Which Kids Face the Highest Risk of Self-Harm?

Growing numbers of American kids and teens are cutting or burning themselves, banging their heads against walls, pulling out their hair and even trying to die by suicide.

But figuring out who is at highest risk for harming themselves has been a daunting challenge. Until now.

Researchers report they have developed risk profiles that can help doctors pinpoint which kids or teens are in the most danger.

“The U.S. is in the midst of a mental health crisis, with mental health diagnoses and hospitalizations surging over the past few years, and many of these hospitalizations are for self-harm events or concern for future self-harm,” said study author Dr. James Antoon, an assistant professor of pediatrics and hospital medicine at Monroe Carell Jr. Children’s Hospital at Vanderbilt University in Nashville, Tenn.

“Self-harm is a big bucket of events from mild things like cutting on the arms or thighs to taking so much Tylenol that you die on purpose or jumping out of a window, and we wanted to find out which kids require hospitalization and more intensive treatment and monitoring,” he said.

There’s a pronounced shortage of in-patient hospital beds for kids with mental health issue in the United States, which makes the situation even more dire. Knowing which kids are at the highest risk can help make better use of these limited resources, Antoon noted.

So, his team developed four risk profiles for serious self-harm based on age, gender and psychiatric and medical conditions. Of nearly 1,100 children hospitalized for psychiatric reasons at two children’s hospitals from April 2016 to March 2020, 37% were there for self-harm.

The researchers found that boys aged 10 to 13 with ADHD, bipolar disorder, autism spectrum disorder or another developmental disorder were 80% more likely to engage in serious self-harm behavior that requires hospitalization. Meanwhile, teen girls aged 14 to 17 with depression and anxiety, substance- and trauma-related disorders, and personality and eating disorders were also at high risk for serious self-harm, the study showed.

Suicide attempts comprised the majority of serious self-harm behaviors in the study.

In a counterintuitive finding, kids who were at moderate risk for serious self-harm didn’t necessarily have depression, Antoon said. “It is assumed that if you are suicidal, you must be depressed, but there are other things that can drive self-harm and suicide, including anxiety disorders,” he noted.

The study was published online May 1 in the journal Pediatrics.

There are many reasons kids and teens will try to harm themselves, said Elizabeth Bailey, director of clinical services at the 3East Boys Intensive Program at McLean Hospital in Boston.

“It can serve to help individuals self-regulate or control overwhelming emotions, escape from feelings of being numb or empty or punish themselves, and [it] also serves as a form of unspoken communication to others about one’s suffering,” said Bailey, who was not involved with the study.

But it’s not always easy to spot the signs of self-harm in kids, as they hide evidence by wearing long sleeves to cover scars on their arms or other methods, she said.

Still, there are some things to look out for. “A typically outgoing and social child who suddenly withdraws, or an academically driven and achieving child who stops completing assignments for a sustained period of time may be cause for concern,” Bailey said.

Self-harming behaviors are often portrayed as problems for girls and women in the media, added Anna Precht, program director at 3East Boys Intensive Program.

“The finding that the highest risk profile is characterized by boys aged 10-13 with anxiety and depression, as well as other psychiatric disorders including externalizing behaviors like ADHD and conduct disorder, highlights the importance of assessing for self-harm behaviors across diagnostic and gender presentations,” said Precht, who was not part of the new research.

If you are concerned that your child is engaging in self-harm, contact a psychologist, social worker or pediatrician, she advised.

Help is available.

“Dialectical Behavior Therapy [a type of talk therapy based on cognitive behavioral therapy] helps people to understand what factors contribute to self-injurious behaviors [as well as other problematic behaviors] and teaches skills for managing emotions more effectively,” Precht said. “This a treatment that has been shown to be effective in treating these behaviors and has been adapted for teens and their families.”

More information

The U.S. National Library of Medicine has more on helping someone who engages in self-harm.

SOURCES: James Antoon, MD, PhD, MPH, assistant professor, pediatrics, hospital medicine, Monroe Carell Jr. Children’s Hospital, Vanderbilt University, Nashville, Tenn.; Elizabeth Bailey, PsyD, director, clinical services, 3East Boys Intensive Program, McLean Hospital, Boston; Anna Precht, PsyD, program director, 3East Boys Intensive Program, McLean Hospital; Pediatrics, May 1, 2023