Autism Learning Skills

What is meant by autism learning skills?

There are several methods through which we learn: Through seeing (visually) Hearing (auditory), Touching or manipulating an object (kinesthetically or 'hands-on' learning).

An example of these would be, looking at a picture book or reading a textbook, this would be visual learning. Listening to a c.d., or going to a lecture this would be learning through hearing…and pressing buttons to determine how to operate a DVD involves learning kinesthetically, through touch and feel.

Mostly we learn through two or more of these learning skills. How we learn will determine how ell we do at school.

Most mainstream school adopt all of these learning methods, we visually learn through reading books and texts, we learn through listening to out teachers and we practice tasks to learn.

With autistic children they will nearly always be visual learners.

Some autistic children will also be kinesthetic learners and may well benefit form their teacher or helper actually guiding their hand while they undertake tasks.

Therefore, it is important that a teacher assess each autistic child in the class to determine which kind of learning skill they prefer.

The teacher can then adapt the teaching style to suit the autistic child's need's and build on their strengths.

However one very important thing to remember when assessing an autistic child is their need for repetition and sameness. Keeping this in mind when setting lessons will be of benefit.

A visual timetable should always be in place for the autistic student to refer too.

As with a normally developing child autism learning skills, can be enhanced by following these simple rules. Another good idea is to set up autism social skills stories. These help keep the autistic child on task, and work as an excellent tool in helping teachers explain why, what and how to their autistic students.

Using autism social skills stories will benefit the autistic student as they will encompass all autism learning skills, they can be read, auditory, they have appropriate pictures and images plus some text, visual and they can be handles kinesthetic, or used as a visual aid with attachable pictures etc…

…However you decide to use them they will nevertheless prove to be a valuable asset to autism learning skills.

To obtain school related autism social skills stories that can be downloaded quickly and effortlessly and are all in printable format please visit: www.autismsocialstories.com/school For all other autism social stories visit: our other sites

Why is Parental Involvement Important in Children's Education?

Why is parental Involvement Important in Children's Education?

Numerous research has been done to conclude that parents who are involved with their children's education are building the foundations for a better educated child. These children will be better adjusted to school which can lead to more education. In addition, parents are sending a message to their children that education is important.

In addition, parental involvement is important because parents who are part of their children education will understand the importance of reading. These parents will read to their children beginning at a young age. Also, this parent will make sure that their child can read on the right grade level throughout the educational process. Since reading is a big problem in our country, the reading foundation that the parent are developing will assist the child in its future educational endears as well as life goals.

Equally important, is the fact that parents who are involved with their children will make sure their home is conductive to education. This means that the home will have plenty of books available for their children to read. The home will also have several kinds of reference materials and tools available, such as: encyclopedias, magazines, computer, calculator, pens, pencils, paper, to name a few. In the home will be a quiet room that children can use to study or concentrate on their school work. Part of setting up a home conducive to learning, also includes limited the amount of television viewing throughout the week. Some parents will even make sure that children's homework is done at the same time everyday and if there is no homework the parent will create some.

Another important reason parents should be involved with their children, is because any kind educational deficiencies can be notice quickly. By having parents involved in their child daily education, they will notice the child's strength and weakness. This can help parents to work with those weaknesses as soon as possible.

Parents who attend their children's parent teacher conferences, and also volunteer for activities at school are demonstrating how important school is. Children observe these parents, and they realize education is important because of parent involvement. Also, the schools appreciate the parents who are involved in the school which can lead to additional educational advantages for their child.

These parents realize that is takes the entire village to raise successful children. Overall, the parents that are involved with their children education are building a stronger foundation for their future. Their children are usually the ones excelling at school and receiving all accolades that are top students receive. Parental involvement is not something parent might get involved with it is something that all parents should be involved with.

http://www.stratesville.org

by Ronnie Phillips

Learning to Think

Summer is quickly coming to an end, and school has begun for many children. School buses are busily picking up students and dropping them off during the morning and evening commutes. With the beginning of a new school year, I thought it would be helpful to look into the realm of education and the way our students think and learn.

