What if the patients we assume are safest from suicide are actually the ones we miss?

Today we're talking about suicide risk in autistic youth, why it's higher than many clinicians expect,

how distress shows up differently, and what small changes in our assessment process and treatment that can make a real difference?

I'm Dr. Josh Fader, the editor-in-chief of the Carlatte Child Psychiatry Report,

and co-author of the Child Medication Fact Book for Psychiatric Practice Second Edition,

and our other book

Prescribing Psychotropics.

In AmeriGovern, a licensed clinical social worker in Southern California with a private practice

and an avid reader of the Carlet Psychiatry Reports.

Many clinicians today may still assume autism lower suicide risks.

The thinking goes, more supervision, more structure, fewer opportunities for harm.

But when we look at the data and from our clinical experience, a different pattern emerges.

Nearly one in four autistic youth report suicidal thoughts more than double the rate in the general

population, and they're about five times as likely to attempt suicide.

Yet the warning signs are easy to miss.

Much of our suicide assessment training comes from neurotypical populations, so we tend to listen for verbal expressions of hopelessness. We look for social withdrawal or explicit statements of intent to harm oneself, and autistic patients don't always present that way.

Autistic use often experience distress differently. Emotional pain may show up through changes in actions or routines rather than through words.

Many struggle to identify or describe internal emotional states.

They may not say they feel depressed even when their functioning is declining.

Clinicians may notice increased shutdowns, irritability, rigidity,

or loss of interest in routines, or special interests.

Another factor is perseverative thinking. That's thinking about things over and over again.

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