Suicide in Teens on the Autism Spectrum

"Can teenagers with ASD Level 1 (high functioning autism) become so depressed that they become a risk for suicide?"

Unfortunately, the answer is ‘yes’. Research reveals a 50% demonstration of what we call “suicidal ideation” (i.e., talking about killing yourself) with Asperger's and High-Functioning Autistic teens.

When we look at the cases of teens on the autism spectrum who have attempted suicide or talk about committing suicide, the main issues usually revolve around self-esteem and social isolation. Thus, the parents and teachers should be as supportive as possible.

Here are 25 tips to show parents how to be supportive of a suicidal teenager:

1. A teenager who you feel is “high risk” for suicide should never be left alone, if even for a moment. Keep talking to that person, and stay with him or her.

2. Ask if he/she is thinking about suicide.

3. Ask if they have a plan. If so, take them seriously and move quickly to get help. Remove anything that would help them carry out their plan – guns, drugs, alcohol, knives, etc.

4. Depression in one youngster can cause stress or anxiety in other family members, so make sure “healthy” kids are not ignored. Siblings may need special individual attention or professional help of their own to handle their feelings about the situation.

5. Don’t act shocked.

6. Don’t ask “why.” This encourages defensiveness.

7. Don’t bait the suicidal. Don’t say, “I think you’re just bluffing. I don’t believe you.”

8. Don’t be afraid to talk with him about suicide. Talking about it does not make it worse, but better. Be direct. Talk openly and freely about suicide.

9. Don’t be sworn to secrecy. Get support.

10. Don’t give up if your adolescent shuts you out at first. Talking about depression can be very tough for teens. Be respectful of your youngster’s comfort level while still emphasizing your concern and willingness to listen.

11. Don’t tiptoe around the issue of teen depression in an attempt to “protect” the other kids. Kids know when something is wrong. When left in the dark, their imaginations will often jump to far worse conclusions. Be open about what is going on and invite your kids to ask questions and share their feelings.

12. Don’t try to talk teens out of their depression, even if their feelings or concerns appear silly or irrational to you. Simply acknowledge the pain and sadness they are feeling. If you don’t, they will feel like you don’t take their emotions seriously.

13. Encourage your adolescent to stay active. Exercise can go a long way toward relieving the symptoms of depression, so find ways to incorporate it into your adolescent’s day. Something as simple as walking the dog or going on a bike ride can be beneficial.

14. Get the emotional support you need. Reach out to friends, join a support group, or see a therapist of your own. It’s okay to feel overwhelmed, frustrated, helpless, or angry. The important thing is to talk about how your teen’s depression is affecting you, rather than bottling up your emotions.

15. In order to help a depressed teen, you need to stay healthy and positive yourself, so don’t ignore your own needs. The stress of the situation can affect your own moods and emotions, so cultivate your well–being by eating right, getting enough sleep, and making time for things you enjoy.

16. Isolation only makes depression worse, so encourage your adolescent to see friends and praise efforts to socialize. Offer to take your teen out with friends or suggest social activities that might be of interest, such as sports, after-school clubs, or an art class.

17. It can be easy to blame yourself or another family member for your teen’s depression, but it only adds to an already stressful situation. Furthermore, depression is normally caused by a number of factors, so it’s unlikely—except in the case of abuse or neglect—that any loved one is “responsible”.

18. Just like you would if your youngster had a disease you knew very little about, read up on depression so that you can be your own “expert.” The more you know, the better equipped you’ll be to help your depressed teen. Encourage your adolescent to learn more about depression as well. Reading up on their condition can help depressed teens realize that they’re not alone and give them a better understanding of what they’re going through.

19. Let depressed adolescents know that you’re there for them, fully and unconditionally. Hold back from asking a lot of questions (adolescents don’t like to feel patronized or crowded), but make it clear that you’re ready and willing to provide whatever support they need.

20. Living with a depressed adolescent can be difficult and draining. At times, you may experience exhaustion, rejection, despair, aggravation, or any other number of negative emotions. During this trying time, it’s important to remember that your youngster is not being difficult on purpose. Your teen is suffering, so do your best to be patient and understanding.

