Many people believe that young children and preteens are incapable of dying by suicide. However, it’s important to understand that it isn’t just teenagers and adults who struggle with suicidality — young children, including 7- ,8-, and 9-year-olds, can also feel this way.
But how do you even begin to talk about a subject like suicide to children so young? Join us as today’s guest, a pediatrician, shares conversation starters and tips on when and how to start talking with your younger children about suicide.
Dr. Noor Jihan Abdul-Haqq is a board certified pediatrician from Oklahoma City, OK, and a faculty trainer for The REACH Institute. She’s a proud graduate of the Oklahoma School of Science and Mathematics. She graduated from Spelman College with honors with a degree in Biochemistry. Her medical school and residency training were completed through Morehouse School of Medicine where she was active with various medical organizations.
She has done medical work in Barbados, Dominican Republic, and Mexico. Her awards include the Leonard Tow Humanism in Medicine award, Practitioner of Excellence Award from Sisters United Organization, Journal Record’s Achievers under 40 award and Outstanding Minority owned business leader. She’s received a Regional award for her work in the OKC Chapter of Jack and Jill of America for providing STEM opportunities for youth. Most recently she was honored as a Healthcare Hero by the Journal Record. Dr. Abdul-Haqq has been interviewed numerous times on local radio, TV, and print media.
Dr. Abdul-Haqq opened her current practice Peace of Mind Pediatrics in Sept of 2015 to serve the community that she grew up in. She opened a 2nd location in Spring of 2021. She serves as a mentor for high school and college students and has assisted other physicians with starting their own practices. In September 2020, she helped open the Clara Community Health Center in OKC which is a free clinic for the uninsured.
In 2018, Dr. Abdul-Haqq took a REACH training course to increase her confidence and skills in diagnosing and managing mental health in pediatric primary care. Three years later, she joined the faculty to assist with expanding mental health education and training for PCPs. Dr. Abdul-Haqq has a particular interest in integrative medicine and is continuously taking additional courses to further her knowledge.
She and her loving husband are the proud parents to 3 wonderful children.
Our host, Gabe Howard is an award-winning writer and speaker who lives with bipolar disorder. He is the author of the popular book, “Mental Illness is an Asshole and other Observations,” available from Amazon; signed copies are also available directly from the author.
Gabe makes his home in the suburbs of Columbus, Ohio. He lives with his supportive wife, Kendall, and a Miniature Schnauzer dog that he never wanted, but now can’t imagine life without.
To book Gabe for your next event or learn more about him, please visit gabehoward.com.
Producer’s Note: Please be mindful that this transcript has been computer generated and therefore may contain inaccuracies and grammar errors. Thank you.
Announcer: You’re listening to Inside Mental Health: A Psych Central Podcast where experts share experiences and the latest thinking on mental health and psychology. Here’s your host, Gabe Howard.
Gabe Howard: Welcome to the podcast, everyone. I’m your host Gabe Howard, and calling in today we have Dr. Noor Jihan Abdul-Haqq and she is a board-certified pediatrician. And three years after taking the REACH training course to improve her skills diagnosing and managing mental health and pediatric primary care, she became a faculty trainer. Dr. Abdul-Haqq, welcome to the podcast.
Dr. Noor Jihan Abdul-Haqq: Thank you so much for having me.
Gabe Howard: Today we are going to be discussing suicide in young children and pre-teens. Now, suicide alone is a difficult topic to discuss with people. And I know from my own work as a public speaker and as host of this podcast that discussing suicidality in teenagers is a very difficult conversation to have with people. So, you can imagine that getting people to acknowledge suicidality in younger children and address it is exceedingly difficult. Most people struggle to see the need to have this conversation with kids. They don’t see, for example, nine-year-olds as being at risk to attempt or complete suicide. As a pediatrician, what are your thoughts?
Dr. Noor Jihan Abdul-Haqq: Well, the reality is today’s nine-year-olds are actually watching social media all the time. They’re looking at reels, they’re hearing about things, they’re seeing news. So, they actually are noticing things that we never would have been exposed to. Just opening up the Internet and the news popping up. And so, a lot of them are actually already seeing people who’ve committed suicide or other things. So, we really do have to have these conversations a little bit earlier.
