Ep 22: AuDHD Experience – Suicidality & Protective Factors

⚠️ Content note: This episode discusses suicide and suicidal thoughts directly and at length. It is general education, not personal advice. If this feels like a lot, please pause and reach out to a support service (Australian helplines listed at the end).

Episode 22: AuDHD Experience – Suicidality & Protective Factors

In this episode of the AuDHD Psych Podcast, clinical psychologist Aaron Howearth explores why suicidality risk is higher in neurodivergent communities — and why that risk is not inherent to being autistic, ADHD, or AuDHD. Drawing on clinical work, lived experience, and recent research, Aaron is clear that elevated risk is an outcome of the interaction between neurodivergent people and environments that don't accommodate them. The through-line of the whole conversation: we are different, not defective, and it's not your fault.

Aaron unpacks the mechanisms behind heightened risk — constant masking leading to defeat and entrapment, thwarted belonging and a sense of burdensomeness, isolation and minority stress, and unmet support needs. He then turns to crisis care and affirming support, with a direct message to clinicians about flat affect, sensory-hostile environments, and the difference between autism, ADHD, AuDHD and trauma. The episode closes on hope: the protective factors and practical safety-planning scripts that can genuinely reduce risk.

Key Themes & Takeaways

• Risk Is Real, Not Inherent – Suicidality is elevated in neurodivergent communities, but it reflects environmental mismatch and accumulated stress, not a flaw in the person.
• Masking → Defeat → Entrapment – Constant camouflaging is exhausting and, when reinforced over time, can drive feelings of defeat and entrapment.
• Belonging & Burdensomeness – Thwarted belonging and a sense of being "a burden" can heighten risk, especially alongside complex trauma histories.
• Isolation & Minority Stress – Social exclusion, sensory load, and the extra stresses of being a disempowered group compound over time.
• Crisis Care Can Fail Us – Flat affect being misread and sensory-hostile crisis settings can drive disengagement from support.
• Affirming Care Matters – Sensory and communication accommodations, and directly asking about risk, help people feel safe enough to engage.
• Protective Factors – Positive childhood experiences, community and belonging, unmasking, and sensory fit all reduce risk.
• Safety Planning Works – Make a safety plan while you're well, with someone you trust — it's yours, and it can change over time. Includes scripts for clients and clinicians.

If you need support: 

 · Suicide Call Back Service 1300 659 467

 · 13YARN (for Aboriginal & Torres Strait Islander people) 13 92 76.

 · QLife (LGBTIQ+ peer support) 1800 184 527.

 · Lifeline 13 11 14

 · Beyond Blue 1300 22 4636

Transcript

Aaron Howearth (00:00)
Potty, potty, potty, potty, potty, potty, potty, potty, potty, potty, potty, pod, podcast. Potty, potty, potty, potty, potty, potty, potty, potty, potty, potty, potty, pod, podcast. We love an audio stim and self-acceptance. It's the AuDHD Psych Podcast.

Aaron Howearth (00:11)
Hi friends, a quick note before we start today. This episode discusses suicide and suicidal thoughts directly and at length. It's intended as general education, not personal advice. If you're in crisis right now, or if you find this episode starts to feel like a lot, please pause, take a break, and use one of these support services in your area. In Australia, that might be for Indigenous Australians, 13 Yarn.

139276 Lifeline 131114 Suicide Callback Service 1300 659467 Beyond Blue 1300 224636. Have you ever wondered why there's so much higher safety risks and concerns?

And suicidality in neurodivergent communities. It is not inherent to us or our characteristics. It is about our interaction with the environments around us. Hi friends, welcome back to the AuDHD Psych Podcast. I'm Aaron Howearth, Clinical Psychologist, and we are different, not defective. Today we're discussing suicidality and protective factors. So please take a break whenever you need and take care of yourself. And know that it's not your fault.

We'll have a talk today about what the science shows about risk. We'll talk about the mechanisms of why the risk is higher for us for suicidality. We'll talk about difficulties with crisis care and affirming support. And finally we'll touch in on protective factors and some scripts that we might be able to use to help minimize our risk.

you may be wondering what the science shows about risk. And I won't go into particular specific detail, but it shows very clearly that we as neurodivergent people are at much higher risk than other people for suicidality, Suicide death is markedly elevated in neurodivergent communities compared to the general population.

