ASD and insomnia, respectively, have synergistic effects on suicidality via an interaction with early life stress. By providing the quantitative account of the polygenic and environmental factors of childhood suicidality in a large, representative population, this study shows the potential utility of the GPS in investigation of childhood suicidality for early screening, intervention, and prevention.

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Suicidality Among Children and Youth With and Without Autism Spectrum Disorder: A Systematic Review of Existing Risk Assessment Tools

Cited by 41 publications

References 66 publications

Development and Validation of the Suicide Behaviours Questionnaire – Autism Spectrum Conditions in Autistic, Possibly Autistic and Non-Autistic Adults.

Development and Validation of the Suicide Behaviours Questionnaire – Autism Spectrum Conditions in Autistic, Possibly Autistic and Non-Autistic Adults.

Genome-wide Polygenic Scores for Multiple Psychiatric and Common Traits Identify Preadolescent Youth with Risk for Suicide

Genome-Wide Polygenic Scores for Common Traits and Psychiatric Disorders Identify Young Children with Risk for Suicides

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