416 - Comprehension of Death and Suicide in Youth with Autism, ADHD, and Other Neurodevelopmental Disorders

Youth with autism, attention-deficit hyperactivity disorder, and other neurodevelopmental disorders (ASD/NDD) are at greater risk for suicide, so effective suicide risk screening for this population is critical. For screening to be effective, understanding the concepts asked about in screeners is essential, and this includes conceptualizations of death and suicide. Since youth with ASD/NDD may have problems in language understanding, it is important to evaluate how ASD/NDD youth understand suicide and its finality, as screeners are developed and validated.

Objective:

To evaluate the understanding of death’s finality and the meaning of suicide among youth with ASD/NDD.

Design/Methods:

Children enrolled in one of 3 NDD clinics, aged 8-17 years, English-speaking, and verbally fluent participated in a suicide risk screener validation. Research staff asked questions regarding the subject’s understanding of the finality of death and suicide (e.g., “If you died, would you wake up the next day?”). Participants also provided a definition of “suicide,” which was scored for understanding by two independent raters. Response categories included: “completely understood” (understanding both death and volition), “somewhat understood” (understanding either death or volition), and “did not understand” (understanding neither death nor volition). A separate committee resolved any discrepancies between the raters.

Results:

The sample included 158 youth, of which 155 had an NDD diagnosis. (72.4% male, 55.1% White, 34.6% Black, mean[SD] age: 12.4 [2.5] years). 41.8% (66) had 2 or more comorbidities, with 94.3% of the sample (149) having ADHD, 24.7% (39) ASD and 22.8% (36) another NDD. 89.9% (142/158) understood that if someone dies they do not come back to life the next day, and 82.3% (130/158) agreed that people had the ability to kill themselves. 15.8% (25/158) were not familiar with the word ‘suicide’. For the 84.2% (133/158) who were familiar, 73.7% (98/133) provided definitions indicating they understood suicide completely, 12.8% (17/133) somewhat understood, and 13.5% (18/133) did not understand at all. Those with a complete understanding tended to be older (t=-4.26, p< 0.001).

Conclusion(s):

Most youth with NDD understood the finality of death. However, a considerable portion were either unfamiliar with or did not understand the meaning of the word ‘suicide,’ particularly at younger ages. Given this limited understanding and higher rates of suicide among ASD/NDD populations, it is important that prevention strategies be age-based and tailored specifically for effectively communicating with neurodiverse populations.