This week’s New Yorker has a gripping article by Andrew Solomon on Newtown shooter Adam Lanza, based primarily on interviews with his father, Peter. To me, the first thing to pop out is that his diagnosis – Asperger’s disorder – doesn’t make any sense.
Here’s the key part: “Adam Lanza was never typical. Born in 1992, he didn’t speak until he was three, and he always understood many more words than he could muster.”
Well, if he didn’t speak until he was three, he didn’t have Asperger’s. Straight from my hefty copy of DSM-IV, retrieved from the box in the garage: “In contrast to Autistic Disorder, there are no clinically significant delays in language (e.g., single words are used by age 2 years, communicative phrases are used by age 3 years).”
Now you tell me, but assuming his own father has his personal history right, Adam as an infant did have clinically significant delays in language. So if he had an ASD, it had to be autistic disorder or PDD-NOS. Since this quickly turns into alphabet soup, here's a footnote from our book The Age of Autism – Mercury, Medicine, and a Man-made Epidemic:
“’Pervasive developmental disorders’ is the diagnostic category often referred to as autism spectrum disorders. The three main categories of pervasive development disorder (PDD) include autistic disorder, PDD-NOS (not otherwise specified), and Asperger’s syndrome. A diagnosis of PDD-NOS is similar to but less severe than autistic disorder and includes language and communication delays, unlike Asperger’s.”
So my question is, how on earth did Adam Lanza get an Asperger’s diagnosis? Yes, in some ways he was functional, although he had the full panoply of seriously autistic traits – “such hypersensitivity to physical touch that tags had to be removed from his clothing. … A doctor diagnosed sensory integration disorder, and Adam underwent speech therapy and occupational therapy in kindergarten and first grade.” His shop teacher said he could hold a Bunsen burner to his wrist and not flinch.
He also had terrible OCD, a strange gait, massive inability to connect with other kids, failures in school and at home and in every other possible way. Terrors, meltdowns.
Solomon tells us that “when Adam was thirteen, Peter and Nancy took him to Paul J. Fox, a psychiatrist, who gave a diagnosis of Asperger’s syndrome. … Peter and Nancy finally knew what they were up against,” Solomon writes. ‘It was communicated as ‘Adam, this is good news. This is why you feel this way, and now we can do something about it,’ Peter recalled. But Adam would not accept the diagnosis.”
Well, it was the wrong diagnosis, was it not? Asperger’s and its weird-but-smart stereotype was manifestly not what they were up against. At 14, his parents took him to Yale’s Child Study Center for further diagnosis. “The psychiatrist who assessed Adam, Robert King, recorded that he was a ‘pale, gaunt, awkward young adolescent standing rigidly with downcast gaze and declining to shake hands.’ He also noted that Adam ‘had relatively little spontaneous speech but responded in a flat tone with little inflection and almost mechanical prosody.”
I find it kind of amazing that in an upper middle class, educated household seeking psychiatric evaluation in the New York metroplex, and at Yale, this elementary misdiagnosis is the result. (Of course, this was the result when upper middle class, educated parents first brought similar children to Leo Kanner at John’s Hopkins in the 1930s).
Kids like Adam Lanza are sick (I'll leave the question of evil to the ethicists and theologians), and the question is why so many are so sick, in such similar and new ways that they suggest a common environmental etiology.
This week in the Washington, D.C., area where I live, police provided insight into another young killer in the Adam Lanza mold. Darius Marcus Aguilar, 19, shot two people at a mall in Columbia, Md., and would have killed a lot more if they had been children trapped in classrooms rather than adults running in a mall. His Internet tracks, like Lanza’s, showed a fascination with guns – in fact, he was trying to enact a replay of Columbine.
“At the same time,” the Washington Post reported, “he sought out clues to mental illness and joined a chat room filled with people contemplating suicide in their search for a way out.”
He apparently was hearing voices. “He knew he was sick,” the police chief said. So did Adam Lanza. No wonder he didn’t accept his “good news” diagnosis. Neither should we.
Dan Olmsted is Editor of Age of Autism.