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Avrahami M, Ben-Dor DH, Ratzon R, Weizman A, Perlman Danieli P. Characterizing the clinical and sociodemographic profiles of hospitalized adolescents with autism spectrum disorder. Glob Ment Health (Camb) 2024; 11:e63. [PMID: 38827333 PMCID: PMC11140491 DOI: 10.1017/gmh.2024.63] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/24/2023] [Revised: 04/17/2024] [Accepted: 05/02/2024] [Indexed: 06/04/2024] Open
Abstract
The prevalence of autism spectrum disorder (ASD) is increasing worldwide. Youngsters with ASD demonstrate higher rates of intellectual disabilities (IDs), comorbid psychopathology and psychiatric hospitalizations, compared to children in the general population. This study characterizes the demographics and clinical parameters of adolescent psychiatric inpatients with ASD compared to inpatients without ASD, all hospitalized during the study period. Additionally, within the ASD group, those with ID were compared to those without. The rate of males among participants with ASD was significantly higher than among those without ASD, and the duration of hospitalization was longer. In contrast, the rate of cigarette smoking, major depressive disorder and suicidal thoughts among those with ASD was lower. One-third of those with ASD had moderate to severe ID, about 10% had comorbid epilepsy, and about half of them demonstrated aggressive behavior. Most ASD patients showed significant improvement upon discharge, although the extent of improvement was more prominent among ASD patients with no ID. Our findings, consistent with previous research, indicate that hospitalization is beneficial to youths with ASD, both those with and those without ID. Further studies that include long-term follow-up are needed.
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Affiliation(s)
- Matan Avrahami
- Child and Adolescent Division, Geha Mental Health Center, Petah Tikva, Israel
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - David Haim Ben-Dor
- Child and Adolescent Division, Geha Mental Health Center, Petah Tikva, Israel
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Roy Ratzon
- Child and Adolescent Division, Geha Mental Health Center, Petah Tikva, Israel
| | - Abraham Weizman
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Laboratory of Molecular and Biological Psychiatry, Felsenstein Medical Research Center, Petah Tikva, Israel
- Research Unit, Geha Mental Health Center, Petah Tikva, Israel
| | - Polina Perlman Danieli
- Child and Adolescent Division, Geha Mental Health Center, Petah Tikva, Israel
- Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Centre for Addiction and Mental Health, Toronto, ON, Canada
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2
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Dardani C, Schalbroeck R, Madley-Dowd P, Jones HJ, Strelchuk D, Hammerton G, Croft J, Sullivan SA, Zammit S, Selten JP, Rai D. Childhood Trauma As a Mediator of the Association Between Autistic Traits and Psychotic Experiences: Evidence From the Avon Longitudinal Study of Parents and Children Cohort. Schizophr Bull 2023; 49:364-374. [PMID: 36434745 PMCID: PMC10016398 DOI: 10.1093/schbul/sbac167] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND Little is known on whether associations between childhood autistic traits and psychotic experiences persist into adulthood and whether genetic confounding and childhood trauma influence them. Here we investigate the associations between childhood autistic traits and psychotic experiences until young adulthood and assess the influence of schizophrenia polygenic risk and childhood traumatic experiences, using the Avon Longitudinal Study of Parents and Children (ALSPAC) population-based birth cohort. STUDY DESIGN We used a measure of broad autistic traits (autism factor mean score), and four dichotomised measures of autistic traits capturing social communication difficulties (age 7), repetitive behaviours (age 5), sociability (age 3), and pragmatic language (age 9). Psychotic experiences were assessed at ages 18 and 24 using the semi-structured Psychosis-Like Symptoms interview (PLIKSi). Traumatic experiences between ages 5 and 11 were assessed with questionnaires and interviews administered to children and parents at multiple ages. STUDY RESULTS Broad autistic traits, as well as social communication difficulties, were associated with psychotic experiences that were distressing and/or frequent until age 24 (autism factor mean score, n = 3707: OR 1.19, 95%CI 1.01-1.39; social communication difficulties, n = 3384: OR 1.54, 95%CI 0.97-2.45). Childhood trauma mediated a substantial proportion of the identified associations (~28% and 36% respectively, maximum n = 3577). Schizophrenia polygenic risk did not appear to confound the associations. Multiple imputation analyses (maximum n = 13 105) yielded comparable results. CONCLUSIONS Childhood trauma may be an important, potentially modifiable pathway between autistic features and later onset of psychotic psychopathology.
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Affiliation(s)
- Christina Dardani
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Rik Schalbroeck
- Rivierduinen Institute for Mental Healthcare, Leiden, The Netherlands
- School for Mental Health and Neuroscience, Department of Psychiatry and Neuropsychology, Maastricht University, Maastricht, The Netherlands
- Section of Nuclear Medicine, Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Paul Madley-Dowd
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Hannah J Jones
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
- Medical Research Council Integrative Epidemiology Unit, Bristol Medical School, University of Bristol, Bristol, UK
- National Institute for Health Research, Bristol Biomedical Research Centre, University Hospitals Bristol NHS Foundation Trust, University of Bristol, Bristol, UK
| | - Daniela Strelchuk
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Gemma Hammerton
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
- Medical Research Council Integrative Epidemiology Unit, Bristol Medical School, University of Bristol, Bristol, UK
| | - Jazz Croft
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Sarah A Sullivan
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
- National Institute for Health Research, Bristol Biomedical Research Centre, University Hospitals Bristol NHS Foundation Trust, University of Bristol, Bristol, UK
| | - Stan Zammit
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
- National Institute for Health Research, Bristol Biomedical Research Centre, University Hospitals Bristol NHS Foundation Trust, University of Bristol, Bristol, UK
- Division of Psychological Medicine and Clinical Neurosciences, Cardiff University, Cardiff, UK
| | - Jean-Paul Selten
- Rivierduinen Institute for Mental Healthcare, Leiden, The Netherlands
- School for Mental Health and Neuroscience, Department of Psychiatry and Neuropsychology, Maastricht University, Maastricht, The Netherlands
| | - Dheeraj Rai
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
- National Institute for Health Research, Bristol Biomedical Research Centre, University Hospitals Bristol NHS Foundation Trust, University of Bristol, Bristol, UK
- Avon and Wiltshire Partnership NHS Mental Health Trust, Bath, UK
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3
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Cervantes PE, Brown DS, Horwitz SM. Suicidal ideation and intentional self-inflicted injury in autism spectrum disorder and intellectual disability: An examination of trends in youth emergency department visits in the United States from 2006 to 2014. AUTISM : THE INTERNATIONAL JOURNAL OF RESEARCH AND PRACTICE 2023; 27:226-243. [PMID: 35608134 PMCID: PMC9684352 DOI: 10.1177/13623613221091316] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
LAY ABSTRACT Youth suicide is a major problem in the United States and globally, but little is known about suicide risk in autistic youth and youth with intellectual disability specifically. Using data from the National Emergency Department Sample, which is the largest database of emergency department visits in the United States, we found that emergency department visits with a suicidal ideation or intentional self-inflicted injury diagnosis were more common in autistic youth and youth with intellectual disability than in youth without these diagnoses (i.e. the comparison group). This was true when examining both suicidal ideation diagnoses and intentional self-inflicted injury diagnoses at emergency department visits. In addition, the number of emergency department visits with a suicidal ideation or intentional self-inflicted injury diagnosis increased more from 2006 to 2014 in autistic youth and youth with intellectual disability compared with the comparison group. We also found both similarities and differences when examining factors, such as age, sex, and co-occurring mental health conditions, related to emergency department visits with a suicidal ideation or intentional self-inflicted injury diagnosis across groups that may be helpful for understanding suicide risk. It is urgent that we improve our understanding, assessment, and treatment of suicidality and self-harm in these groups through more research and clinical efforts.