For those interested, Yates in 2024 did a meta analysis, that's worth having a read of. Suicidal ideation and attempt are also elevated. So systematic review across age and gender by O'Halloran in 2023 showed that quite clearly. ADHD independently raises the risk of suicidality. Lay at 2024 did a

large cohort study and it showed that impulsivity is not the whole story. There's more to it than just ⁓ impulsive behavior when I'm feeling not great. Finally, AuDHD has a compounding effect. AuDHD's risk for suicidality is not just the risk for autistic people and the risk for ADHD is

There's also more on top of it. The risk is real. The person is not to blame. We are different, not defective. It's not our fault. Being autistic, being an ADHDer, being an AuDHDer is not inherently linked or the responsibility for suicidality. It's an outcome of the difficulties we experience as neurodivergent people. So you might wonder.

Why is the risk so much higher? Well, there's a few different reasons. one is a mechanism that pretty much goes camouflaging, defeat, entrapment, suicidality. What's happening there is most of us know the word masking, those things that we do to cover up our neurodivergence. When I suppress my impulses, when I work really hard to pay attention to the thing that I don't naturally have a skill at paying attention to.

When I work really hard to express the social expectations that you have of me, even though they're not my natural social way of being, these are the things that we do when we camouflage. Things that we do to assimilate with the dominant culture, things that we do to mask our own characteristics.

Why is that problematic? It's stressful. If I'm spending all day trying really hard to focus and pay attention to your conversation and put the right face on so I don't have resting bitch face or in my case resting rapid face. ⁓ and then on top of that, I'm trying not to talk only about my special interest. That's really, really stressful. The more I live in a world where I have to do that and that's reinforced, the more stress and vulnerability I have, the more defeated I'm likely to become.

Defeat is the idea that I've engaged in something with hopes of winning, but I've lost and there's no chance of me winning. So if I mask constantly trying to fit in and trying to feel safe, but I constantly don't feel safe, I'm likely, well, I'm more exposed to experience defeat. When I feel defeated,

I'm then likely to feel trapped, and this is the notion of entrapment. I've worked my backside off to fit into the expectations of the typical community. And now I just feel defeated with no energy and motivation, and trapped because I'm defeated, I can't win this battle. So I'm trapped in this space where I feel constantly overwhelmed and suppressing my sensory differences and my responses to those, perhaps. So

I'm at much higher risk. There's a great paper by Cassidy, 2023, talks about that mechanism in its itself. Another mechanism is thwarted belonging and burdensomeness. And I see this in some people with ⁓ characteristics consistent with borderline personality disorder. That I often think to myself that there's probably an autistic ADHD or an AuDHDer. Where if I have a complex

Stressor history or complex trauma history of social exclusion and rejection, I don't feel like I fit in with the group that keeps me safe. My desire to belong has been thwarted. And if I feel like I don't belong in a group, I'm really likely to feel that the people around me, the people that I love, the people who love me, I'm a burden on them.

Maybe they're constantly having to look after me, constantly have to help me downregulate the way I'm feeling because I'm responding to my neurodivergent characteristics and my past trauma history. And I think to myself, why should they have to do that? I'm such a burden. So that sense of burdensomeness can also really, really expose a lot of autistic people to greater risk of suicidal ideation.

There's also the isolation, isolation and minority stress. ⁓ Meyer came up with the notion of minority stress for sexual and gender minority groups. And it's the extra stresses that we experience being a minority, being a disempowered group. And it was extended to the autistic population ⁓ relatively recently.

I'm gonna say in 2018 by Botha and Frost, if my notes behind the camera tell me correctly. Extend it to autistic folk, and I would say it's very extendable to most disempowered groups, but certainly in this context, to ADHDers and AuDHDers If I am impulsively loud, that has social repercussions. If I say the thing without editing my response, that has social repercussions.

If I don't pay attention when people want me to pay attention, that comes with social judgments and social exclusion. If I monologue about my favorite topic, thank you all for listening. ⁓ that can have social repercussions if somebody else just wants to say, Hi, I have needs too. But what happens then? Those social repercussions are often exclusion, exclusion from the group that I want to fit into. If I'm excluded.

I'm isolated and we know that isolation across the community broadly can lead to hopelessness and suicidality. Add that isolation to the other minority stresses of being neurodivergent, of having sensory differences that I'm constantly managing when I go into typical environments. Maybe the bright lights are too much for me, but I just have to get on with it.

Maybe the sounds are too much for me, but I still have to go to the shopping centre and buy my groceries. Maybe the number of people there are too much for me, but I still need to go to that class or give that presentation and manage my social anxiety that I've built up over many years of those isolating exclusionary experiences.

So isolation and minority stress on top of potentially wanting to belong and not and feeling like a burden in combination with that constant masking and feeling overwhelmed and hopeless around that increases my risk. And then there's unmet support needs.

