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What do we know?

• “Social cognition” means being able to understand our own and others’ thoughts, desires, intentions, and feelings.
• Children begin to develop social skills when they understand how people’s thoughts, desires, intentions, and feelings affect the way they act and behave.
• Infants are born with an innate preference for social interactions. From birth, they pay the most attention to human faces and voices.
• In the first months of life, infants are able to smile at people, and respond to others with gestures and facial expressions.
• By the end of the first year, infants start to share interest and attention in objects with you, and may decide whether or not to try a new activity based on your expression. For example, your infant may not play with a new toy if you appear anxious or worried.
• Around the age of two, toddlers distinguish a real object from a pretend object (ex. using a block as a telephone).
• As they grow older, children become able to talk about what they and other people like, want, think or know (around age 3). They also understand that people express different emotions depending on the situation (ex. knowing that an individual is happy when he gets what he wants or sad if he does not).
• Four-year-old children usually recognize that other people’s thoughts may differ from their own. They no longer believe that everyone knows what they know. This step in their development helps them to understand that their own thoughts do not always reflect reality.
• Children who are able to control impulsive thoughts and behaviours are better able to develop social cognition.
• Children who develop social cognition at a young age have the foundations for good social interactions before they start school.
• School-aged children with a well developed social cognition have a tendency to be better at resolving conflicts with friends, which in turn can lead to more positive relationships with their peers. But equally these children may be better at deception and manipulation.
• Social and cognitive understanding can have a positive impact on children’s later school success.

Information
This Key Message is a publication of the Centre of Excellence for Early Childhood Development (CEECD) and the Strategic Knowledge Cluster on Early Child Development (SKC-ECD). These organizations identify and summarize the best scientific work on early childhood development. They disseminate this knowledge to a variety of audiences in formats and languages adapted to their needs.

For a more in-depth understanding of Social Cognition, consult our synthesis and Experts’ articles on this topic in the Encyclopedia on Early Childhood Development, available free of charge at www.child-encyclopedia.com.

Several funders financially support the CEECD and the SKC-ECD, including the Social Sciences and Humanities Research Council of Canada, Université Laval, and private foundations. The views expressed herein do not necessarily represent the official policies of these organizations.

We are grateful to the Fondation Lucie et André Chagnon, the Margaret & Wallace McCain Family Foundation and the Alberta Centre for Child, Family and Community Research for their financial contributions to produce this Key Message.

Centre of Excellence for Early Childhood Development
GRIP-Université de Montréal
P.O. Box 6128, Succursale Centre-ville
Montreal, Quebec H3C 3J7
Telephone: 514.343.6111, extension 2541
Fax: 514.343.6962
E-mail: cedje-ceecd@umontreal.ca
Website: www.excellence-earlychildhood.ca
In this document, the masculine form is used to simplify the text. No discrimination is intended.

http://www.child-encyclopedia.com/sites/default/files/docs/coups-oeil/social-cognition-info.pdf

What do we know?

• It is normal for young children to sometimes feel afraid, shy or sad. However, for some children, these feelings last for a long time and can affect their development.
• Emotional problems like anxiety and depression often happen at the same time. Both can be described as feelings of inner emotional distress.
• It is more common for young children to have fears and anxieties than depression.
• It is hard to detect symptoms of anxiety and depression in young children (unlike aggression and hyperactivity). If anxiety and depression are not noticed and addressed in the early years, they can lead to mental health problems later in life.  However, it is important to know that this only happens in a relatively small percent of children.
• The children who are most likely to have emotional problems later in life are those who are behaviourally inhibited.
• Toddlers and young children who are behaviourally inhibited appear very shy, tend to avoid social contacts and withdraw from unfamiliar situations.
• Children usually first show signs of emotional problems when around other children.
• Young children with anxiety and depression are often fearful, worried and nervous around other children. They rarely initiate contact and are at risk for being rejected or ignored by peers.
• However, a positive peer relationship, such as having a best friend, can help protect anxious and depressed children against the negative consequences of emotional problems.
• Children’s environment, including their parents’ behaviours, family conflicts and traumatic experiences, can also lead at risk children to develop anxiety and depression.
• Parents can help protect children from later emotional problems by showing supporting guidance, allowing children to explore their environment, and by providing warm, sensitive and consistent response and discipline.