Gabe Howard: I really think there are two questions the average parent is wrestling with. Number one is, is it appropriate to discuss suicide with young children? And then if the answer to that is yes, it is appropriate. The second question becomes, how do I even start to have that conversation? I really think the average parent is concerned that, hey, if I sit my nine-year-old down and talk to them about something as serious as suicide, it’s going to upset them and that will be a mistake and that will mess them up. I do want to ask, what is a good age to have these conversations?
Dr. Noor Jihan Abdul-Haqq: I mean, there’s been lots of dialog about this and around the ages of 8 or 9 would be appropriate to have that type of conversation. Of course, the way that you’re going to approach it is going to be very different than how you would approach it with your teenager. But simply asking a child, how have you been feeling? Do you ever feel like you don’t want to be here? You know, it’s not always using the word suicide because most of them don’t understand what that is. But I’ve had nine-year-old patients who said, you know, I don’t think I should still be here. My parents are always, they’re upset with me. I don’t think I belong. And it’s like if no one’s ever had that conversation with them, what would that have turned into? You know, what would the outcome have been if they didn’t feel comfortable, that particular day, having the conversation with me, their pediatrician. So, I don’t think that parents should really fear that. We’re taking a very gentle approach to this, just like we would puberty or death in the family. So, the same thing. Many of these children have experienced it within their families. I know I unfortunately had to have that conversation with my own children due to a family member attempting suicide and another one who was successful, unfortunately.
Dr. Noor Jihan Abdul-Haqq: So, they didn’t quite understand. So, we had to have that whole entire dialog even at the age of eight. It’s such a scary topic and I completely understand why, it’s death. But we talk about death in many other instances quite often, and unfortunately we often have to explain this to our children. So, I don’t think that it will mess them up. It’s not going to give them ideas. Most parents should have a conversation and just really check on their children, see where they are mentally. So many of the families that I take care of the parents don’t even realize that their child can have anxiety. They don’t realize their child can have depression at age 9 or 8. And so they’re like, what do you mean they’re stressed? They can’t be stressed? And I have to explain to them, this is a very different world. You have bombarded their brains. Yes, they get stressed. It’s not the same as what we used to have before. And so, I think 8 or 9 is still an appropriate age to have these types of conversations and check in on those children regularly.
Gabe Howard: One of the things that people are surprised when they learn about me. I talk about my life with bipolar disorder when I was diagnosed and the things that I went through as a child and the signs that my parents missed. One of the big things that people are surprised is when I say that I remember thinking about suicide as far back as I can remember, and there’s a lot of challenge on that. They’re like, well, well, you mean like 13? And I’m like, no, I mean literally as far back as I can remember. And they’re like, Well, you okay, well, 9-10 And I’m like, No. Five. Like every memory I have concerned whether or not I should be alive or dead, literally all the way back. And I and I understand why this makes people uncomfortable as we are sitting here, it makes me uncomfortable and I’m the one who lived through it. But there was no robust mental health education in my childhood. One. This was the 80s too. I come from a stereotypically blue-collar household, so I really received messages like this. You’re a man. Toughen up. We don’t cry in public. Keep your emotions in check. You have to protect the women and girls in your life. You have to get a job. And these were the things that were being discussed with me as important. So, I had no reason to fear it, which I really think left me in harm’s way. Now let’s advance all the way to 2023. You’ve talked about how children are being bombarded with even more. If suicidality was on the menu in 1982, I imagine that it is worse now. And my parents, they just they so regret not giving me any education. Is that the message that if you don’t give children education, they’re left to their own devices and it may not turn out so well.
Dr. Noor Jihan Abdul-Haqq: Okay. I definitely would agree. Same with sex education. Right? We often make that correlation. If you don’t teach them anything, then, you never know what the outcome will be. And then you can’t actually control the narrative. And I think that parents often, especially nowadays, they want to control the narrative of what their child is learning. It’s like, this isn’t a topic that you would just say, oh, just learn about it on T.V. No, you want to control that narrative so you can better understand what your child is learning, taking in and how they’re processing what they just learned. It’s not it’s not a conversation you just have and then you walk away and you never address it again. You have to make sure that they understand what was said and so that they, you know, can ask further questions and also feel comfortable doing that with you. But I will tell you that there are some parents that really shouldn’t have this conversation with their child. And there’s also some who shouldn’t have the sex talk with their children either. And so, I always say, is there an aunt or is there an uncle or a grandparent or somebody who may feel more comfortable?
Gabe Howard: What is the role of parents in suicide prevention for young children and pre-teens?
Dr. Noor Jihan Abdul-Haqq: Every parent’s role is to make sure that they are checking in on their children, to have just candid, open-ended conversations and creating an environment in which the child feels safe to speak to them when things are not going as planned. But also, the role of the parent is to pay attention to their child’s behavior. And because we’re so busy as families, often the dinner time meal is taken away as well. So, we have to find ways of finding time to actually just sit with our children and ask them open-ended questions so that you can gauge more. You have to notice if you see a change in behavior, are they not wanting to go out with their friends? Are they sleeping more than usual? I know they sleep a lot, but is it more than usual? Or are you noticing your little one giving away all their toys or giving away stuff? You know, these are things that you want to be paying attention to, changes in behavior and your child. But if we’re all so disengaged with one another and we don’t find time to actually be present as parents, then we really may miss early signs that our children could possibly attempt suicide.
Gabe Howard: Dr. Abdul-Haqq, are there any other specific things that parents should be on the lookout for?
Dr. Noor Jihan Abdul-Haqq: w You want to really monitor a child that’s not wanting to hang with their friends or wanting to quit the activities or sports things that they previously loved to do and now they don’t want anything to do with them. So, you want to monitor them closely. You also want to pay attention to our children who are part of like the LGBTQI community. If you know that your child has come out or is thinking about those things or their majority of their friends are of that community, then you want to be paying attention to them too, and making sure you’re having a lot of open dialog, no matter how uncomfortable it may be. I am an African-American woman, and so in the African-American community, we often have some of the higher rates. I think just if you’re a minority, you also want to be having these conversations with your children, but paying attention to changes in their behavior, maybe not eating as much, sleeping more, just moving slower, you know, and so you just those are often signs of early depression. But one of the other things is, they’re just they’re not thinking about the future anymore. Like you went from a kid who had all these aspirations and now they’re like, whatever, it doesn’t matter. So, you just want to try to keep an open ear as much as possible, but then just kind of watch some of the things that they’re doing. But I always tell parents, look at your children’s friends as well, because some of these children will seek out people who are thinking similar to them. And so, you want to know who they’re hanging out with and also know what things are being told to them or expressed to them when you’re not around.
Gabe Howard: When it comes to discussing suicide and suicide prevention with young children. I’m talking your eight, nine, ten-year-olds. Do you have any conversation starter recommendations?
Dr. Noor Jihan Abdul-Haqq: Well, I think some of the things that you can just ask is open-ended. Things like how have you been feeling? You know, just keeping it very generic. But, you know, if you’re if you’re feeling in a space where your child is changing some of these behaviors, just say, you know, I mean, are you feeling like low or are you feeling really low? Have you ever thought about that you wish you were never born? Um, you know, do you know any friends or anyone, especially for the teenagers, you know, any friends who attempted suicide? You know, how did that make you feel? Is it something that you’ve ever thought about? Trying to keep the questions as open ended as possible? And, of course, approaching it with a very caring tone is very important to do that. And I see a lot of the kids when we say, you know, have you ever tried to harm yourself? And then they’re like, oh, wow, no one’s ever asked me this. And so that’s, you know, another thing that you just may want to say. Have you have you ever done anything to hurt yourself? Have you ever tried to cut or have you thought about doing anything like this? And it’s hard as a parent to ask your child something like that, but it could save their life.
Gabe Howard: And we’ll be right back after a quick word from our sponsor. And please keep listening, because after the break, Dr. Abdul-Haqq shares the best way to discuss the suicide of a loved one with young children and pre-teens.
Gabe Howard: And we’re back with pediatrician Dr. Noor Jihan Abdul-Haqq learning how to talk to children about suicide and suicide prevention. I don’t think that a conversation about suicidality and suicide prevention in pre-teens would be complete if we didn’t talk about how we handle a suicide in the family. When I was very young, I had a family member, a distant cousin of my mother’s who died by suicide. But I was told that they died by leukemia. And that’s just what I always heard. And I just always believed this. And then one day when I was in my late 30s, so, you know, literally 20 plus years later, I happened to mention this particular cousin. And I you know, I mentioned that that he died from leukemia. And several people said, no, he didn’t. He committed suicide, just that matter of factly. And I was like, wait, what? And I had just never heard this. And I was already a mental health advocate by this point. I’d already had my own struggles with suicidality, bipolar disorder, and nobody thought to circle back and explain this to me, which I can go on for so long about how it made me feel. But how it made me feel was, oh my God, we don’t even talk about it. We don’t even address this. For many parents, they believe that this is a protective factor. I would have been 5 or 6 at the time, so the family was just closing ranks and protecting everybody from this this tragedy that happened. Is it okay to do that or should you explain it to a 5- or 6-year-old about a family suicide?
Dr. Noor Jihan Abdul-Haqq: I think it has a lot to do with the family dynamics because for some families it’s just that it’s so hard. And for a five-year-old, they really don’t know the approach. So, I definitely recommend that they look for those outside resources because families often will lie to the children about how a parent died. And when they find out later on, they feel that betrayal, etc. So, I think that looking for resources, if you don’t feel comfortable to help you and guide you in being able to have that conversation is appropriate. And sometimes we have to just know how to phrase it. And I don’t think that was something that I even learned until much later in my medical career of how to phrase something like this. And so, when we experienced it in our family, we just let the children know. Sometimes people are so sad, they don’t even want to be here anymore. And so, we have to for us, we pray for this person. We pray that no one else feels this sad, that they don’t want to be amongst us. And so, it can be very gentle in terms of what you tell the child. But I do think that so often I hear people lying about it and it does cause some distress later on when people find out the truth. And so, if we can be open and honest and get those resources, I think that it would be more beneficial at that time. But it opens up so many questions later that for some families they can’t even handle that at that time.
Dr. Noor Jihan Abdul-Haqq: So, I understand why they sometimes will do that early on. But at some point I think it is good to have the conversation and make sure that they understand what really happened. Like I have a patient who found her father, but then the younger siblings didn’t know, so they had to kind of explain it. But everyone was mourning and everyone was going through things. So, they chose to just not tell the younger ones exactly what happened. But then later on went ahead and had that conversation with them. They didn’t wait too long, just a few months, and then had the actual conversation with them, which I think is important. But it is something that I think there’s such a stigma behind it. There’s embarrassment. There’s a lot of blame. People blame themselves for why someone did that. That impacts how they’re able to have the conversation. So, I don’t fault people for initially saying something. I don’t think you should just make up something completely out of the blue like leukemia, but just maybe, I don’t know or, I’m not 100% right now or whatever that case is. If they have to do that just for them to make it through the situation. But I think we should also try to come back around to be honest with that child.
Gabe Howard: When it’s time to have that conversation, are there any particular ways that you feel are better than others or any professional recommendations?
Dr. Noor Jihan Abdul-Haqq: I think the biggest thing is to make sure that you have time to answer questions. So, make sure it’s not in a rushed situation. That you sit the child down and use analogies, especially if they’re younger, maybe TV shows they watch or things like that so they can better understand what’s being said. For our older children, letting them express themselves, once you’ve kind of given that information that you’re questioning, well, why would someone want to do that? So, you have to be ready to answer those questions. A good approach is to just make sure that you have gotten yourself to a point as a parent to where you can you can be open and you can be honest and then also reassure them. If you ever have these feelings, I’m here for you.
Dr. Noor Jihan Abdul-Haqq: And if you don’t feel like you can have that conversation, ask a friend, ask a family member or, you know, a mental health expert to assist you with that because it isn’t easy. You know, I’ve also had children whose parents or family members have been murdered, or were in gangs or other things. And they want to preserve the integrity of that person. And so, it’s very difficult for them to be truthful and honest. So, I don’t think it’s just black and white. I think it’s a very gray picture. And but I definitely think that we should do our best to be as honest, because if they find out that you didn’t tell them the truth, it can actually sometimes impair information and things going forward because they’re like, I don’t trust you anymore. So, we have to be very careful in what we say to them.
Gabe Howard: There’s a lot of myths about suicide. And one of them is that if you talk to somebody about suicide, you give them the idea. Now, that’s a complete myth. It’s not true. But even people who understand that talking to someone about suicide does not give them the idea. They sort of regress and think, well, but talking to a nine-year-old most certainly gives them the idea because they’ve never heard about it before. Can you can you bust that myth for us?
Dr. Noor Jihan Abdul-Haqq: Just because you talk about something doesn’t mean someone’s going to do it. If that was the case, then we should take all drug education out of schools because we’re clearly causing everyone to start using drugs. Educating someone doesn’t mean that now they’re going to embark on this thing. But when we don’t educate them and we don’t teach them about what to expect, things to look out for, letting them know that we hear them, we see them, then we can expect worse outcomes. It’s very fearful and I understand. We try to protect our children and they’re babies and we don’t want them to grow up too fast. But that’s out of our hands at this point. Unless you live in a very rural space with no internet and you don’t allow your child to watch TV or read magazines, newspapers, etc. Because they are going to be exposed to many different things. And so now the conversation is just going to be different. And we have to come to that realization, even though it is very difficult to understand how things have changed. So, no. Making sure your child is okay, making sure that they know what suicide is or understand just the idea that sometimes people don’t want to be here. And if you ever feel that way, I need you to let me know or let Auntie know or whomever that is not going to then say, okay, I don’t want to be here today. Let me figure out a plan. That’s just not how it works. We’re seeing this uptick in suicide. And so, there’s true fear around it. But the uptick is not because people are educating more teens about it. That’s not the reason why.
Gabe Howard: I want to be a little difficult for a moment, if I may. You’ve done everything right. You’ve noticed the symptoms. You. You’ve. You’ve done everything. You’re ready. You’re the engaged parent. We’ve done everything that you’ve said, and their child just won’t talk to them. They’ve sat them down. They’ve. They’ve used the conversation starters. They’ve remained open. They’ve asked other family members. They’ve just really done everything they can to broach the topic. But they’re just getting walled off. What should parents do then?
Dr. Noor Jihan Abdul-Haqq: I would say make an appointment with your pediatrician, an urgent appointment to discuss this with them, to see maybe if your child will open up to them. But if not, just allowing them to help direct you in what should be done next. Oftentimes when people come into my office with these scenarios, I immediately am able to set them up with a therapist. Other times we’re not able to, but we have crisis lines. So, making sure families understand, you know, 988 is the new number for the suicide crisis line. But making sure that we put in place what we need to. So, if the child is actually suicidal, whether they’re verbally saying it or from actions or from the history, then in my office, we come up with a plan. We try to see is this emergent today to where I need to admit you into a facility or is this something that we can start with a therapist and then we create a safety plan in the office going forward with frequent checkups and things like that. So do not place it on the back burner if you’re suspecting it and your child will not communicate with you, use your tools and resources. And one of those is your primary care physician. Utilize those and ask for that help. Just like I said, if it was a broken bone, you’d come in. So don’t just let them walk on it.
Gabe Howard: And I have to ask, as a pediatrician, when a parent brings in a child with mental health concerns or even a child who is suicidal, do you think less of those parents?
Dr. Noor Jihan Abdul-Haqq: Oh, no. I really applaud them because that means that they’re paying attention. And I pick up so many children when I have them fill out the PHQ-9 form, which is the suicide screener in my office. And the last three questions asked, have you ever attempted suicide? And I get so many children that check that and the parents have zero clue and that’s just at a well-child check. I applaud the parents who come to me before I’ve had to do the screener because that means they’re paying attention. And so, I hope no one feels that stigma. And I and I hope that no medical provider makes you anyone feel that way, because I think they’re we’re all here to help and make sure that we are in the business of prevention, because every time a life is lost, we all feel that impact because that was a child that could have contributed to this society and somebody was a part of our society and our world. We all need to be more in the business of prevention and applauding those people who take the steps to get the help that they need for their children.
Gabe Howard: Thank you so much for being here. And thank you so much for being candid about such a difficult topic. We really appreciate that and we really appreciate your time. Now, listeners, you can find out more about The REACH Institute and the trainings they offer at The REACHInstitute.org and Dr. Abdul-Haqq owns Peace of Mind Pediatrics in Oklahoma City. You can also find her on Instagram @drjihan08. Dr. Abdul-Haqq, thank you so much for being here.
Dr. Noor Jihan Abdul-Haqq: Thank you for having me.
Gabe Howard: You are very welcome and want to give a big thank you to all of our listeners. My name is Gabe Howard and I am an award-winning public speaker and I could be available for your next event. I also wrote the book “Mental Illness Is an Asshole and Other Observations,” which you can get on Amazon. However, you can grab a signed copy with free show swag and learn more about me just by heading over to my website gabehoward.com. Wherever you downloaded this episode, please follow or subscribe to the show. It is 100% free and you don’t want to miss a thing and listen up. Can you do me a favor? Recommend the show, share it on social media, share it in an email, or share it in a support group. Hell, send somebody a text message because sharing the show is how we grow. I will see everybody next Thursday on Inside Mental Health.
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