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[Updated 12:25 pm Saturday, Pacific]
Although hindsight can often provide a false sense of clarity, a report on Sandy Hook mass murderer Adam Lanza suggests there were many warnings about Lanza’s mental health issues, warnings that were were ignored or dismissed by parents, educators, doctors.
The report (pdf), prepared by the Connecticut Office of the Child Advocate, reviews “the circumstances that pre-dated his commission of mass murder at Sandy Hook Elementary School.”
It is vital to note that [Adam] was completely untreated in the years before the shooting and did not receive sustained, effective services during critical periods of his life, and it is this story that the report seeks to tell (p. 3).
As we approach the second anniversary of the murders, it’s important to take stock of what we as a society do – or fail to do – in the context of mental health.
The report authors make clear that there is no “direct line” of causation, a warning sign that might have led directly to the murders. But they also argue that we need a working “cross-system communication amongst professionals charged with the care of children.”
Finally the report paints a stark picture of a system that failed.
It’s not that his mental illness was a predisposing factor in this tragedy … It was his untreated mental illness that was a predisposing factor.
~ Dr. Harold Schwartz, chief psychiatrist at Hartford Hospital’s Institute of Living
The concluding questions in the report need to be discussed widely and thoroughly, and although they are not presented as accusatory, if you read the entire report you are likely to frame them as such:
Would a similar family from a different race or lower socio-economic status in the community have been given the same benefit of the doubt that [Adam’s] family was given?
Is the community more reluctant to intervene and more likely to provide deference to the parental judgment and decisionmaking of white, affluent parents than those caregivers who are poor or minority?
Would [Adam’s] caregivers’ reluctance to maintain him in school or a treatment program have gone under the radar if he were a child of color?
You know the answers: No. Yes. No.
Key points in the Adam Lanza report
1992: Adam is born on April 22 in Exeter, NH, to Nancy and Peter Lanza. He had an older brother, Ryan.
1994: Adam underwent the New Hampshire “Birth to Three” assessment when he was three years old because of “speech and language delays.”
The assessment concluded that he “fell well below expectations in social-personal development (p. 16)” and the evaluator created a preschool special education plan.
1995-1997: In 1995, Adam began pre-school in Kingston, N.H. He was “removed from speech and language services in late pre-school due to a perception that his challenges were not impeding his ability to learn (p. 17).”
In April 1997, special education services were re-instated after a report noted that Adam might have “a sensory integration disorder, and that he displayed ‘many rituals’ in his behavior (p. 17).” The assessment recommended “significant speech and language support” as well as assessment by a neurologist as well as “work with an occupational therapist certified in sensory integration therapy (p. 17).”
In May 1997, the school district completed its assessment, which confirmed that Adam “still had a dramatic discrepancy between expressive and receptive language abilities (a 42 point standard score difference, p. 17).”
From early childhood [Adam] never received comprehensive educational assessments that could provide recommendations for cohesive, multidisciplinary supports that took all of his abilities and disabilities into account (p. 20).
1998: The Lanza family moved to Connecticut. When Adam began first grade at Sandy Hook, the elementary school implemented the Individual Education Plan (IEP) established in New Hampshire, which focused on speech and language impairments.
1999: Early in the second grade, Adam was still having problems with fine motor skills but nevertheless occupational therapy was discontinued.
2000: In third grade, Adam showed improved speech articulation.
2001: In fourth grade, Adam was no longer in the special education program.
2002: The Lanzas separated; they shared custody of Ryan and Adam but the boys lived primarily with their mother.
By the fifth grade, Adam had begun “perseverative hand washing, avoiding contact with other people, and becoming increasingly fearful (p. 31).”
At Reed Intermediate School, Adam and a friend authored an “extremely disturbing [book] … filled with images and narrative relating child murder, cannibalism, and taxidermy.” Nevertheless: “There is no clear indication in the educational records that school staff carefully reviewed or were otherwise explicitly aware of the contents (p. 29).”
There is intense violence featured in this book, and authors conclude that it was not the sort of creation that most children would even know to invent. Mental health professionals contributing to this report determined that the content of “The Big Book of Granny” can only be described as extremely abhorrent and, if it had been carefully reviewed by school staff, it would have suggested the need for a referral to a child psychiatrist or other mental health professional for evaluation. An appropriate evaluation would have required extended discussion with the child about what the book meant and how it came to be written by encouraging extensive elaboration about what the text revealed regarding the child’s thoughts and social-emotional processing (p. 32).
