Do accidents play a role here? Everyone's always talking about suicide and the possibility of that being more common among those on the autistic spectrum, but...
As someone on said spectrum, I'd say I might be more accident prone than someone who's normal, and potentially more likely to get into trouble in general. For example, while I wasn't seriously injuried by any of it, I've been nearly hit by traffic, fallen off various things, actually been hit by traffic and done quite a few things which would probably be seen as rather 'stupid' (in an 'endangers your health' sense).
Perhaps it's possible that due to various behavioural factors, those on the spectrum might be prone to getting into dangerous situations and paying the price for them more than 'normal' people. Being generally clumsy seems to be a common trait here.
There's also a potential darker side here, in that being on the spectrum might make some more likely to end up in a violent confrontation than someone who isn't. There were quite a few news stories in the past where people with these traits have been assaulted or even killed because they did something that somehow annoyed some random scumbag. Maybe people outside of the autistic spectrum might be more likely to see a situation is trouble and stay out of it.
Those things plus the risk of suicide could all explain this difference in mortality.
The original paper (paywall-free link: http://sci-hub.io/10.1192/bjp.bp.114.160192 ) itemises the frequencies of causes of death by control population and autism spectrum disorder population.
It suggests that autistic people are an order of magnitude more likely to commit suicide. But the figures also suggest that autistic people were more at risk from all causes of death, including common causes of death amongst the general populations (approx twice as likely to die of cancer; are autistic people more at risk of not getting the best available treatments in time or more prone to [uncontrolled] unhealthy behaviours?)
Some caution is needed in interpreting the figures, which appears to escape the notice of a Washington Post subeditor who didn't even get the figure in the headline right (the difference between a sample life expectancy of 70.20 years and 53.87 years is not 18... )
It's worth noting that sometimes autism is likely to have been a symptom of the causes of death recorded (for example, people diagnosed as being on the autism spectrum were more than eight times likely to have "congenital malformation" as a course of death, which is a cause of death which by definition doesn't have a behavioural component).
Another factor is the survey sample is unavoidably biased because the individuals were separated into autistic and non-autistic groups based on whether they had been in contact with clinical psychiatrists over their autism, something plausibly much more likely if they're suffering from unrelated health problems; the short average period between diagnosis of autism and death stands out here.
It sounds like the ascertainment bias there will be improved as time passes:
> Weaknesses of the present study include exclusive reliance on the National Patient Register for case ascertainment, leading to a selected and perhaps severely affected sample by only including individuals with ASD who had been in contact with clinical psychiatry services. This selection bias may be particularly relevant for individuals diagnosed before the year 2001 (i.e. before contact with out-patient psychiatric care services was included in the National Patient Register). However, after the year 2001 (88.2% in current data) all individuals having received an ASD diagnosis are registered in the National Patient Register because of the diagnostic assessment per se, i.e. also in cases with no further contact with psychiatric services.
Another way around this would be genotyping: use an autism polygenic score to quantify genetic liability. If the increased mortality is observed even with elevated polygenic scores which are insufficient to lead to diagnosable symptoms, that would suggest the cause is greater general genetic risk to disease rather than sequelae to symptoms.
I wonder how the mortality for people diagnosed with ASD compares with the mortality for people diagnosed with anything by a psychiatrist. It seems likely that by the time people see psychiatrists they're already on average less healthy than the general population.
I also think we are less scared of death. For example, I didn't feel anything more than anxiety and a little fear when we were robed, but my friends felt like it was the end of the world. When this situation ended, I automatically recovered all my senses, but the others needed some time to recover.
This also happens with other things. I think my ego is too big, and if someone dares me to do something, I might do it, even if it risks my life.
I talked with several other autists about this, and we all can't feel a fear of death as neurotypical seem to feel.
That's interesting to me because I've often wondered if I fall on the autistic spectrum (very high functioning though), and I've had suicidal ideation in the past. Nothing I'd ever act on, of course.
I bet the primary cause of autistic people feeling suicidal is a lack of social awareness and how to act around others. They probably incur large social costs by not seeing social cues, saying the wrong things, and opportunity costs like feeling too anxious or inadequate to even be social.
I think what helped me the most is focusing on being more empathetic, using the golden rule, and thinking from other people's perspectives. It improved my relationships with people drastically and now I'm generally happier. I usually feel like my empathy isn't genuine and too intellectual, if that makes sense, but the change in my focus has helped a ton.
Even if I'm not on the autistic spectrum, trying to be more socially aware and provide value to others has been very worthwhile.
