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Child Psychiatrist /Adult Psychiatrist

Executive Dysfunction Predicts Suicide Risk in Young People with Autism

Executive dysfunction among young people with autism spectrum disorder (ASD), aged 16 to 21 years, is a significant indicator of suicide risk, according to study findings published in Autism.

Suicide Risk

Previous research has established that individuals with ASD are at higher risk for suicide relative to neurotypical individuals. While issues with executive function have been associated with suicide risk in other populations, it has been an underexamined factor among people with ASD — particularly younger individuals. To this aim, investigators evaluated the suicide risk for individuals with ASD, aged 16 to 21 years, and examined depression, autistic traits, and executive function as potential predictors.

The investigators conducted a cross-sectional study using data from the TEACCH School Transition to Employment and Post-Secondary Education (T-STEP) program, a community college-based intervention. At intake, demographic information was collected and participants completed the Wechsler Abbreviated Scales of Intelligence-II (WASI-II), P4 Suicide Screener, Behavior Rating Inventory of Executive Functioning — Adult Version (BRIEF-A), Center for Epidemiological Studies — Depression, Revised (CESDR), and Social Responsiveness Scale, 2nd Edition (SRS-2).

A total of 183 individuals with a medically confirmed diagnosis of ASD were included for analysis. On average, participants were 18.75 (SD, 1.40) years of age, 73.2% were boys/men, and 74.9% identified as White.

These findings highlight the need for integrated intervention approaches between both mental health and developmental disability service systems in order to target complex treatment needs.

The investigators found that 33.3% (n=61) of individuals with ASD had experienced suicidal ideation in their lifetime. Among the group with ideation, 34% reported prior suicide attempt(s), 43% made a suicide plan, and 10% reported an intent to act on thoughts of self-harm within the next 30 days.

The investigators then categorized subjects into risk categories based on their responses. Of the total sample, 65.6% of respondents were “no risk”, 16.4% reported ideation with no additional risk factors and were categorized as “minimal risk”, 14.2% reported ideation and 1 additional risk factor and were categorized as having lower risk, and 3.8% of participants who reported ideation and had multiple additional risk factors and were categorized as “higher risk”.

The investigators found that higher levels of executive dysfunction were correlated with higher autistic traits (r, 0.49; P <.01), increased depression (r, 0.15; P <.05), and suicidal risk (r, 0.22; P <.01). Conversely, autistic traits were not significantly associated with overall suicide risk.

In evaluating predictors of suicide risk, the investigators conducted regression analysis and found that executive dysfunction uniquely predicted suicidality (χ2, 30.36; P <.001), even when controlling for depression (b, 0.02; SE, 0.01; P <.05). The model that included executive dysfunction accounted for approximately 16% of the variance in reported suicidal ideation (R2, 0.16).

Note: This article originally appeared on Psychiatry Advisor

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