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

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.