“How is he?” my mother in law asked worriedly as she hugged me tight.
“Not good, I don’t know how to reach him, he is here, but so far away”, I explained through the tears running down my face.
My precious son had been struggling for weeks emotionally and physically. From my own personal experience with depression and suicidal thoughts, I knew the depths he was in, while fighting to keep his head above water.
On the spectrum himself, my little boy’s struggle was not uncommon. Autism and suicide, unfortunately, can go together often. My concern for him was great.
Seeing him in so much pain, knowing he couldn’t see the treasure that he was, I wanted to make it all better. I wanted to make him safe, to let him see himself through my eyes, and to take away the horrid plague that haunted him.
Do individuals with autism spectrum disorder have higher risk factors for depression and suicide?
Studies, such as, Autism and Depression are Connected: A Report of Two Complimentary Network Studies state:
“Adults with a history of depression report a greater number of autistic traits than adults without a history of depression, 31% and 2.6%, respectively (Geurts, Stek, & Comijs, 2016). Furthermore, in the general population, depression and autistic traits are associated: people with more autistic traits show significantly more depression symptoms than those with less autistic traits (Kanne, Christ, & Reiersen, 2009), and autistic traits and depression are reported to be correlated (r = 0.27; Liew, Thevaraja, Hong, & Magiati, 2015).”
So, knowing the risks of depression is important. Let’s look at the factors now.
Common risks in non-autistic people are:
- low self-esteem
- long term exposure to abuse or stress
- illness, including mental illness
- brain chemistry
The risk factors for depression and suicide among those with autism spectrum disorder may be somewhat different than those without autism. These factors can also be in addition to the common risks we know exist. Here are some risks that are directly related to autism:
- a higher occurrence of anxiety
- decreased communication ability
- social isolation
- strain on relationships due to autism symptoms
- an increased risk of psychiatric comorbidity
In another study titled, AUTISM Spectrum Disorders and Suicidality, we learn:
“Possibly, suicidal behavior in patients with ASDs is related with specific clinical variables different from those typically observed in psychiatric patients affected by mood or schizophrenia spectrum disorders. This could mislead clinicians in their evaluation. It has been hypothesized that low self-esteem due to repeated serious social failures, feelings of isolation, and the “conflict” between patients and their parents are psycho-social predisposing factors . Recognizing suicidal risk in ASDs patients may be difficult also because typical symptoms indicating impending suicidal risk can be masked by other symptoms.
“Impaired communication and social interactions, inappropriate or bizarre behavior, cognitive deficits, prominent negative symptoms can make ASDs patients not easily accessible to psychiatric evaluation. Prominent negative signs can hide under hopelessness, sadness, anguish, and suicidal intention. Neuroleptic-induced akinesia and poverty of speech can cover emotional turmoil and give a misleading impression of stability, quiescence, or even calmness.”
Keeping in mind all we have learned so far, let’s look at the symptoms and signs to look out for that may indicate your loved one is struggling with their mental health.
What are the symptoms of depression?
Some research shows that autistic boys and men are more likely to be depressed and be at a higher risk for suicide compared to autistic girls and women. Someone who is struggling with mental health problems may exhibit these symptoms:
- sudden or abnormal social withdrawal
- anger or irritability
- feelings of worthlessness
- low energy, little interest in things they normally enjoy
- sudden fear or extreme anxiety
Assessing suicide risk can be a scary thing. However, knowing the signs can help us navigate with a little bit of light in an otherwise dark abyss.
In an article titled: Understanding and Prevention of Suicide in Autism, Dr Sarah Cassidy writes: “A small body of research is showing worryingly high rates of suicidality in people with autism. In a large scale clinical study 1 of adults newly diagnosed with Asperger’s syndrome, 66% reported that they had contemplated suicide, significantly higher than rates among the UK general population (17%) and patients with psychosis (59%); 35% had planned or attempted suicide.
“A large scale population study 2 showed that suicide is a leading cause of premature death in people with autism. The risk factors for suicide in people with autism can be very different to those in the general population, and thus require tailored prevention strategies.
“For example, substantially more adults with Asperger’s syndrome experienced suicidal ideation (66%) than were depressed (32%), indicating a different route to suicidality than in the general population.1 Women with autism without comorbid learning disability were most at risk of dying by suicide.2
“By contrast, most suicides in the UK general population are in men.3 Hence, suicide prevention strategies used in the general population might not be appropriate for people with autism.”
We know that just because someone is struggling with their mental health, doesn’t mean they will attempt suicide. Here are some warning signs to look out for that your loved one may be having suicidal feelings:
- the aforementioned symptoms of depression
- suicidal thoughts
- expressing a desire to no longer be living
- extreme withdraw
- refusing to eat or drink
- violent outbursts
- Sleeping too much or not enough
Any of these symptoms on their own or even combined with another don’t necessarily mean someone will commit suicide, but the combination of several could indicate a serious risk.
Suicidal ideation ecompases suicidal thoughts, but it get a little more complicated than that. In a study called Suicidal Ideations, we learn “Suicidal ideations (SI), often called suicidal thoughts or ideas, is a broad term used to describe a range of contemplations, wishes, and preoccupations with death and suicide.”
Suicidal ideation can happen with or without depression. People with autism, as we learned above, may be more attempt suicide because of suicidal ideation without feeling down.
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What can we do to help our children experiencing suicidal thoughts?
