Rethinking Suicide Awareness for Autistics

Rethinking Suicide Awareness for Autistics

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September is Suicide Awareness Month. For many Autistic adults — especially those who are high-masking, late-identified, and have intersecting marginalized identities — this topic feels painfully personal.

I began experiencing suicidality in elementary school — more than two decades before learning I was Autistic and an ADHDer. Many undiagnosed Autistics and ADHDers receive initial diagnoses of depression, bipolar, anxiety, and Borderline Personality Disorder, only to have autism and ADHD missed completely because of inaccurate stereotypes. This is especially true for folks socialized as girls. Discovering I was AuDHD in my 30s finally gave me language for why life felt harder for me than for my peers. That knowledge helped me address the root of my suicidality. Today, I have the privilege of supporting Autistic and ADHD clients who struggle with suicidality and teaching other therapists how to better identify and support suicidal clients.

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What the Research Shows

Research consistently shows that Autistic people are at 2–9 times higher risk of experiencing suicidal thoughts, attempting suicide, and dying by suicide than non-autistic people. Among Autistic adults without co-occurring intellectual disability, studies show lifetime suicidal ideation rates of 60–70% and attempt rates around 30%.

But statistics only tell part of the story. Many Autistic people know the lived reality of feeling unheard, unsupported, or trapped in systems not designed for us — often long before knowing that we are Autistic, and that’s why those systems don’t fit. Too often, reaching out for help leads not to compassion, but to dismissal, coercion, or even punishment.

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Why Suicide Risk is Higher for Autistics

Autistic suicidality arises not from autism itself, but from a convergence of factors that interact with systemic barriers. Research identifies several contributors:

• Masking + camouflaging - Hiding traits to survive in a non-autistic world is linked with exhaustion, shame, defeat, and entrapment.

• Minority stress - Being LGBTQIA+, BIPOC, or otherwise marginalized compounds discrimination and daily stress.
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• Alexithymia - Difficulty naming or recognizing emotions can make it hard to notice crisis points or explain them to others.
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• Chronic pain + health issues- Ongoing conditions like GI problems, autoimmune conditions, migraines, and sleep disorders feed hopelessness and despair.
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• Co-occurring mental health challenges - AuDHDers experience amplified suicide risk, likely due to emotion regulation differences, impulsivity and executive function challenges. Autistic people often experience co-occurring depression, anxiety, substance misuse, and / or trauma, all of which can also increase suicide risk.
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• Isolation + lack of belonging - Social connection is one of the strongest protective factors against suicide. Yet throughout the lifespan we experience high rates of exclusion, bullying, interpersonal violence, and rejection that contribute to feelings of disconnection.
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• Feelings of worthlessness + hopelessness - Years of internalized stigma, exacerbated by implicit and explicit messages about life trajectories can fuel beliefs that we don’t matter or that nothing will improve.
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• Difficulty accessing support - Services are scarce, waitlists are long, and systems are inaccessible. Many stop reaching out — not because we don’t want help, but because the effort rarely leads to meaningful support.
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These factors intersect to create conditions where suicidality takes root. The risk isn't being Autistic — it's the way society treats Autistic people and fails to provide support we need throughout the lifespan.

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Why Traditional Suicide Assessments Might Not Work for Us

Most suicide screening tools were designed for non-autistic populations, so they often fail to capture Autistic realities. For example:

• Our distress may be expressed in literal language that gets misunderstood.
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• We may answer questions literally, giving responses that minimize the depth of our crisis.
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• Flat or incongruent affect and differences in tone can be misread as “not in crisis.”
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• We may downplay or hide suicidal thoughts because we fear forced hospitalization, police involvement, and losing autonomy.

Reaching out often leads to carceral responses — ER visits, involuntary holds, or police intervention. These experiences traumatize, erode trust, and make us less likely to seek help in the future. I've had clients admitted voluntarily to inpatient programs be denied access to comfort items, worsening harm under the guise of “safety.”

