Over the last decade, suicidal and non-suicidal self-injurious thoughts and behaviors (SITBs) have reached crisis levels in children. About 15% of children report having some experience with suicidal thoughts; 10% say they have engaged in self-injury; and 1 in 100 report a suicide attempt. The younger youth are when they begin experiencing SITBs, the more likely they are to progress to more frequent and dangerous forms of self-injury and be hospitalized. Despite the importance of early intervention in this group, there are currently no outpatient, research-supported treatments specifically for children experiencing SITBs. Developing and testing treatments specifically for children is crucially important, as risk factors for SITBs in children are different than risk factors for adolescents. Treatment for this age group also needs to be developmentally appropriate and incorporate caregivers in ways that address the unique needs of children and their families.
Difficulties with regulating strong emotions, thinking flexibly about the “big picture,” and planning ahead are challenges common across children who struggle with SITBs. Dr. Sarah Kennedy (PI) and Dr. Laura Anthony (Co-I) have developed and tested evidence-based interventions that specifically target these key risk factors for self-injury and suicide in children (trouble with emotion regulation and cognitive control). Their goal is to integrate and adapt these existing interventions to develop the first outpatient treatment designed specifically for children with SITBs that address these underlying processes. To make sure it has the maximum reach possible, the intervention will be designed to be modular and flexible so that it can be tailored to individual families’ needs and be delivered in a variety of contexts, including via telehealth. The aims of this project are to: 1) Iteratively develop a transdiagnostic intervention for SITBs in children, targeting emotion regulation and executive functioning, with guidance from experts and end users to maximize implementation potential; and 2) conduct a phase 0, proof-of-concept trial to further adapt the intervention, evaluate feasibility, and examine indications of safety and efficacy. Participants for the pilot trial will be recruited from children (ages 7-12) who are admitted to the emergency department at a large pediatric hospital in Colorado for acute psychiatric concerns. They will complete a baseline assessment to determine eligibility and participate in a 12-week, modular intervention to address SITBs. Study team tracking and post-treatment interviews with clinicians, children, and families will identify additional, needed adaptations to the intervention. Feasibility of recruitment, retention, measurement, and intervention will be evaluated through study team-collected metrics, descriptive statistics, and mixed methods approaches. Safety will be evaluated through tracking and monitoring of adverse events, and indications of efficacy will be evaluated through exploration of changes in SITBs, symptoms, emotion dysregulation, and executive functioning. Based on pilot trial results, adaptations to the intervention will be finalized with guidance from the network of expertise. The end-product will be an iteratively adapted intervention for preadolescent SITBs and refined study procedures, which will be used in Phase I and Phase II trials to more robustly evaluate effectiveness.
