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Suicide is a complex, multifaceted crisis affecting children and adolescents, and has become a major public health concern. While there is a plethora of research on this topic among neurotypically developing youth, much less is known about the nature of suicidality in autistic individuals. Autistic youth show an increased vulnerability for suicidal tendencies that are poorly understood among school mental health (SMH) professionals, who report a range of competency and self-efficacy to address suicidality in school settings (Debski et al., 2007; O'Neill et al., 2020). Co-occurring mental health difficulties pose significant challenges in the early detection of suicide risk in autistic youth. Given that suicide is the leading cause of death among autistic individuals, the incidence of suicidality among autistic youth is of particular concern. This article provides a practice-friendly review of the research outlining innate vulnerabilities that present risk factors for suicide among autistic youth, along with assessment considerations that help inform the management of suicide risk in autistic youth. We conclude with recommendations for integrating a multi-tiered neurodiverse-affirming approach with sensitivity for student intersecting identities and system-level influences on student mental health that enables SMH professionals to create supportive school environments for autistic youth that prevent further harm.