Riittakerttu Kaltiala-Heino Professor, Chief psychiatrist, Senior research fellow

1. Is he the next school shooter? Adolescent psychiatric perspective on adolescents who threaten with mass violence in school • Riittakerttu Kaltiala-Heino • Professor, Chief psychiatrist, Senior research fellow • University of Tampere • Tampere University Hospital • Vanha Vaasa Hospital

2. My perspective • Clinical and societal discussions and developments after the 2 multiple victim school shootings in Finland in 2007 and 2008 • Research in psychiatric and police files addressing adolescents who threatened with school mass killings • Clinical experience of assessing adolescents referred to our tertiary level adolescent forensic unit due to such threats • Adolescent and forensic psychiatric research, clinical and management work Pirkanmaan sairaanhoitopiiri

3. What counts as ”school shooting”? • Rampageschoolshooting (Newman et al. 2004) • (attempted) killing of multiplevictimsbyone (ormorerelated) shooter(s) • in a publicplace, either at schoolpropertyor at a school-relatedfunction • by (a) currentorformerstudent(s) of theschool • some of thevictimschosendue to theirsymbolicvalueor at random • Rampageschoolkilling • Otherhomicidalviolence in schoolpremises • Newman et al 2004, 2009, Bushman et al.2016 Pirkanmaan sairaanhoitopiiri

4. Who are adolescents? • Adolescence (about 12-22 years) is thedevelopmentalperiodthatstarts in puberty and closeswithconsolidation of adulthoodpersonalitystructures and identity • Earlyadolescence 12-14 y (bodilychanges) • Middleadolescence 15-17 y (relationshipswithparents and peers) • Lateadolescence 18-22 y (personality, identity) • Blos 1962, Erikson 1968 Pirkanmaan sairaanhoitopiiri

5. Adolescent development: progression &normative regression physical • cognitive • emotional girls • emotional boys • 10 • 12 • 16 • 20 Pirkanmaan sairaanhoitopiiri

6. Behavioral control across developmental years • Self-control • 100% • Developmental problems • External control • 0% • 12 • 18 • Ikä • Vermeiren 2003 Riittakerttu Kaltiala-Heino vastuualuejohtaja, ylilääkäri

7. Facets of positive adolescent development • Positive adjustment to bodily maturation • Age-appropriate relationships with parents • Positive peer involvement • Adjustment in school • Positive leisure time activities Pirkanmaan sairaanhoitopiiri

8. Societal / cultural phenomena discussed in research on school rampage killings • Legislative control of firearms • Masculinities and the vanishing triple entitlement • The culture of fame • Media violence and the evil side of Internet • Failure of mental health services • Cultural scripts • Dill et al. 2011, Ferguson et al. 2011, Rocque 2012, Oliffe et al. 2015, Kalesan et al. 2016, • Langman 2016, Lankford 2016, Madfis 2014, 2017 Pirkanmaan sairaanhoitopiiri

9. Suggested risk factors in the immediate environment • Bullying, peer rejection • Unlimited access to media violence • Inappropriate parenting and troubled family relationships • Lack of pro-social support systems • Characteristics of school • Availability of weapons • Levin and Madfis 2009, Dill et al. 2011, Flores et al. 2012, Rocque 2012 Pirkanmaan sairaanhoitopiiri

10. Individual risk factors discussed • Certain personality features • Mental disorders (posttraumatic, depression, autism, psychosis (high risk); suicidality) • Uncommitment to pro-social social systems • Anger, hostility • Extensive use of media violence • Perceived bullying, exclusion, rejection • Verlinden et al. 2001, Langman 2009, Bondu and Scheithauer 2015, Pirkanmaan sairaanhoitopiiri

11. ex • exosystem meso • mesosystem m • microsystem Individual • family, peers • school, other institutions, community • society Pirkanmaan sairaanhoitopiiri

12. Five factors – necessary but not sufficient • The shooter’s perceptions of himself as extremely marginal in the social worlds that matter to him; • Psychosocial problems that magnify his perceptions of social exclusion; • “Cultural scripts” that point the way toward an armed attack as a model for problem solving and bringing shooter from insignificance to infamy; • The failure of the surveillance system intended to identify troubled teens, so that nobody intervenes even if the future shooter is emitting signals of trouble to come; and • The availability of guns and other weapons • Newman et al. 2004, 2009 Pirkanmaan sairaanhoitopiiri

13. Cumulative strain theory • 1. Chronicstrain • A range of difficulties, disappointments and failures in achievingthegoalsthatareimportant to theindividual • 2. Uncontrolledstrain – lack of bufferingprosocialcommitments • 3. Acutestress – loss, narcissisticinsult • 4. Planning phase • 5. Multiplekilling at school • - Motivatedoffender, suitabletargets and lack of capableguardiansconverge in space and time • Levin and Madfis 2009 Pirkanmaan sairaanhoitopiiri

14. Crisis-laden developmental pathway model • Crisis • humiliation, identitythreat; anger, revenge • lack of copingskills • Signs of acutestrain • 2. The idea • rumination; fantasies of compensationbyviolence • culturalscriptsthatoffer a model • Fascination, preoccupation • Scheithauer 2013, Bondu et al. 2013, Leuschner et al. 2017 Pirkanmaan sairaanhoitopiiri

15. … continued • 3. Re-definition • identificationwithviolentrolemodels: fromvictim to avenger • Changes in behaviour, personalappearance and socialrelationships • 4. Planning of theoffence • concretepreparations • pressure to act due to re-definedrole • Possession of weapons, lists, maps, schedules • Leakage Pirkanmaan sairaanhoitopiiri

16. … continued • 5. Finalpreparations • Decision to act, timing • Farewellletters, videosetc • Leakage Pirkanmaan sairaanhoitopiiri

17. Assessing threat • Attitudes that support/ facilitate violence • - in the perceived situation of the adolescent • Capacity to commit the act • Thresholds crossed • Intent • Others’ reactions and responses • Noncompliance with risk reduction • Borum and Reddy 2001 Pirkanmaan sairaanhoitopiiri

18. Accumulating warning signs • Has made a threat • Has access to deadly weapons (C) • Has a plan (I) • Is organized to attack (T, C) • Blames others for problems (A) • Has poor social and coping skills • Is fascinated about and preoccupied with weapons and violence (A) • History of aggression (A) • Feels rejected, bullied, persecuted (A) • Lack of prosocial support system (O) • Verlinden et al. 2001 Pirkanmaan sairaanhoitopiiri

19. Further psychiatric assessment of an adolescent who threatens with mass violence • Structured psychiatric diagnostic work • Appropriateness of developmental environment • Progression / delay / regression of adolescent development • Strengths and difficulties in skills necessary to obtain developmental goals of adolescence Pirkanmaan sairaanhoitopiiri

20. Whatever the kid has, we need to • Support the immediate environment • so that • the (possible) psychiatric disorder can be treated • and • the adolescent can gain appropriate skills • to • progress in the developmental tasks • and • integrate in a developmentally appropriate way Pirkanmaan sairaanhoitopiiri

21. Prevention in schools • Anti-bullying, inclusion, positivecollaborationbetweenschools and parents – good for all in theschoolcommunity • Recognizingthetroubledyouth, lowthresholdinterventions as needed • supporting (return to) normativedevelopmentaltrack; notspecific to massviolencerisk • Breakingthecode of silence – reactingadequatelywhenleakagetakesplace • Leuschner et al. 2013, 2017, Payne and Ellis 2011, Madfis 2014 Pirkanmaan sairaanhoitopiiri