Why Children May Not Always Report Self-Injurious Thoughts Consistently: What Parents and Clinicians Need to Know

How reliable are children when they report mental health concerns like self-injurious thoughts and behaviors (SITBs)? A new study published in the Journal of Psychopathology and Clinical Science raises important questions about the consistency of these reports—and what that means for risk assessment and care.

The Study in Focus

In a groundbreaking longitudinal analysis, researchers led by Andrea Wiglesworth and colleagues examined data from the Adolescent Brain Cognitive Development (ABCD) study. They followed children aged 9–10 over a two-year period, tracking whether those who initially reported self-injurious thoughts and behaviors continued to do so in subsequent years.

The results? Eye-opening.

At the one-year mark, 67% of children who initially reported SITBs no longer reported having had these thoughts or behaviors. This inconsistency spanned a range of behaviors—from nonsuicidal self-injury to suicidal thoughts—suggesting that in late childhood, inconsistency is more the rule than the exception.

Why Are These Reports Inconsistent?

The study offers several possible explanations for these inconsistencies:

1. Developmental and Neurocognitive Maturity

   Children are still developing the cognitive skills necessary for accurate self-reflection and memory. Those with lower general neurocognitive performance were more likely to inconsistently report SITBs.

   
   

2. Less Severe Clinical Symptoms

   Interestingly, children who showed fewer clinical symptoms of distress (as reported by parents or assessed over time) were more likely to stop reporting past self-injurious behavior. This could suggest that their initial reports reflected a transient period of distress that later resolved—or that their recollection of those episodes changed with improved mental health.

   
   

3. Younger Age

   Unsurprisingly, younger children were more likely to be inconsistent in their reports, reinforcing the idea that age and developmental stage impact a child’s ability to report on past psychological states.

   
   

4. Possible Reinterpretation or Forgetting

   The study doesn’t conclude definitively whether children forget, reinterpret, or choose not to disclose their past experiences. However, it emphasizes the importance of exploring these possibilities further.

What Does This Mean for Parents and Clinicians?

This research highlights a critical point: a single report—or lack of one—does not necessarily reflect the full story. Whether you're a parent, teacher, or mental health professional, here are a few takeaways:

• Don’t dismiss prior disclosures. If a child has previously reported self-injurious thoughts or behaviors, even if they later deny them, it’s important to take those earlier disclosures seriously.

• Context matters. Consider changes in the child’s environment, mood, cognitive development, and stressors when evaluating shifts in reporting.

• Use multi-informant, multi-method assessments. Parent reports, teacher observations, clinical interviews, and neurocognitive testing all play a role in forming a more complete picture.

• Create safe spaces for disclosure. Children may be more likely to disclose sensitive information when they feel safe, supported, and not judged.

The Bigger Picture

The findings suggest that inconsistency in reporting SITBs is common in children, and may actually be associated with positive developmental trends, like improving mental health or increased coping skills. However, for some, it may signal deeper cognitive or emotional challenges that need attention.

As researchers continue to investigate the underlying mechanisms behind inconsistent reporting—such as memory, emotional development, and social factors—this study serves as a vital reminder: children’s mental health assessments must be dynamic, developmentally informed, and ongoing.

Final Thoughts

At Baumgarten Child Psychology and More, we believe in meeting children where they are—developmentally, emotionally, and cognitively. This study underscores the importance of that approach. Mental health is not static, and neither is the way children understand and express their experiences. With care, curiosity, and collaboration, we can build systems that better support young minds as they grow.

If you’re concerned about a child’s mental health or have questions about self-injurious behaviors, we’re here to help. Contact us for compassionate, evidence-based support.