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Poster #48 - The Over-Occurrence of Gender Identity-Diversity in Autistic Youth: Suicidal Ideation and Deliberate Self-Harm Behaviors

Thu, March 21, 9:30 to 10:45am, Baltimore Convention Center, Floor: Level 1, Exhibit Hall B

Integrative Statement

Introduction: There is a significant over-occurrence of gender-identity diversity (i.e., identifying as a gender different than the gender assumed at birth, transgender, gender non-binary, etc.) reported by autistic youth (van der Miesen et al., 2018). Children and adolescents with autism spectrum disorder (ASD) are at higher risk for suicidal ideation (SI) and attempts (Mayes et al., 2013). Gender-diverse and transgender adolescents are at extreme risk for SI and attempts, with 30% of transgender adults reporting at least one suicide attempt before the age of 18 (James et al., 2016). Previous SI risk studies either do not explicitly include or identify youth who may be gender-diverse (ASD studies) or consider the ASD-co-occurrence (gender studies). Youth with the ASD and gender-diversity co-occurrence present with complex clinical challenges (Strang et al., 2018), but no studies have investigated the SI risk profiles of these youth.

Methods: Participants included 211 clinic-referred children and adolescents with confirmed ASD ages 10-18 years (32 gender-diverse, 143 cisgender (i.e. identifying with the gender assigned at birth) male, 36 cisgender female; mean age = 13.02, SD=2.48). Parents of participants reported on the Child Behavior Checklist (CBCL) items 18 “Deliberately harms self or attempts suicide” and 91 “Talks about killing self.” The ASD groups were also compared to the CBCL non-referred standardization sample (576 female and 531 male; mean age=13.53, SD=2.30, age range=10-18). In order to account for gender diversity in the in the standardization sample and comparison groups, youth that endorsed item 110 “Wishes to be the opposite sex” were excluded from analysis. Items were recoded into binary variables, collapsing the “Sometimes” and “Often” endorsements vs. the “Never” endorsement. Relative risk (RR) analyses were conducted to identify endorsement differences by group.

Results: Forty three percent of autistic gender-diverse youth reported self-harm behaviors and/or suicide attempts, and 37.5% reported suicidal ideation (Table 1). Self-Harm RR: Gender-diverse autistic youth were 53.81 times more likely to be reported engaging in self-harm or suicide attempts than the non-referred group and 3.26 times more likely than their cisgender autistic peers. Autistic cisgender boys were 24.17 times more likely and autistic cisgender girls were 14.75 more likely to engage in deliberate self-harm than their non-referred respective gender peers. Suicidal Ideation RR: The autistic gender-diverse group was 20.76 times more likely to report SI than cisgender non-referred youth and 2.07 times more likely to report SI than cisgender autistic youth. Cisgender autistic boys were 12.77 times more likely and cisgender autistic girls were 8.60 times more likely to have SI than cisgender boys and girls respectively (Table 2).

Conclusions: As established in previous investigations, this current study affirms that having ASD may predispose youth to increased SI and deliberate self-harm. However, youth with ASD and co-occurring gender-diversity are at even greater risk for safety concerns. This current study highlights the importance of safety monitoring and instantiating supports for youth with the co-occurrence, as well as awareness among ASD clinicians that assessment of gender-diversity may be a key component in evaluating mental health safety in autistic youth.

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