How the Parkland School Massacre Could Have Been Prevented
Reflections from the penalty phase trial
I’m passionate about violence prevention, and mass shootings have been an area of study for decades. As a mental health therapist for over 30 years, I’ve worked as a member of multidisciplinary treatment teams in forensic mental health programs and residential treatment centers. I’ve worked with all sorts of violent people, including murderers. We know mass shootings are one of the most preventable kinds of violent crime; if we want them to stop, we must do some things differently.
I’ve watched the current penalty phase trial of the Parkland killer’s trial (hereafter, I’ll refer to him as NC), and I’ve taken notes on much of the testimony. It’s only half done, and even though there will be many more witnesses, patterns have already become clear. Much evidence has been presented, and we’ve heard testimony from family members, teachers, principals, counselors, psychologists, and psychiatrists.
Systems failed. Errors were made. There were cases of poor judgment that go back years before the crime. There were multiple points in the killer’s life where opportunities for effective intervention were missed.
I see flaws in three primary areas in the case of NC: Assessment/diagnosis, lack of coordination of care, and inadequate and inconsistent treatment. Let me break those down.
Inadequate diagnostic assessment
From birth, NC clearly had pervasive developmental delays in all essential domains. He did not achieve typical milestones on time. He had fine and gross motor problems, delayed speech, and seemed cognitively slow. By the time he was three years old, it was apparent that he was unusually aggressive and didn’t engage in typical play with other toddlers. As he got older, others referred to him as “peculiar” and “weird.”
Despite glaring problems, the only reported diagnosis that’s been shared during his early years was ADHD, assigned by his pediatrician at age six. ADHD would continue to be his primary diagnosis and the one that would drive treatment up until he left treatment at age 18. School staff, a psychologist, and two psychiatrists held ADHD as the primary diagnosis — despite copious evidence that there was much more wrong.
9% of the population have some form of ADD/ADHD. While this can cause challenges (lack of attention, irritability), it does not describe the kinds of increasingly violent and extreme antisocial behavior that NC displayed. Aspects of his obvious neurodevelopmental problems were not explored, and there was no explanation for his pervasive developmental delays, rage, escalating violence, and obsession with guns and murder.
While ADHD was acceptable as a partial diagnosis, it’s clear there was more going on that was not identified. A psychologist who saw him briefly at age eight noted he had “autistic features” but did not give him a diagnosis of autism spectrum disorder. A subsequent psychiatrist also noted autism as a rule-out but never gave the diagnosis. Special education teachers in school continued to identify his diagnosis as ADHD.
Part of this was due to his mother. She adopted him at birth when she was 49 and had been desperate for a child for many years after multiple pregnancy losses. She was thrilled to have a baby. She told people he was her biological child and even colored her hair to match his. Two years later, she would adopt a second baby from the same biological mother. When NC was six years old, his adoptive father died, leaving his mother alone with the children and with little support.
His mother was in denial about NC’s developmental delays and became angry when others pointed it out. Her intense love and attachment to him caused her to have blind spots. She did not disclose to many health care providers that NC had been adopted. She did not disclose to most health care providers that NC’s biological mother had used copious amounts of drugs and alcohol throughout her pregnancy. At times his adoptive mother minimized his problems to health care providers, downplaying his violence. The primary diagnosis of ADHD stuck and was carried on for years. This meant other things were missed.
From the copious evidence that has been presented thus far, it seems a diagnosis of conduct disorder in addition to ADHD and pervasive developmental problems was warranted. There will likely be evidence presented that an additional diagnosis of either Autism Spectrum Disorder or Fetal Alcohol Spectrum Disorder should have been added. Conduct disorder is a serious condition, the precursor to Antisocial Personality Disorder. This is akin to the construct of psychopathy.
People like NC often have multi-layered problems. All the more reason to ensure we know what we’re doing and have obtained an adequate assessment that allows us to target treatment accordingly.
Lack of coordination of care
It is a basic standard of proper care that healthcare professionals regularly communicate with other healthcare professionals treating the same patient. They must also communicate with parents and school staff when working with children. The lack of coordination of care in this case is shocking.
Two psychiatrists who saw NC at different times in his life never consulted a psychologist who saw NC short-term at age eight. When in treatment some months later with the first psychiatrist, NC’s mother told that psychiatrist that NC was still seeing the psychologist when in fact, his mother had terminated his treatment there. The psychiatrist was under the erroneous assumption that NC was having therapy for his behavioral problems when he was not. When a new psychiatrist took over, there was no consultation with the previous psychiatrist or prior psychologist.
There was a series of school counselors who did not communicate with the psychiatrists; the psychiatrists did not communicate with the school counselors. Thus, the psychiatrist did not know about his increasingly violent and dangerous behavior that was occurring at school and at home. He was always polite with the psychiatrists and never disclosed the violence.
