Trinity Mount Ministries - FBI - Suicidal Behavior in Preteens

By Tony Salvatore, M.A.

Police officers frequently have contact with suicidal adolescents and teens. It is far less common for them to become involved with younger children exhibiting suicidal behavior, but this may be changing.

Preteen suicides in the United States are rare but increasing. Suicidal behaviors ranging from ideation to nonfatal attempts also are becoming progressively more common in preadolescents.

If current trends continue, police officers and other first responders can expect to receive a growing number of mental health calls involving suicidal children. They also will have to cope with the aftermath of more suicides by children in coming years.

Suicide prevention training for police officers does not usually cover suicidal behavior and suicides in preteens. Agencies must remedy this. Officers may be among the first to encounter this problem in their communities.

Incidence

It once was widely believed that young children did not take their own lives because they could not grasp the concept of suicide.1 However, in the late 1980s, research showed that suicide claimed a number of victims at an early age and that as many as 12 percent of school-age children experienced suicidal ideation.2

Mr. Salvatore directs suicide prevention and postvention efforts at Montgomery County Emergency Service in Norristown, Pennsylvania.

Even very young children engage in nonfatal suicidal behavior.3 This creates serious suicide risk in childhood that individuals carry into adolescence, young adulthood, and beyond.

Frequency

Early childhood suicidality has made a mark on the health system in the United States. A review of admissions to 31 pediatric hospitals from 2005 to 2015 found almost 15,000 cases of suicidal ideation or suicide attempts by children 5 to 11 years of age.4

Assessments of children ages 10 to 12 presenting to emergency departments in three urban medical centers found 30 percent positive for suicide risk. One in five of the children had made a previous suicide attempt.5 This suggests that emergency departments should screen for suicide risk in all children, even as early as 10 years old.

Although they may have access to only a limited range of lethal means, young children are capable of suicide.6 In 2014, the Centers for Disease Control and Prevention (CDC) for the first time listed suicide as the 10th-leading cause of death for children ages 5 to 11.7 It was the ninth-leading cause of violence-related death for children ages 5 to 9 in 2015.8

Between 1993 and 2012, 657 children in the United States ages 5 to 11 years old died by suicide.9 This is an average of 33 child suicides per year.

Young children can develop suicide plans readily within their capability to carry out.10 One study found that 1 in 10 children ages 3 to 7 acknowledged thoughts of suicide, expressed what appeared to be plans, and acted in a manner that looked like an attempt.11

Demographics

Early childhood suicidality is more common in boys and is associated with attention deficit hyperactivity disorder (ADHD), oppositional defiant disorder, and conduct disorder.12

In one study, victims mostly included black male children who died by hanging, strangulation, or suffocation.13 Data on suicides involving children 5 to 11 years old from 1993 to 1997 and from 2008 to 2012 showed a significant increase in suicides of young black children and a notable decline of suicides in white preadolescents between the two periods. This shift has not presented in other age groups. The increase in suicides among black children is a notable departure from the distribution of suicides by race for all ages and particularly for young children.14

Risk Factors and Warning Signs

Suicidal behavior in preschoolers relates to impulsivity, running away, hyperactivity, morbid ideas, high pain tolerance, not crying after injury, and parental neglect.15 A family history of suicidal behavior, exposure to physical and sexual abuse, preoccupation with death, and prior suicide attempts are additional factors to consider.16

Impulsivity is a prominent characteristic of preteen suicides. For children ages 5 to 11, “impulsive responding” to arguments, conflicts, relationship problems with family members and friends, and other adverse environmental and life situations is a trigger for early childhood suicide.17 Children may lack the ability to foresee their lives getting better or to comprehend the temporary nature of some problems.

Notably, mental illness plays a smaller role in suicidal behavior in preadolescents than in older children.18

Misclassification

It can prove difficult to decisively quantify preadolescent suicide because authorities may misclassify young children’s suicides as accidents or otherwise unintentional deaths.19 This represents a particular problem in the black community.20 Preteen suicide victims leave notes less often than teenagers do and have less access to lethal means, such as firearms, which can raise doubts about suicide as the cause of death.21

Misclassification also may result, at least in part, from old beliefs some coroners and medical examiners still share about the suicidal capability of young children. The fact that accidental deaths and unintentional injuries are the leading cause of death in children under age 14 also can influence this judgment.22 Individuals may not readily see preteen deaths by falls and even by hanging as suicides.

