Teen suicide and the new DSM: Let's give common sense a chance
It’s ridiculous because everyone knows that teens are different but for some reason teens are often screened as though they are adults. For example, teenage boys are less likely to have depression, more likely to abuse alcohol and often exhibit aggressive behavior before a suicide attempt. Teen girls often have depression but are less likely to abuse alcohol. For both, suicide is often spontaneous and impulsive. Meanwhile, adult suicides often follow detailed planning, worsening of depression, heavy drinking, increased anxiety, and agitated behavior.
The recommendation for a separate assessment scale for teens is brilliant because the proposal recommends testing teens without verbally asking questions. Instead, teens will tested on paper or on a computer. It seems teens are reluctant to verbally answer personal questions asked by adult authority figures. (Imagine that.)
Finally, the proposal recommends that the results are recorded in a teen’s medical records. Seems like common sense, but apparently, doctors don’t always record the results of a suicide risk assessment in medical records.
“While clinicians must currently evaluate individuals in their care for suicide risk, there are a number of different scales in use and the evaluation is sometimes not included in the written record,” said David Shaffer, M.D., a member of the Disorders in Childhood and AdolescenceWork Group. “The use of a single research-based scale and accompanying record of assessmentmay help clinicians better assess suicide risk as well as provide important information forresearchers to help us more accurately identify and treat those at greatest risk for suicide.”
How could this proposal possibly be controversial?Because Shaffer is the creator of computerized suicide risk assessment tool called TeenScreen. Shaffer, a psychiatrist at Columbia University, created TeenScreen to identify mental health problems in teens. Screening is voluntary but must be done with written parental consent. TeenScreen is offered through schools, clinics, doctors’ offices, juvenile justice facilities, and other youth-serving organizations and settings.
TeenScreen has some controversial opponents. Among them, Phyllis Schlafly’s Eagle Forum and the Church of Scientology. Critics say that TeenScreen is a plot by pharmaceutical companies to expand their markets to schoolchildren. School authorities could use medication to prevent behavior of which they simply disapprove. And, despite claims that the program is free, it actually costs about $37 to test each student and even more when troubled students are referred for more help.
As someone who tried twice to kill herself as a teen, these arguments are … (can’t use that word on this blog) … dumb. Don’t we already test kids’ hearing and eyes? Aren’t kids required to have vaccines before they can attend school? The passive-consent debate — assuming a parent had given consent if the consent form was not returned to the school — was legit. But let’s move on.
If the TeenScreen reveals that a child needs help, parents will not be forced to seek help for their child. Likewise, a parent can always say, “No!” to antidepressants for their child. No one is forcing anyone to do anything. Nothing is mandatory! Your kids do not have to take TeenScreen or antidepressants.
But wouldn’t you want to know if your child may be having problems? Often after a teen commits suicide, we hear parents say, “I didn’t know,” “I knew she was unhappy but…”, “What could I have done?”
From my view, if TeenScreen saves one life, isn’t it worth it?
But enough about TeenScreen, we are talking about the DSM — which is a DIAGNOSTIC manual — not a school board policy. The proposal is merely a way for a doctor — especially a pediatrician or family practitioner — to assess a teen’s risk of suicide. And like the SAT or ACT, the proposed assessment will provide a uniform measure for other clinicians who will treat the teen in the future.
My fear is that TeenScreen opponents will be reinvigorated when they see Shaffer’s name on the DSM recommendation and assume Shaffer is using a backdoor to push TeenScreen into more schools.
Let’s not confuse TeenScreen with this recommendation. Let’s put this nonsense behind us and get on with trying to save a teen’s life.
Stapleton, C. (2010). Teen suicide and the new DSM: Let's give common sense a chance. Psych Central. Retrieved on November 18, 2017, from https://blogs.psychcentral.com/depression/2010/02/teen-suicide-and-the-new-dsm-lets-give-common-sense-a-chance/