The Problem of Children's Suicide:

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CriminologyTherapy and Comparative

International Journal of Offender

http://ijo.sagepub.com/content/26/1/10The online version of this article can be found at:

DOI: 10.1177/0306624X82026001011982 26: 10Int J Offender Ther Comp Criminol

Donald McGuireThe Problem of Children's Suicide: Ages 5-14

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The Problem of Childrens Suicide:

Ages 5-14

Donald McGuire

J. S. tried to take his own life on several occasions between the

ages of 9 and 11. J.S. expressed his fear of growing up and hisfrustrations with life.

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 thefuture 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 basicallygrowing up.

Interviewer: Did you ever try to kill yourself?

J.S.: Oh, sure.Afeyv times.

Interviewer: How old were you then?

J.S. : Theres been a few times. I remember maybe about 9, I tooka bottle of sleeping pills that were at home.A few times Itried to cut myself with a razor blade. I still got scars. I guessabout 9, 10 and 11.

As far back as 1965, Shaw and Schelkum (1965), experts inchildhood suicide, suggested that childhood suicide statistics wereconservative since a number of deaths reported as accidents forthe 5-to-14 age group actually may have been suicides. Winn (1966),Toolan (1962) and Pfeffer (1979) confirmed this. Peck (1980),director of the LosAngeles Suicide Prevention Center, suggestedthat 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 havegone and continue to go unreported, and that medically and

psychologically many suicide attempts go untreated, as such, dueto the historically strong traditional social, religious and legal taboosassociated with the act (Farberow and Scheidman, 1961; Hall, 1976;Shaw, 1965).

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Limitations on Identifying Childhood Suicide and SuicideAttemptsShaw and Schelkun (1965) reviewed studies on the limitations in

identifying suicide and/or attempted suicide. They identifiedfactors 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, whichis one of the chief categories of evidence used by coroners in deter-

mining suicide.2. Suicidal motives in children often are unacceptable in Western

culture since, generally, adults underestimate the strength of thechildrens emotions and motivations. Because the motives are un-

acceptable in Western culture since, generally, adults underestimate

the strength of the childrens emotions and motivations. Because themotives are unacceptable, they remain uninvestigated in mostinstances.

3. The child suicide often is classified as an accident since the

means open to the child are often those of jumping from heightsor running into traffic. Most very young children do not know howto use weapons and drugs effectively.

4.Accidents are by a wide margin the leading cause of death inchildren 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 studying20 children under 15 years of age and 20 under 10 years of age,

analyzed the ways the children said they thought of killing them-selves. Jumping from windows, being hit by a car, taking pills, orusing a knife were high on the list. Children who had access to rail-roads proposed falling on railroad tracks. Thirty per cent of thechildren in this study had carried out the threat to the gesture stage

byan overt

attempt.Toolan (1962) studied children between 2 and 16 years of agewho had attempted suicide. In tracing the histories of the children,he concluded that parents and physicians conceal many cases ofchildhood and adolescent suicide attempts and report them asaccidents. In support of his conclusion, Toolan (1968) reportedthat the Suicide Prevention Center of LosAngeles had estimatedthat 50 per cent of suicides are disguised as accidents.

Pfeffer (1979) confirmed this in a study of 6-to-12 year oldsuicidal children under

psychiatrictreatment at Albert Einstein

Hospital.AUCLA study of childhood suicide histories (ChildrenWho Want to Die, 1978) recommended further investigation of allserious 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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childhood suicides in Czechoslovakia, Fischer (1971) estimated theratio 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, inthe main, on this phenomenon.

Precipitating Environmental Factors in Presuicidal ChildrenAcommon denominator in the study of suicidal children is theloss or threatened loss of love objects such as parents, parent sur-

rogates, or siblings, regardless of whether this loss is due to death,

divorce or separation (Ackerly, 1967; Glasser, 1978a, 1978b; Rosen-berg, 1966; Toolan, 1968; Winn, 1966).Ackerly (1967) studied 21 children between the ages of 4 and12 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 attemptedsuicide, confirmed that continual parent-child fighting results ina 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 thisconflict.

Pfeffers study (1979) indicated that most children had disruptionsin family life due to death or divorce, alcoholism, physical abuse,or poverty following the sudden loss of employment of the wageearner in the household.

In England, Shaffer (1975) studied the histories of 31 childrenwho had committed suicide before the age of 14.All of them had

experienced a lack of emotional support early in their lives, andsome

had a parent or sibling who had attempted or succeeded inthe suicide act.Research identification of suicidal reactions in children under the

age of three is lacking. Furthermore, it is more difficult to ascer-tain the family environmental history in areas such as emotional

support at this age. Lieberman (1953) of the University of Budapestreported on a child of two years and eight months, whom he con-sidered suicidal. After an incident of scolding by the mother, thechild refused to eat or take nourishment. The mothers emotional

neglectand unconscious dislike of her

child,mixed with the childs

passive identification with its mother, Lieberman concluded, leftno path for the child but to attempt to die. Lieberman further

predicted that, although the child survived the emotional traumathrough treatment, catastrophic results could well occur later inthe childs life.