For most students in the general education population today, the focus of education is on their ability to think and use problem solving skills. We are seeing more and more schools moved towards integrated curricula that teach children math, reading, and writing skills in a more dynamic fashion. A majority of these curricula pose real world problems that students work through and solve as they learn concepts along the way. For many children, this type of curricula proves to be beneficial; for others however, it can be very challenging. For example, children who struggle with reading typically have greater difficulty using curricula formatted in this fashion, since most of it is comprised of written language that needs to be read, dissected, and understood in order to progress through the problem at hand. For these individuals, accommodations to the curricula are usually made to make it easier for the child to understand and process.

When thinking about children with more significant disabilities like cognitive impairments, neurological issues, or Autism, we typically see educators using curricula of a more static nature. These types of curricula tend to be more repetitive. I wonder though: How are these types of materials preparing children for the real world, given that these students typically have the greatest amount of difficulty in the realm of problem solving and creative thinking?

As a teacher of children with severe multiple disabilities, I found myself in an interesting predicament several years back. How was I going to prepare my students to be active participants in the community? Reading books and doing worksheets was not going to cut it. My students needed to learn how to think and be mindful of their surroundings. I decided to take a developmental approach to their learning, and to provide as many opportunities during the day for my students to think and process information. I threw out all of the extras I had plugged into our day, and gave myself and my staff the time that was needed to help our students become mindful. One of the greatest challenges that I faced was getting out of the rut of doing the same thing day in and day out. I had to do so much more thinking in order to plan activities that would allow my students the opportunity to do their own thinking as well. Here are the first few of several modifications and suggestions that I will be sharing with you over the next few months:

• Stop asking so many questions! I found myself constantly asking my students questions like "What color is this?" I used such questions to gauge their understanding of what I was teaching; but, I found that they were responding to my static questions in their own static way. Static questions do not offer opportunities for idea sharing or comparing and contrasting. With this knowledge in mind, think about the questions that you ask. Can you change those questions to more open-ended statements? Instead of "What color is this?" you could say to a student "I forget the name of this color." With a more open-ended statement like this, you will be opening the door for more dynamic dialogue and social interaction.


• Slow down and let your students think! With the demands on today's teachers, it is tough to consider slowing down - especially when you have so much to cover in such a short period of time. I must say, however, that they old saying is true: "Slow down to speed up". By giving your students time to process information, you allow them to think and problem solve on their own. If they can make their own discovery about a topic area, it will be so much more meaningful to them than if they had been told what to do or how to fix the problem. All children have the ability to think and conduct problem solving on their own at their appropriate learning level; but they need to be allowed to have the time to do it, and they need to feel supported in the learning process.

By allowing my students to think about the topic we were studying and providing them more opportunities for open-ended dialogue, I found that my students were learning and thinking about so many different things in their environment. It was wonderful to discover how much of an impact I could make on the learning process of my students and their quality of life now and in the future. See what amazing things can happen when you make little changes like these!

School has been in session for over a month now, and students are busily working on their studies. Teachers have dug into the content of their curriculum for the year, and everyone has had time to adjust to the new routine. As a former teacher, curriculum was an integral part of my day; and working with students with special needs could be very challenging, especially when trying to pull from so many different pieces of curriculum. I did my best to look at each child's unique needs, and best match their capabilities with the curriculum options I had available; however, I still found myself struggling with what I had. My students needed extra practice and a slower pace, which most curricula today do not allow. I also wanted to see my students learning to think and process information instead of learning static skills.

While pondering this issue about mindfulness and curricula, I found myself creating opportunities during the day for thinking and problem solving. I continued to use modified forms of curriculum with my students in order to meet their academic goals; but, I found that providing my students with opportunities to think and do problem solving made a tremendous impact in all aspects of their education and livelihood. Here are a few suggestions for adding moments of "mindfulness" to your day with students.

• Allow your students to get the materials they need instead of doing it for them. For many teachers, it is easier to get the materials that we need before inviting our students to join us. However, asking our students to get the materials themselves gets them thinking ahead to what it is that you will be doing, and to prepare for the activity themselves. This allows for a great deal of thinking on the student's part, which is very important. You are not only teaching them how to think but also how to plan, which is a necessary life skill that every child should have.
• Include a "Surprise Bag" in your daily routines. I have used a "Surprise Bag" for many years now, and all of my students have enjoyed it. When undertaking this activity, you need to have a fabric bag that closes and that cannot be seen through. Each day, pick a student to help you put into the surprise bag something that no one else knows about. They can pick an item from the classroom, or take the bag home and put an item into it. Have the child stand up with you and share three clues about what is inside. You can also pass the bag around and let your students feel the item without looking into the bag. Once the clues have been shared or everyone has felt the bag, you can allow your other students to guess what is inside. This activity is a lot of fun for everyone, and fosters great cognitive thinking and problem solving skills.
• Make mistakes intentionally in front of your students, and have them correct you. It is important for children to see adults in their lives making mistakes, and even more important to discover how adults handle mistakes. As you are teaching, feel free to make simple mistakes that you know your students will catch. When looking at the number 3, for example, you could refer to it as "the number 5" and then wait for a response. When your students correct you, it will be important for you to model how to handle the mistake. For example, you could respond by saying, "Thank you, John, for correcting me. I made a mistake, but that is okay. I am so glad I have a friend like you to help me."

