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Table of Contents
Year : 2022  |  Volume : 4  |  Issue : 2  |  Page : 85-93

Inside the Mind of the Adolescent School Shooter: Contributing Factors and Prevention

Professor, Department of Psychiatry, Herbert Wertheim College of Medicine, Florida International University, Miami, Florida, USA

Date of Submission29-Jun-2022
Date of Decision29-Jun-2022
Date of Acceptance30-Jun-2022
Date of Web Publication22-Aug-2022

Correspondence Address:
Dr. Eugenio M Rothe
2199 Ponce de Leon Boulevard, Suite 304, Coral Gables 33134, Florida
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/wsp.wsp_18_22

Rights and Permissions

Situations involving active firearm shooters in schools have increased exponentially in recent years, especially in the United States. These events result in death and psychological traumatization, not just to the involved school but also to the surrounding communities and to the rest of the population of the United States and other countries who observe these massacres in the media. This article will review the recent statistics of school shooting incidents in the United States, the psychological profiles of the perpetrators, the pattern of circumstances that contribute to the buildup until the point the act if committed, the effectiveness of the responses by authorities, the possible risk factors and precipitating factors for these attacks, the psychological sequelae to individuals, families, and the communities, and the evidence-based preventive interventions.

Keywords: Children, firearms, murder, psychological trauma, schools, violence

How to cite this article:
Rothe EM. Inside the Mind of the Adolescent School Shooter: Contributing Factors and Prevention. World Soc Psychiatry 2022;4:85-93

How to cite this URL:
Rothe EM. Inside the Mind of the Adolescent School Shooter: Contributing Factors and Prevention. World Soc Psychiatry [serial online] 2022 [cited 2023 Mar 24];4:85-93. Available from: https://www.worldsocpsychiatry.org/text.asp?2022/4/2/85/354176

  Introduction Top

Situations involving active firearm shooters in schools have increased in recent years, with each of the past several decades having one significant school shooting resulting in death and psychological traumatization, not just to the involved school and community but also across the United States and the rest of the world. Targeted violence at a school is defined as any premeditated incident where a known or knowable attacker deliberately chooses the school as the location for the attack and an “active shooter incident” as an occurrence where one or more individuals participate in an ongoing, random, or systematic firearm shooting spree with the objective of multiple or mass murders.[1] In addition to this, increasing racial, ethnic, and sexual hate rhetoric seen in many societies worldwide have had a significant adverse impact on youth, encouraging aggressive and violent behavio to promote the cause of various ideologies. Such violence is often associated with racist, xenophobic, and fundamentalist or ultra-religious beliefs. It can also be a reaction to the increasing globalization of cultures and economies, increasing technological and educational demands, and resulting threats perceived by traditionalist groups and cultures. Youth who engage in such violence are typically marginalized from their own mainstream cultural and ethnic groups, or are children of immigrants marginalized from the mainstream cultures within which they reside. The majority of hate crimes appear to be perpetrated by youth, although these youth are not always associated with organized groups.[2],[3] On the other hand, in many parts of the world where youth have been victimized by xenophobia, racial discrimination, rejection, or ostracism in the same society, they were raised and, where their families have belonged for several generations, can also resort to violence out of frustration and desperation, which can start out as part of a protest but can become violent. In the case of the victims of xenophobia and discrimination, their deep sense of frustration with injustice and sometimes with socioeconomic disparities often has its roots in historical trauma perpetrated against their racial and ethnic groups across generations. This article will discuss the neurobiology of the adolescent brain, the consequences of rejection and ostracism in adolescence, the role of bullying, the role of violence and social media, and the role of psychopathology in school shootings. It will also describe the psychodynamic profiles of school shooters, the sequential model of school shootings, and the access and the types of firearms used and will review the treatment interventions and security measures to prevent these massacres and the level of effectiveness of these interventions.

  The Neurobiology of the Adolescent Brain Top

The great majority of school shootings are perpetrated by adolescents, so it is important to understand how the neurobiology of the adolescent brain may, in some ways, contribute to this phenomenon. Adolescence is a time of dramatic changes including rapid physical growth, the onset of sexual maturation, the activation of new drives and motivations, and a wide array of social and affective changes and challenges. Two of these motivational changes include: (1) increases in sensation seeking (motivational tendency to want to experience high-intensity, exciting experiences) and (2) stronger natural interest in, and pursuit of, contact with peers and potential romantic partners. These motivational changes promote exploration of social experiences, development of skills and knowledge relevant to taking on adult social roles, individuation from family, and establishment of an individual identity, all of which represent core developmental tasks during this period in the life span.