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Affiliation(s)
- Paige E. Cervantes
- Department of Child and Adolescent Psychiatry, NYU Grossman School of Medicine, New York, NY
| | - Derek S. Brown
- Brown School, Washington University in St. Louis, St. Louis, MO
| | - Sarah M. Horwitz
- Department of Child and Adolescent Psychiatry, NYU Grossman School of Medicine, New York, NY
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4
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Cleary M, West S, McLean L, Hunt GE, Hungerford C, Kornhaber R. A Scoping Review of Autism and the Way It Changes the Presentation of Suicidal Thoughts and Behavior Compared to the General Population. Issues Ment Health Nurs 2022; 44:282-301. [PMID: 36279193 DOI: 10.1080/01612840.2022.2132329] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
Autism spectrum conditions are a group of neurodevelopmental conditions that carries an array of co-occurring diagnoses, including a heightened risk of suicide attempts and suicide. This scoping review examined primary research focusing on autism and suicidality, to understand what is currently known on the topic, including how autism changes the presentation of suicidal thoughts and behavior; and to assess the suicide awareness and prevention education programs currently available for autistic people, their families, and health professionals and support workers. A comprehensive search (November 2021) across Scopus, PubMed and CINAHL identified 39 articles from 38 studies. Three themes emerged, with five subthemes. 1. The prevalence of suicidality in autistic people; 2. The presentation of suicidality in autistic people, including (a) risk of suicidality; (b) gender, age, employment and education; (c) co-occurring psychiatric conditions; (d) autism traits and social communication; (e) intellectual disability; and 3. Autism-specific approaches to suicidal thoughts, behavior and prevention. Findings were mixed, including conflicting evidence on the risk of autism and suicidality, and limited evidence of resources related to autism-specific suicide awareness or information, and education or prevention programs.
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Affiliation(s)
- Michelle Cleary
- School of Nursing, Midwifery & Social Sciences, Central Queensland University, Sydney, New South Wales, Australia
| | - Sancia West
- School of Nursing, Midwifery & Social Sciences, Central Queensland University, Sydney, New South Wales, Australia
| | - Loyola McLean
- Brain and Mind Centre, Faculty of Medicine and Health, The University of Sydney, Camperdown, New South Wales, Australia.,Consultation-Liaison Psychiatry, Royal North Shore Hospital, Sydney, New South Wales, Australia.,Westmead Psychotherapy Program for Complex Traumatic Disorders, Western Sydney Local Health District, Parramatta, New South Wales, Australia.,The Western Clinical School, The University of Sydney, Camperdown, New South Wales, Australia
| | - Glenn E Hunt
- Speciality of Psychiatry, Concord Clinical School, The University of Sydney, Concord West, New South Wales, Australia
| | - Catherine Hungerford
- School of Nursing, Midwifery & Social Sciences, Central Queensland University, Sydney, New South Wales, Australia.,School of Health, Federation University, Mt Helen, Victoria, Australia
| | - Rachel Kornhaber
- School of Nursing, University of Tasmania, Sydney, New South Wales, Australia
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5
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Alenezi S, Alnemary F, Alamri A, Albakr D, Abualkhair L, Alnemary F. Psychotropic Medications Use among Children with Autism in Saudi Arabia. CHILDREN (BASEL, SWITZERLAND) 2022; 9:children9070966. [PMID: 35883950 PMCID: PMC9322379 DOI: 10.3390/children9070966] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/03/2022] [Revised: 06/19/2022] [Accepted: 06/22/2022] [Indexed: 11/16/2022]
Abstract
Psychotropic medication use is rising among children with autism spectrum disorders (ASD) in Saudi Arabia. Two hundred ninety-three parents of children diagnosed with ASD completed a parental concerns questionnaire (PCQ) online to examine children’s family socio-demographics, health conditions and comorbidities, and past and current exposure to psychotropic medication as prescribed by their primary doctor. Findings revealed that more than one-third of the parents (39.08%) reported that their children were using medications at the time of the survey; risperidone (53%), methylphenidate (30%), and valproic acid (9%) were the most commonly used. A smaller number of parents stated that their children had previously used medications (16.09%). The most often prescribed drugs among this group were risperidone (45%), followed by methylphenidate (32%) and valproic acid (17%). The variables that showed a statistically significant association with the current use of psychotropic drugs were the child’s age (OR = 1.25, 95% CI: 1.12, 1.40, p < 0.001), presence of comorbidities (OR = 7.75, 95% CI: 3.48, 17.24, p < 0.001), communication difficulties (OR = 1.79, 95% CI: 1.09, 2.95, p < 0.021), and anxiety symptoms (OR = 1.70, 95% CI: 1.00, 2.87, p < 0.049). Similarly, the child’s age (OR = 1.23, 95% CI: 1.08, 1.40, p < 0.002) and presence of comorbidities (OR = 2.83, 95% CI: 1.16, 6.29, p < 0.022) showed statistically significant associations with previous use.
