Understanding young autistic people who experience suicidal thoughts and feelings: A pilot study assessing the feasibility of ecological momentary assessment.
Year: 2026
Type: preprint
Abstract: Autistic people are a high-risk group for suicide (Department of Health and Social Care, 2023) and there are no evidence-based supports available for autistic people who experience suicidal thoughts and behaviours (STB) (Camm-Crosbie et al., 2019). Autistic young people are six times more likely to attempt suicide (Chen et al., 2017) and twice as likely to die by suicide than non-autistic young people (Kirby et al., 2019), yet research to date has largely focussed on autistic adults (O’Halloran et al., 2022). Research to date does not accurately describe the mechanisms leading to STB for autistic people (Pelton et al., 2020; M. K. Pelton et al., 2020; Pelton et al., 2023). One community research priority is to better understand how autistic people experience suicidality (Cassidy, Cogger-Ward, et al., 2021) to inform support and risk assessment. Traditional research methods preclude the capture of the lived experiences of autistic people (Pelton et al., submitted) meaning researchers need novel methods to fully capture the lived experience of suicidality. One possible novel method is ecological momentary assessment (EMA) (administration of small sets of items 3-10 times/ day over several days or weeks via smartphone) (Russell & Gajos, 2020). EMA is argued to increase the ecological validity of psychological research by gathering data in real-life setting and can uncover dynamic patterns of psychological experience that vary over hours and minutes (Fritz et al., 2024). These factors may be well-suited to improve our understanding of suicidality in autistic young people: asking participants what is happening ‘in the moment’ may avoid memory difficulties often reported by autistic people in responding to traditional research questionnaires that might ask participants to count instances of suicidality over a given time frame (Gordon et al., under revision). Understanding the dynamics of suicidality will improve insight into the experience of suicidality amongst autistic young people, addressing community priorities to better understand the experience of suicidality across the life course, with early research suggesting a distinct temporal dynamic of suicidality in autistic compared to non-autistic people (Cassidy, Cogger-Ward, et al., 2021; South et al., 2020). Overall, this suggests EMA may offer distinct opportunity to improve our understanding of suicidality amongst autistic young people. Research to understand STB, has yet to explore the impact of the environment on suicidality despite the social and physical environment being well-documented to impact the wellbeing of autistic people (Lai et al., 2020; Saggers & Ashburner, 2019). Sensory sensitivities increase the importance of finding an appropriate fit to the environment to wellbeing. In autistic adults, sensory processing for regulation of low energy states has been associated with suicide ideation and attempts (Moseley et al., 2020) and in children and young people sensory issues predict self-injury (Duerden et al., 2012; Soke et al., 2017). Sensory issues have been identified as a ‘trigger’ for self-injury (Moseley et al., 2020). Sensory sensitivity has been associated with depression in the context of insomnia (Richdale et al., 2023) and is a contributing factor to anxiety in autistic adults (South & Rodgers, 2017), but research has yet to explore the role of sensory sensitivity in suicidal thoughts and feelings. Thus, the current study will explore the role of sensory sensitivities, anxiety and depression in suicidal thoughts for autistic young people. Research to date to address suicidality has focussed primarily on risk factors, despite longstanding calls in the literature for research to understand whether there are protective factors that are important and possibly unique to the autism community (Segers & Rawana, 2014). Effective suicide prevention strategies rely on understanding positive, protective experiences that can disrupt the association between stressors and suicidal outcomes, promote coping and emotion regulation to reduce suicidal thoughts and feelings (Kelliher Rabon et al., 2018; Wingate et al., 2006). Of the few protective factors explored amongst autistic people, connectedness has received most attention (Mournet et al., 2023; Pelton et al., 2020) but there are currently no validated measures to assess connectedness for autistic people (Pelton et al., 2020) meaning that collecting objective data about people and the environment may provide helpful insight. Self-determination theory argues that wellbeing and happiness require that the basic psychological needs of autonomy, competence and relatedness are required to experience intrinsic motivation (Cooper et al., 2024). Self-determination promotion programmes have reported positive outcomes for autistic young