Analysis Causative Factors of Self-Harm Behavior in Early

Childhood: A Systematic Literature Review

Puji Gusri Handayani

, Hafiz Hidayat

, Frischa Meivilona Yendi

, Lisa Putriani

Rahmi Dwi Febriani

and Triave Nuzila Zahri

Department of Guidance and Counselling, Universitas Negeri Padang, Padang, Indonesia

Department Master of Elementary, Universitas Adzkia, Padang, Indonesia

Keywords: Self-Harm, Early Childhood, Counselling, Mental Health, Intervention Counselling.

Abstract: The phenomenon of self-harm at this time is also detected in early children, including early childhood. Given

the long-term impact on children's emotional and social development, this raises serious concerns. The most

significant risk is felt from family factors, especially mental disorders in parents. This study explores self-

harm behaviors that occur in children, their impacts, and influencing factors from various aspects. The study

aims to achieve three main objectives: first, to identify examples of self-harm behavior in children; second,

to detect factors as a precursor to self-harm behavior; and third, to assess the effectiveness of current

prevention strategies. The study involved a comprehensive review of articles from three major databases—

Scopus, ScienceDirect, and Google Scholar—resulting in an initial selection of 160 articles. After applying

specific inclusion and exclusion criteria, 18 articles were considered relevant for the analysis. These findings

suggest that the factors that cause children aged 3-6 to commit self-harm are not just an individual problem,

but also reflect the wider environment and experiences that can affect their wellbeing. Implications highlight

the importance of monitoring and support for at-risk children, as well as the need for intervention approaches

to address these mental health issues at an early age.

1 INTRODUCTION

Self-harming behavior has been on the rise for

decades, not only among adolescents and young

adults, but also begins to be identified early, including

in childhood (Jung et al., 2018). Given its long-term

impact on a child's emotional and social development,

this development raises significant concerns among

educators and mental health professionals. Childhood

traumatic events, including physical abuse, sexual

abuse, neglect, and disharmonious domestic

situations, are closely related to self-harm behaviors

in young children (Stewart et al., 2020). Furthermore,

self-harm behavior is closely associated with

childhood trauma. The fact that 75% of self-harming

https://orcid.org/0000-0001-7343-8896

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https://orcid.org/0000-0001-6163-0362

teens have a history of sexual disclosure as a child

supports this (Naeem, 2024).

Furthermore, long-term research shows that

children who experience trauma or injury from

violence before the age of 15 are significantly more

likely to commit acts of self-harm during their

adolescence and early adulthood (Griffin, 2018).

According to Chinese research, psychological

resilience may act as a mediator in the relationship

between behavioral tendencies to have self-harm

behaviors in early adolescence and violence during

childhood, offering a possible avenue for preventive

measures (Li et al., 2024). Furthermore, it was found

that psychological traits such as impulsivity,

dissociative tendencies, and low self-esteem served as

Handayani, P. G., Hidayat, H., Yendi, F. M., Putriani, L., Febriani, R. D. and Zahri, T. N.

Analysis Causative Factors of Self-Harm Behavior in Early Childhood: A Systematic Literature Review.

DOI: 10.5220/0014054900004935

Paper published under CC license (CC BY-NC-ND 4.0)

In Proceedings of the 7th International Conference on Early Childhood Education (ICECE 2025) - Meaningful, Mindful, and Joyful Learning in Early Childhood Education, pages 145-154

ISBN: 978-989-758-788-7; ISSN: 3051-7702

145

mediating factors, reinforcing the link between self-

harm behaviors and childhood trauma (Cheng et al.,

2023).

According to a longitudinal study of child abuse

and neglect, children who have self-harming

behaviors by the age of four, such as suicidal thoughts

and self-harm, are more likely to continue these

behaviors by the time they are six years old

(Marcheselli et al., 2018). Data from 387 children

between the ages of 5 and 12 who were hospitalized

for self-harm examined in a study in the UK found

that 39% of cases occurred in children aged 5 to 11,

with a greater percentage in boys under the age of 11

(Geulayov, 2022). In addition, the youngest of the 30

children sent to mental health facilities for self-harm

was less than 6 years old, and the majority of them

had a history of learning problems, parental conflict,

or severe family stress (Krishnakumar, 2011).

