A new study has found that people with autism spectrum disorder (ASD) are over three times more likely to attempt and to die by suicide than the rest of the population, as a leading expert calls for improved support for people with ASD in adulthood.

“One thing that we don't do a very good job of is thinking about the needs of teenagers and adults with ASD”, said co-author of the study and Associate Director of Research at Orygen, Professor Stephen Wood.

“There is a stereotype of autism in the community of it just being about children”, he told HealthTimes.

“Obviously, it is about children, as that it is when someone is first diagnosed – but these children then grow into adults with ASD.”

“Having spoken to families and carers, they feel somewhat abandoned by support structures – certainly as soon as their child is in their late teens. But even when children leave primary school and go to secondary school, there is less support
available.”

“We have to be more aware of people with autism in the community and think about how we can engage with them better”, added Professor Wood.

The study, which analysed a Danish population, showed the incidence rates of suicide attempt were 266.8 per 100,000 people diagnosed with ASD, compared to 63.4 for the rest of the population.

“Lack of social integration, unemployment, and psychiatric disorders are common in adults with ASD, the same factors are traditionally associated with suicidal behaviour,” said lead author Dr Kairi Kolves from the Australian Institute for Suicide Research and Prevention.

She said that this was the first study to show an elevated suicide attempt and suicide rate in people diagnosed with ASD, after adjusting for sex, age and time period, in a nationwide cohort study.

“Factors, which have been identified as protective against suicide attempt in the general population, such as older age and higher education were not found to have this effect in those with ASD, and some factors such as being married or cohabiting and employed were linked to less impact among those with ASD.”

Professor Wood described this finding as a surprise. “It was certainly odd in that the things we think are protective [for suicide] in the general population, we didn’t find evidence of that here.”

“If anything, these factors seemed less protecting, for example being married.”

“We honestly don't know why that should be – we would have thought the same explanations for why people without ASD seem to be protected would be the same for people with ASD.”

He said that more research was required to understand these different trends, because “we haven’t got a good handle on why this is.”

Dr Kolves said that higher levels of cognitive functioning and education could imply a wider exposure to different risk factors.

“But also, the self-realisation of rather limited social and problem-solving skills may increase self-imposed pressure to cope with and alter expectations of success.”

“These factors are crucial for assessing suicide risk by practitioners working with people with ASD, particularly for those with other psychiatric comorbidities.”

In the study, psychiatric comorbidity was found to be a major risk factor with over 90% of those with ASD, who attempted or died by suicide, having another comorbid condition, with anxiety and affective disorders being most common.

Professor Wood said that in relation to psychiatric comorbidity, diagnostic overshadowing was a big issue.

“This is where a historical diagnosis can get in the way of seeing the other things going wrong for the person.”

“So, when it comes to psychiatric comorbidities, there might be a sense that ASD prevents a clinician from fully assessing a person in the way they would someone without ASD, or ascribe behavioural features to ASD instead of to potential suicide.”

“They seem to think ‘oh, that’s just part of a person's ASD, that’s the reason they seem to be socially withdrawn’”.

“We need to be more aware that this can happen and develop services that are sensitive to the needs of people with ASD”, Professor Wood said.

“That involves thinking about the kinds of things that they might prefer – they might be less good at introspecting around emotions, or the way they talk about them is different, to someone without ASD. We need to have that sense of supporting clinicians to work with these multi-diagnostic cases.”