Another feature that explains behavior in adolescence is related to the notion that immature neuronal processing in the prefrontal cortex and other cortical and subcortical regions, along with their interaction, leads to behavior that is biased toward risk, reward, and emotional reactivity. During adolescence, the dopamine-modulated neurobehavioral system that underlies incentive-driven behavior undergoes important changes, studies showing differences in the hedonic, or pleasure producing value of sucrose solutions. The brains of adults versus adolescents reveal marked differences in brain functioning during these periods of life. Some studies show that adolescents, compared to adults, experience more negative affect and depressed mood, and may feel less pleasure from stimuli of low or moderate incentive value, and therefore seek stimuli of greater hedonic intensity to satisfy a deficiency in their experience of reward.

Adolescents and adults may also differ in the way they integrate emotional information in decisions: adolescents may be less adept at interpreting or integrating relevant emotional content, or less effective at forming such associations which may be associated with poor social decision-making capacity. All of these changes may translate into propensity toward impulsive behaviors. It is possible that from an evolutionary Darwinian perspective, these characteristics may have conferred positive evolutionary advantages as the adolescent moves to explore new social environments, acquiring relevant knowledge and skills, and moving toward increasing independence.[4],[5]

The ability known as mentalizing, or theory of mind, enables us to understand other people's behavior and actions in terms of underlying mental states such as intentions, desires, and beliefs. Functional magnetic resonance imaging studies have demonstrated how, in early adolescence, the areas of the brain involved in self-awareness and mentalizing become progressively more activated and youth at this age become increasingly self-conscious and more aware of, and concerned with, others' opinions and social brain functions. Furthermore, the pubertal rise in reproductive hormones activates increasing motivations to attract friends, to attain social status, and more generally, in their natural tendencies to pay more attention and to care about, and react to peer, romantic, and sexual contexts, so adolescence is a time during which peers, rather than parents, become influential in shaping social behavior.[6]

As peer relationships become more important in adolescence, the potential negative consequences of rejection or victimization by peers increase and hypersensitivity to social rejection during adolescence can be explained by the neurobiological changes that take place at this stage of development. Relational aggression in adolescence can occur in various forms, such as socially excluding the victim using the “silent treatment,” or by spreading rumors about the victim. Victims of relational aggression oftentimes have social-psychological adjustment problems, including low self-esteem, depression, and rage.[7],[8]

  Social Consequences of Rejection and Ostracism in Adolescence Top

The social brain, which is responsible for the previously mentioned process of mentalization, is defined as the network of brain regions responsible for social cognition, which enables us to recognize others, and to evaluate our own and others' mental states, their intentions, desires, beliefs, feelings, enduring dispositions, and actions. Many different brain regions are involved in social cognition, including medial prefrontal cortex, anterior cingulate cortex, inferior frontal gyrus, posterior superior temporal sulcus, temporoparietal junction (TPJ), the amygdala and anterior insula and TPJ, the amygdala and anterior insula the attribution of mental states to oneself and to others. There is considerable overlap between these social brain regions and regions that are still developing structurally in adolescence.[5],[6]

It appears that adolescents use different cognitive strategies than adults to perform social cognition tasks and that structures in the brain continue to mature and become activated in the transition from adolescence to adulthood. Since peer relationships become more important in adolescence, the potential negative consequences of rejection or victimization by peers also increase. Studies have demonstrated that adolescents aged 13–17 reported that peer evaluations were more important in determining their sense of personal self-worth than did younger children. Peer rejection was commonly viewed as an indication of their “unworthiness” as an individual, and this peer effect on self-evaluation was most apparent in girls aged 13–15 and sensitivity to rejection appears to decline in late adolescence.[7] Williams[9],[10] explains that ostracism (which derives from the word: Oyster) threatens four fundamental psychological needs: (1) Self-esteem, (2) belonging, (3) control, and a (4) sense of meaningful existence. Hence, taking into account our human evolutionary origins as hunter-gatherers who inhabited the East-African plains thousands of years ago and moved around in groups of no more than 30–50 people, if an individual was ostracized and excluded from the group, his chances of survival were significantly reduced, which may explain why the reaction of an individual who is being ostracized can be dramatic and violent, with a strong motivation to overturn this outcome in the service of survival.

