These statistics validate the manifestation of mental illness in early childhood and adolescence, essential periods of socioemotional and brain development. Common symptoms among mood disorders include emotional dysregulation, depressed and irritable mood, lack of worry, and aggressive behaviors. Suicidal behaviors can occur with the presence of a childhood mood disorder, requiring urgency in prevention and treatment.
Biological, psychological, family, and community influenced risk factors can increase a child’s susceptibility to mood disorder development and subsequently the presence of suicidal behaviors or other negative mental health outcomes (Carballo et al., 2020). In order to be considerate of clinically relevant intervention techniques, it’s helpful for play therapists to understand how risk factors may affect a child. One example of a risk factor is family history of mental illness, which places the child at an increased risk for also developing mental illness (Ridge Anderson et al., 2016). Poverty is another risk factor linked to diagnosable mental illness and suicidal behaviors in children (Cree et al., 2008). LGBTQ+ youth are also at a higher risk of developing suicidal behaviors due to bullying, stigma, and inadequate access to inclusive social, emotional, and environmental supports (Garthe et al., 2021; Hatchel et al., 2021).
Family conflict, academic adversity, and unexpected loss of a close relationship are additional risk factors that could increase chances for mood disorder presentation in children (American Mental Wellness due its prevalence in children and connection to negative outcomes attachment to caregivers considerably influence child suicidal behaviors (Wagner et al., 2003). As a result, play therapists should be aware of the potential for untreated childhood trauma to manifest into suicidality.
While multiple risk factors can impact diagnosable mood disorders in children, the combination of risk factors, along with one or more diagnosable mental illnesses, can increase the likelihood of suicidal behaviors (Carballo et al., 2020; Monaco, 2021). Recognizing the collective presence of
risk factors in children underscores the
importance of supportive, effective, and developmentally appropriate intervention such as play therapy.
Neurodevelopmental Considerations for Suicidality
in Children To understand the impact of mood disorders and suicidality in children, it is useful to consider how risk factors can threaten healthy brain development in early childhood and preadolescence. Preadolescence progression of emotional processing, information processing, and stress
responses. The limbic system guides understanding and
regulating emotions, as well as managing and internalizing information to assign meaning. This impacts a child’s capacity for interpersonal skill development. The presence of multiple interacting risk factors places a
CLINICAL EDITOR’S COMMENTS:
Play therapists can effectively care for children with suicidal ideation by assessing for risk and protective factors as well as collaborating with the family system.
child at risk for maladaptive neurodevelopment (Smith & Pollak, 2020), which can lead to emotional and behavioral disturbance.
Mood disorders are categorized by the disturbance in one’s emotional state, leading to impairment in emotional regulation. When this occurs, the prefrontal cortex is directly confronted by the symptoms of mood feelings and regulate emotions, potentially causing them to present with symptoms and behaviors correlated with low or unstable mood, anxiety, and overall impairment in functioning. These behaviors may include isolation, withdrawal from typical daily activities, and disinterest in school and social activities (Children’s Health, 2022). A primary concern with untreated mood disorders should be the possibility for suicidality to develop.
Risk factors can be mitigated with treatment aimed at building protective factors which can increase a child’s sense of well-being and diminish the possibility of negative mental health outcomes. Like risk factors, protective factors are biopsychosocial elements that shape a child’s development and adaptation to their environment. Protective factors include strong family and environmental supports (Steinhauser & Metze, 2001), including relationships where children can observe and practice healthy communication, self-regulation, and conflict- resolution. Protective factors can support building resilience and healthy coping skills that challenge the unfavorable impacts of mood disorder- related symptoms. Additionally, with caregiver involvement in therapy, protective factors increase the caregiver’s capacity to understand and respond productively to their child’s mental health needs.
Using Play Therapy to Enhance Protective Factors When treating mood disorders and suicidality, play therapists should consider incorporating interventions and techniques that strengthen protective factors and increase the possibility for positive outcomes in treatment. Different play therapy approaches have supported improvement in childhood mood disorders and suicidality. For children Adlerian play therapy can be helpful in decreasing these behaviors (Meany-Walen et al., 2012). Child-centered play therapy and group play therapy are correlated with improvement in internalizing symptoms, such as anxiety, social withdrawal, sadness, or low self-esteem (Baggerly, 2004; Lee & Han, 2015).
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