Autism and Suicide

There is no one way to be autistic. Some autistic people can speak, and some autistic people need to communicate in other ways. Some autistic people also have intellectual disabilities, and some autistic people don’t. Some autistic people need a lot of help in their day-to-day lives, and some autistic people only need a little help. All of these people are autistic, because there is no right or wrong way to be autistic. All of us experience autism differently, but we all contribute to the world in meaningful ways. We all deserve understanding and acceptance. (https://autisticadvocacy.org/about-asan/about-autism/)

Autism is a natural variation in how people think, communicate, and experience the world. Autistic people are described as having differences in social communication, being routine based, having focused passions, and sensory sensitivities. Many autistic people consider autism to be an important part of their identity because it touches all aspects of their experiences and can’t be separated from who they are.

Autistic people may be challenged in today’s society due to societal barriers as they navigate the world. Much of what is difficult for autistic people comes from a mismatch between what an autistic person needs and environments fashioned by the broader community. Researchers have found that communication between two autistic people, or two nonautistic people, is often more effective and builds better rapport than communication between an autistic person and a person who is not autistic (Compton, et al., 2020). This suggests that in such mixed conversations, both people need to accommodate their communication styles to meet the needs of their conversation partners. Without adjustments, misunderstandings and social disconnects can happen. This also might explain how autistic people frequently experience being misunderstood and feel a lack of belonging.

Being autistic involves a unique way of thinking, communicating, and experiencing the world; additionally, autistic people face many barriers navigating a world that wasn’t designed with autistic needs in mind. These challenges, among others, may contribute to the risk for suicide for autistic people.

Awareness of autism has increased over the last several decades, and there have been changes in the diagnostic criteria. These changes have contributed to more people receiving diagnoses and—in ideal situations— better care that aligns with their needs. However, sometimes people can be misdiagnosed with other conditions, cannot access an autism evaluation, or are otherwise not aware they are autistic until later in life. Difficulties in accessing appropriate evaluations make estimating rates of suicide and suicidal thoughts and behaviors among autistic people more challenging.

Autistic people do report suicidal thinking and suicidal behaviors, and people with autism diagnoses do die by suicide. Research indicates that rates of death by suicide are higher for autistic people: A 2024 meta-analysis estimated that the relative risk of autistic people dying by suicide was 2.85x higher than population comparisons.ⁱ Furthermore, systematic reviews indicate that approximately 1-in-3 autistic individuals studied report suicidal ideation and between 15-25% of samples report suicide attempts or other suicide behaviors.^{ii, iii} Unlike in the general population, there is not evidence for sex differences in risk to suicide death; autistic males and females have similar rates of dying by suicide. Consistent with sex patterns in the general population, there is some evidence of higher rates of suicide attempt among autistic females compared with autistic males.^iv

Many of the factors that contribute to increased risk of suicidal thoughts and behaviors in autistic people are like factors for non-autistic people, such as:^{v, vi, vii}

• Having a co-occurring mental health condition like depression, psychosis, substance use disorder and anxiety,
• Trauma, abuse, neglect, or discrimination
• Chronic health conditions or pain
• Family history of mental health conditions or suicide
• Head injury
• Impulsive actions or ruminative thinking (overthinking or repetitively thinking)
• Having difficulties with managing emotions and difficulties with problem solving or using coping skills
• Engaging in self-harm
• Enduring stress including bullying, discrimination, and marginalization

Some contributing factors and warning signs seem to be unique to autistic people:^{viii, ix, x}

• Self-reporting high levels of autistic traits
• Masking/camouflaging (trying to hide or change autistic characteristics to fit in, which often results from societal and social pressures)
• Experiencing autistic burnout (feeling exhausted or losing skills due to chronic stress or lacking needed supports)
• Unmet support needs
• Being diagnosed autistic as an adult versus as a child

Warning signs: It is important to consider what that individual is typically like, and then look for changes in their behavior, such as:

• Feeling like a burden to others
• Feeling socially isolated or lacking social support
• Increased self-isolation or withdrawal
• Loss or decrease in communication
• Increased communication about suicide, hopelessness, no reason for living
• Worsening sadness/depression, anxiety, and suicidal thoughts
• Changes in sleep and appetite
• Loss of preferred interest (or decreased pleasure in it) without replacement
• Engaging in riskier behaviors
• Changes in alcohol and other substance use

