Questions about suicidal thoughts or behavior should always be approached progressively and by developing competencies. We would always begin by identifying distress, either actively (by observing changes in behavior and expressions of distress) or by responding to a direct request from the child or adolescent.

Once the presence of pain is confirmed, we would begin assessing for the next essential element of suicide: hopelessness. If we find both elements, which we know are sufficient to indicate suicidal ideation, we should ask about this thought at this point. In some cases, if the child or adolescent says they are thinking about suicide, it would be enough to interrupt the assessment, offer support, and inform them that we will tell their parents about this important matter so they can help them cope with their suffering.