Suicide and
the Exceptional ChildAuthor:
Eleanor C. Guetzloe
ERIC EC Digest
#E508 November 1991 Since
the 1950s, suicide rates have increased dramatically among young people
in the U.S. and Canada. Suicide is the third leading cause of death of
young people between the ages of 15 and 24 in the U.S. (National Center
for Health Statistics, 1989), and the second leading cause in Canada (Health
and Welfare Canada, 1987). Although official suicide rates are much lower
for children under 15, suicidal behavior has been reported even in very
young children. It is generally accepted that many suicides are unreported
or misreported as accidents or death due to undetermined causes (particularly
for young children). It has been estimated that the actual number of suicides
may be two to three times greater than official statistics indicate (American
Psychiatric Association, 1985). The presence of a
psychiatric disorder—particularly a mood disorder such as depression
or bipolar illness, a conduct disorder, or a psychosis—contributes
to the likelihood of suicide. Depression often exists in conjunction with
other mental disorders or with other long-lasting social or behavioral
problems. However, not all students with depression or other psychiatric
disorders are suicidal. Very little information
is available regarding the prevalence of depression or suicide in students
who receive special education services, although relationships between
cognitive deficits and depression and between diminished problem-solving
abilities and suicidal behavior have been noted. Medical problems have
also been associated with depression and suicide. Estimates of the prevalence
of depression or symptoms of depression among children and youth with
learning or behavior problems tend to be higher than those for the general
population (e.g., Forness, 1988). Children with symptoms of depression,
particularly gifted children or children who do not also exhibit symptoms
of another disorder, may be overlooked in the school referral process
for special education services (Guetzloe, 1989, 1991). What Factors
Place Students at Risk of Suicide? Researchers have attempted
to identify situations, experiences, or characteristics that contribute
to the likelihood that a child will complete a suicide (e.g., Blumenthal,
1990; Davidson & Linnoila, 1991; Pfeffer, 1989). When a child has
more than one of these factors, the risk of suicide is increased. In addition
to mental illness and behavior disorders, suicide has been associated
with demographic factors, such as being between the ages of 15 and 24,
being white or male, or having a history of attempted suicide. Psychosocial
conditions, such as parental loss, family disruption, exposure to suicide,
unwanted pregnancy, and particularly, having a relative who has committed
suicide are additional factors. Certain biological conditions have also
been associated with suicide; these include perinatal factors, decreases
in levels of serotonin, and decreases in the secretion of growth hormone,
among others. The American Association
of Suicidology has developed guidelines for the media, aimed at reducing
the contagious effects of suicide reports. They recommend that the press
avoid providing specific details of the method, romanticization of the
suicide, descriptions of suicide as unexplainable, and simplistic reasons
for the suicide. Further, news stories about suicide should not be printed
on the front page, the word suicide should not be in the headline, and
a picture of the person who committed suicide should not be printed. How Can a
Student Who Is Potentially Suicidal Be Recognized? Suicidal ideas, threats,
and attempts often precede a suicide. The most commonly cited warnings
of potential suicide include (a) extreme changes in behavior, (b) a previous
suicide attempt, (c) a suicidal threat or statement, and (d) signs of
depression. Young children who have depression may have physical complaints,
be agitated, or hear imaginary voices. Adolescents may have school difficulties,
may withdraw from social activities, have negative or antisocial behavior,
or may use alcohol or other drugs. They may display increased emotionality,
and their moods may be restless, grouchy, aggressive, or sulky. They may
not pay attention to their personal appearance. They may refuse to cooperate
in family ventures or want to leave home. They may feel that they are
not understood or that they are not approved of, or they may be very sensitive
to rejection in love relationships. What Can Educators
Do? The primary role of
all school personnel is to detect the signs of depression and potential
suicide, to make immediate referrals to the contact person within the
school, to notify parents, to secure assistance from school and community
resources, and to assist as members of the support team in follow-up activity
after a suicide threat or attempt. Special educators should be aware that
many exceptional students, particularly those with emotional or behavioral
disorders, may be depressed or potentially suicidal, and also that many
depressed or suicidal youngsters are not referred for special education
services. Discussions with students should stress the individuals and
agencies that are available to help students and the steps they can take
in seeking help for themselves, their friends, and their families in case
of emergencies. When a classroom teacher
notices changes in a student that may be an indicator of suicidal behavior,
immediate action is crucial. Teachers and other school personnel who detect
signs of depression or potential suicide in a student must immediately
notify the school contact person, who will in turn notify the parents
and other appropriate individuals in the school or community. The student
should be kept under close supervision and must not be left alone. It
is important to let the student know that adults in the school are concerned
about his or her welfare. Students who are depressed or suicidal may misinterpret
uncertainty or failure to respond as a lack of caring (Guetzloe, 1989).
