Showing posts with label Sarah Cassidy. Show all posts
Showing posts with label Sarah Cassidy. Show all posts
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INSAR 2019: Learning How to Prevent Suicide in Partnership with Autistic People and Their Allies

Yesterday we attended the INSAR 2019 panel Where Do We Go from Here? Learning How to Prevent Suicide in Partnership with Autistic People and Their Allies, led by Sarah Cassidy from Nottingham University who has been doing this for four years now. Here is what the speakers had to say. (Any errors or omissions are on us.)

More than 10K stakeholders worldwide have identified the top 10 priorities, with equal representation of #autistic people:
  1. What increased barriers do autistic people experience when seeking help which may put them at greater risk of dying by suicide?
  2. What are the risk and protective factors for suicide in autism across the lifespan?
  3. To what extent are autistic people not believed about the extent of their distress?
  4. How can we further understand suicide where mental health is not a factor across the lifespan?
  5. What are the best ways of identifying and assessing suicidal thoughts and suicidal behaviours, in autistic people, in research and clinical practice?
  6. How should interventions be adapted for autistic people and individual presentations?
  7. What is the experience of suicidality in autsitic people? Is this experience different than the general population?
  8. How do autistic people seek help when they are in a crisis?
  9. How well do existing models of understanding suicide apply to autistic people?
  10. What is the impact of poor sleep on suicide risk in autistic people and how can this be measured?

John Adams, an autistic person and artist on why lived experience is key:

“I don’t live with autism. I live with my wife and two cats. I do live with PTSD."

"We’re losing autistic people daily, and they’re often not remembered."

What barriers do autistic people face? Jon Adams says:
  • Attitudes towards me
  • Attitudes about me
  • The current mental health system
  • Being dismissed
  • No specific autistic pathway
What are the risk and protective factors for suicide in autism across the lifespan?

To what extent are autistic people blamed about the severity of their distress? This leads to trauma.

Adams has heard people say they can’t get treatment for PTSD until the trauma stops? WTF.

"Our narrative is often dismissed and misunderstood."

I want to stay as long as I can, but is leaving a pragmatic decision I need to take if I become infirm?

Autistic people should be leading these discussions, yet our experiences are often written over. The next generation deserves better.

“Mindfulness” is useless. And medication to numb him is not OK either. He wants action, but on #autistic people’s terms.

What is the experience of suicidality in autistic people?

Also: Mental health professionals often cause PTSD in autistic people, according to Jon Adam. Restricted and repetitive behavior SAVED him.

How do autistic people seek help when they are in a crisis?

They’re often called "treatment resistant." Adams says, maybe instead of blaming autistic people, consider how you’re treating them. Why wold they want to “stay” if you blame them so?

Why are the effects of sleep issues on suicidality in autistic people? Sleep problems are bad for everyone, and autistic people are human, so sleep problems in autistic people are bad.

Recommends others treat autistic people with consideration, acceptance, kindness, and genuine listening to unique experiences.  

How can we best identify and assess suicidal thoughts and suicidal behaviors in autistic people?

The validity of tools depends on context:

How can we determine if a tool developed for the general population is OK for autistic people? One factor missing is alexithymia, or not necessarily having access to the real-time experience of one’s own emotions.

We have to involve the autistic community in any tools or interventions for helping people with suicidality.
The Mental Health in Autism project is a participatory research project to deeply new assessment tools for autistic adults.

Theorize that #autistic people would have difficulty communicating their suicidal intent, so they tested the theory.

For threat of suicide attempts, autistic people are more likely than general population that they are having suicidal thoughts, but that this is associated with lifetime   and attempted suicide.

Autistic adults have difficulty attempting certain questions, e.g., questions about what they will do in the future. “I can’t say never, even though I’m not at risk now."

We need to adapt measures to better determine suicidality in the autistic community. We need to do a LOT more work.

Next steps: Measure has been adapted to unrecognizability! Which is good.

Next: Paul Lipkin from Kennedy Krieger, on screening for suicide risk in a pediatric autism population.

WHO say close to 800K people die from suicide every year.

For each death, there are 20 attempts.

Suicide is the 10th leading cause of death for all ages.

The pediatric community has not been on top of this.
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INSAR 2018: Autism and Suicidality Special Interest Group (SIG)

Sarah Cassidy's INSAR 2018 SIG on autism and suicidality brought ~60 autistic people and autism researchers and professionals to discuss research on, and factors underlying and mitigating, suicidality in autistic people—as well as next steps for researchers.

