ARLINGTON, Va. - Our son, Daniel, was 12 years old when he hanged himself with a belt in his bedroom.
On the night of Oct. 27, 2000, my husband and I found him dangling by his neck from a chin-up bar in the doorway between his bedroom and bathroom.
At first, I had difficulty grasping what had happened. His feet were only a few inches off the floor. It looked as if he could have lifted his neck out of the belt by pulling on the bar above him. I found myself searching for some indication that it was a prank.
But when we freed his neck from the makeshift noose and eased his body onto the floor, his head hit the carpet with a heavy thud. His eyes were open, but he was motionless.
Dead. Our precious son was dead.
The horror of that moment still lives within us. Panic rises in our throats whenever our minds begin to re-create the scene. We get a sick, grinding pain deep inside whenever we think of Daniel and all he missed by ending his life so young. After more than three years of grieving, we still cannot fully accept our loss.
Daniel had seemed like a pretty normal kid. He was popular, good-looking and growing up with all the advantages of a well-educated, middle-class family in Arlington, a comfortable suburb of Washington, D.C.
Yet, Daniel's father and I had suspected our son was troubled in ways he wouldn't admit. He never threatened to harm himself, but he seemed depressed and sometimes agitated in the months leading up to his suicide. And even though we sought help for him, we failed to get him what he needed.
Suicide among young people is not uncommon. Experts say it is the third-leading cause of death among people ages 10 to 19. Each year, about 1,600 American teenagers die by suicide, 1-million attempt it, and 1 in 5 consider it.
Our son's death was particularly shocking because he was so young. Only 60 to 70 preteens kill themselves in the United States each year.
My husband, Jim Kidney, and I have chosen to share our story of Daniel's life and death as a cautionary tale for parents of all children, whether they appear to be troubled or not. Many child and teen suicides could be prevented, experts say, if parents and professionals were more attentive and better informed about what causes kids to take their lives.
David Shaffer, a professor of child psychiatry at Columbia University and a leading expert on the subject, cautions that child and teen suicides are not random events, as experts once thought.
"We now know that it's nearly always a fatal complication of an undertreated, mistreated or untreated condition," he says.
Although we will never know what Daniel was thinking when he put his neck into that noose, there is little doubt that he was misdiagnosed by his psychologist and a neurologist, who were treating him for attention deficit hyperactivity disorder (ADHD), which is characterized by inattentiveness, hyperactivity and impulsive behavior.
There is some evidence that the drugs he took for ADHD could have led to his suicide.
Signs of trouble
Although Daniel was 12, he was on the verge of manhood.
A light brown mustache was forming on his upper lip. His shoulders were growing sturdier, his waist narrower, his voice lower. His grip had a new firmness.
These were the signs of a future that died with him.
He was a comely young man with fair skin, brown eyes, light brown hair and a stunning smile. Like most boys in my family, he was always a head taller than most of his friends.
And Daniel seemed to be maturing faster than he wanted to.
He dyed his hair different colors but never was satisfied with it. He denied having a girlfriend, even though several girls phoned him regularly. He secretly searched for porn on the Internet but insisted it did not interest him. At the same time, he continued to sleep with his childhood teddy bear.
His friends were unaware of any struggles he was having. Although Dan often lost his temper with his parents and his sister, his friends remember him as a fun-loving guy.
"I don't remember ever seeing him without a smile - usually a guilty smile," recalls Elizabeth Ridgway, one of Daniel's seventh-grade teachers.
Daniel considered himself a budding comedian. He often talked nonsense, stringing together random sounds or ideas.
"He would never hesitate in making you laugh or feel a little bit better when you were low, no matter the consequence for him," says his buddy Tim Kouril. "I can't remember how many times it ended up that he paid the expense for making others laugh."
A few weeks before he died, he was punished by the school principal for stealing plastic sporks - a combination spoon and fork - from the school cafeteria during the after-school program he attended. He said he did not understand why he couldn't take something at 4 p.m. that was given away during lunch hour.
Everyone laughed at Daniel's prank. After his death, one of his friends hung a sign in the school hallway that spelled out Daniel's name in sporks.
Like many kids his age, Daniel loved Kraft Macaroni and Cheese, baggy pants, sleepovers, inline skating and rock music. His favorite CDs were from Limp Bizkit, Rage Against the Machine and Green Day.
Words and stories fascinated Daniel. As a child, he spent hours in the bathtub, making up stories involving the toys as they floated on the water. He once admonished me for entering the bathroom uninvited and interrupting the "story line" of his bathtub reverie.
As he approached puberty, he took up skating and skateboards. This was a surprising departure for him because he had previously been risk averse, often refusing to try even the mildest amusement park rides.
