Advancing Research on Suicide and Mental Health in Autistic Adults Through a Research Domain Criteria-Inspired Framework

Abstract

Given the dearth of research on adulthood in autism prior to the last decade, we need methods to accelerate progress. One area of interest is mental health, but studies focusing on isolated methods or limited sets of constructs are unlikely to rapidly identify the many contributors to autistic adult mental health outcomes. We argue that adopting a multimethod, dimensional approach will more rapidly speed progress. One framework designed to encourage this approach is the National Institute of Mental Health’s Research Diagnostic Criteria (RDoC) initiative. In this article, we describe the utility of the RDoC and considerations for the design of an RDoC-inspired autism study. We demonstrate this via an example focused on suicide because suicide is one serious and well-documented sequelae of poor mental health. This article begins with a brief overview of the significance of suicide to autism. Then, the article outlines key aspects of the RDoC, including consideration of the following: dimensional processes, development, different units of analysis (methods), content domains, and environmental influences. We describe the University of Pittsburgh Autism Center of Excellence as project context; it adds an example of how RDoC can work and concepts to consider when designing an RDoC-inspired autism study. Specific methods and constructs are highlighted that may lead to improved understanding of suicide and mental health in autistic adults, and ultimately to more tailored interventions and supports.

Community Brief

Why is this topic important?

Mental health, and suicide in particular, are high priorities for adult autism research. A slow pace of research is unacceptable for topics such as suicide, given the high rates of suicide deaths in autism. Current research focuses on a small set of variables, which is unlikely to adequately improve our understanding of adult mental health. To speed up our progress, we need new methods and a comprehensive approach to mental health research. We detail new ways to speed up research progress in autistic mental health.

What is the purpose of this article?

In this article, we argue that the National Institute of Mental Health’s Research Diagnostic Criteria (RDoC) initiative may provide an example for designing research studies that can lead to faster progress. We describe the University of Pittsburgh Autism Center of Excellence (Pitt ACE) as an example of how RDoC can work and concepts to consider when designing an RDoC-inspired autism study. Although the Pitt ACE focuses on many aspects of mental health, we describe its suicide emphasis for illustrative purposes and because suicide is one serious well-documented outcome of poor mental health.

What does this article tell us?

This article begins with a brief overview of why suicide research is so relevant to autism and currently used methods. Then, we describe the RDoC approach partnering with the community. We include a discussion of ensuring fit of RDoC to autism via a research approach that integrates input from autistic adults. RDoC emphasizes the value of: (1) studying dimensional processes instead of focusing on categories, (2) using multiple methods ranging from biological through self-report, (3) considering content domains that span negative and positive emotions and responses to negative and positive events, cognitive and social processes, sensory and regulatory processes, and development, and 4) environmental influences. Each aspect of RDoC is considered with examples of how each is applied in the Pitt ACE and why they may be beneficial. We also include promising methods and understudied topics to consider related to suicide. An example from a single participant’s data and experiences illustrates the value of integrating information from multiple methods and concepts. A supplement with the complete Pitt ACE methods includes information on safety protocols, strategies to promote a positive participant experience, and measures that may be useful for others planning studies on autistic adult mental health.

How will this help autistic adults now and in the future?

Autistic adults cannot afford for the pace of research to be slow, especially on topics such as suicide. This article shows how researchers can design studies that will yield more information more quickly. Including a broad range of methods and concepts can identify new areas for prevention and intervention related to suicide. This article also highlights several topics that have received limited attention in adult mental health research. The hope is that the Pitt ACE results, as well as other research inspired by these methods, may provide new avenues for mental health treatment and support for autistic people.