About this srcd poster session

---

Panel information
Panel 6. Developmental Psychopathology

Abstract

---

While there is increasing evidence that suicidal thoughts and behaviors (STBs)can present in children as young as preschool age, little is known about how these early-onset STBs manifest or the extent to which they are transdiagnostic – occurring across various psychological conditions. Several studies have linked early-onset STBs to preschool-onset depression (Luby et al. 2019) and to externalizing symptoms (Sheftall et al. 2021). However, significant gaps remain in understanding the psychopathological contexts in which early STBs emerge. The present study aimed to further our understanding of early-onset STBs by directly assessing whether 4-7-year-old children with STBs also met criteria for other DSM-5 disorders.

Participants were 103 4–7-year-old children (M=5.54, SD=1.21) and a primary caregiver, recruited primarily from community and clinical sites, oversampling for children with a history of STBs (53.4% White and non-Hispanic, 46.6% non-White and/or Hispanic). Trained interviewers conducted the Kiddie Schedule for Affective Disorders and Schizophrenia–Early Childhood (KSADS-EC), a diagnostic clinical interview, with caregivers. This interview assesses for lifetime presence of a variety of DSM-5 disorders, and includes 3 specific suicide-related items targeting passive suicidal ideation (e.g. “I wish I were dead”), active suicidal ideation (e.g. “I want to kill myself”), and suicidal behaviors or attempts (e.g. holding a knife to themselves). Children were also directly asked age-appropriate versions of these suicide items. A child was considered to have experienced STBs if either caregiver or child endorsed any STB item.

Across the sample, 31 children had experienced STBs. Lifetime diagnoses among these children varied greatly and included attention-deficit hyperactivity disorder (ADHD), major depressive disorder (MDD), generalized anxiety disorder (GAD), oppositional defiant disorder (ODD), and obsessive-compulsive disorder (OCD). Moreover, 10 children met criteria for one diagnosis, and 12 children for two or more diagnoses in their lifetime. An examination of the most frequent diagnoses revealed that 13 children (41.9%) met criteria for ADHD/ADHD-NOS, highlighting ADHD as a prominent externalizing disorder associated with STBs in this sample. In contrast, only 6 children (19.4%) met criteria for MDD/MDD-NOS, fewer than expected based off previous literature. Interestingly, 7 children (22.5%) met criteria for GAD, an association not yet well-established in younger children with STBs. Although often comorbid with ADHD, MDD, or GAD, specific phobias also appeared in this sample, with 8 children (25.8%) experiencing specific phobias, 6 of whom had a comorbid diagnosis.

Thus, STBs in children aged 4-7 appear to be transdiagnostic, occurring across externalizing (ADHD, ODD) and internalizing disorders (MDD, GAD, OCD). While future research is needed to clarify the nature of the association between these disorders and early-onset STBs, these findings indicate that early-onset STBs are present across a broader range of psychopathology than previously recognized. Further analyses will explore patterns of diagnoses in relation to reporter (child or caregiver) and investigate temporal relationships between diagnoses and STBs.

Author information

Author	Role
Christina Chen, Washington University School of Medicine	Presenting author
Laura Hennefield, PhD, Washington University School of Medicine	Non-presenting author

⇦ Back to session