The statements and images below are from our original Twitter Moment compilation/report on this SIG. We then heard back that Twitter feeds can be difficult to parse and access for some, so we've created this version as well, edited for readability. Uncredited statements are from the Thinking Person's Guide to Autism Twitter feed.

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Jon Spiers:
Morning session on suicide and autism starting now at INSAR 2018 - a top priority for Autistica and Mental Health in Autism.
At INSAR 2014, Sarah Cassidy was the only poster on suicidality. Now there is an entire INSAR 2018 track on autism, suicidality, and bullying.

At IMFAR (INSAR) 2016, the SIG goal was to identify priority topic areas. At the 2017, the SIG identified research questions. In 2017, at a summit in the UK, Dr. Cassidy worked on developed theses.

Autism and suicidality overview: Some aspects:

  • Ethics: Does talking about suicide increase risk? 
  • Risk/protective factors: Gender, communication, belonging, lack of joy, disclosing, diagnosis, help seeking, sleep difficulties.
  • Treatment/prevention: "we just don’t know what works"
Advances in research on autism and suicide.
Photo by Sara Luterman
[image: Side. Blue bar at top with white text reading" Progress so far"
The rest of the slide has a white background with red text reading,
"•1 INSAR poster presentation on suicidality in autism in 2014
•INSAR 2018 oral presentations strand "Suicide and bullying and
number of additional posters
•Presentations across numbers of labs
•Increased sample sizes, comparison groups included, looking at the
*why* question"]
Now: Abigail Thompson from Autistica, the UK’s autism research charity, which aims to help autistic people live long healthy happy lives which makes me cry because Autism Speaks and Autism Society: why aren’t your missions this clear and simple?

Sara Luterman:
I know I gush about @AutisticaUK a lot, but I’m going to keep gushing about them as long as they keep leading the world in funding research that actually makes a difference in my life.
Photo by Sara Luterman
[image: Projected slide showing a group of human faces in profile, 
facing right, in white, blue, and dark orange. Orange text on the left reads,
 "Long, happy, healthy lives for all autistic people." Text at the bottom of the slide 
reads, "Autistica" and "Dr. Abigail Thompson"]
Factors: Lack of belonging: “If you don’t belong, you’re gone”
  • What does belonging mean to #autistic people, and how can it be captured?
Sleep difficulties: Important and under-recognized/diagnosed in autism. Also important to define and measure: night awakenings, nightmares?

Development of appropriate assessment tools: They have been developed for the general population, but not yet validated for #autistic people. General questions may not be clear or relevant for autistic ppl.

Social communication: Over/under reporting of suicidality?
  • Literal interpretation of questions: “We mean what we say.” 
  • Negative experiences could lead to masking: “We learn to say we are fine” 
  • Need to consider lived experience in assessment.
Help seeking. Increased barrier for support/treatment.
  • Do negative experiences impact willingness to seek help (e.g., not feeling believed?)
One approach Autistica is taking on underfunded but crucial autism areas: Writing accessible reports, and taking them to the agencies who could possibly fund them (in the US and UK).

Disclosing diagnosis: “You want the right people to know” Exploring experiences of disclosing, and how and when this may impact suicidality.

Risk/protective factors: What keeps people here? …special interests; we need to make sure we aren’t “pathologizing passion”; positive social interaction where desired in the way it is desired.

Conceptualization: Phenomenology of suicidality in autism: Quality of life more important than mental health? What does a “good life” look like?

In every country in the world, there are more undiagnosed adults than diagnosed. This is a fact. This is a factor. This is a risk.

Could religion or other value systems that discourage suicide be a protective factor? Research indicates this is possible.

The strength of the autistic community is what keeps many autistic people going, and mitigates feeling like one doesn’t belong— especially when there’s very little support available.

Medication: “If our brains are wired differently, then medication must have a different effect upon us.” We need to explore the effectiveness & side effects of meds in autism. How do meds interact with autistic traits? Are antidepressants a risk?

Dr. Eileen Crehan:
And even once we are aware of different effects, how can we train more psychiatrists in this area of specialty? Access to medical providers with knowledge of ASD is limited!
Autistica is working with organizations to find out what kinds of mental health services are most helpful. Many autistic people find phones and going to ER/emergency services aversive. Would a text-based chat service be more useful?

We think autistic people are more likely to have a short span of time between considering suicide and acting on it (impulse control?). They also tend to choose more final methods, but research is forthcoming. Limited access to methods may help.

