Are aspies more prone to commit sucide?

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I dont know if we are more prone to suicidal thoughts, but everyone experiences them at one time or another.

I wouldn't be surprised if Aspies are more prone to commit suicide, because we're a part of a minority group that's not readily accepted by society. I bet suicide rates are higher for LBGT people compared to straight people as well.

I wouldn't be surprised if Aspies are more prone to commit suicide, because we're a part of a minority group that's not readily accepted by society. I bet suicide rates are higher for LBGT people compared to straight people as well.

ALL people who are treated like dog**** by parents, peers, or society at large are more likely to commit suicide. Full stop.

The only reason depression so often seems "comorbid with Asperger's" is because most of us are continually treated like dog****.

I really don't think there can be any more to it than that.

However, as mentioned by Howlin (1997), "the inability of people with autism to communicate feelings of disturbance, anxiety or distress can also mean that it is often very difficult to diagnose depressive or anxiety states, particularly for clinicians who have little knowledge or understanding of developmental disorders". Similarly, because of their impairment in non-verbal expression, they may not appear to be depressed (Tantam, 1991). This can mean that it is not until the illness is well developed that it is recognised, with possible consequences such as total withdrawal; increased obsessional behaviour; refusal to leave the home, go to work or college etc; and threatened, attempted or actual suicide. Aggression, paranoia or alcoholism may also occur.

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Symptoms of depression can be psychological (poor concentration/memory, thoughts of death or suicide, tearfulness); physical (slowing down or agitation, tiredness/lack of energy, sleep problems, disturbed appetite (weight loss or gain)); or affects of mood and motivation (eg low mood, loss of interest or pleasure, hopelessness, helplessness, worthlessness, withdrawal or bizarre beliefs etc.) People with depression can also experience periods of mania.

http://www.autism.org.uk/working-with/h ... drome.aspx

There can be increased social withdrawal due to a lack of social competence that decreases the opportunities to develop social maturity and ability. The depression can
also affect motivation and energy for other previously enjoyable activities in the classroom and at home. There can be changes in sleep patterns and appetite, and a negative attitude that pervades all aspects of life and, in extreme cases, talk of suicide, or impulsive or planned suicide attempts.

http://www.reboundtherapy.org/papers/as ... ttwood.pdf

National Suicide Prevention Strategy for England

The National Autistic Society (NAS) is the leading charity for people with autism spectrum disorders in the UK. It has a membership of over 11,000, a network of 57 branches, and 60 affiliated organisations in the autism field. The NAS exists to champion the rights and interests of all people with autism and to ensure that they and their families receive quality services, appropriate to their needs. There are approximately 520,000 people with autism spectrum disorders in the UK. The NAS welcomes the opportunity to comment on the National Suicide Prevention Strategy for England.

Suicide, mental health and autism spectrum disorders

People with autism or Asperger syndrome are particularly vulnerable to secondary mental health problems including anxiety and depression, particularly in late adolescence and early adult life. However, problems with communicating feelings and impairment of non-verbal expression can mean that mental illnesses in people with autism spectrum disorders are often well developed before they are recognised 1, with possible consequences such as total withdrawal, obsessive behaviour, aggression and threatened, attempted or actual suicide. Any suicide prevention strategy for people with autism spectrum disorders must focus on the promotion of mental well-being rather than seeking simply to restrict potentially suicidal behaviour.

Two key facts pertain to any discussion of suicide, mental health and autism spectrum disorders:
· Experts in the field have highlighted the striking lack of systematic scientific research on suicide, suicide rates and predictors of suicide in autism and Asperger syndrome
· In almost every part of England, there is no locally identifiable NHS service for assessing needs and diagnosing possible cases of autism and Asperger syndrome except in children and adults with a generalised learning disability.

In 2001, the NAS conducted a major report on the life experiences of adults with autism spectrum disorders 2. Of the report sample, 32% had experienced mental ill-health. Of these, 56% had suffered with depression and 8% felt suicidal or had attempted suicide. Evidence from practitioners supports this pattern of suicidal impulses in people with autism spectrum disorders. A sample of 27 patients assessed at the Autism Research Centre in Cambridge University found that 14 had felt suicidal and 4 had either planned or attempted suicide.

