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Chi20673 847.852
Schuyler W. Henderson, M.D., Michael S. Jellinek, M.D.
Prelude to a School Shooting? Assessing Threatening
On March 21, 2005, Jeffrey Weise, a 16-year-old student at Red Lake
16, 2007, the deadliest school shooting in U.S. history
High School, Minnesota, killed his grandfather and his grandfather_s
occurred at Virginia Tech when a student, Seung-Hui
girlfriend. Next, he drove his grandfather_s squad car to the high schooland fatally shot a security guard. Before mortally wounding five students
Cho, gunned down 32 students and teachers and
and a teacher and injuring seven others, Jeffrey smiled and waved. He
wounded another 25 before taking his own life.4
then committed suicide by shooting himself in the head.
As each school massacre unfolds, debate in the media
recurs as to where blame can be laid. BExperts[ and
Weise left many dark and depressive postings on Web sites such as
pundits will make claims about the purported roles of
Bnazi.org,[ calling himself BTodesengel[ (German for Bangel of death[)
all aspects of the school shooters_ life, from violent
and BNativenazi.[ He dressed in black and wrote stories about schoolshootings and zombies. Weise_s Internet animation, BTarget Practice,[
movies, video games, gun control, heavy metal music to
depicted his blueprint for murder and suicide.1 Weise was reportedly
parenting techniques and antidepressant medications.
taking Prozac and had been hospitalized for suicidal behavior.2 His
There is, however, little evidence to draw on to explain
father had committed suicide after a standoff with police and his motherwas in a nursing facility after sustaining head injuries in a car accident.3
this frightening phenomenon. This is also true aboutstudents who make threats. With few studies of these
Columbine. Red Lake. Virginia Tech. Merely invoking
students, the child and adolescent psychiatrist must
the names of these schools is enough to introduce the
extrapolate lessons from related studies of aggression in
topic to be discussed. Since the 1999 Columbine High
childhood and adolescence and a nonscientific literature
School shooting, child and adolescent psychiatrists have
based on reports in the press about school shooters.
been called on with ever-increasing frequency to
A major symposium, partly prompted by the
evaluate children and adolescents who have made
Columbine High School shooting, took place in 1999
threats toward other students or school staff. On April
when the National Center for the Analysis of ViolentCrime brought together 160 law enforcement person-nel, school personnel, and psychiatrists and other mental
Accepted March 19, 2008. Clinical Perspectives aims to provide a venue for exploring topics of
health professionals. Eighteen cases of school shootings
importance to child and adolescent psychiatry, fostering discussion about these
or foiled shooting attempts from the 1990s were
issues, educating child and adolescent psychiatrists and the broader medical
studied.5 The FBI had exclusive access to the case
community, and bridging clinical practice and research. Where applicable,
files, and a number of the law enforcement and school
appropriate permissions for publication were obtained from the patient(s).
Dr. Weisbrot is with Stony Brook University Medical Center.
personnel at the symposium were present during the
The author expresses grateful appreciation to Alan Ettinger, M.D., Gabrielle A.
actual shooting incidents and had known the school
Carlson, M.D., and Kathy Grzymala for their support of this work. The author
shooters personally.6 A key finding of the symposium
also thanks the Clinical Perspective Section editors Drs. Michael S. Jellinek andSchuyler W. Henderson for their invaluable suggestions in the preparation of this
was that school shooters indicated their plans before the
shootings occurred through direct threats or by
The case vignettes described in this article are composites created by the author
implication in drawings, diaries, or school essays.
and do not refer to any specific patient or family.