  Bullying Top

Bullying is defined as the systematic abuse of power utilizing aggressive behavior or intentional harm perpetrated by peers that is carried out repeatedly and involves an imbalance of power, either actual or perceived, between the victim and the bully. In the United Kingdom, for instance, being bullied by peers is the most frequent form of abuse encountered by children, much higher than abuse by parents or other adult perpetrators.[11] Bullying can take the form of direct bullying, which includes physical and verbal acts of aggression such as hitting, stealing or name calling, or indirect bullying, which is characterized by social exclusion and rumor spreading. Children can be involved in bullying as victims and bullies, and also as bully-victims, a subgroup of victims who also display bullying behavior.[8] Children bullying others, those being bullied, and those who were both bully and bullied had significant common health problems including psychosomatic symptoms, and psychiatric problems including depression, suicide attempts, anxiety, externalizing behaviors, hyperactivity, substance abuse, and eating disorders. Although bullying is associated with various psychopathological behaviors including social problems, aggression, and externalizing behavioral problems.

Bullying is found in all societies, including modern hunter-gatherer societies and ancient civilizations. It is considered an evolutionary adaptation, the purpose of which is to gain high status and dominance, get access to resources, secure survival, reduce stress, and allow for more mating opportunities. Bullies are often bi-strategic, employing both bullying and also acts of aggressive “prosocial” behavior to enhance their own position by acting in public and making the recipient dependent as they cannot reciprocate. Thus, pure bullies (but not bully-victims, or victims) have been found to be strong, highly popular, and to have good social and emotional understanding. Hence, bullies most likely do not have a conduct disorder. Moreover, unlike conduct disorder, bullies are found in all socioeconomic and ethnic groups. In contrast, victims have been described as withdrawn, unassertive, easily emotionally upset, and as having poor emotional or social understanding, while bully-victims tend to be aggressive, easily angered, low on popularity, frequently bullied by their siblings, and come from families with lower socioeconomic status, similar to children with conduct disorder.[8]

Oftentimes bullying occurs in settings where individuals do not have a say concerning the group they want to be in. For these children, school classrooms or the home with siblings has been compared to being “caged” with others. In an effort to establish a social network or hierarchy, bullies will try to exert their power with all children. Those, who have an emotional reaction and have nobody or few to stand up for them, are the repeated targets of bullies. Bullies may get others to join in as bystanders or even as henchmen (these then become bully-victims). It has been shown that conditions that foster higher density and greater hierarchies in classrooms, homes, or even in nations tend to increase the frequency in which bullying occurs. Childhood bullying has serious effects on health, resulting in substantial costs for individuals, their families, and society at large. Many bullied children suffer in silence and are reluctant to tell their parents or teachers about their experiences for fear of reprisals or because of shame.

Health professionals should always ask children about their peer relationships, and it is important to remember that many children abstain from school due to bullying and related health problems and being bullied throws a long shadow over their lives.[8],[12]

  Violence and Social Media Top

Cyberbullying has become an international public health concern among adolescents, and as such, it deserves further study. It can be broadly defined as any bullying which is performed via electronic means, such as mobile phones or the Internet. In general, cyberbullying involves hurting someone else using information and communication technologies. This may include sending harassing messages (via text or Internet), posting disparaging comments on a social networking site, posting humiliating pictures, or threatening/intimidating someone electronically.

Adolescents who are targeted via cyberbullying report increased depressive affect, anxiety, loneliness, suicidal behavior, and somatic symptoms. Perpetrators of cyberbullying are more likely to report increased substance use, aggression, and delinquent behaviors. Compared to traditional bullying, cyberbullying is unique in that it reaches an unlimited audience with increased exposure across time and space, preserves words and images in a more permanent state, and lacks supervision. The perpetrators of cyberbullying do not see the faces of their targets, and subsequently may not understand the full consequences of their actions, thereby decreasing important feelings of personal accountability. This has often been referred to in the literature as the “disinhibition effect.”[13]

A study of American middle school students examined the relationship between involvement in cyberbullying (either as a victim or perpetrator) and suicidality. The results revealed that both targets and perpetrators of cyberbullying were more likely to think about suicide, as well as attempt suicide, when compared to their peers who were not involved with cyberbullying. This relationship between cyberbullying and suicidality was stronger for targets, as compared to perpetrators of cyberbullying. Specifically, targets of cyberbullying were almost twice as likely to have attempted suicide (1.9 times), whereas perpetrators were 1.5 times more likely compared to their uninvolved peers and that cyber victims and cyberbully-victims were more likely to experience somatic problems, including difficulty sleeping, headaches, and stomachaches, as compared to their unaffected peers.[14]

