Parent-Reported Suicidal Ideation in Three Population-Based Samples of School-Aged Korean Children With Autism Spectrum Disorder and Autism Spectrum Screening Questionnaire Screen Positivity.

This Korean study found that children with autism are much more likely to have thoughts of suicide than other children. About 14% of autistic children had suicidal thoughts compared to only 3-7% of other children. Even when researchers considered other factors like bullying and depression, autism was still linked to higher suicide risk. Anxiety was the biggest warning sign for suicidal thoughts in autistic children.

This shows doctors and parents need to regularly check if autistic children are having thoughts of suicide, especially those who are very anxious.

This cross-sectional study examined suicidal ideation prevalence in Korean school-aged children with autism spectrum disorder (ASD) or autism screening questionnaire screen positivity (ASP) across three population-based samples (total n=22,962). Parent-reported suicidal ideation was significantly higher in children with ASD (14%) and ASP (16.6-27.4%) compared to screen-negative peers (3.4-6.9%). ASD/ASP remained independent risk factors for suicidal ideation (OR: 2.87-5.67) even after controlling for demographics, peer victimization, behavior problems, and depression. Within the ASD/ASP groups, anxiety emerged as the strongest predictor of suicidal ideation.

Results highlight the critical need for routine suicidal ideation screening in children with ASD and social difficulties, particularly those experiencing high anxiety levels.

Results emphasize urgent need for routine suicidal ideation screening protocols in clinical settings serving autistic children. Anxiety management should be prioritized as a suicide prevention strategy. Healthcare providers should implement systematic assessment tools and develop autism-specific suicide risk protocols, particularly for children presenting with high anxiety levels.

Study limited to Korean population which may limit generalizability to other cultural contexts. Reliance on parent-reported suicidal ideation may underestimate actual prevalence as children might not disclose such thoughts to parents. Cross-sectional design prevents establishing causal relationships between autism and suicidal ideation.

Higher prevalence of suicidality has been reported in individuals with ASD. This study aimed to (1) Estimate the prevalence of suicidal ideation (SI) in epidemiologically-ascertained, population-based, samples of children with ASD or Autism Spectrum Screening Questionnaire (ASSQ) Screen Positivity (ASP); (2) Determine whether ASD/ASP is an independent risk factor for SI, controlling for known SI risk factors; and, (3) Develop an explanatory model for SI in children with ASD/ASP. Participants came from three epidemiologically-ascertained samples of school-aged Korean children ( = 14,423; 3,702; 4,837). ASSQ ≥ 14 was the cutoff for ASP.

A subsample ( = 86) was confirmed to have ASD. SI was based on parents' endorsement of items on the Behavioral Assessment System for Children-2-Parent Report Scale-Children. Logistic regressions were used to assess associations between SI and ASD/ASP, controlling for demographics, peer victimization, behavior problems, and depression. To develop an explanatory model for SI within ASD/ASP, the associations between SI and child characteristics (comorbid conditions, ASD symptoms, IQ, adaptive function) were tested.

SI was higher in children with ASD (14%) and ASP (16.6-27.4%) than ASSQ Screen Negative (ASN) peers (3.4-6.9%). ASD/ASP was strongly predictive of SI (ORs: 2.87-5.67), after controlling for known SI risk factors compared to ASN. Within the ASD and ASP groups, anxiety was the strongest predictor of SI. SI prevalence was higher in non-clinical samples of children with ASD and ASP, relative to ASN peers.

These results underscore the need for routine screening for SI in children with ASD and social difficulties, particularly those with high anxiety. HighlightsPopulation-based, epidemiologically-ascertained, school-aged childrenASD and ASP are independent risk factors for SI in school-aged childrenAnxiety is an independent risk factor for SI in children with ASD or ASP.