Was The Sandy Hook Shooter Misdiagnosed?

Was Adam Lanza’s Asperger’s diagnosis accurate? That query lurks between the lines and inside quotes from the Sandy Hook shooter’s father, Peter Lanza, in this piece by Andrew Solomon for the New Yorker. In the devastating article about a father’s waking nightmare, Solomon specifics the younger Lanza’s boyhood, which includes Lanza’s sensory defensiveness, his detection of odd, non-existent smells, and enjoyment of elaborate innovative perform with LEGO bricks and his father when he was a youngster. Later on, as Solomon describes it, the Lanzas’ younger son underwent a form of disintegration all around his middle college many years that incorporated withdrawal, a refusal to make eye make contact with, increased rigidity, and the onset of awkward gait and posture. Peter Lanza says of this time, “You could see the modifications occurring.”

In his piece, Solomon repeatedly frames considerably of these manifestations within the diagnosis of Asperger’s that the younger Lanza obtained when he was 13, saying that

All the symptoms that afflicted Adam are indications of autism that may be exacerbated by the hormonal shifts of adolescence.

Autism, a developmental condition that manifests in the 1st many years of lifestyle, does not involve onset of gait disturbance or lowered eye get in touch with in adolescence. If these signs are current, they are usually first indicators of autism spectrum disorder in really early childhood. Autism isn’t a condition of disintegration. It is a condition in which individuals carry on on a forward trajectory of improvement but present delays in acquisition.

It’s true, nonetheless, that a tiny fraction of autistic men and women struggle with some kind of regression throughout adolescence, although according to one latest review,

… most young children with autism expand up and grow to be adolescents and then grownups, with no manifesting major grownup psychiatric issues … indeed, the core signs of autism–deficiencies in social interaction, language delay and communication disabilities, and restricted and stereotyped behavior–tend to show improvement above time.

That mentioned, some autistic men and women can “experience severe disruptive issues during adolescence,” which can be related with clinical deterioration, in accordance to the authors of that research, who also note that “normal intellectual capabilities look to be protective.” Their investigation of younger autistic men and women in a psychiatric hospital for “severe disruptive behaviors” located that all of the sufferers have been intensely autistic–i.e., they manifested quite clear symptoms of autism–all had intellectual disability, and two thirds had “no practical verbal language.”

At several points in his piece, Solomon casts the younger Lanza’s adolescent manifestations in the framework of autism. A psychiatrist recalls that the boy was

a “pale, gaunt, awkward young adolescent standing rigidly with downcast gaze and declining to shake hands.” He also mentioned that Adam “had fairly tiny spontaneous speech but responded in a flat tone with tiny inflection and virtually mechanical prosody.”

And Solomon adds interpretatively:

Many folks with autism speak in a flat tone, and keeping away from eye get in touch with is typical, too, due to the fact making an attempt to interpret sounds and faces at the exact same time is overwhelming.

Except that’s anything that autistic individuals really don’t commence performing in adolescence. It is a lifelong habits.

Solomon by no means unequivocally says that the younger Lanza was misdiagnosed–and thus, handled for the incorrect condition. The closest he comes is right here, in what in my mind is the article’s lede, buried a lot of paragraphs in:

Peter and Nancy have been confident ample in the Asperger’s diagnosis that they didn’t appear for other explanations for Adam’s behavior. In that sense, Asperger’s might have distracted them from no matter what else was amiss.

And he estimates the father, Peter Lanza, as saying:

Peter gets annoyed when individuals speculate that Asperger’s was the lead to of Adam’s rampage. “Asperger’s tends to make people unusual, but it doesn’t make men and women like this,” he explained, and expressed the view that the issue “veiled a contaminant” that was not Asperger’s: “I was thinking it could mask schizophrenia.”

