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Source: iStock_61677612_SMALL.jpg

The title to this blog post is probably startling to most readers. But perhaps more startling is the documented frequency of suicidality in pre-adolescent children. According to one study (Dilillo et al., 2015), in pre-adolescents suicide occurs at a rate of .5 to 100,000 in girls, and .9 to 100,000 in boys. However, suicidal thinking, according to a study in 1998 (Gould et al., 1998), was present in 24 out of 560 children ages 7-12 years. Of those children, having disruptive behavior problems was predictive in boys of suicidal thoughts, as was having any mental health diagnosis. The American Psychological Association noted that, in 2006, in the US, 56 children under age 12 committed suicide—not had suicidal ideas, but actually completed a suicide attempt and died.

Children under 12 are less likely to be verbally expressive of suicidal ideas, so knowing the warning signs is important. They are also less capable of thinking about a better future, due to developmental limitations on how they think. If children try to commit suicide, the APA article tells us that they will likely hang themselves.

Adults tend to dismiss children’s statements about wishing to die. While more boys than girls will likely have these thoughts at a young age, teachers and parents might not pay attention to them because of the tendency for these children to exhibit behavior problems. Far too often, their history includes victimization (e.g., being bullied, sexual abused, or physical abused).

What to Listen For

1.  Wishing to Die: Children this young don’t easily articulate a wish for death. However, they may say things like they wish they hadn’t been born, wish they could disappear, or wish they didn’t wake up in the morning. Suicidal children will likely couple these statements with no clear sense of how things could get better. Victims of abuse at this age often build a story to their lives in which adults can hurt them, adults don’t keep them safe, and they are helpless to stop the emotional pain.

2. Self-Blame: Children who think about dying will likely say things about being the reasons bad things happen. These children have excessive sense of guilt, sometimes so much so that their feelings lead them to act out against others to cope. But if you listen, you can often hear “It’s my fault,” or “If I weren’t here, bad things wouldn’t happen.”

3. Death Isn’t Final: Children at this age don’t grasp that death is an end. They tend to emphasize feelings over thinking, since they live in a world of very concrete ideas.  They often see death as an escape, and don’t grasp the totality of it.

What to Do

First and foremost, pay attention to significant changes in children’s mood. If there are signs of depression (loss of interest in fun things, unusual irritability, sadness, wishing to disappear, preoccupation with death), begin a dialog with the child. Remember, your fears of the idea of suicide may need to take a back seat to a child’s need to talk about feelings and reduce loneliness. Adults can help suicidal children by being more involved in their lives and seeking positive interactions on a daily basis.

Second, work on teaching social and problem solving skills. Children who contemplate death likely have lost friends over time, and don’t know how to fix that.  Teaching them that you care, being engaged with them, and modeling skills for friendships helps them learn to be less alone. Also, children who think about committing suicide benefit from learning how to manage conflicts with others. Teaching how to value relationships, to talk about feelings with peers, and to seek a compromise with friends can go a long way to preventing self-harm.  

Third, if you fear a child is suicidal, keep things that can be used to commit suicide away from them. If you own weapons, keep them locked up; if you have ropes, store them safely. If you have lethal medication in the home, put it up and away from easy access.

Fourth, alert the school. Ask them to not just keep an eye on the child, but to be sure that bullying isn’t happening to them. If the school can make available a social skills group, or a school counselor, then ask for those services.

Fifth, and perhaps most obvious, you can talk to the child about getting professional help.  Find a competent psychologist or mental health professional who knows how to work with children who think about killing themselves. Talk to your pediatrician, and seek out a competent mental health professional.

Zero-Tolerance in Schools and Suicidal Ideas

Since the research indicates that behavior problems relate to suicidal ideas in children, the notion of Zero-Tolerance may, in fact, undermine helping such children. The punitive and isolating nature of suspension and expulsion for young children not only is behaviorally and developmentally unsupported, but it may very well further a suicidal child’s beliefs of hopelessness and self-blame.

An alternative to Zero-Tolerance is the tiered approach to managing mental health problems in children. Schools can build positive programs that teach children how to engage one another and reward good behaviors. Further, the use of Restorative Justice interventions, that focus on helping children care about how they make others feel and promotes restoration to the peer relationships, is both supported by evidence and can reduce the chances of marginalizing students of diversity or with disabilities.

Finally, schools can build a Positive Behavioral Interventions and Supports program (PBIS). The PBIS strategies are building and system wide, and promote reduction to bullying and improved discipline outcomes. 

Summary

When a child says they wish they were dead, always take the time to ask that they tell you more. If you can empathize with statements like “You must be feeling really sad and helpless right now, tell me why you wish you disappeared.” adults can open a child up to talking and connecting over not just those thoughts, but the pain they must be feelings. It is best to remember, as well, that suicide is a way to turn off the noise, and for a young child that noise is emotional pain. To them, it makes sense—stop the pain and feel better. Our job is always to find ways to feel better, replace the pain with joy, and eliminate the need to die as a necessary option.

Resources

Dilillo, D, Mauri, S, Mantegazza, C, Fabiano, V, Mameli, C, & Zuccotti, GV. (2015). Suicide in pediatrics: epidemiology, risk factors, warning signs and the role of the pediatrician in detecting them. Italian Journal of Pediatrics, 41, 49. http://doi.org/10.1186/s13052-015-0153-3

Gould, MS, King, R, Greenwald, S, Fisher, P, Schwab-stone, M, Kramer, R, Flisher, AJ, Goodman, S, Cannino, G, and Shaffer, D. (1998). Psychopathology associated with suicidal ideation and attempts among children and adolescents. Journal of the American Academy of Child & Adolescent Psychiatry, 37, 915-923.

American Psychological Association Resource on Childhood Suicidality 

American Academy of Pediatrics Video for Parents to Help Children who are Thinking about Suicide

Evidence on Zero Tolerance 

Mayo Clinic Video for Teens to Connect to a Trusted Adult

Mayo Clinic Video on Teen Suicide Prevention

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