Rethinking Suicide Through a Neurodivergent Lens

Person alone holding face in hands in a dark setting.

Source: Daniel R (Mindworld!) / Pixabay

The recent heartbreaking news of two brothers lost to suicide in Adelaide, South Australia, is every family’s worst nightmare. As a psychologist who has spent over two decades working with individuals whose lives have been shaped by addiction, trauma, profound psychological distress, and suicidality, tragedies like this force me to reflect on how clinical protocols often miss critical risk factors long before an acute crisis occurs. Despite national initiatives in both Australia and the U.S., suicide rates remain alarmingly high. What are we missing? To improve outcomes, we must ask more nuanced questions that illuminate the broader context of a crisis, allowing clinicians to identify tailored, effective supports.

The Overlooked Intersection of Autism and Suicidality

One critical, frequently overlooked risk factor in individuals presenting with substance use disorders, self-harm, and suicidal ideation is neurodivergence, particularly autism. This is not speculation regarding the two brothers; none of us can know the exact source of the internal pain described in reports as "overwhelming sensory noise." Rather, their deaths should prompt a broader professional conversation about how to make systems of care more responsive to individual neurodivergent experiences.

In a world built for neurotypical individuals, the pressure to conform is relentless. For an autistic person, navigating social spaces requires immense cognitive effort: interpreting non-verbal cues, forcing eye contact, tolerating sensory overload, and suppressing self-soothing behaviors (stimming).

The empirical evidence linking autism to substance use and suicidality is hard to ignore:

• A systematic review of population-based studies indicates that autistic individuals face an estimated eight-fold greater risk of death by suicide compared to non-autistic peers.
• Meta-analyses estimate that approximately one in three autistic individuals experience suicidal ideation, and up to 25% attempt suicide.

The Diagnostic Shadow: Misidentification in Clinical Practice

In clinical practice, I have worked with many adults who were only identified as autistic in their forties or fifties. They had cycled through decades of psychotherapy, psychiatric admissions, and addiction treatment before anyone asked the questions that helped them understand why they experienced the world so intensely.

I have encountered countless individuals diagnosed with major depressive disorder, conduct disorder, bipolar disorder, obsessive-compulsive disorder, or borderline personality disorder whose clinical presentations were better explained by underlying autism.

For many undiagnosed autistic people, their psychiatric symptoms reflect a lifelong struggle to navigate a neurodivergent mind without sufficient insight and support.

Furthermore, autistic individuals without intellectual impairment or extreme functional impairment, often referred to as "level one", "high functioning", or "mildly autistic") are substantially more likely than the general population to develop substance use disorders. Alcohol and illicit substances frequently serve as chemical masking tools and coping mechanisms to dull sensory overload and social anxiety. When these substances wear off, the underlying sensory overload and social exhaustion return, compounded by the physiological toll of withdrawal. This cycle fuels autistic burnout, a state of profound physical, mental, and emotional exhaustion that is often misdiagnosed as treatment-resistant depression. Despite this, screening for autism is rarely included in standard protocols for crisis support or substance use disorders.

The Limitations of Standardized Protocols

When individuals seek mental health support, clinicians are trained to follow standardized assessment and treatment protocols. However, these methods can inadvertently exacerbate an undiagnosed autistic person’s distress. Evaluation interviews and group therapy in highly stimulating environments, cognitive behavioral strategies that demand increased self-monitoring, and intense focus on self-care strategies can compound the very social anxiety and cognitive exhaustion the patient is trying to escape. We end up treating downstream symptoms while overlooking the upstream neurodivergent vulnerability.

We must listen better, but we also need to question better.

While evidence-based practices are essential, clinical protocols must evolve to integrate new evidence on neurodivergence. In addition to standard lethality assessments, clinicians can dig deeper with more nuanced questions to explore hidden risk factors:

Autism Essential Reads

What Happens When You Stop Fighting Yourself

Autism and Vaccines: Questions Science Hasn’t Settled

• “What are you seeking relief from?”
• “Does the world frequently feel too loud, bright, or physically overwhelming to you?”
• “Does it feel as though the world was not built for the way your mind works?”
• "Who in your life really understands you?"
• “How can we help you feel more comfortable in the world?"

Shifting the Clinical Paradigm

National suicide prevention strategies rightly focus on high-risk populations, including veterans, LGBTQIA+ communities, and indigenous peoples. However, autism is too often categorized as a co-occurring developmental condition rather than recognized as an independent and robust risk factor for suicide. That distinction matters. If we do not routinely screen for autism in adults presenting with addiction, self-harm, treatment-resistant mental illness, or suicidality, we miss critical opportunities for life-saving intervention.

Integrating a neurodivergent-affirming lens shifts the clinical question away from, "Why is this person failing to cope?" to, "What has this person been coping with, unsupported, for their entire life?" This paradigm shift can transform care. It prompts clinicians to address sensory accommodation, mitigate chronic burnout, and help people develop safe, neurodivergent-affirming coping strategies.

If we are serious about preventing suicide and overdose deaths, autism screening must be integrated into routine psychiatric and addiction assessments. Our mental health workforce needs targeted training to recognize adult autistic presentations, and clinical research must treat autism as a primary risk factor. By looking beyond diagnoses to understand nuanced individual experiences and risk factors, we can identify new pathways to intervention. The answer begins with asking better questions, not only about how someone died, but about how they lived.

Copyright (C) 2026, Kelly E Green, PhD, and Inclusive Restorative Wellness Pty Ltd