Wednesday, December 19, 2012

National Association of School Psychologists: Stigmatizing Mental Health or Developmental Disorders is Harmful

The following is a statement released by the National Association of School Psychologists in response to the recent tragedy at an elementary school in Connecticut:


Bethesda, MD—As the initial shock of the horrific events in Newtown, Connecticut begins to subside, the nation is left to contemplate why such a terrible tragedy occurred. There have been frequent reports in the news that the perpetrator had been diagnosed with an autism spectrum disorder and this may have been related to his homicidal behavior. While it is natural for people to want to understand why such an event occurred, speculating on possible causes at this time would be irresponsible. To conclude that the presence of such a diagnosis predisposes someone to commit this type of violence perpetuates an incorrect stereotype and maintains a stigma that often creates a reluctance to seek treatment.

Homicidal or sociopathic behaviors are often the result of a complex combination and interaction of risk factors, which may be environmental, biological, or both. In most cases, the presence of a diagnosable disorder or disability alone does not predispose someone to extreme or calculated violence. Implying so risks undermining the important efforts to reduce stigma around mental health problems and disabilities and may discourage individuals and families from seeking appropriate treatment. With appropriate treatment, especially early intervention, people with mental health issues can lead rich, full, and productive lives. 

The same is true for children exhibiting problem behaviors and learning difficulties. With proper interventions, children can overcome barriers to learning, display positive behavior, and engage in positive socialization. Indeed, the primary focus of school-based mental health services is to provide students with the necessary supports to thrive in school and throughout life. Providing ongoing access to these services also promotes school safety by helping students feel connected and supported and by helping to identify students who may need more intensive services. In these cases, collaboration among school, community providers, and families is critical to ensuring continuity and effectiveness of supports. Improved access to mental health services in schools remains among the most critical factors in preventing and responding to school crises. 

 Our nation must engage in a serious discussion about how we can improve our efforts to provide for the mental health needs of our children and youth; not just to prevent horrific acts of violence, but to support their well- being, academic achievement, and success in life. Speculating or circulating misinformation can be harmful and distracting to the mission of providing a safe school environment for our children. Numerous organizations have accurate information on the real risk factors and interventions for specific disorders and disabilities. These include, among others: the National Association of School Psychologists (NASP), The Child Mind Institute, the American Psychological Association, the American Academy of Pediatrics, the Academy of Child and Adolescent Psychiatry, the National Council for Behavioral Health, and the Autism Society of America

NASP believes that ongoing efforts to improve school safety and to create safe and welcoming school environments are vital to promoting the well-being of all of our children. Eliminating stigma and providing needed mental health services and accurate information is critical to this mission. 

For additional information, visit or contact NASP Director of Communications, Kathy Cowan at


Below is a short list of articles that might be of interest. The first few focus on psychiatric co-morbidity and autism spectrum disorders. The last two articles provide information about the challenges young people with autism spectrum disorders face as they transition to adulthood.  These topics are important areas for further research.

Mazzone, Luigi; Ruta, Liliana; Reale, Laura.   Psychiatric comorbidities in Asperger syndrome and high functioning autism:  diagnostic challenges. Annals of  General  Psychiatry. 2012; 11: 16.
Published online 2012 June 25. doi:  10.1186/1744-859X-11-16
Link from publication:
Summary of studies published between 2000-2011 exploring psychiatric comorbidity in Asperger syndrome and high functioning autism:

Gagan Joshi, Carter Petty, Janet Wozniak, Aude Henin, Ronna Fried, Maribel Galdo, Meghan Kotarski, Sarah Walls, and Josephe Biederman: The Heavy Burden of Psychiatric Comorbidity in Youth with Autism Spectrum Disorders: A Large Comparative Study of a Psychiatrically Referred Population
Journal of Autism and Developmental Disorders10.1007/s10803-010-0996-9

Taylor, Julie Lounds, Seltzer, Marsha Mailick. Employment and Post-Secondary Educational Activities for Young Adults with Autism Spectrum Disorders During the Transition to Adulthood Journal of Autism and Developmental Disorders© Springer Science+Business Media, LLC 201010.1007/s10803-010-1070-3
Link to online publication:

Hendricks, D. (2010). Employment and adults with autism spectrum disorders: Challenges and strategies for success (pdf).Journal of Vocational Rehabilitation, 32(2), 125-134.