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What We Actually Need

Regardless of neurotype, individuals experiencing suicidality deserve collaborative, trauma-informed support. 

• ‍Peer-led spaces + community connection - Loneliness is a strong predictor of suicidality. We need authentic connection to buffer against despair. Autistic peer groups and crisis lines staffed by people with lived experience provide opportunities to share without fear of judgment.
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• Tools + resources adapted for Autistics - Despite how some therapists and behavioral health programs may act, safety planning is intended to be an active and ongoing process. Autistic adults may benefit from adapted safety plans that use visual supports, concrete language, and sensory-informed strategies, incorporating stimming, special interests, or safe withdrawal. Assessment tools + strategies may also need to be adapted for Autistic communication + processing styles.
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• Mental health providers who are curious - Mental health providers are often unsure how to navigate disclosures around suicidality. They may minimize the severity of a person's distress, or may react from a place of panic, resulting in reliance on police + behavioral health hospitals. Getting curious about what has contributed to suicidality + regulating their emotional responses will strengthen the therapeutic relationship, which has been shown to buffer against drivers of suicidality.
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• Non-carceral crisis responses - Autistics are at higher risk for excessive interventions, including seclusion, restraint, unnecessary medications, + more frequent / longer psychiatric admissions. This risk is compounded for persons of the global majority. We need alternatives to police involvement and involuntary hospitalization, such as community-based crisis centers and peer-led support groups. It is integral to Autistic wellbeing to prioritize autonomy, dignity, and choice rather than surveillance and coercion.
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• ‍Structural changes - Public policy shapes suicidality. Without addressing poverty, discrimination, and systemic exclusion, Autistic people will continue to face higher risks related to suicidality. We need systemic reforms that provide economic security, social inclusion, and accessible, affirming healthcare.

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Autistic people deserve compassion, connection, and care that adapts to the realities of the Autistic experience, including appropriate and adaptive responses to suicidality.
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Download Wired Differently Therapy's free Self-Harm + Suicidality Resource Guide here.

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Looking for support navigating suicidal thoughts as an Autistic person? Interested in professional development training or consultation? I offer neurodiversity-affirming therapy that prioritizes autonomy over carceral approaches, as well as trainings for mental health providers.

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Schedule a consultation at Wired Different Therapy >

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References + Related Reading

(Believe it or not, this is the abridged list)

• Arqueros, M., Jamett-Cuevas, V., Pulgar-Vera, V., Santander-Gonzalez, R., Pemau, A., & Álvarez-Cabrera, P. (2025). Camouflaging and suicide behavior in adults with autism spectrum condition: A mixed methods systematic review. Research in Autism, 121, 202540. doi:10.1016/j.reia.2025.202540
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• Bentum, J. V., Sijbrandij, M., Huibers, M., & Begeer, S. (2024). Occurrence and predictors of lifetime suicidality and suicidal ideation in autistic adults. Autism, 28(9), 2282-2294.
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• Botha, M, & D. M. Frost. (2020). Extending the minority stress model to understand mental health problems experienced by the Autistic population. Society and Mental Health, 10(1), 20-34. doi:10.1177/2156869318804297
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• Camm-Crosbie, L., Bradley, L., Shaw, R., Baron-Cohen, S., & Cassidy, S. (2019). ‘People like me don’t get support’: Autistic adults’ experiences of support and treatment for mental health difficulties, self-injury and suicidality. Autism, 23(6), 1431-1441.