A study of adolescents who were harassed online found that they were more likely to use alcohol, drugs, and carry a weapon at school. In fact, victimized youth were eight times more likely than their peers to carry a weapon to school in the past 30 days.[15]

Perpetrators of cyberbullying have been positively associated with hyperactivity, relational aggression, conduct problems, smoking, and drunkenness and with decreased levels of self-esteem, self-efficacy, prosocial behavior, perceived sense of belonging, and safety at school. Cyberbullying perpetration has also been associated with adolescents' negative emotions such as anger, sadness, frustration, fear, and embarrassment. Disruptions in relationships have also been associated with cyberbullying perpetration among youth, including lower levels of empathy, increased levels of depression, weaker emotional bonds with caregivers, lower parental monitoring, and increased use of punitive discipline. Finally, perpetrators of cyberbullying were more likely to rationalize their destructive behaviors by minimizing the impact they had on others.

In contrast, adolescents who have been both victims and then perpetrators of bullying experienced the most adverse health outcomes, including decreased psychological and physical health, increased levels of depression, substance use, and conduct problems compared to their peers who were either only targets or perpetrators. Adolescents who were both targets and perpetrators of cyberbullying also reported poorer relationships with their caregivers, and higher levels of victimization and perpetration offline, compared to their peers. These results suggest that this group of adolescents may require extra support from health-care professionals, educators, and caring adults.[13]

Adolescents involved in cyberbullying may be less inclined to experience empathy for targets online, in part because they are not privy to the targets' facial expressions. Future prevention and intervention efforts should be targeted toward increasing adolescents' affective and cognitive empathy in an effort to reduce participation in cyberbullying. Efforts should also address adolescents' self-esteem, as well as specific problem behaviors and health-care professionals and educators should work toward helping adolescents and their parents establish warm, nurturing relationships that include close adult monitoring and to encourage parents to participate in open discussions with children and adolescents about their online behavior, as well as to implement the necessary safeguards to protect youth from engaging in cyberbullying behaviors.[16],[17]

  Psychopathology, Aggression, and Violence among Youth Top

An important distinction can be made between predatory aggression versus reactive aggression. Predatory aggression is more typically associated with youth who have antecedents of antisocial personality disorder, particularly in youth who have been subjected to severe emotional neglect or abuse that has contributed to failures in empathy. Reactive aggression occurs in the moment as a result of the interaction between mood or anxiety disturbance, impulsivity, and significant triggering events in the youth's environment. Incidents of school shootings are mostly related to reactive aggression and reactive aggression, and violence is much more frequent than predatory aggression, yet most funding and law enforcement efforts are directed at predatory aggression.[18],[19],[20]

  School Shootings Top

The most comprehensive study on the profile of school shooters up to date is the one done by Vossekuil et al[21], which is summarized by Bonnano and Levenson (1) as follows. There were 37 incidents of targeted school violence in the United States and found that the great majority of the attackers were males, and 95% of them were current students with 5% being former students. Attackers worked alone in 81% of the incidents. Assistance from at least one other peer in the planning of the attack occurred in 11% of the incidents, but the attackers in those incidents ultimately carried out the attack alone. Two or more attackers committed the assault together in 8% of the incidents.

In terms of weapons, 76% of the attackers used only one weapon, whereas 24% of the attackers had more than one weapon with them at the time of the attack. Handguns were used by 61% of the attackers, and 49% of the attackers also used rifles or shotguns. In 73% of the incidents, the attacker killed one or more individuals at the school, and in the remaining incidents, at least one person was injured by a weapon. Fifty-nine percent of the incidents occurred during the school day.

Targets were not necessarily random, although persons in addition to targets were also harmed. Attackers had selected at least one administrator, faculty member, or staff member as a target in 54% of the incidents. Students were chosen as targets in 41% of the cases, and attackers selected more than one target prior to the attack in 44% of the incidents. Persons who were targeted before the attack were actually harmed in the attack in 46% of the cases. Individuals not identified as original targets of the attack were also injured or killed, and of these individuals, 57% were students and 39% were administrators, faculty, or staff.

