Why Autistic Children Are at Higher Risk of Suicide — And Why Families and Clinicians Often Miss the Signs

When Anthony Tricarico was diagnosed with autism at age 7, his parents focused on the supports everyone recommended: school accommodations, speech therapy and motor-skills work. They did not hear that the same cognitive patterns and coping strategies that helped Anthony succeed could also intensify suicidal thinking, or that masking his autism might have been harming his mental health.

A family's experience

As a teenager, Anthony — described by his parents as kind, popular and accomplished — began to struggle with depression and suicidal thoughts. Despite reaching out to crisis hotlines, school counselors and inpatient facilities, the family says they were not offered autism-adapted therapies, safety plans, or guidance that warning signs can look different in autistic youth. Anthony died by suicide on May 25, 2024. Only afterward did his parents learn how much higher the risk of suicide is for autistic children, especially for those whose differences are not immediately visible.

“Our son has always been different. So why wouldn't how we approach suicide be different?” — Neal Tricarico

Why risk is higher and often hidden

Autistic children face multiple overlapping risk factors: co-occurring psychiatric conditions, sensory overload, social isolation and the emotional cost of constantly masking autistic traits to fit in. Masking — consciously or unconsciously suppressing natural behaviors to appear neurotypical — is strongly linked to depression, anxiety and suicidal behavior.

Population studies highlight the scale of the problem. The share of U.S. children diagnosed with autism has risen from roughly 1 in 150 eight-year-olds in 2000 to about 1 in 31 in 2022. A large 2021 caregiver survey found 78% of autistic children had at least one co-occurring psychiatric condition, compared with 14% of non-autistic children. A 2024 meta-analysis estimated about 10% of autistic children and teens have attempted suicide — more than twice the rate for non-autistic peers.

Hidden warning signs

Autistic young people can express distress in ways adults often miss. Many have alexithymia — difficulty naming internal feelings — and may not show dramatic outward signs of despair. In some cases, giving away possessions, sudden mood lifts, or increased decisiveness can signal imminent crisis, but these behaviors are frequently misread.

Why common screenings and responses can fail

Frontline clinicians and families often rely on tools and practices designed for neurotypical youth. Research shows that standard approaches can miss suicidal ideation in autistic children: in one study, the Columbia-Suicide Severity Rating Scale identified about 80% of autistic children when given verbally, while a written version identified many others who were missed. Emergency and inpatient settings can also be disorienting for autistic youth — bright lights, unfamiliar routines and restricted movement may increase distress.

Adapting tools and care

Researchers and advocates are adapting screening and intervention tools so they work better for autistic children. Examples include:

• Using both written and verbal screening questions at intake to account for different processing styles.
• Modifying the Stanley-Brown safety plan to remove implied numeric instructions (for example, leaving open space rather than numbered lines) and including sensory- and routine-friendly coping strategies.
• Providing crisis spaces with dim lighting, reduced noise and allowance for familiar routines and objects.

Clinical teams led by Shari Jager-Hyman, Lisa Morgan and others are testing an autism-friendly safety-plan template and studying outcomes in suicidal autistic children.

Practical steps for families, schools and clinicians

Recommendations from clinicians and advocates include:

• Educate families at diagnosis about the elevated risk of co-occurring mental-health conditions and possible warning signs.
• Ask directly about suicidal thoughts, using the communication format the child prefers (text, written note or conversation).
• Create safety plans that respect sensory needs and routines, and include trusted contacts who understand the child’s neurodiversity.
• When evaluating risk, allow extra processing time, offer quiet spaces and avoid assuming that fluent speech means emotional insight.

After the loss: turning grief into action

Following their son’s death, Anthony’s parents founded the Endurant Movement to raise awareness about autism, youth suicide and mental health and to push for autism-informed crisis care, earlier conversations about risk, and supports that let autistic children be themselves rather than forcing them to mask. Advocates emphasize that preventive conversations about suicide do not plant ideas; research shows asking directly can be protective.

Resources

If you or someone you know is struggling with suicidal thoughts, seek professional help or contact crisis services: call 988 in the U.S. to reach trained crisis counselors, or text “HOME” to 741741 in the U.S. and Canada for the Crisis Text Line.

Selected sources and experts quoted or referenced: Danielle Roubinov (UNC Chapel Hill), Lisa Morgan (Autism and Suicide Prevention Workgroup), Jessica Schwartzman (USC Keck/Children’s Hospital Los Angeles), Mayank Gupta (psychiatrist), researchers studying autism and suicidality, and family accounts from Neal and Samara Tricarico.