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Peer-reviewedCC BY 4.0Discover Mental Health

Underrecognized suicidality in higher functioning youth with autism spectrum disorder and attention deficit hyperactivity disorder

  • Mayank Gupta1
  • James McCall2
  • Priyal Khurana3
  • Nihit Gupta3,4
4 affiliations
  1. 1Rutgers University, New Brunswick, NJ USA
  2. 2Independent Researcher, Boise, ID USA
  3. 3Mahatma Jyotirao Phoole University, Jaipur, India
  4. 4Department of Psychiatry, Dayton’s Children Hospital, Dayton, OH USA
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Abstract

Objective: To examine factors associated with elevated risk of suicidal thoughts, behaviors, and death by suicide among high functioning individuals with autism spectrum disorder and attention deficit hyperactivity disorder, with particular emphasis on phenotypes characterized by high cognitive ability and delayed recognition.

Methods: A structured review of the literature was conducted across multiple electronic databases using controlled vocabulary and key terms including suicidal risk, autism spectrum disorder, attention deficit hyperactivity disorder, high functioning, and neurodivergence. After screening for relevance, duplication, and methodological rigor, 7 studies meeting inclusion criteria were synthesized from an initial yield of fifty publications.

Results: Across studies, individuals with ASD demonstrated a consistently elevated risk of STB and death by suicide compared with the general population, both over the lifetime and within shorter follow up periods. Risk was disproportionately concentrated among individuals without intellectual disability, with higher cognitive ability emerging as a vulnerability factor rather than a protective one. Communication differences, alexithymia, and impaired interoceptive awareness limited the sensitivity of caregiver and clinician assessments, contributing to under recognition of suicidality. Traditional protective factors such as educational attainment, employment, and relationship status did not reliably mitigate risk in ASD and ADHD populations. Camouflaging behaviors and diagnostic overshadowing frequently delayed identification, increasing exposure to cumulative psychosocial stress and untreated mental health conditions.

Conclusions: High functioning individuals with ASD and co-occurring ADHD represent a concealed yet high risk population for suicidality. These findings underscore the urgent need for autism informed suicide risk assessment, early identification of neurodevelopmental traits in suicidal individuals, and prevention strategies tailored to cognitive profile, developmental history, and comorbidity. Advances in the current screening and intervention frameworks may mitigate adverse outcomes in this vulnerable group.

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Cite

BibTeXRIS
BibTeX
@article{gupta2026underrecognized,
  title = {{Underrecognized suicidality in higher functioning youth with autism spectrum disorder and attention deficit hyperactivity disorder}},
  author = {Mayank Gupta and James McCall and Priyal Khurana and Nihit Gupta},
  journal = {Discover Mental Health},
  year = {2026},
  month = aug,
  doi = {10.1007/s44192-026-00453-0},
  url = {https://doi.org/10.1007/s44192-026-00453-0},
  note = {CC BY 4.0},
}
RIS
TY  - JOUR
TI  - Underrecognized suicidality in higher functioning youth with autism spectrum disorder and attention deficit hyperactivity disorder
AU  - Mayank Gupta
AU  - James McCall
AU  - Priyal Khurana
AU  - Nihit Gupta
PY  - 2026
DA  - 2026/08/10
JO  - Discover Mental Health
DO  - 10.1007/s44192-026-00453-0
UR  - https://doi.org/10.1007/s44192-026-00453-0
AB  - Objective: To examine factors associated with elevated risk of suicidal thoughts, behaviors, and death by suicide among high functioning individuals with autism spectrum disorder and attention deficit hyperactivity disorder, with particular emphasis on phenotypes characterized by high cognitive ability and delayed recognition.  Methods: A structured review of the literature was conducted across multiple electronic databases using controlled vocabulary and key terms including suicidal risk, autism spectrum disorder, attention deficit hyperactivity disorder, high functioning, and neurodivergence. After screening for relevance, duplication, and methodological rigor, 7 studies meeting inclusion criteria were synthesized from an initial yield of fifty publications.  Results: Across studies, individuals with ASD demonstrated a consistently elevated risk of STB and death by suicide compared with the general population, both over the lifetime and within shorter follow up periods. Risk was disproportionately concentrated among individuals without intellectual disability, with higher cognitive ability emerging as a vulnerability factor rather than a protective one. Communication differences, alexithymia, and impaired interoceptive awareness limited the sensitivity of caregiver and clinician assessments, contributing to under recognition of suicidality. Traditional protective factors such as educational attainment, employment, and relationship status did not reliably mitigate risk in ASD and ADHD populations. Camouflaging behaviors and diagnostic overshadowing frequently delayed identification, increasing exposure to cumulative psychosocial stress and untreated mental health conditions.  Conclusions: High functioning individuals with ASD and co-occurring ADHD represent a concealed yet high risk population for suicidality. These findings underscore the urgent need for autism informed suicide risk assessment, early identification of neurodevelopmental traits in suicidal individuals, and prevention strategies tailored to cognitive profile, developmental history, and comorbidity. Advances in the current screening and intervention frameworks may mitigate adverse outcomes in this vulnerable group.
SN  - 2731-4383
ER  -