Suicide Prevention Interventions for Autism

Recruiting at 4 trial locations

Overseen By Jessie Bishop

Age: Any Age

Sex: Any

Trial Phase: Academic

Sponsor: University of North Carolina, Chapel Hill

Disqualifiers: Acute psychosis, Intoxication, Mania, others

No Placebo Group All trial participants will receive the active study treatment (no placebo)

Compensation: Varies

Number of Visits: 3

Duration: 6 weeks

1665 Participants Needed

What You Need to Know Before You Apply

What is the purpose of this trial?

This trial explores two approaches to prevent suicide among autistic youth. It compares the effectiveness of a customized Safety Planning Intervention tailored for autistic individuals with the same intervention plus additional follow-up support. The aim is to find the best way to reduce short-term suicide risk in autistic individuals. Those who have received a safety plan for autistic youth during a clinical visit might be a good fit. As an unphased trial, participants can contribute to pioneering research that could significantly advance mental health support for autistic youth.

Will I have to stop taking my current medications?

The trial information does not specify whether you need to stop taking your current medications. It's best to discuss this with the trial coordinators or your doctor.

What prior data suggests that these suicide prevention strategies are safe for autistic individuals?

Research has shown that the Safety Planning Intervention for autistic individuals (SPI-A) is a safety plan specifically adapted for autistic people. This approach reduces the risk of suicide by creating a personalized plan for times of crisis. Tests have demonstrated its effectiveness and acceptability for autistic individuals, yielding promising results.

For the Safety Planning Intervention with structured follow-up contacts (SPI-A+), studies have demonstrated its effectiveness when combined with regular check-ins after the initial plan is made. Although detailed safety data is unavailable, this method relies on proven strategies to ensure safety during high-risk times.

Overall, both approaches in the trial are based on well-researched methods and have been adjusted to better support autistic individuals. While specific safety data for these adaptations is not detailed, their foundation in established methods provides confidence in their safety and effectiveness. ^{1 2 3 4 5}

Why are researchers excited about this trial?

Researchers are excited about the Safety Planning Interventions tailored for autistic individuals because these approaches are personalized to address the unique needs of autistic youth, which is not typically the focus of standard suicide prevention methods. These interventions are distinct in that they provide an individually tailored safety plan designed specifically for autistic individuals, and the enhanced version includes structured follow-up contacts to ensure ongoing support. This could potentially lead to more effective short-term risk reduction for suicide among autistic youth, a group that often lacks targeted mental health strategies.

What evidence suggests that this trial's treatments could be effective for suicide prevention in autistic individuals?

In this trial, participants will receive either the Safety Planning Intervention for Autistic Individuals (SPI-A) or the Safety Planning Intervention Plus Structured Follow-Up Contacts (SPI-A+). Research has shown that SPI-A is a promising method to reduce suicide risk in autistic youth by creating a personalized plan to help manage suicidal thoughts during difficult times. Studies have found that these tailored plans can effectively lower suicide risk in the short term.

SPI-A+ includes the same personalized planning but adds regular check-ins. These follow-ups strengthen the safety plan and offer extra support. Both methods have shown promise in reducing self-harm and suicide risk among autistic individuals, making them important tools for suicide prevention in this group. ^{1 3 6 7 8}

Who Is on the Research Team?

Danielle Roubinov, PhD

Principal Investigator

University of North Carolina, Chapel Hill

Shari Jager-Hyman, PhD

Principal Investigator

University of Pennsylvania

Are You a Good Fit for This Trial?

This trial is for young people aged 15-24 with autism who have had suicidal thoughts or behaviors. They must speak English and have received a safety plan tailored for autistic youth during a clinical visit. Those over 18 can consent themselves, while those under need parental consent.

Inclusion Criteria

I'm sorry, but it seems like the criterion you provided is incomplete. Can you please provide more information?

I am between 15 and 24 years old.

I received a safety plan designed for autistic individuals during my clinic visit.

Timeline for a Trial Participant

Screening

Participants are screened for eligibility to participate in the trial

2-4 weeks

Treatment

Participants receive either the Safety Planning Intervention tailored for Autistic individuals (SPI-A) or SPI-A plus structured follow-up contacts (SPI-A+)

6 weeks

At least 2 visits (in-person or virtual)

Follow-up

Participants are monitored for changes in suicidal ideation, behavior, and other mental health outcomes

12 months

Follow-up assessments at 1, 6, and 12 months

What Are the Treatments Tested in This Trial?

Interventions

• Safety Planning Intervention tailored for Autistic Individuals
• Safety Planning Intervention Tailored for Autistic Individuals Plus Structured Follow-Up Contacts

Trial Overview The study compares two suicide prevention strategies specifically designed for autistic individuals: one is the Safety Planning Intervention (SPI-A), and the other adds structured follow-up contacts to SPI-A (SPI-A+).