21. Make sure you take any threat of suicide seriously. Of all the people who have committed suicide, 80% have given some kind of warning.

22. Make sure your adolescent is following all treatment instructions and going to therapy. It’s especially important that your youngster takes any prescribed medication as instructed. Track changes in your teen’s condition, and call the doctor if depression symptoms seem to be getting worse.

23. Offer hope that alternatives are available.

24. Resist any urge to criticize or pass judgment once your adolescent begins to talk. The important thing is that your youngster is communicating. Avoid offering unsolicited advice or ultimatums as well.

25. You could very well be that voice of hope to someone you love. Most times a suicidal person needs someone close to them to be a voice of hope.

Because of the very real danger of suicide, Aspergers teens who are depressed should be watched closely for any signs of suicidal thoughts or behavior. The warning signs include:

• Changes in eating and sleeping habits
• Difficulty concentrating
• Engaging in reckless behavior or having a lot of accidents resulting in injury
• Fatigue or lack of energy
• Feelings of worthlessness and guilt
• Giving away prized possessions
• Irritability, anger, or hostility
• Lack of enthusiasm and motivation
• Loss of interest in activities
• Restlessness and agitation
• Sadness or hopelessness
• Saying goodbye to friends and family as if for good
• Saying things like, “I’d be better off dead,” “I wish I could disappear forever,” or “There’s no way out”
• Seeking out weapons, pills, or other ways to kill themselves
• Speaking positively about death or romanticizing dying (“If I died, people might love me more”)
• Talking or joking about committing suicide
• Tearfulness or frequent crying
• Thoughts of death or suicide
• Withdrawal from friends and family
• Writing stories and poems about death, dying, or suicide

==> My Aspergers Teen: Help for Defiant Aspergers and HFA Teens

Follow-up Question:

"My son Avi is 14 years old. He was diagnosed with Aspergers at age 9 and since then, has been attending a special ed class within a regular school. He’s generally happy in the class, he has a great teacher and a peer group with whom he can identify and feel comfortable. He is the middle of 7 children. Recently, his 16 year old brother, with whom Avi usually has a fairly good relationship, got frustrated with Avi and told him that if he didn’t change (stop talking incessantly about Pokemon, have better attitude to homework, etc) that he’d never get anywhere in life. Avi sometimes has extreme reactions, but this time his reaction had a new and scary aspect. He lay down on the floor, crawl up the stairs towards his bedroom, breathing heavily and growling “I’m no good, I’ll never amount to anything, I might as well be dead”, and then he climbed on his bed and tried to climb out of the window, as if to jump out. I managed to calm him down, it took about an hour, he took a bath, went to bed and never mentioned it again. I’m not sure if he would have jumped, or if he was “play-acting” the role of a suicidal person (he’s very imaginative) but it was very frightening. My question is: Avi is a fragile personality without resources to deal with a simple insult. How can I speak to him about suicide, when he’s calm, and give him the TOOLS he needs to deal with insults, as I’m sure this won't be the last time that someone insults or offends him?"

Answer:

First of all, I’m very sure he was play-acting and has no intention of committing suicide.

Secondly, he obviously looks up to his older brother and values his opinion (otherwise, he wouldn’t have over-reacted like this). So you may want to have a conversation with your older son that he needs to be careful what he says to his younger brother.

Thirdly, what we are dealing with here is a child with very low self-esteem. I think this is the core issue. Children with Aspergers and HFA have a much harder time with their self-esteem. Here are just a few reasons why:

1. Expressive and comprehensive communication has a direct impact on a child’s self-esteem. These are areas that do not come easily to children on the autism spectrum.

2. The expectations of siblings and the all-too-frequent bullying interactions from many peers can leave an Aspergers or HFA child feeling devastated.

3. The visits to doctors, or speech therapists, or OTs, the testing, and the stream of interventions that we try with them can easily leave them feeling like they're under the microscope, a specimen that warrants investigation, a person who needs fixing.

