Tuesday, May 22, 2018

Social Communication Impairments in Childhood Sometimes Linked to Later Suicidal Behavior

Children who have difficulty communicating in social situations—a trait common in children with autism spectrum disorder (ASD)—may be at higher risk for suicidal ideation and behavior in late adolescence compared with those without these problems, according to a report in the Journal of the American Academy of Child & Adolescent Psychiatry.

“Suicidal behavior in individuals with autism is often underreported, particularly in those with impaired communicative abilities and comorbid self-injurious behavior,” Iryna Culpin, Ph.D., of the University of Bristol and colleagues wrote. “Our findings emphasize the potential importance of assessing whether self-injurious behavior occurs in the context of suicidal ideation.”

For the study, the authors analyzed data on a subset of children who were participants in the Avon Longitudinal Study of Parents and Children, a large birth cohort study in the United Kingdom. The starting sample included children who had received a diagnosis of ASD or showed signs of difficulties in at least one of four ASD traits—social communication, pragmatic language, repetitive behavior, and sociability—measured by parent report on validated instruments. Culpin and colleagues also examined how these youth responded to questions about self-harm and suicidal thoughts or plans at age 16. Complete outcome data on suicidal behavior and ideation at age 16 years were available for 5,031 adolescents.

Culpin and colleagues found a statistically significant association between impaired social communication and self-harm with suicidal intent, suicidal thoughts, and suicidal plans. There was no association between an ASD diagnosis, per se, and suicidal behavior.

Additional statistical analysis revealed that “children with impaired social communication skills were at increased risk for depressive symptoms in early adolescence, which, in turn, was a strong risk factor for suicidal behavior later in adolescence,” they wrote. While “depression explained about a third of the variance of the association between childhood autistic traits and suicidal behavior, substantial variance remained unexplained,” they added.

“These results are important in identifying difficulty with social communication as a potential risk factor for suicidality in the context of depressive symptoms,” wrote Jeremy Veenstra-VanderWeele, M.D. (pictured above), director of the division of child and adolescent psychiatry at Columbia University, in an accompanying editorial. “As a clinician who works with the ASD population, I am dismayed but not surprised to see data support our experience with youth who are suffering and considering suicide at elevated rates compared to their peers. …This is an urgent and obvious area for further research to try to prevent what we now recognize.”

For related information, see the Psychiatric News article “Basis of Inability to Regulate Emotions in Autism Identified.”


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