International Journal of Offender Therapy and Comparative Criminology http://ijo.sagepub.

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The Problem of Children's Suicide: Ages 5-14

Donald McGuire Int J Offender Ther Comp Criminol 1982 26: 10 DOI: 10.1177/0306624X8202600101 The online version of this article can be found at: http://ijo.sagepub.com/content/26/1/10

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The Problem of Childrens Suicide: Ages 5-14

Donald McGuire
J. S. tried to take his of 9 and 11. J.S. frustrations with life.
ages
own

life on several occasions between the expressed his fear of growing up and his

J.S.: Its funny. I just-to me the whole thing was a joke. Really, I was really scared of growing up. I couldnt imagine how the future would be. So, if I could avoid growing up in any way, I would do anything to avoid it. If I had to kill myself, I will. I mean, its that kind of thing. I think I was scared basically

growing

up.
ever

Interviewer: Did you

J.S.: Oh,
sure.

try to kill yourself?

feyv times.
were

Interviewer: How old

you then?

J.S. : Theres been a few times. I remember maybe about 9, I took a bottle of sleeping pills that were at home. A few times I tried to cut myself with a razor blade. I still got scars. I guess about 9, 10 and 11.
As far back as 1965, Shaw and Schelkum (1965), experts in childhood suicide, suggested that childhood suicide statistics were conservative since a number of deaths reported as accidents for the 5-to-14 age group actually may have been suicides. Winn (1966), Toolan (1962) and Pfeffer (1979) confirmed this. Peck (1980), director of the Los Angeles Suicide Prevention Center, suggested that another factor contributing to the under-reporting may be the practice of United States coroners of avoiding the term &dquo;suicide&dquo; to describe the cause of death for persons under ten years of age. Authorities seem to agree that a large number of suicides have gone and continue to go unreported, and that medically and psychologically many suicide attempts go untreated, as such, due to the historically strong traditional social, religious and legal taboos associated with the act (Farberow and Scheidman, 1961; Hall, 1976;

Shaw, 1965).
10

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11

Limitations on Identifying Childhood Suicide and Suicide Attempts Shaw and Schelkun (1965) reviewed studies on the limitations in identifying suicide and/or attempted suicide. They identified factors that may cause the recorded suicides of children under 10 years of age to be far fewer than the actual incidences. Some of these factors include: 1. Young children often are unable to write suicide notes, which is one of the chief categories of evidence used by coroners in determining suicide. 2. Suicidal motives in children often are unacceptable in Western culture since, generally, adults underestimate the strength of the childrens emotions and motivations. Because the motives are unacceptable in Western culture since, generally, adults underestimate the strength of the childrens emotions and motivations. Because the motives are unacceptable, they remain uninvestigated in most instances. 3. The child suicide often is classified as an accident since the means open to the child are often those of jumping from heights or running into traffic. Most very young children do not know how
to use weapons and drugs effectively. 4. Accidents are by a wide margin the

leading cause of death in children and adolescents. There is no way of knowing how many reported accidents are actually suicides. Other studies serve to substantiate the finding that childhood suicide attempts often resemble accidents. Winn (1966), in studying 20 children under 15 years of age and 20 under 10 years of age, analyzed the ways the children said they thought of killing themselves. Jumping from windows, being hit by a car, taking pills, or using a knife were high on the list. Children who had access to railroads proposed falling on railroad tracks. Thirty per cent of the children in this study had carried out the threat to the gesture stage by an
overt

attempt.

Toolan (1962) studied children between 2 and 16 years of age who had attempted suicide. In tracing the histories of the children, he concluded that parents and physicians conceal many cases of childhood and adolescent suicide attempts and report them as accidents. In support of his conclusion, Toolan (1968) reported that the Suicide Prevention Center of Los Angeles had estimated that 50 per cent of suicides are disguised as accidents. Pfeffer (1979) confirmed this in a study of 6-to-12 year old suicidal children under psychiatric treatment at Albert Einstein Hospital. A UCLA study of childhood suicide histories (Children Who Want to Die, 1978) recommended further investigation of all serious accidents of children in order to rule out self-destruction as a factor in the accident. In reporting on the ambiguity of definition and reporting of

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12

childhood suicides in Czechoslovakia, Fischer (1971) estimated the ratio of children committing suicide to be between 7: 1 and 100: 1. It is, therefore, difficult to make predictions about any individual group and even more so about an individual child in any age or sex group. Little research was found on suicidal children below the age of five. This may be because early infancy research does not focus, in the

main,

on

this

phenomenon.

