Psychological Implications of the Connecticut School Shooting

A lone gunman killed 20 children and 6 adults including himself at a Connecticut) School He used guns registered to his mother. The emergence of ASD and PTSD Acute Stress Disorder and/ Post Traumatic Stress Disorder) were identified as happening after a major incident such as this one. The symptoms that can be present in this situation were reviewed as well as some possible long term effects. The grieving process was also discussed. In the aftermath of such situations, attention is often focused on people with mental illness who might have the potential do do violence and/or commit a copycat crime even though in retrospect this is very small proportion of the population.The gun control issue and related psychological factors were also discussed.

I am writing this blog one day after the horrific massacre at a school in Newtown, Connecticut. Thus far it is known that a 24 year old man shot and killed his mother and then took three weapons including automatic assault rifle, dressed in combat gear and  appeared at the school where his mother taught. He was recognized as the son of a teacher and was buzzed in. He then killed 4 adults including the principle who had recently  instigated stricter security measures at the school and 20 students between the ages of 6 and 10 as well as himself. There was one report that he had some kind of argument at the school the day before the shooting. There are also descriptions that he was a troubled kid in school who had no friends and was very shy. He was said to be very bright in math. It was suggested that  he may have had Asperger’s Syndrome and was on the Autism Spectrum. Another report said that he spoke of demons and therefore suggesting he may have been paranoid with schizophrenia. His parents were divorced after 17 years of marriage and his mother was reported as very protective. He has a brother at college.

I have no idea of his diagnosis and would not make any attempt to speculate on on the nature of his mental condition.

Psychological Trauma 

Common wisdom and research in this area tell us  that the closer a person is to the traumatic event,  the more likely and the more severe the psychological trauma will be. This however is a complicated issue. Certainly the adults and children who witnessed the shooting (including of course anyone wounded ) would be directly effected.  This would include anyone in the school  who heard sounds and participated in the terror of hiding and escaping from danger.

The two conditions that will emerge from such an incident  are  Acute Stress Disorder (ASD) and Post Traumatic Stress Disorder(PTSD) . According to the Diagnostic Manual of the American Psychiatric Association (DSM IV), the necessary requirement for both of these conditions must include the following :

The person has been exposed to a traumatic event in which both of the following were present.

1-The person experienced, witnessed, or was confronted with an event or events that involved actual or threatened death or serious injury or a threat to the physical integrity of self or others.

2- The person’s response involved intense fear, helplessness, or horror (in children, this may be expressed instead by disorganized or agitated behavior.)

In addition for us to make a diagnosis of ASD there needs to be three or more  symptoms such as  numbing, detachment, absence of emotional responsiveness or reduction in awareness of his or her surroundings (being in a daze) or derealization ( things don’t seem real) or depersonalization ( you don’t feel like yourself) , a tendency to re-experience the event by flashbacks, an avoidance phenomena related to recollection of the traumatic event, impairment of social and other areas of functioning, increased  anxiety and arousal with sleep and concentration problems and a duration of these symptoms  2 to 4 weeks.

In order for us to make diagnosis of PTSD  there needs to be similar symptoms as ASD with one or more symptoms of recurrent and intrusive recollections (manifested in young children by repetitive play), recurrent dreams, re-experiencing the traumatic event with illusions , hallucinations and flashbacks , physiological reactions, , persistent avoidance of stimuli associated with the trauma, numbing , efforts to avoid thoughts and feelings related to trauma, decreased interest or estrangement, inability to have loving feelings, insomnia, outbursts of anger , exaggerated startle response  impairment in social functions, with a t least one of these symptoms lasting more than one month.

For more detailed and exact definitions see the DSM IV (or the new DSM V which may be somewhat revised )

Trauma Not Limited to Immediate Geographic  Area

The development of these symptoms is not limited to people in the immediate vicinity.

Classmates who didn’t attend school that day can have symptoms as can people all over the world who are traumatized by accounts in the media which vividly reconstruct the events and allow others to identify with the victims. There will be very few school age children in the U.S. who will not have heard about the details of this event

I recall at the time of the Challenger disaster, we saw school children all over the country effected by seeing this spacecraft carrying the astronauts and some teachers disintegrate before their eyes on television . Similar situations have happened in other tragedies, which are covered, on TV.

