OBJECTIVES: Considering that suicide is one of the most common reasons of 
adolescent death worldwide, there is a lack of clinical awareness on suicidal 
behaviors of children and adolescents with autism spectrum disorder (ASD). The 
present study aims to assess the rate of suicidality (suicidal ideation, 
behaviors and attempts) and associated risk factors for suicidality in high 
functioning ASD.
METHODS: Medical records of 55 adolescents (six girls, 49 boys), aged between 
7-20 years, with diagnosis of ASD were reviewed. The participants were all able 
to speak fluently and had no significant limitations in intellectual 
functioning. Clinical assessment of participants was carried out on the basis of 
Diagnostic and Statistical Manual of Mental Disorders 4th Edition, Text Revision 
criteria and Schedule for Affective Disorders and Schizophrenia for School-Age 
Children-Present and Lifetime Version. Eskin's Suicide Screening Questionnaire 
and sociodemographic data form including detailed history of suicidal behaviors 
were used. The study group was also divided into suicidal and non-suicidal 
groups for the purpose of comparing the results.
RESULTS: The rate of suicidal behaviors was 29% and suicide attempt was 12.7%. 
Types of suicidality were behaviors (43.7%), thoughts (37.5%), and verbal 
declarations (18.7%). A number of bizarre acts were recorded. Rates of comorbid 
psychiatric disorders such as mood disorders, anxiety disorders and disruptive 
behaviors were 23.6%, 43.6% and 65.4% respectively. Groups with the psychotic 
features, positive family history for suicidal behaviors and completed suicide 
showed more suicidality than the non-suicidal group.
CONCLUSION: Consistent with the previous findings, rate of suicidality is higher 
in individuals with ASD. The type of suicidal behaviors showed some differences 
compared to typically developing individuals. The presence of psychotic features 
and positive family history for suicidality may be risk factors for suicidality 
in children and adolescents with ASD. To prevent suicide and implement 
protective health care systems, identifying the population at risk is crucial.