As diverse as the experiences of children and teens on the autism spectrum are, one sobering fact holds true: Autistic youth are more likely to think about and die from suicide, and at earlier ages, than their neurotypical peers.

The Times spent months interviewing autistic self-advocates, families, physicians and researchers to understand the factors behind this crisis and the changes that could better support youth and their families.

Solutions are still in their infancy, but autism researchers and advocates are working to develop screening tools, safety plans and therapies based on the unique strengths and differences of an autistic brain.

A crucial first step is educating parents, pediatricians and other community professionals on the particular risks and challenges facing autistic youth, and why taking neurodiversity into account could help reduce the number of young lives lost too soon.

Here are some key findings:

Autistic youth are more likely to struggle with suicidal thoughts and mental health conditions than non-autistic kids.

Suicide is a leading cause of death in the U.S. for kids between the ages of 10 and 18. For autistic teens and children, the risk is higher. One 2023 meta-analysis found that some 10% of autistic children and teens had attempted suicide, a rate more than twice that of their non-autistic peers.

About 20% of U.S. high schoolers disclosed suicidal thoughts in 2023, according to the Centers for Disease Control and Prevention. When the Kennedy Krieger Institute in Baltimore asked caregivers of 900 autistic children between 8 and 17 if the children had thought about ending their lives, 35% said yes. Nearly 1 in 5 said their child had made a plan.

Children across the autism spectrum are far more likely to also be diagnosed with mental health conditions than their allistic, or non-autistic, peers.

A 2021 study of more than 42,000 caregivers of children between ages 3 and 17 found that 78% of autistic children had at least one co-occurring psychiatric condition, compared to 14% of non-autistic kids. Contributing factors include the stress of living in a world that’s sensorially overwhelming or socially impenetrable.

Autistic children without intellectual disabilities may be at greater risk.

The diagnostic definition of autism has evolved over the years and now includes children who cope by “masking”: consciously or unconsciously suppressing autistic traits in order to fit in at school or in social environments. For children with a propensity for masking, autism is often diagnosed much later in childhood or even adulthood.

Many children who mask are able to participate in mainstream classes or activities. But constantly deciphering and mimicking social responses is cognitively and emotionally exhausting. Masking is strongly correlated with depression, anxiety and suicide.

“Masking is actually a risk factor of suicide for autistic people, and it has a negative effect on one’s mental health,” said Lisa Morgan, founder of the Autism and Suicide Prevention Workgroup, who is autistic herself.

Research has found that autistic people with a higher IQ are both more likely to mask and more likely to suffer from anxiety and other mental health conditions.

In one 2023 study from the University of Iowa, autistic kids with an IQ of 120 or higher were nearly six times more likely to have suicidal thoughts than autistic children with an average IQ. For non-autistic children, the opposite was true: Higher cognitive ability was associated with a decreased risk of suicide.

Crisis warning signs often look different in autistic kids, and mental health interventions designed for neurotypical youth may not be as effective for them.

Most mental health interventions start with a provider verbally asking a deceptively simple question: What are you feeling?

But up to 80% of autistic kids have alexithymia, or difficulty identifying and describing one’s own internal emotional state. For this reason, “it makes sense that all of the interventions that have been designed for a neurotypical youth probably aren’t going to translate in the same way to autistic youth,” said Jessica Schwartzman, director of the Training and Research to Empower NeuroDiversity Lab at Children’s Hospital Los Angeles and assistant professor of pediatrics at USC’s Keck School of Medicine.

A neurodiverse workgroup of researchers has identified crisis warning signs specific to autistic people, including a noticeable decline in verbal communication abilities.

“Oftentimes it’s thought that somebody might be really agitated or show a lot of emotional distress when they are talking about wanting to die,” said Danielle Roubinov, an associate professor and director of the Child and Adolescent Anxiety and Mood Disorders Program at University of North Carolina at Chapel Hill. “An autistic individual might not do that. They might say it in a really matter-of-fact way, or they might have a really hard time articulating it.”

Asking about suicide could save a life.

There is a common misconception that asking about suicide could plant the idea in a child’s head and lead to further harm. If anything, researchers said, it’s protective.

Ask clearly, directly and in whatever format a child is most comfortable with, Schwartzman said. Some autistic children may prefer a text or written letter, for example, rather than a direct verbal conversation.

Researchers are looking for low-cost ways to tailor existing therapies to better serve autistic kids, and to educate the medical community on the need to use them.

Experts are currently working on modifications to the standard screening tool that providers use to identify suicidality, as well as the Stanley-Brown safety plan, where patients list coping strategies and contacts on a one-page sheet that can be easily accessed in a crisis. Studies on the effectiveness of versions tailored for autistic people are underway.

Changes to the way providers interact with autistic children can also make a difference. Sensory overwhelm can be destabilizing, and an autistic child may first need a quiet place with dim lighting to calm themselves, and extra time to process and form answers to questions.

The most effective way to reduce depression, anxiety and the mental harm of masking is to ensure that autistic kids have the support they need, advocates and clinicians say, and don’t feel like they have to change everything about themselves in order to fit in.

“Suicide prevention for autistic people is being accepted for who they are, being able to be who they are without masking,” Morgan said.

If you or someone you know is experiencing thoughts of suicide, help is available. Call 988 to connect to trained mental health counselors or text “HOME” to 741741 in the U.S. and Canada to reach the Crisis Text Line.