Long Term Effects

It should be recognized that the acute and  long term psychological  effects of this trauma  goes beyond the two disorders described above The experience also  becomes woven in the psychological makeup of people who are impacted by it whether near or far where it happened . For some, the innocence of childhood is taken away . The sense of security is changed forever. Long after the acute symptoms are gone, the effects of this event will have changed the individuals who experienced it. In some cases it will be a determining factor in how they will mold their future lives. Perhaps they will always be a cautious person, looking for unexpected danger. In other ways, the trauma can motivate persons to become doctors, nurses, police, researchers or influence the way they view their own lives for better or worse.

The Need for Immediate Psychological Intervention;

There has immediately been an outpouring of offers of psychological help.

I am sure the school system ,local and state agencies  will bring in counselors and therapists. Local mental health professionals  will ofter their help. I know the Committee on Disasters of the American Psychiatric Association ( of which I have been a member ) has offered the local Psychiatric Society materials and information that can be useful . There has been offers from International Groups that have experience  with these situations as well as from the Red Cross and from the nearby Yale Child Study Group. There will be individual and group meeting with the teachers and counselors as well with parents and of course with the children. The teachers will be trained how to be sensitive to the reactions of the children. It is important that all involved be aware of the various symptoms that can develop after events like this (some of which were described above) Danger signals need to be picked up. I am sure a wide variety of techniques will be used for one to one therapy  as well as in groups. Talking in groups can be useful for many but for others individual sessions can be very helpful  or a combination can  be used. For some of the children, the comfort of discussions and interactions with their parents will be  most important. Some parents will know how to handle this, other parents will benefit by discussion or counseling. I don’t believe there is one method which needs to be applied. The techniques used in individual and group treatment can cover a wide range from catharsis which involves expressing  one’s experience and feelings, Cognitive Behaviors Therapy ( CBT) which uses correcting misconceptions  and directly dealing with ideas and behavior and  psychodynamic therapy  where underlying meaning is explored and interpreted. In some acute situations medication (anti-anxiety or other stronger tranquilizers  can be used and when conditions  such as major depression is identified, antidepressants may be prescribed.  Other techniques and combinations of approaches will be used especially the human support and caring offered by people near and far and by such groups as the Red Cross which will be quite useful and meaningful.

Grieving the Loss of Life.

As most of us know grieving is a very intense process. Kubler-Ross described five stages of grief ; denial,, bargaining , anger , depression and acceptance. However, when there is unexpected death, traumatic death especially by murder and death of children, the grief takes on a different pattern which has been labeled Complicated Grief. We can expect the anger and depression to be greatly intensified and the duration of the intense emotions to be much more prolonged especially when there is the loss of a young child. Ultimately various types of memorials to the lost child which can give significances to the lost out life can be helpful

Concern About Other Disturbed Individuals Including Copycat Incidents

It is only natural that there will be concern on all levels that disturbed individuals who might do anything like this incident should be identified , receive help and be safely  in a place where they can not harm anyone. This problem is accentuated at the time of such an incident and in the immediate aftermath since we know that sometimes in the mind of a severely mentally disturbed person, media reports of this event have  the possibility of precipitating a copycat pattern of behavior in another disturbed person. The presence of mental illness is usually identified by family , friends and teachers at an relative early point in life. While there has been great progress in providing mental health care in the United States since the 1960s , there are still people who do not get the care that they need because of finances and the unavailability of services. Quality health care should be available to everyone and this includes those with mental illness.

The Overwhelming Majority of People with Mental Illness are Not Dangerous

Only a very small percentage of people with mental illness are a serious danger to other people. An incident such as this school shooting invariably unfairly intensifies the stigma towards people with mental illness. This can hinder recovery and adaptation to this condition. We need continued research in identifying people who could be dangerous and we also need to understand and educate the public about mental illness.

The Gun Control Issue and The Psychological Implications.

We don’t yet know the history and the story why the Connecticut shooter’s mother   had registered guns in the house. I would guess that most probably if there were not these guns in the house ( which included automatic weapons ) that untold psychological trauma would not have occurred. The young man may have done something terrible but if guns were not available to him, the   chances are,  not as many people would have been killed.

I also wonder about the psychological effect of his growing up in a household where such guns were owned , kept and valued. I understand the argument that most gun owners may teach their children about gun safety. However when there are guns present, there may very well be the underlying message to a disturbed child, that when you are angry this is the way that you can act.

