As diverse as the experiences of children and teens on the autism spectrum are, one sobering fact holds true: Autistic youth are more likely to think about and die from suicide, and at earlier ages, than their neurotypical peers.
The Times spent months interviewing autistic self-advocates, families, physicians and researchers to understand the factors behind this crisis and the changes that could better support youth and their families.
Solutions are still in their infancy, but autism researchers and advocates are working to develop screening tools, safety plans and therapies based on the unique strengths and differences of an autistic brain.
A crucial first step is educating parents, pediatricians and other community professionals on the particular risks and challenges facing autistic youth, and why taking neurodiversity into account could help reduce the number of young lives lost too soon.
Here are some key findings:
Autistic youth are more likely to struggle with suicidal thoughts and mental health conditions than non-autistic kids.
Suicide is a leading cause of death in the U.S. for kids between the ages of 10 and 18. For autistic teens and children, the risk is higher. One 2023 meta-analysis found that some 10% of autistic children and teens had attempted suicide, a rate more than twice that of their non-autistic peers.
About 20% of U.S. high schoolers disclosed suicidal thoughts in 2023, according to the Centers for Disease Control and Prevention. When the Kennedy Krieger Institute in Baltimore asked caregivers of 900 autistic children between 8 and 17 if the children had thought about ending their lives, 35% said yes. Nearly 1 in 5 said their child had made a plan.
Children across the autism spectrum are far more likely to also be diagnosed with mental health conditions than their allistic, or non-autistic, peers.
A 2021 study of more than 42,000 caregivers of children between ages 3 and 17 found that 78% of autistic children had at least one co-occurring psychiatric condition, compared to 14% of non-autistic kids. Contributing factors include the stress of living in a world that’s sensorially overwhelming or socially impenetrable.
Autistic children without intellectual disabilities may be at greater risk.
The diagnostic definition of autism has evolved over the years and now includes children who cope by “masking”: consciously or unconsciously suppressing autistic traits in order to fit in at school or in social environments. For children with a propensity for masking, autism is often diagnosed much later in childhood or even adulthood.
Many children who mask are able to participate in mainstream classes or activities. But constantly deciphering and mimicking social responses is cognitively and emotionally exhausting. Masking is strongly correlated with depression, anxiety and suicide.
“Masking is actually a risk factor of suicide for autistic people, and it has a negative effect on one’s mental health,” said Lisa Morgan, founder of the Autism and Suicide Prevention Workgroup, who is autistic herself.
Research has found that autistic people with a higher IQ are both more likely to mask and more likely to suffer from anxiety and other mental health conditions.
In one 2023 study, autistic kids with an IQ of 120 or higher were nearly six times more likely to have suicidal thoughts than autistic children with an average IQ. For non-autistic children, the opposite was true: Higher cognitive ability was associated with a decreased risk of suicide.
Crisis warning signs often look different in autistic kids, and mental health interventions designed for neurotypical youth may not be as effective for them.
Most mental health interventions start with a provider verbally asking a deceptively simple question: What are you feeling?
But up to 80% of autistic kids have alexithymia, or difficulty identifying and describing one’s own internal emotional state. For this reason, “it makes sense that all of the interventions that have been designed for a neurotypical youth probably aren’t going to translate in the same way to autistic youth,” said Jessica Schwartzman, an assistant professor of pediatrics at USC’s Keck School of Medicine and director of the Training and Research to Empower NeuroDiversity Lab at Children’s Hospital Los Angeles.
A neurodiverse workgroup of researchers has identified crisis warning signs specific to autistic people, including a noticeable decline in verbal communication abilities.
“Oftentimes it’s thought that somebody might be really agitated or show a lot of emotional distress when they are talking about wanting to die,” said Danielle Roubinov, an associate professor and director of the Child and Adolescent Anxiety and Mood Disorders Program at University of North Carolina at Chapel Hill. “An autistic individual might not do that. They might say it in a really matter-of-fact way, or they might have a really hard time articulating it.”
Asking about suicide could save a life.
There is a common misconception that asking about suicide could plant the idea in a child’s head and lead to further harm. If anything, researchers said, it’s protective.
Ask clearly, directly and in whatever format a child is most comfortable with, Schwartzman said. Some autistic children may prefer a text or written letter, for example, rather than a direct verbal conversation.
Researchers are looking for low-cost ways to tailor existing therapies to better serve autistic kids, and to educate the medical community on the need to use them.
Experts are currently working on modifications to the standard screening tool that providers use to identify suicidality, as well as the Stanley-Brown safety plan, where patients list coping strategies and contacts on a one-page sheet that can be easily accessed in a crisis. Studies on the effectiveness of versions tailored for autistic people are underway.
Changes to the way providers interact with autistic children can also make a difference. Sensory overwhelm can be destabilizing, and an autistic child may first need a quiet place with dim lighting to calm themselves, and extra time to process and form answers to questions.
The most effective way to reduce depression, anxiety and the mental harm of masking is to ensure that autistic kids have the support they need, advocates and clinicians say, and don’t feel like they have to change everything about themselves in order to fit in.
“Suicide prevention for autistic people is being accepted for who they are, being able to be who they are without masking,” Morgan said.
If you or someone you know is experiencing thoughts of suicide, help is available. Call 988 to connect to trained mental health counselors or text “HOME” to 741741 in the U.S. and Canada to reach the Crisis Text Line.
This article was reported with the support of the USC Annenberg Center for Health Journalism’s National Fellowship’s Kristy Hammam Fund for Health Journalism.