There's been very little research published on suicide among elementary-aged children, and perhaps that's understandable: Death by suicide among elementary school-aged children is an extremely rare event.

However, suicide becomes perplexingly more common once children enter puberty.

For example, suicide is currently the 10th leading cause of death among American 5-11 year olds, but the 2nd leading cause of death among younger adolescents aged 12-14.  Accidents, of course, rank as the number 1 cause of death for both age groups.

To put that in context using real numbers, in 2014, only 49 of the total US population of 28,720,456 children aged 5-11 died by suicide, whereas 963 died from accidents, according to most recent data available from the Centers for Disease Control and Prevention.

That same year, 379 suicides occurred among the total population of 12,470,616 12-14 year olds, compared to 517 deaths by accidents.

Why the increase at the time of puberty?  And, prior to puberty, what places elementary school aged children at risk for suicide?

A grim study published last week in top medical journal Pediatrics can provide at least some answers to these questions.  In it, researchers examined how the risk factors and characteristics of suicide between elementary-aged children and early adolescents might differ.

The authors of the study compared data from the National Violent Death Reporting System for all deaths by suicide for 5-11 year olds and 12-14 year olds from 2003-2012. The researchers found that children who died by suicide, as compared to the early adolescents, were more likely to be boys, more likely to be black, and more likely to die by hanging/suffocation.

Interpretation of the results deserves caution. Not all states participate in the National Violent Death Reporting System and data for this study could only be collected from 17 states, which accounted for only one-third of all US deaths by suicide in this age group. Hence the data was incomplete and the results may not be the same if all suicide deaths in these age groups from all states had been included.

Results also should be placed in context of the overall trends in death by suicide for all age groups, because they are mostly consistent.  Though there were relatively more boys in the sample of 5-11 year old children who died by suicide, the majority of the early adolescent suicides were also boys, consistent with the fact that males of all age groups die by suicide far more frequently than females.

The elementary school-aged children were also more likely than the younger adolescents to have experienced recent conflict with family members or friends versus conflict with girlfriends or boyfriends. But the similarity here is more important than the expected developmental difference – that problems in relationships are a common precipitant of suicide attempts for all human beings.

Among the section of the sample with known psychiatric disorders, the children who died by suicide were more likely to have diagnoses of ADHD and less likely to have diagnoses of depression than the early adolescents. But depression is far more common once children enter adolescence and a strong risk factor for suicide.  It is of interest that the most common diagnosis among the children who died by suicide was ADHD – perhaps suggesting elevated impulsivity as a risk factor for this age group – but then again impulsivity is a common factor in suicide across all age groups.

By contrast, hanging/suffocation was the method most commonly used by both young children and early adolescents in this study, but this changes in later adolescence and adulthood, where guns are by far the most common method of completed suicide.

The racial difference found in the study, coming as they do after an earlier study published by the same research team showing an increased rate of suicide among young black children over the past two decades, is very sobering and deserves a separate post, which will be coming up next week.

Again, death by suicide among children and early adolescents is a relatively rare event and a preventable one. Teachers and other school staff of K-12 graders can help the effort by enrolling in online programs that teach them to recognize signs of suicide risk, how to talk effectively to students about whom they are concerned, and when to refer students to school counselors or administration.  "Signs Matter: Early Detection" is one such program available online from the American Foundation for Suicide Prevention and can fulfill the mandated training for educators on this topic.

For parents, there is excellent information on how to proactively talk with your children about suicide prevention at the Society for Prevention of Teen Suicide website, much of which is appropriate for elementary-aged children.

If the results regarding the higher rate of ADHD diagnoses among 5-11 year old children who died by suicide is replicated in future studies, then suicide prevention intervention for children with ADHD should be the same intervention indicated for all children with ADHD; that is, good, evidence-based treatment for the ADHD. Currently, the two treatments for ADHD that have the most scientific support are stimulant medications and behavioral therapy with strong involvement of parents.

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