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Identifying warning signs of teenage self-harm in early childhood

Self-harm is extremely common among teens worldwide. Data from the Millenium Cohort Study in 2020 showed that 1 in 4 UK teens report self-harming in the last 12 months. Despite this, the behavioural and emotional profiles underlying adolescent self-harm, and its longitudinal risk factors, are relatively unknown. Stepheni Uh’s recent article sought to identify these. Her study found two distinct pathways to self-harm.

The first is a “psychopathology” pathway, associated with early and persistent emotional difficulties and bullying, from the age of five. The second is termed the “adolescent risky behaviour” pathway, where risk taking and external challenges emerge later into adolescence. The fact that one of these groups has a long history of psychopathology means that there is an extended window for interventions, as well as potential improvements in the identification of children at risk of self-harm.

Summary

The article differs to most previous research into self-harm which has largely focused on young people presenting to hospital or other clinical facilities. However, most young people who self-harm never seek clinical help. Instead of looking at a clinical sample, Stepheni’s paper drew on data from the Millennium Cohort Study, a nationally representative longitudinal study, which has been following 19,000 young people born between 2000-2002, since they were nine months old. 

After identifying young people who said that they had self-harmed at the age of 14, the team analysed preceding data from when these young people were 5, 7 and 11 years old, to identify risk factors from childhood. They found two distinct subgroups at age 14 years.

The first, smaller group had a long history of psychopathology, difficulties with emotional regulation from an early age, had experienced bullying and their caregivers had faced emotional challenges.

A second, much larger group did not have a history of mental health problems, but were likely to take risks as teens and reported less secure relationships with peers and family. Sleep problems and low self-esteem were characteristics associated with both groups.

At least one of these groups could be predicted almost a decade before the reported self-harm. This research suggests that there is an extended period of time where interventions and self-harm prevention strategies could be implemented. Early targeted interventions focused on emotion regulation may be helpful for some young people.

Implications

‘Establishing early risk factors and profiles that can be traced and tracked across development provides a crucial step toward the early identification of these young people, to elucidating underlying casual mechanisms and, ultimately, prevention and treatment’.

Implications for parents – Given the link between low self-esteem and self-harm, parents should actively seek to boost children’s self-esteem from an early age. Focusing on good sleep hygiene and a regular bedtime routine is also important. 

Implications for schools – Teachers are often the first responders to self-harm, but don’t always know the best way to deal with the situation. Effective training for school staff in this area is critical. Schools should seek to use effective evidence-based interventions, such as whole school anti-bullying programmes. Early interventions to help with emotional regulation and problem-solving may be impactful, as might enhancing support systems and peer relationships from an earlier stage. 

Resources Created from and Related to this Research

Stepheni Uh, PhD student and Gates Cambridge Scholar at the University of Cambridge’s MRC Cognition and Brain Sciences Unit

Stepheni graduated from Emory University with degrees in Neuroscience and Ethics. As the 2014-15 Bobby Jones Fellow, she completed her MPhil in Behavioural and Neural Sciences at the University of St Andrews, Scotland. She has also engaged in exploratory and clinical research at the University of Pennsylvania’s Center for Neuroscience & Society and the Center for Autism Research at the Children’s Hospital of Philadelphia.

Her primary interests lie in the multidimensional nature of mental health outcomes, risk profiles, and resilience as well as the ethical, social, and legal implications of human neuroscience research. Stepheni’s work on identifying different profiles of young people who self-harm and their respective risk factors across development has been featured on the BBC, The Sun, and The Times. Alongside her PhD, she has been involved with the Global Neuroethics Summit to promote and engage cross-cultural collaborations for neuroethics. She is currently investigating dimensions of adversity and resilience at the neural, behavioural, as well as cognitive and mental health levels in children with the hope to better inform interventions and policies targeting positive development and well-being.

Link to Article