By providing my students with more opportunities to be mindful and do problem solving on their own, I saw a dramatic change in their academic skills as well as in their functional skills. It is very exciting to see children begin to think and problem solve on their own. The possibilities are endless! I look forward to sharing more about "Mindfulness in the Classroom" next month.

Fall is well underway here in Michigan, and the beautiful fall colors can be seen for miles around. It is such a wonderful sight to see children, young and old, out and about enjoying the wonderful scenery. My young son has become increasingly aware of the seasons, and it has been amazing for me to watch him make discoveries about the changes in his world. During this time of change, I continue to think about the mindfulness that is so important for every child. Watching my son think, learn, and process information related to the changing seasons has brought me more joy than I could have ever imagined.

In my last article, I discussed two strategies to increase students' mindfulness throughout the school day. It is so important for our students to be learning to think independently, and not just learning rote skills that they cannot apply. Here are a few more strategies that I would like to share with you that will help increase the mindfulness of your students.

• Play "I Spy" with your students. Students at any age love to play games. The "I Spy" game can be adapted for any age of students. This game consists of one person visually locating an item within a room, and then providing clues to his or her peers about the item. You could spy a small plant growing on the teacher's desk, for example, and then provide clues like "this is green" and "it continues to grow". The audience then guesses what the person is spying, and whoever guesses correctly gets to be the "spy" next. This game provides students with opportunities to practice basic problem solving skills and information processing.
• Rearrange the daily schedule. As teachers, we often get into a rut of doing the same thing at the same time each day. Consistent schedules are often positive elements of an effective classroom; however, the same thing day in and day out can become monotonous, static, and even boring for the students and the teachers. Providing simple variations to your classroom schedule can be an effective tool for increasing the flexibility and mindfulness of your students. For example, if you consistently have a snack before doing math, try having the snack during or after your math lesson. By providing a schedule that is fairly consistent yet flexible, you will be providing your students with opportunities to increase their abilities as well.
• Vary the way you teach lessons. Often as teachers, we have a favorite spot of two from which we prefer to teach. These may be in front of the class, by the white board or projector, or walking amongst our students. There are, however, many different places within the classroom where you can teach from. For example, you could teach while sitting at a student's desk, sitting in the back of the room, or sitting on the floor together as a group. By providing variations to the way you deliver instruction, you can provide students with variations and opportunities to do think independently as well as get a glimpse of what may be happening in other portions of your classroom.

By providing your students, and yourself, with some simple variations and opportunities to be mindful individuals, you will be setting the stage for a community of lifelong thinkers. I look forward to sharing more thoughts with you regarding learning and thinking in the months to come!

by Courtney Kowalczyk, M.Ed.

Multiplication by Two - How to Practice Multiplying with Playing Cards

If you want to teach a child to multiply by two, one of the easiest ways is to explain that multiplication by two is simply doubling the number.

Instead of showing the child endless multiplication tables and multiplication charts, get out a deck of cards and do the following:

• Remove the Tens, Jacks, Queens and Kings. You won't need them.

• Take a Two of any other suit (say Spades) and place it face up on the table.

• Take the Ace through Nine of any suit (say diamonds). Shuffle them face down.

• Start turning the cards over one by one, and as you do, say what the product of that number, multiplied by two, is.

• It is important to remember not to say to yourself, "Two times (whatever number you are working on) is..." Try to just say the answer.

If you have trouble with a problem, like say, two times 9, remember, you are just doubling the number. If you have problems with that, you may want to "skip count" to the number.