Self-harm behaviors and bad childhood

experiences are also mediated by psychological

characteristics, including problems with emotional

control, low resilience, and low self-esteem (Chen et

al., 2022). Children who are victims of bullying,

neglect, or poor parenting also tend to do self-harm,

either directly or indirectly through aggressive

behavior towards others (Handayani et al., 2023;

Myklestad & Straiton, 2021). In populations with

developmental disorders such as ADHD or bipolar

disorder, where self-harm behaviors are more

common and influenced by traumatic childhood

experiences, these problems become more severe.

Self-harm behaviors in early childhood have serious

long-term impacts, such as a higher risk of

psychopathological diseases, social isolation, and

risky behavior tendencies in adulthood (Handayani et

al., 2024; Islam et al., 2020; Müller-Vahl et al., 2023;

Suryana & Latifa, 2023). To stop self-harm behaviors

and more serious psychosocial problems in the future,

children exposed to risk factors must receive early

detection and treatment (Kirkbride, 2020).

Based on these considerations, it is essential to

conduct a systematic review of the existing literature

to gain a deeper understanding of risk factors,

psychological mechanisms, and relevant preventive

and intervention measures for self-harm behaviors in

children. Emphasizing the importance of taking

action to prevent self-harm behavior in children, this

study aims to systematically identify the factors that

contribute to self-harm behavior in children and

analyze planned or carried out interventions related to

this phenomenon. In addition, as far as we know,

research on various forms of self-harm behavior in

children is still minimal.

Research on self-harm behaviors in early

childhood is urgently needed to identify risk factors,

mechanisms, and practical preventive measures that

will protect children from long-term negative

impacts. Researchers believe that self-harm behavior

can be reduced if the factors that trigger it can be

avoided. As self-harm behaviors become more

common and interfere with children's development

later in life, this research is critical to address as soon

as possible. This research aims to find ways to reduce

incidents and their impact.

2 METHODOLOGY

The Preferred Reporting Items for Systematic

Reviews and Meta-Analyses (PRISMA) tool was

utilized in this SLR investigation. A series of

recommendations created by the PRISMA approach

is intended to raise the caliber and openness of

systematic reviews and meta-analyses (Page et al.,

2021). SLR is an exacting research methodology that

entails a thorough and systematic search for relevant

studies, followed by a critical evaluation and

synthesis of the results (Azarian et al., 2023).

PRISMA provides an organized approach to SLR,

including guidelines for choosing research, creating a

search strategy, gathering data, and synthesizing the

findings (Shaffril et al., 2021). The following

Systematic Searching Strategies are used when

conducting SLR research:

2.1 Identification

This part involved looking through the current

internet research databases on Scopus, Google

Scholar, and Scopus for relevant scientific papers.

Many criteria, such as accessibility, time coverage,

subject relevance, and content quality, affect the

choice of these platforms (Wesz et al., 2023). To find

articles about self-harm, the article search included

many keywords, including "Self-harm" OR "Self-

Injury" AND "Self-harm for Child".

2.2 Screening

We found 160 articles total—147 on the Scopus

database, four on the Sciencedirect database, and nine

on the Google Scholar database—by conducting

keyword searches across three databases. Only

English articles from the last 10 years, 2015–2025,

have been found.

ICECE 2025 - The International Conference on Early Childhood Education

146

Table 1. Data Base.

No. Data Base Total

1 Sco

us 147

2 Sciendirec

3 Goo

le Schola

Total 160

Figure 1: PRISMA Flow Chart.

Duplication is possible; out of 160 articles, 12 are

identified as duplicates, making the total number of

articles 148. After that, we chose publications

pertinent to the research issue by going through the

148 titles and abstracts. We eliminated 47 items out

of 148, leaving 100 articles. The researchers next

identified the population: children aged three to six.

