The Growing Concern of Suicide and High Functioning Autism (aka Asperger’s Syndrome)
How many suicides are enough to warrant concern that there is a problem in this country with our suicide rate? Just one, one should be enough to make us pause and wonder why someone would feel that suicide was the best solution to his situation. There are 30,000 deaths every year in this country due to suicide making it every 17 minutes a suicide is completed and every 42 seconds someone is attempting suicide. SOS Tucson Suicide Postvention services says studies show 80-90% of those who commit suicide had a mental health issue. The rates of suicide are rising among teens with high functioning autism (formerly called Asperger’s /Aspies). There is not a study to provide empirical numbers, but those working with Aspie teens are suggesting that 50% of Aspie teens have contemplated or attempted suicide and Aspie teens are at a 40-50% higher risk of completing suicide than their Neuro-typical (NT) counterparts.
Consider these two scenarios:
“Zach” (not his real name) age 18, is an honor student about to be inducted into a national honor society. Lately his family feels he has been turning some poor choices around and for once he is really talking about college and pursuing a choice career. There have been no changes in his friend circles, no talk of depression lately in the past 3-4 months, things seem to be looking up! The future is bright. The family couldn’t be prouder of his high school and fencing achievements.
“Susie” (not her real name) is a 13 year old 8th grader. She makes all A’s, and everyone around her tells her of her beauty and intelligence. She has a few good friends and is one of the teacher’s favorites. There has been some middle school girl drama and some ups and downs in friendships. Recently, a mean girl targeted her to exclude her from a group going on a school trip that had been highly anticipated since 6th grade. Her family is concerned about the exclusion/ bullying and ask her how she was doing processing all of this. She gave all the right answers, her grades never dropped and her routine did not change.
Which student would you be more concerned about contemplating or completing suicide? We are taught that the common markers are the onset of depression, talking about death or never being born, giving away treasured items, talks of actual plans, acute anxiety, or changes in friends or routines. What if the parent of each were concerned and went to mental health providers but were turned away? What if these students came to you as a counselor or minister do they present as suicide risk? The answer to the question as to which one was at higher risk is- both! Both students were diagnosed with Asperger’s. “Susie” attempted and daydreamed about suicide but did not complete the action. Zach unfortunately successfully took his life this year.
What makes an Aspie teen a higher risk? The number one reason is social isolation and/or rejection which lowers an already low self esteem. What adds to this feeling of rejection is many times Aspies do have decent friendships and get invited to parties in elementary school, then there is sudden shift in middle school. Middle school is the time the teen notices he is “different.” Other students seem to notice it too. Those who had been friends in elementary school suddenly distance themselves. This is confusing for the Aspie. “Why were we friends in 5th grade but not 6th grade? What did I do? How can I make them like me again?” A blog called “Your little Professor” said: “In the teenage world where everyone feels insecure, teens that appear different are voted off the island. Aspies often have odd mannerisms. One teen talks in a loud unmodulated voice, avoid eye contact, interrupts others, violate physical space of others, and constantly steers the topic of conversation to his or her favorite odd topic.” Sometimes these teens appear aloof, cold, selfish or “want to be loners.” Adolescence is a time students are seeking identity and peer approval. What is one to do when all attempts to make friends results in being shunned or bullied?
What else in changing in middle school? School work is getting harder. The “hand holding” and encouragement many received in elementary school is no longer the case in middle school. School expectations are different. Students are expected to do public presentations and worse for Aspies- group projects. When teachers allow the students to pick their own groups, guess who is often left out and then has to reluctantly form what gets referred to as the “loser group“ with the others that were also not included.
We have all heard of “anxiety attacks” but Dr. Tony Attwood said Aspie teens are prone to “depression attacks”. An Aspie teen can wake up fine in the morning exhibiting no signs of anxiety or depression and have a trigger at school such a bully, low grade on an assignment, believe a teacher does not like them, a friend break up, and suddenly be under what he calls a “depression attack.” The depression comes on intensely and paired with a pre-frontal cortex that does not always see permanent consequences of actions is not getting a “do not do it” message from the executive part of their brain. They see the suicide as an immediate response to end sudden, intense pain and thoughts of it being something that can not be undone is not usually part of their prefrontal cortex thinking process. Attwood adds that inherent to the condition is the tendency to catastrophize. Because of this tendency, there are challenges to regulate their emotions. Add to that the amygdala of an Aspie tends to be 10-15 % larger than in Neuro-typicals which can inflate the “danger alerts” in the fight/flight/freeze system. What would have been a 1 on the stressor scale for a NT individual could easily have registered as a 10 to the Aspie. The overactive amygdala sends signals that begin the heart racing, adrenaline production, stomach churning and as Attwood said “It is like the Aspie is the last to know about his or her heightened emotions. He appears to be just as surprised as the observer when emotions have escalated.” He added that in addition to an enlarged amygdala there is less white fiber between amygdala and frontal lobe. The frontal lobes are not getting the signals that the system is under duress and little interaction from executive function which in NTs would be saying “Calm down, hitting them will get you in trouble. Breaking that is not a good idea.”
Aspies have made an art form of “making a mountain out of a molehill” to many people but we need to understand is that what may be a molehill to one IS a mountain to the Aspie. I agree with Dr. Attwood that cognitive-behavorial therapy is crucial for Aspie teens to get often. We should not wait until we think the teen has exhibited something to “need” therapy. A good therapist who understands Asperger’s and issues of adolescence can help the teen explore various issues before it is a major problem. Attwood said that Aspie teens should be getting regular “mental health check ups” routinely to help navigate the tumultuous times of adolescence as preventive measures to help with “depression attacks” and learn positive self-talk and recognizing catastrophizing before the teen takes a permanent action for a temporary problem. I am urging therapists and ministers to understand high functioning autism (Asperger’s). It appears to becoming a matter of life and death in this population of teens.