Comment

Suicide risk in adults with Asperger's syndrome

A major issue of individuals with autism spectrum disorder (ASD) is having a comorbid, psychiatric disorder. However, the mental health of those with ASD is understudied. This study this study utilized a nationally representative population-based cohort data, to investigate the risk of psychiatric comorbidity with ASD and its association with, diagnosis timing.

Characteristics of those without ASD, ASD (overall), early-diagnosed ASD, and latediagnosed, ASD were compared using a chi-squared test. Subsequently, a multiple, logistic regression was performed to estimate the risk of psychiatric comorbidity in, those with ASD, early-diagnosed ASD, and late-diagnosed ASD compared to those, without ASD, after controlling for covariates. Moreover, the association of psychiatric, comorbidity and diagnosis timing of ASD was investigated using multiple logistics while controlling for covariates.

Individuals with ASD had a higher risk of having a psychiatric disorder than those, without ASD. Specifically, those with ASD showed a higher risk of schizophrenia and, related disorders, mood disorders, anxiety and stress disorders, intellectual disability, and behavioral and emotional disorders with onset usually occurring during childhood, and adolescence compared to those without ASD. Moreover, individuals with latediagnosed, ASD showed a higher risk of having all comorbid psychiatric disorder than, early-diagnosed ASD when compared to non-ASD, except for schizophrenia and related disorders.

Children with ASD are at a higher risk of psychiatric comorbidity than typically, developed children. Especially early ASD diagnosis may be important in alleviating the, risk of psychiatric comorbidity of those with ASD.

Mainstream education can be difficult for autistic children given the social communication difficulties, highly focused interests and sensory sensitives associated with autism. Educators can still find providing a safe, inclusive and supportive environment for autistic students challenging. Subsequently some parents decide to remove their children from school and home educate. The purpose of this thematic review is to synthesise reported findings on home educating autistic children who have previously attended formal education.

PRISMA guidelines informed the review process. Articles included were published in the last 10 years and specific to autistic children being educated at home. Of the 22 articles meeting eligibility for full text review, 10 matched the final inclusion criteria.

Findings related to four main themes emerging from the synthesis: the motivations and reasons that led parents to home educate their autistic children; parents’ experiences of home educating; practices and pedagogical approaches used by parents; and the impact of home education on the outcomes for autistic students. Findings revealed that home education can be a positive experience for families with good academic and social outcomes for autistic children and young people. Limitations of the evidence base are considered.

Although not all parents may be in a position to home educate their children, this review indicates that parents with appropriate educational, financial and social supports have found home educating their autistic child empowering. They report being able to provide flexible, balanced and individualised education leading to positive outcomes.

Adults diagnosed with autism are at significantly increased risk of suicidal thoughts, suicidal behaviours and dying by suicide. However, it is unclear whether any validated tools are currently available to effectively assess suicidality in autistic adults in research and clinical practice. This is crucial for understanding and preventing premature death by suicide in this vulnerable group. This two stage systematic review therefore aimed to identify tools used to assess suicidality in autistic and general population adults, evaluate these tools for their appropriateness and measurement properties, and make recommendations for appropriate selection of suicidality assessment tools in research and clinical practice. Three databases were searched (PsycInfo, Medline and Web of Knowledge). Four frequently used suicidality assessment tools were identified, and subsequently rated for quality of the evidence in support of their measurement properties using the COSMIN checklist. Despite studies having explored suicidality in autistic adults, none had utilised a validated tool. Overall, there was lack of evidence in support of suicidality risk assessments successfully predicting future suicide attempts. We recommend adaptations to current suicidality assessment tools and priorities for future research, in order to better conceptualise suicidality and its measurement in autism.

Individuals with Autism Spectrum Disorder (ASD) are at increased risk of suicidal ideation and behavior. This study characterized the inter-relationships between loneliness, depression and thoughts of self-harm in adults with ASD.

Participants were 71 adults with ASD who completed questionnaires that provided information on loneliness, depression and thoughts of self-harm. Relationships between study variables were examined with correlations and a regression analysis. Two exploratory mediation models were then explored. Model 1 tested whether the relationship between depression and thoughts of self-harm was mediated through loneliness. Model 2 tested whether loneliness acted on thoughts of self-harm through depression.

Twenty-six percent of participants met the clinical cut-off for depression and 21% reported thoughts of self-harm. Depressive symptoms, loneliness, and thoughts of self-harm were significantly correlated. Only Model 2, that identified an indirect pathway from loneliness, through depression to thoughts of self-harm, was supported. The mediator for this model accounted for 56.7% of the total effect.

This study examined potential mechanisms underlying depression and thoughts of self-harm in ASD. These results highlight a possible contribution of loneliness to depression and thoughts of self-harm, suggesting treatment options that target loneliness may prove beneficial in improving mental health outcomes in ASD.