Of the 100 articles not categorized as children, 37

were classified as individuals, and 63 were left. We

eliminated forty-five articles after rereading the entire

manuscript on the results, indication, intervention,

and research design. Ultimately, the researchers

identified the details by excluding any references to

juvenile self-harm; 18 articles remained from the 45

that had nothing to do with the circumstances at hand.

2.3 Eligibility

Articles that now meet the first set of requirements

still need to be thoroughly validated by reading and

analyzing the entire text. Making sure all required

portions are included is the primary goal. A thorough

examination of the abstract, introduction, methods,

results, discussion, and conclusion is part of this

evaluation process. The researcher must guarantee

coherence and seamless integration between all

segments. To lessen potential bias, the researcher

should openly explain the rationale for exclusion of

any publication that is judged inappropriate (Tawfik

et al., 2019).

3 RESULT

All eighteen of the papers that are pertinent to this

study topic are quantitative studies. The 18 research

environments differed.

Table 2: Article Details Studies Included in Review.

o Autho

Findin

s Causal Factors Intervention

1 (Paul, 2019) It has been found that children between

the ages of 4 and 6 engage in self-harm

behavior. This behavior affects about

3.9% of 4-year-olds and 3.2% of 6-year-

olds. Overall, self-harm behavior in

children is not just a personal problem;

These behaviors also reflect the broader

environment and events that can affect

their wellbein

● Experiencing abuse,

especially physical

neglect, indicates a link

between harmful

behavior and an

unsupportive

environment.

● supervision and

support for

children

2 (Paul &

Peralta, 2016)

Children who are victims of violence—

physical, emotional, or neglect—are

more likely to have suicidal thoughts

and self-harm.

● Children who

experience physical,

emotional, or neglect are

more likely to have

● Trauma care

interventions

Analysis Causative Factors of Self-Harm Behavior in Early Childhood: A Systematic Literature Review

147

suicidal thoughts and

self-harm.

● In the context of

preventing harmful

behaviour in children,

attention to physical and

sexual education is just

as significant as dealing

with forms of violence,

including emotional

lect.

(Aitken,

2016)

Thoughts of suicide and self-harm

were found to be more common in

children referred to gender dysphoria,

and the impulses for self-harm and

suicide increased with age.

● One example of

behavioral problems is

the refusal to accept

gender norms.

● The social problems

arise from the feeling

that their current gender

has re

ected them.

● Clinical

Medicine

4 (Zubrick,

2016)

Self-harm behavio

occurs in 11% of

children aged 4 to 17 years. Suggests

that this behavior occurs in early

childhood.

● Having a mental illness ● Clinical

treatment

5 (Mitchell,

2018)

Children who feel imperfect are more

likely to self-harm or end their lives.

● Physical violence

● Economically

disadvantaged.

● Psychosocial

care

● Providing

education to

arents.

6 (Borschmann,

2020)

Self-harm behavior in early childhood

is quite prevalent and can be

anticipated from an early age based on

many risk factors.

● These include ongoing

anxiety issues, experien-

ces of social oppression

and rejection, as well as

emotional disorders and

behaviors such as

emotional dysregulation

and antisocial behavior.

● School

environment

collaboration,

including peers.

7 (MacMullin,

2020)

Suicidal thoughts and actions in a

community sample of children who

exhibit

ender nonconformit

(GNC).

● Gender today does not

match the wishes of

parents.

● Marriage

education

● Parent education

8 (Geulayov,

2022)

Men are more likely to commit acts of

self-harm than women, especially at the

ages of 5 and 10.

● Gender

● Marriage

education

● Parent Education

9 (Predescu,

2023)

Girls with depressive symptoms were

more likely to attempt suicide than boys,

and girls with depressive symptoms and

behavioral problems showed more self-

harm behaviors.

● Depression

● occurs in an unstable

family and social

environment.

● Counseling

● Clinical

treatment

10 (McCluskey,

2022)

Children between the ages of 5 and 18

who are treated for diagnoses involving

intentional self-harm or suicide attempts.

Women are the cause of the most

hospitalizations, while men are the cause

of the most deaths in hospitals.

