Suicide and suicidal behaviors in youth are occurring at an epidemic rate. In the past 20 years death rates for suicide for youth 5 to 14 years of age have doubled. In 2005, suicide was the sixth leading cause of death in the USA for 5- to 14-year-olds and the third leading cause of death for 10- to 14-year-olds. The medical cost of suicide for Americans aged 0 to 20 approaches $1 billion a year. Although completed suicides are less frequent in childhood than in adolescence, the rate of 14.4 suicide attempts for every suicide in 10- to 11-year- olds indicates that suicide attempts are quite frequent in childhood. Further, suicidality is strongly associated with non-suicidal self-harm behaviors (e.g., cutting) as up to 40% of those who engage in self-harm report having suicidal ideations and up to 85% have attempted suicide at least once. Despite the urgent need, there are no empirically supported treatments, including psychosocial and pharmacological interventions, to address suicidality and self-harm behaviors in at risk children. The proposed research project will involve adapting Dialectical Behavior Therapy (DBT) for maltreated children (ages 7 to 12) with suicidality (ideations and attempts) and/or self-harm behaviors. DBT is an empirically supported intervention for adults with suicidality and self-harm behaviors, and is currently the only empirically supported intervention for suicidal adolescents. DBT engages patients in treatment and is cost effective, as clients receiving this treatment require fewer psychiatric hospitalizations and emergency room visits. Candidate: Dr. Perepletchikova received her Ph.D. in Clinical Psychology from Yale University. She has extensive clinical experience working with children and their families, expertise in treatment integrity of psychotherapy research, received intensive training in DBT, and has worked clinically with adults and adolescents using DBT model. Further, her preliminary studies support feasibility, acceptability and initial efficacy of DBT skills training for children. Training goals: 1) work closely with experts in the field of psychotherapy development research; 2) acquire knowledge in childhood maltreatment research and interventions, suicidality and self-harm behaviors, and interfacing with the child protective services system; 3) acquire expertise in conducting randomized clinical trials; 4) take courses in biostatistics and fundamentals of clinical trials; and 5) acquire knowledge on the neurobiological effects of trauma, and genetic and environmental predictors of risk and resiliency, to better understand the etiology of these symptoms in children. Research goals: 1) adapt established adult/adolescent DBT treatment manuals and treatment integrity measures for DBT for children; and 2) conduct a pilot randomized clinical trial comparing DBT for children with Treatment-As-Usual with maltreated children in state custody with suicidality and/or self- harm behaviors. The proposed training activities and research project will allow Dr. Perepletchikova to transition into an independent investigator with a specific focus on addressing the needs of maltreated children, including suicidality and self-harm behaviors.

Although suicidality and self-harm behaviors in children are currently on a rise, and are associated with increase in mortality and significant cost to society, there are no empirically supported interventions to address this problem. This research project will evaluate the efficacy of an intervention geared towards stabilization of children's self-control, reduction in suicidality, self-harm behaviors and other emotional and behavioral difficulties, helping caregivers manage severely affected children in the home environment, and reducing the need for higher level services (e.g., psychiatric hospitalizations) and, thus, associated economic burden. Given the impact of early onset psychopathology on development, the main objective of this intervention is to improve the life course trajectory of these vulnerable children.