To "skip count" you just count by twos, and put out a finger for each number you say. So you'd say "two" and put out one finger. Then you'd say "four" and put out another one. By the time you have nine fingers out, you should be up to "eighteen." That is two times nine.

This is important: Whenever you come to a problem that you don't immediately know the answer to (like if you have to think about it, or skip count to it), you may think you now know the answer because you have figured it out. Don't fall into that trap! That's what hurts many learners most. You must know the answer to simple multiplications in your bones.

So when you get to something like two times nine and have to skip count, stop, look at the cards, see the problem, and say out loud:

"2 times 9 in 18"

"9 times 2 is 18"

"18 is 2 times 9"

"18 is 9 times 2"

"2 times 9 is 18."

Say that out loud each time you hesitate with the answer. It will definitely help you for the next time. You won't have to do this often until you will instantly recognize that two times nine is eighteen, any time you see it.

After you have gone through all nine cards, it's time to do some serious practicing.

• Leaving the Two of Spades face up on the table, take the rest of the cards, except for the Tens, Jacks, Queens and Kings, and shuffle them face down.

• Start turning over cards as before, saying their products. Don't forget to do , stop, look at the cards, see the problem, and say the combinations of the answers out loud, as above.

• Keep this up until you can go through all of the cards (there will be 35 of them) in less than one minute. This will not take much practice, and you'll feel great about yourself when you can do it in under a minute.

Learning this way has huge advantages. Once you are great at multiplying by two, try it with three. This method also has the advantage that you don't have to print out worksheets, and you can carry a deck of cards anywhere. You also will improve your powers of concentration when you learn like this. I have been diagnosed with ADD, and this method worked wonders for me.

Please keep in mind that we are only talking about whole numbers here. "Simply doubling" is not the definition of multiplication by two. There are subtleties involved that are beyond the scope of this article. But in order to learn simple multiplication by two, this method is much preferable to the "multiplication tables."

If the above seems a little complicated, it really isn't. You can see a free video of exactly how to do this at http://mathmojo.com/chronicles/2009/02/11/how-to-practice-multiplying-by-two-with-playing-cards/ . You will immediately understand how to practice multiplying by two with playing cards once you see it.

by Brian Foley

What Parents and Teachers should Know about Suicide in Adolescents (Part 2)

What can be done to help someone who may be suicidal?:

1. Take it seriously.

Myth: "The people who talk about it don't do it." Studies have found that more than 75% of all completed suicides did things in the few weeks or months prior to their deaths to indicate to others that they were in deep despair. Anyone expressing suicidal feelings needs immediate attention.

Myth: "Anyone who tries to kill himself has got to be crazy." Perhaps 10% of all suicidal people are psychotic or have delusional beliefs about reality. Most suicidal people suffer from the recognized mental illness of depression; but many depressed people adequately manage their daily affairs. The absence of "craziness" does not mean the absence of suicide risk.

"Those problems weren't enough to commit suicide over," is often said by people who knew a completed suicide. You cannot assume that because you feel something is not worth being suicidal about, that the person you are with feels the same way. It is not how bad the problem is, but how badly it's hurting the person who has it.

2. Remember: suicidal behavior is a cry for help.

Myth: "If someone is going to kill himself, nothing can stop him." The fact that a person is still alive is sufficient proof that part of him wants to remain alive. The suicidal person is ambivalent - part of him wants to live and part of him wants not so much death as he wants the pain to end. It is the part that wants to live that tells another "I feel suicidal." If a suicidal person turns to you it is likely that he believes that you are more caring, more informed about coping with misfortune, and more willing to protect his confidentiality. No matter how negative the manner and content of his talk, he is doing a positive thing and has a positive view of you.

3. Be willing to give and get help sooner rather than later.

Suicide prevention is not a last minute activity. Unfortunately, suicidal people are afraid that trying to get help may bring them more pain: being told they are stupid, foolish, sinful, or manipulative; rejection; punishment; suspension from school; written records of their condition; or involuntary commitment. You need to do everything you can to reduce pain, rather than increase or prolong it. Constructively involving yourself on the side of life as early as possible will reduce the risk of suicide.

4. Listen.

Give the person every opportunity to unburden his troubles and ventilate his feelings. You don't need to say much and there are no magic words. If you are concerned, your voice and manner will show it. Give him relief from being alone with his pain; let him know you are glad he turned to you. At times everyone feels sad, hurt, or hopeless. You know what that's like; share your feelings. Let the child know he or she is not alone. Avoid arguments and advice giving. If the child's words or actions scare you, tell him or her. If you're worried or don't know what to do, say so.