4. They often perceive the constant correction of their behaviors and their social interactions as criticism

5. Understanding subtle jokes and participating in human interplay, actions natural to their neurotypical peers, further increase their feelings of 'not fitting in' and erode their self-esteem.

Here's how you can play an important role in promoting healthy self-esteem in your son:

1. As parents, we must believe in our children’s value ourselves before we can ever change their minds. These children know when we're faking our compliments or arbitrarily handing out encouragement because the therapy book says we should give 5 positive comments to each correction. 

2. Be a positive role model. If you're excessively harsh on yourself, pessimistic, or unrealistic about your abilities and limitations, your son may eventually mirror you. Nurture your own self-esteem, and your son will have a great role model.

3. Be spontaneous and affectionate. Your love will go a long way to boost your son's self-esteem. Give hugs and tell him you're proud of them. Pop a note in your son's lunchbox that reads, "I think you're terrific!" Give praise frequently and honestly, without overdoing it. Children can tell whether something comes from the heart.

4. Believing in your son involves empathy, walking in their shoes, rather than sympathy; no one wants to be felt sorry for. Each child is a gift, with his own special qualities. We just need to look for these special gifts, tune into the child with our hearts, and bring their essence out.

5. Create a safe, loving home environment. Children who don't feel safe or are abused at home will suffer immensely from low self-esteem.

6. Empower your son to be himself, perfectly okay with who and how he is. Do this by loving him for who he is now, today, not who you think he should become someday. 

7. Encourage your son to share his thoughts and feelings; this is so important and often sheds new light on existing situations. 

8. Explain the disorder to your son when he is able to understand his disorder. Who are we really kidding, other than ourselves, when we pretend a child does not have the autism label, or we try to camouflage it? Who are we hurting? It's the child who is hurt in the long run.

9. Give positive, accurate feedback. Statements like, "You were really mad at your brother. But I appreciate that you didn't yell at him or hit him" acknowledges a child’s feelings, rewards the choice made, and encourages him to make the right choice again next time.

10. Go to conferences, read books, research and share information that takes into consideration the many sensory, social, behavioral and communication challenges faced by your child. Armed with this understanding of how the disability affects him, you and others can better find ways to help him fit in. 

11. Help your son become involved in constructive experiences. Activities that encourage cooperation rather than competition are especially helpful in fostering self-esteem. For example, mentoring programs in which an older child helps a younger one learn to read can do wonders for both children.

12. Identify and redirect your son's inaccurate beliefs. It's important for you to identify your son’s irrational beliefs about himself, whether they're about perfection, attractiveness, ability, or anything else. Helping children set more accurate standards and be more realistic in evaluating themselves will help them have a healthy self-concept. Inaccurate perceptions of self can take root and become reality to children.

13. Keep your son’s life manageable, refraining from overwhelming him with so many activities that he becomes too challenged physically and mentally to succeed at anything. Like most people, children with Aspergers and HFA feel better about themselves when they're balanced physically, emotionally, and spiritually. 

14. Provide choices to your son frequently so he understands that he has a say in his own life -- and even let him be in charge sometimes. 

15. Since children on the spectrum are often very picky eaters and gravitate towards junk food, it's important to try supplementing their diet. Also, provide regular physical activity, when possible, to relieve stress and clear his mind. 

16. Watch for signs of abuse by others, problems in school, trouble with peers, and other factors that may affect your son’s self-esteem. Deal with these issues sensitively - but swiftly. 

17. Watch what you say. Kids on the spectrum are very sensitive to their parent’s words. Remember to praise your son not only for a job well done, but also for effort. But be truthful. For example, if your son doesn't make the soccer team, avoid saying something like, "Well, next time you'll work harder and make it." Instead, try "Well, you didn't make the team, but I'm really proud of the effort you put into it." Reward effort and completion instead of outcome.

18. Lastly, when we say, "You are great!" to your son often enough, he, too, will believe it and feel valued for who he truly is.