New research develops comprehensive psychiatric profiles of students who make threats at school

A study opens in new tab/window in the Journal of the American Academy of Child and Adolescent Psychiatry (JAACAP), published by Elsevier, reports that students who make threats in school have a wide range of psychiatric diagnoses, learning disorders and major needs for both educational and psychiatric interventions.

While previous studies have focused on identifying potential school shooters, little is known about the mental health and associated characteristics of the broader group of students who make school threats of diverse types and levels of severity. This study 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 by schools. The study included outpatient clinic evaluations of youths from diverse socioeconomic backgrounds, representing 19 school districts, conducted between 1998 and 2019.

A “threat” was defined 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) or bringing a weapon to school. The study found that as many as 29% had brought a weapon to school, while an even larger number, 80%, had made some type of verbal threat.

Nearly 90% of the students reported significant traumatic life experiences; 43% had a history of being bullied. Most youths had one or more psychiatric diagnoses, including attention-deficit/hyperactivity, depression, anxiety, and autism spectrum disorders. Learning disorders were common. Most students received recommendations for mental health treatment, including psychotherapy and/or psychiatric medications. Of the students evaluated, over 60% were recommended to return to their original school. Among this group, 22% were advised to transition to a more supportive and structured class setting. Over a third received recommendations for therapeutic school settings.

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. The study highlights the importance of understanding the psychiatric characteristics of all students who make threats rather than focusing exclusively on identifying potential school shooters. Dr. Weisbrot and colleagues emphasize that psychiatric evaluation of students who issue threats of any type can lead to crucial revelations about psychiatric diagnoses which could then lead to critically needed treatment and educational interventions.  Such interventions could change the course of students’ educational careers and greatly improve their emotional well-being.

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Notes for editors

The article is "Psychiatric Characteristics of Students Who Make Threats Toward Others at School," by Deborah M. Weisbrot, MD, DFAACAP, Gabrielle A. Carlson, MD, Alan B. Ettinger, MD, MBA, FAES, FAAN, Michael L. Reed, PhD, Kristina M. Fanning, PhD, Ryan C. Bostic, BS (https://doi.org/10.1016/j.jaac.2022.12.016). It appears in the Journal of the American Academy of Child and Adolescent Psychiatry, volume 62, issue 4 (July 2023), published by Elsevier opens in new tab/window.

Copies of this paper are available to credentialed journalists upon request; please contact Deborah M. Weisbrot, MD, DFAACAP at [email protected].

About JAACAP

Journal of the American Academy of Child and Adolescent Psychiatry opens in new tab/window (JAACAP) is the official publication of the American Academy of Child and Adolescent Psychiatry. JAACAP is the leading journal focusing exclusively on today's psychiatric research and treatment of the child and adolescent. Published twelve times per year, each issue is committed to its mission of advancing the science of pediatric mental health and promoting the care of youth and their families.

The Journal's purpose is to advance research, clinical practice, and theory in child and adolescent psychiatry. It is interested in manuscripts from diverse viewpoints, including genetic, epidemiological, neurobiological, cognitive, behavioral, psychodynamic, social, cultural, and economic. Studies of diagnostic reliability and validity, psychotherapeutic and psychopharmacological treatment efficacy, and mental health services effectiveness are encouraged. The Journal also seeks to promote the well-being of children and families by publishing scholarly papers on such subjects as health policy, legislation, advocacy, culture and society, and service provision as they pertain to the mental health of children and families.

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