Information
This information sheet is a publication of the Centre of Excellence for Early Childhood Development (CEECD) and the Strategic Knowledge Cluster on Early Child Development (SKC-ECD). These organizations identify and summarize the best scientific work on early childhood development. They disseminate this knowledge to a variety of audiences in formats and languages adapted to their needs.

For a more in-depth understanding of anxiety and depression, consult our synthesis and experts’ articles on this topic in the Encyclopedia on Early Childhood Development, available free of charge at www.child-encyclopedia.com.

Several organizations financially support the CEECD and the SKC-ECD, including the Social Sciences and Humanities Research Council of Canada, Université Laval, and private foundations. The views expressed herein do not necessarily represent the official policies of these organizations.

We are grateful to The Lawson Foundation and the Margaret & Wallace McCain Family Foundation for their financial contribution to produce this information sheet.

Centre of Excellence for Early Childhood Development
Strategic Knowledge Cluster on Early Child Development

Université de Montréal
3050, Édouard-Montpetit Blvd., GRIP
P.O. Box 6128, succursale Centre-ville
Montreal, Quebec H3C 3J7
Telephone: 514.343.6111, extension 2541
Fax: 514.343.6962
E-mail: cedje-ceecd@umontreal.ca
Websites: www.excellence-earlychildhood.ca and www.skc-ecd.ca
In this document, the masculine form is used merely to simplify the text. No discrimination is intended.

http://www.child-encyclopedia.com/sites/default/files/docs/coups-oeil/anxiety-and-depression-in-children-info.pdf

What do we know?

• Discipline is what you do everyday–it is about teaching and guidance, not punishment.
• Discipline teaches children what is acceptable and what isn’t.
• Discipline that combines high levels of warmth and acceptance with firm control helps children to follow instructions, to respect rules, and to be attentive.
• Parents who establish clear rules and limits encourage the development of positive behaviours and attention in children. They also encourage children to explore their environment while respecting certain limits.
• Good discipline helps children develop their social skills (empathy, cooperation, problem-solving) and succeed in school.
• Children have a higher likelihood of developing behavioural problems when parents react with punishments or temper outbursts in face of misbehaviours.
• Attitudes toward discipline and control vary based on the social and cultural context.
• Too much parental control may limit children’s ability to make decisions for themselves and to express their needs to parents.
• In contrast, children who are allowed to do anything they want tend to have trouble distinguishing between what is acceptable and what is not. Poor parental supervision also increases the risk of injuries in young children.

Information
This information sheet is a publication of the Centre of Excellence for Early Childhood Development (CEECD) and the Strategic Knowledge Cluster on Early Child Development (SKC-ECD). These organizations identify and summarize the best scientific work on early childhood development. They disseminate this knowledge to a variety of audiences in formats and languages adapted to their needs.

For a more in-depth understanding of discipline, consult our topics Aggression and Parenting skills in the Encyclopedia on Early Childhood Development, available free of charge at www.child-encyclopedia.com.

Several organizations financially support the CEECD and the SKC-ECD, including the Social Sciences and Humanities Research Council of Canada, Université Laval, and private foundations. The views expressed herein do not necessarily represent the official policies of these organizations.

We are grateful to the Fondation Lucie et André Chagnon for its financial contribution to produce this information sheet and to the Margaret & Wallace McCain Family Foundation for its financial support of this revised edition.

Centre of Excellence for Early Childhood Development
Strategic Knowledge Cluster on Early Child Development

Université de Montréal
3050, Édouard-Montpetit Blvd., GRIP
P.O. Box 6128, succursale Centre-ville
Montreal, Quebec H3C 3J7
Telephone: 514.343.6111, extension 2541
Fax: 514.343.6962
E-mail: cedje-ceecd@umontreal.ca
Websites: www.excellence-earlychildhood.ca and www.skc-ecd.ca
In this document, the masculine form is used merely to simplify the text. No discrimination is intended.

http://www.child-encyclopedia.com/sites/default/files/docs/coups-oeil/discipline-info.pdf

The death of a family member, friend or other significant person is a lifelong loss for children. It is normal for children to miss the person who died and to experience grief that might come and go with different levels of intensity for some time after the death. It can be challenging to parents and caregivers to know what to do for, what to say to and how to help children who are obviously hurting. Here are a few suggestions about how to be helpful to a grieving child based on research and practice among children’s grief support professionals and volunteers. It is important to note that grief reactions in children are varied, wide ranging and unique to each individual. The following suggestions will help guide you as you seek to be provide understanding and compassion to children living with grief.