Correspondence to Dr. Deborah Weisbrot, Putnam Hall, South Campus,
A similar study was performed by the Secret Service
Stony Brook University Medical Center, Stony Brook, NY 11794-8790; e-mail:
and the Department of Education, aiming to identify
information available before a school attack that could
0890-8567/08/4708-0847Ó2008 by the American Academy of Child and
be used to formulate policies and strategies to prevent
school attacks.7 The study examined 37 incidents of
J. AM . ACAD . CHILD ADOLESC. PSYCH IAT RY, 47:8, AUGUST 2008
Copyright @ 2008 American Academy of Child and Adolescent Psychiatry. Unauthorized reproduction of this article is prohibited.
school violence involving 41 students who attacked
Threat assessment requires a thorough psychiatric
someone at his or her school with lethal means (e.g.,
diagnostic evaluation, including fundamental assess-
gun, knife) and where the student attacker purposefully
ments of suicidality, homicidality, thought processes,
chose his or her school as the location of the attack. The
reality testing, mood, and behavior. As always, a detailed
findings were similar. In more than three fourths of
developmental and educational history should be
incidents, at least one person had information indicating
obtained with a specific focus on abuse, past trauma,
that the attacker was thinking about or planning the
school suspensions/expulsions, school performance, and
school attack; in nearly two thirds of incidents, more
peer relationships. One needs access to descriptions of
than one person had information about the attack before
the actual events leading to referral. In an office-based
it occurred. However, the information known by other
setting, the clinician should request collateral informa-
students or friends was rarely communicated to adults.
tion in the form of past school records and previous
Furthermore, most attackers did not threaten their
psychological and psychiatric assessments. A detailed
written or verbal description of the incident from school
The assessment of a student associated with poten-
administration is needed; description by the child or
tially threatening behaviors presents diverse challenges
parents is generally insufficient, although in an
to teachers, school administrators, and mental health
emergency department evaluation, it may be the only
professionals. They may ask, BWill this student be the
information available. In this case, the clinician should
next school shooter?[ and BIf I miss something, will I be
chart efforts to obtain this information and to ensure
responsible for the next school shooting?[ These fears
adequate follow-up if the child is to be discharged from
often lead to the knee-jerk reaction of removing any
the emergency department. Obtaining this information
student with suspected threatening behavior. Although
may also be difficult when a student has been suspended
the actual school shooters were likely to have made
for a long time or when legal implications promote
threats, the number of completed school shootings is
reluctance by school administration or parents to share
extremely small compared to the number of threats
occurring in school but never acted on. The exact
Specific issues include whether a threat has indeed
number of actual threats occurring each year is
been made, its severity level and the child_s ongoing
unknown. In 2003, an estimated 9.3% of all U.S.
intent, the focus of the threat, the intensity of threat
students in grades 9 through 12 had been threatened or
preoccupation, access to weapons, and degree of concern
injured with a weapon in school,8 suggesting school-
expressed in the child_s environment. A Bthreat[ can be
related threats of violence are not a rare occurrence.
defined as an expression of intent to do harm or act out
Remarkably, there is limited psychiatric literature on
the assessment of child or adolescent threatening
Threats can be categorized according to level of
behaviors, and few of us received training in threat
realism.5 In low-level threats, there are no strong
assessment during our child and adolescent psychiatry
indications that preparatory steps were taken and
fellowships. This Clinical Perspectives section is based
realism is lacking. There may be vague allusions to
on my experience in evaluating 114 students during the
violent books or movies. Medium-level threats are those
course of 9 years running an outpatient child and
that could be carried out; they may not appear realistic,
adolescent psychiatry clinic receiving referrals from
but they are more direct and concrete and may give
more than 25 school districts in eastern Long Island,
general indications of place and time. High-level threats
represent an imminent and serious danger; they containdirect, specific, and plausible plans.
Direct threats have clear content indicating intent
(e.g., BI know where to get a gun and I_m going to shoot
A 15-year-old girl_s crumpled paper with a Bhit list[ to kill five students
you and your buddies[). Indirect threats are vague,
unclear, and ambiguous (e.g., BYou_re going to be sorryyou ever said that,[ BI could kill you if I wanted to[).
