Linguistic and Cultural Adaptation of the Suicide Behaviors Questionnaire—Autism Spectrum Conditions: A Suicide Risk Assessment Tool for Autistic Adults in Spanish

Abstract

Background:

Autistic individuals face significantly elevated risk for suicidality, yet existing suicide risk assessment tools often lack cultural and linguistic validity—particularly in low- and middle-income countries (LMICs) and where English is not the primary language. The Suicide Behaviors Questionnaire—Autism Spectrum Conditions (SBQ-ASC) is a validated instrument developed in English for autistic adults without intellectual disability. However, the lack of availability of this instrument in other languages limits its clinical and research applicability worldwide. This study reports the foundational phase of a translational research program: the linguistic and cultural adaptation of the SBQ-ASC into Spanish, intended for eventual psychometric validation studies across Latin America.

Methods:

Adaptation followed the International Test Commission Guidelines and the Ecological Validity Framework, using a seven-country participatory process involving autistic adults, clinicians, and bilingual researchers, with integrated expert judgment on sufficiency, clarity, coherence, and relevance.

Results:

The final Spanish version demonstrates conceptual, functional, and linguistic equivalence, and the original developer of SBQ-ASC approved it for research use. Clinicians can integrate it into primary care, community clinics, and telehealth platforms in under-resourced settings. This tool addresses a critical equity gap in mental health screening for autistic adults in LMICs and supports early identification of suicide risk in a population often overlooked in prevention efforts.

Conclusion:

This tool provides a necessary foundation for ongoing validation studies and supports translational efforts to improve early identification and eventually suicide prevention among autistic adults in Spanish-speaking populations. It addresses a critical equity gap in mental health screening tools and advances global autism research infrastructure.

Community Brief

Why is this an important issue?

Autistic people face a much higher risk of thinking about or attempting suicide compared with non-autistic people. Tools designed to spot this risk often do not work well for autistic individuals because they use confusing or emotional language that can be hard to understand. This issue is even bigger in Spanish-speaking countries, where no tools have been specially adapted for autistic adults.

What was the purpose of this study?

This study aimed to translate and adapt an English questionnaire called the SBQ-ASC—designed specifically for autistic adults without intellectual disability—into Spanish. The goal was to create a version that is easy to understand, respectful of autistic ways of thinking, and that fits the cultural contexts of Latin America and other Spanish-speaking regions.

What did the researchers do?

The team used international guidelines to adapt the questionnaire step by step. They collaborated with autistic adults, clinicians, and researchers from six countries: Argentina, Chile, Dominican Republic, Mexico, Spain, and Uruguay. The process involved translating into Spanish, checking for cultural fit, including expert evaluations of clarity and relevance, gathering feedback from autistic people in each country, making improvements, translating back to English for accuracy, and getting final approval from the tool’s original creator.

What were the results and conclusions of the study?

The original developer approved the final Spanish version of the SBQ-ASC for use in research studies. However, researchers still need to test it in other settings, like clinics or online surveys, to confirm that it accurately identifies suicide risk among Spanish-speaking autistic adults. It includes clearer, more neutral wording, cultural examples, and ways autistic people in these regions express distress.

What is new or controversial about these findings?

This is the first suicide risk tool for autistic adults adapted into Spanish through a collaborative process involving people from multiple countries. The adaptation process highlights how autistic people may understand questions differently and why cultural differences matter in mental health tools. The findings emphasize the need to include autistic voices in creating these tools to make them more accurate and respectful.

What are potential weaknesses in the study?

Some limitations include the fact that the study focused only on translation and adaptation. It did not test how well the Spanish version works in practice. In addition, we chose the autistic adults who gave feedback because they were easy to reach through our networks, which might mean the group did not include a wide enough range of backgrounds or experiences. This phase did not include formal testing to check if the tool gives consistent answers over time or truly measures what it is supposed to (like suicide risk). The study also focused on self-identified autistic adults without intellectual disability, so it may not apply well to all autistic people, such as those with intellectual disabilities or from less represented groups.

How will these findings help autistic adults now or in the future?

This adapted tool can help doctors, therapists, and community workers better identify suicide risk in autistic adults who speak Spanish. Doctors, therapists, and community workers can use it in clinics, hospitals, and even through telehealth. With more testing, it may support earlier intervention and better mental health care for autistic people in Latin America and other Spanish-speaking regions in the future.