Grief is a normal reaction for children to the death of someone significant. When children experience the death of a person who has played a significant role in their life, it is normal for children to struggle, whether the relationship with that person was caring and loving, or contentious and difficult. The absence of a person takes time to fully accept and even then, children may continue to miss them in their own special way. In truth, children never “get over” a person’s death, but they can learn to live with the reality. Grief is not a problem we are trying to fix for a child; it is an experience they are living. Mood changes or feelings of grief, even several years out from the event, are a common part of adapting to life without someone and to the changes that come with that person’s death. Children need adults to be patient with them as they adjust to these changes.

Children need to know the truth. Most parents and caregivers would agree that they would prefer that their children not have to deal with the difficult truths that might accompany a death. So, quite often we avoid words like “dead” or “die,” or we shade over the truth about how a person died in a desire to protect children. Unfortunately, in doing so, we often create other problems. Although it may be challenging to share the truth about how someone died, honest answers build trust, help provide understanding and allow children to feel comfortable approaching us with questions because they know they can trust us to tell them the truth. Children know more than we think they do and by not telling the truth, we risk leaving children to process complicated information on their own, rather than with the loving adults in their lives.

Each child’s grief is as unique to him or her as was their relationship with the deceased. Because of this, the way children experience and express their grief will vary for each person. Some children have a need to talk about the person who died and their feelings about it; others might not talk about the person at all; and even others, might express their grief through art, play, music or writing. In whatever way children might experience and respond to their grief, these expressions are how they are adapting to life without the physical presence of that person and adjusting to one of memories. It is important not to assume what children might be feeling about a person’s death. Reactions vary from sadness, anger, fear, guilt and even relief. It is important to listen to children, meet them on their terms and come to understand their unique grief reactions.

Grieving children often feel alone and misunderstood. Many well-meaning adults avoid talking about the deceased person in fear that doing so will exacerbate the grief children are experiencing. In doing so, children might feel as though talking about or even expressing their grief is not acceptable. Also, many children feel like they are the only person who has experienced the death of someone in their life, even though there might be other friends experiencing similar circumstances. It is helpful to children when the adults in their lives provide opportunities to acknowledge the grief everyone is feeling. It is also helpful when children are able to gather with peers grieving similar situations. When children feel understood by family and friends and when they have the opportunity to express their grief in their own unique way, they feel less alone and, in turn, fare better than they would otherwise.

Children will experience grief over the death of significant people at different times throughout their lives. Many times, intense feelings of grief will last longer and come more often than we think they should. In time, as children have opportunities to express their grief, tell their stories, share their memories and process what this death means to them, they might find the intense feelings come less often. But, grief is a lifelong journey and children often experience their grief on different levels and at different times throughout their lives. When a child gets their driver’s license, scores a touchdown, goes to prom or graduates from high school, they might revisit their grief in a very intense way. This extends into adulthood as well, when they have children of their own, or get married. Grief has no time limit. Allowing children to share openly about feelings can help to normalize this experience and help them find ways to deal with these powerful feelings that will come and go…and come back again throughout their lives.

Grieving children often experience personal growth as a result of their loss. Personal growth is often a by-product of going through the grief. It is important to note that personal growth does not diminish the sense of loss or grief a person feels, nor does it imply that someone’s death was a positive experience. Yet, many children have reported that they are more compassionate toward others, value relationships with friends and family on a new level or experience a greater sense of appreciation for life after the death of someone.