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Apossible parallel to the Lieberman study may be found in a

study of &dquo;failure-to-thrive&dquo; infants. In a psychiatric study of suchinfants, aged between 3 and 24 months, Pollitt (1975) found that

the mothers of these infants scored significantly lower on a Motherand Child Interaction Scale and in observations and interviews inobservations and interviews in this area when compared to a con-trol 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 interactionswith the infants, have fewer spoken contacts with them, and resortedmore often to physical punishment than the mothers in the control

group. The infants presented disturbances in eating, sleeping, andeliminating, and showed autoerotic and self-harming behaviors.

Presuicidal Behaviors of Children

In the literature reviewed, there appears a relatively consistentlist of behaviors exhibited by children who had attempted to commitsuicide. The lack of uniformity of criteria in defining and classify-ing these behaviors is a recognized impediment to a synthesis ofresearch on the topic (Cytryn, 1972; Fischer, 1971) Glaser, 1978;

Shaw, 1965).Researchers have

attemptedto isolate a

groupof

symptoms in presuicidal children, but although common behaviorsand behavioral changes seem to occur in suicidal children, no onehas crystallized a predictive presuicidal syndrome (Otto, 1964;Shaffer, 1975).

DepressionWinn (1966) simply defined childhood depression as internalized

aggression.Acting-out behaviors such as stealing, running away, andvarious school dysfunctions were present in the lives of most ofthe children in his study. Very few of the children studied overtlyexpressed guilt or remorse. In addition, symptoms of depersonal-ization or psychomotor retardation, which often accompany broaderdefinitions of depression, were not generally in evidence.

Fischer (1971) attempted to clarify the use of the term depressionin relating to suicidal children. In reviewing studies, he found thatresearchers had used the term to denote such dynamics of depres-sion as: aggression and hatred turned toward self, a depressivemood, and/or behavior caused by external conditions like the lossof a parent or loneliness. Psychiatrists put together various com-binations of symptoms in different ways to make the diagnosis ofdepression. Since most studies include depression as a symptom,Fischer recommended that there be more precise limitations on theterm to make possible comparisons among studies and conclusionsin studying child suicidology.



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Cytryn and McKnew advanced a proposed classification of child-hood depression. The authors chose the diagnostic labels of acute,chronic, and masked depressive reaction because childhood depres-

sions that are neurotic rather than psychotic types bear enoughsimilarity to justify the use of the officialAPAnomenclature.Cytryn and McKnew (1972) studied 37 children aged 6 to 12 whowere referred to as being depressed in an attempt to arrive atclassification. These children became a group within a hospitalstudy of mood disorders in children in the Childrens Hospital ofthe District of Columbia. The larger hospital study as well as thatof the authors group both revealed that chronic and acute depres-sions were rather infrequent. Masked depressive reactions in child-

ren were frequent although often unrecognized. Cyhryne andMcKnew summarized their definition of child depression in this

complex descrption (see Case History p.15 for the entire text): Themasked depressive reaction takes the form of aggressive behavior,hyperactivity, psychosomatic illness, hypochondria, delinquency or acombination of emotional symptoms. In addition, they identified a

syndrome of depressive symptoms of latency-age children as a per-sistently sad affect, social withdrawal, helplessness, social failure,anxiety, sleep and feeding disturbances, and suicidal ideas andthreats. Suicidal

attemptswere rare.

Specific Behaviors of Presuicidal Children

Although specific behaviors of presuicidal children could be sub-sumed in the definition of masked depressive reactions, each of thebehaviors 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 home2. Accident proneness3. Impulsive acting out4. Temper tantrums5. Self-deprecation6. Serious conflict7. Lineliness

8. Aggressions, external and inhibited9. Changes in school performance

10. Psychosomatic illness

In addition to the behaviors listed, Shaw (1965) included diffi-

culty in communicating, sado-masochistic tendencies, hypersensi-tivity, hypersuggestibility, low frustration tolerances, and morbidfantasies and dreams. Toolan (1968) concurred with this idea. He

reported the young childs fantasy life may center around his or



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her feeling of being unwanted and how his death would result inthe grief and sorrow of the parents.

Otto (1964) studied 1,700 Swedish children under the age of 21known to have

attemptedsuicide between the

years1955 to 1959.