So many neurodivergent people have sought support and felt that they haven't received the support that they needed, and that increases my risk to hopelessness, which reduces my opportunity and my likelihood of engaging with services. And so, with all of those mechanisms in mind, our suicidality is understandable. If I'm completely hopeless.

It is likely that I'll look for the best way to manage that feeling. In therapy, when I do my in-take interviews with people, I often have this conversation about suicidality and self-harm. And that is, generally, and I cannot speak for every human, it is an emotional regulation strategy. Every human across the world, when we feel overwhelmed in some way, we reach for the most available strategy to manage that.

For some people it might be going for a run or to the gym. For some people it might be alcohol or substance misuse. But if those things aren't available or realistic to me, then I'm going to reach for, "if I wasn't here, I wouldn't feel this way". And it's understandable. It's also not the only way that we can regulate ourselves. But if we've never been taught other ways, how can we learn?

And that's what we hope to do with this podcast and with building community. So There is no shame in needing support and wanting to feel better, but we can do it in ways that serve us and our goals.

So it's mechanistic. There is a series of things that happen that act together as a system, not deliberately, just the way the world is, that leads to us having a much higher risk of suicidality. It is not inherent to our neurodivergence. It is simply an interaction between us and a system that's not ideal for us. So now I'm going to scroll back up so I can see my notes.

Because I won't edit that out either, because I think perfection is not required. Now, crisis care and affirming support, and this is really important for clinicians out there, I'll ask you to please take note. Crisis care difficulties and affirming support are both causal and also preventative. So, crisis care, if I'm an autistic person and I seek care from somebody.

But I happen to have the characteristic where I have flat effect, and so you don't see the stress playing out across my face as I'm explaining what's going on to me. And you think, ⁓ they're not really that distressed. That is harmful. Many autistic people have actually highlighted that that's been a difficulty and a problem for them in seeking care and support in times of crisis. And it has often yielded

A resistance to engaging with care services again. Crisis pathways, crisis care is obvious often sensory hostile to people who have sensory sensitivities, regardless of your flavor of neurodivergence. If I need to go to, let's say, an emergency room and very bright, very sterile.

I go there, it's all I'm already overwhelmed, that's even more overwhelming, and I seek support, and perhaps I'm dismissed because everybody else can cope with it. Perhaps there's no space for me to go safely and actually sit in the dark or the quiet. Perhaps I have to go to a really busy place to engage in that service. Or perhaps if I have a long-term history of social exclusion and feeling other.

Perhaps calling a stranger on a crisis line is just it exposes me to too much of my social anxiety for me to be able to do that. And so I just and I quote, I just suck it up and deal with it myself. I'll sort it out. The disengagement of people makes sense. If you have a bad experience with a support service, why would you go back? If I put a pair of shoes on that are too small and cause me pain,

I don't continue to wear them and go running in them. So we can see why many neurodivergent people disengage from care pathways. We as clinicians, people who run practices, people who work or manage in healthcare, we can create little spaces that can be a little more neurodivergent, a little more sensory aware. Maybe it's just one small room where somebody who's overwhelmed can go with less sound and light.

Or less people to have to manage, less busyness. Little things can make a big difference. Affirming care is exactly what I just spoke about. It's adapting my environment, my care environment, to meet the needs of neurodivergent folk or queer folk or any other marginalized or disempowered group. It's doing the things that we need to do to make sure that people feel safe enough.

To engage in our service that seeks to promote health. And that includes sensory accommodations, as I've already mentioned, communications accommodations. You know, I spoke about flat effect communication. Some people will dismiss how distressed you are if they can't see it playing out in your voice and face. So better to directly ask somebody who's seeking help, can you tell me how at risk do you feel right now?

And get a direct response and believe that person because they know their experience more than you do. To everyone who's not a healthcare worker out there, you are the expert in your life, not us. We don't have the right to tell you whether you are or are in crisis. We can just consider that autism, ADHD, and trauma are not mutually exclusive.

Trauma is a diagnostic confound to diagnosing neurodivergence, but in my clinical experience, it is rarely ever neurodivergence without trauma. It doesn't mean that it doesn't exist without trauma, but it's really, really common, and we can't formulate just autism, just ADHD, or just trauma. Usually we need to get the full story and understand a formulation with all of those factors that relate to you considered in that formulation.

And that treatment plan.

Also, because often we don't seem to show our distress in many ways the same way everyone else does. Sometimes because of the way we communicate, sometimes because we've learned that we're being "unrealistic" or "too much" or "a lot, so we mask our true distress. We need to wait until we are absolutely in crisis before people take it seriously.

if that's been your experience on behalf of the system revol ⁓ involved, I'm so sorry. And if that is your experience, your distress is real. You don't, you shouldn't need to be in crisis to get the care that you need. For clinicians and healthcare workers out there, please consider that. Be aware of how autism.

