(PS4-25) Associations Between Anxiety, Depression, Executive Functions, and Suicidal Ideation Among Autistic Children: A Longitudinal Analysis

Autistic children are at elevated risk of suicide-related outcomes, including increased suicidal ideation (SI) beginning in the elementary school period (O’Halloran et al., 2022). Internalizing symptoms have been linked to increased SI among autistic adolescents and adults (Ellison et al., 2022; Pelton et al., 2023), and executive functions (EF)-specifically, the ability to inhibit impulses and shift between activities-have been associated with more frequent and more severe suicidality among non-autistic adolescents (e.g., MacPherson et al., 2022). Despite alarmingly high rates of SI among autistic children (Hunsche et al., 2020), research on risk factors of SI in this vulnerable demographic is limited and inconclusive. Studies also primarily involve treatment-seeking samples, which precludes generalizing results to the broader autistic population. Better understanding the role of internalizing symptoms and EFs on SI across development may support identification of children at increased risk of SI, and thus guide efforts to monitor, effectively respond to and potentially reduce SI risk in this vulnerable group. 

This study used parent-reported behavioural data to examine whether whether internalizing symptoms (anxiety and depression), EFs (shifting, inhibition), and their interaction at age 8 years act as risk factors of SI at any point from age 8 to 14 in a longitudinal inception cohort of autistic children. 

Parents (N=117) from the Canadian Pathways in ASD study with complete data at 4 time points (T1: 8 years–T4: 14 years) on the Child Behaviour Checklist (CBCL) and the Behaviour Rating Inventory of Executive Function (BRIEF) were included in analyses. SI was assessed via CBCL Item 91. Two logistic regression models examined the association between anxiety and depression symptoms, inhibition (Model 1) or shifting  (Model 2) and SI endorsement at any point between T1-T4. We also examined whether inhibition or shifting moderate the associations between anxiety and depression symptoms and SI. These models controlled for age, gender, communication ability (at T1) (measured by the Vineland Adaptive Behaviour Schedule Communication subscale). 

Depression at T1, but not anxiety or EF (inhibition or shifting), predicted SI (at any time point; T1-T4) in both models (Model 1: β=.28, p= .04, OR=1.32, R2=.23; Model 2: β=.28, p=.03, OR=1.33, R2=.21). Depression at T1 (age 8) also predicts later SI across ages 9-14 years. Shifting and inhibition did not significantly moderate effects. Next, we aim to conduct latent growth curve analyses to estimate profiles of internalizing symptoms over time and probability of SI endorsement across profiles.

Findings demonstrate that elevated depression symptoms as early as 8 years may be a key indicator of future SI risk among autistic children, above and beyond anxiety and EFs. Trajectory analyses will further clarify whether the pattern of anxiety and depression symptoms across development, and their interaction with EFs, predicts the emergence of SI. Together, these findings may inform if and when internalizing symptoms and EFs indicate heightened SI risk, and when suicide risk assessment and intervention is most needed among this at-risk population.