Precipitating Environmental
A loss
common

Factors in Presuicidal Children denominator in the study of suicidal children is the or threatened loss of love objects such as parents, parent surrogates, or siblings, regardless of whether this loss is due to death, divorce or separation (Ackerly, 1967; Glasser, 1978a, 1978b; Rosen-

the ages of 4 and 12 who had threatened suicide. Each childs circumstances included a long history of fighting with a parent. Rosenberg and Latimer (1966), in studying 9- to 18-year-old children who had attempted suicide, confirmed that continual parent-child fighting results in a crippling emotional environment that may cause an acute distress; this in turn leads to the final regression from reality that results in suicide. Thus, suicide may be a cry for help in coping with this conflict. Pfeffers study (1979) indicated that most children had disruptions in family life due to death or divorce, alcoholism, physical abuse, or poverty following the sudden loss of employment of the wage earner in the household. In England, Shaffer (1975) studied the histories of 31 children who had committed suicide before the age of 14. All of them had experienced a lack of emotional support early in their lives, and some had a parent or sibling who had attempted or succeeded in the suicide act. Research identification of suicidal reactions in children under the age of three is lacking. Furthermore, it is more difficult to ascertain the family environmental history in areas such as emotional support at this age. Lieberman (1953) of the University of Budapest reported on a child of two years and eight months, whom he considered suicidal. After an incident of scolding by the mother, the child refused to eat or take nourishment. The mothers emotional neglect and unconscious dislike of her child, mixed with the childs passive identification with its mother, Lieberman concluded, left no path for the child but to attempt to die. Lieberman further predicted that, although the child survived the emotional trauma through treatment, catastrophic results could well occur later in the childs life.

berg, 1966; Toolan, 1968; Winn, 1966). Ackerly (1967) studied 21 children between

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13

to the Lieberman study may be found in a of &dquo;failure-to-thrive&dquo; infants. In a psychiatric study of such infants, aged between 3 and 24 months, Pollitt (1975) found that the mothers of these infants scored significantly lower on a Mother and Child Interaction Scale and in observations and interviews in observations and interviews in this area when compared to a control group. All other variables were not statistically significant. Indication of parental rejection or neglect of the &dquo;failure-to-thrive&dquo; infants was based on items that found these mothers were more distant and less affectionate, showed fewer interpersonal interactions with the infants, have fewer spoken contacts with them, and resorted more often to physical punishment than the mothers in the control group. The infants presented disturbances in eating, sleeping, and eliminating, and showed autoerotic and self-harming behaviors.

possible parallel

study

Presuicidal Behaviors of Children In the literature reviewed, there appears a relatively consistent list of behaviors exhibited by children who had attempted to commit suicide. The lack of uniformity of criteria in defining and classifying these behaviors is a recognized impediment to a synthesis of research on the topic (Cytryn, 1972; Fischer, 1971) Glaser, 1978; Shaw, 1965). Researchers have attempted to isolate a group of

symptoms in presuicidal children, but although

common

behaviors

and behavioral changes seem to occur in suicidal children, no one has crystallized a predictive presuicidal syndrome (Otto, 1964;

Shaffer, 1975).

Depression Winn (1966) simply defined childhood depression as internalized aggression. Acting-out behaviors such as stealing, running away, and various school dysfunctions were present in the lives of most of the children in his study. Very few of the children studied overtly expressed guilt or remorse. In addition, symptoms of depersonalization or psychomotor retardation, which often accompany broader definitions of depression, were not generally in evidence. Fischer (1971) attempted to clarify the use of the term depression in relating to suicidal children. In reviewing studies, he found that researchers had used the term to denote such dynamics of depression as: aggression and hatred turned toward self, a depressive mood, and/or behavior caused by external conditions like the loss of a parent or loneliness. Psychiatrists put together various combinations of symptoms in different ways to make the diagnosis of depression. Since most studies include depression as a symptom, Fischer recommended that there be more precise limitations on the term to make possible comparisons among studies and conclusions in studying child suicidology.

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14

Cytryn and McKnew advanced a proposed classification of childdepression. The authors chose the diagnostic labels of acute, chronic, and masked depressive reaction because childhood depressions that are neurotic rather than psychotic types bear enough
hood

similarity to justify the use of the official APA nomenclature. Cytryn and McKnew (1972) studied 37 children aged 6 to 12 who were referred to as being depressed in an attempt to arrive at classification. These children became a group within a hospital study of mood disorders in children in the Childrens Hospital of the District of Columbia. The larger hospital study as well as that of the authors group both revealed that chronic and acute depressions were rather infrequent. Masked depressive reactions in children were frequent although often unrecognized. Cyhryne and McKnew summarized their definition of child depression in this complex descrption (see Case History p.15 for the entire text): The
depressive reaction takes the form of aggressive behavior, hyperactivity, psychosomatic illness, hypochondria, delinquency or a combination of emotional symptoms. In addition, they identified a syndrome of depressive symptoms of latency-age children as a persistently sad affect, social withdrawal, helplessness, social failure, anxiety, sleep and feeding disturbances, and suicidal ideas and
masked

threats. Suicidal attempts

were rare.

