Adolescent Mental Healthcare After Sandy Hook: (The Hill)

By Gregory Wallance

December 14, 2014, 09:00 am

Today, Dec. 14, is the second anniversary of the mass killings at Sandy Hook Elementary School in Newtown, Connecticut. The national dialogue over this searing tragedy until now has largely been about gun control. But a report released last month by the Connecticut Office of Child Advocate on the developmental history of the killer, Adam Lanza, including his mother’s parenting decisions, suggests that we urgently need a discussion about when and how to intervene when a parent is actually damaging the mental health of a child, especially an already troubled one.

Far more of us are parents than gun owners, we only want the best for our children, but, even when raising normal children, we make mistakes and can only hope there is room for error in our parenting choices. The choices made by Adam’s mother, Nancy Lanza, who also wanted the best for her son, may have cost the lives of 20 first graders and 6 school administrators, not to mention her own life.

Nancy Lanza, who had principal custody of Adam since he was nine, by no means was raising a normal child. As described in the Child Advocate’s report, Adam Lanza had multiple developmental problems, including severe anxiety and dysfunction, pre-occupation with violence, and suicidal ideation.

Parents of children with developmental disabilities experience extraordinary stresses. Many manage well, but some exist in a state of denial, others take the path of least resistance by placating the child when more aggressive intervention is needed, and yet others, perhaps out of exhaustion or despair, simply give up. Nancy Lanza appears to have been in the category of “all of the above.”

In the 9th grade, Adam Lanza was evaluated by the Yale Childhood Study Center. The Center’s staff found that he was living in an increasingly restricted “box” and recommended anti-anxiety and anti-depressant medication and “tons of special education support, with expert consultation.” But Adam disliked the medication. Re-inforced by his mother, he stopped taking it. In fact, Adam received no further mental health treatment.

Nancy Lanza actually made it harder for Adam to deal with his problems. The Yale clinicians observed that Nancy Lanza had above average resistance to accepting her son’s problems, which meant that Adam was likewise unable to perceive their severity. She also failed to appreciate the value of “pushing” Adam “out of his comfort zone” and instead helped her son withdraw from society instead of adapting to it.

Thus, after her son finished high school, Nancy Lanza became “a major factor, likely unwittingly, in increasing Adam’s isolation from the world.” He disengaged from any structured community activity while she discouraged her ex-husband from seeing his son and even shielded him from landscapers that came to the house. Adam hardly left his room (at one point he reportedly did not leave it for three months), whose door he kept locked and whose windows he covered with black plastic garbage bags. Even though much of their own communication was by email, she surely saw enough of him to observe that he was becoming emaciated.

But the most inexplicable – and tragic — choice by Nancy Lanza was failing to contact mental health or health care professionals given this alarming behavior. In fact, if anything, she apparently retreated from Adam, spending “a lot of time” in a restaurant and bar. Then she informed Adam that she planned to sell the house and relocate to another state. Thus, having enabled her son to live deep inside an hermetically sealed cocoon, she abruptly took it away, which the report suggests may have pushed Adam from “fantasy into action.” On the morning of December 14, 2012 he shot his mother four times and set out for the Sandy Hook Elementary School.

The Child Advocate’s report properly stresses that Adam Lanza “alone bears responsibility for this monstrous act.” The report makes many useful recommendations for improved screening, evaluation, care coordination and accountability by schools and mental health institutions.

But Adam’s mother was closer to, and had more influence over, her son than anyone. No one should minimize the difficulties any parent would face in managing a developmentally-challenged child. Nonetheless, the report’s most pertinent observation may be that “when a parent has difficulties reaching out to helping providers or feels mistrust in the medical and educational systems,” the parent’s efforts can be “unwittingly destructive” of the child’s well-being. The report recommends that “our health care and educational systems must become better at reaching these parents and helping the children.”

So, here’s a start on a new Sandy Hook debate. All of the report’s recommendations should be implemented promptly — but this recommendation is by far the most pressing. Sandy Hook must never happen again.