Case Report: Suicidality response to treatment for attention deficit hyperactivity disorder in adult females with autism spectrum disorder: three cases

Background: Suicidality, suicide attempts and non-suicidal self-injury occur more frequently in untreated attention deficit hyperactivity disorder (ADHD), and in females with autism spectrum disorder (ASD), especially in late adolescence and young adulthood. Diagnosis and treatment of the comorbid ADHD may rapidly improve coping skills, reducing impulsivity and suicidality. Methods: We obtained IRB approval and written consent to publish the de-identified cases of three young adult females with recurrent suicidality and serious mental illness. Each met DSM-based diagnostic criteria for ASD and ADHD, but received no ADHD treatments on presentation. Presentations, treatment, side effects and precautions are discussed. Results: Each responded remarkably to ADHD treatments, but with notable side effects especially in one case. Addition of ADHD medications led to rapid improvements in mood, suicidality and self-reported use of coping skills, enabling taper of antidepressants and antipsychotics. Conclusions: ADHD diagnosis and treatment may rapidly improve treatment-resistant suicidality and mood, by improving executive functions, impulse control and use of coping skills; larger-scale studies are indicated to elaborate on our findings in these three cases. ASD and comorbid ADHD are important predisposing factors to suicidality that are commonly missed. ADHD treatment may provide remarkable response, described by patients as enabling greater functioning, confidence and use of coping skills when under stress. Suicidality assessment should include screenings for ADHD and ASD, especially in atypical cases. Prior maltreatment, executive dysfunction and impulsivity in females all raise suicide risks.