Winter 02


April 20, 1999 Revisited




School officials said neither of the shooters were known
to have discipline problems. “I never knew them
to threaten anybody or bully anybody,
but we avoided them because they were different."
His father seems unable to provide any details
of K's history or current behaviors except to repeatedly
characterize K as "violent." He repeats often
that K's behavior at home is destructive.
Puberty is somewhat easier for parents and
physicians to understand. Parents must be prepared
to buy new clothes and razors. . .

K is a little bit worn at the edges, like a little boy
who has left the house very neatly dressed and groomed
but a lot of moving around along the way. . .
Armed with guns and explosives, two young men wearing
ski masks and black trench coats shot and killed
as many as 25 people. . . "They were going around,
they were laughing about it. . . They'd shoot somebody,
they'd laugh, they'd giggle."

K did not respond well to verbal directions, particularly that
by his father, to behave himself or stop doing certain things.
However, in terms of following directions that were task involved
K was highly cooperative.
Adolescence is more confusing for everyone.
Popular misconceptions abound, and the traditional
reaction of adults ranges from tolerance to outright dread. . .

The gunmen, who police say may have turned
their weapons on themselves . . . were a longtime target
of derision. "They were kind of the freaks of the school."

When asked to draw a picture, K first did so and then when
the finished product was not promptly removed he
first erased and then scribbled over it. Thus, left to himself,
K's activity level is high and his behavior poorly directed,
structured and often deteriorating into something destructive.
Several students said the shooters . . . were deeply into death,
talking, reading, and fantasizing about it.

A review of the literature, however, reveals that adolescence
has gotten a "bad rap." There is evidence to suggest that teenagers
may not be more moody, antisocial, or suicidal than other age groups.

Mood is neutral. Affect seems slightly blunted. I was impressed
with the number of self-comforting behaviors that K engaged,
and overall, I would consider him to be a somewhat anxious little boy.
There is no perceptual disturbance.
"It was horrible. . . They left nothing but damage and bodies."
about 60 others fled into a classroom behind the school's
auditorium where they could hear the crack of gunfire and
the boom of explosions coming nearer.

In fact, adolescence is an exciting developmental period when
new cognitive abilities emerge and social relationships are transformed.

Then gunmen giggled as they fired. . . "We saw a teacher
and an entire class running by in the hall with a look of
complete terror on their faces. "

When K was not given any specific directed activity to perform
his general activity level was extremely high. . . When it was K's turn
to come into the office he was found to be running up and down the halls
and the father yelling rather futilely at him and indicating that he would
"try to catch him" to bring him into the office.
The emerging capacity for abstract thought allows adolescents
to grasp concepts like "future" and use propositional logic
or "what if' thinking.

Family reports "violence" and "aggressiveness" as habitual
and overriding behaviors. Again, during the evaluation
these behaviors did not manifest.
At least 23 others were hospitalized, most with gunshot
wounds. . . .One suffered nine shrapnel wounds in the melee
and standoff, which ended about four hours later when
specially trained police found the two shooters dead. . .

Families must renegotiate parent-child relationships
as adolescents make the transition from dependence
to autonomy and mutual problem solving. Parents must
empathize with the need to be "one of the crowd" while
simultaneously encouraging safe group activities.

Personality factors of a negative-type included K's repeated
“aggressive” behaviors. which seemed to occur particularly
at home and include those directed toward family pets
(for example, closing the cat in a school satchel.)
"All the jocks stand up--I'm going to kill every single one of you.”
When parents or teachers request increases in medication
they may be targeting symptoms like lying, stealing, or
fighting that signal a second diagnosis and are unlikely
to respond to stimulant medications.

Based on the present evaluation I do not feel that K meets
the criteria for an Attention Deficit Hyperactivity Disorder.
He certainly does display maladaptive behaviors.
Some of these seem to be attention seeking in response to
environmental influences. With the understanding that
diagnosis of Oppositional Defiant Disorder generally
reflects adaptive behavior to the environmental reinforcers,
diagnoses are: ODD; Mixed Expressive-Receptive Language
Disorder. Phonological Disorder. Borderline Intellectual Disorder.


Kelley White was born and raised in New Hampshire, has degrees from Dartmouth College and Harvard Medical School and has been a pediatrician in inner city Philadelphia for more than twenty years. She has been published in over 200 journals including American Writing, The Cafe Review, Feminist Studies, Journal of the American Medical Association, Nimrod, Poet Lore and Rattle. She has published a full length collection of poems related to her medical practice, The Patient Presents (The People's Press, Baltimore) a chapbook, I am going to walk toward the sanctuary, and has a second chapbook Blues: Songs for Desdemona accepted by Via Dolorosa Press.