A 12-year-old boy announced, BI have a gun in my locker,[ and laterannounced he was going to shoot. After returning from 1 week of
Veiled threats are more suggestive of intent (e.g., BThis
suspension, he declared, BA bomb, here and now![
school would be a lot better off if you weren_t here)[,
J. AM. AC AD. C HIL D AD OLESC. PSYCHIATRY, 47:8 , AUG UST 2008
Copyright @ 2008 American Academy of Child and Adolescent Psychiatry. Unauthorized reproduction of this article is prohibited.
whereas conditional threats include a demand (e.g.,
behaviors and/or paranoid ideation, an intensified
BYou_d better not fail me. If you do, I_m going to bomb
perception of dangerousness may occur.
the school[).5 Sometimes threatening statements blur
Another red flag is a history of trauma or violence,
these categories and cannot be easily classified.
either as victim or perpetrator. The clinician needs to
With respect to access to weapons, numerous
devote time in the interview(s) to explore and formulate
epidemiological studies document a direct relation
the meaning of the student_s threat behavior in the
between accessible firearms and young people_s risk of
context of his or her history. For example, a child_s
homicide and suicide.9 All children and their parents
experience of witnessing parental conflict and aggression
need to be asked about a child_s potential access to
may engender aggressive and antisocial behaviors.12 The
weapons, both inside and outside the home. I routinely
child_s earlier responses to fears of threat in his or her
provide parents with the American Academy on Child
environment may play a significant role in the later
and Adolescent Psychiatry_s gun safety handout10 when
development of threat behavior as traumatic memories
the evaluation is completed. When the evaluation is
are evoked. Complex identifications with a parent and/
initiated through a school and involves only an
or subtle ways where a parent covertly encourages
evaluation session(s), the psychiatrist should initiate
threatening behaviors are likely to take more than one
direct contact with a school mental health professional
to ensure that appropriate follow-up on psychiatricconcerns is pursued. Child protective services may also
need to be contacted if the child_s psychiatric care isbeing neglected. If an imminent danger to others is
A 14-year-old boy was drawing violent pictures in school. At age 10, he
thought to be present, then the issue of duty to warn
sprinkled lighter fluid on another child and threatened to light a match.
becomes the responsibility of the psychiatrist, and
Preoccupied with his drawings and stories about aliens and superior
confidentiality will need to be breached to inform the
violent characters; he considered himself one of the world_s greatestcartoonists.
target(s) of the threats, as well as the police.
A student_s preoccupation with violent themes can
emerge in diverse contexts. Leakage is a term originallyused in an FBI monograph to describe potential Bclues
The basis for a study of actual aggression must be a study of the roots of
signaling a potentially violent act including, feelings,
thoughts, fantasies, attitudes and intentions.[5 Exam-
Any assessment of threats must to look beyond overt
ples include direct threats, boasts, doodles, Internet sites
symptomatology to probe the multiple levels of mean-
(e.g., MySpace, YouTube), songs, tattoos, stories, and
ings of behaviors and how aggression is integrated into
yearbook comments with themes like death, dismem-
one_s personality. In the following five sections, the
berment, blood, or end-of-the-world philosophies. No
focus is on thought processes, preoccupations, fantasies,
conclusion can be drawn from these clues in isolation;
and conflicts, all of which are needed in a threat
violent drawings/themes can be developmentally appro-
priate and are common in adolescence. Understandingthe context is critical. During an interview, students
typically minimize such preoccupations with comments
What makes some student_s threats more disturbing
such as BThey_re just drawings, I would never hurt
than others? Ultimately perhaps, the concern is clinched
anyone[ or BIt was a stupid thing to say. I didn_t mean
by the intuition of the astute clinician who senses signs
of the student_s dark, inner rage, particularly in the
The psychiatric evaluation must delve into the nature of
context of social isolation from family and peers as well
these materials to clarify the nature and degree of violent
as the student_s emotional disconnection during the
preoccupation. In a student who is obsessed with violence,
interview. Furthermore, intense immersion into fantasy
the theme is likely to emerge no matter what the nature of
combined with less-than-secure reality testing should
the discussion. Clearly, many adolescents are fascinated
also arouse concerns. When an adolescent_s odd beliefs
with violent and/or macabre themes; this can be a
or magical thinking are combined with suspicious
developmentally appropriate and common experience. I
J. AM . ACAD . CHILD ADOLESC. PSYCH IAT RY, 47:8, AUGUST 2008
Copyright @ 2008 American Academy of Child and Adolescent Psychiatry. Unauthorized reproduction of this article is prohibited.