Theory

Most models attempting to explain suicide focus on teens, adults, and elders. However, one theoretical paradigm suggests how suicidal behavior may arise in anyone, including young children. The interpersonal-psychological theory explains how overcoming the natural resistance to lethal self-harm can result in a suicide attempt.23

According to this theory, a suicide attempt may occur when two factors exist: 1) an intense desire to die and 2) the capacity for self-harm.24 The former arises from negative self-perceptions, a poor self-image, and unfavorable social comparisons.25 The latter is associated with a high tolerance to pain, diminished fear of severe injury, and lowered fear of death.26 This “acquired capability” becomes established over time through exposure to hurtful, painful, or violent experiences, such as self-injury, physical or sexual abuse, or bullying.27

Circumstances that contribute to suicidality in young children include—

• decreased self-esteem;
• belief that they hold responsibility for some family problem (e.g., divorce);
• feeling worthless or like a burden to the family;
• not feeling valued;28
• violent interactions between parents, which may cause children to believe they are worthless and expendable;29
• bullying and being bullied;30
• parental abuse and neglect, which may produce self-directed aggression;31
• having a sibling who attempted suicide;32 and
• experiencing conflict, aggression, and abuse in the household.33

Suicide threats and attempts relate to antisocial behavior and hostility toward parents in children 5 to 12 years of age.34 Abuse, neglect, or other trauma in the family may produce suicidal behavior in young children. Research shows that witnessing violence promotes suicidal ideation in urban 9- and 10-year-olds.35 Officers called to a household because of domestic violence must keep collateral suicide risk in mind during their investigations.

Bullying can generate an intense desire to die and the development of an acquired capability for lethal self-harm. Both victims and bullies themselves more likely will exhibit suicidal ideation or behavior compared with children not exposed to bullying.36

“Although they may have access to only a limited range of lethal means, young children are capable of suicide.”

Prior suicide attempts, self-injury, and mentally practicing a suicide plan represent other ways an individual may acquire the capability for a lethal attempt.37 Evidence suggests that these behaviors may significantly contribute to suicidality in young children.38

“Suicide competence” comes with making attempts over time.39 Many preadolescent suicide victims engaged in earlier suicidal behavior.40 Repeated tries facilitate future attempts as the individual accrues lethal experience and skill and sheds inhibitions to suicide.

Histories of multiple increasingly lethal suicide attempts are present in prepubertal children.41 Suicidal teens may have histories of past attempts starting as early as age 9.42

One study found self-injury in almost 8 percent of surveyed third graders (average age 7) and 4 percent of sixth graders (average age 11).43 In this age group, more boys than girls self-injured, and hitting oneself proved the most common method.44 Such behaviors reduce the natural inhibition to self-harm and enhance the risk of suicide.

Preadolescents can make basic suicide plans.45 Mentally going over the plan is one way to gain the ability to carry it out.46 This may occur even in very young children. Children can experience persistent suicidal ideation over time.47 This may be how suicidality in the very young progresses from vague thoughts of death to a concrete selection of means.48

Screening

No specific guidelines exist for police officers to use in identifying suicide risk in young children. However, when dealing with young children troubled by suicidal thoughts, officers should assure them that they are safe and not in trouble and that the officers are there to help. They should use terms children can understand and ask age-appropriate questions.

Screening for suicide risk in very young children is only recommended if high risk is evident or strongly suspected.49 Officers can ask general questions, such as “Do things ever get so bad that you think about hurting yourself?” or “Have you ever tried to kill yourself?”50 Suicide risk screening questions do not harm young children and have not been found to induce or intensify suicidality.51

Identifying suicide risk in this age group relies on interviews with the child, parental reporting, and self-reporting by the child.52 A flexible interview using questions that the child can answer is the recommended approach for determining suicide risk in prepubertal children.53 Parents will serve as the best sources in cases with very young children, and talking with them will avoid upsetting a possibly suicidal child.