• Cassidy, S., Bradley, L., Cogger-Ward, H., & Rodgers, J. (2021). Development and validation of the Suicidal Behaviours Questionnaire – autism spectrum conditions in a community sample of autistic, possibly autistic and non-autistic adults. Molecular Autism, 12(1), 46.
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• Cassidy, S., Bradley, P., Robinson, J., Allison, C., McHugh, M., & Baron-Cohen, S. (2014). Suicidal ideation and suicide plans or attempts in adults with Asperger's syndrome attending a specialist diagnostic clinic: A clinical cohort study. The Lancet Psychiatry, 1(2), 142-147.
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• Cassidy, S. A., Gould, K., Townsend, E., Pelton, M., Robertson, A. E., & Rodgers, J. (2020). Is camouflaging autistic traits associated with suicidal thoughts and behaviours? Expanding the interpersonal psychological theory of suicide in an undergraduate student sample. Journal of Autism and Developmental Disorders, 50(10), 3638-3648.
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• Cassidy, S., McLaughlin, E., McGranagham, R., Pelton, M, O’Connor, R., Rodgers. (2023). Is camouflaging autistic traits associated with defeat, entrapment, and lifetime suicidal thoughts? Expanding the Integrated Motivational-Volitional Model of suicide. Suicide and Life‐Threatening Behavior 53(4), 572-585. doi:10.1111/sltb.12965
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• Cassidy, S. A., Robertson, A., Townsend, E., O’Connor, R. C., & Rodgers, J. (2020). Advancing our understanding of self-harm, suicidal thoughts and behaviours in autism. Journal of Autism and Developmental Disorders, 50(10), 3445-3449.

• Costa, A. P., Loor, C., & Steffgen, G. (2020). Suicidality in adults with autism spectrum disorder: The role of depressive symptomatology, alexithymia, and antidepressants. Journal of Autism and Developmental Disorders, 50, 3585-3597. doi:10.1007/s10803-020-04433-3

• Goodwin, J.,Gordon, I., O’Keefe, S., Carling, S., Berresford, A., Bhattarai, N., Heslop, P., Nielsen, E., O’Connor, R. C., Ogundimu, E., Pelton, M., Ramsay, S. E., Rodgers, J., Townsend, E., Vale, L., Wilson, C., & Cassidy, S. (2024). Adapting safety plans for Autistic adults with involvement from the autism community. Autism in Adulthood, 7(3). doi:10.1089/aut.2023.0124
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• Graham, J., Rodgers, J., & Cassidy, S. (2024). Why are autistic people more likely to experience suicidal thoughts? Applying the Integrated Motivational–Volitional Model with autistic adults. Autism in Adulthood, 6(3), 272-283.
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• Grzeszak, A., & Pisula, E. (2025) Experiences of females on the autism spectrum through the perspective of minority stress theory: A review. Frontiers in Psychiatry, 16, 1578963. doi:10.3389/fpsyt.2025.1578963
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• Hirvikoski, T., Mittendorfer-Rutz, E., Boman, M., Larsson, H., Lichtenstein, P., & Bölte, S. (2016). Premature mortality in autism spectrum disorder. The British Journal of Psychiatry, 208(3), 232–238. doi:10.1192/bjp.bp.114.160192
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• Howe, S. J., Hewitt, K., Baraskewich, J., Cassidy, S., & McMorris, C. A. (2020). Suicidality among children and youth with and without autism spectrum disorder: A systematic review of existing risk assessment tools. Journal of Autism and Developmental Disorders, 50(10), 3462-3476.
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• Hua, P., Fenton, S. J., Freestone, M., Bhui, K., & Shakoor, S. (2025). Ethnic disparities as potential indicators of institutional racism in inpatient care within acute mental health wards: A rapid review. Social Science & Medicine- Mental Health, 8. doi:10.1016/j.ssmmh.2025.100478
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• Huggett, C., Peters, S., Gooding, P., Berry, N., & Pratt, D. (2024). A systematic review and meta-ethnography of client and therapist perspectives of the therapeutic alliance in the context of psychotherapy and suicidal experiences. Clinical Psychology Review, 113. doi:10.1016/j.cpr.2024.102469