Gender differences: Autistic females are more at risk of suicide, compared to general population. Why? Masking? Late diagnosis? Differences in communication, suicide planning, methods?

Many autistic people are able to realize that being in an extremely aversive in-patient/hospitalized situation is better than being dead — but those shouldn’t be the only options. Need more humanistic, autism-friendly options for those in crisis.

Suicidality can be due to needing to "release pressure.” Especially when aware mental health services don’t recognize autistic symptoms/experience. 

Some autistic people find meds can help with compulsive thoughts that can build to suicidal impulses.

Lack of joy: “How do we find joy in a world that doesn’t understand us?” 
  • Autistic people discussed that stressors associated with being autistic can make life feel joyless. Does this increase suicidality risk?

Jon Adams:
Talking suicide & autism 
but maybe I don’t understand as they’re only including ‘attempts’ 
What about those of us that have ideation ‘all the time’ due to co-morbid conditions such as PTSD or are so isolated they ‘don’t feel they belong’ 
#INSAR2018 #AutisticCultureShift
Some commonly prescribed medications for co-occurring conditions (or medication prescribed for “autism”) have known risks not just for elevating suicidal ideation, but possibly causing other physical symptoms (tics etc.) that increase distress.

Need to be cautious about making autistic people in mental health crisis join group “mindfulness” efforts that are aversive (e.g., visualizing exercises may be NOT GOOD for synesthetes), increase feeling of not belonging, then blamed for “failing."

Maxfield Sparrow:
I am on the aphantasia spectrum. Visualization exercises are really weird experiences for me.
How effective are current therapies for suicidality in #autistic people? Can these therapies be adapted?

Response and prevention: Important to identify and respond to potentially stressful life events (leaving/changing schools).

Jon Adams:
This is great 
a small ‘table’ of #ActuallyAutistic people talking feeding in ‘lived experiences’ informing with researchers sat with us 2 develop projects = studies = policies with our “voice” at the core 
@slooterman @shannonrosa @AutisticaUK @YesWeJon #SuicideAutism #INSAR2018
Shannon Rosa:
Would like to know more about suicidality in autistic ppl w/communication disabilities (non-speaking) or intellectual disability/learning disabilities. I wonder, hard, how many written off as “aggressive” or self-injurious are actually suicidal.  
And everything that has to do with preventing or containing or medicating these behaviors, rather than understanding/mitigating distress factors is making people with profiles similar to my son’s even more miserable. 
This keeps me up at night.
Sara Luterman:
There is no autism-specific drug research on preventing suicidality. As long as the method being looked at isn’t a chemical straitjacket, I’m all for pharmaceutical research on this topic. 
Shannon Rosa:
Yes definitely. I am opposed to chemical straightjackets and for understanding autistic mindsets/motivations; the latter includes appropriate meds, as needed.

Sara Luterman:
Protip: 24/7 invasive tracking of everything I do isn’t going to make me less suicidal. I suspect this is true for most autistic people, of all ages. Treat us like we’re human, because we are.
Shona Dav:
It’s true that a mental health crisis might prompt a diagnosis. 
But also masking prevents diagnosis and masking increases mental health problems so that might change the data in the opposite direction. 
It is hard to get any reliable autism stats cos we are under identified in my view.
Autistic kids (and adults) have a high rate of co-occuring conditions like OCD, anxiety, depression, etc. that can interfere with quality of life and happiness. If they are in distress and medications can help, they should have access to those meds.

James Cusack:
  1. There is a need for a strategic coordination network for research area in order to enable high quality research and rapid progress. 
  2. To drive suicidality research forward we need a clear strategy bringing together research in to i) risk/protective factors, ii) intervention/assessment and iii) policy and practice.
Handout from the INSAR 2018 Autism and Suicidality SIG: Suicidality factors flow chart:



[Image desciption for Autism and Suicidality factors flow chart.

Black text in titled boxes on a white background, in landscape orientation. Boxes’s text content from left-to-right, top to bottom:

Lack of belonging:
“If you don’t belong, you’re gone”
What does belonging mean to autistic people and how can it be captured?

Help Seeking
Increased barriers for support/treatment?
Do negative experiences impact willingness to seek help (i.e., not being believed)

Disclosing diagnosis
“You want the right people to know”
Explore -ve/+ve (negative/positive) experiences of disclosing autism diagnosis
How and when may this impact suicidality

Gender differences
Autistic females are moe at risk of suicide than males - opposite to general population, why?
•”Masking”
•Late diagnosis?
•Differences in communication, suicide planning, methods?

