Clinicians’ Impressions of the Developmental Appropriateness of the Ask-Suicide Screening Questions for Children Aged 6–12

Background: Although the suicide rate for children ages 8–12 is increasing, there is not a developmentally adapted suicide risk screener for children younger than 10. Current practices to screen preteen children for suicide risk often include unstructured interviewing and/or suicide risk screeners that are validated for use with older children. It is clinically important to understand the limitations of existing suicide risk screeners when they are used with preteens to inform the design of developmentally appropriate measures and to tailor support for clinicians. Objective: To characterize the rate at which clinicians in an outpatient crisis clinic indicated that they felt the Ask Suicide-Screening Questions (ASQ) was developmentally inappropriate for children between the ages of 6 and 12. Methods: We analyzed electronic medical record data from an outpatient psychiatric crisis clinic, including a suicide risk screening interface that allows clinicians to administer the screener during a clinical encounter or indicate that they feel it is developmentally inappropriate. Results: The percentages of suicide risk screening instances where the clinician marked the ASQ as developmentally inappropriate were 72.5% for 6-year-olds, 55.8% for 7-year-olds, 30.1% for 8-year-olds, 11.5% for 9-year-olds, 4.9% for 10-year-olds, 0.9% for 11-year-olds, and 0.5% for 12-year-olds. These results were similar in analyses stratified by race, but the ASQ was determined to be developmentally inappropriate significantly more often for boys than girls (p <.001; 2.8% of screens with girls aged 6–12 vs. 9.0% of screens with boys aged 6–12). Conclusions: These findings clearly highlight the urgent need to design and test a developmentally adapted suicide risk screener that can be used with preteen children, especially those who are age 10 and younger.