and Addressing Anxiety and Suicidal Thoughts in Children

The child expresses thoughts of wanting to commit suicide and is experiencing anxiety issues?

Dear Doctor,
My child (an only daughter, 6 years old) has just started elementary school two weeks ago.
During the summer vacation before starting school, I noticed she had involuntary blinking, and I'm unsure if it is Tourette syndrome.
The frequency has improved, but recently she has been repeatedly asking the same questions:
1.
She says she has been thinking about very bad things lately and has thoughts of suicide.
When I ask her what kind of bad things, she just says she thinks about bad issues in general.
2.
She mentioned that when she sees others sad, she feels happy, and when others are happy, she feels sad.
For example: (I wonder if she has been influenced by the cartoon "Doraemon"...)
(1) On a rainy day, she saw her classmates at kindergarten stuck in the classroom and unable to play outside.
She felt they would be very sad, but since she could play during recess, she thought her happiness came from her classmates not being able to play.
(2) She saw a classmate wake up with tears in their eyes, crying while the teacher comforted them, and she felt happy inside, even smiling slightly.
She asked if it was normal to feel happy when others are sad.
(3) During a game of tag, when she was caught by the "monster," the monster was happy, but she felt sad.
She asked if this was normal.
(4) When her classmates were happily playing outside, she felt sad seeing the teacher alone in the kindergarten because she couldn't see all her classmates.
3.
When she sees others sad, she wants to comfort them, but she says her reason for wanting to comfort others is that she finds their crying very noisy.
4.
When she feels sad, she wants comfort from her classmates but thinks it doesn't matter if no one comforts her.
5.
While using the restroom, she imagines scenes of boys and girls without clothes and mimics a gesture (pointing her finger) that resembles a male genitalia.
6.
She mentioned wanting to hurt her classmates (locking someone inside and bullying them), thinking it would be fun since it wouldn't hurt her.
However, she expressed inner conflict, realizing that if others get hurt, it doesn't benefit her.
When I advised her against it, she continued to ask the same questions the next day and even expressed wanting to poke a classmate's eye with a pen.
I told her she cannot do that, and she said it's better not to, but not necessarily.
I insisted that she cannot hurt others, or she would get in trouble with the police and wouldn't see her parents.
She responded that it wouldn't matter.
7.
She expressed anxiety about possibly having hurt a classmate's eye, and when I reassured her that she hadn't, she kept asking what if she had.
8.
She said she wants to be a thief and smoke, thinking it would be fun.
9.
She dislikes knocking things over, like cups, but still wants to hear the sound of a cup breaking.
She asked if this was normal.
She keeps repeating these questions, and even after I answer, she continues to ask if it’s better not to think about it or if there are no certainties.
We tell her not to think too much, but she says she can't help it and asks if this is normal and if I experience this too.

As parents, how should we support our child through this phase? I kindly request your response.
Thank you!

Ping An Xi Yue, 0~9 year old female. Ask Date: 2021/09/17

Dr. Wu Menghuan reply Psychiatry

1.
"Tic disorder" refers to the presence of either motor or vocal tics, while Tourette's disorder involves both motor and vocal tics.
Tic disorders or Tourette's disorder typically emerge during the early to middle elementary school years.
Common motor tics include blinking, making faces, furrowing the brow, and shoulder shrugging; vocal tics may involve throat clearing, sniffing, and can also include sudden outbursts of profanity or the repetition of certain phrases.
However, other conditions such as allergic rhinitis or conjunctivitis may also cause children to exhibit behaviors like blinking or sniffing.
Additionally, it is important to note that tic disorders or Tourette's disorder often co-occur with other mental health conditions, such as Attention Deficit Hyperactivity Disorder (ADHD) and anxiety disorders.
These comorbidities can significantly impact a child's academic performance, family dynamics, and social interactions, so a comprehensive evaluation by a child and adolescent psychiatrist is recommended.
2.
Recently, the child has been repeatedly asking the same questions...
If the child mentions suicide, it is important to ask where she heard the term "suicide." Has anyone around her mentioned anything related to suicide? What does she think "suicide" means? Starting elementary school is a significant transition for children, involving long separations from family, unfamiliar environments, and interactions with unfamiliar people.
It may be helpful to inquire whether she has faced any difficulties or frustrations in class, learning, or interacting with peers and teachers, and to encourage teachers to pay attention to her situation at school.
It seems she is aware of her emotions and is curious about them.
This presents a valuable opportunity to help her learn about and process her emotions, guiding her to recognize and understand her internal feelings and to practice empathy by considering others' perspectives.
Typically, children before the lower grades of elementary school perceive behavior in terms of whether the consequences meet their own needs (e.g., avoiding punishment or obtaining desired items).
After the middle grades, they gradually develop a desire for approval (meeting the expectations of parents and teachers) and adherence to certain norms (such as classroom or school rules).
Following puberty, they begin to form their own values to discern right from wrong.
This is part of a child's moral development process, and it is advisable to spend time with them, listen, and provide timely guidance to reflect on the impact of their actions on themselves and others, thereby enhancing the development of empathy.