Sleep difficulties
Risk marker in Gen Pop - impacts capacity to cope
Important and under-recognised/diagnosed in autism
Important to define and measure: night awakenings, nightmares?

Risk/Protective Factors
“What keeps people here? …special interests; we need to make sure we are not “pathologizing passion”; positive social interaction where desired in the way it is desired.”

Lack of Joy
“How do we find joy in a world that doesn’t understand us?”
Autistic People discussed that stressors associated with being autistic can make life feel joyless. Does this increase risk of suicidality?

Development of Appropriate Assessment Tools
Suicidality assessment tools have been developed for the general population, and not yet validated for autistic people - questions may not be clear or relevant for this group.

Conceptualization
Phenomenology of suicidality in autism
Risk Protective Factors
Exploring and adoption existing models of suicidality
Quality of Life more important than mental health? What does a “good life” look like.

Treatment Approaches
“We don’t know what works”

Social Communication
Over/under reporting of suicidality?
Literal Interpretations of questions? “We mean what we say”
Negative experiences could lead to masking: “We learn to say we are fine”
Need to consider lived experience of autistic people in suicidality assessment (e.g., lack of belonging)

Psychosocial Interventions
Few studies of adapted interventions for autistic adults - added complexity of suicidality.
What people need depends on the profile they present with (e.g., virtual reality to treat anxiety in autism).
How effective are current therapies for suicidality in autistic people? Can these therapies be adapted (e.g. DBT)?
In terms of response and prevention, important to identify and respond to potentially stressful life events such as transition (e.g., leaving school, going to University)
Online support is a potential opportunity
Tiered support? Or does this close doors?

Medication
“If our brains are wired differently then medication must have a different effect upon us”
Explore effectiveness and side effects of medication in autism
Is anti-depressant medication more likely to increase suicidality in autism than in the general population?
How does medication interact with autism characteristics?

(End text box descriptions and contents)

Arrows lead from “Conceptualization” to “Risk/Protective Factors” “Development of Appropriate Assessment Tools” and ”Treatment
Approaches”

Arrows lead from “Risk/Protective Factors” to “Sleep Difficulties” “Lack of Belonging” “Help Seeking” “Disclosing Diagnosis” “Gender Differences” and “Lack of Joy”

Arrows lead from “Treatment Approaches” to “Medication” and “Psychosocial Interventions”

An arrow leads from “Development of Appropriate Assessment Tools” to “Social Communication”

An arrow leads from “Social Communication” to “Adapting Current Tools”]
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Autism and Suicidality: Conversations Between Researchers and Autistic People

Sadness
Photo © Gayan Gunawardana | Creative Commons
[image: Backlit photo of a sad ponytailed person
with their head down, in profile in front of an
ocean sunset.]
Dr. Sarah Cassidy co-chaired a SIG (Special Interest Group) on Autism and Suicidality at IMFAR 2016, in Baltimore. We weren't able to attend her session, but Dr. Cassidy was kind enough to take time, later that same day, to talk with TPGA editors Shannon Rosa and Carol Greenburg, autistic autism researcher Dr. Steven Kapp, and Autistic Self Advocacy Network Executive Director Julia Bascom. The following is a transcript of our conversation.

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Shannon Rosa: Tell us about what you discussed in the SIG. What has your research revealed about suicidality in autistic people?

Dr. Cassidy: We’ve published two studies so far. The first study we did, which is free to access in the new Lancet (Psychiatry) journal, was a medical chart review, a type of data mining, at the Autism Research Center, Cambridge University, UK. It had a clinic called the Cambridge Lifetime Asperger’s Service (CLASS) Clinic, which was set up by Simon Baron-Cohen, and specialized in the diagnosis of Asperger’s in adulthood.

The clinicians collected a lot of data from individuals before they went though the diagnostic appointment, such as:
  1. Have you ever contemplated suicide in your lifetime
  2. Have you ever planned or attempted suicide in your lifetime
  3. Have you ever been diagnosed with depression.
Everyone seen over a nine-year period was asked these same three questions very consistently. They also completed the AQ and EQ questionnaires.

When we analyzed all the data, we found 374 people had been diagnosed with Asperger’s syndrome, and out of those individuals, 66% had self-reports of contemplating suicide at some point in their lifetime. In the same group, one third had planned or attempted suicide in their lifetime, and about another third had been diagnosed with depression.  

That depression diagnosis was a significant risk factor in planning or attempting suicide, or suicidal ideation—those who had a diagnosis of depression were at significant risk for both those factors.