have found it helpful to include several projective measures
(about 50% in my series of 114 students evaluated for
as part of the psychiatric evaluation to potentially obtain
threats). They are often socially isolated loners who
these clues, including a sentence completion measure and
conceal retaliatory thoughts. Such students have been
asking the student to draw a picture of him- or herself.
described as Binjustice collectors[ who nurse resentment
Sometimes, the traditional question of asking the child or
about real or perceived injustices. No matter how much
adolescent to provide his or her life story can also
time has passed, the Binjustice collector[ will not forget
illuminate underlying violent preoccupations.
or forgive those wrongs or the people he or she believesare responsible.5 In the Safe Schools Initiative Study, 29
of the attackers (71%) were reported to have feltpersecuted, bullied, threatened, attacked, or injured by
An 11-year-old boy made multiple threats toward other children. He
others before their attack.7 Although it has often been
had severe attention-deficit/hyperactivity disorder. His parents were avidhunters who did not believe in standard safety precautions for guns. The
assumed that threats result from intense teasing and
boy stated he knew that guns were kept in the parents_ bedroom closet.
bullying, it is nevertheless unclear whether students who
When this concern was raised, the father angrily exclaimed, BOur child
threaten school violence are teased and bullied more
than their peers. What is important to explore during a
Denial refers here to the parent_s acceptance of the
threat assessment is the student_s reaction to such
child_s threatening behaviors and a limited reaction to
behaviors that most others would find disturbing or
Another hypothesis centers on the presence of covert
abnormal.5 Parents who are in denial respond defen-
power dynamics in schools with a high level of violent
sively to real or perceived criticism of their child; the
episodes. For example, in these situations, there may be
parents appear unconcerned, minimize the problem, or
Bconspiracies of silence[ in which students remain
silent while their peers are being harassed.13,14
Parents may present as angry and defensive when
Psychiatric assessments should query a student_s
psychiatric evaluations are school mandated. Often the
experiences of bullying and teasing, including their
child has been suspended for indeterminate duration,
reactions and responses and the student_s experiences
with education disrupted; the child and parents attend
of how his or her peers are responding to this bullying.
intimidating disciplinary hearings with school district
Once the clinician discovers a history of teasing or
officials. Some parents may not accept the notion of
bullying, intensive inquiries should be made about
their child threatening others and consider their child to
retaliatory fantasies and whether these become diffuse,
be a victim. I have found the most disturbed children
with a desire to retaliate against not just perceived
often had parents who demonstrated pathological levels
perpetrators but also those who are perceived as
of denial, a statement of the potential contribution of
colluding in the bullying. Revenge fantasies may be
parental psychopathology. Such attitudes may be
associated with Bsoft[ psychotic symptoms, including
associated with a chaotic home environment, highly
vague paranoid ideation, ideas of reference, or vague
conflicted parentYchild relationships, and inadequate
limit setting.5 These problematic parental responses
There is no evidence that proves that interest in
leave the impression that if the child revealed threats at
violent video or Internet games, BGoth[ culture, music
home, then the parents would minimize such behaviors,
with dark or morbid themes, and so forth directly leads
potentially heightening the threat risk.
to threatening behaviors. Nevertheless, immersion intovarious cultures of violence, including involvement with
a troubled peer group or identification with violentgroups, could promote antisocial and threatening
A 12-year-old boy with severe anxiety and social skills deficits was
behaviors; the psychiatrist should delve into these
severely teased throughout elementary school. One boy kicked his
potential issues during the interview. In some cases,
backpack, and another teased him as having a nerdy backpack. Later in
Bcontagion[ and Bcopycat[ dynamics can also occur, as
the day, H. said, BI_m going to get a gun and kill those kids.[
in a recent episode involving two students planning to
Children and adolescents who threaten others
attack a school and creating a journal that frequently
frequently have histories of being intensely teased
J. AM. AC AD. C HIL D AD OLESC. PSYCHIATRY, 47:8 , AUG UST 2008
Copyright @ 2008 American Academy of Child and Adolescent Psychiatry. Unauthorized reproduction of this article is prohibited.