[…]
[The authors] strongly caution that nothing in these findings would predict that [Adam] was likely to commit mass murder, even if a better connection had been made between the writing of “The Big Book of Granny” and a need for mental health evaluation and intervention (p. 34).
2003: Adam’s pediatric record “noted obsessive-compulsive tendencies,
including hand washing¸ leading to excoriated skin, and clothing rituals. There is no documentation in the pediatric record of any exploration of these issues or of a referral to a mental health specialist (p. 36).”
2005: In April, Adam withdrew from the seventh grade at Newtown Middle School due to “social, emotional, and communicative struggles (p. 36).” He transferred to a local catholic school to complete the school term but left before the fall term (8th grade) began.
There is no indication in the record that he was offered a re-evaluation for special education services based on social-emotional or other developmental concerns (p. 36).
In September, his mother took him to the hospital.
Hospital records described him as “anxious,” “withdrawn,” and “hesitant to be touched.” He presented as agitated, hyper-vigilant, and overwhelmed with fear. The clinical consultation resulted in diagnoses of Anxiety Disorder, NOS; Rule out Asperger Syndrome; Rule out Autistic Disorder, followed by a discharge diagnosis of Asperger Syndrome and Obsessive Compulsive Disorder (p. 38).
[…]
Mrs. Lanza declined the additional evaluation and referral as documented by the clinical team at Danbury Hospital. … Hospital staff agreed to provide a note excusing [Adam] from school for three days, pending an IEP meeting. Mrs. Lanza agreed in writing to return him to the Emergency Department should his anxiety symptoms increase at home. The hospital agreed to discharge [Adam]. It does not appear that a subsequent IEP meeting took place until December 2005 (p. 39).
After the hospital visit, Adam’s mother sought to “home school” him but the school “recommended that the family and school work together to try and meet [Adam’s] needs, even in unconventional ways if necessary. However, the community psychiatrist wrote a note saying that Adam should not attend school because of “mounting overwhelming anxiety” (p. 41).
Clinical and educational professionals contributing to this report agree that the recommendations articulated here by the community psychiatrist were completely inappropriate and non-therapeutic (p 41).
2006: Adam had not returned to school. In response to a request about standardized testing, the psychiatrist told the school that Adam was “medically/emotionally unavailable to be tested” (p. 43).
The report authors note that Adam was not “home-schooled.” Instead, Adam had a designation of “homebound” which “is permitted by Connecticut education law when a child is deemed too disabled to receive services in school even with modifications and supports (p. 43).” His mental health had “significantly deteriorate[d] during middle school (p. 44).”
There did not appear to be any significant or timely follow up to the psychiatrist’s [report to the school] that [Adam] was not only unavailable for testing, but unavailable for any instruction whatsoever (p. 46).
In June 2006, Adam’s medical record documents raw hands due to over-washing. “There is no documented follow up or coordination between the pediatrician and the community psychiatrist that he was purportedly seeing at that time (p. 70).”
In October 2006, Adam was evaluated by a Yale Child Study Center psychiatrist.
The tone and level of urgency in the doctor’s report appears a testament to his degree of concern. He references the use of medication to relieve symptoms… [Adam] had been seen by the community psychiatrist for 10 visits and [had refused medication].
The psychiatrist … recommended further evaluation to clarify cognitive, social, and linguistic strengths and weakness. Psychological and speech and language evaluation was seen as essential. Treatment, the psychiatrist stated, would be difficult to implement outside of a broader therapeutic day school setting.
[The psychiatrist wrote:] Beyond the impact of OCD symptoms on himself and his mother, we are very concerned about [Adam’s] increasingly constricted social and educational world.
Finally, the Yale psychiatrist noted that the family needed “tons of parental guidance—without that, any office based approach to his [challenges] will fail, certainly if it is without medication.”
In November of the 9th grade (2006), the Adam’s parents agreed to a school-district conducted psychological evaluation, which determined that there was “no evidence of a specific learning disability (p. 60).”
2007: For a period of three days, Adam took an anti-depressant. His mother decided to discontinue the medicine, ostensibly in consultation with community psychiatrist.
Overall, the psychiatrist and APRN at Yale both indicated, in present-day interviews, their view that [Adam] was profoundly impaired by anxiety and Obsessive Compulsive Disorder, and that his parents, and certainly [Adam], may not have understood the depth or implications of his disabilities. It may have been easier for the parents to accept that [Adam] was a youth with a “high functioning” disorder, conceptualizing him as someone who was gifted but who had odd or challenging behaviors that needed behavioral modification.