 

Recent Research About Autism

The following are three recent research developments concerning the Autism Spectrum Disorders

Dr. Ricardo Dolmetsch

Stem Cell Possiblities in Autism Research

Dr. Thomas R. Insel

Dr. Ricardo Dolmetsch from Stanford University  and his colleagues have generated stem cells from children with autism allowing them to study how the brain develops in children with Autism Spectrum Disorder (ASD). The motivations for this research occurred when a child with autism spectrum was born to Dr. Dolmetsch and his wife . In a video  interview with With Dr. Thomas Insel, director of the National Institute of Mental Health, he described how this event led to change in the direction of the  research that he had previously been doing.

Stem cells can be made from skin cells or blood cells. The stem cell has the capacity to make any cell in the body including brain cells. Dr. Dometsch explained how he has been able to take skin cells from his own child with autistm and make little pieces of brain which can be analyzed as to their development and function. One of preliminary findings is that some autistic children are making too many cells that produce dopamine, a chemical that transmits signals to various cells in the brain and nervous system. This provides a potential target for future therapeutic research. To see a video clip of this interview please go to:   http://www.nimh.nih.gov/media/video/dolmetsch.shtml

Increased Incidence of Autism Spectrum in Children

In an earlier interview, Dr. Insel interviewed Dr. Peter Bearman, Professor of Sociology at Columbia University, on his research into the prevalence of autism. It is s quite remarkable that in the past several years the prevalence has increased from 1 in 1500 births to 1 in 150 births.  If one just looks at Autism Spectrum, the prevalence may be 1 in 100 births. Some of these statistics may be due to the fact that there has been a change in the diagnostic critieria which would include more children to fit into this diagnosis. This may account for ¼ of this

Dr. Peter Bearman

increase. Another important discovery which may influence these statistics is the discovery that there are certain relatively small geographic areas called  “spatial clustering” where there is an apparent very high incidence of the diagnosis of ASD. This raises the possibility of some toxic agent in this area. There also is the consideration that such an increase incidence is due person to person education and awareness which allows for cases of ASD not to be missed and therefore a higher reported rate. One other factor which may account for the increased incidence in the diagnosis of autism and ASD is the fact that people are having children at a later age. It has been postulated that increased parental age leads to mutations which are associated with this condition. To see a video clip of this interview please go to : http://www.nimh.nih.gov/media/video/bearman.shtml

Repetitive Behaviors in Adults with Autism Spectrum Disorders Significantly Lessen With Antidepressant Treatment

In News release from the American Psychiatric Assoication dated 12/2/11 it was reported that a .12-week study showed that the antidepressant fluoxetine produced a greater decrease in repetitive behaviors and more overall improvement than placebo in adults with autism spectrum disorders. The study by Eric Hollander, M.D., of the Albert Einstein College of Medicine and Montefiore Medical Center and colleagues from Mt. Sinai School of Medicine represents the first large-scale, double-blind, placebo-controlled trial of fluoxetine in adults that targeted changes in the core domain

Dr. Eric Hollander

of repetitive behaviors as well as overall functioning. Overall improvement in autistic symptoms occurred in 35% of individuals receiving fluoxetine and none of those receiving placebo. Half of the individuals in the fluoxetine group experienced substantial improvement in their repetitive behaviors (versus 8% of those receiving placebo). Previous trials of treatments for these disorders have mostly tested interventions for children. An earlier high-profile trial of another antidepressant, citalopram, did not reduce repetitive behaviors in children with autism spectrum disorders.

Although treatments for common characteristics have been studied, Dr. Hollander notes, “Research on medications for the core features of autism spectrum disorders is still in the early stages, and successful treatments could greatly improve the daily lives of patients and their families. The full study will be published in a future edition of the American Journal of Psychiatry

Autism & Fragile X- New Treatment

Two new research projects concerning Autism Spectrum Disorder and Fragile X Syndrome are briefly reviewed. In the first, a random controlled study of children with Autism Spectrum showed that the Early Start Denver Model showed statistically improvement over a control grouop in regard to intellectual development and adaptive behavior. In the second study ,preliminary research showed that a new medication improved behavior associated with Fragile X Syndrome compared to the contorl group. There is also some belief that such mediciation would be effective with children with Autism Spectrum. In conclusion there is a a link to a 4 minute video where a 12 year old boy with Asperger’s Syndrome interviews his mother.