Sunday, December 16, 2012

UPDATED: Links and Resources for coping with (and preventing) tragedy - Sandy Hook and beyond

I have spent much of my adult life as a school psychologist,  working with children, teens, young adults, and those who care about them. This Sandy Hill Elementary tragedy hit close to home, because among those killed was a fellow school psychologist, Mary Sherlach.  My heart goes out to everyone who has been touched by this event in some way, especially the families of those who lost their lives. 

Before going on to the rest of my post, I encourage you to take a few moments to listen to the children singing Silent Night in honor of those who lost their lives on Friday, December 14, 2012.



Over the past few days, members of the National Association of School Psychologists  (NASP) have been providing information and resources for the public to assist with coping with the tragedy, and Twitter and Facebook have proven to be great ways to spread the word. 

Some of the information below is appropriate for those who are directly involved with the children who attend Sandy Hook Elementary or those who attend other elementary schools in the community.   Other articles have suggestions that would be appropriate for parents, teachers, and support staff in schools around the nation (and world).  There are other articles below that are good for those responsible for planning longer-term safe school strategies

Leading School Psychologist Advises How to Talk to Kids about Sandy Hook ShootingNASP: A National Tragedy: Helping Children Cope - Tips for Parents and Teachers 
NASP: Managing Strong Emotional Reactions to Traumatic Events: Tips for Parents and Teachers (pdf)
NASP: Threat Assessment at School: A Primer for Educators (pdf)
NASP: Threat Assessment: An Essential Component of a Comprehensive Safe School Program (pdf)
NASP: Helping Children Cope With Crisis: Care for Caregivers (pdf)
NASP: Tips for School Administrators for Reinforcing School Safety (pdf)
NASP: School Safety and Violence Prevention (Multiple links on topics such as mental health, suicide prevention, bullying, violence prevention planning, crisis prevention and intervention, and behavior/discipline). 
NASP: National Emergency Assistance Team (NEAT)
North Carolina Dept. of Justice: Keeping North Carolina Schools Safe & Secure (pdf)

If you are a parent or concerned member of your community, check your school district's website to learn more about what local safe school policies are in place. There may be a section with tips for parents. (Additional related resources can be found in the body of the comments below and at the end of this post.)


Violence prevention is a complex problem.
From my point of view, preventing or minimizing tragedies such as the one experienced at Sandy Hook Elementary will take a systems approach, and involve people from a number of disciplines. I am convinced that it will take a larger number of people, who can commit to sustaining their efforts over a long period of time. 

What troubles me in this case is that the perpetrator was homicidal, suicidal. and matricidal. He had the wherewithal to know that the school most likely had a school safety plan in place.  He did the unthinkable - he  used a powerful weapon to gain access by blasting through the entry doors. And he would not stop until he had killed 20 young children and a good handful of caring adults.

The problem of protecting schools from intruders can't be solved by making schools more prison-like. Sandy Hook school reportedly had a video surveillance system, locked front doors, a policy for visitors to be buzzed in, and a safe schools policy that required that all teachers (and students) receive training in what to do in an emergency requiring a school lock-down.  If these things were not in place, many more lives would have been lost.  

Firearms:  The Elephant in Our Nation's Living-Room
The elephant that is taking up a huge space in our country's living room?  Weapons that are appropriate for military and law enforcement use, such as the semi-automatic rifle that was in the hands of this young man, are readily available in most communities. We know that the perpetrator did not own the weapons he brought to Sandy Hook Elementary School.  We know that he had easy access to it because it was purchased legally by his mother, and apparently was kept in his home.  

This topic is a political hot potato, but worthy of serious study.  With "Big Data", advanced analytics, and some engaging information visualizations, I am sure something positive can emerge from the 'debate'.   (Nate Silver, author of the New York Times FiveThirtyEight blog, might have a few words to say on this topic, judging from his December 14th post, "In Public 'Conversation' on Guns, a Rhetorical Shift".)

Need for Research - Co-Morbidity - Identification, Evidence-based Treatment, and Prevention

At the time of this post, it was not certain if the perpetrator had a disability, a personality disorder, or a mental health disorder that may have contributed to his violent acts. We do not know if he was receiving treatment, or if he had ever been hospitalized or prescribed medication.  

Whatever the case, I am sure that the tragedy that happened at the Sandy Hook elementary school has caused additional worry for a number of parents of teens and young adults who struggle from mental health problems and other disorders.  Having worked with a number of young people with challenging mental health concerns over the years, including psychiatric patients with a history of serious violence, my heart goes out to these parents. I am sure some of them wonder if the next crisis that flashes on the news is something that was initiated by their child, no matter what the child's age.

