Written by Mercedes Bagshawe, member of the 2024 CanFASD Trainee Program.
My name is Mercedes Bagshawe and I am a PhD student in the School and Applied Child Psychology Program at the University of Calgary. I have worked in pre-and post-natal risk, including Fetal Alcohol Spectrum Disorder (FASD), for several years. My MSc thesis explored suicidality in neurodiverse youth, including those with FASD. For my doctoral studies, I will transition to examining the effects of prenatal cannabis use on mental health and developmental outcomes in exposed youth. As part of the 2024 CanFASD trainee program, I am reviewing my prior MSc thesis on suicidality in neurodiverse youth and access/barriers to support and healthcare services.
Background
Autistic individuals and individuals with FASD are at increased risk for experiencing mental health problems, including suicidality. Both groups have compounding physical and psychological challenges leading to high utilization rates of healthcare services, such as emergency department services, social services, and government funding supports. Little is currently known about the access and utility of services for suicidal neurodiverse youth and their caregivers. My study examined suicidality and barriers to care among neurodiverse youth (i.e., autistic youth and youth with FASD), as well as caregivers’ experiences with accessing healthcare services for their youth.
Methods
Caregivers of neurodiverse youth (FASD n=25; autistic n=35) answered questions in an online modified Columbia Suicide Severity Rating Scale (CSSR-S) about their children’s experiences with suicidality, early life adversity, co-occurring mental health conditions (i.e., ADHD, learning disabilities, intellectual difficulties, depression, anxiety, etc.) healthcare services, and barriers to accessing support. The purpose of the CSSR-S is to identify current and overall lifetime suicide risk, including severity of suicidal ideation, self-harm and suicidal behaviours. Early life adversity was accounted for using the Life Event’s Checklist, which is designed to screen for traumatic events (i.e., death of a loved one, car accident, etc.).
In addition to the online survey, 12 semi-structured interviews (FASD n=6; autistic n=6) were also conducted with caregivers of youth who have experienced suicidality to generate insight into experiences within the healthcare system, ability to access services and receive support, and barriers to seeking help.
Results
On the CSSR-S, group differences determined that autistic youth had increased suicidal ideation when compared to youth with FASD. Within each of the neurodivergent groups, females with FASD had increased overall suicidality compared to males. Additionally, across both sexes, as age increased, so did suicidal intensity. No sex or age differences were seen in autistic youth.
Co-occurring mental health conditions were associated with increased suicidality across neurodiverse groups, and suicidality was associated with the total number of adverse early life events in only the FASD youth. Services or barriers were not associated with measures of suicidality in either diagnostic group. Both groups of caregivers reported difficulties accessing services to address their child’s suicidality, and that healthcare providers lacked the training to work with neurodiverse youth.
Discussion
This was the first study to contrast suicidality, service utilization, and barriers to seeking help in autistic youth and youth with FASD from a caregiver’s perspective. Prior studies generally compare neurodiverse groups to their neurotypical peers, and as such assume that neurodiverse groups face similar challenges related to suicidality. Overall, caregivers of neurodiverse youth are facing a lack of available services and support for helping their children and a healthcare system that is not equipped to work with neurodivergent individuals experiencing suicidality. This study sheds light on the needs and challenges of different neurodiverse groups and the necessity for tailored support and services. By highlighting caregivers perspectives, the study underscores the importance of involving caregivers in support systems and services. These points can help in advocating for more inclusive and effective mental health support systems for neurodiverse populations.
Mercedes Bagshawe is PhD student in the School and Applied Psychology Program. She completed her BA in Psychology with a minor in Biological Sciences at the University of Calgary. Mercedes took time off before pursuing Graduate studies working in private practice and as a supervisor at the Calgary Distress Centre. Prior to starting her MSc, she was working as a Research Coordinator for Dr. Catherine Lebel in the Developmental Neuroimaging Lab focused on brain development and pre-postnatal risks in children and youth. Mercedes’ research interests lie in exploring the associations between pre-postnatal risk, mental health and Fetal Alcohol Spectrum Disorder. She is also passionate when it comes to supporting those with suicidal ideation/behaviours and continues to work at the distress centre helping individuals in crisis. In her free time, she enjoys skiing, camping, climbing, and spending time with friends.