Reply Date: 2021/09/17

More Info

Addressing anxiety and suicidal thoughts in children, especially in a six-year-old, is a complex and sensitive issue that requires careful consideration and a multifaceted approach. It is essential to understand that children at this age are still developing their emotional and cognitive skills, and their expressions of feelings can often be confusing or alarming to adults. Here are some insights and strategies to help navigate this challenging situation.

Understanding the Child's Behavior
1. Expression of Thoughts: The child's mention of suicidal thoughts and feelings of happiness when others are sad can be alarming. It's crucial to understand where these thoughts are coming from. Children often mimic emotions and behaviors they observe in media or from adults. It would be beneficial to explore whether she has encountered any distressing content, such as violent cartoons or discussions about death.

2. Emotional Awareness: The child seems to be grappling with complex emotions, such as empathy and guilt. Her feelings of happiness when others are sad may indicate a misunderstanding of social cues or emotional responses. This could be a developmental phase where she is learning to navigate her feelings and the feelings of others.

3. Repetitive Questions: The repetitive nature of her questions suggests anxiety. Children often seek reassurance when they feel uncertain or scared. This behavior can be a way of processing their fears, and it is essential to provide consistent and calm responses.

Strategies for Support
1. Open Communication: Encourage open dialogue about feelings. Ask her to express what she feels when she thinks about these "bad things." Use simple language and be patient, allowing her to articulate her thoughts without judgment. This can help her feel heard and understood.

2. Normalize Emotions: Explain that it is normal to have a range of feelings, including sadness and confusion. Share that everyone experiences difficult emotions sometimes, and it’s okay to talk about them. This can help her feel less isolated in her experiences.

3. Teach Coping Mechanisms: Introduce simple coping strategies for managing anxiety. Techniques such as deep breathing, counting to ten, or using a "worry box" where she can write down her fears and set them aside can be effective. Engaging in creative activities like drawing or storytelling can also provide an outlet for her emotions.

4. Model Empathy: Help her understand empathy by discussing feelings in relatable terms. For example, you could say, "When we see someone sad, we can try to help them feel better because it’s nice to be kind." This can help her learn to connect her feelings with those of others in a healthier way.

5. Limit Exposure to Distressing Content: Monitor what she watches on television or online. Ensure that the content is age-appropriate and does not expose her to themes of violence or death that could exacerbate her fears.

6. Professional Help: Given the complexity of her thoughts and behaviors, it may be beneficial to consult a child psychologist or psychiatrist. A professional can provide a thorough assessment and offer tailored strategies to address her specific needs. They can also help determine if there are underlying issues such as anxiety disorders or other mental health concerns.

7. Parental Support: As parents, it’s vital to remain calm and supportive. Your reactions to her fears can significantly influence how she processes her emotions. Show her that you are there for her, and reassure her of your love and support.

Conclusion
Navigating anxiety and suicidal thoughts in children requires a compassionate and informed approach. By fostering open communication, teaching coping strategies, and seeking professional guidance when necessary, you can help your child develop a healthier understanding of her emotions and the world around her. Remember, it’s essential to take her feelings seriously and provide a safe space for her to express herself. With patience and support, she can learn to manage her anxiety and develop resilience.

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