Not everyone is aware that serious mental health disorders can crop insidiously during the early teens. The "red flags" might be attributed to puberty, and not be interpreted as precursors to something more serious.  Some mental illnesses become full -blown during the later teen years or during young adulthood, often past the age where a school psychologist or similar professional in the education system can step in to intervene, or provide resources and information for parents. 

Many families have struggled to obtain an appropriate level of care for their teen or young adult child, only to find that these services have been reduced due to budget cuts to mental health and transition-to-adulthood programs in their communities.  Many of these young people have good potential, but their mood states, unusual mannerisms, or periods of erratic thought processes make it difficult to interview for jobs and keep them unless they receive consistent support in the form of counseling, job coaching, and/or medical management. 

There is a need for more research and support that focuses on the needs of teen to young adult age group. This includes research in psychological treatment,group counseling approaches, psychopharmacology, mental health education, and more.   

For a graphic description of what this might be like for a parent of a teen who struggles with emotional/behavioral issues at time, see the blog post that has been circulating around the internet.  The mother, Liza Long, wrote the post  immediately after she learned of the Sandy Hook shootings. Her post triggered hundreds of comments, some of them critical.  In response, an anonymous school psychologist reflected on some experiences with a student in need of support.  I do not think the school psychologist's story exaggerates reality in any way. 

Role of technology in Intervention and Prevention:
Interactive digital media, such as serious games, might play a role in this effort.  For example, the Australian National University developed the MoodGym training program, an interactive, free web-based application that use a cognitive-behavior approach to cope with anxiety and depression, and E-Couch, an online program for preventing and coping with depression, generalized anxiety disorder, and social anxiety disorder.  

For middle-school children, the PBS ItsMyLife website provides a number of activities, games, and videos that explore topics such as emotions, school, friendships, bullying, and more. The website includes lesson plans for teachers and tips for parents. 

More research is underway to support the use of interactive digital technology to support mental health.  One example is the work of Stanford University's Calming Technology lab. Another example is the use virtual reality for treating post-traumatic stress disorder. The USC Institute of Creative Technologies has been involved in this area for a number of years. MindHabits, a suite of games developed by psychologists in Canada, was based on research and aims to help people reduce stress. 

Coincidentally, Connecticut's Southwest Regional Mental Health Board is developing a web-based resource for young adults with mental health concerns, if the information from a job posting for the project is correct:

"The goal of this project is to design or adopt an electronic/virtual system to engage young adults in mental health services.  This system would assist young adults in enhancing their own mental health, and addressing mental health issues as they arise or develop via an interactive, multi-media electronic platform.  This platform would integrate social networking and information media which may include website, facebook, You-Tube, Skype, blog, chat room, texting and phone apps.  Development of this platform will be informed by Connecticut youth and young adults and advised by an advisory group of statewide young adult leaders in the mental health and addiction fields."

It is my hope that the power of the "social" web will support efforts to collaborate and tackle this problem, on many levels.


Mental Health Issues - Co-morbidities
After I learned that it was speculated (but not confirmed) that the perpetrator of the Sandy Hook Elementary School shootings may have had Asperger's Syndrome,  I thought it would be helpful to include additional on the topic of Asperger's Syndrome and co-morbid mental health disorders.  

Mazzone, Luigi, Ruta, Liliana, Reale, Laura.   Psychiatric comorbidities in Asperger syndrome and high functioning autism:  diagnostic challenges. Annals of  General  Psychiatry. 2012; 11: 16.
Published online 2012 June 25. doi:  10.1186/1744-859X-11-16
Link from publication:
Summary of studies published between 2000-2011 exploring psychiatric comorbidity in Asperger syndrome and high functioning autism:

Taylor, Julie Lounds, Seltzer, Marsha Mailick. Employment and Post-Secondary Educational Activities for Young Adults with Autism Spectrum Disorders During the Transition to Adulthood Journal of Autism and Developmental Disorders© Springer Science+Business Media, LLC 201010.1007/s10803-010-1070-3

Mental Health Issues: Funding
State Mental Health Cuts: A National Crisis (pdf) (2011) National Alliance on Mental Illness

Systems Approach/Prevention
The following resources are from various disciplines:

Systems Theory (Wikipedia)

2012 National Strategy for Suicide Prevention: Goals and Objectives for Action (pdf)
A Report of the U.S. Surgeon General and of the National Action Alliance for Suicide Prevention