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Autism with co-occurring exceptional cognitive ability is often accompanied by severe internalizing symptoms and feelings of inadequacy. Whether cognitive ability also translates into greater risk for suicidal ideation is unclear. To investigate this urgent question, we examined two samples of high-ability autistic individuals for factors that were predictive of suicidal ideation. In the first sample (N = 1,074 individuals seen at a clinic specializing in gifted/talented youth), we observed a striking excess of parent-reported suicidal ideation in autistic individuals with IQ ≥ 120 (Odds Ratio = 5.9, p = 0.0007). In a separate sample of SPARK participants, we confirmed higher rates of suicidal thoughts compared to non-autistic children from the ABCD cohort (combined N = 16,049, Odds Ratio = 6.8, p < 2.2 e - 16), and further that autistic children with suicidal thoughts had significantly higher cognitive ability (p < 2.2 e - 16) than those without. Elevated polygenic scores (PGS) for cognitive performance were associated with increased suicidal thoughts (N = 1,983, Z = 2.16 , p = 0.03), with PGS for educational attainment trending in the same direction (Z = 1.4 , p = 0.17). Notably, similar results were found in parents of these autistic youth, where higher PGS for educational attainment was associated with increasing thoughts of suicide (N = 736, Z = 2.28 , p = 0.02). Taken together, these results suggest that on a phenotypic and genetic level, increasing cognitive ability is an unexpected risk factor for suicidal ideation in individuals diagnosed with, or at risk for autism. [ABSTRACT FROM AUTHOR]

• Academic milestones are more predictive of diagnosis than motor milestones. • IQ was negatively associated to all diagnosis types. • Age an individual began to count and read and acquire speech were most predictive. • Male and low SES were the most associated demographic characteristics. Twice-exceptional individuals are those who have high cognitive ability in one or more areas, but also have a diagnosed disability. The needs of these individuals likely differ from those with high cognitive ability without a disability and those who solely have a disability. Intervening early can offer exceptional benefits for twice-exceptional individuals, but this has proved challenging due to the high cognitive abilities masking disabilities. This study explores if parent-reported developmental milestones can predict the number of disabilities diagnosed for an individual, including Autism Spectrum Disorder (ASD), Attention-Deficit/Hyperactivity Disorder (ADHD), and Specific Learning Disorder (SLD). Using a clinical sample of about 1,300 individuals, we used a Bayesian cumulative logistic model to explore if developmental milestones can predict the number of diagnoses after controlling for IQ and age. Study results showed that when an individual began to count and read informed predictions for the number of future diagnoses in the clinical sample. Implications for future study and practitioners are discussed in further detail. [ABSTRACT FROM AUTHOR]