This article was reported with the support of the USC Annenberg Center for Health Journalism’s National Fellowship’s Kristy Hammam Fund for Health Journalism.

The first person infected with the H5N5 bird flu has died, according to health officials in Washington.

The person, who lived in Grays Harbor County, had been hospitalized earlier this month in Kings County, where Seattle is located.

Officials from the Washington State Department of Health did not release the person’s name, age or gender. According to a news release from Grays Harbor County health officials last week, the person was considered “older” and had underlying health conditions. Their symptoms included a high fever, confusion and trouble breathing.

The person had a backyard flock consisting of mixed domestic poultry.

Testing by the health department found virus in the “environment of the flock … making exposure to the domestic poultry, their environment, or wild birds the most likely source of exposure for this patient.”

Officials at the state’s health department said they were monitoring other people who were exposed to the flock and environment.

This particular strain of bird flu, H5N5, had never been seen in a person before. It appeared first in 2023, infecting birds and mammals in eastern Canada.

According to research published last year on the novel strain, some infected animals carried a key mutation in the virus that allows it to transfer more easily between mammals.

Epidemiologists and virologists worry that avian influenza could generate a pandemic if allowed to spread and mutate. For instance, the H5N1 virus circulating in dairy cattle in North America is one mutation away from being able to spread easily between people.

Every time a bird flu virus infects a person, concerns grow that it could change, becoming more transmissible or more deadly. For instance, if a sickened person also has another flu virus replicating in their body, there’s concern the viruses could exchange genetic material. Just by having an opportunity to replicate and evolve millions of times in the human body, it could acquire deadly mutations.

Health officials say the risk to the public remains low and that no other people involved have tested positive for avian influenza. They say there is no evidence of transmission of the virus between people, but they are monitoring anyone who was in close contact with the patient.

The U.S. Centers for Disease Control and Prevention has altered its website on autism and vaccines, removing unequivocal statements that immunizations don’t cause the neurodevelopmental disorder and replacing them with inaccurate and misleading information about the links between the shots and autism.

Until Wednesday, the CDC page, “Autism and Vaccines,” began: “Studies have shown that there is no link between receiving vaccines and developing autism spectrum disorder (ASD).”

This was followed, in large font, by the blunt statement: “Vaccines do not cause autism.”

The rest of the page summarized some of the CDC’s own studies into autism and vaccine ingredients, none of which found any causal links between the two.

On Wednesday, the page was altered so that it now begins: “The claim ‘vaccines do not cause autism’ is not an evidence-based claim because studies have not ruled out the possibility that infant vaccines cause autism.”

The words “Vaccines do not cause autism” still appear near the top, but with an asterisk that leads to a note at the bottom.

“The header ‘Vaccines do not cause autism’ has not been removed due to an agreement with the chair of the U.S. Senate Health, Education, Labor, and Pensions Committee that it would remain on the CDC website,” the site states.

The chair of that committee, Sen. Bill Cassidy (R-La.), cast the deciding vote to advance Robert F. Kennedy Jr.’s appointment as Health and Human Services secretary, in exchange for Kennedy’s promise that he wouldn’t erode public confidence in vaccines.

“What parents need to hear right now is vaccines for measles, polio, hepatitis B and other childhood diseases are safe and effective and will not cause autism. Any statement to the contrary is wrong, irresponsible, and actively makes Americans sicker,” Cassidy said in a post on X on Thursday afternoon. “Families are getting sick and people are dying from vaccine-preventable deaths, and that tragedy needs to stop.” Cassidy’s office did not immediately respond to further requests for comment Thursday.

“Studies supporting a link have been ignored by health authorities,” HHS spokesman Andrew Dixon said in an email. “We are updating the CDC’s website to reflect gold standard, evidence-based science.”

The news was met with outrage and alarm by scientists and advocates.

“Can we trust what’s coming from CDC anymore? I don’t know the answer to that question,” said Dr. Sean O’Leary, chair of the infectious disease committee at the American Academy of Pediatrics, adding that the website change reflects a “tragic moment” for U.S. public health.

“We are appalled to find that the content on the CDC webpage ‘Autism and Vaccines’ has been changed and distorted, and is now filled with anti-vaccine rhetoric and outright lies about vaccines and autism,” the nonprofit Autism Science Foundation said in a statement. “The CDC’s previous science- and evidence-based website has been replaced with misinformation and now actually contradicts the best available science.”

Alison Singer, the organization’s co-founder and president, expressed further frustration.

“Just like we no longer study whether the Earth is flat, at some point with regard to autism and vaccines, you have to call it and say ‘enough is enough,’” Singer said. “We don’t have an unlimited amount of money with which to study autism, and if we keep asking the same questions, we will never find the true causes of autism.”

The current CDC page now says the rise in autism diagnoses correlates with an increase in the number of vaccines given to infants. Multiple researchers have argued that the rise in autism spectrum disorder diagnoses is better explained by an expanding diagnostic definition of the disorder, along with better monitoring and diagnosis for more children.

“This issue has been studied exhaustively, and it has been shown over and over again that vaccines do not cause autism,” said Colin Killick, executive director of the Autistic Self-Advocacy Network. “This administration continues to lie about autism in ways that endanger both our community and the broader population.”