Correlates of Deliberate Self-Harm in Youth With Autism and/or Intellectual Disability

Objective

To identify correlates of deliberate self-harm (DSH) in youth with autism and/or intellectual disability (ID).

Method

This retrospective longitudinal cohort analysis used claims data for youth ages 5 to 24 years continuously enrolled in Medicaid in a midwestern state for 6 months and diagnosed with autism and/or ID between 2010 and 2020 (N = 41,230). Cox proportional hazards regression examined associations between demographic and clinical variables and time to DSH for study cohorts with autism and/or ID.

Results

Autism was diagnosed in 34.3% of the sample, ID was diagnosed in 30.6%, and both autism and ID were diagnosed in 35.1%. Sample youth were predominantly male (73.4%) and had an internalizing (74.8%) or externalizing (62.1%) mental health condition. At least 1 DSH event was identified for 734 youths (2.6%) with autism and 686 youths (2.7%) with ID during follow-up. Increased risk of DSH was associated with older age; female sex; history of abuse or neglect; and co-occurring externalizing problems, internalizing problems, substance use, and thought problems for the autism cohort and ID cohort and with the presence of a chronic complex medical condition in the autism cohort. Risk of DSH was significantly lower for youth with moderate ID and youth eligible for Medicaid via disability and foster care.

Conclusion

Risk factors for DSH in youth with autism and ID are similar to those in neurotypical youth and include increasing age, trauma, mental health conditions, substance use, and female sex. Clinician and consumer education regarding suicide risk and its correlates in youth with autism and ID warrants study.

Plain language summary

This study of youth aged 5 to 24 enrolled in Ohio Medicaid found that 2.6% of youth with autism and 2.7% of youth with intellectual disabilities (ID) had at least one deliberate self-harm (DSH) event between 2010 and 2020. Youth who were older, female, had a history of abuse or neglect, and had co-occurring externalizing, internalizing, substance use, or thought problems, had increased risk for DSH. Risk of DSH was lower for youth with moderate ID and those eligible for Medicaid via disability and foster care.