5. ASK: "Are you having thoughts of suicide?"

Myth: "Talking about it may give someone the idea." People already have the idea; suicide is constantly in the media. If you ask a despairing person this question you are doing a good thing for them: you are showing him that you care about him, that you take him seriously, and that you are willing to let him share his pain with you. You are giving him further opportunity to discharge pent up and painful feelings. If the person is having thoughts of suicide, find out how far along his ideation has progressed.

6. If the person is acutely suicidal, do not leave him alone.

If the means are present, try to get rid of them. Detoxify the school or home.

7. Urge professional help.

Persistence and patience may be needed to seek, engage and continue with as many options as possible. In any referral situation, let the person know you care and want to maintain contact.

8. No secrets.

It is the part of the person that is afraid of more pain that says "Don't tell anyone." It is the part that wants to stay alive that tells you about it. Respond to that part of the person and persistently seek out a mature and compassionate person with whom you can review the situation. Distributing the anxieties and responsibilities of suicide prevention makes it easier and much more effective.

Interventions with a suicidal student:

Schools should have a written protocol for dealing with a student who shows signs of suicidal or other dangerous behavior. The following steps may be effective in dealing with a student who expresses active suicidal intent.

1. Calm the immediate crisis situation. Do not leave the suicidal student alone even for a minute. Ask whether he or she is in possession of any potentially dangerous objects or medications. If the student has dangerous items on his person, be calm and try to verbally persuade the student to give them to you. Do not engage in a physical struggle to get the items. Call administration or the designated crisis team. Escort the student away from other students to a safe place where the crisis team members can talk to him. Be sure that there is access to a telephone.

2. The crisis individuals then interview the student and determine the potential risk for suicide. a. If the student is holding on to dangerous items, it is the highest risk situation. Staff should call an ambulance, the police and the student's parents. Staff should try to calm the student and ask for the dangerous items. b. If the student has no dangerous objects, but appears to be an immediate suicide risk, it would be considered a high-risk situation. If the student is upset because of physical or sexual abuse, staff should notify the appropriate school personnel and contact the police. If there is no evidence of abuse or neglect, staff should contact parents and ask them to come in to pick up their child. Staff should inform them fully about the situation and strongly encourage them to take their child to a mental health professional for an evaluation. The team should give the parents a list of telephone numbers of crisis clinics. If the school is unable to contact parents, and if the police cannot intervene, designated staff should take the student to a nearby emergency room. c. If the student has had suicidal thoughts but does not seem likely to hurt himself in the near future, the risk is more moderate. If abuse or neglect is involved, staff should proceed as in the high-risk process. If there is no evidence of abuse, the parents should still be called to come in. They should be encouraged to take their child for an immediate evaluation. d. Follow-Up: It is important to document all actions taken. The crisis team may meet after the incident to go over the situation. Friends of the student should be given some limited information about what has transpired. Designated staff should follow up with the student and parents to determine whether the student is receiving appropriate mental health services. Follow-up is crucial, because most suicides occur within three months of the beginning of improvement in depressive symptoms, when the youth has the energy to carry out plans conceived earlier. Regularly scheduled supportive counseling should be provided to teach the youth coping mechanisms for managing stress accompanying a life crisis, as well as day-to-day stress.

In a counseling situation, a contract can be an effective prevention technique. The suicidal adolescent can be made to sign a card which states that he or she agrees not to take the final step of suicide while interacting with the counselor.

Role of the teachers:

Teachers play an especially important part in prevention, because they spend so much time with their students. Along with holding parent-teacher meetings to discuss teenage suicide prevention, teachers can form referral networks with mental health professionals. They can increase student awareness by introducing the topic in health classes.

Some schools have automatic expulsion policies for students who engage in illegal or violent behavior. It is important to remember that teens who are violent or abuse drugs may be at increased risk for suicide. If someone is expelled, the school should attempt to help the parents arrange immediate and possibly intensive psychiatric and behavioral interventions.

Role of the peers:

Peers are crucial to suicide prevention. According to one survey, 93% of the students reported that they would turn to a friend before a teacher, parent or spiritual guide in a time of crisis. Peers can form student support groups and, once educated themselves, can train others to be peer counselors.

