The combination of autism and exceptional cognitive ability increases risk for suicidal ideation

Abstract

Autism with co-occurring exceptional cognitive ability is often accompanied by severe internalizing symptoms and feelings of inadequacy. Whether cognitive ability also translates into greater risk for suicidal ideation is unclear. To investigate this urgent question, we examined two samples of high-ability individuals with autism for factors that were predictive of suicidal ideation. In the first sample (N=1,074 individuals seen at a clinic specializing in gifted/talented youth), we observed a striking excess of parent-reported suicidal ideation in autistic individuals with IQ >= 120 (OR=5.9, p = 0.0007). In separate sample of N=1,983 SPARK participants, we confirmed higher rates of suicidal thoughts compared to non-autistic children from the ABCD cohort (OR=6.8, p < 2.2 x 10^-16), and further that autistic children with suicidal thoughts had significantly higher cognitive ability (p < 2.2 x 10^-16 ) than those without. Elevated polygenic scores (PGS) for cognitive performance were associated with increased suicidal thoughts (Z = 2.16, p = 0.03), with PGS for educational attainment trending in the same direction (Z = 1.4, p = 0.17). Notably, similar results were found in parents of these autistic youth, where higher PGS for educational attainment was associated with increasing thoughts of suicide (Z=2.28, p=0.02). Taken together, these results suggest that on a phenotypic and genetic level, increasing cognitive ability is an unexpected risk factor for suicidal ideation in individuals diagnosed with, or at risk for autism.

Autism in gifted youth is associated with low processing speed and high verbal ability

“…2). This surprising result is a stark departure from the main effect of IQ that ameliorates these symptoms and many others in the general population, and these observations are likely linked to increased rates of suicidality in 2e individuals [43]. These findings underscore the importance for clinicians, educators, parents, and other caregivers to provide specific support in these areas, especially since they run counter to the general expectation for gifted individuals.…”

Conditions Associated with Autism

“…5 The rate of death by suicide has sky-rocketed by 7 ½ times in people with autism than those without an autism diagnosis. 6 The increased suicide rate in autism may be due to a vast increase in symptoms of depression because autistic people have been shown to quadruple in lifetime rates of depression. 7 Anxiety is mostly measured using subscales from behavioral instruments, which usually do not describe the range of anxiety symptoms in children with autism spectrum.…”