|
Article Excerpt
Although suicide is considered a leading cause of death for all age groups, resources and recommendations regarding methods of assessment of suicide risk in children appears to be scattered across related disciplines. Most risk assessment measures for "youth" are intended for use with adolescents, and the nature of children's developmental functioning presents particular challenges for accurate assessment. This article includes a brief review of risk factors and recommendations for preparing to conduct suicide risk assessments with children. Guidelines for mental health counselors who conduct developmentally appropriate risk assessments with children are detailed, and suggestions for consulting with caregivers are provided.
ASSESSING SUICIDE RISK IN CHILDREN: GUIDELINES FOR DEVELOPMENTALLY APPROPRIATE INTERVIEWING
Suicide is a leading cause of death for all age groups in the United States (National Institute of Mental Health [NIMH], 2003), accounts for approximately 5.8% of deaths in 10-14 year-olds (Gould, Shaffer, & Greenberg, 2003), and remains between the 3rd and 7th leading cause of death among 5-14 year olds (American Association of Suicidology [AAS], 2006; Wise & Spengler, 1997). Although the prevalence of completed suicide among children is low in comparison to other age groups (AAS, 2003), suicidal thoughts and behaviors in children are reportedly quite common (Brent & Kolko, 1990; Klimes-Dougan, 1998). Indeed, the AAS (2006) reported that youth make approximately 100-200 suicide attempts for each completed suicide.
Although clinicians are likely to address suicide at some point in their careers, many mental health counselors remain uncomfortable regarding the prospect of doing so (Shea, 1999); feelings are frequently amplified when attempting to address suicidal issues with children. According to Wise and Spengler, "low occurrence of childhood suicide, widespread myths and misconceptions, and a general lack of awareness about this phenomenon make assessment of childhood suicide one of the most difficult of diagnostic tasks" (1997, p. 318). These authors have argued that the prevalence of suicidal behavior in children is grossly underestimated due to statistical classification errors and adults' unwillingness to believe that children can and do plan and implement suicides. Similarly, Stefanowski-Harding (1990) identified lack of preparation for dealing with child suicide, discomfort, and denial as key elements to clinicians' difficulties in addressing child suicide. Nonetheless, mental health counselors must be prepared to assess for child suicide and intervene appropriately (Hendren, 1990; Juhnke, 1996; Stefanowski-Harding; Wise & Spengler).
Although mental health counselors are often on the front lines for assessing, referring, and treating children, information regarding suicide risk in children and recommendations for assessing suicide risk in this population tend to be scattered across disciplines. Evidence indicates some commonality of risk factors and course of suicidal behavior among children, adolescents, and adults (Gould et al., 2003; Pfeffer, 2003), but the unique nature of children's developmental functioning presents unique risk factors and particular challenges for accurate assessment (Hendren, 1990; Pfeffer, 2003; Stillion & McDowell, 1996; Wise & Spengler, 1997). The goal of this article is to review risk factors for childhood suicide and suicidal behavior, provide a commentary on current methods of assessing suicide risk in children, and discuss guidelines for conducting developmentally appropriate risk assessments with children.
RISK FACTORS FOR SUICIDE
A variety of theoretical and conceptual models related to suicidality are available to guide one's interpretation and understanding of suicide risk factors (see Berman, Jobes, & Silverman, 2006; Stillion & McDowell 1996; Westefeld et al., 2000). Although some models are grounded in specific biological, psychological, or sociological theories, Berman et al. reported "an increasing emphasis on theoretical integration, particularly among psychological theorizing" (p. 66). In this spirit, Stillion and McDowell provided a multidimensional Suicide Trajectory Model that aids in exploration of common risk factors and triggering events that may lead to suicidal ideation and behavior within and across developmental stages.
Stillion and McDowell (1996) proposed that individuals who experience certain biological, psychological, cognitive, and environmental risk factors will be more apt to respond to stressors with suicidal ideation or behavior. Although not all individuals who experience these risk factors become suicidal, the majority of those who are suicidal experience a number of such risk factors. Examination of risk factors, then, assists the clinician in calling attention to children who may need more comprehensive assessment (Wise & Spengler, 1997) and evaluating risk levels of individuals who present with suicidal ideation (Weller, Young, Rohrbaugh, & Weller, 2001). Specific risk factors for children ages 5-14 are reviewed in the following paragraphs.
Biological Risk Factors
Biologically, children are at risk for suicide due to higher degrees of impulsivity, and this greater degree of impulsivity is reflected in suicide attempts and gestures that are closely related to opportunity and require little planning (e.g., running in front of a car or jumping out a window) (Stillion & McDowell, 1996). Juhnke (1996) also identified biological risk factors including sex and age. Although very young boys and girls have similar rates of suicide attempts and completions, sex differences in rates of completed suicide emerge by age 10 (Wise & Spengler, 1997). The gap between the number of males and females who complete suicide continues to increase as age increases (Gould et al., 2003); by adolescence, boys complete and girls attempt suicide more often (AAS, 2006). In addition, the rates of suicide are very low among the very young and continue to increase as children mature (Juhnke); thus, age may be considered a risk factor even among 5 to 14 year-olds.
Psychological Risk Factors
Stillion and McDowell (1996) identified psychological risk factors among young children to include feelings of inferiority and the "expendable child syndrome" (p. 60). Children at risk for suicide frequently experience disturbance in psychological functioning and in one or more diagnosable mental health disorders (Brent & Kolko, 1990; Gould et al., 2003; Weller et al., 2001; Wise & Spengler, 1997). Common symptoms most often include depression (Juhnke, 1996; Wise & Spengler) but may also include anxiety, aggression, and impulsivity (Weller et al., 2001). Similarly, these children are more likely to internalize problems and stressors (Weller et al.) and present with poor coping skills (Wise & Spengler). As such, many children may present as hopeless about the future (Brent & Kolko; Juhnke; Stefanowski-Harding, 1990).
Cognitive Risk Factors
Cognitive risk factors...
|