For people with autism spectrum disorders, a first step to mental well-being is prompt and accurate diagnosis. It is recognised that birth to five is a critical stage in the promotion of mental well-being, and this will be greatly assisted for people with autism spectrum disorders if a correct diagnosis is made early. However, to prevent the development of a secondary mental illness in people with autism spectrum disorders, practitioners must address the issues of prevention and early intervention. Prevention means dealing with bullying and social isolation. Early intervention means recognizing mental health problems in the context of autism spectrum disorders.

In the 2001 report, 46% of people with Asperger syndrome were not diagnosed until after the age of 16. Without a diagnosis, it is impossible to put in place interventions that can assist the positive development of people with autism spectrum disorders. They are unlikely to receive appropriate services and may experience feelings of frustration, depression and anger as they struggle to comprehend their impairments. The illustration below expands on how failure to diagnose impacts on people with autism spectrum disorders.

To be effective for people with autism spectrum disorders, the National Suicide Prevention Strategy must address the issues leading to this downward spiral, in particular the support systems which need to be to be put in place to meet the secondary mental health needs of people with autism and Asperger syndrome.

A report by the Department of Health and Royal College of Psychiatrists found that of 479 people with mental illness who committed suicide, 85% were diagnosed as absent or low suicide risk by the last professional to see them alive 3. This is of great concern in terms of the support that potentially suicidal people can expect to receive. For people with autism spectrum disorders, it is even more likely that they will not be assessed as high risk due to the nature of the disorder. Without a specialist adult diagnostic service for autism, the question remains as to how many of these unpredicted suicides could be explained by the presence of an undiagnosed autism spectrum disorder.

A Danish study found risk of suicide to be increased with male gender, unemployment, single status, low income and receipt of social security benefit. The strongest risk factor was admission to a psychiatric hospital 4. Although autism spectrum disorders are not mental illnesses, there seems to be a high proportion of people with autism spectrum disorders who also have an accompanying psychiatric disorder. Ghaziuddin et al found 65% of patients with Asperger syndrome presented with symptoms of psychiatric disorder 5. Tantam estimates that roughly one in fifteen people with Asperger syndrome have symptoms of depression and that many more have a history of depression 6.

Some research exists which tends to confirm the increased risk of suicide amongst the population with Asperger syndrome / high-functioning autism. Wolff and McGuire investigated the links between "schizoid personality" and Asperger syndrome, finding that overlaps existed between the groups and that girls with schizoid personality were significantly more likely to manifest suicidal behaviour 7. More generally, Phillips highlights the lack of guidelines and research on people with learning difficulties who are at risk of suicide 8. In addition, this work recognises the need for learning disability and mental health teams to collaborate more effectively when dealing with this population.

In Phillip's case study, 'Jim', a 36-year-old detained client with learning difficulties, had attempted suicide twice. In the risk assessment for Jim, two key risks were identified with implications for people with autism spectrum disorders. Firstly, Jim's limited support network and communication impairments were seen to be inducing feelings of worthlessness and symptoms of depression. This risk was managed through the provision of weekly therapy sessions and escort provision from Jim's care facility. Secondly, the risk posed by social isolation was countered through moving Jim to supported accommodation with accessible care staff.

Phillips also identifies key risks for the general population with learning difficulties, including depression, bullying, unemployment and social isolation. There are more men than women with autism spectrum disorders. Low employment rates and single status are common in people with autism spectrum disorders. An NAS survey in 2001 found a 6% rate of full-time employment in adults with autism spectrum disorders 9, and a survey in 2000 found only 8% in a long-term sexual relationship 10. All this, along with the general social exclusion that a communication disorder brings, suggests that people with autism spectrum disorders are a significant group to consider for suicide risk.