prolonged suspension or expulsions, it may be difficult
As was the case for Jeffrey Weise, a number of the
for the student catch up on course work. College
school shooters committed suicide or attempted to do
applications may be ruined by notations on a student_s
so. In students referred for threats, depressive symptoms
and suicidal ideation may also be present, and a careful
School suspensions lasting many months may end up
assessment of mood is essential. The close ties between
serving no purpose beyond displaying administrative
externalized aggression and aggression against the self
enforcement of Bzero tolerance[ school policies and may
were originally highlighted in an earlier psychoanalytic
in fact be problematic. Such policies may discourage
literature emphasizing disturbances of ego function in
classmates from coming forward to make such dis-
aggressive children. From this perspective, intense
closures.5 For some students with academic and social
emotions of self-hate become organized into highly
difficulties, suspension and home tutoring may lead to
resistant defenses against the world around them (i.e.,
improved scholastic functioning and reduced stress
projection).16 These concepts were used to explain the
levels. The mental health clinician may have a role in
dynamics involved in anti-Semitism and genocide and
facilitating return to school or appropriate treatment
may also be valuable in understanding the mental
and education during the course of a suspension, with
functioning of children who develop intense fantasies of
an eye on helping the child, family, and school return to
hatred against fellow students or teachers. The complex
a safe and developmentally appropriate relationship.
relation between homicide and suicide is beyond thescope of this article and is mostly concentrated in the
forensic psychiatry literature. Notably, of the 37 attacks
The child and adolescent psychiatrist plays a crucial
analyzed in the Safe Schools initiative, Bmost attackers[
role in evaluating threats made in school settings,
were reported to have some history of either suicidal
including estimating the severity of danger level, as well
attempts, thoughts, or a history of feeling extreme
as clarification of unrecognized or inadequately treated
depression or desperation. In contrast, only 17% (n = 7)
psychiatric disorders. The school consultant must be
had been diagnosed with Ba mental health or behavior
prepared to interpret complex individual, family and
group dynamics potentially leading to the expression ofthreats, such as retaliation for bullying and teasing. Such
situations are compounded by potential access toweapons in the home. Effective educational and
A 17-year-old honor student with no history of behavior problems has
treatment recommendations for children and adoles-
drawn doodles of a girl hanging from a rope. He revealed being upset
cents who make threats depend on an in-depth
about a girl gossiping about him. On psychiatric evaluation, he was not
appreciation of their diverse psychiatric problems.
found to be a danger to others nor was a psychiatric diagnosis present. Nonetheless, he was suspended for months, his college applications weredelayed, and he was ostracized by peers.
Disclosure: The author has received grant support from Cyberonics, Inc.,and Pfizer, Inc.
A 12-year-old girl left a message on her school_s voice mail threatening toblow up the school. The call was traced; she was suspended. The risk ofattack was assessed to be low. She subsequently became preoccupied byBthe terrible thing[ she did, calling herself a Bterrorist[ and resisted
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BOARD OF FIRE COMMISSIONERS DRAFT REGULAR MEETING MINUTES TUESDAY, FEBRUARY 7, 2012 5:30 P.M. – GUILFORD FIRE HEADQUARTERS Present: Jim Galvin, Gary Gilbert, Barbara Hemming, Chief Charles Herrschaft, Assistant Chief Wayne Vetre, Deputy Chief Ken Maginniss, Captain Mr. Gilbert called the meeting to order at 5:30 p.m. 1. Public Forum Approve minutes of: Appr
"' A vedova allera" all'Opera di Roma. Franz Lehar riveduto in versione napoletana da Vincenzo Salemme Programmare un' operetta nel periodo delle festività natalizie in un grande teatro d'opera non costituisce un'anomalia né di per sé dovrebbe originare alcuna polemica; molte capitali europee inseriscono in programmazioni di altissimo profilo, titoli del "genere minore