Wednesday, January 4, 2023

Youth Who Threaten Violence at School May Have Psychiatric, Learning Problems

Youth who make threats of violence against others at school often have a range of psychiatric and learning disorders, according to a report in the Journal of the American Academy of Child & Adolescent Psychiatry. Also, many of these youth report having been bullied, and more than half have a history of traumatic family events.

“Evaluations of youths who make threats need to go beyond simply assessing the threat itself and should include identifying underlying psychiatric problems,” wrote Deborah M. Weisbrot, M.D., of Stony Brook University Medical Center and colleagues. “Psychiatric evaluation of students who issue threats of any type can lead to revelations about psychiatric diagnoses and crucial treatment and educational recommendations.”

Weisbrot and colleagues reviewed the records of children and adolescents referred by school staff for threat assessment evaluations between 1998 and 2019 to the Stony Brook University Child and Adolescent Outpatient Clinic. The clinic serves over 19 school districts with youth from diverse socioeconomic backgrounds across eastern Long Island.

The researchers defined a “threat” as an expression of intent to do harm or act out violently against someone or something. Threats were categorized as being either verbal or nonverbal (such as violent drawings), as well as those that involved bringing a weapon to school.

The study sample included 157 youth aged 5 to 18 years (average age, 13 years); 51.6% were receiving special education services. Eighty percent of students had made a verbal threat, and 29.3% had brought a weapon to school. About 50% had a history of medication treatment, and 36.3%, psychotherapeutic intervention.

Each student received a psychiatric evaluation with a systematic, semistructured interview, which also included discussions with the student, school faculty, and the student’s guardian. Here are some of the findings:

  • 89.8% reported a history of trauma, such as bullying, teasing, physical or sexual abuse, a traumatic family event (such as the death of a loved one), and/or severe parental discord and/or divorce.
  • 26.8% reported severe teasing or bullying during the academic year when the threat was made.
  • 66.9% were diagnosed with ADHD (the most common of the diagnoses among the youth). Other diagnoses included learning disorders in 28.7%, depressive disorders in 26.8%, oppositional defiant disorder in 24.2%, and anxiety disorders 22.9%. The most common comorbidities in the youth were ADHD plus learning disorder, oppositional defiant disorder, depression, or anxiety.
  • 88.5% received recommendations for psychiatric medication, including stimulants (63.1%), antidepressants (26.1%), and antipsychotics/mood stabilizers (23.3%). 70.1% received recommendations for psychotherapy and medication.
  • Students with a prior threat history or with paranoid symptoms were more than five times as likely to be recommended for a therapeutic school settings or psychiatric hospitalization.

“School-based threat assessment teams are essential to the evaluation of student threats. Close collaboration between the psychiatric clinician and the school-based threat assessment team and school administrators enhances effective threat assessment,” the authors wrote. “We found that even among those who made relatively minor threats, … there were often major underlying psychiatric disorders. Formal psychiatric evaluations of all students who issued threats were invaluable in discovering crucial treatable psychiatric conditions.”

For related information, see the Psychiatric News article “Threat Assessment Can Help Prevent School Violence, but Reliance on a ‘Profile’ Doesn’t Work.”

(Image: iStock/Dusan Stankovic)

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