Self-Harm Showing Up in Elementary Schools: Study

MONDAY, June 11 (HealthDay News) — When young people purposely
hurt themselves it’s disturbing at any age, but a new study suggests that
kids in elementary school cut and otherwise injure themselves at about the
same rate as older children.

“One of our main messages is: This happens earlier than you think. And
then it’s: How are kids at different ages doing this and what do you need
to look for?” said study author Benjamin Hankin, an associate professor of
psychology at the University of Denver.

Appearing online June 11 and in the July print issue of
Pediatrics, the study included youths aged 7 to 16 from the Denver
area and central New Jersey.

Of the 665 participants, 53 children (8 percent) in third, sixth and
ninth grades admitted to doing what’s known as “nonsuicidal self-injury”
at least once. Among third graders, 7.6 percent had intentionally hurt
themselves, compared to 4 percent of sixth graders and 12.7 percent of
ninth graders.

All kids were taking part in a larger study of social, emotional and
mental health development. “During this nonsuicidal self-injury interview,
we were talking to the child separately, without the parent present,”
Hankin explained.

Cutting, burning and head banging are self-injury methods, along with
inserting sharp objects into skin or nails, skin picking, biting, or
pulling hair to cause pain.

“The older adolescents in our study — basically ninth graders — were
engaging in cutting and burning,” Hankin said. “The boys, and especially
the younger kids, were actually doing more head banging.”

By ninth grade, girls were three times more likely to self-injure than
boys, the study found.

“Of those who engaged in nonsuicidal self-injury– about a third of
them did it once and didn’t do it again,” Hankin said. “Of course that
means the rest of them, 66 percent, go on and repeat.”

It’s possible that, at least initially, some kids try self-injury as a
form of imitation.

“There’s some emerging evidence of that imitation, copycat,
‘peer-contagion’ effect,” Hankin said. “But there is not really strong,
excellent scientific data for that yet.” He said some kids may try it
once and decide, “Nope, it’s not for me.”

A March 2011 Pediatrics study found that a variety of YouTube
videos posted by teens engaging in self-injury had together attracted more
than 2 million views.

In the current study, 1.5 percent of participants had self-injured at
least five times that year. Repeaters tend to feel depressed, anxious,
angry or consumed with negative feelings or thoughts, the study authors
found.

“What maintains the behavior usually is that it works,” said Alec
Miller, chief of child adolescent psychology at the Montefiore
Medical Center/Albert Einstein College of Medicine in New York City. “At
least from what we understand with adolescents and adults, the primary
reason people do it is for emotional regulation effects. It helps relieve
emotional pain for many children.”

Self-injury is considered a risk factor for eventual suicidal thoughts
and behaviors. And there can also be physical consequences, such as
infection or worse.

“Usually, people who do those kinds of things, they’re not wanting to
die,” Hankin said. “Most of these individuals have a decent sense of how
far they can go without causing really significant medical damage. But
sometimes they accidentally hit an artery or do other things and the
accumulation gets them into medical problems.”

Miller recommends a form of treatment called dialectical behavior
therapy, in which kids who self-injure learn a variety of coping skills,
such as mindfulness — noticing emotions and the urge to do self-harm —
and emotional regulation.

“What’s very important is distress-tolerance skills,” Miller said. “Can
we teach them replacement behaviors in lieu of self-injuring? Can you
distract yourself, can you soothe yourself, can you weigh the pros and
cons of the act before you do it?”

When parents come to suspect that their children are self-injuring,
it’s difficult.

Miller advises parents to “ask questions gently and assertively.”
Parents should “ask what’s going on and whether they’re feeling stressed
and is that a way that they’re coping.” If so, the children should be
asked if they would “like to learn some other ways of managing their
distress,” Miller added.

“The worst thing you can do is be judgmental and angry, even though I
understand that parents — in their fear and horror — might come
[across] that way,” he said. “So the parents have to be very careful;
otherwise, the kid will go further underground and conceal it more.”

Study author Hankin said, “If you have a concern, talk with a
pediatrician. That pediatrician can confidentially ask things and make
appropriate referrals for mental health specialists.”

Because the study involved children in relatively well-off families,
the results might not apply to the general population, the researchers
noted.

More information

The American Academy of Child Adolescent Psychiatry has more
facts on self-injury.

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