Fear of death is arguably either an emotion, or has a high emotional component and since autistic people do not process emotion well, they may well be far more inclined to see suicide as an option. (disclaimer: pure layman speculation)
Public perception and available resources have changed dramatically over the last 25 years. As recently as the mid-80s, nobody even knew about autism. Not even doctors. Depending upon where you lived, you might have to visit a dozen different specialists before you could find someone familiar with autism and get that diagnosis. Once you had the diagnosis, all the normal people you'd encounter in life would regard it as some made-up condition ("Hey, I'm artistic too, lol."). It was difficult to explain, which made it difficult to get special services at school, etc. Early childhood intervention was not widely available the way it is today.
The people who are now dying early and contributing to these statistics got little of the help and awareness that benefits newer generations of those on the spectrum. I have hope that these numbers will improve over time as autism becomes more widely understood.
Nobody knew about autism, so instead you were mislabeled as mentally challenged or mentally ill.
Treatment was a lot less humane too for those affected by mental illnesses. Things like lobotomy and electroconvulsive therapy were accepted as routine, safe, and effective treatments for those patients afflicted with what you would now call autism in modern medicine.
I thought that everybody was on the "spectrum". So what does it mean to say the average lives 18 fewer years? Isn't that like saying that people on the skin color spectrum live 18 fewer years?
The autism spectrum is a continuum of mild to severe impairment in the domains of social communication and restrictive repetitive behaviors and interests. It is not coextensive with the range of possible cognitive dispositions. The introduction of autism spectrum disorder in the DSM-V was meant to collapse hard-and-fast distinctions between what were previously classified as four distinct disorders (autistic disorder, Asperger's disorder, childhood disintegrative disorder, and pervasive developmental disorder). It does not recast autism as just another shade of normal.
Curious the depth to which they compared reduced cognitive function in general and how much that correlated with other low functioning conditions. Autism often brings the image of a quirky or simply socially awkward individual to mind, but the reality is some are sufficiently developmentally delayed that they lack the ability to care for themselves at all. (Its a very wide spectrum). Which is only to say I wonder if the statistic is autism specific or generalizable to any low functioning individual.
I don't think the autism diagnosis has been broadened for long enough to actually have meaningful lifetime statistics.
Is the data for this study public? I wouldn't be surprised if the their claim is simply based on the fact that only severe impairment would have been classified as "autism".
I get frequent suicidal ideations. It's always like when I'm overhwlemed and upset, it just goes from angry --> sad --> suicide --> planning but I never go through with it. It's impossible for me to do it. So I just take it as my way of coping...with self destructive fantasies.
I think studying Eastern philosophy, buddhism and taoism will help people on spectrum gain a much more rational and scientific view on reality.
Anyways, sure is a struggle, especially with people, relationships, intimacy, everything is that much more difficult but you know I just think like people have different skills, people on autistic spectrum are off the scale in one area but equally unable in many other areas that normal people will have no issues with.
So, I'm autistic. Anyone who follows me on HN or Reddit has seen me speak about what it's like to grow up autistic in a part of America that didn't officially recognize Autism (let alone variants like Aspergers) until it was too late to help me.
I sometimes do suicidal ideations, but then the part of me that is usually being like "hey, you can't have fun and enjoy yourself, because ten years ago someone you didn't know very well said bad shit about you" (ahh, depression, my old friend), is like "you committing suicide isn't the answer... them committing is a more acceptable answer."
And, well, that part of me is right. If you're that big of a pile of shit to attack people based on their disabilities, well, society doesn't really need you, and you're representative of the cancer that is killing society.
And, for a while, I'm okay again. The depression goes away, and I start functioning half way decent again.
I will say, though, 200mg of Theanine twice daily with a strong cup of coffee (and only one, let's not get into caffeine obsession), one an ~hour after I wake up, one about 6-8 hours later, powers me through the day and shuts that part of me up.
As someone on said spectrum, I'd say I might be more accident prone than someone who's normal, and potentially more likely to get into trouble in general. For example, while I wasn't seriously injuried by any of it, I've been nearly hit by traffic, fallen off various things, actually been hit by traffic and done quite a few things which would probably be seen as rather 'stupid' (in an 'endangers your health' sense).
Perhaps it's possible that due to various behavioural factors, those on the spectrum might be prone to getting into dangerous situations and paying the price for them more than 'normal' people. Being generally clumsy seems to be a common trait here.
There's also a potential darker side here, in that being on the spectrum might make some more likely to end up in a violent confrontation than someone who isn't. There were quite a few news stories in the past where people with these traits have been assaulted or even killed because they did something that somehow annoyed some random scumbag. Maybe people outside of the autistic spectrum might be more likely to see a situation is trouble and stay out of it.
Those things plus the risk of suicide could all explain this difference in mortality.