Adolescents often will try to support a suicidal friend by themselves. They may feel bound to secrecy, or feel that adults are not to be trusted, and this may delay needed treatment. Ideally, a teenage friend should listen to the suicidal youth in an empathic way, but then insist on getting the youth immediate adult and professional help.

Role of the parents:

Parents need to be as open and as attentive as possible to their adolescent children's difficulties. The most effective suicide prevention technique parents can exercise is to maintain open lines of communication with their children. Sometimes teens hide their problems, not wanting to burden the people they love. It is extremely important to assure teens that they can share their troubles, and gain support in the process. Parents are encouraged to talk about suicide with their children, and to educate themselves by attending parent-teacher or parent-counselor education sessions and from nearby libraries or the internet. Once trained, parents can help to staff a crisis hotline in their community. Parents also need to be involved in the counseling process if a teen has suicidal tendencies. These activities may both alleviate parents' fears of the unknown and assure teenagers that their parents care.

Postvention:

The rationale for school-based postvention/crisis intervention is that a timely response to a suicide is likely to reduce subsequent morbidity and mortality in fellow students, including suicidality, the onset and exacerbation of psychiatric disorders, and other symptoms related to pathological bereavement.

An attempted or completed suicide can have a powerful effect on the staff and on the other students. One study found an increased incidence of major depression and posttraumatic stress disorder 1.5 to 3 years after the suicide. There have been clusters of suicides in adolescents, and some feel that media sensationalization or idealized obituaries of the deceased may contribute to this phenomenon.

The school should have plans in place to deal with a suicide or other major crisis in the school community. The administration or the designated individual should try to get as much information as soon as possible. He or she should meet with teachers and staff to inform them of the suicide. The teachers or other staff should inform each class of students. It is important that all of the students hear the same thing. After they have been informed, they should have the opportunity to talk about it. Those who wish should be excused to talk to crisis counselors. The school should have extra counselors available for students and staff who need to talk. Students who appear to be the most severely affected may need parental notification and outside mental health referrals. Rumor control is important. There should be a designated person to deal with the media. Refusing to talk to the media takes away the chance to influence what information will be in the news. One should remind the media reporters that sensational reporting has the potential for increasing a contagion effect. They should ask the media to be careful in how they report the incident. Media should avoid repeated or sensationalistic coverage. They should not provide enough details of the suicide method to create a "how to" description. They should try not to glorify the individual or present the suicidal behavior as a legitimate strategy for coping with difficult situations.

It is imperative for crisis interventions to be well planned and evaluated; otherwise, not only may they not help survivors, but they may potentially exacerbate problems through the induction of imitation.

COMMUNITY BASED PREVENTION PROGRAMS

Crisis Services (hotlines):

Crisis centers and hotlines are based on the premise that suicide is often associated with a critical stress event, it is usually approached with ambivalence, and the wish to commit suicide is seen as a way to solve an immediate problem. Crisis centers and hotlines are designed to deal with the immediate crisis, and use the individual's ambivalence to convince them that there are other means of solving the problem other than suicide.

Restricting access to lethal means:

The underlying rationale for means restriction is that suicidal individuals are often impulsive, they may be ambivalent about killing themselves, and the risk period for suicide is transient. Restricting access to lethal methods during this period may prevent suicides. The following steps may be useful:

* Safe storage of guns 
* Fences on bridges 
* Restricting drugs/poisons 
* Other restrictions on guns

Educating the media:

This includes educating media professionals about contagion, in order to yield stories that minimize them, and encouraging the media's positive role in educating the public about risks for suicide and shaping attitudes about suicide.

CONCLUSION

Suicide attempts and completed suicides among adolescents are problems of increasing significance. School staff, parents, and health professionals should be sensitized about the risk factors and warning signs of suicide, and about the ways to deal with suicidal adolescents.

By Dr. Shahul Ameen, M.D.

