Case Study: Adam Lanza

Assessment

History

Assessment

• Rorschach Test

• Brief Assessment of Cognition in Schizophrenia (BACS)

• Clinical Global Impression-Schizophrenia (CGI-SCH)

Education

Early Childhood

*Attended Sand Hook Elementary School as a child from kindergarten to 4th grade.

*Attended public middle school for 5th and 6th grade.

-Diagnosed with Asperger’s in 6th grade.

*Adam moved to a catholic school in 7th grade due to “societal stresses .The Catholic school that Nancy enrolled Adam in was St. Rose of Lima

*Adam took some classes at Newtown High and was homeschooled for others (dad was worried about Adam being isolated during homeschooling).

*He took classes at Western Connecticut State University, for high school credit at Newtown High School.

*He was also enrolled in a school technology club at Newton High; which was pushed at the urge of the club’s advisor. He stated “Adam had episodes were he would completely withdraw, but he was making progress.

• Medical/Physical Exam

• Mental Status Exam

• Beck Depression Inventory

• MMPI

The Basics…

• NAME: Adam Peter Lanza
• DOB: 04-22-1992
• ETHNICITY/SEX: Caucasian/Male
• PLACE OF BIRTH: Exeter, New Hampshire
• SIBLINGS: Ryan Lanza - brother who is five years older
• PARENTS: Mother filed for divorce in December of 2008 after being married for 27 years (whenAdam was 16)

Childhood Diagnosis

Interesting Occurences

Prior Treatment

• In the 5th grade, Adam wrote a story alled "The Big Book of Granny" which was about a Grandmother that kills people with her cane that has a loaded gun in it. Two years later a teacher noted Adam’s disturbed writing and said he was an intelligent boy who was “not normal” and had “anti-social issues”

*Until 2007, Adam saw Dr. Paul Fox. Fox diagnosed him with Asperger’s and prescribed Lexipro for depression and general anxiety.

*Adam never accepted the Asperger’s diagnosis and stopped taking the medication after one day. He said it made him feel weird.

*In 2012, Dr. Fox was accused of having sexual relations with patients. Fox destroyed his patient records and moved to New Zealand.

*The same year, Adam was evaluated by The Yale Child Study Center. They recommendedthat Lanza receive "extensive special education supports, ongoing expert consultation, and rigorous therapeutic supports embedded into (his) daily life." Those recommendations went largely unheeded.

*Adam's psychiatrist was Robert King, who reorded that Adam exibited evidence of obsessive-compulsive disorder, which often accompanies autism.

* King saw “significant risk to Adam in creating, even with the best of intentions, a prosthetic environment which spares him having to encounter other students or to work toovercome his social difficulties.” and concluded that Nancy was “almost becoming a prisoner in her own house.”

*The Yale Child Study Center prescribed Celexa for depression and anxiety.

*Mom discontinued use of elexa due to what she believed was a physical reation to the medicine.

• When he was in the 9th grade, he hacked into a government computer. The CIA or FBI showed up at his home. Mom convinced law authorities that Adam was intelligent and just challenging himself. No charges were filed.

• Major Depressive Disorder
• Anxiety
• OCD
• Autism (Asperger Syndrome)

*There were no known complications in pregnancy

*Adam had early childhood delays in speech. He did not speak until the age of 3

*Received Speech Therapy and Occupational Therapy and special education services from the age of 2

*In kindergarten he was identified as needing an individual education plan as well as extra attention in the classroom and at home

*He was diagnosed with Sensory Integration Disorder (SID) in kindergarten*When he was young, he would smell things that weren’t there and would wash hands excessively

Online Activity and Guns

in the House

Family

MOTHER

NAME: Nancy Lanza

*Mom quit working when Adam was born and after the divorce she lived off the money she received from the alimony (which was over 200K yearly on average).

*Nancy collected guns and went to the shooting range as a hobby; she would take Adam and Ryan with her often where they would shoot alongside their mother. 

* Nancy would take son travelling with her (minus the trip that she returned from the day before she was murdered).

* Several neighbors and friends considered Nancy as social and warm.

* According to Fox News, FBI documents stated that Nancy mentioned that Adam had not left his bedroom in 3 months and did not want to communicate with her; only through email.

Presenting Behaviors/Problems

FATHER

NAME: Peter Lanza



* Dad works as accountant and vice-president for taxes at General Electric Financial Services

*Adam and his father spent quality time together. They went hiking occasionally, played video games, and went shooting twice.