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Affiliation(s)
- Shuliweeh Alenezi
- Department of Psychiatry, College of Medicine, King Saud University, Riyadh 11451, Saudi Arabia;
- Correspondence:
| | - Fahad Alnemary
- Department of Special Education, College of Education, Taif University, Taif 21944, Saudi Arabia;
| | - Asma Alamri
- Department of Child Psychiatry, King Abdullah Specialist Children Hospital, Riyadh 14611, Saudi Arabia;
| | - Dalal Albakr
- Department of Psychiatry, Imam Abdulrahman Bin Faisal University, Dammam 34212, Saudi Arabia;
| | - Lamees Abualkhair
- Department of Psychiatry, College of Medicine, King Saud University, Riyadh 11451, Saudi Arabia;
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6
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Predictors of Suicidal Thoughts in Children with Autism Spectrum Disorder and Anxiety or Obsessive-Compulsive Disorder: The Unique Contribution of Externalizing Behaviors. Child Psychiatry Hum Dev 2022; 53:223-236. [PMID: 33462740 DOI: 10.1007/s10578-020-01114-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/09/2020] [Indexed: 12/28/2022]
Abstract
Children with autism spectrum disorder (ASD) are at elevated risk of suicidal ideation, particularly those with comorbid anxiety disorders and/or obsessive-compulsive disorder (OCD). We investigated the risk factors associated with suicidal ideation in 166 children with ASD and comorbid anxiety disorders/OCD, and the unique contribution of externalizing behaviors. Suicidal ideation was reported in the child sample by 13% of parents. Controlling for child age, sex, and IQ, perceived loneliness positively predicted the likelihood of suicidal ideation. In addition, externalizing behaviors positively predicted suicidal ideation, controlling for all other factors. Reliance on parental report to detect suicidal ideation in youth with ASD is a limitation of this study. Nonetheless, these findings highlight the importance of assessing and addressing suicidal ideation in children with ASD and comorbid anxiety disorders/OCD, and more importantly in those with elevated externalizing behaviors and perceptions of loneliness.
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7
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O'Halloran L, Coey P, Wilson C. Suicidality in autistic youth: A systematic review and meta-analysis. Clin Psychol Rev 2022; 93:102144. [DOI: 10.1016/j.cpr.2022.102144] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Revised: 01/26/2022] [Accepted: 03/03/2022] [Indexed: 12/28/2022]
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8
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Ozbaran B, Kose S, Barankoglu I, Dogan N. Inpatient Care Unit in Children and Adolescents With Autism Spectrum Disorder: Benefits, Difficulties, and Conditions of Hospitalization. J Nerv Ment Dis 2022; 210:206-211. [PMID: 34643184 DOI: 10.1097/nmd.0000000000001429] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
ABSTRACT Autism spectrum disorder (ASD) is a complex neurodevelopmental disorder that affects social interactions and behavior. The number of children and adolescents with ASD treated in mental health services has been growing in recent years. Knowing clinical and familial characteristics of hospitalized patients with ASD and multidisciplinary approach are crucial for children and adolescents mental health professionals. In this study, 253 Turkish children and adolescents, with and without ASD, treated in psychiatry inpatient care unit were examined. Applied approaches such as medical consultation areas, psychiatric management of mothers, and pharmacological treatment during hospitalization, were studied. In addition to familial and clinical characteristics of patients with ASD, the benefits and the hospitalization conditions were evaluated. Patients with ASD showed a higher tendency on having relatives with a psychiatric disorder than the patients without ASD. A significant difference was found in terms of age, sex, and intellectual functioning, whereas length of stay did not differ drastically. Also, suicide attempts were significantly higher in patients without ASD than in patients with ASD. This study eases the management of hospitalized ASD patients with giving important information of clinical and familial characteristics.
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Affiliation(s)
- Burcu Ozbaran
- Department of Child and Adolescent Psychiatry, Faculty of Medicine, Ege University, Izmir, Turkey
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9
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Stewart TM, Martin K, Fazi M, Oldridge J, Piper A, Rhodes SM. A systematic review of the rates of depression in autistic children and adolescents without intellectual disability. Psychol Psychother 2022; 95:313-344. [PMID: 34605156 DOI: 10.1111/papt.12366] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Accepted: 08/12/2021] [Indexed: 11/29/2022]
Abstract
OBJECTIVES Increasing evidence suggests that major depressive disorder (MDD) is highly prevalent in autism spectrum disorder (ASD). The current study is a systematic review of rates of depression in autistic children and adolescents, without intellectual disability. DESIGN Adhering to PRISMA guidelines, a total of 14,557 studies were identified through five databases (MEDLINE, EMBASE, Cinahl, ERIC, PsycINFO, and Web of Science). METHODS Articles were screened for inclusion and exclusion criteria and 10% double coded at each stage. Nineteen studies met criteria and were retained in the review. RESULT The reported rates of depression in autistic children and adolescents varied from 0% to 83.3%. We discuss these findings in relation to method of report (self/informant, interview/questionnaire), recruitment status (clinical/community recruited), and age (pre-pubertal/adolescent). CONCLUSION Rates of depression vary considerably across studies and do not show a particular pattern in relation to methodology, or age. Our research joins a crucial call to action from the research community for future research to improve the identification of depression in autism, which in turn will aid our understanding of the potentially different characterization and manifestation of depression in autism, to ultimately improve assessment and treatment of depression in autistic children and adolescents. PRACTITIONER POINTS Rates of depression in autistic children and adolescents vary and do not show a particular pattern in relation to methodology or age. Our research joins the call to action from the research community for future research to improve the identification of depression in autistic children and adolescents, which in turn will aid understanding of depression in autism, and ultimately improve assessment and treatment of depression in autistic children and young people. The development of new measures of depression, specifically designed with, and for, children and adolescents with autism, is warranted.
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Affiliation(s)
- Tracy M Stewart
- Moray House School of Education and Sport, University of Edinburgh, UK
| | | | | | - Jessica Oldridge
- Child Life and Health, Clinical Brain Sciences, University of Edinburgh, UK
| | - Allan Piper
- Child and Adolescent Mental Health, NHS Lothian, Edinburgh, UK
| | - Sinead M Rhodes
- Child Life and Health, Clinical Brain Sciences, University of Edinburgh, UK
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10
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Cervantes PE, Li A, Sullivan KA, Seag DEM, Baroni A, Horwitz SM. Assessing and Managing Suicide Risk in Autistic Youth: Findings from a Clinician Survey in a Pediatric Psychiatric Emergency Setting. J Autism Dev Disord 2022; 53:1755-1763. [PMID: 35122186 DOI: 10.1007/s10803-022-05448-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/17/2022] [Indexed: 12/14/2022]
Abstract
Suicidal thoughts and behaviors (STB) and emergency department (ED) utilization are prevalent in autistic youth. The current study surveyed clinicians in a pediatric psychiatric ED to examine differences in attitudes on suicide-related care for autistic and non-autistic patient populations. While clinicians rated addressing STB in ASD as important and adaptations to care as necessary, less than half identified ASD as a suicide risk factor and confidence ratings were significantly lower for autistic patients. Previous ASD training predicted confidence and accounted for approximately 25% of the variance in confidence scores. Findings highlight the urgency to develop and disseminate ED clinician training, and address the lack of validated assessment tools, adapted suicide prevention practices, and evidence-based treatments for STB in autistic youth.