Grieving children feel less alone when they are with other children who have experienced the death of a significant person and when they have loving, consistent adults in their lives. Greater than any education, information or advice we can give to children who are grieving is to allow children who are grieving to connect with other children going through a similar experience. When children have the opportunity to interact with one another, they feel less alone. It is also important for children to have adults in their lives who provide a safe environment that is consistent, teaches resilience and encourages accountability, while allowing children the freedom to express their grief. Research has shown that one of the top indicators of how well children will do after the death of a significant person in their life is directly related to the type of relationship they have with the surviving adult(s) in their lives and how well these adults are able to cope with their own grief.

Knowledge is Power. You do not have to be alone as the parent or caregiver of a grieving child. There are many resources available via the internet and in the form of grief support for your child. You can find children’s grief support programs near you at www.ChildrenGrieve.org and you can find encouragement and answers to some of your questions at the following websites:

www.dougy.org
www.hellogrief.org
www.achildingrief.com

Copyright © 2013 by National Alliance for Grieving Children. All rights reserved. You can quote, link to, re-post or translate this article, in its entirety, as long as you include the author name and a working link back to this website. www.ChildrenGrieve.org

References
Silverman, Phyllis R., Madelyn, Kelly (2009) A Parent’s Guide to Raising Grieving Children. New York, NY: Oxford University Press.
Worden, William J. (1996) Children and Grief: When a Parent Dies. New York, NY: Guilford Press.
Schuurman, Donna (2003) Never the Same: Coming to Terms with the Death of a Parent. New York, NY: St. Martin’s Press.
Emswiler, Mary Ann, Emswiler, James P. (2000) Guiding Your Child through Grief. New York, NY: Bantam Books.
Tedeschi, Richard, Calhoun, Lawrence G. (1999) Facilitating Post Traumatic Growth. Mahwah, NJ: Lawrence Erlbaum Associates, Inc.
Kubler-Ross, Elisabeth (1969) On Death and Dying. New York, NY: Scribner.

https://childrengrieve.org/resources/about-childhood-grief

Authors: Lawrence Robinson, Melinda Smith, M.A., and Jeanne Segal, Ph.D. Last updated: November 2018.
Helpguide.org

Sure, it’s fun to share a good laugh. But did you know it can actually improve your health? It’s true: laughter is strong medicine. It draws people together in ways that trigger healthy physical and emotional changes in the body. Laughter strengthens your immune system, boosts mood, diminishes pain, and protects you from the damaging effects of stress. As children, we used to laugh hundreds of times a day, but as adults, life tends to be more serious and laughter more infrequent. But by seeking out more opportunities for humor and laughter, you can improve your emotional health, strengthen your relationships, find greater happiness—and even add years to your life.

Why is laughter the sweetest medicine for the mind and body?

Laughter is a powerful antidote to stress, pain, and conflict. Nothing works faster or more dependably to bring your mind and body back into balance than a good laugh. Humor lightens your burdens, inspires hope, connects you to others, and keeps you grounded, focused, and alert. It also helps you release anger and forgive sooner.

With so much power to heal and renew, the ability to laugh easily and frequently is a tremendous resource for surmounting problems, enhancing your relationships, and supporting both physical and emotional health. Best of all, this priceless medicine is fun, free, and easy to use.

Laughter is good for your health

Laughter relaxes the whole body. A good, hearty laugh relieves physical tension and stress, leaving your muscles relaxed for up to 45 minutes after.

Laughter boosts the immune system. Laughter decreases stress hormones and increases immune cells and infection-fighting antibodies, thus improving your resistance to disease.

Laughter triggers the release of endorphins, the body’s natural feel-good chemicals. Endorphins promote an overall sense of well-being and can even temporarily relieve pain.

Laughter protects the heart. Laughter improves the function of blood vessels and increases blood flow, which can help protect you against a heart attack and other cardiovascular problems.

Laughter burns calories. OK, so it’s no replacement for going to the gym, but one study found that laughing for 10 to 15 minutes a day can burn approximately 40 calories—which could be enough to lose three or four pounds over the course of a year.

Laughter lightens anger’s heavy load. Nothing diffuses anger and conflict faster than a shared laugh. Looking at the funny side can put problems into perspective and enable you to move on from confrontations without holding onto bitterness or resentment.