How Is the Trial Designed?

Group I: Safety Planning Intervention Tailored for Autistic Individuals Active Control 1 Intervention

The Safety Planning Intervention Tailored for Autistic individuals (SPI-A) is a brief collaborative intervention that results in an individually tailored plan designed to lower the short-term risk of suicide in autistic youth.

Group II: Safety Planning Intervention Tailored for Autistic Individuals Plus Structured Follow-Up Contacts Active Control 1 Intervention

The Safety Planning Intervention Tailored for Autistic individuals plus structured follow-up contacts (SPI-A+) is a multi-component intervention comprised of SPI-A and structured follow-up consisting of at least 2 brief contacts.

Who Is Running the Clinical Trial?

University of North Carolina, Chapel Hill

Lead Sponsor

Trials

1,588

Recruited

4,364,000+

Seattle Children's Hospital

Collaborator

Trials

319

Recruited

5,232,000+

Patient-Centered Outcomes Research Institute

Collaborator

Trials

592

Recruited

27,110,000+

University of Pennsylvania

Collaborator

Trials

2,118

Recruited

45,270,000+

Nationwide Children's Hospital

Collaborator

Trials

354

Recruited

5,228,000+

Hugo W. Moser Research Institute at Kennedy Krieger, Inc.

Collaborator

Trials

93

Recruited

25,200+

Children's Hospital of Philadelphia

Collaborator

Trials

749

Recruited

11,400,000+

Published Research Related to This Trial

Over 90% of adolescents recently hospitalized for suicide risk reported having access to their safety plans after discharge, indicating high retention and potential for use during critical periods.

While safety plan use and suicidal ideation both declined over time, the relationship between them varied by sex: girls showed a correlation in changes, while boys' safety plan use decreased regardless of their suicidal ideation changes.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Safety plan use in the daily lives of adolescents after psychiatric hospitalization. May, AM., Al-Dajani, N., Ballard, ED., et al.[2023]

The Autism Adapted Safety Plan (AASP) is the first safety plan specifically designed for autistic adults at risk of self-harm and suicidal behavior, aiming to provide structured support during crises.

This pilot study will assess the feasibility and acceptability of the AASP among 90 participants, focusing on their experiences and the effectiveness of recruitment methods, which could inform larger future studies.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Adapted suicide safety plans to address self-harm, suicidal ideation, and suicide behaviours in autistic adults: protocol for a pilot randomised controlled trial. Rodgers, J., Goodwin, J., Nielsen, E., et al.[2023]

The study developed a new assessment tool called the Risk Assessment Checklist for Self-Injury in Autism-Medical (RASCA-M) to evaluate medical risk factors associated with self-injurious behavior in non-verbal children with autism spectrum disorder (ASD).

Preliminary validation of the RASCA-M showed promising results in terms of content validity, criterion-related validity, and interobserver agreement, indicating it could effectively identify underlying medical issues in this population.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Preliminary Development and Testing of the Risk Assessment Checklist for Self-Injury in Autism-Medical (RACSA-M). Alberts, LB., Kettering, TL.[2022]

Children with autism spectrum disorder (ASD) initially showed a 12% higher risk of injury compared to those without ASD, but this risk decreased to lower than that of non-ASD children after adjusting for demographic factors and co-occurring conditions.

The study suggests that co-occurring conditions, such as seizures and depression, may contribute to the increased injury risk in children with ASD, indicating that addressing these conditions could help reduce injury rates and improve overall safety for these children.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Injuries among children with autism spectrum disorder. Jain, A., Spencer, D., Yang, W., et al.[2019]

The Safety Planning Intervention (SPI) is a structured six-step action plan designed to help individuals at risk of suicide by enhancing their coping strategies and social support, and by removing access to means of self-harm.

Research shows that SPI is highly effective in reducing suicidal behavior, making it a valuable tool in various settings such as emergency rooms and outpatient clinics.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

[SAFETY PLANNING INTERVENTION FOR SUICIDE PREVENTION]. Perlstein, J., Katzir, N., Lotan, A., et al.[2022]

A systematic review identified only 30 relevant studies out of 818 titles, highlighting a significant gap in research on treatment outcomes for older adolescents and adults with autism spectrum disorders (ASDs).

The review found that most studies used non-standardized assessments and lacked valid measures specifically designed for adults with ASDs, which limits the effectiveness of treatment evaluations.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Outcome measures in intervention trials for adults with autism spectrum disorders; a systematic review of assessments of core autism features and associated emotional and behavioural problems. Brugha, TS., Doos, L., Tempier, A., et al.[2021]

Clinicians feel more confident in screening for suicide risk in non-autistic clients compared to autistic clients, indicating a potential gap in training or resources for assessing suicidal risk in autistic individuals.