FURTHER READING

* Gould, M.S., Greenberg, T., Velting, D.M. & Shaffer, D. (2003) Youth suicide risk and preventive interventions: a review of the past 10 years. Journal of the American Academy of Child and Adolescent Psychiatry, 42, 4, 386-405. 
* Hawton, K. & James, A. (2005) Suicide and deliberate self harm in young people. British Medical Journal, 330, 891-894. 
* www.depts.washington.edu/hiprc/practices/topic/suicide 
* www.baltimorepsych.com/suicide.htm 
* www.metanoia.org/suicide/

What Parents and Teachers should Know about Suicide in Adolescents (Part 1)

Suicide is one of the commonest causes of death among young people. The latest mean worldwide annual rates of suicide per 100,000 are 0.5 for females and 0.9 for males among 5-14-year-olds, and 12.0 for females and 14.2 for males among 15-24-year-olds. Suicide is the sixth leading cause of death among children aged 5-14 years, and the third leading cause of death among all those 15-24 years old. In most countries, males outnumber females in youth suicide statistics. There are far more suicidal attempts and gestures than actual completed suicides. One epidemiological study estimated that there were 23 suicidal gestures and attempts for every completed suicide. Though female teens are much more likely to attempt suicide than males, male teens are more likely to actually kill themselves.

The suicide rate among young teens and young adults has increased by more than 300% in the last three decades. Social changes that might be related to the rise in adolescent suicide include an increased incidence of childhood depression and decreased family stability. Some researchers argue that economic and political institutions have penetrated the family unit, reducing it to a consumer unit no longer able to function as a support system, and no longer able to supply family members with a sense of stability and rootedness. Awareness of the existing state of the world, now threatened by sophisticated methods of destruction, can cause depression which contributes to the adolescent's sense of frustration, helplessness, and hopelessness. Faced with these feelings and lacking coping mechanisms, adolescents can become overwhelmed and turn to escapist measures such as drugs, withdrawal, and ultimately suicide.

The rising rate has also been explained as a reaction to the stress inherent in adolescence compounded by increasing stress in the environment. Adolescence is a time when ordinary levels of stress are heightened by physical, psychological, emotional, and social changes. Adolescents suffer a feeling of loss for the childhood they must leave behind, and undergo an arduous period of adjustment to their new adult identity. Yet society alienates adolescents from their new identity by not allowing them the rights and responsibilities of adulthood. They are no longer children, but they are not accorded the adult privileges of expressing their sexuality or holding a place in the work force. Our achievement-oriented, highly competitive society puts pressure on the teens to succeed, often forcing them to set unrealistically high personal expectations. There is increased pressure to stay in school, where success is narrowly defined and difficult to achieve. In an affluent society which emphasizes immediate rewards, adolescents are not taught to be tolerant of frustration.

RISK FACTORS FOR SUICIDE

Contrary to popular belief, suicide is not an impulsive act but the result of a three-step process: a previous history of problems is compounded by problems associated with adolescence; finally, a precipitating event, often a death or the end of a meaningful relationship, triggers the suicide. The major, empirically proven risk actors for suicide among adolescents are detailed below.

PERSONAL CHARACTERISTICS

Psychopathology: More than 90% of youth suicides and around 60% of younger adolescent suicide victims have had at least one major psychiatric disorder. The most prevalent disorder in adolescent suicide victims is depressive disorders. Depression that seems to quickly disappear for no apparent reason is a cause for concern, and the early stages of recovery from depression can be a high risk period. Substance abuse, conduct disorder, posttraumatic stress disorder and panic attacks are the other disorders found to be common in this population.

Previous suicide attempts: A history of prior suicide attempts is one of the strongest predictors of completed suicide, especially in boys. One quarter to one third of teen suicide victims have made a previous suicide attempt.

Cognitive and personality factors: Hopelessness, poor interpersonal problem solving ability and aggressive impulsive behaviour have been linked with suicidality.

Biological factors: Some teens are at greater risk for suicide because of their biochemical makeup. Abnormalities in the function of serotonin, a neurotransmitter, have been associated with suicidal behaviour.

FAMILY CHARACTERISTICS

Family history of suicidal behaviour: Teens who kill themselves have often had a close family member who attempted or committed suicide.

Parental psychopathology: High rates of parental psychopathology, particularly depression and substance abuse, have been found to be associated with completed suicide and suicidal ideation and attempts in adolescents. Moreover, family cohesion has been reported to be a protective factor for suicidal behaviour among adolescents.

ADVERSE LIFE CIRCUMSTANCES

Stressful life events: Life stressors such as interpersonal losses and legal or disciplinary problems are associated with completed suicide and suicide attempts in adolescents. The anniversary of a loss can also evoke a powerful desire to commit suicide.