Laughter may even help you to live longer. A study in Norway found that people with a strong sense of humor outlived those who don’t laugh as much. The difference was particularly notable for those battling cancer.

Physical health benefits of laughter:

Boosts immunity Lowers stress hormones Decreases pain Relaxes your muscles Prevents heart disease

Mental health benefits of laughter:

Adds joy and zest to life Eases anxiety and tension Relieves stress Improves mood Strengthens resilience

Social benefits of laughter:

Laughter helps you stay mentally healthy

Laughter makes you feel good. And this positive feeling remains with you even after the laughter subsides. Humor helps you keep a positive, optimistic outlook through difficult situations, disappointments, and loss.

More than just a respite from sadness and pain, laughter gives you the courage and strength to find new sources of meaning and hope. Even in the most difficult of times, a laugh–or even simply a smile–can go a long way toward making you feel better. And laughter really is contagious—just hearing laughter primes your brain and readies you to smile and join in the fun.

The link between laughter and mental health

Laughter stops distressing emotions. You can’t feel anxious, angry, or sad when you’re laughing.

Laughter helps you relax and recharge. It reduces stress and increases energy, enabling you to stay focused and accomplish more.

Laughter shifts perspective, allowing you to see situations in a more realistic, less threatening light. A humorous perspective creates psychological distance, which can help you avoid feeling overwhelmed and diffuse conflict.

Laughter draws you closer to others, which can have a profound effect on all aspects of your mental and emotional health.

Laughter brings people together and strengthens relationships

There’s a good reason why TV sitcoms use laugh tracks: laughter is contagious. You’re many times more likely to laugh around other people than when you’re alone. And the more laughter you bring into your own life, the happier you and those around you will feel.

Sharing humor is half the fun—in fact, most laughter doesn’t come from hearing jokes, but
rather simply from spending time with friends and family. And it’s this social aspect that plays such an important role in the health benefits of laughter. You can’t enjoy a laugh with other people unless you take the time to really engage with them. When you care about someone enough to switch off your phone and really connect face to face, you’re engaging in a process that rebalances the nervous system and puts the brakes on defensive stress responses like “fight or flight.” And if you share a laugh as well, you’ll both feel happier, more positive, and more relaxed—even if you’re unable to alter a stressful situation.

How laughing together can strengthen relationships

Shared laughter is one of the most effective tools for keeping relationships fresh and exciting. All emotional sharing builds strong and lasting relationship bonds, but sharing laughter also adds joy, vitality, and resilience. And humor is a powerful and effective way to heal resentments, disagreements, and hurts. Laughter unites people during difficult times.

Humor and playful communication strengthen our relationships by triggering positive feelings and fostering emotional connection. When we laugh with one another, a positive bond is created. This bond acts as a strong buffer against stress, disagreements, and disappointment. Humor and laughter in relationships allows you to:

Be more spontaneous. Humor gets you out of your head and away from your troubles. Let go of defensiveness. Laughter helps you forget resentments, judgments, criticisms, and doubts.

Release inhibitions. Your fear of holding back is pushed aside.

Express your true feelings. Deeply felt emotions are allowed to rise to the surface.

Use humor to resolve disagreements and tension in your relationship

Laughter is an especially powerful tool for managing conflict and reducing tension when emotions are running high. Whether with romantic partners, friends and family, or coworkers, you can learn to use humor to smooth over disagreements, lower everyone’s stress level, and communicate in a way that builds up your relationships rather than breaking them down.

How to bring more laughter into your life

Laughter is your birthright, a natural part of life that is innate and inborn. Infants begin smiling during the first weeks of life and laugh out loud within months of being born. Even if you did not grow up in a household where laughter was a common sound, you can learn to laugh at any stage of life.

Begin by setting aside special times to seek out humor and laughter, as you might with exercising, and build from there. Eventually, you’ll want to incorporate humor and laughter into the fabric of your life, finding it naturally in everything.

Here are some ways to start:

Smile. Smiling is the beginning of laughter, and like laughter, it’s contagious. When you look at someone or see something even mildly pleasing, practice smiling. Instead of looking down at your phone, look up and smile at people you pass in the street, the person serving you a morning coffee, or the co-workers you share an elevator with. Notice the effect on others.

