Identification of Suicide Risk in Pediatric Patients with Autism Spectrum Disorder Presenting to an Emergency Department

Introduction: Recent evidence indicates that suicidal ideation and behavior is common among youth diagnosed with autism spectrum disorder (ASD). Despite this concern, there is limited research on the assessment of suicide risk in children and adolescents with ASD, and no existing models of suicide risk in this population. In addition, youth with ASD may have a difficult time communicating their emotions and suicidal thoughts to others due to communication and cognitive challenges associated with ASD. Given the challenges of identifying suicide risk in youth with ASD, and the high rates of emergency department (ED) visits in this population, developing methods to identify suicide risk in patients with ASD in ED settings is essential to determine the patient’s safest disposition plan. This study investigated the value of the Ask Suicide -Screening Questions (ASQ) in detecting suicide risk in children and adolescents with ASD in the ED setting. Additionally, characteristics of children and adolescents with ASD who reported suicidal ideation in the ED were examined.

Methods: This study is a retrospective chart review of 104 children and young adults with ASD, ages 8 to 21, who presented to the Johns Hopkins Pediatric ED with a psychiatric chief complaint between March 2013 and February 2016. All participants were administered the ASQ, a suicide screening tool, as part of standard of care during triage.

Results: Among the 104 participants with ASD, 30% (31/104) screened positive on the ASQ for suicide risk, compared to 48% (1,119/2,315) of patients without ASD. Descriptive characteristics of the ASQ were examined for 21 of the 31 patients with ASD who screened positive for suicide risk on the ASQ. The most common comorbid psychiatric diagnoses were anxiety disorders (52%), externalizing disorders (41%), and depression (26%). Suicide attempts (ASQ4) were reported among 12 youth and consisted of the following methods: stabbing/cutting (5), choking/holding breath/hanging (3), jumping from a height (2), overdose (1), and firearms (1).

Conclusion: This study demonstrates that brief suicide screening instruments, such as the ASQ, might be effective in assessing suicide risk in children and adolescents with ASD who present to the ED. Additional research is needed to examine the validity of the ASQ in ASD populations and to identify specific risk factors and clinical determinants that characterize suicidal behaviors in youth with ASD in acute settings.