According to recent studies[1],[21], there is no “profile,” or “set of demographic and other traits that a set of perpetrators of a crime have in common” for student attackers. Attackers came from a variety of family situations, and they differed considerably in social relationships.

Most importantly, 71% of the attackers felt bullied, threatened, or injured by others before committing the attack, a significant finding to note if one was to attempt to categorize traits of active shooters. In addition, most attackers had some history of suicidal ideation or attempts, or a history of extreme depression. Most attackers were known to have had difficulties coping with “significant losses or personal failures” (21, p. 35).

Academic achievement ranged from failing to excellent grades. Some attackers had no behavioral problems whereas others had histories of disciplinary problems. Although most attackers had no history of violent or criminal behavior before the attack, 59% demonstrated some interest in violence whether it was through video games, movies, books, or other media. Most attackers did not display any significant change in academic performance, friendship patterns, interest in school, or disciplinary problems before the attack. At the same time, noted that 93% of the attackers engaged in some form of suspicious, out of the ordinary behavior before the attack that made others, such as parents, school officials, teachers, fellow students concerned about their behavior.

Targets did not seem to know about the attack beforehand, as most attackers did not threaten their targets directly before the attack. The targeted violence at school was often planned ahead of time with some attackers devising the idea as few as 1 or 2 days before the attack and others holding the idea of the attack for as long as a year before its execution.

Motives for attacks varied, and 54% of the attackers held multiple motives or reasons. For 61% of the attackers studied, revenge was a reason for the attack, 81% of the attackers had some type of grievance at the time of their attack, and 66% of the attackers had told other people about the grievance before the attack. Additional but less common motives of attackers were trying to solve a problem (34%), suicide or desperation (27%), and attempts for attention or recognition (24%).

In terms of advancing the attack, many attackers had experience using weapons and had access to weapons. Fifty-nine percent of the attackers had some experience with a gun, and 68% used firearms that they obtained from their own home or that of a relative.

Most school shootings were not stopped by law enforcement despite prompt response times. Instead, the shooter surrendered to or was apprehended by school staff (27% of the incidents) or by students (5% of the incidents). The attacker stopped on his or her own or left the school in 22% of the attacks, and in 13% of the attacks, the shooter killed himself. Law enforcement stopped only 27% of the shootings and only discharged weapons in three of the incidents examined. Most school shootings were not stopped by law enforcement, in part, because of their short duration. In terms of the characteristics and motives of the school shootings, these findings are summarized in [Table 1] and [Table 2].
Table 1: Characteristics of school shootings

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Table 2: Motivating factors of school shooters

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  Sequential Model of the School Shooter Top

Levin and Madfis[22] have described a five-stage sequential model that is necessary for a school shooting to occur. In this model, each stage is a necessary precondition that builds up cumulative strain until the culmination of the fatal event. It is divided into: (1) chronic strain, (2) uncontrolled strain, (3) acute strain, (4) the planning stage, and the (5) massacre at School.

Chronic strain begins with negative experiences in social, family, and school relationships that result in frustration, depression, fear, disappointment, and anger. The majority of these youth have experienced chronic rejection prior to the incident, in addition to bullying, personal loss, and many had been threatened by others. Some may even reach such degree of anger that they kill their parents prior to the shooting. Uncontrolled strain is reached when the victim reaches a saturation point and it often goes unnoticed by the adults and people responsible for these youth and it highlights the lack of meaningful relationships. In some cases, the few people in their lives that constitute meaningful relationships exert a negative influence and may even encourage their plans. A quarter of these school shooters belonged to a group that was outright disliked and rejected by others and a third of these were loners who tended to externalize blame on others. The stage of acute strain is reached when there is a loss that is perceived as catastrophic by the attacker and serves as a catalyst for the attack. The loss destabilizes an already troubled individual, and in this study, 98% of the attackers had experienced a personal loss, oftentimes the rupture of a romantic relationship. The majority perceived the loss as a personal failure and loss of status that left them with nothing left to lose. In the planning stage, attackers often spend days, months, or years planning the attack. These massacres are almost never impulsive and the attackers tend to have a perception of damaged personal identity and self-worth, they associate violence with masculinity, and the attack is seen as a reparative act helping the attacker regain a lost pride, power, and masculinity and to attain international fame and attention. For up-to-date information about school shootings and prevention in the U. S., the reader may access The Violence Project.[23]