Intentional drug consumption is the most

common mode of self-harm.

● Deliberate excessive

consumption of drugs.

● Clinical

treatment

● Counseling

ICECE 2025 - The International Conference on Early Childhood Education

148

11 (Jiang, 2019) Self-harm behavior arises triggered by

stress because it was born to

HIV/AIDS-positive parents.

● The experience of

verbal victimization

● Depression

● Taking

preventive

measures

12 (Sekmen,

2023)

1,098 children treated at (37%) were

diagnosed with a self-harm event. We

identified four different profiles with

varying risks for the diagnosis of self-

harm behavior, mainly consisting of

children ages 5 to 9 years without a

revious

chiatric dia

nosis.

● Health conditions

● Social environment

● Medical care

● Family education

13 (Townsend,

2022)

Understanding of how widespread the

problem of self-harm is among

younger school students is still

limited. Further, support is needed to

help children who engage in self-

urious behaviour.

● Anxious

● Stress

● Bullying

● Improving the

skills of teachers

and parents

14 John, J.R.

(John, 2024)

Children with disabilities show

significantly higher incidents of self-

harm than children without

disabilities.

● Disability

● Sleep problems

● Medical care

● Therapeutic

Treatment

15 (Avanci,

2021)

The results showed 58 deaths of

Brazilian children with intentional

self-harm, mainly male, white ones.

● Related risk factors

include social,

cultural, and family

conditions and stigma

that inhibit early

reporting and

treatment.

● Improve early

identification,

prevention, and

strengthening of

health and edu-

cation systems to

protect children

from the risk of

suicidal

behaviour from

an earl

16 (Townsend,

2024)

Self-harm and suicidal thoughts occur

as a result of poor parenting.

● Bad use of language

from parent to child.

● Collaboration

with parents is

mainly essential

in the use of

lan

17 (Zhu, 2019)

Children with one or several

disabilities have a statistically higher

tendency to self-harm than children

without disabilities.

● Disability ● Carry out

preventive

efforts together

with a disability

therapist.

18 (He, 2025)

The increase in self-harm behavior is

caused by academic pressure and

relationships with parents that result

in stress and depression.

● Study pressure

● Depression

● Parent-child

relationship

● Carry out

preventive

intervention

efforts before it

happens.

There is a substantial correlation between the

experience of self-harm behavior and its causative

factors, based on data on self-harm behavior, causal

variables, and interventions in Table 1. These results

suggest that many complex elements, such as social

context, mental health, and experiences of violence,

influence self-harm behavior in children. According

to research, children who are abandoned, physically

abused, or emotionally abused are more likely to self-

harm or consider suicide. The increase in self-harm

behaviors is also caused by a variety of factors,

including gender identity challenges and scholastic

pressures. Supporting at-risk children requires

effective interventions. Collaboration between

schools and families, teaching mindful of children's

needs, and parental supervision can help reduce the

likelihood of these negative behaviors. By

understanding the factors that contribute to self-harm

Analysis Causative Factors of Self-Harm Behavior in Early Childhood: A Systematic Literature Review

149

behaviors, we can create more effective prevention

strategies to maintain the mental health of children

and adolescents.

Further, it is essential to remember that

children in need may be reluctant to seek help due to

social stigma and a lack of knowledge about mental

health issues. To reduce this stigma and make it easier

for children and families to receive requests for help,

communities must be strengthened through education

and awareness initiatives. Peer support is also

essential to provide a safe space for children to

express their emotions and experiences.

Finally, further investigation is needed to

explore the relationship between risk variables and

self-harm behaviors fully. Interventions can be more

appropriately tailored to meet the needs of each

individual by recognizing a more specific risk profile

and understanding the underlying mechanisms.

Researchers, medical experts, and the general public

must work together to create conditions that improve

children's mental health and prevent negative

behaviors in the future.