In addition to most of the symptoms listed at the beginning of thissection, 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 presentin all the research cited. The descriptions of some of the behaviors,or categories of behavior such as serious conflict, varied widelyfrom 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 fieldwere interviewed about their cases. One of the first interviewedwas a Grief Counsellor, Eileen McGrath, Director of Shell of Hopein Brooklyn who stated that betweenApril and November of 1980she had worked with twelve suicidal children under the age of

12.

The following presentation of a case history raises the unsolvedproblem of &dquo;intent to take ones own life&dquo; in young childrenssuicide. (The adults, in this case, attempted to minimize the childsintent, but it was overcome by the child himself.)

Case HistoryMcGrath: We know that children are sometimes-theyre not little

passive recipients of our actions-they know whats happening, and theyneed 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 wasntin the middle, but he wasnt near the end, either. He wasnt the lastone. Johnny felt very out of the family. Every time he wanted to saysomething 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 moreand more frustrated. He said one day to his older brother, who was

12, &dquo;Nobody wants me around here, Im going to kill myself. MaybeI could go as the bionic man, or maybe I could go as Superman.&dquo; Thenhe 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 wouldtalk 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 justtried to play Superman and jumped out of the window recently. Butthis little fellow, he sat down then, and his brother overhead him,and was doodling, like by drawing little pictures. He was saying, &dquo;Icant y. un-huh, and I cant run real fast. I know what Ill do, Illwait on the comer, and when the car goes by real fast, Ill run in frontof it.And I know I wont be able to stop it, cause nobody will missme anyway.&dquo;And then he went on and on and on. Sure enough, maybeabout three weeks later, he was standing on the comer.And it was a



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rather busy highway and he looked down the road, and there was

nothing coming this way.And he looked the other way, and there wasa truck coming, and he waited, and the truck got closer, and he dartedout in front of the truck.And the got hit. He lived for maybe four

weeks after that.And he became conscious again.And everybody wassaying, &dquo;What a terrible accident&dquo;. So, when I was called in to speakwith him, he said-he could just about speak, but he said very softly-he couldnt move, he looked around to see if anybody was around, andhe 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 gethurt that bad and die?&dquo; He said, &dquo;I figured, if I died, it wouldnthurt as much as if I lived.&dquo;

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

REFERENCES

Ackerly, W. (1967) LatencyAge Children Who Threaten orAttemptto Kill Themselves, Journal ofAmericanAcademy 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.

Fischer, J. (1971) Depressive States and Suicidal Thoughts in Child-ren, In Proceedings of the 4th UEP Congress, Stockholm: AlmquistWiksel.

Glaser, K. (1978)Attempted Suicide in Children and Adolescents:Psychodynamics,American Journal of Psychotherapy, 32, 225-227. (a)

(1978) The Treatment of Depressed and SuicidalAdolescents:

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 theAdoles-cents Preceding SuicidalAttempts,Acta Psychiatrica Scandinavica, 40,386-399.

Peck, M. (1980) Recent Trends in SuicideAmong 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) SuicideAttempts 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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Toolan, J. (1962) Suicide and Suicidal Attempts in Children and

Adolescents,American Journal of Psychiatry, 118, 719-724. (1968) Suicide in Childhood andAdolescence. In E. Resnik (Ed.),

Suicide Behavior: Diagnosis and Management, Boston: Little Brown.

Winn, D. & Halia, R. (1966) Observations of Children Who Threatento 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, Carol Antoinette Peacock, New York:

Schocken, 1981, 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 indetail, and describes her work with a group of particularly difficult andseemingly hopeless adolescent girls. They were all brought up almost

entirely by a mother who had had children too early, had failed in allher hopes and had no discipline or tradition in child-rearing to fall backon. The mothers themselves had had little experience of a loving caringupbringing; they sought escape and love, and found teenage pregnancy,poverty and loneliness, increasingly dependent on their own daughtersto whom they had passed on their own hopes and dreams-and theirown inadequacies. Miss Peacock describes how she established her

&dquo;group&dquo;, gave thema

feeling of belonging, tried to meet the girls andtheir mothers regularly and independently, tried to establish limits totheir behaviour and by continuous encouragement and cajoling, ledthem in most cases to a more realistic view of life, to work for successon a limited basis and then widen their vision so that they could go onto a better future.At the same time, she encouraged the mothers to

accept their daughters independence, and to develop their own interestson a more realistic basis.

The situation described is an unhappy cycle which is likely to go onperpetuating itself if there are not enough people like the author willingto devote a

greatdeal of time and

patienceand care on adolescent

girls of this type.At a time when infertile couples have the greatestdifficulty in adopting children, would it not be better to reverse thecurrent trend in social work and encourage teenage mothers to havetheir babies adopted? Not only would the mothers have the chance of afresh start, but the babies would have a better hope for the future.

Betty Tahourdin
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The Problem of Children's Suicide: