Objective To develop a brief screening instrument to assess risk of suicide in pediatric emergency department (ED) patients. Design A prospective, cross-sectional instrument development study which evaluated 17 candidate screening questions assessing suicide risk in young patients. The Suicidal Ideation Questionnaire (SIQ) served as criterion standard. Setting Three urban, pediatric EDs associated with tertiary care teaching hospitals. Patients/Participants A convenience sample of 524 patients aged 10–21 years who presented with either medical/surgical or psychiatric chief complaints to the ED between September 2008–December 2010. Main Exposure Participants answered 17 candidate questions followed by the SIQ. Main Outcome Measures Sensitivity, specificity, predictive values, likelihood ratios, and area under the receiver operating characteristic curves of the best-fitting combinations of screening questions for detecting elevated risk of suicide. Results 524 patients were screened (344 medical/surgical and 180 psychiatric). Fourteen (4%) of the medical/surgical patients and 84 (47%) of the psychiatric patients were at elevated suicide risk on the SIQ. Of the 17 candidate questions, the best-fitting model was comprised of 4 questions assessing: current thoughts of being better off dead, current wish to die, current suicidal ideation, and past suicide attempt. This model had a sensitivity of 96.9% (95% CI, 91.3%–99.4%), specificity of 87.6% (95% CI, 84.0%–90.5%), and a negative predictive value (NPV) of 99.7% (95% CI, 98.2%–99.9%) for medical/surgical patients; 96.9% (95% CI, 89.3%–99.6%) for psychiatric patients. Conclusions A four-question screening instrument, the Ask Suicide-Screening Questions (ASQ), with high sensitivity and NPV, can identify risk of suicide in patients presenting to pediatric EDs.

Dickstein, Daniel P.; Tone, Erin; and Pine, Daniel S., "Neural circuitry engaged during unsuccessful motor inhibition in pediatric bipolar disorder" (2007 Objective: Deficits in motor inhibition may contribute to impulsivity and irritability in children with bipolar disorder (BPD). Therefore, studies of the neural circuitry engaged during failed motor inhibition in pediatric BPD may contribute to our understanding of the pathophysiology of the illness. We tested the hypothesis that children with BPD and controls would differ in ventral prefrontal cortex (vPFC), striatal, and anterior cingulate activation during unsuccessful motor inhibition. We also compared activation in medicated vs.unmedicated children with BPD, and in children with BPD and ADHD (BPD+ADHD) vs.those with BPD but without ADHD (BPD-ADHD).Method: Event-related fMRI study comparing neural activation in children with BPD and controls while they performed a motor inhibition task. The sample included 26 children with BPD (13 unmedicated, 15 with ADHD) and 17 age, gender, and IQ matched controls. Results:On failed inhibitory trials, controls showed greater bilateral striatal and right vPFC activation than did patients. While our findings were somewhat more prominent in unmedicated than medicated, patients, and in BPD+ADHD than BPD-ADHD, the findings did not differ significantly (?) among these subgroups of children with BPD.

Acts of war and terrorism are increasingly prevalent in contemporary society. Throughout history, weaponry has become more efficient, accurate, and powerful, resulting in more devastation and loss of human life. Children are often overlooked as victims of such violence. Around the world, children are exposed to violence in multiple forms, frequently developing traumatic stress reactions. Such reactions are best understood within the context of social-emotional and cognitive development, as children respond differently to the stress of violence depending on their developmental level. Furthermore, the violence of war and terrorism often results in a multitiered cascade of negative life events including loss of loved ones, displacement, lack of educational structure, and drastic changes in daily routine and community values. These numerous losses, challenges, and stresses affect children's brains, minds, and bodies in an orchestrated whole-organism response. This paper describes these effects, synthesizing the current state of research on childhood traumatic stress reactions from the fields of neuroscience, clinical psychology, and pediatric diagnostic epidemiology.

Objective Screening children for suicide risk when they present to the emergency department (ED) with nonpsychiatric complaints could lead to better identification and treatment of high-risk youth. Before suicide screening protocols can be implemented for nonpsychiatric patients in pediatric EDs, it is essential to determine whether such efforts are feasible. Methods As part of an instrument validation study, ED patients (10–21 years old) with both psychiatric and nonpsychiatric presenting complaints were recruited to take part in suicide screening. Clinically significant suicidal thoughts, as measured by the Suicidal Ideation Questionnaire, and suicidal behaviors were assessed, as well as patient opinions about suicide screening. Recruitment rates for the study as well as impact on length of stay were assessed. Results Of the 266 patients and parents approached for the study, 159 (60%) agreed to participate. For patients entering the ED for nonpsychiatric reasons (n = 106), 5.7% (n = 6) reported previous suicidal behavior, and 5.7% (n = 6) reported clinically significant suicidal ideation. There were no significant differences for mean length of stay in the ED for nonpsychiatric patients with positive triggers and those who screened negative (means, 382 [SD, 198] and 393 [SD, 166] minutes, respectively; P = 0.80). Ninety-six percent of participants agreed that suicide screening should occur in the ED. Conclusions Suicide screening of nonpsychiatric patients in the ED is feasible in terms of acceptability to parents, prevalence of suicidal thoughts and behaviors, practicality to ED flow, and patient opinion. Future endeavors should address brief screening tools validated on nonpsychiatric populations.

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