Type, content, and triggers for self-injurious thoughts and behaviors in autistic youth and their disclosure to caregivers.

Lay abstract: Self-injurious thoughts and behaviors are high among autistic youth, yet research most often relies on caregiver reports and does not include youth perspectives. Relatedly, specific characteristics of self-injurious thoughts and behaviors (e.g. type of behavior, thought content, triggers), and choices to share these thoughts and behaviors with caregivers/parents (or not), have not been studied in autistic youth. With limited information on self-injurious thoughts and behaviors in autistic youth, clinicians and families supporting autistic youth in crisis continue to experience major challenges to best assess and support youth. Therefore, to begin to understand youth perspectives of self-injurious thoughts and behaviors, we administered a self-injurious thoughts and behaviors clinical interview (Columbia-Suicide Severity Rating Scale; C-SSRS) to 103 autistic youth without intellectual disability (10-17 years of age) at a clinic for outpatient mental health services. We added follow-up questions to the interview about suicide to better understand what youth think about when it comes to suicide, what triggers them to feel suicidal, and whether they let their caregiver know about what they are thinking and feeling. Results show that most autistic youth reported suicidal thoughts at some point in their life (n = 86; 83.5%), with thoughts of dying/suicide (n = 20; 23.3%) and death by cutting (n = 13; 15.1%) as common thought content. Half of youth experiencing suicidal thoughts (n = 43; 50.0%) did not share this with their caregiver. Nearly one in four youth had attempted suicide at some point in their life (n = 25; 24.3%), while some youth (n = 16; 15.5%) sought help from caregivers to prevent an attempt. Sadness/depression and bullying/teasing were the most common triggers of suicidal behaviors, while anger/frustration was the leading trigger for nonsuicidal self-injury. Findings can be used to improve current assessment tools and prevention approaches for autistic youth to create better support for autistic youth in crisis.