Neurodivergence broadly can present that's not the same way as a typical person in community. Be aware of the differences between autism, ADHD, and AuDHD because they do each present with their own cluster of characteristics that you may not recognize. I certainly didn't until I moved into this space, even knowing myself. And finally, the system failing you.

Is not you failing. If the system isn't set up for you, it's not necessarily a system that's set against us. But it is also absolutely not a problem that resides within you. It is a mismatch between who and what you and I and other neurodivergent people are and the expectations of the systems that we engage with. So

We are different, not defective. It is not a problem within you or your neurodivergent characteristics. That's not what increases the risk to suicidality. It's the interactions, it's the extra stresses that we deal with in living in a typical world. And it's the expectations of the typical world that doesn't necessarily always see the needs that we have and the increased stress that that creates for us, which can in the end lead to us feeling defeated.

Stark and somewhat hopeless.

What's protective from suicidality? There was a really good research article that I was reading, and I'm sorry I'm gonna say it was Cassidy, perhaps, in 2024. I'll have a research list on the back of episodes moving forward. And they showed that positive childhood experiences carry over into adulthood, and that can actually be inoculative against suicidality.

Why do I share that with a lot of you who have already been through your childhood? Because a lot of you are parents, and so being able to foster those positive experiences for our kids so that they don't have similar difficulties to what we do, now you know that that's actually really protective of your children for their well-being in the future. Belonging, community. We've known this in the queer community for a terribly long time, and we're starting to build this in the neurodivergent community. Building community.

Is a simple, affordable and helpful way to manage a lot of the isolation that we feel, a lot of the disconnection, a lot of the burden that we feel, oddness, the difference, the disempowerment. When we have others around us like ourselves, we recognize actually I'm not a craptastic weirdo. I'm actually just a weirdo, and that's good. When we have people like us around us,

We don't have to mask all the time. If I have a space where I'm not masking all the time, I'm less likely to burn out, to feel defeated, to feel stuck in this world where I don't fit. I'm more likely to go, maybe I'm not an ideal match for the whole world, but I have this space where people are just like me, or similar enough for me to feel comfortable and unmask a little and reduce my stress and reduce my risk.

And we also know that sensory fit is important, and I I I bang on about this. Making sure that we also accommodate ourselves. It's important that we choose the environments that are right for us. Or we choose them as often as we can and we do the best that we can to manage our sensory differences in the environments where we can't control the input, we can't control the stimuli. Sometimes that can be.

Asking a good employer for reasonable workplace accommodations. Sometimes it can be wearing headphones when I have to go to the shopping centre or sunglasses inside if that's what I need. I don't care if people think I'm too cool for school if I'm going to do that. It's my business, not theirs. So belonging, unmasking, and sensory fit are really powerful protectors. And there's good research about suicide safety plans. Safety planning helps keep us safe.

It's exactly what it's for. And it's not for crisis only. If you have somebody that you trust, make a safety plan with them, your clinician, your GP. When you're feeling good, what could I do if I was feeling overwhelmed? Who could I speak to? What support could I engage in? What emotional regulation strategy works for me that I could try in that time and have it somewhere available so that you have another.

resource to use when you're overwhelmed and potentially feeling suicidal. So, a script, if you do want to make a safety plan with somebody you trust, might be perhaps it's your GP or your psychologist, hey I'm feeling okay at the moment, but can we make a safety plan together? Not because I'm in crisis right now, but so that if I ever am, I already know what I can do. It's mine. We can change it.

later on, but I just want to start now. And there's a reverse script for clinicians. We can say to our neurodivergent clients, can we make a safety plan for you now? While you're while you're healthy and you can think well about what will serve you at that time.

If we ever want to change it, we can and it's just so that you have something there waiting for you if anything does come up and you do start to feel overwhelmed.

We're different, not defective. If you're suicidal, that's not evidence that you are broken or wrong or doing it wrong. It's evidence that your load has been so high for so long, often in environments that just don't accommodate you, and that's not a you thing. Your nervous system's become overwhelmed, and that's an interactional thing between.

A person and the environment that doesn't often recognize and doesn't accommodate their needs. Well,

thank you very much, friends. I really appreciate you taking the time. This has been a really heavy content episode. So please take a break, take a walk, take a breath, do what you need to do to refill your cup,

and

We are different, not defective.

and

I'll see you next time