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Affiliation(s)
- Paige E Cervantes
- Department of Child and Adolescent Psychiatry, NYU Grossman School of Medicine, One Park Avenue, 7th Floor, New York, NY, 10016, USA.
| | - Annie Li
- Department of Child and Adolescent Psychiatry, NYU Grossman School of Medicine, One Park Avenue, 7th Floor, New York, NY, 10016, USA.,Child and Adolescent Psychiatry, Bellevue Hospital Center, New York, NY, USA
| | - Katherine A Sullivan
- Department of Child and Adolescent Psychiatry, NYU Grossman School of Medicine, One Park Avenue, 7th Floor, New York, NY, 10016, USA
| | - Dana E M Seag
- Department of Child and Adolescent Psychiatry, NYU Grossman School of Medicine, One Park Avenue, 7th Floor, New York, NY, 10016, USA
| | - Argelinda Baroni
- Department of Child and Adolescent Psychiatry, NYU Grossman School of Medicine, One Park Avenue, 7th Floor, New York, NY, 10016, USA.,Child and Adolescent Psychiatry, Bellevue Hospital Center, New York, NY, USA
| | - Sarah M Horwitz
- Department of Child and Adolescent Psychiatry, NYU Grossman School of Medicine, One Park Avenue, 7th Floor, New York, NY, 10016, USA
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11
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Karadaş C, Bakkaloğlu H, Demir Ş. Exploring the effect of motor coordination on repetitive behaviours in children with autism spectrum disorder. INTERNATIONAL JOURNAL OF DEVELOPMENTAL DISABILITIES 2021; 69:238-247. [PMID: 37025329 PMCID: PMC10071942 DOI: 10.1080/20473869.2021.1948318] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Revised: 05/24/2021] [Accepted: 06/22/2021] [Indexed: 06/19/2023]
Abstract
Objective: This study was conducted to explore the effect of motor coordination on repetitive behaviors in children with Autism Spectrum Disorder (ASD) aged 5-15 years. Methods: The study employed the causal-comparative design, one of the correlational survey designs. The study was carried out with data obtained from parents of 241 children with ASD. The parents were administered the measurement tools of Gilliam Autism Rating Scale-2-Turkish Version to confirm the diagnosis of ASD, Demographic Information Form to obtain information about the child and the parent, Repetitive Behavior Scale-Revised-Turkish Version to evaluate the repetitive behaviors, and Developmental Coordination Disorder Questionnaire-07-Turkish Version to evaluate the motor coordination performance. The data were analyzed MANCOVA in the R package program. Results: The study results revealed that 72% of children with ASD had a risk of Developmental Coordination Disorder (DCD). The repetitive behaviors of children with and without DCD risk differed significantly. The severity and intensity of the repetitive behaviors of children with DCD risk were higher than those without DCD risk when age, gender, and comorbidity were taken under control. Conclusion: The motor coordination problems in children with ASD are effective on repetitive behaviors.
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Affiliation(s)
- Cebrail Karadaş
- Department of Special Education, Ankara University, Ankara, Turkey
| | | | - Şeyda Demir
- Department of Special Education, Ankara University, Ankara, Turkey
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12
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Jachyra P, Lai MC, Zaheer J, Fernandes N, Dale M, Sawyer A, Lunsky Y. Suicidal Thoughts and Behaviours Among Autistic Adults Presenting to the Psychiatric Emergency Department: An Exploratory Chart Review. J Autism Dev Disord 2021; 52:2367-2375. [PMID: 34128145 PMCID: PMC9021086 DOI: 10.1007/s10803-021-05102-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/19/2021] [Indexed: 12/04/2022]
Abstract
Despite increasing attention on suicidality in autistic people, we know little about suicidal presentations when autistic individuals present to hospital emergency departments (ED). We conducted an exploratory retrospective chart review of suicidal thoughts and behaviours (STB) of autistic adults who presented to a psychiatric ED. The analysis included 16 charts over a 10-week period. Findings highlight that reported STB were not always the presenting issue. Life transitions and interpersonal conflicts were common antecedents, and active rumination about STB was distressing and fatiguing. Findings imply that ED visits serve as important opportunities for suicidal risk reduction for autistic individuals, through implementation of strategies for identification of STB such as active screening, and the provision of suicide resources tailored to autistic people.
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Affiliation(s)
- Patrick Jachyra
- Azrieli Adult Neurodevelopmental Centre, Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, ON Canada
- The Margaret and Wallace McCain Centre for Child, Youth & Family Mental Health, Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, ON Canada
| | - Meng-Chuan Lai
- Azrieli Adult Neurodevelopmental Centre, Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, ON Canada
- The Margaret and Wallace McCain Centre for Child, Youth & Family Mental Health, Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, ON Canada
- Department of Psychiatry, The Hospital for Sick Children, Toronto, ON Canada
- Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, ON Canada
- Autism Research Centre, Department of Psychiatry, University of Cambridge, Cambridge, UK
- Department of Psychiatry, National Taiwan University Hospital and College of Medicine, Taipei, Taiwan
| | - Juveria Zaheer
- Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, ON Canada
- Institute for Mental Health Policy Research, Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, ON Canada
| | - Natasha Fernandes
- Azrieli Adult Neurodevelopmental Centre, Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, ON Canada
- Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, ON Canada
| | - Michelle Dale
- Azrieli Adult Neurodevelopmental Centre, Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, ON Canada
| | - Amanda Sawyer
- Azrieli Adult Neurodevelopmental Centre, Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, ON Canada
- The Margaret and Wallace McCain Centre for Child, Youth & Family Mental Health, Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, ON Canada
- Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, ON Canada
| | - Yona Lunsky
- Azrieli Adult Neurodevelopmental Centre, Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, ON Canada
- Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, ON Canada
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13
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Warrier V, Baron-Cohen S. Childhood trauma, life-time self-harm, and suicidal behaviour and ideation are associated with polygenic scores for autism. Mol Psychiatry 2021; 26:1670-1684. [PMID: 31659270 PMCID: PMC8159746 DOI: 10.1038/s41380-019-0550-x] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2019] [Revised: 07/26/2019] [Accepted: 08/19/2019] [Indexed: 12/28/2022]
Abstract
Autistic individuals experience significantly elevated rates of childhood trauma, self-harm and suicidal behaviour and ideation (SSBI). Is this purely the result of negative environmental experiences, or does this interact with genetic predisposition? In this study we investigated if a genetic predisposition for autism is associated with childhood trauma using polygenic scores (PGS) and genetic correlations in the UK Biobank (105,222 < N < 105,638), and tested potential mediators and moderators of the association between autism, childhood trauma and SSBI. Autism PGS were significantly associated with childhood trauma (max R2 = 0.096%, P < 2 × 10-16), self-harm ideation (max R2 = 0.108%, P < 2 × 10-16), and self-harm (max R2 = 0.13%, P < 2 × 10-16). Supporting this, we identified significant genetic correlations between autism and childhood trauma (rg = 0.36 ± 0.05, P = 8.13 × 10-11), self-harm ideation (rg = 0.49 ± 0.05, P = 4.17 × 10-21) and self-harm (rg = 0.48 ± 0.05, P = 4.58 × 10-21), and an over-transmission of PGS for the two SSBI phenotypes from parents to autistic probands. Male sex negatively moderated the effect of autism PGS on childhood trauma (β = -0.023 ± 0.005, P = 6.74 × 10-5). Further, childhood trauma positively moderated the effect of autism PGS on self-harm score (β = 8.37 × 10-3 ± 2.76 × 10-3, P = 2.42 × 10-3) and self-harm ideation (β = 7.47 × 10-3 ± 2.76 × 10-3, P = 6.71 × 10-3). Finally, depressive symptoms, quality and frequency of social interactions, and educational attainment were significant mediators of the effect of autism PGS on SSBI, with the proportion of effect mediated ranging from 0.23 (95% CI: 0.09-0.32) for depression to 0.008 (95% CI: 0.004-0.01) for educational attainment. Our findings identify that a genetic predisposition for autism is associated with adverse life-time outcomes, which represent complex gene-environment interactions, and prioritizes potential mediators and moderators of this shared biology. It is important to identify sources of trauma for autistic individuals in order to reduce their occurrence and impact.