What we still don’t know:

• If there are differences based on race or ethnicity among autistic people
• If there are differences among autistic people who are non- or minimally speaking
• Whether there are protective factors that keep autistic people from experiencing suicidal thoughts or behaviors
• If there are protective factors that may be unique to the autistic population

Autistic adults are more likely to experience suicidal thoughts and behaviors than other adults.^xi Several groups of autistic adults rate suicide as a high priority for autism research.^{xii, xiii, xiv, xv} Until recently there has been little research about suicide among autistic people, so a lot is still unknown.

A subgroup of autistic adults report chronic/persistent suicidal thoughts.^xvi Some autistic adults also report that thinking about suicide as an “option” is actually comforting to them.^xvii

It is important for autistic adults to ask for help when experiencing suicidal thoughts or experiencing warning signs and for those around them to take them seriously. This is often difficult for most people, and autistic people may experience additional barriers.

Autistic youth are a growing population in the U.S. with 1 in 36 youth diagnosed each year.^xviii Tragically, as with youth in general, suicide has become a leading cause of death among autistic youth and a critical challenge facing families, clinicians, and our communities more broadly.^{xix, xx} Unfortunately, autistic youth are also 2-3x more likely to experience depression^xxi and 7-8x more likely to experience suicidal thoughts and behaviors than other youth.^xxii While research on factors that contribute to (or protect against) suicide risk in autistic youth is ongoing, several important factors are clear.

First, some studies suggest that suicidal thoughts and behaviors can occur in autistic youth as young as 7 years old; so, earlier (and more frequent) screening is important for this community.^xxiii Asking youth about suicide does not increase the likelihood that they will attempt suicide.^xxiv Second, standard assessments for suicide do not work well for all autistic youth; so, using mixed assessments (e.g., clinical interviews and questionnaires) is optimal for identifying autistic youth at risk of suicide.^xxv Third, discrepancies between youth and parent report may be more common among autistic youth and their parents than other youth;^{xxvi, xxvii} so, it is critical to examine both youth and parent perspectives in understanding suicide risk. Fourth, parents can play a critical role in asking their child about suicide and using safety planning strategies to keep youth safe; collaboration between youth and parents in this process is key. Lastly, validation and affirmation of a child’s autistic identity from family members, friends, and providers is an essential step to creating a supportive and safe environment for youth.

Supportive and affirming communities can make a difference. Clinicians should take care to recognize, validate, and affirm a child’s autistic identity and consider ways to adapt suicide assessments and safety plans for autistic youth. Standard safety approaches, such as Safety Planning Intervention, may work for some autistic youth if they are adapted for this community. Adaptations can include: (a) identifying unique warning signs of crisis (e.g., sensory overload, autistic burnout, etc.), (b) consider the role of focused interests, alone time, and sensory-friendly environments as potential coping skills, (c) examine whether social supports may provide distraction for some youth or could be overwhelming and unhelpful for other youth, and (d) role play exercises to practice asking for help or using the crisis hotlines, among other adaptations.

Being both autistic and LGBTQ+ can bring unique challenges. This is particularly relevant because autistic people are more likely to be LGBTQ+ than the general population,^{xxviii, xxix} which means they may face overlapping experiences of discrimination and misunderstanding.

Multiple social identities interact in shaping a person’s experiences, influencing how they are treated and how they see themselves.^{xxx, xxxi} Individuals with multiple marginalized identities may struggle to find communities that fully understand and support all aspects of who they are. Facing discrimination on multiple fronts—along with challenges such as difficulty accessing affirming healthcare, social rejection, un/underemployment, greater rates of interpersonal violence (e.g., sexual assault), having their LGBTQ+ identities questioned, and the exhaustion of masking autistic traits—can take a toll on mental health.^{xxxii, xxxiii} This can lead to feelings of loneliness, increased stress, and a higher risk of mental health struggles including suicidal thoughts and behavior.^xxxiv Sexual-minority youth and adults have elevated suicide risk,^xxxv and compared with heterosexual autistic peers, autistic sexual-minority adults report significantly higher levels of depression, anxiety, and everyday stress.^xxxvi Being both autistic and transgender or gender nonconforming is associated with a higher risk of suicidal thoughts and behavior when compared to being either autistic or transgender or gender nonconforming alone.^xxxvii

