INTERPERSONAL PROBLEM-SOLVING SKILLS OF SUICIDAL AND NONSUICIDAL CHILDREN: ASSESSMENT AND TREATMENT

Suicidal children and nonsuicidal psychiatric controls, hospitalized on child inpatient units, were given a brief, intensive training program designed to remediate deficits in interpersonal cognitive problem-solving skills. Before and after treatment, thirty 8-to-13-year-old children (ten suicidal and twenty nonsuicidal) were administered two measures of interpersonal coping skills (Means-End Problem-Solving Test and Alternative Solutions Test) and one test of impersonal problem-solving skills (Unusual Uses Test). During seven 45-minute individual sessions, suicidal children and a randomly selected group of half of the nonsuicidal sample received training based on programs developed by Shure and Spivack. Training was effective in enhancing means-end thinking of suicidal children and alternative thinking about both interpersonal and impersonal problems of all trained (suicidal and nonsuicidal) children. Suicidal children, who prior to treatment were significantly more deficient than were nonsuicidal controls in flexibly generating alternative solutions to common interpersonal problems, improved dramatically such that after training they significantly surpassed their nonsuicidal counterparts. Moreover, following training social coping strategies selected by both suicidal and nonsuicidal children were qualitatively more sophisticated; however, whereas nonsuicidal children also used less aggressive solutions, sucidal children did not. These results indicate that suicidal children have specific deficits in both the efficiency and the quality of their cognitive problem-solving skills. Faced with interpersonal conflicts, suicidal children rigidly conceptualize a limited number of viable alternative solutions and focus impulsively on social goals rather than the means to achieve them. These cognitive deficits, which severely restrict coping effectiveness, proved responsive to treatment. Findings are discussed in terms of etiologic factors in childhood self-destruction and their cognitive corelates. Suggestions are made for implementing, improving, and evaluating the effectiveness of such a program on inpatient psychiatric units. Training in interpersonal problem-solving skills is recommended as one component of comprehensive treatment for suicidal children.