Common problems preceding suicide attempts:

* School or work problems 
* Difficulties with boyfriends or girlfriends 
* Physical ill health 
* Difficulties or disputes with parents, siblings or peers 
* Depression 
* Bullying 
* Low self esteem 
* Sexual problems

Physical abuse: Childhood physical abuse has been found to be associated with increased risk of suicide attempts in late adolescence and early adulthood.

SOCIOECONOMIC AND CONTEXTUAL FACTORS

School and work problems: Difficulties in school, neither working nor being in school, dropping out of high school and not attending college pose significant risks for completed suicide.

Contagion/Imitation: Teens are more likely to kill themselves if they have recently read, seen, or heard about other suicide attempts. Evidence continues to amass from studies of suicide clusters and the impact of the media, supporting the existence of suicide contagion. The impact of suicide stories on subsequent competed suicides appears to be greatest for teenagers.

PREVENTION STRATEGIES

Youth suicide prevention strategies have primarily been implemented within three domains - school, community, and health are systems. This article reviews the school-based programs in detail and briefly describes the community based interventions.

SCHOOL-BASED SUICIDE PREVENTION PROGRAMS

School based suicide prevention programs include both curricula components to teach students about these warning signs and what to do, as well as non-curricula components such as peer groups, hot lines, intervention services and parent training. Prevention includes education efforts to alert students and the community to the problem of teen suicidal behavior. Intervention with a suicidal student is aimed at protecting and helping the student who is currently in distress. Postvention occurs after there has been a suicide in the school community. It attempts to help those affected by the recent suicide. In all cases it is a good idea to have a clear plan in place in advance. It should involve staff members and administration. There should be clear protocols and clear lines of communication. Careful planning can make interventions more organized, and effective.

The goals of school based suicide prevention programs are to:

* Increase awareness 
* Promote identification of students at high risk of suicide and suicide attempts 
* Provide knowledge about the behavioral characteristics ("warning signs") of teens at risk for suicide. 
* Provide information to students, teachers and parents on the availability of mental health resources 
* Enhance the coping abilities of teenagers

Education: Education may be done in a health class, by the school counselor or outside speakers. Education should address the factors that make individuals more vulnerable to suicidal thoughts. Education regarding the ill effects of drug and alcohol abuse would be useful. PTA meetings can be used to educate parents about depression and suicidal behavior. Parents should be educated about the risk of unsecured firearms in the home. Outside mental health professionals can discuss their programs so that students can see that these individuals are approachable. Education on the following topics will be useful:

Warning signs of suicide:

* Preoccupation with death and dying 
* Signs of depression 
* Taking excessive risks 
* Increased drug use 
* The verbalizing of suicide threats 
* The giving away of prized personal possessions 
* The collection and discussion of information on suicide methods 
* The expression of hopelessness, helplessness, and anger at oneself or the world 
* Themes of death or depression evident in conversation, written expressions, reading selections, or artwork 
* The scratching or marking of the body, or other self-destructive acts 
* Acute personality changes, unusual withdrawal, aggressiveness, or moodiness 
* Sudden dramatic decline or improvement in academic performance, chronic truancy or tardiness, or running away 
* Physical symptoms such as eating disturbances, sleeplessness or excessive sleeping, chronic headaches or stomachaches, menstrual irregularities, apathetic appearance

Sudden changes in behavior that are significant, last for a long time, and are apparent in all or most areas of his or her life (pervasive) are more specific than presence of isolated signs. However, it should be noted that many completed suicides had only a few of the conditions listed above, and that all indications of suicidality need to be taken seriously in a one person to another person situation.

Signs of depression in teens:

* Sad, anxious or "empty" mood 
* Declining school performance 
* Loss of pleasure/interest in social and sports activities 
* Sleeping too much or too little 
* Changes in weight or appetite

Features of self harm that suggest high suicidal intent:

* Conducted in isolation 
* Timed so that intervention is unlikely (for example, after parents have gone to work) 
* Precautions to avoid discovery 
* Preparations made in anticipation of death (for example, leaving indication of how belongings to be distributed) 
* Adolescent told other people beforehand about thoughts of suicide 
* The act had been considered for hours or days beforehand 
* Suicide note or message 
* Adolescent did not alert others during or after the act

(Article continued in Part II)

By Dr. Shahul Ameen, M.D.