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Affiliation(s)
- Varun Warrier
- Department of Psychiatry, Autism Research Centre, University of Cambridge, Cambridge, UK.
| | - Simon Baron-Cohen
- Department of Psychiatry, Autism Research Centre, University of Cambridge, Cambridge, UK.
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14
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Conner CM, Golt J, Righi G, Shaffer R, Siegel M, Mazefsky CA. A Comparative Study of Suicidality and Its Association with Emotion Regulation Impairment in Large ASD and US Census-Matched Samples. J Autism Dev Disord 2020; 50:3545-3560. [PMID: 31939083 DOI: 10.1007/s10803-020-04370-1] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Evidence suggests increased rates of suicidality in autism spectrum disorder (ASD), but the research has rarely used comparison samples and the role of emotion dysregulation has not been considered. We compared the prevalence of parent-reported suicidality ideation and considered the role of emotion dysregulation in 330 psychiatric inpatient youth with ASD, 1169 community youth with ASD surveyed online, and 1000 youth representative of the US census. The prevalence of suicidal ideation was three and five times higher in the community and inpatient ASD samples, respectively, compared to the general US sample. In the ASD groups, greater emotion dysregulation was associated with suicidal ideation. Implications include consideration of emotion regulation as a potential mechanism and treatment target for suicidality in ASD.
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Affiliation(s)
- Caitlin M Conner
- Department of Psychiatry, University of Pittsburgh School of Medicine, 3811 O'Hara Street, Webster Hall Suite 300, Pittsburgh, PA, 15213, USA
| | - Josh Golt
- Department of Psychiatry, University of Pittsburgh School of Medicine, 3811 O'Hara Street, Webster Hall Suite 300, Pittsburgh, PA, 15213, USA
| | - Giulia Righi
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University, Providence, RI, USA
- Emma Pendleton Bradley Hospital, Providence, RI, USA
- Division of Biology and Medicine, Rhode Island Consortium for Autism Research and Treatment (RI-CART), and the Hassenfeld Child Health Innovation Institute (HCHII), Brown University, Providence, RI, USA
| | - Rebecca Shaffer
- University of Cincinnati College of Medicine, Cincinnati, OH, USA
- Division of Developmental and Behavioral Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Matthew Siegel
- Maine Medical Center Research Institute, Spring Harbor Hospital, Tufts University School of Medicine, Westbrook, ME, USA
| | - Carla A Mazefsky
- Department of Psychiatry, University of Pittsburgh School of Medicine, 3811 O'Hara Street, Webster Hall Suite 300, Pittsburgh, PA, 15213, USA.
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15
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Hunsche MC, Saqui S, Mirenda P, Zaidman-Zait A, Bennett T, Duku E, Elsabbagh M, Georgiades S, Smith IM, Szatmari P, Ungar WJ, Vaillancourt T, Waddell C, Zwaigenbaum L, Kerns CM. Parent-Reported Rates and Clinical Correlates of Suicidality in Children with Autism Spectrum Disorder: A Longitudinal Study. J Autism Dev Disord 2020; 50:3496-3509. [PMID: 32034647 DOI: 10.1007/s10803-020-04373-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
This study investigated rates of suicidal ideation (SI) and suicidal and/or self-injurious behaviour (SSIB) reported by parents on the Child Behavior Checklist for 178 children with ASD over four annual assessments (ages 7-11 years). Analyses examined the frequency and persistence of SI and SSIB, and the association of SI and SSIB at any time point with child characteristics and internalizing and externalizing problems at age 7. SI occurred in 9.6% of children and was associated with fewer ASD symptoms and better adaptive functioning at age 7. SSIB occurred in 14.6% and was associated with poorer adaptive functioning and more externalizing behaviour at age 7. Internalizing problems were not associated with SI or SSIB at any time point. SI and SSIB rarely co-occurred (4%).
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Affiliation(s)
- Michelle C Hunsche
- University of British Columbia, 2136 West Mall, Vancouver, BC, V6T 1Z4, Canada
| | - Sonja Saqui
- University of British Columbia, 2136 West Mall, Vancouver, BC, V6T 1Z4, Canada
| | - Pat Mirenda
- University of British Columbia, 2136 West Mall, Vancouver, BC, V6T 1Z4, Canada
| | - Anat Zaidman-Zait
- University of British Columbia, 2136 West Mall, Vancouver, BC, V6T 1Z4, Canada.,Tel Aviv University, Tel Aviv, Israel
| | | | - Eric Duku
- McMaster University, Vancouver, BC, Canada
| | | | | | | | | | | | | | | | | | - Connor M Kerns
- University of British Columbia, 2136 West Mall, Vancouver, BC, V6T 1Z4, Canada.
