Students who threaten violence often have psychiatric or learning disorders

While previous studies have focused upon identifying potential school shooters, little is known about the mental health and associated characteristics of students who make threats in schools. A study by a team of Stony Brook child psychiatry experts uncovers the wide range of psychiatric diagnoses, learning disorders, educational and treatment needs of this population. The findings are published early online in a paper in the Journal of the American Academy of Child & Adolescent Psychiatry.

The research team investigated child and adolescent psychiatry threat assessment evaluations of 157 school-age youth (mean age: 13.4), referred to the Stony Brook University Child and Adolescent Outpatient Clinic (now called the Child and Adolescent Psychiatry Outpatient Clinic at Stony Brook Medicine) by school staff. The children were evaluated at the clinic between 1998 and 2019 and represented 19 school districts encompassing students from diverse socioeconomic backgrounds.

"Our work is based on two decades of school threat assessment evaluations performed by myself and colleagues," says Deborah Weisbrot, MD, lead author and a Clinical Professor in the Department of Psychiatry at the Renaissance School of Medicine at Stony Brook University.

"Evaluations of youths who make threats need to go beyond simply assessing the threat itself and should include identifying underlying psychiatric problems," she explains. "And psychiatric evaluations of students who issue threats of any type can lead to revelations about psychiatric diagnoses and crucial treatment and educational recommendations."

Dr. Weisbrot and colleagues 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.

Of the children in the threat assessment study, details from their records, school history, and actions showed marked similarities and trends:

• Most youths had one or more psychiatric diagnosis such as attention-deficit/hyperactivity, depressive, anxiety, and autism spectrum disorders. Learning disorders were common.
• A history of psychiatric medication treatment was reported in 50%, and psychotherapeutic interventions in 37%.
• Traumatic family events had occurred in 52%.
• Nearly 90% reported significant traumatic life experiences.
• 43% had a history of being bullied.
• Verbal threats were made by 80% of the children.
• 29% had brought a weapon to school.
• Nearly 52% were receiving special education services.

This is the first study to provide a comprehensive description of the psychiatric characteristics of students referred to a child and adolescent outpatient setting for a threat assessment, thus highlighting the importance of understanding the psychiatric characteristics of all students who make threats rather than focusing only on identifying potential school shooters.

They emphasize that the study is of critical importance in that it "demonstrates that psychiatric threat assessment is much more than a risk assessment; it is also an intervention providing essential psychiatric and educational treatment recommendations that could change the course of students' educational careers and emotional well-being."