Research consistently shows that autistic people face higher risks of mental health difficulties and are more likely to think about or attempt suicide than the general population.
For example, a 2014 study found that up to 66% of those surveyed had had suicidal thoughts (compared to 20% of non-autistic adults) and up to 35% have planned or attempted suicide. There may be many reasons for this, but it is thought that pressures such as chronic stress, isolation and bullying, compounded by trauma, anxiety and inadequate support, can lead to exhaustion and hopelessness.
We need to find ways to intervene earlier with autistic young people, to build wellbeing, prevent crisis and create safer environments around them.
To help us do this, we need to look at the experiences of autistic children across education, health and social care services. This includes A&E, where past studies have shown that autistic children are nine times more likely to receive psychiatric care than non-autistic children.
Our study – a collaboration between researchers at Liverpool John Moores University, children’s mental health charity Anna Freud, Edge Hill University, University College London and Alder Hey Children’s NHS Foundation Trust – set out to map patterns among young people in suicidal crisis at A&E. We analysed the records of 338 young people aged eight to 16 who attended a UK paediatric hospital A&E for suicidal crisis over three years.
Patterns within emergency departments
We found that autistic young people were disproportionately represented, at over a third (35.8%) of all attendees. Nearly two thirds of these (62%) were girls. This mirrors the way autistic girls are often under-identified in childhood, leading to missed or late diagnosis and more internalising difficulties. This can result in an increased risk of anxiety, depression and suicidality.
The data showed autistic children were seeking help for suicidal thoughts in A&E at significantly younger ages than their non-autistic peers (eight v ten years). This could suggest that the cumulative emotional toll of negative experiences builds up faster or starts earlier for autistic children. It’s consistent with previous research which found that negative school experiences generate twice the emotional burden in autistic and ADHD adolescents compared to their neurotypical classmates.
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We found that autistic young people were more likely to have a pre-existing mental health diagnosis (64% v 46%). They were also more likely to have previously been seen by Child and Adolescent Mental Health Services (CAMHS)(74% v 49%) and to have repeat A&E attendances for suicidal crisis (31% v 18%).
This highlights a paradox: autistic young people were more likely to be known to CAMHS and to have sought help at A&E previously, but were also more likely than non-autistic young people to attend (and re-attend) A&E in suicidal crisis. This points to a gap between recognising an autistic child is struggling and delivering the help they need, with A&E departments left to act as a safety net when earlier support falls short.
What can services learn?
As this was a single-site UK study based on routine clinical records (which can be incomplete), we may not be able to generalise the findings to other settings. Despite this, we think these findings have implications for how to provide earlier and better care.
CAMHS are incredibly stretched. Limited resources means the threshold to receive help is very high, with many not getting support as a result. Barriers are even steeper for autistic young people. For example, “diagnostic overshadowing”, where symptoms of mental health difficulties are attributed to autism, is common. Furthermore, some therapeutic options aren’t suited to how autistic people think and communicate. Improving the accessibility of services and offering adapted support could help reduce the risk of crisis.
Alternatives to A&E are also needed. The government’s recent announcement of 159 new NHS mental health centres in England will help provide crisis care in the community. However, crisis alternatives tailored to the needs of autistic people still need to be developed and delivered, to offer more appropriate pathways specifically for autistic young people. Improved early intervention in schools and communities can also support prevention.
The A&E environment is likely also part of the problem, with bright lights, noise and unpredictability intensifying overwhelm. This can make it harder to assess a young autistic person and more likely they’ll leave before being seen. Small changes like quiet rooms and ear defenders could help.
Communication differences can further complicate A&E experiences for autistic people. Expressing distress non-verbally may increase the risk of crisis being misread, missed or misunderstood, particularly in such a busy environment. Tools like communication passports and reasonable-adjustment flags are starting to appear in some NHS services but could be made standard practice.
These changes are not possible without services being given adequate funding and resources. Staff training in autism is also key, with the NHS-funded National Autism Trainer Programme providing a good model.
Our findings show that something isn’t working in services for a group of children at serious risk of harm. In collaboration with autistic young people and their families, we need to turn this evidence into action, providing much earlier support and building safer, more understanding environments so that no one falls through the gaps.
Emma Ashworth received funding from Liverpool John Moores University QR Policy Support Fund to conduct the research associated with this article.
Georgia Pavlopoulou has an honorary contract with mental health charity Anna Freud. She is Chair of Autism Central, England’s Autism Peer Education Programme.