Social communication difficulties are linked to increased risk of self-harm and suicidal behavior

Future studies should focus on identifying other changeable mechanisms to develop preventative interventions for autistic people


Washington, May 1, 2018

Children who have difficulties with social communication have a higher risk of self-harm with suicidal intent by the age of 16 years compared to those without, reports a new study published in the May 2018 issue of the Journal of the American Academy of Child and Adolescent Psychiatry (JAACAP). The study was designed to understand whether characteristics of Autism Spectrum Disorders in childhood are linked with suicidal thoughts, plans and self-harm at 16 years.

Children with autism spectrum disorders often have difficulties in social communication and recent research suggests that suicidality is under-recognized in this population. However, until now, community-based studies on suicidal thoughts and behaviors among children with symptoms of Autism have been limited. Factors that could explain the risk of suicide in this population, such as depression, have also not been studied.

Researchers analysed data on 5,031 adolescents from the Avon Longitudinal Study of Parents and Children (ALSPAC), to assess whether there were any associations between Autism-like traits (social communication, pragmatic language, sociability, repetitive behavior) and the risk of suicidal self-harm, and suicidal thoughts and plans by the age of 16 years.  Depression in early adolescence at 12 years of age was considered as a possible explanatory mechanism.

“Our study suggests that children who have difficulties with social communication are at higher risk for suicidal ideation and behavior in late adolescence,” said Dr. Iryna Culpin, Senior Research Associate in the Bristol Medical School (PHS). “Depressive symptoms in early adolescence partially explain this association.

The researchers found that children with difficulties in social communication had a higher risk of suicidal self-harm, suicidal thoughts and suicide plans by the age of 16 years as compared to those without such difficulties. There was no evidence for an association between a diagnosis of Autism Spectrum Disorders and suicidal behaviors, but the sample was not large enough to definitively rule out such an association.

The team found that approximately a third of the association between social communication difficulties and suicidal self-harm was explained by depression in early adolescence.

“Future studies should focus on identifying other changeable mechanisms to develop preventative interventions for autistic people,” Dr. Culpin concluded.

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Notes for editors
The article is "Autistic Traits and Suicidal Thoughts, Plans and Self-harm in Late Adolescence: Population Based Cohort Study," by Iryna Culpin, PhD, Becky Mars, PhD, Rebecca M. Pearson, PhD, Jean Golding, DSc, Jon Heron, PhD, Isidora Bubak, PhD, Peter Carpenter, FRCPsych, Cecilia Magnusson, PhD, David Gunnell, DSc, and Dheeraj Rai, PhD (https://doi.org/10.1016/j.jaac.2018.01.023). It appears in Journal of the American Academy of Child and Adolescent Psychiatry, volume 57, issue 5 (May 2018), published by Elsevier.

This research was specifically funded by the Baily Thomas Foundation (grant ref: 3747-6849). The UK Medical Research Council and Wellcome (grant ref: 102215/2/13/2) and the University of Bristol provide core support for the Avon Longitudinal Study of Parents and Children (ALSPAC). This study was also supported by the National Institute for Health Research (NIHR) Biomedical Research Centre at the University Hospitals Bristol NHS Foundation Trust and the University of Bristol (BRC-1215-2011). Dr. Magnusson is supported by the Swedish Research Council for Health, Working Life and Welfare (grant ref: 2017-01006). Dr. Culpin is funded by the Elizabeth Blackwell Institute for Health Research Early Career Fellowship (ref: 105612/Z/14/Z). Dr. Mars is supported by a grant from the American Foundation for Suicide Prevention (ref: PDF-0-091-14).

This publication is the work of the authors who will serve as guarantors for the contents of this paper. The views expressed in this publication are those of the author(s) and not necessarily those of the NHS, the NIHR, or the Department of Health. The funders played no role in the study design, data collection, analysis, data interpretation, or writing of the report. The corresponding author has access to all the data in the study and full responsibility for the decision to submit for publication.

Copies of this paper are available to credentialed journalists upon request; please contact Mary Billingsley at mbillingsley@aacap.org or +1 202 587 9672. Journalists wishing to interview the authors may contact Iryna Culpin, PhD, Population Health Sciences, Bristol Medical School, University of Bristol, Oakfield House, Bristol, UK BS8 2BN at iryna.culpin@bristol.ac.uk.

About ALSPAC
Based at the University of Bristol, the Avon Longitudinal Study of Parents and Children (ALSPAC), also known as Children of the 90s, is a world-leading birth cohort study.

Between April 1991 and December 1992, the long-term health project recruited more than 14,000 pregnant women into the study and these women (some of whom had two pregnancies or multiple births during the recruitment period), the children arising from the pregnancy, and their partners have been followed up intensively over two decades.

ALSPAC is the most detailed study of its kind in the world and provides the international research community with a rich resource for the study of the environmental and genetic factors that affect a person’s health and development. Through our research we aim to inform policy and practices that will provide a better life for future generations. It receives core funding from the Medical Research Council, the Wellcome Trust and the University of Bristol. Find out more at http://www.bristol.ac.uk/alspac/.

About Baily Thomas Charitable Fund
The Baily Thomas Charitable Fund is a grant making registered charity which was established primarily to aid the research into learning disability and to aid the care and relief of those affected by learning disability by making grants to voluntary organisations working in this field.

About JAACAP
Journal of the American Academy of Child and Adolescent Psychiatry (JAACAP) is the official publication of the American Academy of Child and Adolescent Psychiatry. JAACAP is the leading journal focusing exclusively on today's psychiatric research and treatment of the child and adolescent. Published twelve times per year, each issue is committed to its mission of advancing the science of pediatric mental health and promoting the care of youth and their families.

The Journal's purpose is to advance research, clinical practice, and theory in child and adolescent psychiatry. It is interested in manuscripts from diverse viewpoints, including genetic, epidemiological, neurobiological, cognitive, behavioral, psychodynamic, social, cultural, and economic. Studies of diagnostic reliability and validity, psychotherapeutic and psychopharmacological treatment efficacy, and mental health services effectiveness are encouraged. The Journal also seeks to promote the well-being of children and families by publishing scholarly papers on such subjects as health policy, legislation, advocacy, culture and society, and service provision as they pertain to the mental health of children and families. www.jaacap.org

About Elsevier
Elsevier is a global information analytics business that helps institutions and professionals advance healthcare, open science and improve performance for the benefit of humanity. Elsevier provides digital solutions and tools in the areas of strategic research management, R&D performance, clinical decision support and professional education, including ScienceDirect, Scopus, SciVal, ClinicalKey and Sherpath. Elsevier publishes over 2,500 digitized journals, including The Lancet and Cell, more than 38,000 e-book titles and many iconic reference works, including Gray's Anatomy. Elsevier is part of RELX Group, a global provider of information and analytics for professionals and business customers across industries. www.elsevier.com

Media contact
Mary Billingsley
JAACAP Editorial Office
+1 202 587 9672
mbillingsley@aacap.org