Impulsivity Linked to Completed Suicides in Elementary School Aged Children

Sheftall AH, Asti L, Horowitz LM, et al. Suicide in Elementary School-Aged Children and Early Adolescents. Pediatrics. 2016;138(4):e20160436

Suicide is the 10th leading cause of death among school age children. Despite this startling fact, most research examining risk factors for suicide in those under 18 has focused on adolescents. The lack of research on completed suicides in elementary-school aged children led researchers at Ohio State to examine data from the National Violent Death Reporting System (NVDRS). The researchers studied suicides in children and young adolescents from seventeen states that fully reported all violent deaths to the NVDRS. The researchers compared the characteristics of younger elementary-school age children (ages 5 to 11) to young adolescents (ages 12 to 14) who died by suicide to determine if there were any characteristics that distinguished these age groups. They reported that almost 60% of the children aged 5 to 11 who completed suicide and who had a prior mental health diagnosis had been diagnosed with ADHD. By contrast, among the young adolescents with prior mental health diagnoses, depression was the common mental health diagnosis.

The researchers concluded that among the young children who committed suicide, impulsivity is linked to higher risk of suicide. Supporting this conclusion is the fact that many of the elementary school aged children who died from suicide were experiencing a major conflict with their family or their friends prior to the event. Many killed themselves by hanging or strangulation in their homes, suggesting that these children may have not planned their attempts beforehand, highlighting that impulsivity in the context of family or social stressors can potentially be lethal. Another important finding was of the 16 elementary school-aged children for whom drug testing was available and who carried a diagnosis of ADHD, only 1 child had evidence of amphetamine at the time of death. This suggests that many of the children with ADHD in this sample may not have been in active treatment at the time of death; thus, they were not benefitting from the impulsivity-reducing effects of stimulant medication. The majority of the children who committed suicide were African-American boys, a surprising finding given that among U.S. adults, Caucasians are significantly more likely than African-Americans to commit suicide. It has been well documented in other studies that African-American children are less likely to receive adequate treatment for mental health disorders than their Caucasian peers. This research study lends further support to the view that mental health disparities may be endangering the lives of African-American children, especially those with untreated ADHD. Since impulsivity may be a major risk factor for completed suicide in elementary school-aged children, this study can help guide suicide prevention efforts in this age group by encouraging the teaching of problem-solving skills in crisis situations. Hopefully, it will encourage pediatricians, educators and others who work with elementary-school aged children to provide extra supervision and support for them during times of conflict with family members or peers, and to refer those with risky behaviors for mental health treatment. Equally important, this study points out the life-threatening aspects of ADHD and the urgent need to take the diagnosis and its treatment seriously. As Dahlsgaard and others have already noted, ADHD is associated with premature mortality. With growing concerns about youth suicide as a public health problem in the U.S., this study makes an important contribution to the scientific literature.

Reference

Søren Dalsgaard, Søren Dinesen Østergaard, James F Leckman, Preben Bo Mortensen, Marianne Giørtz Pedersen
“Mortality in children, adolescents, and adults with attention deficit hyperactivity disorder: a nationwide cohort study”
The Lancet, Volume 385, Issue 9983, 30 May–5 June 2015, Pages 2190-2196

Lisa Adler MD
Anthony Rostain MD

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