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16
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Howe SJ, Hewitt K, Baraskewich J, Cassidy S, McMorris CA. Suicidality Among Children and Youth With and Without Autism Spectrum Disorder: A Systematic Review of Existing Risk Assessment Tools. J Autism Dev Disord 2020; 50:3462-3476. [PMID: 32100237 DOI: 10.1007/s10803-020-04394-7] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Individuals with autism are at heightened risk for experiencing suicidality compared to those without autism. Despite this, it is unknown what tools are used to assess suicide risk in research and clinical practice among children and youth with autism. This systematic review examined tools commonly used to measure suicidality in children and youth with and without autism spectrum disorder. Four databases were searched. We identified five tools (C-SSRS, PSS, SITBI, SIQ-JR, BSS) commonly used with youth in the general population; however, we did not identify any tools that were commonly used autistic children and youth. Results highlight the lack of available tools utilized to measure suicidality in autistic children and youth. We propose a framework to facilitate research to fill this gap.
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Affiliation(s)
- Stephanie J Howe
- Werklund School of Education, University of Calgary, EDT 508, University Dr. NW, Calgary, AB, T2N1N4, Canada.,Alberta Children's Hospital Research Institute, University of Calgary, Calgary, AB, Canada
| | - Katie Hewitt
- Werklund School of Education, University of Calgary, EDT 508, University Dr. NW, Calgary, AB, T2N1N4, Canada.,Alberta Children's Hospital Research Institute, University of Calgary, Calgary, AB, Canada
| | - Jessica Baraskewich
- Werklund School of Education, University of Calgary, EDT 508, University Dr. NW, Calgary, AB, T2N1N4, Canada.,Alberta Children's Hospital Research Institute, University of Calgary, Calgary, AB, Canada
| | - Sarah Cassidy
- School of Psychology, University of Nottingham, Nottingham, UK
| | - Carly A McMorris
- Werklund School of Education, University of Calgary, EDT 508, University Dr. NW, Calgary, AB, T2N1N4, Canada. .,Alberta Children's Hospital Research Institute, University of Calgary, Calgary, AB, Canada.
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17
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Masi G, Scullin S, Narzisi A, Muratori P, Paciello M, Fabiani D, Lenzi F, Mucci M, D’Acunto G. Suicidal Ideation and Suicidal Attempts in Referred Adolescents with High Functioning Autism Spectrum Disorder and Comorbid Bipolar Disorder: A Pilot Study. Brain Sci 2020; 10:brainsci10100750. [PMID: 33080887 PMCID: PMC7603180 DOI: 10.3390/brainsci10100750] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Revised: 09/22/2020] [Accepted: 10/14/2020] [Indexed: 12/28/2022] Open
Abstract
Suicidal ideation and attempts in adolescents are closely associated to bipolar disorders (BD). Growing evidence also suggests that high functioning autism spectrum disorders (HF-ASD) are at increased risk for suicidal ideation and behaviors. Although BD and HF-ASD are frequently comorbid, no studies explored suicidality in these individuals. This exploratory study addressed this issue in a clinical group of inpatient adolescents referred to a psychiatric emergency unit. Seventeen adolescents with BD and HF-ASD and severe suicidal ideation or attempts (BD-ASD-S), were compared to 17 adolescents with BD and HF-ASD without suicidal ideation or attempts (BD-ASD-noS), and to 18 adolescents with BD and suicidal ideation or attempts without ASD (BD-noASD-S), using a structured assessment methodology. Individuals with BD-ASD-S had a higher intelligence quotient, more severe clinical impairment, more lethality in suicide attempts, more internalizing symptoms, less impulsiveness, and lower social competence. Severity of ASD traits in individuals and parents did not correlate with suicidal risk. Some dimensions of resilience were protective in terms of repulsion by life and attraction to death. Main limitations are the small sample size, the lack of a control group of typically developing adolescents. However, a better understanding of the specificities of bipolar HF-ASD individuals with suicidality may improve prevention and treatment strategies.
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Affiliation(s)
- Gabriele Masi
- IRCCS Stella Maris, Scientific Institute of Child Neurology and Psychiatry, Calambrone, 56018 Pisa, Italy; (S.S.); (A.N.); (P.M.); (D.F.); (F.L.); (M.M.); (G.D.)
- Correspondence:
| | - Silvia Scullin
- IRCCS Stella Maris, Scientific Institute of Child Neurology and Psychiatry, Calambrone, 56018 Pisa, Italy; (S.S.); (A.N.); (P.M.); (D.F.); (F.L.); (M.M.); (G.D.)
| | - Antonio Narzisi
- IRCCS Stella Maris, Scientific Institute of Child Neurology and Psychiatry, Calambrone, 56018 Pisa, Italy; (S.S.); (A.N.); (P.M.); (D.F.); (F.L.); (M.M.); (G.D.)
| | - Pietro Muratori
- IRCCS Stella Maris, Scientific Institute of Child Neurology and Psychiatry, Calambrone, 56018 Pisa, Italy; (S.S.); (A.N.); (P.M.); (D.F.); (F.L.); (M.M.); (G.D.)
| | - Marinella Paciello
- Faculty of Psychology, Università Telematica Internazionale Uninettuno, 00186 Rome, Italy;
| | - Deborah Fabiani
- IRCCS Stella Maris, Scientific Institute of Child Neurology and Psychiatry, Calambrone, 56018 Pisa, Italy; (S.S.); (A.N.); (P.M.); (D.F.); (F.L.); (M.M.); (G.D.)
| | - Francesca Lenzi
- IRCCS Stella Maris, Scientific Institute of Child Neurology and Psychiatry, Calambrone, 56018 Pisa, Italy; (S.S.); (A.N.); (P.M.); (D.F.); (F.L.); (M.M.); (G.D.)
| | - Maria Mucci
- IRCCS Stella Maris, Scientific Institute of Child Neurology and Psychiatry, Calambrone, 56018 Pisa, Italy; (S.S.); (A.N.); (P.M.); (D.F.); (F.L.); (M.M.); (G.D.)
| | - Giulia D’Acunto
- IRCCS Stella Maris, Scientific Institute of Child Neurology and Psychiatry, Calambrone, 56018 Pisa, Italy; (S.S.); (A.N.); (P.M.); (D.F.); (F.L.); (M.M.); (G.D.)
