Suicidality in Very Young Children

Abstract

uring the past several decades, the scientific conversation about early childhood psychopathology D has shifted from questions about whether it exists to understanding how it manifests. There is increasing recognition that deviant developmental trajectories can be identified in the earliest years of life, and research is rapidly expanding our understanding of biological correlates and clinical presentations. A central issue in the study of early childhood psychopathology has been the degree to which it resembles or diverges from psychopathology in later childhood and adolescence. Two lines of research have suggested similarities. First, studies of preschool children have found broad similarities between disorders presenting in children 2 to 5 years of age and disorders presenting in older children and adolescents. Second, the stability of psychopathology from preschool years to middle childhood seems roughly equivalent to the stability of disorders from middle childhood to adolescence. These data suggest continuities between psychopathology in early childhood and later developmental epochs. Conversely, the enormous changes in brain and behavioral development occurring in the first few years of life suggest that differences in psychopathology and how it presents ought to be apparent. For example, apart from sleep disorders, feeding disorders, and excessive crying or colic, few psychiatric disorders have been defined in the first year of life, although it is clear that infants can experience a range of emotional reactions in response to various stressors. Even in preschool-age children, diagnostic criteria of some disorders have been modified to accommodate the clinical signs and symptoms in young children. Further, in following symptoms and disorders from early to middle childhood, heterotypic continuity seems to be involved in at least 2 ways. First, disorders at one age might lawfully relate to disorders at a subsequent age, such as anxiety disorders in early childhood predicting anxiety and oppositional defiant disorder in middle childhood. Second, symptoms, such as aggression, might be present in many different disorders and mean different things in children of different ages. Against this backdrop, Whalen et al. present data from the Preschool Depression Study about suicidal cognitions and behaviors in young children whose average age was 5 years at the initial assessment. Even with the broad definition of suicidal cognitions and behaviors used in this study, many readers will be surprised to learn that 11% of the children at baseline expressed suicidal cognitions or engaged in suggestive behaviors, and nearly 3 of 4 of these same children endorsed suicidality in middle childhood. Whalen et al. were specifically interested in exploring developmental continuity, for which their large sample and