Suicide Risk in Children (page 2)

By — Pearson Allyn Bacon Prentice Hall
Updated on Jul 20, 2010

Developmental Considerations of Childhood Suicide Risk

As was noted in the case of Bryan, one of the most salient aspects of understanding suicide risk in children is determining whether children have an understanding of the permanence of suicide and death. This question was originally raised toward the end of World War II by researchers who interviewed children about what they thought happens when a person dies. Two researchers (Anthony, 1940; Nagy, 1948) developed a series of stages through which children progress in their acquisition of a mature understanding of death. Children with immature belief systems did not believe that death was permanent, inevitable, or universal. These early researchers attempted to delineate stages that were fixed to chronological age, with very little success.

Research during the 1970s found that beliefs about death were not necessarily related to chronological age. Both Koocher (1973) and Melear (1973) found that cognitive development, rather than chronological age, determined conceptualizations of death. Other research found that exposure to death increased the likelihood of mature understandings of the concept. Raimbault (1975) found that terminally ill children had advanced understandings of death, even at very young ages.

More recently, Normand and Mishara (1992) attempted to understand what children know about death and when they know it. They found that 87% of elementary school age children understood the concept of the universality of death, and 90% understood the finality. In their study, all children had a mature concept of death by the age of 10 years. When asked about suicide, only 10% of first graders knew what the word suicide meant, but when fifth graders were interviewed, 95% had an understanding of the word.

In 1999, Mishara extended the original study. He found that students in first grade had relatively immature concepts of death, although the majority understood the permanence of death. Students in fifth grade had a very mature understanding of death. There was strong evidence that as children matured, they grew in their understanding of death. They concluded that most of the children in this and the 1992 (Normand & Mjshara) studies understood the permanence and finality of death, even at very young ages. Additionally, Mishara (1999) found that 100% of children in second grade and higher understood the concept of suicide or "killing oneself," including the permanence of the act. Therefore, it might be inappropriate to argue that self-injurious behaviors in children should not be called suicides or suicide attempts because of their immature belief systems. It appears that most children over the ages of 7 or 8 years—at least those in the studies reviewed here—do understand that self-injurious behaviors can lead to permanent death. However, it should be noted that in a 1994 study, suicidal hospitalized children ages 8-10 were less likely to understand the finality of death than were their nonsuicidal same-aged peers (Carlson, Asarnow, & Orbach, 1994). Thus, it appears that immature conceptualizations of death may be a risk factor for childhood suicide.

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