*Father was responsible for paying Adam’s college and also bought him his vehicle



*Dad had not seen his son for two years prior to Sandy Hook shootings. He said Adam had even stopped communication by e-mail.

*Father remarried in 2011

• In 2009, the year that the divorce was finalized, Adam developed his private obsession with killing.
• He started editing Wikipedia entries on various well-known mass murderers and seems to have been eerily well informed.
• Forensic records of Adam’s online activity show that, in his late teens, he developed a preoccupation with mass murder

• Adam’s mother owned 6 guns, including semi-automatic weapons.
• Mom loved the feeling and power of a gun in her hand and was a “gun nut” according to neighbor.
• Mom taught Adam to shoot.
• Dad said Adam was fascinated with guns and WWII

Evidence for Possible Psychosis

Adolescence-Young Adulthood Diagnosis

Here is what Adam wrote in an online group chat in 2010:

“Getting back to the subject of paranoia — those images were the worst ‘hallucinations’ I had experienced until a couple of weeks ago late one night when I was getting very tired. The incident was so surreal that I only a remember a small amount of the details. Basically, I began to ‘see’ many different things. Although I knew that none of it was actually real, it came as close to being real as it could for me without it being physically tangible. I heard screaming around me, and I had an overwhelming sense that there was someone dead behind me. I kept seeing silhouettes of flickering people everywhere. I felt like I had to cry. The entire ordeal persisted for about fifteen minutes and sort of faded away. Prior to it happening, I had never had that sort of delusional hysteria before. It was possibly the strangest thing I’ve ever experienced.”

• Anxiety

• Hallucinations

• Social isolation & social skills (family primarily)

• Increased obsession with mass murder

• Depression

• Suicidal ideation

• Schizoaffective Disorder - 295.70 (F25.1) Depressive type

Treatment

Short Term Goals

Safety First

-Adam needs to removed from his current environment to an inpatient facility.

Possible Problems with Treatment

-Refusal to accept previous diagnosis and treatment

-Mom

-Possible psychosis. Will need to stabilize.

Individual Therapy

Group Therapy

Family Therapy

Reccomend Mom Seek Individual Therapy

Education on Diagnosis and Efficacy of Treatment

Work with a nutritionist for nutritional rehabilitation

Short Term

-Comply with testing and treatment

-Vocalize his thoughts and feelings

-Verbalize understanding of diagnosis

-Begin to understand healthy vs. unhealthy thoughts and emotions

-Begin to increase insight into behavior and relationships that are causing current symptoms.

Conclusion

Mediating and Moderating Factors

SES

- The Conneticul State Office of Child Advocacy questioned in their investigation after the shooting if Adam's red flags would have been ignored if he wasn't white and privilaged.

2. Prior Treatment Failures

- Adam refused to accept his Autism diagnosis

- Yale Children's Center called Adam's mom "non-compliant to treatment.

3. Mom

- Did not follow treatment plan and discontinued treatment all together.

- Allowed Adam to isolate himself.

- She is paranoid. Once a neighbor placed an invitation to a get together in the mailbox and she was upset becasue she believed it had a poisonus substance on it. She owned 5 guns, including a semi-automatic used by the military.

The Deadly Event

*20 year-old Adam Lanza went into his mother’s room on the morning of December 14, 2012 and shot his mother (using a .22-caliber rifle), in the head multiple times as she lay in bed.

*Following, Lanza then left the house and drove his 2010 Honda Civic to Sandy Hook Elementary school, where he used a XM15-E2S rifle to kill the victims on site

*He first executed two staff upon entrance, and injured a few others before entering two classrooms filled with children. He fired his semiautomatic rifle away. He killed 20 First grade students (12 Female, 8 Male).

*Lanza soon after, used a Glock 10mm handgun to kill himself at the crime scene In total, the death toll was 27, which included himself and his mother

Following Up on Progress

Long Term Goals

"There can be no direct line drawn between one entity or person's actions and a mass murder"

- Report of the Office of the Child Advocate

-Attain a level of normal functioning

-Improve level of social, relational and vocational impairment

-Self-monitor negative thoughts and beliefs and learn to replace them with healthy thinking patterns

-Learn and implement behavioral strategies to overcome depression

-Show ability to implement conflict resolution text here

Behavioral observations:

-Beck Depression Inventory

-Behavior observations

-Input from family

-Monitor weight

Reccomend a Step-Down or outpatient program after inpatient

Case Study: Adam Lanza