Daniel was a good student until fourth grade, when his grades began to plunge. By fifth grade, our hopes that he might become a doctor were dashed when he flunked health and got some C's and D's in other subjects. By the time he was in sixth grade, a psychologist diagnosed him as having ADHD, and a neurologist prescribed a stimulant, Adderall.
Although one of his teachers thought he was suffering from depression, the psychologists disagreed. But there were warnings that Daniel's temperament could lead to serious mental health problems.
"Emotions are difficult for Daniel, especially negative ones," wrote Peter A. Spevak, the first counselor who tried to help him, in 1998. "Daniel does not easily process emotions. They are often internalized, neither easily experienced nor sorted.
"He relies on an inappropriate coping style that involves passive detachment and a lowering of personal expectation. While making him feel relieved, his eventual ineffectiveness will yield personal dissatisfaction."
The experts we consulted encouraged us to set limits for Daniel and not shield him from adverse consequences. But whenever we did that, he lost his temper. The anger in his face and voice were sometimes so intense, he scared me.
He also had trouble sleeping and frequently complained of feeling hyper around bedtime, long after his daily dose of Adderall XR had worn off.
It was not until August 2000, however, that we saw clear evidence that Daniel's unacknowledged problems were taking a toll. At a rental vacation home at Smith Mountain Lake in southern Virginia, he chose to spend all his time in a windowless basement bedroom, watching television. He got angry whenever we tried to coax him to go boating or swimming.
Back home, he was withdrawn and expressed no interest in being with his friends.
By then, Daniel was seeing another therapist. When we returned home from the vacation, we told the therapist that we feared our son was depressed. The therapist, who was treating him for ADHD, scoffed at our amateur diagnosis.
"What do you want," he asked, "more drugs?"
His response made us think we had suggested something stupid. We allowed him to intimidate us. Thus, we did not take Daniel to a doctor who could have prescribed antidepressants.
Many times over the past three years, I have chastised myself for failing to scream "yes" when the therapist asked if we wanted more drugs for Daniel.
Instead of antidepressants, he said Daniel needed "a kick in the pants" and perhaps should be sent to military school.
We still were certain that Daniel was depressed, but sometimes during those final days, he surprised us with sudden cheerfulness.
The night before he died, he had a good time creating a Halloween costume. He said it was a "punk" costume, but it looked remarkably similar to his usual attire: baggy pants, big T-shirt and a small stocking cap.
A prayer for Daniel
"I love you, Dad," Daniel said as he headed out to a Halloween party on the night of Oct. 27, 2000. "I love you, too, son," his father replied. "Have a good time."
Even though he was getting into a car with one of his friends and the boy's father, Daniel was not embarrassed to declare his affection for his father in their presence.
Those were the last words his father exchanged with him.
At the party, friends say, Daniel seemed to be extremely tired and spent time lying on the floor. As the party wound down, one of the boys invited Daniel and some other friends to a sleepover. When Daniel called home for permission, I said no. That made him angry, but I reminded Daniel that he always had trouble recovering from sleepovers with friends.
When Daniel arrived home about 10:30 p.m., he was still wearing a Playboy stocking cap that was part of his Halloween costume. I tried to talk to him, but he brushed past me and went into his room, slamming the door, which was covered with "Keep Out" signs.
I had never seen him that angry. His eyes blazed with contempt for me. Hoping to avoid a fight, I decided to leave him alone and went to bed.
Shortly after 11 p.m., my husband and I were awakened by a commotion in the hallway outside our closed bedroom door. "Oh my God; oh my God." Our 15-year-old daughter and a friend were screaming and pointing us toward Daniel's room.
That is when we found him, hanging.
Panic consumed us. As my husband tried to give him CPR, I called 911. The call took far longer than it should have, I thought. The woman on the other end asked repeatedly if my son was hanging from a tree. When I replied "No, he's in his bedroom," she didn't seem to understand. It took what seemed like forever for her to say the words I wanted to hear: "The paramedics are on their way."
My husband, daughter and I sat together in a nearby room listening as the paramedics worked on Daniel on his bedroom floor. We heard nothing encouraging. I prayed he would be revived but thought I was asking God for more than he could deliver.
All the work the paramedics and the emergency room personnel did to revive Daniel was for naught. Doctors concluded that his trachea was broken by the noose and he had lost the ability to breathe moments after he hanged himself.
Daniel was pronounced dead at Arlington Hospital at 12:05 a.m. Oct. 28, 2000.
Before his body was taken away for an autopsy, we were allowed one last look at our dead son. He was laid out on a stretcher, covered with a sheet. Only his head and his big feet were visible. A tube had been jammed into his neck. His hair was black, the last color he had chosen to dye it.
