Health Update

Suicide-Prevention Plan Envisions Larger Role for Schools: Noting that suicides outpace murders in the United States, the U.S. surgeon general has crafted a national suicide-prevention strategy that calls on all sectors of society—including the education community—to work together to improve the grim picture.

In a report issued this month, Dr. David Satcher emphasizes the need for greater awareness of the problem, earlier intervention and better support to help people who are at risk of committing suicide. Suicide takes more than 30,000 lives a year, making it the nation’s eighth-leading cause of death.

The report outlines a key role for schools, both in ensuring their teachers are better trained to recognize a suicidal young person and in presenting evidence-based suicide-prevention programs. Federal statistics show that people age 19 or younger account for about 9 percent of U.S. suicides. Many experts have faulted schools’ prevention efforts, though some programs get high marks. (“Complex Set of Ills Spurs Rising Teen Suicide Rate,” April 12 and “Suicide: Many Schools Fall Short on Prevention,” April 19, 2000.) “Only recently have the knowledge and tools become available to approach suicide as a preventable problem with realistic opportunities to save many lives,” Dr. Satcher said in releasing the report May 2. “The public-health approach laid out in this national strategy represents a rational and organized way to marshal prevention efforts and ensure that they are effective.”

Among the recommendations in the report are finding ways to reduce the stigma associated with seeking counseling, promoting effective clinical practices, and stepping up efforts to reduce access to lethal means of self-injury.

The surgeon general’s report, “National Strategy for Suicide Prevention: Goals and Objectives for Action,” is available online at www.mentalhealth.org/suicideprevention/nsspfullreport.pdf.

Recognizing Signs of Autism: The American Academy of Pediatrics has issued new guidelines to help pediatricians spot early signs of autism.

Diagnosing autism is difficult because it is a collection of brain-development disorders. As a result, doctors must look for the presence or absence of a group of symptoms, relying on parents’ anecdotes, clinical judgment, and the ability to recognize autistic behaviors, the academy said in a statement accompanying release of the guidelines, published in the May issue of Pediatrics.

The AAP recommends that doctors listen carefully to parents, especially when they voice concerns about their child’s language and social development, and that, if possible, doctors use screening tools designed to help diagnose autism. Early diagnosis and intervention are shown to create better outcomes in autistic patients, academy officials said.

The group also tried to dispel fears of a link between autism and the measles-mumps-rubella childhood immunization. It said there is no scientific evidence that the vaccine causes autism.

Children who are autistic have some impairment in reciprocal social interaction and communication. They also engage in repetitive behaviors and a limited range of interests and activities. Experts believe that as many as two in 1,000 children are autistic.(“Sharp Rise Seen in Identification of Autistic Pupils,” October 20, 1999.)

The guidelines, “Technical Report: The Pediatrician’s Role in the Diagnosis and Management of Autistic Spectrum Disorder,” are available online at www.aap.org/policy/re060018.html .

Head Lice Policies: School policies that prohibit children from attending school when they have “nits"—which are lice eggs—but no actual head lice may be too restrictive, a report suggests.

The study, published in this month’s issue of Pediatrics, notes that the epidemiology of head-lice infestation is not well understood, and that many schools treat all children with nits as though they were contagious.

Researchers examined 1,729 students in two Atlanta elementary schools and found 28 with lice, and 63 who had nits but no lice. Of the 63 nits-only children, 50 had follow-up screening two weeks later, and only nine—18 percent—of those were found to have become infested with lice, the study found.

The researchers recommend that children who have only nits be examined repeatedly, and treated if they have crawling lice, but say that excluding them from school is “likely excessive.”

The abstract of the report is available online at www.pediatrics. org/cgi/content/abstract/107/5/1011.

—Catherine Gewertz