people (Oswald et al., 2018) and self-determination has been associated with in-school wellbeing (Shogren et al., 2012). In the general population, an absence of self-determination is a distal risk factor for suicide and self-harm (Emery et al., 2016; Tucker & Wingate, 2014). One limitation of current self-determination research amongst autistic people is that this pays less attention to the impact of the environment on self-determination for autistic people (Cooper et al., 2024) which could suggest that self-determination is an important but overlooked protective factor. Self-determination theory argues that an individual needs to be able to regulate themselves according to their personal needs to obtain desired goals (Deci & Ryan, 2012), live according to one’s purpose, make meaning (Heisel, 2018) and develop relatedness to others (Kleiman et al., 2018). Developing meaning and purpose in life protects against suicidality, and self-destructive behaviours (Ratner et al., 2022; Wang et al., 2007), particularly in minority groups (Hong et al., 2024). Autistic characteristics have been associated with identity exploration, identity distress and existential anxiety (Ratner & Berman, 2015) suggesting that a sense of self may enable the development of a protective sense of purpose (Ratner & Berman, 2015). Of note for adolescents in general and specifically for autistic adolescents is that searching for meaning does not have the same protective capacity as the presence of meaning. One documented way to develop and express meaning and purpose for young autistic people could be through special interests (Quinn et al., 2019). Spending time in interests is intensely rewarding, builds personally meaningful knowledge, developments communication skills and connections with like-minded others (Quinn et al., 2019) yet services and education settings offer relatively few opportunities to develop life skills and purpose (Quinn et al., 2019). This could suggest that purpose in life expressed and developed through special interests could be an autism-specific pathway through which to develop purpose for recovery. References: 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. (30497279). https://doi.org/10.1177/1362361318816053 Cassidy, S., Cogger-Ward, H., Robertson, A. E., Goodwin, J., & Rodgers, J. (2021). Autism Community Priorities for Suicide Prevention: An International Society for Autism Research Policy Brief. International Society for Autism Research. https://cdn.ymaws.com/www.autism-insar.org/resource/resmgr/files/policybriefs/2021-insar_policy_brief.pdf Chen, M.-H., Pan, T.-L., Lan, W.-H., Hsu, J.-W., Huang, K.-L., Su, T.-P., Li, C.-T., Lin, W.-C., Wei, H.-T., Chen, T.-J., & Bai, Y.-M. (2017). Risk of Suicide Attempts Among Adolescents and Young Adults With Autism Spectrum Disorder: A Nationwide Longitudinal Follow-Up Study. The Journal of Clinical Psychiatry, 78(9), e1174–e1179. (28872268). https://doi.org/10.4088/JCP.16m11100 Cooper, K., Kumarendran, S., & Barona, M. (2024). A systematic review and meta-synthesis on perspectives of autistic young people and their parents on psychological well-being. Clinical Psychology Review, 109, 102411. https://doi.org/10.1016/j.cpr.2024.102411 Deci, E. L., & Ryan, R. M. (2012). Self-determination theory. In Handbook of theories of social psychology, Vol. 1 (pp. 416–436). Sage Publications Ltd. https://doi.org/10.4135/9781446249215.n21 Department of Health and Social Care. (2023). Suicide prevention in England: 5-year cross-sector strategy. UK Government. https://www.gov.uk/government/publications/suicide-prevention-strategy-for-england-2023-to-2028/suicide-prevention-in-england-5-year-cross-sector-strategy Duerden, E., Oatley, H., Mak-Fan, K., McGrath, P., Taylor, M., Szatmari, P., & Roberts, S. (2012). Risk Factors Associated with Self-Injurious Behaviors in Children and Adolescents with Autism Spectrum Disorders. Journal of Autism & Developmental Disorders, 42(11), 2460–2470. https://doi.org/10.1007/s10803-012-1497-9 Emery, A. A., Heath, N. L., & Mills, D. J. (2016). Basic Psychological Need Satisfaction, Emotion Dysregulation, and Non-suicidal Self-Injury Engagement in Young Adults: An Application of Self-Determination Theory. Journal of Youth and Adolescence, 45(3), 612–623. https://doi.org/10.1007/s10964-015-0405-y Fritz, J., Piccirillo, M. L., Cohen, Z. D., Frumkin, M., Kirtley, O., Moeller, J., Neubauer, A. B., Norris, L. A., Gordon, I., Pelton, M., Goodwin, J., Herrington, R., Rodgers, J., & Cassidy, S. (2025). “My answers don’t fit your options”: Measuring self-harm with autistic people using the Self-Injurious Thoughts and Behaviours Interview (SITBI). OSF. https://doi.org/10.31234/osf.io/pkej5_v2 Hong, J. H., Talavera, D. C., Odafe, M. O., Barr, C. D., & Walker, R. L. (2024). Does purpose in life or ethnic
Subfield: Clinical Psychology
Field: Psychology
Domain: Social Sciences
Open Access status: gold
OpenAlex ID: W7155498540
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