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Children don’t usually have the words to communicate even the darkest of thoughts.

As a result, some children aged 5 to 11 take their own lives. It’s a rare and often overlooked phenomenon—and one that scientists are only just beginning to understand. A study

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published today in the journal Pediatrics reveals that attention deficit disorder (A.D.D.), not depression, may be the most common mental health diagnosis among children who die by suicide. By contrast, the researchers found that two-thirds of the 606 early adolescents studied (aged 12 to 14) had suffered from depression.

While the finding isn’t necessarily causal, it does suggest that impulsive behavior might contribute to incidences of child suicide. Alternatively, some of these cases could be attributed to early-onset bipolar disorder, misdiagnosed as A.D.D. or A.D.H.D.

Suicide is a leading cause of death among U.S. elementary school-aged children.

Here’s Catherine Saint Louis, reporting for The New York Times:

Suicide prevention has focused on identifying children struggling with depression; the new study provides an early hint that this strategy may not help the youngest suicide victims. “Maybe in young children, we need to look at behavioral markers,” said Jeffrey Bridge, the paper’s senior author and an epidemiologist at the Research Institute at Nationwide Children’s Hospital in Columbus, Ohio. Jill Harkavy-Friedman, the vice president of research at the American Foundation for Suicide Prevention, agreed. “Not everybody who is at risk for suicide has depression,” even among adults, said Dr. Harkavy-Friedman, who was not involved in the new research.

The team also found that about 37 percent of the 87 elementary school-aged victims of suicide studied were black, compared with just 12 percent of adolescents who’d committed suicide. That finding is in keeping with a study these same researchers conducted a year ago, which found that the suicide rate among black 5- to 11-year-olds had nearly doubled since 1993.

Of course, race alone doesn’t lead to an increased likelihood of child suicide. Environmental factors like tension at home, troubles in school, or even early puberty (for girls) could increase the risk of suicide—now, or in the future.

The new study also implies that previous studies pointing to a decline in severe childhood mental health problems could be misleading. Just because we’re experiencing an overall trend toward better mental health care for children doesn’t mean that all children have access to this care, nor that this type of support would make an appreciable difference.

But if adults are willing to ask their children uncomfortable questions, that could change. Bridge and his colleagues found that only about 30 percent of all the children studied had told someone about their desire or intent to kill themselves. That means more than a third of these victims either couldn’t vocalize their struggles or chose not to. Either way, understanding the intersection of child behavior and mental health could save lives for many vulnerable young people.