Tuesday, 3 January 2017

Suicidality in children and young adults with 'high-functioning' autism

"Consistent with the previous findings, [the] rate of suicidality is higher in individuals with ASD [autism spectrum disorder]."

That was one of the conclusions reported in the paper by Sevcan Karakoç Demirkaya and colleagues [1] (open-access) yet again touching on a most important topic when it comes to autism, particularly the part of the autism spectrum labelled as 'high-functioning'. Personally, I'm not a great fan of the 'functioning' description typically added to autism to somehow denote can from can't do. As science is starting to realise, high-functioning does not automatically imply 'can function' across the board just as the even worse description 'low-functioning' does not necessarily generalise to mean 'can't function'. I know it's the best we have at the moment but...

Anyhow, Karakoç Demirkaya et al report results following a review of medical charts for some 55 adolescents (mostly boys) aged between 7 and 20 years of age. All were diagnosed with an ASD and all had "capability of reading, writing and speaking" and were deemed to have cognitive abilities in the typical range (i.e. no learning disability). Included in the data examined were responses to the Eskin’s Suicide Screening Questionnaire; specifically answers to 5 questions on thoughts of (suicidality) and actual attempts at suicide.

Results: "Suicidality was observed in 16 individuals in our group which accounts for a rate of suicide of 29%. Among the suicidal ones, seven individuals had the diagnosis of AD [autistic disorder], eight had AS [Asperger syndrome], and an individual had PDD-NOS [pervasive developmental disorders - not otherwise specified]." Because no 'not autism' control group was included in this specific study, authors draw attention to how their figure compared with "the result of previous studies implemented on a typically developing adolescent population in our country" (Turkey) and suggest that their figure was slightly higher (29% vs 25%). I have to say that I'm pretty shocked by the suicidality figures reported in both the autism and not-autism groups.

On the issue of actual suicide attempts, Karakoç Demirkaya and colleagues report that about 12% of their small-ish cohort had some history of this type of behaviour. Again, this contrasted with data from other independent studies where around 4-5% of adolescents were reporting such a history. Worrying figures again.

Further: "Rates of comorbid psychiatric disorders such as mood disorders, anxiety disorders and disruptive behaviors were 23.6%, 43.6% and 65.4% respectively. Groups with the psychotic features, positive family history for suicidal behaviors and completed suicide showed more suicidality than the non-suicidal group." This is an important part of the results obtained. It implies that when we say suicidality (thoughts and/or behaviours) is 'elevated' when it comes to the autism spectrum, we can't at the present time, tease autism apart from other comorbidities that may also have an important bearing on this type of behaviour. It's a point that has been raised in relation to suicidality accompanying other labels too (see here).

I'm gonna leave it at that with the Karakoç Demirkaya findings save any charges of 'going beyond the data'. As I seem to do quite a lot these days, the primary message is that screening - preferential screening - should be an important part of the continued 'management' of autism (see here). Alongside other media headlines illustrating how for example, psychosis can be (a) present and (b) can sometimes exert a powerful effect on some people on the autism spectrum, further investigation(s) on the role of such issues (minus any stigma) in relation to suicidality and autism is also indicated.

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[1] Karakoç Demirkaya S. et al. Assessment of suicidality in children and adolescents with diagnosis of high functioning autism spectrum disorder in a Turkish clinical sample. Neuropsychiatr Dis Treat. 2016 Nov 11;12:2921-2926.

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ResearchBlogging.org Karakoç Demirkaya, S., Tutkunkardaş, M., & Mukaddes, N. (2016). Assessment of suicidality in children and adolescents with diagnosis of high functioning autism spectrum disorder in a Turkish clinical sample Neuropsychiatric Disease and Treatment, Volume 12, 2921-2926 DOI: 10.2147/NDT.S118304