What would drive a 3-year-old to suicide?

"One reason is that 70 percent of them are severely abused," says Dr. Perihan A. Rosenthal. "They want to escape from the abuse."

Rosenthal and her husband, psychiatrist Stuart Rosenthal, studied 16 preschoolers who had run into traffic, taken drugs, jumped off buildings or otherwise tried to injure themselves.

Compared to 16 other children with behavior problems, the suicidal group showed more symptoms of depression and were more likely to have tried to run away. Thirteen of the 16 were physically abused or neglected.

As part of the study, the researchers asked the children to play with dolls in a form of analysis called play therapy. Writing in the American Journal of Psychiatry, they reported these findings in the case of one 4 1/2-year-old boy, Chester, a child-abuse victim who had tried several times to kill himself:

"He . . . tried to put the doll into a chest of drawers and head-down into a toilet bowl. He then had the doll climb to the roof of the house and jump. When the therapist expressed concern about the boy doll being crushed by the fall and dying, Chester made the boy doll get up and kiss and hug the mother doll. Then the father doll walked in. At this point both mother and son dolls climbed to the roof and jumped, killing themselves."

The writers suggest that attempted suicide by preschool children, though rare, may be more widespread than believed because cases are concealed or misdiagnosed. Most poisonings, for example, are recorded as "accidental," Perihan Rosenthal says. "But nobody knows whether they're accidental or not."