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18
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Hirvikoski T, Boman M, Chen Q, D'Onofrio BM, Mittendorfer-Rutz E, Lichtenstein P, Bölte S, Larsson H. Individual risk and familial liability for suicide attempt and suicide in autism: a population-based study. Psychol Med 2020; 50:1463-1474. [PMID: 31238998 DOI: 10.1017/s0033291719001405] [Citation(s) in RCA: 66] [Impact Index Per Article: 16.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
BACKGROUND Studies on the individual gender-specific risk and familial co-aggregation of suicidal behaviour in autism spectrum disorder (ASD) are lacking. METHODS We conducted a matched case-cohort study applying conditional logistic regression models on 54 168 individuals recorded in 1987-2013 with ASD in Swedish national registers: ASD without ID n = 43 570 (out of which n = 19035, 43.69% with ADHD); ASD + ID n = 10 598 (out of which n = 2894 individuals, 27.31% with ADHD), and 270 840 controls, as well as 347 155 relatives of individuals with ASD and 1 735 775 control relatives. RESULTS The risk for suicidal behaviours [reported as odds ratio OR (95% confidence interval CI)] was most increased in the ASD without ID group with comorbid ADHD [suicide attempt 7.25 (6.79-7.73); most severe attempts i.e. requiring inpatient stay 12.37 (11.33-13.52); suicide 13.09 (8.54-20.08)]. The risk was also increased in ASD + ID group [all suicide attempts 2.60 (2.31-2.92); inpatient only 3.45 (2.96-4.02); suicide 2.31 (1.16-4.57)]. Females with ASD without ID had generally higher risk for suicidal behaviours than males, while both genders had highest risk in the case of comorbid ADHD [females, suicide attempts 10.27 (9.27-11.37); inpatient only 13.42 (11.87-15.18); suicide 14.26 (6.03-33.72); males, suicide attempts 5.55 (5.10-6.05); inpatient only 11.33 (9.98-12.86); suicide 12.72 (7.77-20.82)]. Adjustment for psychiatric comorbidity attenuated the risk estimates. In comparison to controls, relatives of individuals with ASD also had an increased risk of suicidal behaviour. CONCLUSIONS Clinicians treating patients with ASD should be vigilant for suicidal behaviour and consider treatment of psychiatric comorbidity.
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Affiliation(s)
- T Hirvikoski
- Department of Women's and Children's Health, Pediatric Neuropsychiatry Unit, Center for Neurodevelopmental Disorders at Karolinska Institutet (KIND), Karolinska Institutet, Stockholm, Sweden
- Habilitation & Health, Stockholm County Council, Stockholm, Sweden
- Center for Psychiatry Research, Stockholm County Council, Stockholm, Sweden
| | - M Boman
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Q Chen
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - B M D'Onofrio
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
- Department of Psychological and Brain Sciences, Indiana University Bloomington, Bloomington, Indiana, USA
| | - E Mittendorfer-Rutz
- Department of Clinical Neuroscience, Division of Insurance Medicine, Karolinska Institutet, Stockholm, Sweden
| | - P Lichtenstein
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - S Bölte
- Department of Women's and Children's Health, Pediatric Neuropsychiatry Unit, Center for Neurodevelopmental Disorders at Karolinska Institutet (KIND), Karolinska Institutet, Stockholm, Sweden
- Center for Psychiatry Research, Stockholm County Council, Stockholm, Sweden
- Child and Adolescent Psychiatry, Stockholm County Council, Stockholm, Sweden
| | - H Larsson
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
- School of Medical Sciences, Örebro University, Örebro, Sweden
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19
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What is the Prevalence of Self-harming and Suicidal Behaviour in Under 18s with ASD, With or Without an Intellectual Disability? J Autism Dev Disord 2020; 50:3510-3524. [DOI: 10.1007/s10803-020-04422-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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20
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Wijnhoven LA, Niels-Kessels H, Creemers DH, Vermulst AA, Otten R, Engels RC. Prevalence of comorbid depressive symptoms and suicidal ideation in children with autism spectrum disorder and elevated anxiety symptoms. J Child Adolesc Ment Health 2019; 31:77-84. [PMID: 31109252 DOI: 10.2989/17280583.2019.1608830] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Objective: Children with autism spectrum disorder (ASD) often have comorbid depressive symptoms and suicidal ideation. The aim of this study was to examine levels of depressive symptoms and suicidal ideation in a sample of children with ASD, normal cognitive functioning and elevated anxiety. Methods: In total, 93 children aged 8-16 years with ASD and with normal cognitive functioning and (sub)clinical anxiety symptoms participated in the present study. Both parents and children filled in questionnaires to measure the level of depressive symptoms. Moreover, children reported their level of suicidal ideation. Results: More than 35% of the children with ASD reported clinical levels of depressive symptoms while, according to parents, even more than 75% of these children showed clinical levels of depressive symptoms. Girls reported significantly higher levels of depressive symptoms than boys. Moreover, 32.2% of the children with ASD and anxiety had suicidal thoughts and 2.2% of the children showed active suicidal ideation. No gender differences were found in suicidal ideation. Conclusions: The findings indicated that children with ASD, normal cognitive functioning and anxiety symptoms have an increased prevalence of clinical depressive symptoms and suicidal ideation. Therefore, depressive symptoms and suicidal ideation should be assessed when working with anxious children with ASD.
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Affiliation(s)
- Lieke Amw Wijnhoven
- a Mental Health Care Institute , GGZ Oost-Brabant , Boekel , The Netherlands.,b Behavioural Science Institute, Radboud University , Nijmegen , The Netherlands
| | | | - Daan Hm Creemers
- a Mental Health Care Institute , GGZ Oost-Brabant , Boekel , The Netherlands.,b Behavioural Science Institute, Radboud University , Nijmegen , The Netherlands
| | - Ad A Vermulst
- a Mental Health Care Institute , GGZ Oost-Brabant , Boekel , The Netherlands
| | - Roy Otten
- b Behavioural Science Institute, Radboud University , Nijmegen , The Netherlands.,c Mental Health Care Institute Pluryn , Nijmegen , The Netherlands.,d REACH Institute, Arizona State University , Tempe , Arizona , USA
| | - Rutger Cme Engels
- e Erasmus School of Social and Behavioural Sciences , Erasmus University , Rotterdam , The Netherlands
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21
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Weiner L, Flin A, Causin JB, Weibel S, Bertschy G. A case study of suicidality presenting as a restricted interest in autism Spectrum disorder. BMC Psychiatry 2019; 19:126. [PMID: 31029170 PMCID: PMC6487006 DOI: 10.1186/s12888-019-2122-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2018] [Accepted: 04/16/2019] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND Suicidality has been under-researched in autism spectrum disorders (ASD). Most studies have linked increased suicidality in ASD to psychiatric comorbidities such as depression. Here we investigated, from a neuropsychological and clinical standpoint, the relationship between core ASD symptoms, i.e., restricted behaviors and social and communication impairments, and the suicidal behaviors in an adult male individual with ASD, with no psychiatric comorbidities. CASE PRESENTATION We report the case of a 21-year-old male with ASD who attempted suicide twice, in the absence of other psychiatric diagnoses. His behavior and communication skills were rigid. His suicidality was characterized by a rigid, detailed, and pervasive thinking pattern, akin to restricted interests. Consistently, from a neuropsychological standpoint, we found below-average planning and attention skills, and mind-reading skills were rigid and lacked spontaneity. CONCLUSIONS Our case-study suggests that specific clinical and neuropsychological dimensions might be related to suicidal behaviors in ASD. Clinically, the repetitive and rigid suicide-oriented thinking of our patient was not part of a depressive episode. Instead, it followed a purely logical, inflexible, and pervasive reasoning pattern focused on a topic that fascinated him - i.e., suicide --, akin to restricted behaviors. From a neuropsychological standpoint, restrictive suicide-oriented thinking in our patient seems to be related to attention and executive anomalies that have been linked to repetitive and restricted behaviors in ASD. New tools need to be developed to assess persistent suicidal thoughts in this population, as they might be related to intrinsic features of ASD.