With our pastor, Kim Rodrigue, my husband and I prayed over Daniel's body. We thanked God for his life. I got down on my knees and rested my head against the side of the stretcher.
Our tears were so heavy, we choked on them.
Our grief was more painful than anything we had known. My whole body literally ached for nearly two years after Daniel died. I felt as bruised as if I had been run over by a car. And along with the pain, there were the inevitable questions.
Would he still be alive if we had allowed him to go to the sleepover? Would he have survived if we had gotten him treatment for depression? Could we have stopped him from committing suicide if we had followed him into his room and talked to him after he had come home angry? What was he thinking in the moments before he died?
It is hard to avoid the conclusion that we failed our son. Even when we were assured by experts that suicide is the act of an irrational person, we kept thinking of things we could have done and words we could have uttered that might have prevented his death.
For months after Daniel died, my husband and I read nothing but books about childhood suicide, depression and mental illness. Some of the most helpful were I Want to Kill Myself by Tonia K. Shamoo and Philip Patros; Help Me, I'm Sad by David G. Fassler and Lynne S. Dumas, and Growing Up Sad by Leon Cytryn and Donald McKnew.
What we learned might have saved Daniel if we had known it a year earlier. In an effort to share our newfound wisdom, my husband developed a Web site for parents, www.depressedchild.org which he updates regularly.
The Diagnostic and Statistical Manual of Mental Disorders, better known as the DSM IV, lists the criteria commonly used to assess whether a person is clinically depressed. We decided that Daniel suffered from all of it to some extent: unhappiness, sadness, hopelessness, loss of appetite, disturbance of sleep, slowness of movement or agitation, loss of pleasure, loss of energy, low self-esteem, decreased concentration and suicidal thoughts or actions.
Dan's psychologist should have recognized these symptoms. Very often, I later learned, children diagnosed with ADHD have other mental health problems, such as depression, that go undetected because the two disorders have similar symptoms.
Lance Clawson, a child and adolescent psychiatrist who practices in the Washington area, told me that more than half the children with ADHD also have "a second, significant psychiatric problem."
Like most professionals, Clawson disputes the view that too many children are being diagnosed with ADHD. But he does think that too few children diagnosed with ADHD are being screened for other mental health problems.
David Shaffer, the Columbia child psychiatry professor, says our son should have been given an antidepressant when he showed signs of depression. He says the suicide rate has declined among children and young adults in recent years, apparently as a result of the availability of antidepressants.
There also is a growing belief among experts that the stimulants used to treat ADHD may intensify other mental disorders. Clawson says stimulants such as Ritalin and Adderall often cause dysphoria, a symptom of depression defined as a "generalized feeling of discontent."
Carol Watkins, a child psychiatrist in Baltimore, says stimulants "sometimes can exacerbate depression" and a combination of depression and ADHD can be lethal.
"Children with ADHD usually have problems with impulsivity and poor coping skills," Watkins says. "If somebody has underlying depression, then their impulsivity and poor coping skills make them more at risk for suicide."
Shaffer, who has been studying childhood suicide since the 1960s, says he suspects that our son was bipolar, a condition also known as manic depression. He bases this conclusion on the dramatic shifts in Daniel's behavior from frisky to sad. Bipolar children are much more likely to commit suicide than those with ADHD.
Shaffer's postmortem diagnosis explains why Daniel's depression seemed to come and go.
Demitri Papolos, an associate professor of psychiatry at Albert Einstein College of Medicine in New York City, and his wife, Janice, co-authors of The Bipolar Child, say a child with bipolar disorder shifts frequently from manic to depressive, throwing tantrums and having trouble sleeping.
Bipolar symptoms are often mistaken for ADHD, they say.
"The moods of children who have ADHD or bipolar disorder may change quickly, but children with ADHD do not generally show dysphoria as a predominant symptom," the Papoloses write.
"The trigger for temper tantrums is also different. Children who have ADHD are typically triggered by sensory and emotional over-stimulation, whereas children who have bipolar disorder typically react to limit-setting, such as a parent saying "no.' "
If Daniel was bipolar, the stimulants he received for ADHD could have been the cause.
The Papolos' book says a child with a genetic predisposition for being bipolar should not take stimulants because it can precipitate early onset of the disorder. Antidepressants could have a similar effect.
Children diagnosed with bipolar disorder are usually given mood stabilizers, such as lithium.
No treatment plan
If my husband and I learned one lesson from Daniel's death, it is that parents of children with emotional problems cannot simply leave their treatment to the professionals.
We should have done independent research, asked more questions about the treatment plans and challenged the diagnosis every step of the way. When the psychologist dismissively asked me if I wanted more drugs for my son, I should have pressed the issue.
