I am in an interesting conversation with a reader on Facebook about the Newtown shootings.

I am in an interesting conversation with a reader on Facebook about the Newtown shootings. Her most recent post asks: “What other parties do you think bear responsibility?”

Here is what I wrote:

The Office of the Child Advocate’s report goes into painstaking detail on the shortcomings of the school district and the medical community. The OCA report documents numerous instances in which the school district deviated from recommended practices. To cite but one example, the SD persisted in classifying Adam as “Other Health Impaired” rather than “Autistic” or “Emotionally Disturbed.” Quoting from the report: “By this point [2006 – six years before the fatal outcome], there were multiple indicators that AL met statutory-regulatory criteria and applicable guidance for autism spectrum disorders or, alternatively, for emotional disturbance…By not classifying his needs appropriately, attention to AL’s severe disabilities focused, as the Yale psychiatrist previously warned, on curricular issues rather than on the social and emotional characteristics that were seriously impacting his ability to participate in a regular educational environment. .. The school district appears to have accepted the recommendations of the mother and the community psychiatrist for homebound placement (without instruction) with no documented discussion of alternatives. It is difficult to determine why there was no review of therapeutic school settings as a consideration for placement or even other therapeutic supports that could be put in place for AL in the school setting…” The OCA report also questions “whether the Lanzas…needed to be compelled into services,” and goes on to ask “Would a similar family from a different race or lower socio-economic status in the community have been given the same benefit of the doubt that AL’s family was given?”

As for the medical community: The OCA report is filled with information about the shortcomings of Adam’s medical care, and lack of integration between mental health and general medical care. If “one picture is worth ten thousand words,” here is the picture:

(Click to enlarge.)

This is Adam’s growth curve. The red dots indicate Adam’s height (upper graph) and weight (lower graph) plotted as percentile values for his age. You won’t find this in the OCA report, however. I created this graph myself, using the heights and weights mentioned in the OCA report. Even an untrained eye can see that at age 13 (the earliest data I could find in the OCA report), Adam was a tall, skinny kid: His height was at the 98^th percentile and his weight was slightly above the 25^th percentile for age. From that point onward, both his height and weight take a nose dive. This was a serious medical problem that went unaddressed. Potential causes for this type of growth pattern include underlying medical illness (for example, inflammatory bowel disease), or an eating disorder. Had Adam’s growth pattern been investigated properly at the time, it might have led to a diagnosis of depression, and proper intervention. As with the school records, note that Adam’s growth curve tanked seven years before the fatal outcome.

The OCA report admonishes against fixing “blame,” and I concur with that philosophy. However, there’s a difference between “blame” (punitive, moralistic) and “responsibility” (something mature adults take when they have screwed up). In my opinion, the OCA report undercuts itself by pulling back at the very end, and assigning all responsibility to Adam – an emotionally disturbed youth whose needs had been steadfastly ignored or exacerbated by all of the adults in his environment. At the time of his death, Adam was an emotionally disturbed child. There is enough responsibility to go around, and the OCA report slights the needs of future victims of the next shooting, by not coming out and saying so.

I invite you to join the conversation. Post your comments here or join the discussion on Facebook.

James Coplan, MD is an Internationally recognized clinician, author, and public speaker in the fields of early child development, early language development and autistic spectrum disorders. Join Dr. Coplan on Facebook and Twitter. Have a question for Dr. Coplan? Ask the doctor.