5-Step Screening Protocol for Autism in Adults
Step by step protocol for mental health and medical professionals to better support unidentified Autistic and masking adults, who research links to increased suicide
Studies show that Autistic people are up to seven times more likely to die by suicide and six times more likely to attempt suicide than the general population. Suicide is the second leading cause of death for Autistic people.
To add to this complexity, highly-masked Autistics are at an increased risk of lifetime suicidality due to factors related to consciously or subconsciously hiding their true selves on a daily basis. So, even those clients who do not appear to be Autistic may be struggling with Autism and the exhaustion of masking behind the scenes, with great impact on their mental health.
With the added layer of masking, in addition to the overall lack of education most providers (medical, mental health, etc) receive on neurodivergence, it’s no wonder that many continue to feel underprepared to screen for Autism at the onset of mental health screenings and assessments in clinics and hospitals around the globe.
This must change, as lives are at stake.
What can we do?
I’m proposing that we collectively screen for Autism in all of our adult & young adult patients/clients at every mental health assessment using a simple 5-step flow chart for providers, that offers specific step-by-step guidance on:
Which Autism-specific screenings to offer your patients/clients
How to navigate elevated screenings with the patient/client
What to say and what resources to offer patients/clients who are curious in more information or assessment
[Scroll down to access the 5-Step Screening Protocol for Screening for Autism in Adults]
Who can use this protocol?
Anyone who works with clients/patients in a mental health, healthcare, or health-related setting can integrate this 5-Step Protocol into their adult mental health screenings and/or assessments.
Therapists | Coaches | Psychologists | Physicians | Nurse Practitioners | Functional Medicine Providers | Social Workers | Addiction Specialists | Nurses | Admissions Staff | Acupuncturists | Integrative Health Providers | School Psychologists | & More
Why is this important?
Statistics on Suicide Risk in Autistic Individuals (www.autistica.org.uk)
Autistic adults with no learning disability are 9 X more likely to die by suicide than the general population
It is the second leading cause of death for Autistic people. Average life expectancy for Autistic people is just 54 years old
Up to 66% of Autistic adults have considered suicide
Suicide attempts tend to be more aggressive and lethal
Autistic children are 28 X more likely to think about or try suicide
One study showed that 15% of Autistic children had suicidal thoughts
compared to 0.5% of typically developing children
In the 86 days leading up to the first Lockdown and up to the 56 days
after, 1⁄4 of young people who died by suicide were Autistic or had ADHD
Autistic people make up approximately 1% of the population but 11% of suicides
Is Camouflaging Autistic Traits Associated with Suicidal Thoughts and Behaviours?… (Cassidy, 2020)
Results suggest that camouflaging Autistic traits is associated with increased risk of experiencing thwarted belongingness and lifetime suicidality. It is important for suicide theories such as the IPTS to include variables relevant to the broader Autism phenotype, to increase applicability of models to both Autistic and Non-Autistic people.
Autistic People and Suicidality (www.autism.org.uk)
Just like in the general population, experiencing mental health problems, social isolation and unemployment can increase suicide risk in Autistic people. Yet, being Autistic in itself is thought to contribute to this risk over and above these other factors.
Autism combined with high IQ increases risk of suicidal thoughts (University of Iowa)
Twice exceptional youth—children who have a diagnosis of Autism and who also have exceptional cognitive ability—are at increased the risk of suicidal thoughts, according to a recent study by researchers at the University of Iowa.
Specifically, the study found that Autistic children are almost six times more likely to have thoughts of suicide if they have an IQ of 120 or higher than if they have average IQ.
This finding is both unexpected and concerning because high cognitive ability is generally considered to be protective against suicidal ideation, and because suicide rates are already significantly higher in Autistic individuals.
This likely translates to Neurocomplex and 2E adults
As providers of all types, we have the ability to collectively reduce the distress and suicide rates in unidentified Autistic individuals by screening for Autism in all of our patients/clients at every mental health assessment. Identifying Autistic traits during an assessment has the opportunity to help the client in many ways that may include:
Access to wiring-aligned accommodations to support their work, education and mental health
Increase in self understanding and acceptance around their neurodivergence and how it impacts sensory, communication, social, and other areas of functioning in neurotypically dominated environments
Rewriting their life narrative around their mental health journey (ie why medication trials have not been helpful, understanding the overlap of Autistic burnout and depressive symptoms, etc.)
Opportunity to seek out neurodiversity-affirming therapists and providers who truly understand Autistic wiring, masking, etc.
How do we start?
5-Step Screening Protocol for for Autism in Adults
Download the 5-Step Screening Protocol for Screening for Autism in Adults below:
Click “Download” button to see the entire document:
Need some additional resources?
Links to Free Screening Tools used in this Screening Protocol:
Takes 2-5 minutes to complete
Threshold score: 6+
Camouflaging Autistic Traits Questionnaire (CAT-Q)
Takes 5-10 minutes to complete
Threshold score: 100+
Ritvo Autism Asperger’s Diagnostic Screening- Revised (RAADS-R)
Takes 10-30 minutes to complete
Threshold score: 65+
(Note: Self-rating screening tools can be difficult for Autistic clients to complete, so it may take them longer and/or it may be helpful to be available to go through questions with clients upon request.)
Starter Kit for Autistic Self-Exploration Resources:
Neurodivergent Insights: Blog + Downloads
Method Creative: Books + Downloads
Job Accommodation NetworkWhen? Now.
When can I begin to integrate this screening protocol?
You’ve got all of the tools and the 5-Step Screening Protocol, so get this integrated into your assessment process NOW!
You can make a difference.
PLEASE SHARE THIS WITH OTHER PROVIDERS!
-Lindsey Mackereth, MA, LPCC, LADC
Thank you for this contribution. Diagnosis is suicide prevention!
I feel like this information could be useful to prescribing doctors.
One of their routine med-check questions tends to be “any thoughts of suicide?”. I always feel “put on the spot” and like the hard answer is supposed to be a resounding “NO!”
“Any thoughts of suicide (possibly related to this medicine) MORE THAN USUAL for you?” might be a better question in my case.
( TBH the realest answer would maybe be more comedic: )
“YES. OBVIOUSLY. ALL THE TIME, BRUH! I’m only visiting this planet and HAVE YOU SEEN OUTSIDE?? I’m scared for the world, my kids, myself, I hate capitalism and violence and injustice and inequality…but I believe MORE in love, hope, charity, kindness, and that our common struggles bind us, challenge us, provide us with insight, and move us forward as a collective to something more inclusive. “
*stunned look from doctor.*
I add: “It’s no measure of health to be well adjusted to a profoundly sick society, Doc.”
*dr half my age: So is that a…?”
Me: I’m just gonna say NO, Doc. *eyeroll*
p.s. I’m not on meds at the moment or suicidal if anyone’s concerned. Just trying to brighten your day with dark humour. Or “regular”’humour in my instance. :)