However, accurate figures are not available because suicide rates are highest among young unattached men and older men. People with ASD have difficulty in accessing services for themselves, and often disappear from the knowledge of services once they cease to be supported by family members. Studies of adults with autism spectrum disorders have also usually relied on contact through family members. People with autism spectrum disorders who have lost contact with their families may have moved areas, and will often either have never been diagnosed or have lost their childhood diagnosis on entering adult services. So, although many adults with autism spectrum disorders are a high risk for suicide, the actual number of suicides is not known.

Specific case studies highlight the lack of understanding and support that can lead to suicide in people with autism spectrum disorders. Jenny Roberts, the mother of a young man with Asperger syndrome who committed suicide in his twenties, has written an open letter to the specialists who treated 'Tom' 11. Tom experienced regular misunderstanding, prejudice, bullying and ridicule. He was discriminated against not only by his peers, but also by ill-informed professionals. As a result of this he considered himself to be a failure and blamed himself for all that he suffered. He had no confidence or self-esteem and in the end found this sense of regret and failure too much to cope with.

Specific comments

The Introduction to the Strategy outlines the main risk factors known for suicide as "being male, living alone, unemployment, alcohol or drug misuse, mental illness". The body of the consultation only specifically deals with the factors of gender and mental illness. Although these are vital issues, the other areas mentioned in the introduction also need to be addressed. Unemployment and living alone can lead to feelings of exclusion and isolation from society. For people with autism spectrum disorders, these feelings are increased by the difficulties with communication and interaction that they face in their daily lives. The key areas of unemployment, living alone and alcohol or drug misuse need to be specifically addressed in the strategy.

In Goal 2, the Strategy sets out to reduce suicide risk in key high risk groups. While people with autism spectrum disorders do not meet the criteria to be selected as 'high-risk', in that actual numbers of suicides in the group are not known, they will certainly be present within the group of people who are currently or who have recently been in contact with mental health services.

To address the needs of the autism sub-group within this group, the Strategy should recommend that doctors and clinical psychologists are trained to recognize the signs and symptoms of autism spectrum disorders, to use the diagnostic criteria provided in the International Classification of Diseases, and to be able to recognize depression or anxiety occurring in the context of autism spectrum disorders. In addition, psychiatrists should be trained in the diagnostic indicators of autism spectrum disorders, as recommended by Wing 12 and Attwood 13. Such training is provided by Elliot House, the NAS Centre for Social and Communication Disorders in Bromley, Kent.

Adult psychiatrists do not currently routinely consider the developmental histories of their patients or interview parents, both of which may be necessary to make a definite diagnosis of an autism spectrum disorder. The NAS is aware of the common mis-diagnosis of autism spectrum disorders, and in particular Asperger syndrome, in generic mental health services. Confusion with schizophrenia, obsessive-compulsive disorder, schizoid or schizotypal personality disorders in men and borderline personality disorder in women may lead to inappropriate drug treatments with potential adverse side-effects or negative reactions. If personality disorder is diagnosed, mental health services may simply refuse treatment of any sort. Prompt diagnosis and appropriate medical and psychological treatment is essential to prevent people with autism spectrum disorders spiralling downwards towards potential suicide.

Where people with autism spectrum disorders fall into other high-risk categories which have been identified, such as young men aged 19-34, their specific needs must be considered. Existing initiatives such as the CALM helpline must be able to signpost individuals with autism or Asperger syndrome on to relevant specialist advisors. Similarly, the ongoing initiatives within the prison service should consider the needs of people with autism spectrum disorders, who may be over-represented within the prison population. The specific impairments associated with autism may make interventions designed to prevent suicide and promote mental well-being in other groups inappropriate or even potentially detrimental to these individuals, particularly when these interventions depend on drug treatment.

There is a presumption that diagnosis is always made early in life, so that an older person who suspects that they may have an autism spectrum disorder rarely receives support from general practitioners to get a firm diagnosis. Doctors need to be informed that so many cases of autism spectrum disorders have been missed in childhood in the past, that the disorder may remain undiagnosed until late in life.