While everyone in the group had a diagnosis of Asperger’s, those who had planned or attempted suicide also had significantly more self-reported autistic traits than those who didn’t.

Carol Greenburg: I have a question, and I’m not quite sure how to ask it. How can you differentiate between an actual attempt at suicide, and an overdose that happens because of an autistic person’s medication not being properly monitored? Do you control for that?

Cassidy: I think that’s a really excellent question. In this particular study, which was retrospective, we just asked one question—one self-report question—which was “have you ever planned or attempted suicide in your lifetime?”

So it wasn’t looking at “completed” suicides, where you’re not sure if it was an accidental overdose or it it was deliberate. And this was self-report. I think that’s a real challenge, for coroner studies, or studies of “completed” suicides. In the UK, those kinds of suicides are recorded as “open verdict.” We don’t know unless they leave a note.

Greenburg: That’s what we have in the U.S., too; they say that it was not possible to determine whether it was an accidental or deliberate overdose.

Steven Kapp: I’ve seen in many studies that higher numbers of autistic traits, whether in adolescents or adults, or perceived differences from typical peers, or attributing social difficulties to oneself—any way you slice it—exposure to normalization attitudes is usually related to higher rates of depression, and anxiety, and internalized ableism. We did find this even in a self-reporting using an online screener, that a higher level of  autistic traits was related to lower self-endorsed quality of life, and a feeling of disempowerment. Because the stigma is still so high, and there are still so many forces against you, that people might not be disclosing even if they’re relatively comfortable with who they are.

Cassidy: The 66% rate of depression of autistic people in our study was higher than those in other studies, higher than the 59% rate in a sample of patients diagnosed with psychosis, and significantly higher than people diagnosed with one or more medical illnesses, significantly higher than the UK general population, where a similar self-report questionnaire was used, and where the rate is 17%.

Julia Bascom: What are the next steps, in terms of supports and prevention? What did you talk about during the SIG?

Cassidy: It was really eye-opening to hear from autistic people and family members, and quite hard-hitting as well. Because a lot of the limited research, which is really only about eight studies looking at suicidality in adults, adolescents, and children with autism, are usually only counting studies about prevalence, about “how common is it?? But nothing about how does it develop, what are the family experiences and dynamics. What are the interventions we can do now? It’s not enough to talk about rates. You can have as many counting studies as you want, but knowing that the rate is high doesn’t really tell you what to do about it, especially in the short term.

We need to know what the risk factors are, whether there are protective factors? What is the difference between people with autism who experience suicidality and those that don’t, and how does that compare to the general population?

What really came out of the study is that we need some short-term goals, right now, and to come up with useful guidelines for parents and clinicians who are trying to help people experiencing these difficulties.

What was really great is that there were people at the SIG who had access to really big research databases like the Interactive Autism Network, ones in Newcastle and Cambridge, and Swedish databases. We talked about sharing out expertise, and actually do a qualitative survey targeting parents, young people with autism, and adults with autism—and asking them “what kind of supports do you actually need? What would help you, if you were experiencing these kind of difficulties?” So we could try to make recommendations about what the next steps could be, and interventions or preventative measures or supports we need to develop.

Another thing we discussed during the SIG was sharing data. In our study, we have a short set of questions that could be collected routinely in all of the studies that we do, so we could put data together and look at a variety of factors. Things like quality of life are really, really important. And there is really exciting work going on, in developing quality of life measures specifically for people with autism, and the unique challenges that they have. So if we provide these quick questions to go with it, we’d be able to directly compare and pull resources, and ideally untangle some of the causatory factors.

The last thing that came out, because there are lots of research questions to sift through and get feedback on, but another thing we really want to do is to run a seminar series. In the SIG we only had 1 1/2 hours, and could only scratch the surface. So we want to hold a seminar series in the UK, try to get funding for that, and invite people from Canada, Sweden and other European countries, The US, involving autistic people, families, funders, researchers, clinicians who are interested in this topic. I want it to be like the SIG, involving lots of different stakeholders, because it’s really important to include everyone involved when talking about next steps and research priorities.

I think we’ve done as much as we can with the prevalence and counting studies; we need to go a bit further and ask what we’re going to do about it, what is the response going to be, and how can we pull resources so we don’t waste time doing more of the same? So we can do something useful?

