June 12, 2007
There is a lot of material available about assessing for risk of suicide in adolescents, but much less that focuses on small children. Some cases are relatively (and I mean relatively) straightforward, like the child who says he is going to kill himself in anger when he doesn’t get his way. But I have seen a fair number of young children where it is more complicated. Some of them may express the suicidality in anger, but they also take actions like grabbing a kitchen knife or putting shoelace around their necks and pulling it.
Now, in all of the cases I have seen this action has been taken in full view of parents or other adults, which makes it somewhat less concerning (at least in terms of immediate risk for suicide), but nevertheless the child has taken an action which, if done at another time and in a slightly different way could be dangerous.
Our frameworks for assessing risk in adults fall short in these cases. I know I feel on less steady ground. If anyone knows of good resources–ones that not only provide risk factors, but ways of conceptualizing suicidal behavior in young children, I’d love to hear from you.
“Our frameworks for assessing risk in adults fall short in these cases. ” Why not going on the safe side and treat EVERY such threat as viable?
Thanks for your question. Yes, any time someone thinks about suicide it is serious. However, for clinicians it is important also to be able to distinguish between someone who, for example, has had fleeting thoughts of wishing to die, and someone who has a high likelihood of ending soon. Again, both are important AND it’s important to understand variations of risk.
I agree, a tool of some sort would be helpful. I recently cared for a nine-year-old with suicidal ideation. More research needs to be done on the topic of suicide in the very young so that those of us who care for them have a clue how to handle the situation. This tyoe of risk is far different from the teen version and there is simply no literature on it.
Well said, J-Bloom. The clinical feel is different and more confusing, the younger the person is. Knowing that that base rates for completed suicide at that age is low is of little comfort when you’re working directly with the child and family.
It is unlikely that we’ll ever have an actuarial (meaning based on statistics) tool, but we do need better conceptual frameworks and guidance about the standard of care.
Thank you for your thoughtful comment.
There is very little info out there on this, certainly if there is a history mental illness, behavioral problem, learning disability, personality disorder, or even delayed speech or cognative problems, there is an increased risk, as well as environmental problems such as death in the family (especially if it’s a suicide), divorce, abuse, etc. But with children so young, it’s not unusual for there to be little or no history because of their age. Not to mention it is extremely difficult to diagnose mental illness in young children. For example, bipolar disorder is typically difficult to diagnose until 14 and most will not treat a child under 14 via medication for bipolar even with a diagnosis. It is also difficult to tell if a young child committed suicide since they frequently look like accidents, as well as the fact that neither medical examiner nor parents want to accept a determination of suicide in a child that young.
Thanks for your comment, Halli. Yes, it is difficult. In some ways, the situation is not REALLY different from what we have with adults when it comes to _predicting_ suicide. We can’t really do it. In the case of children and of adults, we can make an informed assessment and plan accordingly. In that sense, it is no different even though there is technically more information available about statistical risk factors in adults. Thanks again.
My son at the age of three said that he wanted to go back up there from where he came. It was nice up there but down here people are mean. He tried to slash his wrists and burn himself between the ages of 3 and 6. Finally, at the age of 22 years and 10 months fatally shot himself – success for himself at last.
It is a very long story, but his suicide note said that his earliest memories were of wanting to die.
Dan, I am sorry for what must have been (still is) a long and painful journey. Thank you for sharing it here. I think it can be helpful to others, including clinicians who work with children. The number of deaths among young children may be very low, but that doesn’t mean we should dismiss suicidal themes in young children. On the contrary, while near-term death is not likely, we need to be attuned to what early suicidal thinking might mean for the long-term needs of the child. You are generous to share this poignant illustration of that. Tony
I was physically abused since I was very young and for about 15 years. I remember contemplating suicide for the first time when I was 6. I don’t remember feeling sad. I remember thinking of suicide as a way to get out of the painful beatings. I still think about suicide without getting depressed.