A suicide risk screener for young children should consist of a few short questions about recent thoughts and behaviors. Police officers may not need to use a formal screener with young children, but looking at an example of such a tool can be helpful.

One set of suicide-screening questions has proven successful with children as young as 10 years of age.54

What is therapeutic presence?

Musings of a Christian Psychologist

What is therapeutic presence?

If you go to a counselor, you’d probably prefer that person to be awake versus asleep, to pay attention to you versus check their smart phone, to respond to what you are talking about versus make non sequitur responses. As I’ve noted here before, it is probably better to have a counselor who cares about you than one who has a big bag of techniques–though most of us would prefer our counselors to care AND be competent.

Therapeutic presence is a way of talking about the act of being with our clients in such a way as to build safe, trust-filled relationships where clients can grow and change. I think most people can easily identify failures of therapeutic presence. Try these on for fun:

CLIENT: I’m just so depressed.

THERAPIST: You think you are depressed? Let me tell you about depression. I have a client who just lost job, family, church, home. Now, that is something to be depressed about. You just had a bad day, that’s all.

Or,

CLIENT: I don’t understand why God would take away this job from me.

THERAPIST: Well, theologically speaking, God does things for all sorts of reasons. He sometimes does this to cause us to trust him more, to reveal some sin, to give him glory.

Notice how both responses fail miserably to be either therapeutic or present with the person in the moment of counseling. Not hard to miss, right? So here’s a question: Why do so many of us counselors, even seasoned ones at that, fail the “presence” test?

My answer? When we fail to be present in helpful ways, it reveals a lack of preparation and a lack of attention to purpose.

Shari Geller and Leslie Greenberg (in Therapeutic Presence: A Mindful Approach to Effective Therapy. APA, 2012) define the building blocks of therapeutic presence as

• how therapists prepare for being present (in personal life and in session)
• the process (or therapist activities) of being present (aka purposingto be present)
• the experience of being present

Sound like mumbo-jumbo? Here’s another way of putting it. What does a counselor need to do to be ready to be in tune with their clients? What do they do to stay in tune when with clients, and are they aware of when they are failing to be in tune? (If I am unaware, then I am likely to get out of tune.)

Here are some things counselors ought to be asking themselves:

• Do I have adequate space to move from my private life to being present with my clients? Do I have enough space between clients? The answer is not always an amount of time, but what we do during the space between.
• As I prepare for sessions, what am I meditating and praying about? For example, if I pray for clients to be free from something that has them bound up, I could accidentally encourage myself to push for change or to talk about a subject that the client is not able or ready to talk about. I’m all for praying for healing. I just think we have other prayers to pray as well. “Lord, help me to be with the client today and not focused on my own personal goals for them.”
• Am I staying present with their mood, their cognitions, their silences in such a way that it is as easy to talk about what is happening in the session as it is to talk about what happened in the past or might happen in the future?
• When I sense a disconnect, am I quick to invite dialogue and learn (vs. avoid or defend/explain away)?

Therapeutic presence isn’t everything. I could be present with someone and no healing might take place. But without therapeutic presence, I will only be a barrier to whatever growth is taking place. When I do it well, I imagine that I might see just a tiny glimpse of how Jesus was with the woman caught in adultery, the Samaritan woman, or with Peter after he had abandoned Jesus.

Trinity Mount Ministries

Psychology as Religion: The Cult of Self-Worship by Paul C. Vitz

By: Johnny Kicklighter

It seems everyone you meet these days is a self-proclaimed psychologist. From radio talk shows, television interviews, romance novels, weekly magazines, to cliques at work; everybody has an opinion on the latest "mental illness." I was first introduced to practical psychology when I joined the United States Air Force in 1970. It was expected that Non-Commissioned Officers (NCOs) would become counselors to their subordinates. Profession military education devoted entire chapters and lectures on non-directive or eclectic counseling techniques. Maslow's hierarchy of needs was drilled into our heads. We were sternly warned to avoid any mention of religion, but instead to make ample use of psychological techniques.