Bascom: Was there any discussion (in US or other countries) of where to find supports and resources for people with developmental disabilities and communication disabilities (autistic or not)? Because this is a huge problem—it’s very difficult to find mental health providers for people with developmental disabilities, especially if they’re autistic, especially if they also have intellectual disability, limited speech, or don’t have a good communication system. As an advocacy organization, ASAN considers this area really important, but we often feel like our hands are tied because people will come to us, and ask for resources—and they just don’t exist, because the providers don’t exist. Was there any discussion about how these factors might be affecting the numbers?

Cassidy: What we did discuss—and it was to do with preventative strategies, interventions, and treatments—is trying to improve experiences of hospitalization. There was talk of doctors or clinicians overreacting, and over-intervening, or not knowing how to intervene. We need those guidelines, and there’s so little research on it. Just taking simple steps, like using the NAS hospital passports that give out information like:

  • This is what my pain threshold is like
  • This is how I prefer to be communicated with
  • I’m verbal/I’m not verbal
  • These are my interests
  • This is how you talk to me

And things like that. Also training health providers that they need to provide structure, they need to provide a bit more explanation, a little bit more processing time. Or they have to be aware of really literal interpretations. Just small things like that can make peoples’ experiences with health care scenarios so much better.

But we do need to have a research study, because most of this is anecdotal, from discussions with clinicians experiences with people with autism coming in, and they’re not to sure how to deal with them. And then there are other clinicians who are really excellent, who really do have experience in autism. But it’s not consistent.

Bascom: In the States, we have this huge gap between autistic people who need services and providers. You find people, like primary care providers or therapists, who don’t necessarily have autism training but are good with autistic people—and then people find out about them and then they’re overloaded and can’t take more patients. We have an association, The NADD, that tries to be specifically for people with autism and developmental disabilities who need mental health support, but it’s so tiny, because there just hasn’t been funding for the training, and providers often think accommodating autistic patients is going to be a lot more complicated than it is. There’s a lot of room for specific training, but we certainly don’t have any large US organizations who are trying to do anything like the UK’s NAS Passport yet. ASAN helped AASPIRE develop a customizable healthcare toolkit, and it’s great, but it hasn’t gone to scale in any meaningful way. So it’s interesting to hear that that’s what you’re looking at, as well.

Cassidy: NAS Wales had a great, very customizable toolkit. You go to the website, and you can click on different kinds of difficulties, and you can put in picture symbols.

The UK overall is evaluating the effectiveness of the passports, in terms of what’s the uptake, and what’s the experience of using it.

Bascom: There are people who are going to need specialized expertise. People who, for instance, are autistic and have communication disabilities, and they don’t have good access to AAC, and they have challenging behavioral issues—there are very few practitioners who even know where to start. Which is frustrating, because we know mental health disabilities are underlining a lot of what is going on, though that’s also kind of a separate population from what you (Dr. Cassidy) are talking about, I think. Or maybe there’s an assumption that it’s a separate population. It would be good to know how many of those kids grow up into suicidal adults.

Shannon Rosa: If you’re never accommodated, or understood…

Bascom: I can think of several people I know, who were that way as kids. And now as adults, they seem to be doing a lot better. But when you pay attention to their mental state, it’s a lot more dangerous than maybe when they were a little more open about what they were feeling.

Cassidy: We have a group of adults with autism who experienced suicidality, and they are helping us design a survey that goes into more detail, about the issue of lack of supports, and different kinds of difficulties and what causes them. One of them is a parent who has a diagnosis herself but also her son has a diagnoses. And she was saying similar things to what you (Julia Bascom) are saying, in looking back at the lack of supports throughout. I think it does take its toll, and we’re going to explore that a bit more.

My work is just for adults, but we need to expand it somehow, to look at children, and that developmental pathway. Or following up autistic children, because there are a lot of cohort studies in the UK and overseas, and making sure people include those questions and look at those things is going to be really important.

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Dr. Cassidy will be co-chairing another SIG on autism and suicidality at IMFAR 2017.

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SUICIDE RESOURCES

Anyone who is feeling suicidal may receive immediate help by logging onto Suicide.org or by calling 1-800-SUICIDE. Suicide is preventable, and if you are feeling suicidal, you must get help. So please visit Suicide.org or call 1-800-SUICIDE immediately. Please also know that you are not alone.

MHAutism, which focuses on mental health for autistic people, has developed a Safety Plan, which allows those who are vulnerable to plan for when and if they experiencing suicidal thoughts, and also to record information to help other people provide supports.

For autistic people seeking specifically autistic perspectives, please read our archive posts below. While aimed towards younger people, they discuss getting through the kind of tough times familiar to autistic people of any age who have been conditioned into negativity:
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