Specific Behaviors of Presuicidal Children

Although specific behaviors of presuicidal children could be subsumed in the definition of masked depressive reactions, each of the behaviors in the following list has also been described separately by Ackerly (1967), Winn (1966), Glaser (1978a), Shaffer (1975), Pfeffer (1979), Toolan (1962) and Shaw (1965):
1. Running away from home 2. Accident proneness 3. Impulsive acting out 4. Temper tantrums 5. Self-deprecation 6. Serious conflict 7. Lineliness 8. Aggressions, external and inhibited 9. Changes in school performance 10. Psychosomatic illness

In addition to the behaviors listed, Shaw (1965) included difficulty in communicating, sado-masochistic tendencies, hypersensitivity, hypersuggestibility, low frustration tolerances, and morbid fantasies and dreams. Toolan (1968) concurred with this idea. He reported the young childs fantasy life may center around his or

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15

her feeling of being unwanted and how his death would result in the grief and sorrow of the parents. Otto (1964) studied 1,700 Swedish children under the age of 21 known to have attempted suicide between the years 1955 to 1959. In addition to most of the symptoms listed at the beginning of this section, he found sleep disturbances a common behavioral pattern. The behaviors isolated in the research discussed in this section occur in combinations. Several behaviors were described as present in all the research cited. The descriptions of some of the behaviors, or categories of behavior such as serious conflict, varied widely from one individual childs case study to the next. In an effort to obtain a glimpse of the scope of the problem of childrens suicide, ages 5-14, professionals prominent in the field were interviewed about their cases. One of the first interviewed was a Grief Counsellor, Eileen McGrath, Director of Shell of Hope in Brooklyn who stated that between April and November of 1980 she had worked with twelve suicidal children under the age of 12. The following presentation of a case history raises the unsolved problem of &dquo;intent to take ones own life&dquo; in young childrens suicide. (The adults, in this case, attempted to minimize the childs intent, but it was overcome by the child himself.)
Case History
are sometimes-theyre not little actions-they know whats happening, and they need to be listened to. You want another case. Johnny was five also. And Johnny was one of eight children. He had two younger than he, and he really got the short end of the stick a lot of times. He wasnt in the middle, but he wasnt near the end, either. He wasnt the last one. Johnny felt very out of the family. Every time he wanted to say something he was hushed up or &dquo;go out and play&dquo;, or &dquo;do the dishes&dquo;, or &dquo;set the table&dquo;, or &dquo;help do the dishes&dquo;. He was just getting more and more frustrated. He said one day to his older brother, who was 12, &dquo;Nobody wants me around here, Im going to kill myself. Maybe I could go as the bionic man, or maybe I could go as Superman.&dquo; Then he started fantasizing. His fairy tales were into the shows hed been watching. His brother said, &dquo;Dont be silly&dquo;, as a 12-year-old would talk to a 5-year-old: &dquo;This is ridiculous. Thats just a television show. You cant do that.&dquo; Its almost like the little four-year old who just tried to play Superman and jumped out of the window recently. But this little fellow, he sat down then, and his brother overhead him, and was doodling, like by drawing little pictures. He was saying, &dquo;I cant y. un-huh, and I cant run real fast. I know what Ill do, Ill wait on the comer, and when the car goes by real fast, Ill run in front of it. And I know I wont be able to stop it, cause nobody will miss me anyway.&dquo; And then he went on and on and on. Sure enough, maybe about three weeks later, he was standing on the comer. And it was a

McGrath: We know that children

our

passive recipients of

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16

busy highway and he looked down the road, and there was nothing coming this way. And he looked the other way, and there was a truck coming, and he waited, and the truck got closer, and he darted out in front of the truck. And the got hit. He lived for maybe four weeks after that. And he became conscious again. And everybody was saying, &dquo;What a terrible accident&dquo;. So, when I was called in to speak with him, he said-he could just about speak, but he said very softlyhe couldnt move, he looked around to see if anybody was around, and he said, &dquo;It wasnt an accident&dquo;. I said, &dquo;What are you telling me, John? Did you really want to kill yourself? Did you really want to get hurt that bad and die?&dquo; He said, &dquo;I figured, if I died, it wouldnt
rather

hurt

as

much

as

if I lived.&dquo;

Adults, including professionals, have tended to explain away the possibility of a childs intent to take his or her own life. But the evidence has made these explanations less and less acceptable.
REFERENCES

to Kill

Ackerly, W. (1967) Latency Age Children Who Threaten or Attempt Themselves, Journal of American Academy of Child Psychiatry,

6, 242-259.