Paul Vitz in his book "Psychology as Religion" attempts to expose psychology for what it really is, i.e., religion. He begins by giving the reader a brief biography on the fathers of the modern psychology movement along with some of their theories. The opening chapter was dry reading but I suppose necessary as a historical backdrop. My interest peaked when I immediately recognized Carl Rogers and Abraham Maslow since I was forced to study them for 26 years while in the military. Vitz also discusses Carl Jung, Erich Fromn, and Rollo May as being significant contributors to the movement.

Vitz quickly transitions into explaining the concept of self-esteem which he promotes as the center of the entire selfism movement. This became important to me as it seems no matter where you turn, a lack of or poor self-esteem appears to be the cause of every ill known to mankind. For a movement to be so widespread to the point where psychology has been woven into the gospel message, Vitz says that the self-esteem concept has "no clear intellectual origins." That's a surprising claim considering the impact selfism has had on academia and the practice of counseling.

Vitz states that self-esteem should be understood as an emotional response and not a cause. He says it is a reaction to what we have done and what others have done to us. High self-esteem is a desirable feeling to have (like happiness), but the feeling itself isn't the cause of anything. In trying to obtain a feeling of self-esteem, the only successful way is to do good to others or accomplish something. In so doing, you'll get all the self-esteem you want. However, the downside is people begin to pursue happiness as a far greater goal than the goal of obtaining personal holiness.

Not only is selfism a self-defeating goal for the Christian, Vitz goes on to make the case that it is also simply bad science and a warped philosophy. The little clinical evidence that does exist is mostly based on empirical observations and doesn't stand the test of solid scientific problem solving. He exposes flaws in each step of the process, from stating the problem, forming and testing the hypothesis, to testing the conclusion. He also identifies several philosophical contradictions and in some cases, actual misrepresentations. The spread of this bad science and faulty philosophy is believed by the author to have contributed to the destruction of families. Additionally, the entire recovery group mentality convinces the person with "low self-esteem" that their ills are due to trauma inflicted on them in the past. Recovery group therapy strokes the patient with self-pity thereby convincing the clients are victims. Once labeled, the "victim" now assumes the attitude of victimhood.

Values clarification has become the model taught in schools and begins with the assumption that man is naturally good. Since the developers of values clarification reject moral teachings, Vitz claims that if responsible adults, i.e., teachers, don't promote good values then someone else will. Providing a permissive environment supposedly nourishes the child by granting satisfaction for the child's desires and interests. However, this philosophy is bankrupt because kids will assume the values of irresponsible sources in lieu of responsible ones. This combined with the aforementioned teachings has produced a society of victims where everyone is pointing to blame someone else for their misfortunes.

Vitz takes three chapters to present a Christian analysis and criticism of humanistic self-theories. He gives the credit to our educational system for the transformation of our society into a culture of pure selfism. He notes that the New Age movement has many founders, but Abraham Maslow's theories have been the most influential. Vitz argues his Christian critique within a historical framework and the impact it has had on the evolution of our society. Unfortunately he gives scant attention to biblical references for his position, but does show how the selfism heresy affects teachings on depression, idolatry, and suffering. He closes his work with the observation, "never have so many people been so self-conscious, so aware of the self as something to be expressed...., the self has become an object to itself." (I think this may make the case that self-esteem has become a new barometric indicator to the question everyone asks, "How are you doing today?")

Overall, Vitz's book uses a cerebral approach in attempting to prove that self-worship is simply a religion. Biblical counselors looking for material to help their counselees break free of a selfish worldview of life will be disappointed. Then again, Vitz didn't write his book for that purpose. Moreover, he provides a wealth of information and a refreshing argument against those who say, "You can't teach religion in public schools." This leaves the reader with an irony: it's not a question of should we or should we not teach religion in public schools, but instead, what religion will we teach; selfism or Christianity?

Author Bio

Johnny Kicklighter is a counselor at Gateway Biblical Counseling & Training Center, a ministry of www.ebiblechurch.net, Edgemont Bible Church.

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