ERIC Identifier: ED340152
Publication Date: 1991-11-00
Author: Guetzloe, Eleanor C.
Source: ERIC Clearinghouse on
Handicapped and Gifted Children Reston VA.
Suicide and the Exceptional Child. ERIC Digest #E508.
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,
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
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?
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
HOW CAN A STUDENT WHO IS POTENTIALLY SUICIDAL BE
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,
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
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
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
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
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.
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
American Psychiatric Association (1985, March).
Facts About Teen Suicide. Washington, DC: Author.
Blumenthal, S. (1990, December 26). Youth Suicide: The Physician's Role in
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Davidson, L., & Linnoila, M. (Eds.) (1991). Risk Factors for Youth
Suicide. New York: Hemisphere.
Forness, S. R. (1988). "School Characteristics of Children and Adolescents
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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
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National Center for Health Statistics. (1989). Advance report of final
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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.