All of what is described about the Sandy Hook shooter in this write-up does, in reality, match the presentation of childhood onset schizophrenia, but that’s not a diagnosis he ever acquired, as far as published information indicates. An additional achievable explanation, from between numerous, for these sudden adjustments in adolescence is childhood onset bipolar disorder. Obviously, only a person who could directly assess a patient could make the contact. Solomon’s report implies between its lines–while continuing to emphasize the Asperger’s framework–that the Sandy Hook shooter went undiagnosed with something other than Asperger’s and consequently untreated, and the implications of that are profound.

As with autistic men and women, people with schizophrenia or any other psychological disorder are largely nonviolent and are a lot more most likely to have violence accomplished towards them than to commit it towards somebody else. A United kingdom study located that the huge bulk of individuals incarcerated for violent offense or homicide do not appear to have any psychological illness at all, suggesting that mental illness is not an overriding risk aspect for both. Indeed, even between men and women who have delusions and engage in violent acts, it is anger, not the delusions or the mental illness itself, that appears to drive their violent habits. Anger.

In the context of the schizophrenia that Peter Lanza talked about, which comes up most often (and unfairly so) when folks are speaking about psychological sickness and violence, remedies are accessible that can aid ameliorate some of its a lot more challenging facets. A crucial discovering described in this write-up is that a person’s culture may well drive the tone and content of the voices that some individuals with schizophrenia hear. As Stanford anthropology professor T.M. Lurhmann notes in that piece,

… neighborhood culture could form the way folks with schizophrenia pay attention to the complex auditory phenomena created by the disorder and so shift what the voices say and how they say it.

Lurhmann goes on to observe

… it is a sobering imagined that the greater violence in the voices of Americans with schizophrenia might have something to do with individuals of us with no schizophrenia.

We really do not need to appear extremely far to comprehend what an angry, angry culture ours can be. The DSM doesn’t record “anger disorder” as a pathological situation ((just “intermittent explosive disorder) if it did, US prices very likely would be quite, extremely higher.

Did Adam Lanza have an undiagnosed and untreated issue, a feasible error of diagnosis that unspooled into a national tragedy? No expert would (or need to) be comfortable asserting that unequivocally without having ever obtaining met or evaluated him. But there’s one particular diagnosis he ought to not have obtained, based on the well-established criteria for that diagnosis at the time, and that diagnosis is Asperger’s.

According to Solomon’s piece, the younger Lanza did not communicate until finally age 3. The criteria for an Asperger’s diagnosis (prior to it was removed from the DSM) quite specifically contain:

There is no clinically significant common delay in language (e.g., single words used by age two many years, communicative phrases utilised by age three many years).

This criterion thus rules out an Asperger’s diagnosis for someone who did not talk till age 3. It is most likely real that some clinicians use Asperger’s rather than autism in some cases to “soften” the diagnosis due to the fact Asperger’s possibly carries significantly less stigma. But significantly else about how the younger Lanza is described fails to match autism spectrum diagnosis, despite the fact that Solomon, who has a PhD in psychology, often interjects to interpret it that way for the reader. Not all oddly behaving or anti-social boys are autistic. And the implications of derailment of focus from the true or other situation and applicable interventions are all too clear in hindsight.

In an interview I just finished as a member of a conference advisory board, in response to a question about the partnership in between psychology and neuroscience, I stated:

An illustration is the DSM, which is handled as a psychological manual that resolves the identity of a situation based mostly much more on a checklist than on neuroscience-primarily based indicators. The converse of that, clearly, is that neuroscience has a whole lot of work to do to catch up with these conditions that we’ve classified as diagnosable and place them in the context of essential mechanisms. Psychology, in my thoughts, offers us a rough concept of exactly where perform derailment crosses in excess of into pathology, a broad impression that neuroscience ought to eventually make a lot more specific and concrete.

As the Lanza case tends to make clear, these rough tips are not enough and can alternatively be dangerously conflated. The trail from his early childhood to the deaths of twenty children is littered with fallen or overlooked markers, some of which we even now do not have the tools to decipher. No quantity of comprehending of pathology will most likely ever be adequate to describe what he did. But the fuzzy outlines that are emerging seem to encompass variables that exclude no factor of American life … except potentially an Asperger’s diagnosis.

*Disclosure: I have an autistic son.

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