One course of action
for students who show signs of depression or potential suicide is referral
for special education assessment. A special education teacher can provide
a safe, structured, and positive classroom environment and an appropriate,
effective educational program. Classroom behavior management systems that
emphasize support, encouragement, gains, and rewards rather than punishment
should be implemented. The individualized education program (IEP) of a
student with symptoms of depression or suicidal behavior should include
goals and objectives related to the alleviation of risk factors. What Are the
School's Responsibilities Regarding Assessment? School assessments
should be regarded as additional to, rather than a substitute for, an
assessment by a mental health professional. Authorities have often suggested
that evaluation for suicide potential should be included in the diagnostic
procedure for any child referred for any reason to a physician or psychiatrist.
The assessment process provides a means of consulting with parents and
other school professionals and an opportunity to assess the risk factors
present in the student's life. Alleviation of the risk factors should
be goals on the student's IEP. The involvement of the family as part of
the school program for depressed and potentially suicidal youngsters is
extremely important. School psychologists
are important members of the IEP team for depressed or suicidal children.
Assessment instruments suitable for use by school psychologists who have
received specific training are available. Many clinicians feel that a
battery of screening and assessment instruments, including a variety of
assessment techniques such as interviews, checklists, questionnaires,
and inventories is required for an accurate assessment of depression and
suicidal risk. The role of the school psychologist may also include crisis
intervention and treatment within the school. If these responsibilities
are part of the school psychologist's role, they should be included in
the job description, and the psychologist should carry liability insurance.
What Are the
Components of an Effective School Program? Many school suicide
prevention programs have not been evaluated for efficacy and safety. Researchers
have questioned the effectiveness of curricular programs, and some research
suggests that such programs may actually increase the risk for students
who have attempted suicide (Shaffer, 1988). They recommended instead that
schools concentrate on providing individual assistance to students who
are most at risk. Schools should exercise caution in developing a plan
for suicide prevention, but a written and approved plan must be developed.
Each school plan should
be developed by the district's own committee and should be a team effort
by all individuals, groups, and agencies that may be affected by its implementation.
A comprehensive program will include procedures related to all three levels
of prevention—for the aftermath of a suicide crisis (tertiary prevention),
for dealing with suicide attempts, threats, and ideation, (secondary prevention),
and for the enhancement of mental health (primary prevention). The full
continuum of special education services—ranging from counseling,
special materials, and specialized instruction within the regular school
program to short- and long-term residential placements—is an essential
component of the intervention plan. It is advisable to seek legal counsel
regarding the plan to address issues of liability. A comprehensive plan
would include the following (Guetzloe, 1989, 1991): - Crisis teams at
the school and district levels as well as a community crisis team or
network of professionals.
- A contact person,
such as the school counselor, who is designated to maintain communication
among teachers, students, parents, and community treatment providers.
- Case management.
- Procedures for
documenting referrals, notifying parents and working with depressed
or suicidal students.
- Policies and procedures
that clearly delineate the appropriate steps to follow in the event
of suicidal behavior and the responsibilities of the various school
personnel in carrying out the plan.
- Training for teachers
and other school personnel.
- Provision of positive
information to students about the symptoms of depression and suicidal
behavior, resources available in the school and community, and procedures
for referring themselves or others to these services.
References American Psychiatric
Association (1985, March). Facts About Teen Suicide. Washington, DC: Author.
Blumenthal, S. (1990,
December 26). Youth Suicide: The Physician's Role in Suicide Prevention.
Journal of the American Medical Association, 264 (24), 3194-3196. Davidson, L., &
Linnoila, M. (Eds.) (1991). Risk Factors for Youth Suicide. New York:
Hemisphere. Forness, S. R. (1988).
"School Characteristics of Children and Adolescents with Depression."
In R. B. Rutherford, C. M. Nelson, & S. R. Forness (Eds.), Bases of
Severe Behavioral Disorders of Children and Youth (pp. 177-204). Boston:
Little, Brown. Guetzloe, E. C. (1989).
Youth Suicide: What the Educator Should Know. Reston, VA: The Council
for Exceptional Children. (ED 316963) Guetzloe, E. C. (1991).
Depression and Potential Suicide: Special Education Students at Risk.
Reston, VA: The Council for Exceptional Children. Health and Welfare
Canada (1987). Suicide in Canada. Ottawa: Minister of National Health
and Welfare. National Center for
Health Statistics. (1989). Advance report of final mortality statistics,
1987. Monthly vital statistics report, Vol. 38 No. 5, Supplementary DHHS
Publication. Hyattsville, MD: U.S. Public Health Service. Pfeffer, C. R. (1989).
"Studies of Suicidal Preadolescent and Adolescent Inpatients: A Critique
of Research Methods." In Suicide and Life-Threatening Behavior, 19
(1), 58-77. Shaffer, D. (1988,
April). "School Research Issues." Paper presented at the 21st
Annual Conference of the American Association of Suicidology. Washington,
DC.
The
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