While clinicians use Safety Planning, an evidence-based suicide prevention strategy, at similar rates for both autistic and non-autistic clients, they find it more acceptable for non-autistic clients, suggesting a need for improved acceptance and implementation of these strategies for autistic individuals.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Mental Health Clinicians' Screening and Intervention Practices to Reduce Suicide Risk in Autistic Adolescents and Adults. Jager-Hyman, S., Maddox, BB., Crabbe, SR., et al.[2020]

A meta-analysis of 6 studies involving 3536 participants found that safety planning-type interventions (SPTIs) significantly reduce suicidal behavior, with a relative risk of 0.570 compared to control groups, indicating they are effective in preventing suicide attempts.

However, the same analysis showed no significant effect of SPTIs on reducing suicidal ideation, suggesting that while SPTIs are beneficial for preventing actions, additional strategies may be necessary to address thoughts of suicide.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Safety planning-type interventions for suicide prevention: meta-analysis. Nuij, C., van Ballegooijen, W., de Beurs, D., et al.[2022]

The case study highlights that a 17-year-old male with autism spectrum disorder (ASD) attempted suicide, indicating a potentially higher risk for suicidal behaviors in individuals with ASD than previously understood.

The report emphasizes the importance of understanding the unique characteristics of suicidal behaviors in adolescents with ASD and outlines strategies for preventing future suicide attempts, although specific prevention methods are not detailed in the abstract.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Attempted suicide of an adolescent with autism spectrum disorder. Mikami, K., Onishi, Y., Matsumoto, H.[2014]

An 11-year-old girl with Autism Spectrum Disorder (ASD) and adjustment disorder was successfully treated after a suicide attempt, highlighting the importance of addressing both environmental triggers and personal relationships in her recovery.

The treatment focused on reducing risk factors and enhancing protective factors, leading to a complete absence of suicidal ideation or re-attempts during the course of her care.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Suicide Leap of an 11-Year-Old Girl with Autism Spectrum Disorder. Takahashi, Y., Mikami, K., Akama, F., et al.[2020]

Citations

1. withpower.com withpower.com/trial/phase-suicidal-and-self-injurious-behaviour-7-2022-089a8

Suicide Prevention Interventions for Autism This trial is testing two methods to prevent suicide in autistic youth aged 12-24. One method involves creating a personalized safety plan, while the other ...

2. clinicaltrials.gov clinicaltrials.gov/study/NCT05398250

A Comparison of Two Brief Suicide Prevention ... The purpose of this study is to compare the effectiveness, feasibility, and acceptability of two suicide prevention strategies tailored for autistic individuals ...

3. autism.unc.edu autism.unc.edu/2021/08/unc-teacch-researchers-awarded-9-million-for-study-of-suicide-prevention-tailored-for-youth-on-the-autism-spectrum/

UNC TEACCH Researchers Awarded $9 Million for Study of ... “SPI-ASD is a brief intervention that results in an individually tailored plan designed to lower the short-term risk of suicide in autistic ...

4. med.unc.edu med.unc.edu/aaset-sp/why-are-we-doing-this/

Why Are We Doing This? | AASET – Suicide Prevention The goal of this study is to compare the effectiveness of these two tailored suicide prevention approaches among autistic youth.

5. pmc.ncbi.nlm.nih.gov pmc.ncbi.nlm.nih.gov/articles/PMC11165343/

Feasibility and acceptability of autism adapted safety plans We undertook a pilot feasibility randomised controlled trial of autism adapted safety plans (AASP) to reduce self-harm and suicide for autistic people.

6. autismcenter.org autismcenter.org/safetyplanning

The Safety Planning Intervention Tailored for Autistic ... This workshop introduces a suicide safety plan specifically tailored for autistic people. Modified from the Stanley-Brown Safety Plan, with input from autistic ...

7. pmc.ncbi.nlm.nih.gov pmc.ncbi.nlm.nih.gov/articles/PMC9377164/

Safety Planning for Suicidality in Autism Safety planning is an evidence-based intervention designed to help people stay safe during periods of acute suicide risk. This intervention is ...

8. actcommunity.ca actcommunity.ca/wp-content/uploads/2024/04/Jager-Hyman-ACT-2024.04-.pdf

A Tailored Approach to Suicide Prevention for Autistic Youth Safety Planning Intervention (SPI). Adapting SPI for Autistic Individuals (SPI-A). How to Develop a Tailored Safety Plan. SPI-A Components. Page 4. Background ...