[…]
[T]he Yale Child Study Center clinicians who evaluated and treated [Adam] felt that his parents, and certainly his mother, may have had greater than average difficulty with accepting the extent of [Adam’s] disabilities (p. 56).
Subsequently, the school and family created an IEP that did not reflect recommendations contained in the Yale Child Study Center report. The report contains “no assessment of social-emotional behavior” despite this being the argument Adam’s mother presented for his being homebound (p. 60).
School records contain no documentation of input from the community psychiatrist past early 2006 and no copies of any treatment recommendations. School records also contain no documentation of phone correspondence between school personnel and [the community] psychiatrist (p. 59).
For the 2007-2008 academic year (10th grade), the school prepared to mainstream Adam despite an “ongoing underestimation” of Adam’s abilities (p. 62).
There were multiple indicators that [Adam] met statutory-regulatory criteria and applicable
guidance for autism spectrum disorders or, alternatively, for emotional disturbance (p. 63).
[…]
The absence of a plan to address [Adam’s] social-emotional issues with a program that was sufficiently intense and therapeutic likely contributed to a situation in which he eventually became increasingly withdrawn and socially isolated (p. 64).
2008: By February, Adam had dropped his mainstreamed classes. He never re-entered mainstream classes (p. 68).
By 11th grade [Adam] was not able or willing to attend high school with his peers and there was nothing in his IEP that reflected consultation with a mental health professional, behaviorist, or any other individual experienced in educating youth with significant developmental or mental health needs. Notably, [Adam’s] IEP consistently stated that his transition skills, including his “daily living skills” were “age appropriate,” while simultaneously noting his significant mental health disabilities (p. 69).
2008-2009: Adam took courses at Norwalk Community College and
Western Connecticut State University, many for high school credit.
2011: Adam began researching mass shootings online, where he found like-minded people who “would write about their mutual interest in various shooters and incidents (p. 99).”
The emails exchanged between [Adam] and members of this macabre online community offer a rather breathtaking reflection of a negative micro-society within our midst (p. 100).
At the time of his death, Adam was 6′ tall and weighed 112 pounds.
And his routine medical visit intake forms, completed primarily by his mother, never mentioned mental health issues. And yet anorexia can directly affect mental acuity.
Mental health and access to guns
[Adam] grew up in a home where it was common place to use guns for recreational activity. It cannot be overlooked that as his mental health deteriorated and his isolation from the world increased dramatically, his access to guns did not diminish. His parents, and certainly his mother, seemed unaware of any potential detrimental impact of providing unfettered access to firearms to their son (p. 78).
Individuals with Disabilities Act (IDEA)
Maybe you’ve heard of this law. I hadn’t.
States are required by federal law to offer evaluation and support services for children age birth to thirty-six months who have developmental delays or who have a medical condition that places them at risk for developmental delays (p. 16).
[…]
Federal law requires that local school systems have processes for identifying and providing special education and related services for children age 3 to 21 who have a disability that is interfering with the child’s education or ability to learn (p. 16).
According to the Department of Education, IDEA “governs how states and public agencies provide early intervention, special education and related services to more than 6.5 million eligible infants, toddlers, children and youth with disabilities.”
IDEA requires that schools provide special education services to eligible students. And IDEA requires that parents participate in the child’s school team to develop an Individualized Education Program (IEP).
It is important to note that youth with disabilities who receive special education services are eligible for academic and transition services through age 21 if the continued provision of services is necessary to assist with making educational progress and in achieving agreed-upon goals and objectives. In fact, a youth may complete all academic requirements for graduation but continue with transition services for a year or even more, working on independent living skills and other goals necessary for transition to post-secondary life. Here, [Adam] not only had a paucity of transition planning, he graduated early
from high school (p. 70).
In conclusion
The report is depressing. On Facebook, a friend called it “utterly devastating”.
The report authors detail a complex network of parental denial, medical community indifference and repeated failure to follow through.
The authors make it clear that they cannot explain why Adam took such an extreme action on Dec. 14, 2012. And there is no single moment in his troubled life that would point to such a horrific outcome.
But there was clearly something amiss in his judgment as early as age 10, and this defect was apparently ignored by all the adults in his life.
What do you think?
- Featured image adapted from NBC screen capture.
- Connecticut Office of the Child Advocate report (pdf)
Known for gnawing at complex questions like a terrier with a bone. Digital evangelist, writer, teacher. Transplanted Southerner; teach newbies to ride motorcycles. @kegill (Twitter and Mastodon.social); wiredpen.com