Autism, Attention-Deficit Hyperactivity Disorder and Substance Abuse: A Dangerous Combination

Author: Dr Emma Saliba

Aims and Hypothesis: To identify and distinguish between modifiable and non-modifiable risk factors for suicide. To assess a case thoroughly including full history and mental state examination for a better risk assessment. To Appreciate the impact of other co-morbid psychiatric conditions on suicide risk. To discuss management of a case and the application of the biopsychosocial approach. To address the importance of de-escalation techniques in acute high risk cases.

Background: Suicides among young people continue to be a serious problem. They remain the second leading cause of death amongst adolescents, following motor vehicle accidents.  According to the World Health Organisation, more than 1.2 million adolescents die every year and most of these cases are preventable. The majority of adolescents who attempt suicide have a significant mental health disorder, typically depression. 

Methods: The SAD Persons Suicide Assessment, Tool for Assessment of Suicide Risk (TASR) and Kutcher Adolescent Depression Scale (KADS) were applied to the case.  A complex case with multiple challenges was selected to highlight the numerous risk factors and discuss both short term and long term management.

Results: SAD PERSONS Score: 8;   TASR: High;   KADS: 9

Conclusions: Patient safety is a must. The patient scored as high risk of depression and suicide. The risk factors for suicide associated with individual neurodevelopmental disorders (autism and ADHD) and substance abuse and their complex interplay play an important role. Thorough history taking, mental state examination and a detailed formulation are invaluable for applying evidence based management. Biopsychosocial management for patient-centred care in the context of the multi-disciplinary team is necessary.