At age 11, NC and his mother received in-home counseling from a behavioral health agency. The assigned clinician was an intern, and NC was one of her first cases. She did not communicate with the school or the psychiatrist and had no idea about his diagnosis or pervasive developmental problems. Most importantly, she was given no information about his extreme aggression in school or in home. She only had seven home visits with NC and his mother before the mother terminated services with that agency. The school thought these in-home services were ongoing and had no idea they had stopped.
A counselor in his middle school saw him weekly but never spoke with any of the teachers. The teachers were terrified of him because of his violence and threats in their classrooms. He needed to have a security monitor walk him from class to class and sit next to him in some classes. He bullied teachers and other students, and he often made threats and engaged in violence. He destroyed property in school. The school counselor had no idea this was happening and said he was polite and cooperative when he met with her. She had no idea he was fantasizing about guns and mass murder and drawing pictures of people shooting each other on his schoolwork. The teachers knew. Even without the same school, there was a breakdown in communication.
A glaring example occurred when NC attempted to mainstream to Marjorie Stone Douglass High School, and the therapist from his previous special education school wrote a letter to the High School stating that he should NOT be allowed to take junior ROTC because of his fixation on guns and killing. As soon as NC transitioned to Stone-Douglass, he enrolled in Junior ROTC, earning a sharpshooter award; he was described by the ROTC instructor as a polite and model student. Clearly, he had the capacity to control himself in a class where he wanted to be.
Inconsistent and inadequate treatment
The psychologist who saw NC at age six recommended regular weekly therapy. NC’s mother instead tended to use the clinician for crisis intervention, only coming in after a crisis every so often. This prevented the clinician from making any progress with NC. The mother didn’t continue treatment.
Mother was not an accurate reporter to the two psychiatrists NC subsequently saw. She minimized his extreme behavior. They did not know about his violence or his obsession with guns, death, and killing. They did not know about the destruction of property and bullying of other children. They did not know that he held a gun to his mother’s head on at least one occasion and threatened to kill her.
Medications prescribed for NC were targeted for ADHD. His obsessions with guns and killing were never addressed clinically because the psychiatrist didn’t know about them.
The mother did not give the medicines regularly, often only using them episodically after an “incident” and dividing pills to give half to NC and half to his younger brother. At times she would discontinue medication on her own without consultation with the psychiatrist.
NC was under the care of his last psychiatrist for six years; however, in all that time, he had only had 13 visits. These were 15-minute medication follow-up check-ins where the psychiatrist largely talked to his mother. The psychiatrist had no knowledge that NC was obsessed with guns and killing or acting out with violence, or making threats to kill his mother.
Residential treatment could have made a difference.
As her sons grew into adolescence, it became increasingly clear that they were out of control at home and in school, and the mother was in over her head. Holes were punched in the walls; the property was damaged at school. She was an older woman, a widow, and worried about finances. Many reported that she had difficulties setting boundaries with the boys and was increasingly bullied by them. She confessed to friends that she was frightened of them.
NC’s mother began to use the Sheriff’s Department as a co-parent, calling 911 for help when she couldn’t figure out what to do. I believe this was a clear cry for help. Living at home with his mother was not working for NC, and it was unsafe for her. He needed a higher level of care. If he had been placed in a highly structured residential treatment program in early adolescence, it’s possible his worst impulses could have been curbed. He could have received targeted therapy, strict behavior monitoring by 24-hour professional staff, and structure. Though he would still have developmental problems, it’s possible his antisocial behavior could have been reigned in. It might have been the first time in his life he would have experienced some degree of success. It would have been wonderful if law enforcement or the mobile crisis team had presented this option.
Guns
Though NC’s school counselor told his mother that NC should NOT have guns, she purchased both an airsoft rifle and a bb gun for him in his early teen years (which he used to kill small animals). She did this to pacify him. As he turned 18, she facilitated the purchase of his prized AR-15. By this time, NC was making social media posts that he intended to be a school shooter and posing with his gun like an action-movie villain on Instagram. There were dozens of these posts. One was reported to the FBI, which failed to follow through.
There were many points where interventions could have been made. These stand out to me:
If treatment had been consistent with good coordination of care…
If a proper diagnostic assessment had been done…
If treatment had been more targeted to his problems…
If NC was in a structured living environment, he would have been forced to learn better self-control and be unable to manipulate…
If NC had been placed in a residential treatment facility when he became entirely incorrigible at home and school…
If NC’s mother had pressed charges when he threatened to shoot her in the head, his AR-15 would have been confiscated, and he would have been prohibited from having a firearm. The mass shooting would not have happened.
I’m sure as the trial continues, we’ll learn more. My concern is that we do better in the future.
What we can do:
Make sure all healthcare is coordinated and that schools, counselors, and mental health clinicians are communicating.
Always push for quality assessments and make sure all professionals agree on the diagnosis and treatment plan.
