Differences in Reporting Suicidality Among Autistic Girls: Comparing Parent-, Child Self-, and Clinician-Rated Child Self-Reports Between Distinct Measures

PURPOSE: Suicidality in autistic girls is an emerging albeit understudied concern, driven by elevated internalizing symptoms, socio-emotional challenges, and limited autism-sensitive assessments. This study examined diagnostic (autistic vs. non-autistic), informant (parent-, written child self-, clinician-rated child self-report), and measure (written self-report (CDI-2) vs. verbal interview (C-SSRS and K-SADS)) differences in suicidality. It was hypothesized that (1) suicidality would be reported more in autistic than non-autistic girls, and (2) written child self-report would yield the highest suicidality endorsement rate, followed by parent- and clinician-rated child self-report. METHODS: Participants consisted of 213 autistic (N = 112) and non-autistic (N = 101) girls aged 6-13. Suicidality was assessed using the Kiddie Schedule for Affective Disorders and Schizophrenia (K-SADS; parent-report), the Children's Depression Inventory, Second Edition (CDI-2; written child self-report), and the Columbia Suicide Severity Rating Scale (C-SSRS; clinician-rated child self-report). RESULTS: Across informants/measures, autistic girls had three times greater odds of endorsing suicidality than non-autistic peers (OR = 3.05, 95% CI [1.64, 5.67], p < 0.001). Written child self-report yielded the highest endorsement, while parent- (OR = 0.51, 95% CI [0.32, 0.82], p = 0.006) and clinician-rated child self-report (OR = 0.39, 95% CI [0.24, 0.64], p < 0.001) were less likely to capture suicidality. CONCLUSIONS: Findings highlight the role of child self-report in detecting suicidality among autistic girls and suggest that multi-informant, autism-informed approaches utilizing both written and verbal response methods can reduce underestimated risk and facilitate timely intervention.