In youngest suicide victims, ADD is more common than depression

(Reuters Health) - When children under 12 commit suicide, they are more likely to have a diagnosis of attention deficit disorder than depression, a U.S. study suggests.

“Although suicide is extremely rare in elementary school-aged children, a child can and sometimes will think about and even attempt suicide,” said senior study author Dr. Jeffrey Bridge of Nationwide Children’s Hospital in Columbus, Ohio.

The findings suggest that suicide prevention efforts may need to include a focus on behavior even before children appear suicidal, Bridge added by email.

“This approach has incredible potential to reduce suicide rates in young people,” Bridge said.

In 17 states from 2003 to 2012, researchers compared 87 suicides in kids ages 5 to 11 to 606 suicides in adolescents aged 12 to 14.

About one third in each group had a diagnosed mental health problem, researchers report in the journal Pediatrics.

Roughly 59 percent of the young kids in the study with a mental health diagnosis had attention deficit disorder, with or without hyperactivity, compared with 29 percent of the teens.

The pattern was reverse in the teens. Depression accounted for 66 percent of their mental health diagnoses, compared with just 33 percent for the younger children.

Overall, few children and early adolescents had illegal drugs or alcohol in their systems when they died, the study also found.

However, about 4 percent of the younger kids and 8 percent of the older children tested positive for opiates, which can include prescription painkillers such as codeine and hydrocodone (Vicodin) as well as heroin.

Compared to the teens, the younger suicide victims were more often male, black, and experiencing relationship problems with friends or family members. Younger child suicides were also more likely to happen at home and involve hanging, strangulation or suffocation.

Among the younger suicides, slightly more than 33 percent were black, compared with about 12 percent of the teens.

One limitation of the study is that it only included 17 states, so it isn’t a nationally representative snapshot of suicides among children and teens, the authors note. Researchers also lacked data on drug and alcohol use and the circumstances preceding suicide in some cases.

Even so, the findings suggest that factors contributing to suicide may be different for younger children than for teens, said Dr. Benjamin Shain, a researcher at NorthShore University HealthSystem and the University of Chicago who wasn’t involved in the study.

“Suicide among children may be even more impulsive than it is among adolescents,” Shain added by email.

Prevention efforts might include teaching children how to regulate their emotions and solve problems, said Dr. Bernard Biermann, a psychiatry researcher at the University of Michigan’s C.S. Mott Children’s Hospital in Ann Arbor.

“When it comes to school-aged children, it is important to recognize that impulsivity, combined with low frustration tolerance, can be dangerous,” Biermann, who wasn’t involved in the study, said by email.

Parents should be alert for behavior problems that may surface at school or at home, said Dr. Yolanda Evans, a researcher at Seattle Children’s Hospital who wasn’t involved in the study.

“It may be more beneficial to focus school prevention on improving family and adult communication around emotions, providing avenues for impulse control, and encouraging children to speak up about feelings and teaching parents, teachers, and staff to take any children seriously if they mention thoughts of suicide,” Evans said by email.

What happens after school matters, too.

“Engage children in after-school activities if possible, this exposes them to adults they may learn to trust and confide in, provides an outlet for hyperactive behaviors, provides distraction and social connections to peers, too,” Evans added. “Keep an open line of communication with your kids and if they talk at all about death and suicide, take it seriously.”

SOURCE: Pediatrics, online September 19, 2016.