Goal 3 claims that although it cannot include general measures in the strategy, it aims to "stress the importance of general measures to improve mental health and to address aspects of people's life experiences that may damage their self-esteem and their social relationships". This is not reflected in the remainder of the section. Although Objective 3.1 is in theory for the mental health of "socially excluded groups", all the actions to be taken (apart from 3.1.5, which focuses on those in prison) target those with mental health problems. This excludes all those "socially excluded groups" who either do not have mental health problems or whose problems are not yet diagnosed. People with autism spectrum disorders are especially vulnerable due to the "unseen" nature of the disability. Their communication impairments often lead to social exclusion, lack of friendships and a feeling of worthlessness. One adult with autism told the NAS that "I only found professional help after I took an overdose" 14.

This section needs to be broadened to include all groups who are socially excluded, as the objective states.

Goal 5 highlights the need for more research into suicide and suicide prevention, in particular for further studies of high risk groups. The criteria for selecting the high risk groups were based on those that are supported by a number of research studies. The document admits "there are several groups over whom concern has been expressed but who in our view do not meet these criteria. This is usually because there are no satisfactory current figures for suicide and/or there are no research data suggesting the main preventive measures that should be taken." Therefore, it is surely of utmost importance to encourage research into those high risk groups that were excluded because not enough research is currently available.

Further recommendations

The NAS would advocate the inclusion of people with autism spectrum disorders within this potential high-risk group. Further research will need to be conducted to determine which particular sub-groups within this population are likely to be at greatest risk. It has been suggested that all adolescents with autism spectrum disorders should be able to demand a statement of psychological and social need, just as children with autism spectrum disorders can expect to have a statement of educational need.

Also, community-based research should be undertaken into adults with autism spectrum disorders that will identify such adults who are not 'connected' by carers to existing ascertainment methods, such as membership of the NAS. Finally, a requirement should be introduced in relation to suicide verdicts to establish competently the presence or otherwise of developmental disorders of social impairment, and in particular autism spectrum disorders, as is currently the practice with mental illness.

Steve Broach
Policy and Campaigns Officer

Email: [email protected]
Tel: +44 (0)20 7903 3565

References

· Tantam D. 'Asperger syndrome in adulthood' in U. Frith (ed) Autism and Asperger Syndrome, Cambridge University Press: Cambridge, 1991
· Barnard, J, et. al., Ignored or Ineligible? The Reality for Adults with Autism Spectrum Disorders, NAS: London, 2001
· Department of Health/Royal College of Psychiatrists, National Confidential Inquiry into Suicide and Homicide by People with Mental Illness, December 1997
· Mortensen et al, 'Psychiatric illness and risk factors for suicide in Denmark', The Lancet, January 2000, 355:9-12
· Ghaziuddin E et al, Comorbidity of Asperger syndrome: a preliminary report, 1998, Journal of Intellectual Disability Research, 42:4 pp 279-283
· Tantam, D., 'Asperger syndrome in adulthood' in Frith, U. (ed.) Autism and Asperger syndrome, Cambridge University Press: Cambridge, 1991 pp147-183
· Wolff & McGuire, 'Schizoid personality in girls: a follow-up study - what are the links with Aspergers syndrome?', Journal of Child Psychology and · · Psychiatry and Allied Disciplines, 1995, 36:5, pp793 - 817
· Phillips, J., 'Risky Business', Bulletin, BILD, 2001, 122 (5)
· Barnard, J. et al, Ignored or ineligible? The reality for adults with autism spectrum disorders, NAS: London, 2001
· Barnard, J. et al, Inclusion and autism: is it working?, NAS; London, 2000
· Roberts, J., Dear PsychiatristDo Childcare Specialists Understand?, The Lutterworth Press: London, 1995
· Wing, L., The autistic spectrum: a guide for parents and professionals, Constable: London, 1996
· Attwood, T., Asperger's Syndrome: A guide for parents and professionals, Jessica Kingsley: London, 1998
· Barnard, J. et al, Ignored or ineligible? The reality for adults with autism spectrum disorders, NAS: London, 2001