The Silent Struggle: Autism, High Intelligence, and the Rising Tide of Suicide
The story of Anthony Tricarico is a stark reminder of a hidden crisis: the heightened risk of suicide among autistic youth, particularly those who are also highly intelligent. Anthony, a bright and active 16-year-old from Southern California, seemed to have it all. He excelled academically, earning a remarkable 4.6 GPA in advanced placement classes. He thrived socially, surrounded by friends and enjoying hosting gatherings. He was physically fit, participating in demanding events like Spartan Races and marathons. Yet, beneath the surface of a seemingly successful life, Anthony was battling a profound internal struggle that ultimately led to his tragic death.
His parents, Neal and Samara Tricarico, first noticed differences in Anthony’s behavior at the age of three. A disturbing incident involving self-inflicted hair pulling prompted them to seek professional help. Anthony was diagnosed with anxiety at four, followed by a diagnosis of high-functioning autism spectrum disorder at seven. While these diagnoses initially brought a sense of understanding and relief, they didn’t fully equip Anthony, his family, or even the professionals involved to navigate the complex challenges that lay ahead.
The pandemic exacerbated Anthony’s mental health struggles. He confided in his best friend about experiencing suicidal thoughts, a revelation that prompted his parents to seek immediate support. Despite their efforts, the underlying pain and anguish persisted, masked by Anthony’s dedication to physical well-being. One evening, Anthony went for a walk and never returned, leaving his parents to grapple with the devastating reality of youth suicide.
Anthony’s story is not unique. Research indicates a disturbing trend: autistic children and teens are significantly more vulnerable to suicidal ideation and attempts compared to their non-autistic peers. A 2023 study from the University of Pittsburgh revealed that autistic youth have approximately a 5% higher rate of suicidal thoughts and are twice as likely to attempt suicide. This risk is even more pronounced for those who are both autistic and highly intelligent, a group often referred to as "twice exceptional." A separate study from the University of Iowa found that these individuals are nearly six times more likely to experience suicidal thoughts than their neurotypical counterparts.
Despite these alarming statistics, research into the intersection of autism, high intelligence, and suicide remains woefully inadequate. Experts lament the lack of awareness and understanding surrounding this issue, even within the mental health community. This silence leaves many young people like Anthony struggling in isolation, with their families, educators, and therapists often ill-equipped to provide the necessary support.
"It’s very difficult for us to understand where autism starts and ends, and where being a high schooler, a teenager starts and ends," Neal Tricarico reflects, highlighting the challenges they faced in seeking appropriate help for their son. "That was our biggest challenge in all this. There was no training or tools around that."
Dr. Mayank Gupta, a psychiatrist and medical director at Southwood Psychiatric Hospital in Pittsburgh, observed a concerning pattern among his patients. Many of the teens admitted after suicide attempts, despite appearing to lack traditional risk factors, shared similar traits. They exhibited sensory sensitivities, aversions to certain foods and clothing, and heightened sensitivity to noise. Many were also exceptionally bright but struggled with social interactions.
"When I look at their profiles, I see they are honor-roll students," Dr. Gupta notes. "They come from very good families. But they don’t have friends."
Dr. Gupta realized that many of these young people had undiagnosed or misdiagnosed autism, a critical oversight that compounded their existing mental health challenges. He emphasizes the urgent need for increased awareness, research, and targeted interventions to address this neglected issue.
There are several factors that contribute to the increased suicide risk among autistic youth. Many tend to think in concrete, black-and-white terms, struggling to grasp emotional nuance and often perceiving situations as entirely good or entirely bad. This can make it difficult to maintain hope during times of adversity. Their challenges with socialization can also hinder their ability to form meaningful connections and build supportive networks, essential buffers against depression and isolation. Additionally, autistic individuals may be more susceptible to bullying and social exclusion.
Furthermore, many autistic individuals engage in "masking," a conscious effort to mimic the social behaviors of their peers. While this can lead to successful social integration, it often comes at a significant emotional cost, leading to exhaustion and burnout. Samara Tricarico believes this played a role in Anthony’s struggles.
"It’s almost like he overcompensated in the social department because he learned how it operated," she explains. "Really, underneath that, they are feeling completely isolated and alone and different."
Tragically, those whose autism goes unrecognized or misdiagnosed are often at the greatest risk. Dr. Gupta estimates that the rate of autism among suicidal children and teens at his hospital is five times higher than in the general population, indicating a systemic failure to identify and support these vulnerable individuals.
Samia McCall, a lawyer from Boise, Idaho, believes her daughter Maisa was one of these overlooked cases. Maisa, a bright and imaginative 14-year-old, loved nature, solitude, and learning. She excelled academically and possessed a remarkable ability to master new skills quickly. However, she struggled socially and felt like an outsider.
Maisa’s first suicide attempt at 13 prompted Samia to delve into research, ultimately leading her to believe that Maisa was autistic. She faced resistance from mental health professionals who dismissed her concerns, citing Maisa’s eye contact and friendships as evidence against autism.
Samia points out that many girls with autism remain undiagnosed until adulthood. She believes Maisa’s sensory sensitivities and alexithymia, a condition that often accompanies autism and makes it difficult to recognize and express emotions, further contributed to her struggles.
Dr. Gupta notes that highly intelligent autistic individuals often struggle to reconcile their academic abilities with their difficulties in social and emotional domains. The ease with which they grasp complex concepts contrasts sharply with the challenges they face in everyday social interactions, leading to feelings of frustration and inadequacy.
Samia argues that labeling these young people as simply "gifted" fails to acknowledge the significant challenges they face. She believes that Maisa’s intelligence, while a source of pride, also enabled her to perceive the world’s complexities and injustices in ways that were overwhelming.
Instead of exploring the possibility of autism, Samia says mental health professionals focused solely on Maisa’s depression. She believes that a lack of understanding about autism and its unique manifestations led to inadequate treatment and ultimately contributed to her daughter’s tragic death.
Maisa died by suicide in November 2023. Since then, Samia has dedicated herself to raising awareness through Maisa’s Space, a blog and advocacy platform.
Anthony’s life was also cut short in May 2024. Throughout Anthony’s time in the hospital after his suicide attempt, a poignant reminder appeared on his phone every morning: "Volunteer for suicide prevention." Anthony’s passion for advocacy and his desire to break the stigma surrounding suicide inspired his parents to establish the Endurant Movement, a campaign dedicated to mental health awareness, autism research, and suicide prevention.
"He was adamant that it needed to be suicide prevention, that we needed to talk about suicide," Samara Tricarico emphasizes. "We needed to get the conversation going. We needed to say those scary words and get it out there, because there is so much stigma associated with it."
The conversation about suicide and autism is only beginning. The challenge now is to ensure that these voices are heard, that research is prioritized, and that resources are allocated to support autistic youth and their families. Only through increased awareness, understanding, and targeted interventions can we hope to prevent future tragedies like the deaths of Anthony and Maisa.
If you or someone you know is struggling with suicidal thoughts, please reach out for help. You can call or text 988 in the US and Canada, or dial 111 in the UK. These services are available 24/7 and offer confidential support.