As suicide rates and autism diagnosis rise, and research attempting to catch up with the data, helping our kids with their mental health can seem daunting. There are things we can do to empower them, and ourselves.
The first thing we as parents can do to help our children is to be prepared. This way, if the time comes when the risk of suicide is present, we will be ready.
Know the signs
The information we have learned thus far is definitely useful. However, it is also important to know how those specific signs can manifest in your child. Parents are often the first line of defense, because we know our child better than anyone else.
Paying attention to how your child acts, communicates, interacts with others, and conducts their everyday activities. Note any changes, disturbances, or long term stresses. Talk with your child, their teachers, another family member, doctor, and/or therapist about any potential conflicts, stressors, or behavior that concern you.
Set up support in advance
Knowing the risks and signs to look for can give insight into how to support our children. Preventative measures can be something we put into place long before our children struggle. Partnering with other professionals for early intervention can begin in infancy.
The addition of occupational therapy, physical therapy, and other interventions can decrease our children with autism’s risk of suicide. Learning how to better communicate, seeing their full potential, and feeling loved and celebrated in the process boosts their confidence, increases their social interactions, and paves the way for better mental health.
If we are also set up to receive support ourselves, we will be better equipped to help our children.
What to say
Learn how to speak or not speak to your child who is exhibiting signs of suicide risk. Telling them that they shouldn’t be sad, worried, or afraid, minimizes their pain and invalidates their experience.
I shared in my book a story about when I was in a depressive episode so bad I was afraid to move for fear that I would attempt suicide. I remember sobbing to my husband how worthless I was and how confused and scared I was.
He held me and said to me over and over “You know I love you right? You gotta know I love you! I love you so so much!” I couldn’t believe anything positive in that moment, but when I came safely out, I remembered and absorbed what he said.
I’ve carried that conversation with me for the past 15 years, and each time I have negative thoughts I remember the sound of his voice, the desperation, the intense love, and I remember that I have so much to live for. He saved my life that night.
Our words matter–how we deliver our message when trying to help our loved one matters. Experiencing suicidal thoughts is scary for all involved. Here are somethings you can say (or a version of them that is appropriate for your loved one):
- I am here for you
- You are loved
- You are important
- What you are feeling is valid
- What is happening in your life, body, or mind that has you thinking of suicidal thoughts?
- Do you have a plan for how you will harm yourself?
- If you don’t feel safe by yourself I will stay with you
- Going through this just means you could use some help, I will go with you to talk to someone
Talking to someone about their suicidal feelings and thoughts does not make their chances of commiting suicide higher.
What to do
Knowing what to do for our autistic family member who is feeling suicidal is crucial. As I mentioned before, preparation is key. Part of the preparation could be building a support system that includes input from the autism community.
One of the biggest proponents of mental health problems in autism is social isolation. If we know this, then exposing our children to the thoughts, content, support systems, and wisdom from those in the autistic community, can help prevent those feelings of isolation. Especially if the content directly correlates to what they are going through at the time.
Stephanie Bethany, one of the speakers in the last Autism Parenting Summit, posted a video on her youtube channel sharing her experience with depression. Things like this can be so encouraging and help our loved ones.
If our child is struggling with their mental health, getting them to a doctor as soon as possible is imperative. They may need medications, counseling and/or therapy to help them.
Be there for them. Keep reaching out to them and for them. Love them, support them, sit with them, and advocate for them.
Who to call
In the US, dialing 988 will get you to a crisis helpline. This helpline is not only for people who are struggling with suicidal thoughts or fears, they are also for loved ones who need to know how to help their child, friend, family member who needs it.
In the UK, here you can find information about how to access help and crisis lines.
Australia’s crisis helpline info is here.
My little boy did eventually come out of his struggle triumphant. It wasn’t the last time he experienced it though. We talked about it after.
We talked through what he learned through the experience, what helped, what didn’t, and what he learned about himself. The next time, he put into practice what he learned, and I did too as I supported him.
Having been on the brink of suicide more than once in my own life, I know all too well its perils. Please know that mental health struggles and even suicide attempts do not indicate lack of care, and they are no one’s fault. Supporting your child as they battle mental health challenges no matter what they bring shows a love to them, even if they don’t understand in the moment, they will feel relieved later.
Just because a differently abled person is at a higher statistical risk of suicide, doesn’t mean the will battle for their life. An autism diagnosis can clue us in on things our child might be at higher risk for, and help us make decisions for them and with them to reduce the risks. There is help available!
van Heijst, B. F., Deserno, M. K., Rhebergen, D., & Geurts, H. M. (2020). Autism and depression are connected: A report of two complimentary network studies. Autism : the international journal of research and practice, 24(3), 680–692. https://doi.org/10.1177/1362361319872373
Raja, M., Azzoni, A., & Frustaci, A. (2011). AUTISM Spectrum Disorders and Suicidality. Clinical practice and epidemiology in mental health : CP & EMH, 7, 97–105. https://doi.org/10.2174/1745017901107010097
Sarah C., Jacqui R. (June 2017) Understanding and Prevention of Suicide in Autism www.thelancet.com/psychiatry Vol 4 https://www.thelancet.com/pdfs/journals/lanpsy/PIIS2215-0366(17)30162-1.pdf
Harmer, B., Lee, S., Duong, T., & Saadabadi, A. (2022). Suicidal Ideation. In StatPearls. StatPearls Publishing. https://pubmed.ncbi.nlm.nih.gov/33351435/