In the past few months two very interesting research studies have emerged  from the literature concerning the treatment of individuals  on the autism spectrum or with Fragile X Syndrome. One involves early intervention and the other involves a medication which can be used at any age. I also suggest that you look at the unrelated but heart warming short video concerning a conversation between a 12 year old boy with autism and his mother at the conclusion of the blog.

Early Intervention for Autism Spectrum

The first  study was by Dr. Geraldine Dawson at the University of North Carolina and Dr. Sally Rogers at UC Davis. The study was supported by an NIMH grant and published in  Pediatrics. It was a randomized controlled study of 48 children between 18 months and 30 months of age who had been diagnosed with autism spectrum disorder (ASD) or pervasive developmental disorder (PDD). These children were randomly assigned to either a treatment program known as the Early Start Denver Model (ESDM), which was developed by the authors of the study, or were put in a group which received the usual community care. After two years,  children who underwent ESDM intervention showed greater improvement in intellectual development and adaptive behavior compared with the children who received the usual care.

The children in the ESDM group underwent an average of 15 hours a week intensive interventions with a trained therapist for two years . The parents of children in the ESDM group also received  16 hours a week  of guided interactive activities taught by the ESDM staff. Children in the usual care group received an average of nine hours a week of individual therapy and nine hours of group interventions such as pre-school education.

After two years the two groups of children did not differ significantly in the Autism Diagnostic Observation Schedule severity score and repetitive-behavior scores. However, the children’s scores on the Mullens Scores of Early Learning increased by 17.6 points in the ESDM group and 7.0 points in the usual care group, which was statistically significant. In addition the ESDM group also showed significantly higher Vineland Adaptive Behavior Scale scores which measured social, communication, motor and daily living skills based on parent’s reports.

This research would appear to indicate that while the diagnosis of the children was not changed, their ability to learn as well as  social communication and motor skills could be improved with this early intervention program. This reaffirms the importance of early diagnosis and treatment with dedicated treatment programs.

Possible Drug Treatment for Fragile X Syndrome and Autism Spectrum

Information about the second piece of research comes from an article I read in the New York Times two weeks ago about an experimental drug which achieved substantial improvement in the behavior associated with retardation in adults with Fragile X Syndrome. Normally, I would not give much credence to an unpublished piece of research discussed in a newspaper article. However, I was impressed by a statement of Dr. Thomas R. Insel, Director of the NIMH when he learned of these results. He said, “Just three years ago I would have said that mental retardation is a disability needing rehab not a disorder needing medication. Any possible results from clinical trials ( of this drug)  will be amazingly helpful.”

The preliminary research trial of this new medication were began by the Novartis Pharmaceutical Company in Europe in 2008 and the data analysis was completed this year. The action of the drug is based on its effect on brain synapses and the ability of medication to change genetic instructions needed to produce proteins that encourage and regulate brain signaling. The research measured a range of aberrant behavior such as  hyperactive repetitive motions, social withdrawal and inappropriate speech in the patients that were studied. They gave one set of patients the drug and another a placebo and after a few weeks switched treatment with both doctors and patients unaware of which pill was give to each patient. It was reported that the drug showed clear improvement in behavior. The Times article quoted Dr. Geraldine Dawson, the lead researcher in the other study sited above concerning early intervention who is also chief science officer at Autism Speaks, the world’s largest autism advocacy organization. She said, “The exciting thing about these results is that it is our hope that these same medications have similar positive benefits for people with autism who don’t have fragile X syndrome.” Dr. Luca Santarelli head of neuroscience at Roche Pharmaceutical confirmed that Roche is in the midst of testing a similar medication at four sites in the U.S. and  appears encouraged with the results thus far. Experts such as Dr. Santarelli believe that such compounds may prove most effective in young children whose brains are far more likely to respond rapidly when barriers to learning are removed, in this case by medication.

The Human Side of Autism- Mother –Child Interview

StoryCorps is an oral history program where people share life stories. In 2006 a 12 year old boy who has Asperger’s Syndrome (which is part of the autism spectrum) interviewed his mother Sarah as part of the StoryCorps program. This interview was put on line with recently added animation. This is a one-of-a kind four minute conversation which covered everything from cockroaches to Sarah’s feeling about Joshua as a son. This heart warming conversation is well worth watching.

Your comments on the above research and this conversation are welcome below: