Suicide Risk Screening in Children and Adolescents with Autism Spectrum Disorder Presenting to the Emergency Department

Background: Youth with autism spectrum disorder (ASD) are over three times more likely to experience suicidal thoughts and behaviors (STB) than children in the general population. Screening to detect suicide risk is therefore critical for youth with ASD. This study examines the capacity of the Ask Suicide-Screening Questions (ASQ), a standard suicide screening tool, to detect suicide risk in children and adolescents with ASD who present to the pediatric emergency department (PED).

Methods: This is a retrospective chart review of 393 (2.1%) youth with ASD and 17,964 (97.9%) youth without ASD, aged 8 to 21 years, who presented to the PED of a large urban academic medical center between 2017 and 2020. During the study period, the ASQ was universally administered to children and adolescents who presented to the PED for any reason. Data extracted from the electronic health record included demographic information, presenting concerns, ASD diagnosis, and ASQ results.

Results: Autistic children and adolescents were more likely to present to the PED with STB at the first PED visit compared to non-autistic children (12.7% vs. 4.4%, p < 0.001). In both autistic and non-autistic groups, presenting concerns about STB were significantly associated with a positive ASQ screen. More autistic youth were found to have a positive ASQ without STB as their chief presenting complaint as compared to non-autistic youth (22.6% vs. 11.6%, p < 0.001). Youth with ASD endorsed each item of the ASQ at roughly twice the rate of those without ASD.

Conclusion: This preliminary descriptive study indicates that the ASQ may be a promising screening tool to assess suicide risk in autistic individuals. Further research on the predictive validity and overall reliability of the ASQ in youth with ASD is recommended.