• Kirby, A. V., Conner, C. M., & Mazefsky, C. A. (2024). Are autistic females at greater risk of suicide? A call for clarity to advance suicide prevention for the whole community. Autism Research, 17(5), 898-905.
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• Kirsch, A. C, Huebner, A. R. S., Mehta, S. Q., Howie, F. R., Weaver, A. L., Myers, S. M., Voigt, R. G., Katusic, S. K. (2020). Association of comorbid mood and anxiety disorders with autism spectrum disorder. JAMA Pediatrics, 174(1), 63. doi:10.1001/jamapediatrics.2019.4368
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• Kõlves, K., Fitzgerald, C., Nordentoft, M., Wood, S. J., & Erlangsen, A. (2021). Assessment of suicidal behaviors among individuals with autism spectrum disorder in Denmark. JAMA Network Open, 4(1). doi:10.1001/jamanetworkopen.2020.33565

• Lai, M. C., Saunders, N. R., Huang, A., Artani, A., Wilton, A. S., Zaheer, J., Ameis, S. H., Brown, H. K., & Lunsky, Y. (2023). Self-harm events and suicide deaths among autistic individuals in Ontario, Canada. JAMA Network Open, 6(8), e2327415-e2327415. doi:10.1001/jamanetworkopen.2023.27415
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• Marsden, S. J., Eastham, R., & Kaley, A. (2025). (Re) thinking about self-harm and autism: Findings from an online qualitative study on self-harm in autistic adults. Autism, 29(1), 247-258.
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• McVey, A. J., Glaves, K. J., Seaver, S., & Casagrande, K. A. (2023). The ethical imperative to honor Autistic clients’ autonomy in mental health treatment. Frontiers in Psychiatry, 14. doi:10.3389/fpsyt.2023.1259025
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• Moscardini, E. H., Oakey-Frost, D. N., Robinson, A., Powers, J., Aboussouan, A. B., Rasmussen, S., Cramer, R. J., & Tucker, R. P. (2022). Entrapment and suicidal ideation: The protective roles of presence of life meaning and reasons for living. Suicide and Life Threatening Behaviors, 52, 14-23. doi:10.1111/sltb.12767
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• Moseley, R. L., Gregory, N. J., Smith, P., Allison, C., & Baron-Cohen, S. (2020). Links between self-injury and suicidality in autism. Molecular Autism, 11(1), 14.
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• Moseley, R. L., Gregory, N. J., Smith, P., Allison, C., Cassidy, S., & Baron-Cohen, S. (2024). Potential mechanisms underlying suicidality in autistic people with attention deficit/hyperactivity disorder: Testing hypotheses from the interpersonal theory of suicide. Autism in Adulthood, 6(1), 9-24. doi:10.1089/aut.2022.0042
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• Moseley, R. L., Hedley, D., Gamble-Turner, J. M., Uljarević, M., Bury, S. M., Shields, G. S., Trollor, J. N., Stokes, M. A., & Slavich, G. M. (2025). Lifetime stressor exposure is related to suicidality in autistic adults: A multinational study. Autism, 29(5), 1184-1208.
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• Moseley, R. L., Marsden, S. J., Allison, C. L., Parsons, T. A., Cassidy, S., Procyshyn, T., Peloton, M., Weir, E. M., Chikaura, T., Mosse, D., Hall, I., Owens, L., Cheyette, J. Crichton, D., Rodgers, J., Hodges, H., & Baron-Cohen, S. (2025). “A combination of everything”: A mixed-methods approach to the factors that Autistic people consider important in suicidality. Autism in Adulthood. doi:10.1177/25739581251371393
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• Mournet, A. M., Wilkinson, E., Bal, V. H., & Kleiman, E. M. (2023). A systematic review of predictors of suicidal thoughts and behaviors among autistic adults: Making the case for the role of social connection as a protective factor. Clinical Psychology Review, 99, 102235.
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• Newell, V., Phillips, L., Jones, C., Townsend, E., Richards, C., & Cassidy, S. (2023). A systematic review and meta-analysis of suicidality in autistic and possibly autistic people without co-occurring intellectual disability. Molecular Autism, 14, 12. doi:10.1186/s13229-023-00544-7
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• Nguyen, W., Ownsworth, T., Nicol, C., & Zimmerman, D. (2020). How I see and feel about myself: Domain-specific self-concept and self-esteem in Autistic adults. Frontiers in Psychology, 11(913). doi:10.3389/fpsyg.2020.00913
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• Nyrenius, J., Waern, M., Eberhard, J., Ghaziuddin, M., Gillberg, C., & Billstedt, E. (2023). Autism in adult psychiatric out-patients: Self-reported suicidal ideation, suicide attempts and non-suicidal self-injury. BJPsych Open, 9(5), e167.