Cytryn, L. & McKnew, D. (1972) Proposed Classification of Childhood Depression, American Journal of Psychiatry, 192, 2, 63-68. Farberow, N. & Shneidman, E. (1961) The Cry for Help, New York:
McGraw-Hill.
ren, In

Fischer, J. (1971) Depressive States and Suicidal Thoughts in ChildProceedings of the 4th UEP Congress, Stockholm: Almquist

Wiksel.

Glaser, K. (1978) Attempted Suicide in Children and Adolescents: Psychodynamics, American Journal of Psychotherapy 32, 225-227. (a) ,
(1978) The Treatment of Depressed and Suicidal Adolescents: Psychodynamics, American Journal of Psychotherapy, 32, 22-268. (b) 22-268. (b)7225-227. (a) Lieberman, E. P. (1952-53) Three Cases of Attempted Suicide in Children, British Journal of Psychology, pp. 110-114. Otto, U. (1964) Changes in the Behavior of Children and the Adolescents Preceding Suicidal Attempts, Acta Psychiatrica Scandinavica, 40,
— —

386-399.

Peck, M. (1980) Recent Trends in Suicide Among Young People, Los Angeles: Institute for Studies of Destructive Behaviors. Pfeffer, C. (1979) Why Six-Year-Olds Try Suicide, The New York Post, May 14, p. 24. Rosenberg, P. & Latimer, R. (1966) Suicide Attempts by Children, Mental Hygiene, 50, 354-359. Schaffer, D. (1975) Suicide in Children, British Medical Journal, 15,
592.

Shaw, C. & Schelkun, R. (1965) Suicidal Behavior in Children, Psychiatry, 28, 157-168.

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17

Toolan, J. (1962) Suicide and Suicidal Attempts in Children and Adolescents, American Journal of Psychiatry, 118, 719-724. (1968) Suicide in Childhood and Adolescence. In E. Resnik (Ed.), Suicide Behavior: Diagnosis and Management, Boston: Little Brown. Winn, D. & Halia, R. (1966) Observations of Children Who Threaten to Kill Themselves, Canadian Psychiatric Association Journal, 11, 283— —

294.

Donald McGuire, A.C.S.W., Ed.D. Assistant Professor, Fordham University Graduate School of Social Service, Lincoln Center, New York, 10023, USA.

Book Review
Hand-Me-Down

Dreams,

Schocken, 1981,

Carol Antoinette Peacock, New York: ISBN 0 8052 3761-5, ISBN 0 8052 0678-7 (pbk).

In a recent article in this Journal (23, 3, 1979) Miss Peacock described problems in mother-daughter relationships which frequently lead to delinquency in adolescence. In this book, she examines the problem in detail, and describes her work with a group of particularly difficult and seemingly hopeless adolescent girls. They were all brought up almost entirely by a mother who had had children too early, had failed in all her hopes and had no discipline or tradition in child-rearing to fall back on. The mothers themselves had had little experience of a loving caring upbringing; they sought escape and love, and found teenage pregnancy, poverty and loneliness, increasingly dependent on their own daughters to whom they had passed on their own hopes and dreams-and their own inadequacies. Miss Peacock describes how she established her &dquo;group&dquo;, gave them a feeling of belonging, tried to meet the girls and their mothers regularly and independently, tried to establish limits to their behaviour and by continuous encouragement and cajoling, led them in most cases to a more realistic view of life, to work for success on a limited basis and then widen their vision so that they could go on to a better future. At the same time, she encouraged the mothers to accept their daughters independence, and to develop their own interests

realistic basis. The situation described is an unhappy cycle which is likely to go on perpetuating itself if there are not enough people like the author willing to devote a great deal of time and patience and care on adolescent girls of this type. At a time when infertile couples have the greatest difficulty in adopting children, would it not be better to reverse the current trend in social work and encourage teenage mothers to have their babies adopted? Not only would the mothers have the chance of a fresh start, but the babies would have a better hope for the future. Betty Tahourdin
on a more

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