@Risk
Thursday, July 27, 2017

School Violence

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School Violence

“One child at a time” is the scope for today’s problem of school violence.  It is unacceptable, frightening, costly and misunderstood, yet it does happen.  It has evolved to be part of our culture.  Students are caught brining weapons into schools, bullying one another, and using violence to resolve frustration with teachers and the system.  In a nationwide survey, 6% of students reported “not going to school on one or more days in the 30 days preceding the survey because they felt unsafe, either at school or on their way to and from school” (CDC 2010).  It is an unfathomable reality.  In addition to injury, death, trauma and a lost sense of safety, there is something else that is stripped away.  Lives are taken without realization of potential.   The shooters shown on our screens are described to be troubled youth and seemingly average students who had become notorious for their final acts.   As the intense media focus continues to unravel facts of the latest shootings, current administration considers stricter gun control laws  and soon afterwards the buzzword  is “mental health.”  Now the nation has at least some idea for how to deal with the latest crisis, or so it would appear.

“I don’t get it” said one of the parents in my office one day on the topic of school violence.  “All of a sudden, strange things are happening at school, even with the kids we knew from kindergarten.”  Her daughter also happened to be one of the students getting bullied and my patient.  “These are good kids” continued the mother.  “I have to say that I believed that only irresponsible, self-absorbed parents had children who bullied others, but now I know that not to be true.  I know these parents, and it is frightening to think that their children could do something so horrifying.  What is the problem?”

The problem of course, is something that the country has been trying to figure out and manage for sometime.  The problem also comes under a heading of “mental health” to explain the aggressive, violent behaviors that take many forms.  Aggressive behaviors are also one of the largest studied treatment issues in mental health and are associated with a wide range of psychological disturbances.  There does appear to be a presence of psychopathology in violent youth, but what is the link between aggression and various disorders?

Many of the school shootings that took place between 1979 and 2014 attracted high-profile news coverage.  The shooters and some of the victims made statements that should have shed some light on the perpetrators’ motivations.  Yet few repots considered the idea that what some students wanted most was to form a group or a resistance to the perceived notion of popularity.  Popular students only make up a small minority of the school population.  Most students fall in the middle and others fervently struggle to avoid pariah status.  Whether perceived to be polite and subordinate, young men and women, at present, experience extreme social pressures to present as worthy, capable and achieving, creating an appearance for fitting a much desired socially acceptable norm.  This explains why some youth are more likely to commit acts of violence, especially when achieving that “norm” is a challenge due to diagnosed or undiagnosed mental health conditions.

Is it necessary that shooters have some sort of mental health issue? Or is there something more going on? It could be a combination of factors.  A need to belong and find a group is what feeds our society.  When one is unable to connect, vulnerabilities deepen.  Those same vulnerabilities can expose and aggravate an already present set of mental health problems that only act in development of resistance versus prioritizing community, compassion and cooperation.  In the absence of connection, we become accustomed to loneliness, exposing certain psychopathologies.

Oppositional Defiant Disorder (ODD) and Conduct Disorder (CD) have been linked to aggressive behaviors.  These are the disorders that will most likely draw attention from teachers and parents due to their troublesome nature.  These disorders are frequently viewed on a continuum of severity with ODD being the lighter of the two.  If left unchecked, ODD can progress into CD by infringing upon safety and rights of others, including property damage.  Typically children could present with ODD displaying tantrums, defiance and argumentativeness with authority figures.  These children can also shift their behaviors to that of lying fighting and using weapons, which would be under a diagnostic label of CD.  If not addressed early on, CD can develop into Antisocial Personality Disorder, which can only be met after being diagnosed with CD as a youth.  It should be stated emphatically, that not all children diagnosed with ODD and CD develop aggressive behaviors.  Additional factors such as family patterns, peer interactions, aggression in early school years and environment also can and do contribute to violent markers.

A diagnosis that has received a lot of media coverage is Attention-Deficit/Hyperactivity Disorder (ADHD) and also happens to be a comorbid factor of violence amongst youth diagnosed with ODD and CD.  Children with such a clinical presentation have more violent reactions due to instigation from peers and are more likely to be aggressive in their response.  Poor peer relationships are due to the disruptive nature of play, issues with focus and impulse control, along with subsequent rejection that may follow due to poor social skills.  In addition, children diagnosed with ADHD are difficult to parent and are often victims of parental abuse due to the impulsive nature of their behaviors.  Living in an abusive home can take a very large emotional toll, developing a predisposition to violence.

It is not uncommon for learning disabilities to be part of the clinical presentation of those diagnosed with ADHD, ODD or CD.  Youth with learning disabilities are more prone to violence, due to having a more difficult time with social interactions.  For example, a child responding negatively to being made fun of by his peers learns to conclude that others will never accept him.  If that child also struggles to find the words necessary to express his angry feelings, those feelings are more likely to manifest in a negative, physical response.  Those same feelings could also foster development of depression, posing a unique challenge for the treating  clinician.

A diagnosis of depression is very unique and presents differently in youth versus adults.  Thus, one has to be careful to not attribute acts of aggression to those disorders already mentioned, but in fact, consider a depressed state of the youth in question.  Of the symptoms listed in the Diagnostic and Statistical Manual of Mental Disorders, depression in children and adolescents manifests somewhat differently from adults.  In fact, irritability is a closely connected factor of depression in youth that is a precursor for aggressive behaviors.  This link is somewhat counterintuitive if we consider a depressed state to be an inability to function or get energized however, irritability, which could grow into frustration can be a primer for violent behaviors.

The names Eric Harris, Dylan Klebold, Mitchell Johnson, Andrew Golden, Seung-Hui Cho are just a few that stand out in the memories of many.  These were the mass murders who have taken lives at Columbine, Arkansas, and Virginia Tech.  There have been many more since them.  What were their issues? What were their diagnoses?  Why did they commit such horrid acts? Recognizing the different psychopathologies behind perpetrators of violence is an important step forward to understanding and treating them.  Such efforts can only be fruitful if also understanding the driving mechanism behind acts of violence – a need to belong.  The perpetrators of school violence were only resigned to the fact that they might never fit in, believing that the only thing they could do was become the biggest resistance of them all.  People deprived of a connection do not grow kinder and more understanding.  Categorizing perpetrators as traumatized or psychopathic only paints part of the pictures, since the relationship between aggression and psychopathology is a complicated one..  As such, it is imperative that we recognize some of the more common psychopathologies and set up the proper training and funding necessary for effective assessment and treatment  – “one child at a time.”

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