At the time this article was completed, the last American school shooting had occurred in the town of Uvalde, Texas, perpetrated by an 18-year-old Hispanic adolescent who had dropped out of school a few months before and on the day of the massacre, shot his grandmother in the face, and proceeded to the school where he subsequently killed nineteen children and two school teachers. There was no apparent motive or warning signs and the killer had no prior history of violence or mental illness, although there were several signs of leakage, in which the killer had sent messages to others insinuating his intentions. The police waited outside the school for one hour, mistakenly thinking that the killer had barricaded himself, while in actually during this time, he was actively killing victims.[24],[25] The Chief of the Texas State Police regarded the police intervention as “an abject failure.”[26],[27]

  Firearms and School Shootings Top

In 1997, estimates were approximately 44 million gun owners in the United States and most firearm owners owned multiple firearms. In 2009 estimated, there were 310 million firearms in the U. S., not including weapons owned by the military, and 110 million were rifles.[1] The increase in guns held by the civilian population in the United States has led many schools and local communities to take the problem into their own hands by providing young students with early gun safety courses to make them aware of the dangers these objects actually are also to prevent school shootings. According to the Centers for Disease Control and Prevention, an average 1297 children die (two children per 100,000) and 5790 are treated for injuries caused by guns each year, the study reported. A preventive measure proposed for stopping school shooting has been focused on securing firearms in the home. A 2000 study of firearm storage in the United States found that 55% of the homes reported to have one or more firearms in an unlocked place and 43% reported keeping guns without a trigger lock in an unlocked place.[28] Most states have child access prevention laws designed to prevent children from accessing firearms. Each state varies in the degree of the severity of these laws. The toughest laws enforce criminal liability when a minor achieves access to a carelessly stored firearm. The weakest forbid people from directly providing a firearm to a minor. Mass shootings in schools are among the most difficult violent acts to prevent using gun control because most school shooters have access to guns through a relative or family member.[29] Since most firearms were acquired from a family member, guns should be stored in a way that makes them completely inaccessible by troubled youngsters. The AR-15 style rifles have been used in a number of the deadliest mass shooting incidents, and have come to be widely characterized as the weapon of choice for perpetrators of mass shootings. They can function like a single-shot rifle or as a machine gun, maximizing the number of victims that can be targeted in a matter of seconds.[30]

  Treatment and Preventive Intervention Top

Schools are the first line of defense with school shooters, so it is important to clarify the roles and responsibilities of the school social workers, counselors, psychologists, nurses, teachers, and administrators in their work with students who have mental health disorders.

Since school shootings have occurred with increasing frequency in the past 20 years and research is needed on prevention, particularly in the areas of security of the physical plant, school climate, and promoting prosocial behavior among students, faculty, and staff. Professional development activities that consist of pertinent information regarding known characteristics of school shooters should be a regular part of all school personnel's continuing education. School districts need to form partnerships with law enforcement personnel who are specialists in threat assessment with the goal of policy and program development as prevention measures.

”Leakage” is a frequent occurrence prior to school shootings, and it happens when the perpetrator “leaks” his intentions, telling others, hinting, or trying to recruit others to participate in the attack. Hence, it is important to educate parents, peers, community members, and school personnel to come forth immediately if they observe warning signs that identify a potential perpetrator, focusing on the specific warning signs, psychological profile, and the preventive interventions, including referral to the appropriate mental health professionals. It is also important to foster better communication and supervision by parents with their children. For schools to implement bullying prevention interventions, for the authorities to try to reduce media coverage, in order to avoid copycat phenomena and for parents to establish gun control in their homes, since most perpetrators find the guns in their home.

Monitoring behavioral symptoms of disorders that are being treated (e.g., inattention in a student being treated for Attention Deficit Hyperactivity Disorder (ADHD)), and documenting their nature to the treating clinician. Assisting teachers in understanding the nature of the student's disorders and helping them in their work with the students. Communicating with parents about the student's challenges and successes, and seeking information and suggestions from parents about interventions. Assisting in prereferral mental health interventions that might prevent the need for special education services and screening for mental health and chemical health disorders when appropriate.[23],[31]

  Security Measures as Prevention Top

School shootings, especially those that receive extensive media coverage, can affect those not directly affected by the school shooting and lead to copycat phenomena, thus extensive media covering of a school shooting may serve to invite disaffected individuals to commit a similar crime.