• Pelton, M. K., Crawford, H., Bul, K., Robertson, A. E., Adams, J., De Beurs, D., Rodgers, J., Baron-Cohen, S., & Cassidy, S. (2023). The role of anxiety and depression in suicidal thoughts for autistic and non‐autistic people: A theory‐driven network analysis. Suicide and Life‐Threatening Behavior, 53(3), 426-442.
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• Pelton, M. K., Crawford, H., Robertson, A. E., Rodgers, J., Baron-Cohen, S., & Cassidy, S. (2020). Understanding suicide risk in autistic adults: Comparing the interpersonal theory of suicide in autistic and non-autistic samples. Journal of Autism and Developmental Disorders, 50(10), 3620-3637.
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• Purtle, J., Mauri, A. I., Lindsey, M. A., & Keyes, K. M. (2025). Evidence for public policies to prevent suicide death in the United States. Annual Review of Public Health, 46, 349-367. doi:10.1146/annurev-publhealth-071723-121359

• Reid, M., Delgado, D., Heinly, J., Kiernan, B., Shapiro, S., Morgan, L., Maddox, B, & Jager-Hyman, S. (2024). Suicidal thoughts and behaviors in people on the autism spectrum. Current Psychiatry Reports, 26(11), 563-572. 

• Rodgers, J., Goodwin, J., Nielsen, E., Bhattarai, N., Heslop, P., Kharatikoopaei, E., O'Connor, R., Ogundimu, E., Ramsay, S. E., Steele, K., Townsend, E., Vale, L., Walton, E., Wilson, C, & Cassidy, S. (2023). Adapted suicide safety plans to address self-harm, suicidal ideation, and suicide behaviours in autistic adults: protocol for a pilot randomised controlled trial. Pilot and Feasibility Studies, 9(1), 31.
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• Schwartzman, J. M., McMorris, C. A., Brown, C. M., Trollor, J. N., Uljarević, M., Stokes, M. A., Williams, Z. J., & Hedley, D. (2025). Elevated suicidal thoughts and behaviors and nonsuicidal self-injury in autistic youth and adults: A multinational study. Autism in Adulthood. doi: 10.1089/aut.2024.0225
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• Schwartzman, J. M., Muscatello, R. A., & Corbett, B. A. (2023). Assessing suicidal thoughts and behaviors and nonsuicidal self-injury in autistic and non-autistic early adolescents using the Columbia Suicide Severity Rating Scale. Autism, 27(8), 2310-2323.
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• South, M., Beck, J. S., Lundwall, R., Christensen, M., Cutrer, E. A., Gabrielsen, T. P., Cox, J. C., & Lundwall, R. A. (2020). Unrelenting depression and suicidality in women with autistic traits. Journal of Autism and Developmental Disorders, 50(10), 3606-3619.
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• South, M., Costa, A. P., & McMorris, C. (2021). Death by suicide among people with autism: beyond zebrafish. JAMA Network Open, 4(1), e2034018-e2034018.

• White, L. C. J., Ixqe, K. V., Goodall, K., & Gillespie-Smith, K. (2024). Minority stress, camouflaging, and mental health outcomes in transgender and/or nonbinary Autistic adults. Autism in Adulthood. doi:10.1089/aut.2023.0151