Listen to teachers. They often have the best read on what is actually happening with a kid.
Listen to parents. Encourage them to be honest about how they are struggling and overwhelmed.
When it’s clear that a young person is out of control at home and there are signs of danger or violence, residential treatment should be considered as an option. It may give the child the best chance at normal development.
We need more therapeutic residential treatment programs for young people like NC.
I think both the defense and prosecution are making their cases. NC did come into the world with a damaged neurobiological system due to constant prenatal exposure to drugs and alcohol. He was poisoned in the womb. This left him with pervasive developmental delays and other problems like ADHD. This meant he would have a very challenging life and was vulnerable to many behavioral problems like anger management and impulse control.
The prosecution is also making a good case that despite his vulnerabilities and deficits, he displays a pattern of cunning behavior, manipulation, and predatory behavior. He was fixated on murder for years. He gave red flag after red flag of his intent. As with so many other mass killers, he studied those who went before him and tried to emulate them. He planned the mass murder methodically, coldly, and seemed to have an elevated mood during the experience. It was not impulsive. He had no problem controlling his behavior when he was in a class he wanted to be in, and was also polite around counselors and school administrators. He particularly became aggressive and bullied female teachers and his mother while controlling himself around males. He had no problems controlling his behavior in the months previous to the murders when he was successfully employed as a cashier at Dollar Tree.
In the transcript of a recorded phone call just a few weeks ago, NC stated that he would wear a mask during the trial so people wouldn’t see him smile and laugh. Another social media post stated, “I like to see the families suffer.”
I’m not a supporter of the death penalty for many reasons, but I understand the pain and anger experienced by the victims and survivors. I’m told that Florida case law considers Fetal Alcohol Spectrum Disorders a mitigating factor, and if so, it may impact how the jury rules. Either way, NC will never walk free in society again, which is good. Nonetheless, I wish we’d prevented this tragedy. More effective diagnosis and treatment coordination and more structured living options might have taught him to put on the brakes before he killed people.
Bravo. This is well analyzed. Your explanations are also well organized to give a clear picture of what was missed and a roadmap of what could have been done. The interesting contrast for me is how your analysis in review of the history diverges with how people along the way missed things and let matters go down a different path to a mass shooting.
What do we need to change in the way we view and interpret behavior, including our own but more importantly others' behavior? Particularly those of us whose responsibility in part includes raising, educating, and treating children and adolescents, how can we focus better and not turn away from situations obviously in need of intervention? That's it in a nutshell. Pay attention and respond appropriately. Bring in the right help at the right time.
Between the lines of your excellent recounting and analysis, we should also take note that much of what was missed or let slide occurred because of the emotional state and assumptions of those responsible for taking the right actions. A mother's love for her child, her resentment of potential stigma and of insinuations about his obvious antisocial behavior, her desire to compensate for her own feelings of failure; her using medication and therapy as crisis intervention rather than ongoing behavior modification efforts; the teachers, counselors, and mental health professionals, whose workload or preference to avoid dealing with this to focus on someone and something they liked, and lapses that allowed them to be lulled by ordinary evasions; and everyone else who reframed abnormalities and danger signs as being within normal limits and acted as if.
My favorite in all this is perhaps the gun-ROTC training nexus. Well, the lad has finally found an interest in something his ADHD doesn't get in the way of! Let's indulge that, and isn't it great we have a culture and community that provides, nay, facilitates such openings?
Before it gets away, I also feel inclined to bring up the responses in the wake of Uvalde, another example of how prevention is completely, intentionally de-prioritized because, frankly, we live in a society that values allowing opportunities to learn and promote acts of efficient, effective use of force, including mass shootings. I'll skip the obvious ultimate preventative of removing weapons entirely or at least those with the capacity to kill a lot of people quickly. What is interesting in the aftermath of Uvalde TX is the focus on how the response was not more focused on getting in there quicker and killing the killer and that is the lapse and failure raised high and most loudly reported now.
Are we expected to agree it would be nice if for every antisocial aka bad guy with a gun there were at least one handy fearless social aka good guy with a gun ready to go gung-ho without any sense of self-preservation and repugnance at the taking of another human life? Is that what we ought to take away from at least this one shooting in the Lone Star State? Given the talk about turning schools into "hardened targets" aka little fortresses bristling with gun-toting teachers, that seems to be the after-the-fact approach some folks believe is the best we can do.
I prefer your approach. It seems more social and less militarized. The militarization of civil society and our thinking about problems may likely be the result of the longest wars in a period of relative global peace in our history. I'll conclude by pointing out that the gunfighter period in our history followed the Civil War, when all these males got training and practice in using violence and specifically with state-of-the-art killing tools and techniques as a normal way of dealing with important social problems. As an expert in these kinds of behaviors and human behavior generally, do you think there may be a connection there, and in our own life and times?