The principle of bounded subadditivity is a cognitive process that influences the psychological impact of an event by changing perceptions that an event that was once considered an impossibility is now a clear reality. Under the principle of bounded subadditivity, an individual can go from thinking that school shootings do not happen at all, or in their type of neighborhood, to thinking that shootings can happen at any school, at any time, in the United States.[32] In fact, as school shootings continue to occur, it seems likely that this cognitive restructuring must occur. Oftentimes, after an active shooter attack, the media focus on gun control and not on the shooter's personal or the family's responsibility for the actual act. In response to a school shooting, many institutions react with increased security measures. Visible security measures include physical devices (such as the use of security cameras) and trained personnel (school security guards) to prevent school violence.[31] Communication between parents, school administrators, and law enforcement personnel likely influenced decisions to increase school security measures. There are several different categories of security measures that can be implemented in schools. One security measure category is limiting access to the school building through the use of identification cards (staff and/or students), locked school entrances including “one-door” policies, visitor sign-in requirements, and gated campuses. Another category is prohibiting weapons on campus through metal detectors, lockless student lockers, and random sweeps for contraband. The third category is increasing surveillance of students through security cameras, school resource officers, and staff training, such as lockdown drills. The final category of security measure is reacting to a crisis or violent incident through student drills, duress alarms, and telephones in classrooms.[31] When schools have a climate of safety, adults and students have mutual respect and students have a positive connection to at least one adult. In addition, students are able to openly voice their concerns without any fear of reprisal. Without fear of punishment, students are more likely to help other students who are in distress by appealing to adults in the school environment. In the ideal, safe climate school, concerns are raised and handled early on before they become more serious. Ultimately, the potential for school violence is reduced because action is taken instead of the information being kept secret until it is too late and an attack has occurred. In a safe school climate, staff and students respect each other, and communication between them is encouraged and supported. Staff members serve as positive role models for students. Diversity is respected and part of the respect component is establishing “shame-free zones” where “daily teasing and bullying is not accepted as a normal part of the adolescent culture.” Conflicts are mediated and teachers and administrators address social–emotional needs in addition to academic needs.[33] Because most school shooters shared their plans for an attack with peers, having a “code of silence” keeps the information undisclosed. In a school climate of safety, students are more willing to share concerns about their peers without feeling that they are snitching on a friend (Recommendations are listed in [Table 3]).
Table 3 : Major components and tasks for creating a safe/connected school climate

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  Threat Assessments Top

The primary objective of a threat assessment is the prevention of targeted violence through analysis of the “actions, communications, and specific circumstances that might suggest an individual intends to mount an attack and is engaged in planning or preparing for that event” (32, p. 29). When conducting a threat assessment, attention should be placed on students who make a threat or have a plan to harm someone, as well as those who pose a threat, such as engaging in behaviors that suggest an intent or plan to attack. A threat assessment investigation should also seek to identify any major losses or perceived failures with which a student may be struggling to cope. The inquiry must address whether the student has access to weapons or firearms. There are also three elements that guide the formation and operation of a school threat assessment program: (a) authority to conduct an assessment, (b) capacity to conduct inquiries and investigations, and (c) system relationships.[31]

It is important to remember that threat assessments involve legal issues related to access to information, sharing of information, and searching students or their property. Administrators should consult with the school's legal counsel. School officials should develop a formal policy that authorizes the assigned individuals to conduct a threat assessment and demarcate the conditions under which these assessments can be conducted so that they do not constitute a violation of students' rights to privacy. In terms of capacity to conduct school threat assessments, schools must be proactive and implement a structured program of response to these situations instead of waiting for a crisis to occur.

Fein et al.[31] recommend that a multidisciplinary threat assessment team be composed, with a respected school faculty member or administrator, an investigator, a mental health professional, and other professionals that will contribute to the process. The roles and responsibilities of the team and the individuals should be clearly defined, and team members should be trained together.

  Conclusion Top

Mass casualty school shootings have occurred with increasing frequency in the past 20 years. Research is needed on prevention, particularly in the areas of security of the physical plant, school climate, and promoting prosocial behavior among students, faculty, and staff. Professional development activities that consist of pertinent information regarding known characteristics of school shooters should be a regular part of all school personnel's continuing education. School districts need to form partnerships with law enforcement personnel who are specialists in threat assessment with the goal of policy and program development as prevention measures.[1]

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  [Table 1], [Table 2], [Table 3]


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