Count your blessings. Literally make a list. The simple act of considering the positive aspects of your life will distance you from negative thoughts that block humor and laughter. When you’re in a state of sadness, you have further to travel to reach humor and laughter.

When you hear laughter, move toward it. Sometimes humor and laughter are private, a shared joke among a small group, but usually not. More often, people are very happy to share something funny because it gives them an opportunity to laugh again and feed off the humor you find in it. When you hear laughter, seek it out and ask, “What’s funny?”

Spend time with fun, playful people. These are people who laugh easily–both at themselves and at life’s absurdities–and who routinely find the humor in everyday events. Their playful point of view and laughter are contagious. Even if you don’t consider yourself a lighthearted, humorous person, you can still seek out people who like to laugh and make others laugh. Every comedian appreciates an audience.

Bring humor into conversations. Ask people, “What’s the funniest thing that happened to you today? This week? In your life?”

Simulated laughter

So, what if you really can’t “find the funny?” Believe it or not, it’s possible to laugh without experiencing a funny event—and simulated laughter can be just as beneficial as the real thing. It can even make exercise more fun and productive. A Georgia State University study found that incorporating bouts of simulated laughter into an exercise program helped improve older adults’ mental health as well as their aerobic endurance. Plus, hearing others laugh, even for no apparent reason, can often trigger genuine laughter.

To add simulated laughter into your own life, search for laugh yoga or laugh therapy groups. Or you can start simply by laughing at other people’s jokes, even if you don’t find them

funny. Both you and the other person will feel good, it will draw you closer together, and who knows, it may even lead to some spontaneous laughter.

Creating opportunities to laugh;

Watch a funny movie, TV show, or YouTube video Invite friends or co-workers out to a comedy club Read the funny pages Seek out funny people Share a good joke or a funny story Check out your bookstore’s humor section Host game night with friends Play with a pet Go to a “laughter yoga” class Goof around with children Do something silly Make time for fun activities (e.g. bowling, miniature golfing, karaoke)

Tips for developing your sense of humor

An essential ingredient for developing your sense of humor is to learn not to take yourself too seriously and laugh at your own mistakes and foibles. As much as we’d like to believe otherwise, we all do foolish things from time to time. Instead of feeling embarrassed or defensive, embrace your imperfections. While some events in life are clearly sad and not opportunities for laughter, most don’t carry an overwhelming sense of either sadness or delight. They fall into the gray zone of ordinary life—giving you the choice to laugh or not. So choose to laugh whenever you can.

How to develop your sense of humor

Laugh at yourself. Share your embarrassing moments. The best way to take yourself less seriously is to talk about times when you took yourself too seriously.

Attempt to laugh at situations rather than bemoan them. Look for the humor in a bad situation, and uncover the irony and absurdity of life. When something negative happens, try to make it a humorous anecdote that will make others laugh.

Surround yourself with reminders to lighten up. Keep a toy on your desk or in your car. Put up a funny poster in your office. Choose a computer screensaver that makes you laugh. Frame photos of you and your family or friends having fun.

Remember funny things that happen. If something amusing happens or you hear a joke or funny story you really like, write it down or tell it to someone to help you remember it.

Don’t dwell on the negative. Try to avoid negative people and don’t dwell on news stories, entertainment, or conversations that make you sad or unhappy. Many things in life are beyond your control—particularly the behavior of other people. While you might view carrying the weight of the world on your shoulders as admirable, in the long run it’s unrealistic and unhealthy.

Find your inner child. Pay attention to children and try to emulate them—after all, they are the experts on playing, taking life lightly, and laughing at ordinary things.

Deal with stress. Stress can be a major impediment to humor and laughter, so it’s important to keep your stress levels in check. One great technique to relieve stress in the moment is to draw upon a favorite memory that always makes you smile—something your kids did, for example, or something funny a friend told you.

Don’t go a day without laughing. Think of it like exercise or breakfast and make a conscious effort to find something each day that makes you laugh. Set aside 10 to 15 minutes and do something that amuses you. The more you get used to laughing each day, the less effort you’ll have to make.