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Affiliation(s)
- Luisa Weiner
- Department of Psychiatry and Addictology, University Hospital of Strasbourg, Strasbourg, France
- INSERM 1114, Department of Psychiatry, 1 place de l’hôpital, 67000 Strasbourg, France
| | - Amandine Flin
- Department of Psychiatry and Addictology, University Hospital of Strasbourg, Strasbourg, France
- INSERM 1114, Department of Psychiatry, 1 place de l’hôpital, 67000 Strasbourg, France
| | - Jean-Baptiste Causin
- Department of Psychiatry and Addictology, University Hospital of Strasbourg, Strasbourg, France
- INSERM 1114, Department of Psychiatry, 1 place de l’hôpital, 67000 Strasbourg, France
| | - Sébastien Weibel
- Department of Psychiatry and Addictology, University Hospital of Strasbourg, Strasbourg, France
- INSERM 1114, Department of Psychiatry, 1 place de l’hôpital, 67000 Strasbourg, France
| | - Gilles Bertschy
- Department of Psychiatry and Addictology, University Hospital of Strasbourg, Strasbourg, France
- INSERM 1114, Department of Psychiatry, 1 place de l’hôpital, 67000 Strasbourg, France
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22
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Internalizing Mental Health Issues in Individuals with Neurodevelopmental Disorders: Implications for Practitioners. CURRENT DEVELOPMENTAL DISORDERS REPORTS 2019. [DOI: 10.1007/s40474-019-0154-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
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23
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Kirby AV, Bakian AV, Zhang Y, Bilder DA, Keeshin BR, Coon H. A 20-year study of suicide death in a statewide autism population. Autism Res 2019; 12:658-666. [PMID: 30663277 PMCID: PMC6457664 DOI: 10.1002/aur.2076] [Citation(s) in RCA: 95] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2018] [Accepted: 12/29/2018] [Indexed: 01/11/2023]
Abstract
Scientific Summary Growing concern about suicide risk among individuals with autism spectrum disorder (ASD) necessitates population‐based research to determine rates in representative samples and to inform appropriate prevention efforts. This study used existing surveillance data in Utah to determine incidence of suicide among individuals with ASD over a 20‐year period, and to characterize those who died. Between 1998 and 2017, 49 individuals with ASD died by suicide. Suicide cumulative incidence rates did not significantly differ between 1998 and 2012 across the ASD and non‐ASD populations. Between 2013 and 2017, the cumulative incidence of suicide in the ASD population was 0.17%, which was significantly higher than in the non‐ASD population (0.11%; P < 0.05). During this period, this difference was driven by suicide among females with ASD; suicide risk in females with ASD was over three times higher than in females without ASD (relative risk (RR): 3.42; P < 0.01). Among the individuals with ASD who died by suicide, average age at death and manner of death did not differ significantly between males and females. Ages at death by suicide ranged from 14 to 70 years (M[SD] = 32.41[15.98]). Individuals with ASD were significantly less likely to use firearms as a method of suicide (adjusted odds ratio: 0.33; P < 0.001). Study results expand understanding of suicide risk in ASD and point to the need for additional population‐based research into suicide attempts and ideation, as well as exploration of additional risk factors. Findings also suggest a need for further study of female suicide risk in ASD. Autism Research 2019, 12: 658–666. © 2019 The Authors. Autism Research published by International Society for Autism Research published by Wiley Periodicals, Inc. Lay Summary This study examined suicide risk among individuals with autism spectrum disorder (ASD) in Utah over a 20‐year period. Risk of suicide death in individuals with ASD was found to have increased over time and to be greater than in individuals without ASD between 2013 and 2017. Females with ASD were over three times as likely to die from suicide as females without ASD. Young people with ASD were at over twice the risk of suicide than young people without ASD. Individuals with ASD were less likely than others to die from firearm‐related suicides.
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Affiliation(s)
- Anne V Kirby
- Department of Occupational and Recreational Therapies, University of Utah, Salt Lake City, UT
| | - Amanda V Bakian
- Department of Psychiatry, University of Utah, Salt Lake City, UT
| | - Yue Zhang
- Department of Internal Medicine, University of Utah, Salt Lake City, UT.,Study Design and Biostatistics Center, Center for Clinical and Translational Science, University of Utah, Salt Lake City, UT
| | - Deborah A Bilder
- Department of Psychiatry, University of Utah, Salt Lake City, UT
| | - Brooks R Keeshin
- Department of Pediatrics, University of Utah, Salt Lake City, UT.,Center for Safe and Healthy Families, Primary Children's Hospital, Salt Lake City, UT
| | - Hilary Coon
- Department of Psychiatry, University of Utah, Salt Lake City, UT
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24
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Abstract
BACKGROUND Suicidal ideation (SI) is understudied in inflammatory bowel diseases (IBD). We aim to determine SI rates among IBD outpatients and to evaluate predictors of SI. MATERIALS AND METHODS This is a prospective observational study of consecutive adult IBD outpatients over 18 months. Patients were screened for depression and SI using patient health questionnaire (PHQ-9). Demographic data were obtained from electronic medical record. Regression modeling was used for predictor analyses. RESULTS In total, 71 of consecutive 1352 IBD outpatients had SI. Significant correlations between SI and depression severity, tricyclic antidepressants (TCA), IBD-related quality of life, and low vitamin D levels were seen. Univariate regression showed that depression severity, TCA use, and quality of life predicted SI. Multivariate regression showed depression severity (β=0.46; P=0.002) and TCA use (β=0.31; P=0.012) made unique contributions. CONCLUSIONS SI is associated with depressive severity and less directly with IBD activity. Low-dose TCA, often used for chronic abdominal pain, is also a risk factor. Identifying the subset of IBD patients most vulnerable to SI can facilitate proper referrals to behavioral services and prevent progression to completed suicides.
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25
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Systematic Review of Suicide in Autism Spectrum Disorder: Current Trends and Implications. CURRENT DEVELOPMENTAL DISORDERS REPORTS 2018. [DOI: 10.1007/s40474-018-0133-6] [Citation(s) in RCA: 59] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
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