Thank you for sharing this insight. Many people think about suicide as a way to avoid pain of one sort or another. As one person who recovered from suicide once told me, “I never wanted to kill myself. I just wanted to kill the pain.” The encouraging news is that we know from lots of experience that there are other ways to recover from or escape pain–even the most intolerable pain. When you’re in it, it’s very difficult to believe it, and some people don’t wait long enough to find out, but I can give case examples of people who felt as low as a person could possibly feel and who survived and have gone on to live peaceful, productive lives.
Thank you for your comment.
Tony
Our 8 year old granddaughter was admitted to a psychiatric hospital last Friday after attempting to kill herself. She has fluctuated between a deep depressive state and an alternate bizarre manicial state. She has been diagnosised as bipolar and only now are we all (parents, family, friends) only now recognizing so many clues that we failed to pick up on. She is extremely bright and verbal well beyond her years, sensitive to pain of others to an astounding degree and internalized all of those pains – real and preceived. Being unable to make the pains better caused “her mind to go away” as she put it. Thank God for practitioners and medications. She is responding well to medication and talk therapy but our family’s normal has shifted dramatically for the rest of our lives.
Oh, Grammy. I’m so sorry your family is going through this painful time. I’m glad your granddaughter is in good hands. I hope she can stay connected with good helpers after the hospital.
It is not unusual to see “clues” in retrospect. It always easier to interpret behavior after the fact. Trained clinicians face the same difficulty, so you’re not alone. I’m glad your granddaughter is safe right now. My thoughts are with your family for the road ahead.
I am a single parent of three. I am bipolar. The father of my two youngest is also bipolar and it’s rampant in both of our families. His brother, whom my kids were very close to, committed suicide about five months ago.
My oldest daughter, 17, is diagnosed with depression and shows strong signs of bipolar. My second oldest, 7, has generalized anxiety, also with strong signs of bipolar. My two girls are very good at letting me know they need or want help.
My five year old son tends to take the back seat…he’s the one I’m most concerned for. He’s recently been diagnosed as ADHD and was put on Methelyn (sp). Several people at his school have complimented his improvement and say he’s not going to the principle’s office as much…I didn’t know he was going. I’ve only heard of one occasion. Apparently, it’s been as much as daily. He’s gotten a lot of negative feedback from teachers, has lost his uncle to suicide and been separated from his father after reporting to me that his dad hit and kicked him.
Now, when he gets upset, he cries and says everyone hates him and he should just kill himself. Twice, he’s described ways of he would do it. We are in therapy, but all three kids are being seen by the same therapist and I’m worried he’s not getting the attention he needs.
Overwhelmed mom: Thank you for sharing your experiences. I’m sure other people can relate to feelings you have. As I’m sure you can appreciate, I am not in a position to comment on whether or not son is getting the attention he needs, but I can encourage you to be proactive in sharing that concern with the professionals involved if you have not already.
All the best to you and your family.
Last night my 8 year old son told me he had the very very strong feeling that he should swallow a large marble so he could die. He has never said anything to this effect ever. He also said it was a feeling he couldn”t control and he didn’t like. He wanted it to go away. I am so scared for him and have made an appointment for him to see a child counsellor. I do not understand where this has come from. I am taking it very seriously.
Any help or understanding would be much appreciated
A loving mummy
What frightening words for a loving mummy to hear. I am glad you have made an appointment. Parents who listen and involve others to help can go a long way. Be patient. I hope you and your son find relief. My best, Tony
Mrs T Bridle….
I too have experienced that, except my son was a few months shy of being 7 years old. He was told from a bully at school he should kill himself. That particular bully has really done a number on my son who is now 9 almost 10 and as of yesterday started to write his first “suicide note”. Thankfully we have a good support system although it may not sound like it. His pediatrician, psychologist, teachers and other school personnel are all very supportive of not only him but our whole family. Definitely take your son seriously, mine is still alive today because I did!