Suicide and homicide in children and adolescents, both reasonably foreseeable and preventable events, are terrible losses for families and represent significant public health concerns. The realization that violence can occur anywhere has had a traumatizing impact on schools and communities nation- and worldwide. Violence is a dynamic and complex public health issue that affects millions of children and their families.

Suicide and aggression can occur across the entire spectrum of psychiatric disorders, which emphasizes the need for an organized, systematic assessment. These linked behaviors are best conceptualized as occurring on a final common pathway. Management of violent behavior depends on the stage of the destructive process as well as on the speed of progression. Differentiating the progressive, scalable risk factors that suicidal and homicidal phenomena have in common has important clinical consequences.

No standard of care exists for the prediction of child and adolescent suicide and homicide. However, a standard...

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