Supportive and affirming communities can make a difference. Providers should take care to validate all parts of a person’s identity and acknowledge the societal barriers they face. Legal protections such as nondiscrimination policies regarding disability, gender, and sexuality provide security. Additionally, seeking out spaces that are both LGBTQ+ and autism-friendly can be a vital source of connection and safety.

If you are worried that an autistic person in your life may be in crisis, there are several steps that you can take to best support them. It is important to ask about suicide clearly and to know that autistic people may not show depression or other risk factors externally in their facial expressions, tone of voice, or body language. For autistic adults who cannot talk about their thoughts or feelings, it is also important to notice changes in their personality and behavior that may be warning signs. While each autistic person is unique, we provide several general recommendations that may be helpful.

• Recognize and regulate any distress that you may feel about asking about (or responding to) a crisis in others. Remaining calm and supportive can be effective when offering help.
• Find a private, quiet location to ask the person directly if they may be experiencing suicidal thoughts or urges. Avoid abstract questions about their experiences (e.g., “How are you feeling?”) and instead, use direct and specific questions about suicide (e.g., “Are you having thoughts about killing yourself?”).
• Recognize that autistic people may have diverse responses to your questions, and all their responses are valid and should be taken seriously. For example, some autistic people may say they do not know if they are in crisis (and they mean it!), while others may become overwhelmed by the questions and shutdown. In these situations, it is best to remain quiet, calm, and regulated to allow the autistic person the time and space to process your question and their experiences. After some time, you can offer help by asking direct questions (e.g., “What do you need in this moment?”).
• Autistic people may benefit from different supports during a crisis, so you can explore various strategies with them. For example, you can offer to sit and spend quiet time with the individual while they process and regulate. Or, if they feel it would be helpful, you can offer to help them contact their mental health providers (e.g., therapist, psychiatrist) or a crisis hotline (e.g., 988) to seek support.
• Consistent and regular check-ins with autistic people both during and after a crisis period are extremely important. For example, sending a text or asking in person if they are experiencing suicidal thoughts again, or what you can do to be helpful, is a critical way to offer continued support.

If you are autistic and experiencing suicidal ideation, the safest next step is to reach out for support. There are supports in place already such as 988, warm lines, crisis text supports, the emergency room, or family and friends. Reaching out for support is a social skill that may be challenging. The ideal situation is to have a support plan in place before suicidal ideation becomes too strong to manage alone. There are resources available to assist in making a plan for reaching out for support.

If the supports listed above are available but not accessible to you personally, you can develop a list of reasons to live, utilize a safety plan, and determine your own rules to follow that reduce access to lethal means. Even if you live with suicidal ideation, there will be bouts of strong suicidal ideation that will pass in time and the goal is to keep yourself safe and alive until the thoughts and or behaviors are more manageable.

• Crisis Supports for the Autism Community
• Warning Signs of Suicide for Autistic People
• Reasons for Living
• 988 Information for the Autistic Community
• Autism Resource for Warning Signs of Suicide: Considerations for the Autism Community

i. Santomauro, D. F., Hedley, D., Sahin, E., Brugha, T. S., Naghavi, M., Vos, T., Whiteford, H. A., Ferrari, A. J., & Stokes, M. A. (2024). The global burden of suicide mortality among people on the autism spectrum: A systematic review, meta-analysis, and extension of estimates from the Global Burden of Disease Study 2021. Psychiatry Research, 341, 115654. https://doi.org/10.1016/j.psychres.2024.115654

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xxxvii. Newell, V., Phillips, L., Jones, C., Townsend, E., Richards, C., & Cassidy, S. (2023). A systematic review and meta-analysis of suicidality in autistic and possibly autistic people without co-occurring intellectual disability. Molecular Autism, 14, Article 12. https://doi.org/10.1186/s13229-023-00544-7