Daniel saw three therapists in all. One diagnosed him with "ADHD intuitive-impulsive type," which is characterized by overactivity, impulsivity and aggressive behavior. This therapist said Daniel "has some of the signs and internal stresses that are indicative of depression," but she did not diagnose him as depressed. Her report instructed his other therapist to monitor him carefully for signs of depression.
None of the people we consulted, including the neurologist who prescribed Adderall, warned us that stimulants can complicate depression or cause the early onset of bipolar disorder in children who are predisposed to it. They did know, however, that alcohol abuse and depression run in my family and my husband's family, and that history could have predisposed our children to depression or bipolar disorder.
A month before Daniel killed himself, the National Institute of Mental Health published a fact sheet for physicians warning that childhood depression is often overlooked.
We obtained the practice notes of Daniel's last therapist, the one who said he needed a kick in the pants. The notes indicate that he made one early attempt to probe how much of Daniel's problems were due to ADHD and how much were the result of depression. After that, there is no evidence he explored depression with Daniel.
Nor is there evidence that this therapist tried to determine if Daniel was suicidal. We learned after his death that our son had asked a friend over the summer, "How do you think it would feel to hang yourself?" He might have shared that thought with his psychologist if he had been asked.
The day after Daniel killed himself, his therapist came to our house to offer his condolences. He suggested that Daniel's death was the random result of a childish "prank" and assured us that he had no inkling the child was contemplating suicide.
This year, in response to our complaint, the Virginia Department of Health Professions reprimanded the therapist for failure to keep a treatment plan for Daniel and for not keeping adequate notes.
We had hoped the ruling would alert other parents whose children are being treated by this therapist to ask for a treatment plan, but we doubt that it has had any impact. All such actions are erased from the health department's Web site after 90 days.
The struggle to go on
After the memorial service and after we had acknowledged all the sympathy cards, flowers and gifts, I was overwhelmed by the realization that Daniel's death could destroy my life as well.
I knew, for example, that there is a 70 percent chance that couples who lose a child will end up getting divorced. We were also advised that grief is like being underwater and it causes friction in the family because each person comes up for air at a different time.
My husband and I have weathered our grief together, perhaps because we have availed ourselves of help wherever we can find it: grief counseling, regular therapy and a suicide survivors group. Yet, many of my fears have been realized.
Not an hour passes that Jim and I don't think about our loss. Every time we see a boy on the street or on the subway, we are overwhelmed by a helpless feeling that calls our lives into question. Many days, we ask ourselves whether we can continue to live with this pain.
My husband, Jim, my daughter, Mary, and I have been treated for depression since Daniel's suicide. Jim still cries frequently. His father died when he was young, depriving him of a father-son relationship. Daniel's death reopened that wound.
I have considered suicide several times. I was hospitalized for three months this year with a life-threatening lung virus. My doctors believe that the physical stress of my grief left me more susceptible to the disease. As I struggled to breathe, I was constantly reminded of how my son must have felt during the last seconds of his life.
His death will even leave a mark on children not born yet. Experts say it takes four generations before a family psyche can shake the impact of a suicide.
Daniel's friends and teachers also were profoundly affected by his suicide. One of his teachers told me the heartbreaking story of a lonely little girl Daniel had befriended before he died. She kept to herself the rest of the school year, never smiling, never talking to her classmates.
Whenever Jim, Mary and I do something together, eating dinner or going on a vacation, there is always a hole where Daniel used to be. There is no need for a fourth place mat and no one to eat the extra pork chop. The milk he used to drink goes sour in the refrigerator. His skates and lacrosse stick are where he left them in the garage. And my arms still remember how it felt to hug him.
Jim and I cringe when we think how we used to yell at Daniel for leaving his clothes and shoes in the kitchen. Whenever we see other parents scolding their children, we have to control the impulse to tell them how fortunate they are to have children.
More than any other kind of death, suicide hurts the survivors. We not only lost our son, we feel like he rejected us. Perhaps our best comfort has come from people we have gotten to know who have had the same bitter experience of losing a close relative to suicide.
Our story proves a truism about parenthood that most of us try to deny.
From the moment our children were born, we did everything we could to keep them physically safe. We bought the best car seats and bicycle helmets. We took them to the best physicians. We studied the advice of Dr. Spock and T. Berry Brazelton. We kept close tabs on their whereabouts.
Now, when we lock the doors of our house at night, we realize how powerless we were to keep them safe. Daniel was not killed by a drunken driver, a faulty product or any other physical hazard that we feared, but by demons inside that we failed to recognize.
To comment on this story or ask a question of Sara Fritz, please click on www.sptimes.com/daniel She will post her answers in the coming days. Mail to Sara Fritz can be sent c/o Floridian, St. Petersburg Times, P.O. Box 1121, St. Petersburg, FL 33731; e-mail: firstname.lastname@example.org