4 DISCUSSION

4.1 Factors that Cause Early

Childhood Self-Harm

Although rare, self-harm among young children is on

the rise (Cybulski, 2021). The main risk factors found

were a history of mental disorders or criminal

behavior in the elderly (Nisar et al., 2015). Parents of

nearly 75% of self-harmed children have a history of

mental illness and/or criminal activity (Hare et al.,

2022). After family characteristics were considered,

community environmental factors such as low

socioeconomic status, location, and ecological crime

rates were not shown to be significantly related

(Favril et al., 2020; B. P. Liu et al., 2022; J. Liu &

Accid, 2006).

Adverse childhood experiences (ACEs),

including neglect, emotional, physical, and sexual

abuse, are also closely associated with a higher risk

of self-harm, including suicidal thoughts and non-

suicidal self-harm (NSSI) (Laporte et al., 2023).

Exposure to ACEs in long-term or mid-term

childhood to adolescence increases the likelihood of

depression and self-harm in adolescence (Chen et al.,

2022).

The development of symptoms of anxiety,

sadness, emotional control problems, and aggressive

behavior is one of the mechanisms that links negative

childhood experiences to acts of self-harm (Huang et

al., 2022). Children who are abandoned or victims of

violence tend to show signs of aggression and

depression/anxiety, which increases their risk for self-

harm (Paul & Ortin, 2019). Furthermore, sleep

problems and low self-esteem are significant

predictors of self-harm behavior later in life (Uh et

al., 2021).

4.2 Intervention Plan

Psychological resilience has been proven to reduce

the risk of self-harm in children who experience

violence or neglect (Tian et al., 2020). Interventions

that increase resilience and strengthen family and

peer relationships can be effective prevention

strategies (Pollak et al., 2023). Early detection of a

history of mental disorders in parents, bad childhood

experiences, and psychological symptoms in children

is essential to prevent self-harm (Bunting et al.,

2023). Interventions should involve families, schools,

and communities, and focus on increasing resilience,

emotion regulation, and social support (Bethell et al.,

2022). Prevention efforts should begin early and

continue throughout childhood to adolescence.

To stop the formation of self-harm behaviors in

young children, preventive care is critical (Morken,

2020). One practical approach is school-based

programs focusing on improving emotion

management skills, strengthening self-esteem, and

developing problem-solving skills (Lee et al., 2020).

The program can be broadcast to young people who

show increased risk or is widely used in school

settings (Bıdık & Sisman, 2021). Research shows that

school-based interventions can prevent suicide

attempts in the long term and can reduce suicidal

thoughts and attempts in the short term (Ebrahem et

al., 2019; Gaspar et al., 2018).

From a curative standpoint, parents and

counselors can collaborate to offer evidence-

supported therapeutic and psychosocial help, such as

dialectical behavioral therapy (DBT) (Stallard et al.,

2024), cognitive behavioral therapy (CBT)

(Handayani et al., 2022), and Mentalization Therapy

(MBT) (Yoon et al., 2017). These therapies are

successful in reducing repetitive self-harm behaviors

in children and adolescents. To ensure prompt and

effective treatment, it is also important to identify

signs of depression, anxiety, or other behavioral

problems that can lead to self-injuring behaviors early

on. In addition, in both types of therapy, parental

participation is essential. Parents should be taught

how to recognize the warning signs of self-harm

behavior in their children and how to help them

emotionally (Townsend et al., 2021). In addition,

ICECE 2025 - The International Conference on Early Childhood Education

150

fostering open and loving communication between

parents and children can help children develop

resilience and prevent self-harm (Curtis et al., 2018).

Cooperation between families, schools, and

counselors is essential for early childhood education

to be safe and supportive.

5 CONCLUSIONS

In early infancy (3–6 years), self-harm behaviors can

occur, especially in children who have developmental

disorders, trauma, or an unsupportive environment.

Although its prevalence is lower than during puberty,

health and education providers should be aware of its

dangers from an early age. Although research on self-

harm behavior in early childhood (ages 3–6) is

limited, there is growing concern about the increasing

prevalence of self-harm behavior in children. The

identification and treatment process relies heavily on

age-appropriate language use and parental

involvement, which has educational consequences. In

addition, it is highly recommended that schools,

parents, and mental health specialists work together;

However, teachers and parents still need special

training.

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