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Abstract
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OBJECTIVE: While studies have focused on identifying potential school shooters, little is known about the mental health and other characteristics of the overall group of students who make threats. This study describes these students and factors prompting psychiatric interventions and treatment recommendations.
METHOD: Child and adolescent psychiatry threat assessment evaluations of 157 consecutive school-referred youths in grades K-12, seen over a 22-year period between 1998 and 2019 were reviewed for demographics, reasons for referral, nature of the threat, psychiatric diagnosis, and psychiatric and educational recommendations. Predictors of recommendations for psychiatric interventions were modeled using multivariable logistic regression as a function of above-mentioned covariates.
RESULTS: Mean age of referred students was 13.37 years (sd 2.79), 88.5% male; 79.7% White, 11.6% Hispanic,10.1% Black, 2.5% Asian. 51.6% were receiving special education services. 80% made a verbal threat and 29.3% brought a weapon to school. A history of being bullied was present in 43.4%, traumatic family events in 52.2%, physical abuse in 5.1%, sexual abuse in 5.7%, verbal abuse in 36.3%. Frequently encountered psychiatric diagnoses were ADHD, learning, depressive, anxiety, and autism spectrum disorders, usually in combinations. A history of medication treatment was reported in 79 (50.3%) and psychotherapeutic interventions in 57 (36.3%). Recommendations to return the student to their prior school were made for 63.1%. Recommendations for psychotherapy were made for 79.9%, medication in 88.5% and for both in 70.1%. Therapeutic school settings or psychiatric hospitalization were more likely recommended (with statistical significance) with a prior threat history (OR 5.47 95%CI=1.91-15.70), paranoid symptoms (OR 5.72 95% CI=1.55 to 21.14, p=0.009), autism spectrum disorders (OR=3.45 95%C1.32-9.00), mood disorder (OR=5.71 95% CI=1.36-23.96), personality disorder (OR=9.47 95% CI1.78-50.55), or when psychotherapy was recommended (OR=4.84 95% CI=1.08-21.75).
CONCLUSION: Students who make threats have diverse psychiatric profiles and warrant treatments. A trauma and/or abuse history is common. Evaluations of youths who make threats, need to go beyond simply assessing the threat itself and should include identifying underlying psychiatric problems. Psychiatric evaluation of students who issue threats of any type can lead to revelations about psychiatric diagnoses, and crucial treatment and educational recommendations. DIVERSITY & INCLUSION STATEMENT: The author list of this paper includes contributors from the location and/or community where the research was conducted who participated in the data collection, design, analysis, and/or interpretation of the work.
Language: en |