Recognizing Risk, Responding with Care: The Development of a Crisis Response Program for Suicidal and Homicidal Ideation in Children with Autism

Children with autism experience a higher risk of suicidal and homicidal ideation compared to their peers, but accurate assessment relies on the child’s ability to verbalize their thoughts and respond to questions. Research indicates that clinician assessments may miss suicidal ideation, compared to self-report, even in verbal children assessed by trained professionals. This gap is likely even greater for minimally verbal children in intervention settings where providers lack risk assessment training. As a result, a program to refer, assess, and make recommendations for children with autism enrolled in an ABA intervention was created and evaluated. The Crisis Response program was established at a multi-center therapy organization. Training on identifying and responding to suicidal and homicidal ideation was offered to all providers. A baseline and post-training survey was conducted. Referrals and the resulting recommendations were reviewed. Thirty-eight referrals were submitted to the Crisis Response team through August, 2025. Referrals were assessed by a psychologist using all available records and discussion of referring incident. Risk was categorized using the Columbia Suicide Severity Rating Scale. Qualitative review of referring incidents indicated unique themes such as atypical violent play, unprompted aggression, limited verbal response, and imitated behavior. Post-training survey indicated increased confidence in identifying and appropriately responding to suicidal and homicidal ideation. The Crisis Response team successfully identified children who needed or would benefit from additional psychological support. However, existing assessments and models do not account for the unique assessment components that are present within this population, which limits early identification and intervention. The Development of a Crisis Response Program for Suicidal and Homicidal Ideation in Children with Autism.