Using humor to overcome challenges and enhance your life

The ability to laugh, play, and have fun not only makes life more enjoyable but also helps you solve problems, connect with others, and think more creatively. People who incorporate humor and play into their daily lives find that it renews them and all of their relationships.

Life brings challenges that can either get the best of you or become playthings for your imagination. When you “become the problem” and take yourself too seriously, it can be hard to think outside the box and find new solutions. But when you play with the problem, you can often transform it into an opportunity for creative learning.

Playing with problems seems to come naturally to children. When they are confused or afraid, they make their problems into a game, giving them a sense of control and an opportunity to experiment with new solutions. Interacting with others in playful ways helps you retain this creative ability.

Using fMRI, researchers uncover the neural underpinnings, which could aid development of potential treatments

March 13, 2019 • Press Release

Findings highlight the importance of screening kids as young as 10 for suicide risk in emergency settings

March 11, 2019 • Press Release

A research team found nearly one-third of youth ages 10 to 12 years screened positive for suicide risk in emergency department settings. As part of a larger study on youth suicide risk screening in emergency departments, researchers at the National Institute of Mental Health (NIMH), part of the National Institutes of Health, and collaborators sought to explore how frequently preteen youth ages 10 to 12 screened positive for suicide risk. Notably, 7 percent of the preteens who screened positive for suicide risk were seeking help for physical – not psychiatric – concerns. The study appears online March 11 in Hospital Pediatrics.

“Typically, suicidal thoughts and behaviors are seen in older teens. It was troubling to see that so many preteens screened positive for suicide risk, and we were alarmed to find that many of them had acted on their suicidal thoughts in the past,” said Lisa Horowitz, Ph.D., M.P.H., a clinical scientist in the NIMH Division of Intramural Research Programs (DIRP) and an author on the paper. “This study shows that children as young as 10 who show up in the emergency department may be thinking about suicide, and that screening all preteens — regardless of their presenting symptoms — may save lives. Otherwise, they may pass through our medical systems undetected.”

Suicide is a growing public health problem in the U.S. Between 2008 and 2017, there was a substantial rise in the suicide rate for youth ages 10 to 12 and today suicide is the third leading cause of death for this age group.

Studies have shown that the majority of youth who died by suicide had been seen by a health care provider in the month prior to killing themselves. NIMH has identified hospital emergency departments as a key setting for screening youth for suicide risk given the number of youth who visit the ER every year for mental health concerns and intentional self-harm; however, uncertainty exists about the appropriate age to screen youth.

In this study, researchers examined the extent to which preteens seen in the emergency department screen positive for suicide risk to inform universal youth suicide risk screening efforts. The 79 preteens in the study came from  three large, urban pediatric hospitals. They were screened for suicide risk using the four-item Ask Suicide-Screening Questions (ASQ) and the 15-item Suicidal Ideation Questionnaire-JR (SIQ-JR). Just over half (53.2 percent) of the preteens in the study came to the hospital because of a physical health concern (e.g., back injury or chest pain) and nearly half (47 percent) came because of a mental health concern (e.g., depression or panic disorder). Answering “yes” to any of the four ASQ items and/or scoring above the SIQ-JR cutoff score was considered a positive screen for suicide risk. Preteens who screened positive on either the ASQ or SIQ-JR received a brief suicide safety assessment by a mental health professional.

The researchers found that 23 of the 79 (29.1 percent) preteen patients screened positive for suicide risk. More than half (54.1 percent) of the preteens presenting with a psychiatric concern screened positive for suicide risk, and a substantial number (7.1 percent) of the preteens with physical complaints also screened positive for suicide risk. Roughly one in five (17.7 percent) of the preteens, specifically those who visited the emergency department for a psychiatric concern, had previously attempted suicide.

Of the more than 30 million pediatric emergency visits in 2015, nearly 5.4 million involved youth ages 10-14.

“Many families use the emergency department as their sole source of health care, which presents a unique opportunity to identify these younger kids who are struggling with suicidal thoughts,” said Maryland Pao, M.D., clinical director of the NIMH DIRP and an author on the paper. “But most preteens seen in the emergency department show up with medical problems and will not disclose their suicidal thoughts unless they are asked directly.”